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.

Terms you need to know



Appropriate 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 clinician

A mental health professional who has certain responsibilities related to your healthcare. They are approved to do this by the Department of Health (England) or by the Welsh Ministers (Wales).

Approved clinicians may be:

  • doctors
  • psychologists
  • nurses
  • occupational therapists
  • social workers

Some decisions under the Mental Health Act, such as deciding on your medication or giving you permission to leave the ward or hospital, can only be taken by approved clinicians.

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


'Capacity' means the ability to understand information and make decisions about your life. Sometimes it can also mean the ability to communicate decisions about your life.

If you do not understand the information and are unable to make a decision about your care, for example, you are said to lack capacity.

Care 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:

  • nurse
  • social worker
  • other 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.

Community treatment order (CTO)

If you have been sectioned and treated in hospital under certain sections, your responsible clinician can apply for you to be put on a CTO. This means that you can be discharged from the section and leave hospital, but you might have to meet certain conditions such as:

  • living in a certain place
  • going somewhere for medical treatment


A person is detained if they are being kept in hospital under section and are not free to leave.

Hospital managers (also known as Mental Health Act Managers)


 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 – for example, they can hear your application to be discharged from your section and decide whether or not to discharge you.

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 advocacy, including information on IMHAs in England and IMHAs in Wales.

Judicial review

 This is a type of court procedure where a judge reviews a public authority’s decision, policy, practice, act or failure to act, and decides whether it is lawful or not.

If it is not lawful, the court may cancel the decision or action (‘quash’ it), and require the public authority to reconsider it, lawfully. The court can order the authority to do or not do something.

Mental 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 defines this as “any disorder or disability of mind” (section 1).

Mental disorder can include:

  • any mental health problem normally diagnosed in psychiatry
  • learning disabilities, if the disability makes you act in a way which may seem "abnormally aggressive" or "seriously irresponsible"

Mental 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 illness and need treatment. You can only be kept in hospital if certain conditions are met.

Mental Health Act Administrator

The administrator works in the hospital and deals with collecting and keeping the section or CTO papers safe. They make sure that procedures are followed – like making sure you are given the right information and arranging hearings.  

Mental Health Tribunal (MHT)

This is a special court that deals with cases relating to the Mental Health Act 1983. The Tribunal decides whether you can be discharged from your section and can decide about suitable aftercare and make recommendations about matters such as hospital leave, transfer to another hospital, guardianship and CTOs.

The court is made of a panel, which normally includes:

  •  a legally qualified chairperson
  • a ‘lay person’ who has appropriate experience and qualifications in the area of mental health
  • an independent psychiatrist, who will speak to you and examine you before the tribunal hearing in certain circumstances, and when you request to see them

Where you see a reference to the Mental Health Tribunal in this guide, it means:

  • First Tier Tribunal (Mental Health), if you live in England, or
  • Mental Health Review Tribunal for Wales, if you live in Wales

Nearest relative

This is a family member who has certain responsibilities and powers if you are detained in hospital under the Mental Health Act. These include the right to information and to discharge in some situations.

The law sets out a list to decide who will be the 'nearest relative'. This can sometimes be changed.

See our information on the nearest relative.


This is a legal definition meaning that you can be returned to hospital for up to 72 hours. You can be recalled to any hospital if the responsible clinician thinks that:

  • you need medical treatment in hospital for your mental disorder, and 
  • there would be risk of harm to your health or safety or to others if you are not recalled

You must meet both criteria.

Responsible clinician (RC)

This is the approved clinician 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.


This is a legal definition which means that your CTO has ended and that you are detained under the original section, for example section 3.

Second opinion appointed doctors (SOAD)

This is a doctor who is called for a second opinion to decide whether they agree with your treatment if you are detained under the Mental Health Act 1983.

The Mental Health Act sets out when the hospital should get a second opinion.


In this guide, being 'sectioned' means that you are kept in hospital under the Mental Health Act. There are different types of sections, each with different rules to keep you in hospital. The length of time that you can be kept in hospital depends on which section you are detained under.

See our information on sectioning to find out more.


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

Mental Health A-Z

Information and advice on a huge range of mental health topics

> Read our A-Z


Helping you to better understand and support people with mental health problems

> Find out more

Special offers

Check out our promotional offers on print and digital booklets, for a limited time only

> Visit our shop today