Advocacy or IMCA? How to decide which role fits best

​Introduction

As a case manager our role is to advocate for our clients and represent their needs effectively. This in itself can be complex, especially when working with clients who are less able to share their thoughts, for example those in a disorder of consciousness with little or no ability to communicate.

In these cases, having an ability to know what the client would want to happen in any of the events life throws at them is crucial. Despite always holding the best interests of the client at heart, the case manager co-ordinates support and intervention, there are many conflicting roles which may get in the way of truly advocating for the client. On these occasions it is necessary to have someone in the MDT whose only role is to represent the client’s voice.
 
It is sometimes necessary to consider which role might be most suitable to represent the client’s voice. Whilst and IMCA is available to anyone who lacks capacity and is unbefriended (that is, they have no relative or friend that it would be appropriate to consult with about those decisions), an advocate may be more appropriate and a closer look at the roles helps in making that decision. It is unusual that a client would require the services of both an advocate and an IMCA simultaneously.
 
What do IMCA’s and Advocates do?

• support and represent the person in the decision making process
• find out the person's past and present wishes, feelings, values
• evaluate information including accessing and copying relevant social and medical records
• evaluate alternative courses of action
• consult with others involved in the person's life
• seek a further medical opinion if necessary
• check the Mental Capacity Act principles and best interest check list are being followed
• prepare a report, which the decision maker has a legal duty to consider
• challenge the decision (including capacity) if necessary, informally first and through Court of Protection as a last resort

 
Role of the IMCA

The Mental Capacity Act 2005 introduced the role of the independent mental capacity advocate (IMCA). IMCAs are a legal safeguard for people who lack the capacity to make specific important decisions including making decisions about where they live and about serious medical treatment options.
 
In particular, and IMCA should be instructed  where there is a serious exposure to risk, for example:

• Risk of death
• Risk of serious physical injury or illness
• Risk of serious deterioration in physical or mental health
• Risk of serious emotional distress
• Where a life-changing decision is involved and consulting family or friends is compromised by the reasonable belief that they would not have the person’s best interests at heart.
• Where there is a conflict of views between the decision-makers regarding the best interests of the person.
• Where there is a risk of financial abuse which could have a serious impact on the person at risk's welfare.

 
The IMCA role would be focused on the protective measures being considered and is likely to end when decisions have been made regarding these.
 
Role of the Advocate

Like and IMCA, Advocates provide a crucial role in assisting people to express their views and wishes, secure their rights, access information and to be involved in decisions that are being made about them and their situation. This is however a wider reaching role than safeguarding and protection, and can be relevant to many life decisions that a client faces.
 
When a client is unable to share their wishes, an advocate’s role is to collect and represent the person’s prior expressed values and beliefs. Using this information they will then ascertaining proposed courses of action in order to share these with the MDT.
 
Concluding Remarks

Our clients benefit from the statutory provision that the IMCA brings but sometimes the role is not far reaching enough in the context the litigation process. There are often complex and ethical decisions to be made with the view of returning the client back to as close as they can be if it were not for the index accident, which are out-with the role of the IMCA. On these occasions a specialist Advocate experienced in working with this client group can be incredibly beneficial for all involved in the MDT.

​Jackie Waggott
Director of Operations
​& Case Manager