Independent Mental Health Advocate (IMHA): A Care Staff Guide

People detained under the Mental Health Act can feel they have no voice. An Independent Mental Health Advocate (IMHA) is there to change that. Introduced by the Mental Health Act 2007, the role helps qualifying patients understand their legal position and take part in decisions about their care. This guide explains who qualifies, what an IMHA can do and how staff should support access, including the reforms in the Mental Health Act 2025.

It is general information, not legal advice. In England, services and local arrangements vary, so check your own policy and the current Code of Practice.

What is an IMHA?

An IMHA is an independent advocate who supports a qualifying patient under the Mental Health Act 1983. The law requires that IMHA services are available, and the advocate is independent of the hospital and the clinical team. Their role is to help the person understand their rights and make their views heard, not to decide what is best for them.

Who is a qualifying patient?

Under section 130C of the Act, qualifying patients include people who are:

• detained under the Act, with some short-term exceptions such as emergency holds under sections 4, 5(2), 5(4), 135 and 136
• subject to guardianship
• on a community treatment order (see our guide to community treatment orders)
• being considered for certain serious treatments, such as electroconvulsive therapy for someone under 18, or treatments that need a second opinion under section 57

Patients are entitled to use the service, but they may decline it. Hospital managers and others with responsibility must take reasonable steps to make sure patients know that IMHA help is available and how to get it.

What can an IMHA do?

Under section 130B, an IMHA must help the patient to understand:

• the provisions of the Act that apply to them
• any conditions or restrictions that have been placed on them
• the treatment they are being given or are proposed to be given, and the legal authority for it
• their rights, and how to exercise them

IMHAs may meet with the patient privately, talk to professionals involved in their care, and view relevant records. For records, the patient's consent is needed if they have capacity, and otherwise access is allowed where it is relevant and appropriate. IMHAs often support patients ahead of ward rounds, care planning and tribunal hearings. See our guide to mental health tribunal rights for how this fits together.

How does the role differ from other advocates?

IMHAs are different from independent mental capacity advocates (IMCAs), who represent people who lack capacity in specific serious decisions and have nobody else to consult. Our guide to the independent mental capacity advocate (IMCA) explains that role. An IMHA is also separate from the nearest relative, which is a legal role described in our guide to the nearest relative and nominated person.

What changes under the Mental Health Act 2025?

The Mental Health Act 2025 received Royal Assent on 18 December 2025. According to the British Institute of Human Rights, it introduces an opt-out system of advocacy for all detained patients and extends independent mental health advocacy to informal patients, meaning those in hospital without being detained. The same source stresses that implementation will take place over a number of years. Do not assume the new arrangements are already in force in your service. See our overview of Mental Health Act 2025 changes for the wider picture.

How staff can support access

• Tell people early, and more than once. Distress, medication or confusion can mean information is not retained.
• Make referrals simple. Display the IMHA contact details clearly on wards, and make sure staff know how to refer.
• Give advocates access. Allow private meetings and support them to see relevant records within the rules.
• Respect the independent role. Do not pressure patients to decline, and do not treat an advocate's questions as a complaint about staff.
• Record contact. Note when a patient was told about IMHA, and whether they accepted.

Common mistakes

• Relying on a leaflet in the admission pack as the only explanation.
• Assuming that a patient who lacks capacity cannot benefit from an advocate.
• Forgetting community treatment order and guardianship patients, who also qualify.
• Not building IMHA visits into ward round and care planning timetables.

Frequently asked questions

Does an IMHA give legal advice?

No. They help patients understand and exercise their rights. A solicitor can give legal advice, especially for tribunal cases.

Can a patient refuse an IMHA?

Yes. Patients can decline help. Staff should still make sure the offer is made clearly and can be renewed later.

Is IMHA the same for informal patients?

Not yet in general. The 2025 Act extends advocacy to informal patients, but implementation is phased, so check current arrangements locally.

Where can teams find training?

See the CPD hub for professional development options for care and healthcare teams.

Learnsignal will update this guide as the 2025 Act is implemented.