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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.

  • 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 community treatment order (CTO) will have these two conditions:

  1. If your responsible clinician asks to see you about renewing your CTO, you must make yourself available to meet them. 
  2. You must see the second opinion appointed doctor if you are asked to.

Your responsible clinician can also add other conditions. But these will depend on your circumstances. For example, you may need to:

  • Live in a certain place
  • Attend activities or therapy
  • Get tested for alcohol or illegal drugs
  • Attend appointments for treatment

The conditions must be necessary or appropriate to:

  • Make sure you get medical treatment
  • Prevent risk to your health and safety
  • Protect other people

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

Any conditions that are added must take your views into consideration. This means that you should be involved in planning your discharge and deciding your conditions. And you must have support to help you follow the conditions. This will help make sure that you are happy to follow your conditions.

Your approved mental health professional must also agree to any conditions added to your CTO.

Example

Eloise is being discharged onto a CTO. It has a condition that she must attend cognitive behavioural therapy (CBT) at the local day centre.

The care team must make sure that she is able to get to the day centre. For example, this might mean making sure that it is within walking distance. Or that 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 CTO conditions change?

Yes. Your responsible clinician can change or temporarily stop your conditions. They do not need the approved mental health professional to agree to do this.

You can ask your responsible clinician to change the conditions by writing or speaking to them. You can tell them why you want to change the conditions.

Any changes to your conditions will be recorded on a certain form, depending 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 CTO2 section 17b: variation of conditions of a community treatment order' as a Microsoft Word document. This is the form your responsible clinician will use to record any changes to your CTO conditions, in England.
  • If you are in Wales, visit this CP forms page on the NHS Cymru website. Here you can find a copy of 'CP2 - Section 17a - Variation of conditions of a community treatment order' as a PDF document. This is the form your responsible clinician will use to record any changes to your CTO conditions, in England.

What if my responsible clinician doesn't want to change the conditions?

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 may wish to complain to the ombudsman or regulator. See our pages on complaining about health and social care for more information.
  • Complain to the Care Quality Commission (CQC). The CQC website has guidance on how to complain.
  • Apply for a judicial review. If your responsible clinician doesn't change your conditions, 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. The Law Society has a directory of solicitors that you can search to find legal support.

What happens if I don't follow the CTO conditions?

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

  • Change the conditions or the support you receive, if there is a problem with either of these
  • 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 experienced side effects from the medication so he doesn't want to take it any more.

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. 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.

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This information was published in December 2017.

This page is currently under review. All content was accurate when published. 

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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