Community Treatment Orders (CTOs)

A Community Treatment Order can be made by the Responsible Clinician (RC) — typically the consultant psychiatrist — subject to the agreement of an Approved Mental Health Professional. The statutory criteria for a CTO are:

1. The patient is suffering from a mental disorder of a nature or degree that makes it appropriate for them to receive medical treatment.
2. It is necessary for the patient's health or safety or the protection of others that treatment is provided, and the treatment can be provided without the patient being detained, provided the CTO power of recall is available.
3. Appropriate medical treatment is available for the patient.
4. It is necessary that the RC is able to recall the patient to hospital if needed.

The AMHP must agree that the CTO is appropriate. Unlike a nearest relative objection to Section 3, the nearest relative cannot block a CTO, though they should be consulted where practicable.

Every CTO must include two mandatory conditions:

1. The patient must make themselves available for examination by the RC when required (for CTO renewal).
2. The patient must make themselves available for examination by a SOAD if one is appointed.

In addition, the RC (with AMHP agreement) can impose discretionary conditions, which must be necessary or appropriate to ensure the patient receives treatment, to prevent risk of harm to the patient or others, or to protect others from harm. Common discretionary conditions include:

• Residing at a specified address
• Attending specified clinics or community mental health team (CMHT) appointments
• Allowing access to their accommodation by their care coordinator or community nurse
• Not using alcohol or illicit substances

Conditions must be proportionate and clinically justified — they should not be used to control every aspect of the patient's life.

The RC can recall a patient on a CTO to hospital if:

• The patient needs to receive medical treatment in hospital for their mental disorder, and without recall there would be a risk to the patient's health or safety or to the safety of others; or
• The patient has breached a mandatory condition of their CTO.

A recall is effected by the RC giving the patient a recall notice (or giving the notice to the patient's last known address). Once recalled, the patient can be detained in hospital for up to 72 hours for examination. At the end of 72 hours, the RC must either:

• Revoke the CTO (which means the patient is formally re-detained under Section 3), or
• Discharge the patient from the recall (the CTO continues).

Patients on CTOs have the right to apply to the Mental Health Tribunal to challenge their CTO during each renewal period (the same rules as for Section 3 detention apply). The Tribunal can discharge the CTO.

A CTO ends when:

• The RC discharges the patient from the CTO absolutely.
• The hospital managers direct discharge.
• The nearest relative exercises their discharge power (subject to barring report as for Section 3).
• The Mental Health Tribunal orders discharge.
• The CTO expires without renewal (at the end of the renewal period).
• The CTO is revoked (which converts the patient back to Section 3 detention).

Patients on CTOs are entitled to an IMHA and should continue to be engaged in their care planning throughout.