Community treatment orders (CTOs)
Explains what a community treatment order (CTO) is, how it can affect you, and how you or your family members can change or end it.
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The UK Government is changing the Mental Health Act.
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.
The CTO will come with certain conditions that you have to follow. Sometimes, if you don't follow the conditions or you become unwell, they can recall you to hospital for treatment.
While you are in the community, you will have a specialist team responsible for your care:
- A responsible clinician, who is responsible for the CTO. They are likely to be known as your 'community RC'.
- A care coordinator, who will be your main point of contact.
If you are on a CTO, the Mental Health Act describes you as a 'community patient'.
When can a CTO be made?
A responsible clinician can only make a CTO if you are in hospital under certain sections of the Mental Health Act:
- Section 3
- Section 37 hospital order
- Unrestricted transfer direction under section 47 (Notional section 37)
You cannot be put on a CTO if:
- You are under sections 2, 4 or 5
- You have already been discharged from your section.
See our pages on sectioning to find out more about the different sections of the Mental Health Act.
What are the criteria for making a CTO?
The Mental Health Act states that you can only be put on a CTO if you meet these criteria:
- 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.
- Appropriate medical treatment is available for you in the community
An approved mental health professional must agree in writing that you meet these criteria, and that they are appropriate for you.
The form which they will use to put you on a CTO depends on whether you are in England or in Wales:
- If you are in England, visit this CTO forms page on the UK Government website. Here you can find a copy of 'Form CTO1 section 17a: community treatment order' as a Microsoft Word document. This form is used for CTOs in England.
- If you are in Wales, visit this CP forms page on the NHS Cymru website. Here you can find a copy of the form 'CP1 - Section 17a - Community treatment order' as a PDF document. This form is used for CTOs in Wales.
Example
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.
How long does a CTO last?
A CTO lasts for 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 the CTO being renewed.
You responsible clinician may ask you to attend an appointment to assess whether to renew your CTO. If they ask you to do this, you must attend the appointment. 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 a form. The form they use depends on whether you are in England or Wales:
- If you are in England, visit this CTO forms page on the UK Government website. Here you can find a copy of 'Form CTO7 section 20a: extending the community treatment period' as a Microsoft Word document. This form is used for CTOs in England.
- If you are in Wales, visit this CP forms page on the NHS Cymru website. Here you can find a copy of the form 'CP3 - Section 20a - Report extending the community treatment period' as a PDF document. This form is used for CTOs in Wales.
What support can I get when I am on a CTO?
When you are discharged from hospital onto a CTO, you can get certain aftercare services. You are entitled to this under section 117 of the Mental Health Act.
This means you can get support in the community for your mental health problems. This support is to help you stay well, so you don't have to return to hospital. You will not have to pay for this support.
See our page on leaving hospital for more information about section 117 aftercare services.
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 lots of different ways. For example, they can:
- Support you with participating in meetings
- Help you get relevant information
- Look at alternative options for you
- Help you challenge decisions
Hospital staff should give you information about getting support from an IMHA. If they don't, you can 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.
Responsible clinician (RC)
This is the mental health professional in charge of your care and treatment while you are sectioned under the Mental Health Act.
Certain decisions, such as applying for someone who is sectioned to go onto a community treatment order (CTO), can only be taken by the responsible clinician.
All responsible clinicians must be approved clinicians. They do not have to be a doctor, but in practice many of them are.
Visit our full listing of Legal TermsCare coordinator
A care coordinator is the main point of contact and support if you need ongoing mental health care. They keep in close contact with you while you receive mental health care and monitor how that care is delivered – particularly when you’re outside of hospital. They are also responsible for carrying out an assessment to work out your health and social care needs under the care programme approach (CPA).
A care coordinator could be any mental health professional, for example:
- a nurse
- a social worker
- another mental health worker.
This is decided according to what is most appropriate for your situation.
A care coordinator usually works as part of the community mental health team.
Visit our full listing of Legal TermsMental Health Act 1983 (MHA)
This is a law that applies to England and Wales which allows people to be detained in hospital (sectioned) if they have a mental health disorder and need treatment. You can only be kept in hospital if certain conditions are met.
See our pages on the Mental Health Act for more information.
Visit our full listing of Legal TermsMental disorder
When the Mental Health Act talks about someone with mental health problems and whether or not they should be sectioned, it often uses the term 'mental disorder'. The Act says that this can include "any disorder or disability of mind".
Mental disorder can include:
- any mental health problem normally diagnosed in psychiatry
- certain learning disabilities.
Appropriate treatment or appropriate medical treatment
This means medical treatment for your mental health problem that is:
- suitable for you
- available
- takes into account the nature and degree of your mental health problem and your individual circumstances.
Approved mental health professional (AMHP)
AMHPs are mental health professionals who have been approved by a local social services authority to carry out duties under the Mental Health Act. They are responsible for coordinating your assessment and admission to hospital if you are sectioned.
They may be:
- social workers
- nurses
- occupational therapists
- psychologists.
Independent mental health advocate (IMHA)
An IMHA is an advocate specially trained to help you find out your rights under the Mental Health Act 1983 and help you while you are detained. They can listen to what you want and speak for you.
- You have a right to an IMHA if you are:
detained in hospital under a section of the Mental Health Act, but not if you are under sections 4, 5, 135 and 136 - under Mental Health Act guardianship, conditional discharge and community treatment orders (CTOs)
- discussing having certain treatments, such as electroconvulsive therapy (ECT).
In Wales, voluntary patients can also have an IMHA.
See our pages on IMHAs (England) and IMHAs (Wales) for more information.
Visit our full listing of Legal TermsHospital managers (also known as Mental Health Act managers)
Hospital managers are an independent team of people in a hospital who make sure that the requirements of the Mental Health Act are properly applied. They have certain important responsibilities and can make decisions related to your detention.
In practice, most of the day-to-day decisions are taken by individuals authorised by the hospital managers to do so. This can include hospital staff. Decisions about discharge are normally delegated to a team of people who are independent of the hospital. You can apply to them to be discharged from your section and they will decide whether or not to discharge you.
Visit our full listing of Legal TermsMental Health Act Administrator
The Mental Health Act Administrator works in the hospital and deals with collecting and keeping the section or community treatment order (CTO) papers safe. They make sure that procedures are followed – like making sure you are given the right information and arranging hearings.
Visit our full listing of Legal TermsDetained
A person is detained if they are being kept in hospital under section and are not free to leave.
Visit our full listing of Legal TermsThis information was published in June 2022. We will revise it in 2025.
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