Community Treatment Orders (CTOs)

When a person is involuntarily treated in hospital for a mental health illness or is sectioned under certain sections of the Mental Health Act 1983, a responsible clinician may choose to apply for them to be put on a Community Treatment Order (CTO). The CTO allows the patient to be discharged from the section and hospital under the proviso that they meet specific conditions such as where they will live and how and when they will receive treatment.

CTOs are heavily regulated and serve to provide protection for the patient and the general public. The following guide provides information on how a 

What is a community treatment order (CTO)?

A community treatment order is governed by the Mental Health Act 1983. The CTO allows patients who have been sectioned because of a mental illness to leave hospital and rejoin the community in a safe and measured way, whilst ensuring that the general public is protected and that necessary treatment is still received.

A CTO gives a patient specific conditions that must be met in order for them to live in the community safely. This includes where the patient takes their medication. These conditions will be communicated to the individual by their responsible clinician (RC). The RC will monitor the patient throughout their CTO and can make them return to hospital if the conditions are not maintained, or if they believe that it is in the best interests of the patient.

What are the criteria for putting a patient onto a CTO?

The responsible clinician must evaluate the patient's situation fully in line with guidelines before they can make a CTO for them. The RC must ensure that the patient:

• Has a mental condition that requires medical treatment
• That treatment is required for the health and safety of the patient or the wider public
• That the treatment required can be received in the community
• That if they need to bring the patient back to hospital, they can demonstrate why 
• That the patient can receive the right treatment for their needs in the community.

In order for the CTO to be deemed appropriate, the responsible clinician will also need to show that:

• The patient will not be able to enjoy stable mental health without the community treatment order, and
• The patient's mental health is likely to get worse if their treatment in the community is stopped.

The responsible clinician will make several considerations when deciding whether a CTO is the best treatment option for their patient. Such considerations are likely to include:

• The patient's mental health history,
• How well the patient can contact local services,
• How successful previous treatment has been and how the patient is currently engaging with their treatment plan
• The patient's attitude towards their condition, treatment and future vulnerabilities
• The level of support offered by the person's family, friends and care team.

For a CTO to be issued, a responsible clinician and an approved mental health professional are both required to agree to it.

When can a CTO not be made?

A community treatment order can be made by a responsible clinician if a patient is on a section 3 or section 37 hospital order of the Mental Health Act, or through an unrestricted transfer direction as per section 47. The patient must still be on the section to be placed onto a CTO, and cannot be put on to the CTO if they are on sections 2, 4 or 5.

What are the conditions of a Community Treatment Order?

Each CTO is bound by conditions which must be met to ensure that the order works efficiently and that the patient and general public are safe. The following gives more information on the terms of a community treatment order:

• CTOs are given to people only if they have been treated in hospital under the Mental Health Act, and they are arranged by a patient's responsible clinician.
• The conditions that are outlined in the CTO serve to protect the patient and other people.
• The conditions of the CTO can include where a patient must live and where they will get their treatment.
• One of the CTO conditions will be that the patient will be supervised when they leave the hospital.
• CTOs are implemented with support given to patients by a care coordinator.
• If a patient fails to adhere to the conditions of their CTO, they can be taken back to the hospital. 
• It is possible to keep a patient who is on a CTO in a hospital for up to 72 hours while a decision is made regarding the next course of action.

A person who is placed on a community treatment order is eligible to challenge the decision if they do not agree that they should be on one. Patients have the right to meet an Independent Mental Health Advocate (IMHA) who can help them to understand their rights and support patients in raising concerns relating to the conditions of the CTO.

How long does a CTO last?

A community treatment order lasts for a period of 6 months from the date that the order is initiated. If it is deemed necessary, the CTO can be renewed, with the decision being made by the responsible clinician. Renewal will only be authorised if an approved mental health professional agrees with the RC's decision. The patient will need to meet with their responsible clinician before a renewal decision is made, as this is a condition that must be adhered to as part of the CTO.

When can a CTO be brought to an end?

Upon the end of a community treatment order, a patient will no longer be bound by the conditions of the order and cannot be recalled to hospital for treatment. There are several ways in which a CTO can be brought to an end, including:

• The expiry date of the CTO is reached, and a renewal application has not been made.
• The CTO is revoked because the patient is recalled to hospital. The revocation will come about because the responsible clinician believes that their patient should be detained in hospital. 
• The responsible clinician discharges the patient which can occur if the legal reasons for the individual being on the CTO are no longer applicable. 
• The individual who is on the CTO can apply to a Mental Health Tribunal to request a discharge from the order if they believe that they should not be on the CTO.
• A discharge may also come about if a hospital managers' hearing determines that this should be the case. A patient can request a meeting with hospital managers to request that they discharge them.
• The patient's nearest relative can also discharge them from a CTO by making a request to the medical team.