Further Multi-Agency Risk Management guidance
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.
A 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 self-neglect toolkit should be used and the MARM process enacted where the risk is deemed medium/high.
- Principles for arranging a multidisciplinary MARM
- Key agencies
- Guidance for a MARM meeting
- Outcomes of the MARM meeting
- Continued engagement
- Management of continued risk
Principles for arranging a multidisciplinary MARM
To consider:
- 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
Key agencies
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 a 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
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.
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.
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.
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.
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 the MARM has taken all reasonable steps and not been able to mitigate a high risk of death or serious harm, agencies involved in the MARM should consider escalating the risk to senior officers in their organisation.
Once a MARM has been held, the chair of the MARM meeting is responsible for ensuring outcomes are reported on the CYSAB MARM tracker. This will track the progress the outputs and outcomes, enabling reporting to and oversight from CYSAB.