Community treatment orders (CTOs)

Explains what a community treatment order is, how it affects you and how you can change or end it. Applies to England and Wales.

About CTOs

What is a CTO?

A community treatment order (CTO) is an order made by your responsible clinician to give you supervised treatment in the community.

This means you can be treated in the community for your mental health problem, instead of going to hospital, but your responsible clinician can return you to hospital and give you immediate treatment if necessary.

Conditions are added to the CTO which you have to follow. Sometimes, if you don't follow the conditions or you become unwell, you can be recalled to hospital and treated immediately.

While you are in the community, you will have a specialist care team:

If you are subject to a CTO, the Mental Health Act describes you as a 'community patient'.

When can a CTO be made?

responsible clinician can make a CTO if you are on a:

  • section 3
  • section 37 hospital order
  • unrestricted transfer direction under section 47

You cannot be put on a CTO if:

  • you are on sections 2, 4 or 5
  • you have been discharged. You must still be on the section to be able to be put on the CTO.

To find out more about different sections and what they mean, see our information on sectioning.

What are the criteria for making a CTO?

You can only be put on a CTO if:

  • you are suffering from a mental disorder for which you need to receive medical treatment
  • you need to receive this medical treatment for your health or safety or for the protection of others
  • you can receive this treatment without needing to be detained in hospital
  • your responsible clinician needs to be able to recall you to hospital if necessary, and
  • appropriate medical treatment is available for you in the community

An approved mental health professional must agree in writing that these criteria are met, and they are appropriate for you.

Here is the form used to make a CTO: form if you are in England, or form if you are in Wales.

How long does a CTO last?

A CTO lasts 6 months from the date of the order, but it can be renewed. Your responsible clinician will decide whether to renew your CTO. An approved mental health professional will also need to approve this before the CTO can be renewed.

You will need to have an appointment with your responsible clinician so that they can decide whether your CTO should be renewed – this is a condition of your CTO that you must follow.

If your responsible clinician decides to renew your CTO, they will need to fill out this form: form for England or form for Wales.

What support can I get when I am on a CTO?

When you are discharged from hospital onto a CTO you are entitled to free aftercare services under section 117 of the Mental Health Act 1983.

This means support in the community to help you with your mental health problems and to help you stay well and not have to return to hospital. You will not have to pay for this support.

For more information about section 117 aftercare services see our guide to leaving hospital.

What is an independent mental heath advocate?

If you are on a CTO, you have the right to get support from someone called an independent mental health advocate (IMHA).

An IMHA can help you in all sorts of ways. For example, they can:

  • support you participating in meetings
  • help you get relevant information
  • look at alternative options for you
  • help you challenge decisions

Your hospital managers should give you information about your CTO rights and advocacy services. If they don’t, you should ask the Mental Health Act administrator of the hospital or your care coordinator.

See our guide to advocacy for more information on IMHAs in England and IMHAs in Wales.


Ali has been detained under section 3 for 9 months. He has a diagnosis of bipolar disorder which is managed by medication. He and his care team have agreed that he will be discharged onto a CTO next week, so that he can get supervised treatment in the community.


This information was published in December 2017. We will revise it in 2019.

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