Community Treatment Orders (CTOs): A Guide for Health and Care Staff

A community treatment order (CTO) lets some people who were detained in hospital for treatment live in the community, with conditions and the possibility of being recalled to hospital if their health deteriorates. CTOs sit in section 17A of the Mental Health Act 1983 and they affect many people supported by community teams, supported living and care homes. This guide explains who qualifies, how an order is made, the conditions that can be attached and what happens on recall. It applies in England and Wales. It is general education, not legal advice.

Who can be placed on a CTO?

CTOs apply to people detained under section 3 (admission for treatment) and to unrestricted patients detained under a hospital order from a criminal court. They are not available for patients detained under section 2 for assessment, for restricted patients, for informal patients or for people who were never detained.

How is a CTO made?

The patient’s responsible clinician, the clinician in charge of their treatment, must be satisfied that all of the following apply:

• The person has a mental disorder of a nature or degree that makes treatment appropriate.
• Treatment is necessary for their health or safety, or for the protection of others.
• The treatment can be provided without the person continuing to be detained in hospital.
• The power to recall the person to hospital is necessary.
• Appropriate medical treatment is available.

An approved mental health professional (AMHP) must also agree in writing that these criteria are met and that making the order is appropriate. That second signature is a safeguard, so the decision does not rest with one professional alone.

What conditions can be attached?

Every CTO has two mandatory conditions: the person must make themselves available for an examination if the order is to be renewed, and for an examination by a second opinion appointed doctor so that treatment can be certified. The team can add other conditions where they are necessary or appropriate, such as where the person lives, taking medication, engaging with services, or avoiding certain substances or places. Conditions cannot deprive the person of their liberty. If a condition would amount to confinement, it is not lawful as a CTO condition.

How long does a CTO last?

• The first order lasts up to six months.
• The first renewal is for six months.
• Later renewals are for 12 months at a time.

Recall to hospital

The responsible clinician can recall the patient to hospital if the person needs treatment in hospital for their mental disorder and there would be a risk to their health or safety, or to others, if they were not recalled. Recall permits detention for up to 72 hours. Within that time the responsible clinician and an AMHP must decide whether to revoke the CTO, which returns the person to detention under section 3, or to release them back to the community on the order.

Tribunal rights

People on a CTO can apply to the Mental Health Tribunal. According to mental health law guidance, they can apply once in the first six months, once in each later six-month period and once a year after that. Hospital managers must also make automatic references to the tribunal at six months and again at three years. The nearest relative may also have rights, which are changing under the Mental Health Act 2025.

What should care staff do?

1. Know who is on a CTO. Check the person’s records and confirm the current conditions and the end date.
2. Understand the conditions. If you support the person day to day, you need to know what they must do and what you are expected to report.
3. Report concerns early. Tell the community mental health team promptly if the person’s health is declining, if they stop taking medication or if they are not engaging. Early contact can avoid an emergency recall.
4. Do not enforce conditions yourself. Staff in a care home or supported living setting are not responsible for physically enforcing conditions. Follow the care plan and escalate.
5. Check the liberty position. A CTO cannot authorise a deprivation of liberty. If a person in a care home is under continuous supervision and control, check whether a DoLS authorisation or court order is needed. See our guide to the Liberty Protection Safeguards.
6. Support recovery and rights. Make sure the person knows about their right to apply to the tribunal and to have advocacy support.

CTOs and aftercare

People on CTOs have been detained under section 3, so they are entitled to free aftercare under section 117, which continues after the CTO ends. Our guide to section 117 aftercare explains who is responsible for services and when they can be withdrawn.

How is reform changing CTOs?

The Mental Health Act 2025 changes how the Act works, including in areas that affect CTOs. Our overview of the Mental Health Act 2025 key changes explains the direction of reform. Check for updates on when each change takes effect, because implementation is phased.

Frequently asked questions

Is a CTO the same as being discharged?

No. The person is still subject to the Act, with conditions and the possibility of recall.

Can someone on a CTO be forced to take medication at home?

Medication can be a condition, but treatment cannot be given by force in the community. If the person refuses and becomes unwell, recall may be considered.

How long can a recall last?

Up to 72 hours, after which the order is revoked or the person is released back to the community.

Key takeaways

• CTOs are for some section 3 and hospital order patients, and need a clinician and an AMHP to agree.
• Conditions cannot deprive liberty, and recall allows up to 72 hours of detention.
• Staff should know the conditions, report concerns early and make sure people understand their rights.

To build your confidence with mental health law, explore our healthcare CPD courses.

Sources

• Mental Health Law Online: Community Treatment Order
• legislation.gov.uk: Mental Health Act 2007 explanatory notes, community treatment orders