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Multi-agency risk management

Multi-Agency Risk Management (MARM) is a collaborative approach used when an adult is at significant risk of harm and existing interventions are not enough to manage the risk. It is particularly relevant where an adult with mental capacity declines support or services and risks remain high.

This MARM Guidance has been developed by the City of York Safeguarding Adults Board (CYSAB) to be used by all agencies.

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Multi-agency risk management guidance

MARM guidance and associated documents are designed to support anyone working with an adult where there is a high level of risk and the circumstances sit outside the statutory adult safeguarding framework, but where a multi-agency approach would be beneficial.

MARM enables a proactive approach which helps to identify and respond to risks before crisis point is reached and helps agencies provide supportive intervention particularly when self-neglect is involved which relies on multi-agency co-ordination and risk management.

Multi-Agency Risk Management (MARM) is a collaborative, cross-sector approach used in health and social care to manage high-risk, complex cases where an adult believed to have mental capacity refuses services or lives in situations that risk significant harm.

MARM brings together agencies like police, health, and social services to create a coordinated plan, focusing on safety, prevention, and, where possible, supporting the person.

The MARM is designed to support people where high levels of risk have been identified, and a multi-agency approach would be beneficial.

MARM will be required where a person is considered at risk of harm and where other process have been explored and found to be insufficient to manage the level of risk.

Where self-neglect is identified, the multi-agency self-neglect checklist should be used and the MARM process enacted where the risk is deemed medium/high.

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When to use MARM

The organisation should have attempted all they can to reduce or minimise risk prior to initiating MARM. If risks remain, the organisation can then refer the case for discussion at a MARM meeting, which is designed to enable a collaborative, coordinated and multi-agency response to risks ensuring timely information sharing, a holistic assessment of risk and the development of multi-agency risk plans.

Use MARM when:

  • there is a high level of risk to an adult
  • a multi-agency response is needed
  • other processes have been explored and are insufficient
  • self-neglect risks are assessed as medium or high

The framework does not replace single agency risk management arrangements or pre-existing multi-agency case discussion processes, such as Multi-Disciplinary Team (MDT) meetings, Multi-Agency Risk Assessment Conference (MARAC), Multi-Agency Public Protection Arrangements (MAPPA), and instead seeks to support case discussion where no multi-agency case discussion and risk management process exist.

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Principles for arranging multi-disciplinary MARM

The principles things to consider when arranging a multi-disciplinary MARM are:

  • capacity and consent
  • indications of mental health issues
  • the level of risk to the adult’s physical health
  • the level of risk to their overall wellbeing
  • risk of tenancy or mortgage breach
  • effects on other people’s health and wellbeing
  • serious environmental risk, such as destruction or partial destruction of accommodation
  • support planning

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Key agencies that may be involved in arranging multi-disciplinary MARM

The following is a list of key agencies who may be involved in the MARM - this list is not exhaustive.

This may involve initial referral for MARM, being the lead agency or being part of the MARM meeting.

See further details of Key Agencies and their roles in responding to self-neglect.

  • City of York (CYC) Adult Safeguarding Team are able to advise contact details should this be necessary
  • Adult at risk and their representatives or advocates
  • North Yorkshire Fire and Rescue Service
  • Yorkshire Ambulance Service
  • Primary, Acute and Community Health Care Services
  • Hospital Trusts
  • Adult Social Care
  • Children’s Social Care
  • Environmental Health
  • North Yorkshire Police
  • Housing
  • care agencies
  • community, voluntary sector, community networks
  • own organisation legal services

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Guidance for a MARM meeting

The lead agency is responsible for convening the meeting and making arrangements such as setting up an MS Team’s meeting or providing a venue, chairing and minute taking, and will make arrangements to involve the individual concerned using the most appropriate agency to support them. Please see agenda template.

The MARM process is collaboratively owned by participating agencies operating in York. The MARM meeting should be chaired by the lead agency.

Every effort must be made to engage with the individual and to enable them to communicate their views to the meeting. Where a person has substantial difficulties or lacks the mental capacity to engage in the process relevant advocacy must be considered.

If the individual does not wish to attend the meeting, representatives will need to consider how their views and wishes are to be presented at the meeting, for example by the appointment of a formal invitation extended to an informal or formal advocate.

Participants from all agencies identified should attend the meeting with an understanding of their responsibilities to share relevant information in order to reach an agreement on the way forward.

Clarity should be sought in relation to the persons mental capacity to make decisions about safeguarding themselves from harm. It is important to ensure that any actions agreed comply with legislation and statutory duties. Legal representation at the meeting may need to be considered to facilitate discussions around relevant legal options. This may include application to the Court of Protection where there are concerns about mental capacity or to the High Court (Inherent Jurisdiction) where the individual is believed to have mental capacity.

An action plan should be developed and agreed by members of the meeting. Where there are disagreements about any aspects of the plan, these should be resolved by consultation with a senior manager from the lead agency.

The Chair of the MARM meeting will ensure confirmation of timescales for implementing contingency plans, so that where there is legal and professional remedy to do so, risk is responded to, and harm is reduced/prevented.

The Chair is not responsible for ensuring that identified action points are correctly followed up. It is the responsibility of each agency representative to ensure identified actions are implemented and followed up.

Who should attend a MARM meeting

The adult should be involved wherever possible, alongside relevant agencies such as:

  • Adult Social Care
  • Health Services
  • Housing
  • Police, Fire and Rescue
  • Voluntary Sector organisations
  • others involved in managing the risk

What happens at a MARM meeting

The lead agency coordinates and chairs the meeting. Partners share information, assess risks, consider legal options where necessary, and agree a coordinated action plan.

Every agency is responsible for completing the actions assigned to them.

Common challenges may include:

  • balancing an individual's right to make unwise decisions with the duty of care to keep them safe
  • engaging adults who decline services or refuse to participate
  • complex mental capacity and executive functioning assessments
  • information-sharing barriers between agencies
  • different professional views about risk, legal powers and next steps
  • ensuring agencies remain accountable for agreed actions
  • managing ongoing high risk where support continues to be declined
  • navigating legal and ethical complexities
  • sustaining multi-agency commitment over time

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Outcomes of the MARM meeting

The intended outcomes of the MARM meetings are to:

  • reduce risk to the individual
  • improve safety and wellbeing
  • increase engagement with support
  • ensure multi-agency coordination in practice

In order to achieve these outcomes a number of outputs are needed. Outputs from the MARM meeting will include the following:

  • an action plan - including contingency plans and an escalation process
  • agreement of monitoring arrangements and who will do this
  • a review date based on the level of risk or a decision to close the MARM process with rationale
  • an agreement of a communication plan with the individual or other key people involved
  • an agreement regarding which agencies will take the lead in the case
  • completion of CYSAB MARM tracker

The person at the centre of the concern will be informed of what support is being offered and/or is available and provided an explanation about what will happen. This is irrespective of the level of their involvement to date using a method of communication which is best suited to the individual, taking into account any and all of their communication needs.

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Continued engagement

If support is declined, it is important that the individual understands that they can contact the relevant agency at any time in the future should they change their mind, which will enable access to support or trigger a reassessment. Careful consideration will be given to how this is communicated to the to the individual.

Where an individual has mental capacity and declines support, agencies still have a duty of care. The MARM should explore how this duty of care is met, including exploring the individual’s executive capacity. Every effort should be made to enable individuals to make decisions to access support including reoffering assessment and support on a frequent basis.

When an individual declines support, consideration needs to be given as to the frequency of this being reoffered.

The MARM may decide to reconvene a further meeting for the purpose of revisiting the original assessments, particularly in relation to the individual’s current functioning, risk assessments and known or potential rates of improvement or deterioration in:

  • the individual
  • their environment, or
  • the capabilities of their support system

Decision specific mental capacity assessments will have been reviewed and shared at the MARM meeting. Discussion will need to focus on contingency planning based upon the identified risks.

It may be decided to continue providing opportunities for the individual to accept support, which agencies will be involved and also to monitor the situation. Clear timescales must be set for continuing to provide support opportunities and for monitoring.

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Management of continued risk

Where possible, indicators that risks may be increasing will be identified and that will trigger agreed responses from agencies, organisations or people involved in a proactive and timely way.

A further meeting date will be set at each MARM meeting until there is agreement the situation has become stable, and the risk of harm has reduced to an agreed acceptable level.

If agencies are unable to implement support or reduce risk significantly, the reasons for this will be fully recorded and maintained on the individual’s file, with a full record of the efforts and actions taken. In these circumstances, legal advice should be considered on a case-by-case basis.

Where MARM has taken all reasonable steps and not been able to mitigate a high risk of death or serious harm, agencies involved in MARM should consider escalating the risk to senior officers in their organisation.

Once MARM has been held, the chair of the MARM meeting is responsible for ensuring outcomes are reported within their own organisation including the number of MARMs undertaken and the impact of the MARM in terms of outputs and outcomes being met. This will be reported to the CYSAB as part of the overall data collected on the quarterly CYSAB Activity Report. Agencies may need to consider how the MARM data is collated within their own organisations in order that this can be made available to CYSAB when requested.

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MARM outcomes

MARM should produce:

  • an action and contingency plan
  • monitoring arrangements
  • a review date
  • a communication plan
  • agreement on the lead agency
  • ongoing risk management and escalation where needed

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Further MARM guidance and documents

Read further MARM guidance and documents are available on Tri-x as editable Microsoft Word document files (.docx):

Also see: