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Community treatment orders (CTOs)

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

  • This information applies to England and Wales.
  • This information applies to adults. It doesn't apply to children unless specifically stated.

What conditions can be attached to a CTO?

Every CTO will have these two conditions:

  1. You must make yourself available to see your responsible clinician if your CTO is going to be renewed.
  2. You must see the second opinion appointed doctor if you are asked to.

Other conditions can be added, but they will depend on your particular circumstances.

Examples of other conditions include:

  • having to live in a certain place
  • attending activities or therapy
  • being tested for alcohol or illegal drugs
  • attending appointments for treatment

Any conditions that are added to your CTO must be agreed with your approved mental health professional. The conditions must also be necessary or appropriate to make sure you get medical treatment, prevent risk to your health and safety or protect other people

It's important to know that any conditions that are added must take your views into consideration. This means that you should be involved in planning your discharge, deciding your conditions, and be given help to be able to follow them. This will help make sure that you are happy to follow your conditions.

A condition would be unlawful if it restricts your freedom more than if you were sectioned.

Example

Eloise is being discharged onto a CTO with a condition that she must attend cognitive behaviour therapy at the local day centre.

The care team must therefore make sure that she is able to get to the day centre, for example, making sure that it is in walking distance, or she can apply for a bus pass so that she can get the bus.

It would be unreasonable for them to expect Eloise to pay for a taxi every day if there are no buses.

Can the conditions be changed?

Yes – your responsible clinician can change or temporarily stop your conditions. They do not need the approved mental health professional's agreement to do this.

You can ask your responsible clinician to change the conditions by writing or speaking to them, and telling them the reasons why you want to change the conditions. Any changes to your conditions will be recorded on this form in England or this form in Wales.

If your responsible clinician doesn't want to change the conditions, you can take these steps:

  • Complain through the hospital's complaints procedure. The hospital should be able to give you a copy of their complaints procedure if you ask them for it. If you are not happy with the response you can move on to the next step. You can also have a look at our guide on Complaining about health and social care for more information.
  • Complain to the Care Quality Commission. To find out how to do this, see their guidance on how to complain.
  • Apply for a judicial review. If your responsible clinician doesn't change the condition, you might be able to apply to change them by judicial review. This is a legal process and it is important that you get specialist legal advice. (See Useful contacts for more information).

What happens if I don't follow the conditions?

If you don't follow the conditions, your responsible clinician may:

  • change the conditions or the support you receive if there is a problem with them, or
  • return you to hospital

You cannot be recalled just because you don't agree to medical treatment. As long as you have capacity to consent to treatment, you can only be given treatment if you consent to it. But there are different rules if you are recalled to hospital or do not have capacity. (See our page on recall to hospital to find out more.)

Example

Marco is on a CTO with a condition that he goes to hospital to take his medication. He has been suffering from side effects from the medication so he doesn't want to take it anymore.

Marco's responsible clinician can't recall him just because he refuses to take the medication. But if Marco doesn't take his medication, he may become unwell, and in this situation his responsible clinician may choose to recall him.

Instead, Marco goes to the hospital and speaks to his responsible clinician about changing his medication.

< About CTOs Ending a CTO >

This information was published in December 2017. We will revise it in 2020.

References are available on request. If you would like to reproduce any of this information, see our page on permissions and licensing.

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