What is a Community Treatment Order (CTO)?
A CTO allows you to get mental health treatment while living in the community instead of a hospital. Your clinician can send you back to the hospital for immediate treatment if needed. The order comes with specific conditions, and failing to meet them might result in your return to the hospital. Your care will be managed by :
- A 'Community RC' or responsible clinician, who issues the CTO.
- A care coordinator, your primary contact.
- If you're under a CTO, you're categorised as a 'community patient' under the Mental Health Act.
When Can a CTO be Issued?
CTOs can be issued only if you're in the hospital under certain sections of the Mental Health Act, like Sections 3, 37, or a notional Section 37. You can't be placed on a CTO under Sections 2, 4, or 5, or if you've been discharged.
Criteria for a CTO
You can only be placed under a CTO if :
- You have a mental disorder requiring medical treatment.
- The treatment is necessary for your health, safety, or others' protection.
- Treatment can be provided outside a hospital.
- The clinician can recall you to the hospital.
An approved mental health professional must agree in writing to these criteria. The CTO form varies between England and Wales.
Duration and Renewal of a CTO
A CTO initially lasts for six months but can be extended. Renewals must be approved by an approved mental health professional. You may be required to attend an assessment appointment.
Support Services under a CTO
After being put on a CTO, you are entitled to aftercare services as outlined in Section 117 of the Mental Health Act. These services are free of charge.
Independent Mental Health Advocacy
While on a CTO, you have the right to consult an Independent Mental Health Advocate (IMHA), who can offer various forms of support.
CTO Conditions
- Two mandatory conditions involve meeting your clinician for CTO renewal and seeing a second-opinion doctor if necessary.
- Additional conditions are variable and must be agreed upon by an approved mental health professional.
Conditions can change. Your clinician can modify them without requiring agreement from the approved mental health professional. You also have the right to request changes.
If conditions are not altered, you have multiple channels for filing complaints, including the option of legal action through judicial review.
Non-Compliance and Consequences
Failure to adhere to the conditions may result in modifications to these conditions or a return to hospital. Consent to treatment will depend on your mental state and whether you are recalled to the hospital.
How a CTO Ends
- Expiry of term : If your CTO isn't renewed, it will naturally come to an end.
- Return to hospital : If you are recalled to hospital and your CTO is revoked, you will revert to your original section. This happens when your responsible clinician believes you meet the criteria for hospitalisation.
- Discharge by clinician : Your responsible clinician can terminate the CTO if the initial conditions no longer apply.
- Mental Health Tribunal : You have the option to apply to the Mental Health Tribunal for discharge.
- Hospital managers' decision : You can request a hearing with the hospital managers to discuss ending the CTO.
- Relative's intervention : A close family member can also request your discharge.
Upon the termination of a CTO, you will no longer be subject to its conditions, and you cannot be forcibly returned to the hospital.