Please visit our dedicated family, friends, and carers webpage if you are concerned about the safety or wellbeing of an adult with care and support needs, or if you would just like to know more about adult safeguarding and the work of the Safeguarding Adults Board.
The West Sussex Safeguarding Adults Board has recognised through Safeguarding Adult Reviews (SARs) and audits, (particularly the Complex Case File Audit carried out in 2022/23), that there is a need for a toolkit to support practitioners in working with those who have multiple needs, such as in relation to self-neglect.
This toolkit provides staff with necessary guidance and information around working with adults with multiple needs, including signposting to useful resources and policies. There are also various accompanying templates, which can be used and adapted by all agencies.
Please note, the toolkit should be used in conjunction with the Sussex Safeguarding Adults Policies & Procedures (2025), which, although safeguarding specific, have useful information on working with multiple needs.
In particular, please see sections on:
Please also see other resources (linked throughout this document) to support your work in these areas. Please note that documents intended for completion in Word may not be suitable for users of assistive technology.
When working with an adult with multiple needs, it is crucial that staff work collaboratively with other professionals and agencies involved with the care of an adult. A joined-up, coordinated approach, will help all agencies to understand what work is already being done with the adult, and identify additional actions which may be required to help ensure that risk to the adult is reduced.
Collaborative multi-agency working helps ensure that care is coordinated in a way that feels safe, respectful, and empowering for the adult. By prioritising their voice and choices, it will support them to feel heard, actively involved, and central to the decisions about their care.
Multi-agency meetings are an effective way of ensuring communication across agencies is taking place, as well as jointly identifying any actions for staff. These meetings can be initiated by any organisation who is working with the adult.
It is good practice to identify a professional(s) to coordinate agencies and their response to adults with multiple needs. They will act as a single point of contact for involved agencies and will maintain oversight of the work being undertaken to support the adult. This ensures there is alignment in practice across different organisations.
The multi-agency working section of the Sussex Safeguarding Adults Policies & Procedures (2025) contains more detailed information on this topic, including how and when to arrange a multi-agency meeting, Making Safeguarding Personal (MSP), recording information, information-sharing and risk assessment.
Please also see our multi-agency working learning resources for more bitesize information and tips.
Below are templates for an agenda, action tracker, minutes document, meeting guide, and a commonly held information picture (CHIP) resource, which can be used and adapted by any agency for a multi-agency meeting:
Risk assessment, or the process of risk formulation, is the process of working with an adult to maximise safety and to reduce future risk. This is particularly important when working with adults with multiple needs, as there are likely to be a number of risks or dangers associated.
Risk assessment is an integral part of safeguarding, which requires a flexible, solution-focussed approach to mitigating risk. Measures put in place should be reviewed regularly in response to the level and nature of risk.
Cases which have significant risks often require a multi-agency approach. This should be underpinned by clear and timely information-sharing and shared multi-agency risk assessments, resulting in multi-agency risk plans. These should be proportionate and focussed on preventing, reducing, or eliminating the future risk of harm. Risk assessment is recommended as an agenda item for multi-agency meetings regarding adults with multiple needs.
For more information about risk assessment, including the interface between mental capacity, steps to undertaking a risk assessment, and risk assessing in relation to self-neglect, please refer to our risk assessment learning resources.
Most agencies have their own risk assessment form, but for those that don’t, below is an example of a form that could be considered for use by your agency. There is also a version for multi-agency risk assessments:
Mental capacity is a term used to describe an adult’s ability to understand information and make decisions about their life. It can also mean the ability to communicate decisions about their life. An adult’s capacity to make a decision can vary, depending on the time that the decision needs to be made, and the type of decision being made, which could range from day-to-day choices like what to wear or eat, to more complex decisions such as whether to have medical treatment.
Mental capacity can be impacted in many ways, such as having a brain injury, mental health condition, learning disability or dementia. It could also be impacted by substance misuse, or confusion, drowsiness, or unconsciousness because of an accident, illness or treatment.
Whilst working with adults who have multiple needs, or who are self-neglecting, it is important for mental capacity to be considered. The Mental Capacity Act (2005) is crucial in determining what action may or may not be taken for adults with multiple needs. It places people at the centre of decision-making processes, empowering them to make their own decisions, wherever possible, and to protect those who may lack capacity. However, an adult being determined as having capacity to make specific decisions is not reason alone for agencies to withdraw when risk remains.
Anyone can carry out a mental capacity assessment. For more information on when and how to assess someone’s mental capacity, and the actions to be taken following a mental capacity assessment, please refer to:
Trauma-informed care means being able to see beyond an adult’s presenting behaviours and to ask, ‘what has happened to you?’ rather than ‘what is wrong with you?’. It involves recognising when someone may be affected by trauma, collaboratively adjusting how we work to take this into account, and responding in a way that supports recovery.
Trauma can refer to a traumatic, abusive, or neglectful event(s) which are or have been experienced as emotionally or physically harmful, or life threatening. Whether an event(s) is traumatic depends not only on the adult’s experience of it, but also how it negatively impacts on emotional, social, spiritual, and physical wellbeing.
It is possible that adults with multiple needs have experienced a traumatic event in their past. It is therefore important to use a trauma-informed approach when working with adults, to enable the adult to feel safe and develop trusting relationships with services and staff.
For more information on trauma-informed approaches, including the ‘five R’s’ and the five principles of trauma-informed care, please refer to the following resources:
Our Board identified self-neglect as a Board priority for 2023/24, 2024/25, and 2025/26. Self-neglect is recognised as a complex and challenging area, with around 75% of Safeguarding Adults Reviews (SARs) nationally relating to self-neglect cases. As a result, recent work has been undertaken around self-neglect, including updates to the Sussex Safeguarding Adults Policy and Procedures.
Our SAR subgroup also commissioned a self-neglect meta-analysis in 2023 to look at current practice in relation to self-neglect and to identify recommendations in order to improve self-neglect practice. This was published in June 2024, and the full report, executive summary, and learning resources can be accessed on the SARs page of our website.
Alongside the review, a self-neglect survey was carried out with staff across the partnership to seek their thoughts and experiences of working with adults who self-neglect. The survey covered issues, barriers, and positive factors for them to identify issues, barriers, and positive factors in working with people who self-neglect.
We have also developed a self-neglect practice guidance for staff. This can be used for all adults who self-neglect, regardless of whether they are within safeguarding processes or not.
For more information on self-neglect, please refer to the following resources:
Safeguarding adults is the process of enabling adults with care and support needs to protect themselves from abuse or neglect, whether they are already experiencing, or are at risk of, abuse or neglect.
Care and support needs can include a physical or learning disability, mental health needs, or illness. Somebody with care and support needs may or may not be in receipt of services, but this should not affect their access to safeguarding support.
As part of the safeguarding process, staff must consider:
If you think an adult with care and support needs is experiencing, or is at risk of abuse or neglect, you should raise a safeguarding referral through the West Sussex County Council (WSCC) online form.
Refer to the Safeguarding Threshold (2023) guidance before submitting a concern. It explains what situations meet the criteria for reporting and includes practical examples that warrant referral or escalation. It helps ensure that any action taken is proportionate, respectful, and based on clear criteria. You should also ask the adult or their representative for their consent to report the concern, unless this increases the risk. Staff can call the Adult Social Care Safeguarding Hub on 03302 228400 for advice on whether a referral needs to be made.
Please refer to the following resources for more information:
The role of the Multi-Agency Risk Management (MARM) subgroup is to discuss and consider all available options for increasing the safety of an adult at risk and to agree coordinated actions to mitigate risk.
MARM supports multi-agency communication and information-sharing to further help professionals and their managers in managing the most challenging and concerning cases.
Professionals can refer a case to MARM for consideration to be heard at the meeting, providing the following criteria is met:
If you have a case that you think may meet this criteria and might be suitable to be presented at MARM, please take a look at the MARM Protocol and supporting documents.
Changing Futures is a Sussex-wide system change programme, focussing on improving systems and services for people experiencing multiple disadvantage.
Multiple disadvantage, or multiple complex needs (MCN) is defined by the national Changing Futures programme as people who experience three or more of: homelessness, current or historical offending, substance misuse, domestic abuse, and mental ill health.
The Sussex programme focusses on meeting the needs of the most vulnerable people who repeatedly fall through the net, working alongside people with lived experience of multiple disadvantage, to achieve positive changes in services, to make them better connected and easier to access.
To achieve this, Changing Futures Sussex is embedded and are part of the three Sussex Local Authority areas: Brighton & Hove City Council, East Sussex County Council, and West Sussex County Council.
Anyone can nominate (refer) a person to the Changing Futures Sussex Programme. For more information:
Please note that documents intended for completion in Word may not be suitable for users of assistive technology.
