‘The Supreme Court Dols ruling was right but an impossible workload is diluting advocacy’

An independent mental capacity advocate reflects on the impact of a landmark Supreme Court ruling on deprivation of liberty in care

As Community Care publishes the findings of our investigation into the impact of a landmark Supreme Court ruling on deprivation of liberty caseloads, an independent mental capacity advocate (IMCA) shares his experiences…

In our service, we have two full-time IMCAs, who can call on additional support from me and two other qualified members of staff if things get busy. This tends to be over the summer when people are on holiday or if someone is off sick. Since April, however, we have seen a huge increase in referrals, from a handful to 20 or 30 a month. I have my own caseload for the first time in a long time. We do our best to minimise the impact on the rest of the service but it isn’t easy.

About the IMCA role

An independent mental capacity advocate (IMCA) must be appointed to advocate for people facing a change of accommodation or serious medical treatment, when they lack capacity to make these decisions and have no family or friends to speak on their behalf.

They must also be appointed by councils to represent people being assessed under the Deprivation of Liberty Safeguards (Dols), where the person has no one else to consult, or to help family members represent their loved-ones.

We all agree that the Supreme Court decision was the right one but the impact on our work – and on the quality of our work – is huge. Our IMCAs take their jobs extremely seriously but they have been completely overwhelmed by work every day for months and we have a backlog that is growing and growing. There is nothing we can do to stem the flow of referrals and it’s impossible to manage the workload.

When we get a referral in, we aim to go out and see the person the same day. We need time to talk to the person if appropriate, read the notes, speak to staff and do our research so we can produce an informed report. In a way, you are acting as a person’s family. It’s a big responsibility. The increased workload has put our staff under a huge amount of stress, working longer hours.

It’s been really hard for such committed and conscientious staff to move to a situation where you know you don’t have time to do things thoroughly. As their manager, I feel terrible. I can’t bring in additional resource until I know I will get the funding from the council to cover it – we just don’t have the funding.

Part of the impact is that we are in effect doing less safeguarding because it’s not being done properly. We used to visit someone whose deprivation of liberty had been authorised every two to three weeks to see them and check everything was in order. If a condition of their safeguard was that staff had to take them out every day to a park or the shops, we played a role in making sure that happened. We just don’t have the time now. No one is checking that things are being done properly. If you don’t do it properly, it’s not a safeguard.

We met with the council not long after the judgment and everyone agreed that the situation was out of control and needed additional funding. It’s taken a long time and constant badgering but we finally have the money now to recruit an additional IMCA. As it’s a statutory duty they have no choice but to find the money from somewhere but with budgets so tight at the moment, you worry about what other parts of the service will suffer.

An additional member of staff should help ease the pressure on us all for a while, but part of the problem is that I have no idea how many IMCAs I am going to need in the long term. The number of referrals only indicates the capacity of the Dols team to process those referrals. Our council is now looking at resourcing a five-fold increase in the number of best interests assessors, which will make our workload skyrocket.

The amount of work coupled with the lack of resources means the work we do is incredibly diluted and risks becoming a tick-box exercise. Every case referred to us concerns a real person and the Mental Capacity Act envisages a level of safeguarding that treats them as individuals. I have a real concern about being able to provide the safeguard that our service is there to provide.

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