Community Treatment Orders (CTOs)

What a CTO means

A Community Treatment Order is a legal order under section 17A of the Mental Health Act 1983. It lets an eligible detained patient leave hospital for treatment in the community, while a responsible clinician keeps a power to recall them. It is different from section 17 leave. It can follow section 3 or certain unrestricted hospital orders; it cannot simply be imposed on any person living at home. Learning disability or autism does not automatically mean someone needs a CTO.

Who decides and what they must consider

The responsible clinician is the professional overseeing your mental health treatment, often a psychiatrist. They make the order. An Approved Mental Health Professional (AMHP) must agree in writing that the legal criteria are met and that a CTO is appropriate. The criteria include the need for treatment, its availability, the ability to provide it outside hospital and the need for a power of recall. Ask why voluntary care and support would not meet your needs. Your formal consent to the order is not required, but you should be involved and given accessible information.

Your conditions

Ask for a copy of your CTO and an explanation of each condition. Two mandatory conditions concern making yourself available for examinations for extending the order and for a second-opinion treatment certificate where required. Other conditions must be necessary or appropriate for receiving treatment, preventing harm to your health or safety, or protecting others. The responsible clinician can change or suspend conditions. Ask for a review if a condition is unclear, unworkable or more restrictive than needed.

When recall to hospital is allowed

Recall is a legal instruction to return to hospital. Usually the responsible clinician must consider that you need hospital treatment for mental disorder and that there would be a risk of harm to you or other people without recall. Breaching an ordinary condition does not automatically meet this test. A separate recall power applies if you do not make yourself available for either mandatory examination. Recall must be by written notice. Ask why you are being recalled and contact your advocate or solicitor promptly.

The 72-hour period and revocation

After recall you can be detained for up to 72 hours from when your detention in hospital under the notice begins. You can be released sooner and remain on the CTO. Alternatively, the responsible clinician can revoke the CTO, with an AMHP’s written agreement, if the criteria for hospital detention are met. Revocation means you become detained for treatment again; it does not mean you are free from the Act. If neither released nor revoked by 72 hours, you must be released from recall.

Treatment and consent

Staff should explain treatment, side effects and alternatives, and support you to decide. If you are aged 16 or over and have capacity to decide, a CTO does not authorise forcing mental health treatment on you in the community against your refusal. Different safeguards apply if you lack capacity or are under 16; narrowly defined emergency treatment powers also exist. A second-opinion certificate is not unlimited permission to use force. After recall, hospital treatment rules can differ. Ask an IMHA or mental health solicitor about your situation.

How long the CTO lasts

The first period lasts up to six months. It can be extended for a further six months, then for up to a year at a time. Extension requires reassessment, continued satisfaction of the legal criteria and an AMHP’s written agreement. It is not automatic. The CTO can end before the expiry date. Ask for the start date, review date, expiry date and a clear explanation of what would support ending it.

Getting independent help and challenging the order

You have a right to a free Independent Mental Health Advocate (IMHA) while on a CTO. Ask your care team for the local service and how to contact it directly. An IMHA can explain your rights and support your views; a solicitor gives legal advice and representation. You can ask the responsible clinician or hospital managers to discharge you from the CTO, or apply to the independent Mental Health Tribunal. Specialist legal representation at a CTO tribunal is free. Ask a solicitor to check the application period for your case.

What a tribunal can do

The tribunal considers whether the legal requirements for your CTO remain satisfied, including whether the power to recall you is necessary. It can discharge the CTO. Ask the responsible clinician to change particular conditions; the tribunal’s main decision is whether the order should continue. You can prepare your own account and supporting evidence with your solicitor. Ask for communication support, accessible reports, breaks, extra time and arrangements that help you participate.

The nearest relative

The nearest relative is a specific legal role and may be different from your chosen next of kin. In qualifying cases they can give the responsible hospital’s managers at least 72 hours’ written notice of discharge. The responsible clinician can bar this using the legal dangerousness test. A solicitor should explain the process, the effect of any barring report and the nearest relative’s tribunal rights. Do not assume a family request ends the CTO immediately.

Your home, freedom and daily life

A CTO does not authorise conditions that amount to depriving you of your liberty. In Welsh Ministers v PJ [2018] UKSC 66, the Supreme Court confirmed this limit. If you cannot leave your home or placement, or face continuous supervision and control, ask your solicitor what legal authority is being relied on. You can also ask for a review of restrictions and for support that better fits your wishes and daily life.

Section 117 aftercare

People leaving qualifying detention on a CTO are entitled to section 117 aftercare. This is free support addressing needs connected with mental disorder and helping reduce the risk of deterioration and readmission. The NHS and council share responsibility for arranging it. Ask for an agreed aftercare plan, named contacts and clarity about housing, care, medication, transport and crisis support. Aftercare is required throughout the CTO and does not automatically end when the CTO ends. Not every ordinary living expense becomes free.

Make the plan work for you

Ask staff to record your communication method, sensory needs, access requirements and what helps you feel safe. You can ask for Easy Read information, an interpreter, a quiet meeting, more time and someone you trust. Discuss practical barriers such as travel, appointment times and medication side effects before they become problems. Ask who to contact if you feel unwell or cannot attend, and keep copies of your CTO, care plan and crisis plan.

Complaints are different from challenging the order

You can complain to the care provider about poor care, inaccessible information or how the Act is used. An IMHA can help. The Care Quality Commission can consider complaints about the use of Mental Health Act powers, including CTOs; it will usually expect you to raise the issue with the provider first. A complaint does not replace an application to the tribunal or stop a legal time limit.

Current law and planned changes

This guide uses the rules checked on 2 November 2026. The Mental Health Act 2025 contains further reforms, but passing an Act does not bring every provision into force. The main reforms require phased commencement. Do not assume the new nominated-person system or revised CTO criteria already apply. Ask your solicitor which provisions apply to your current order.

A Community Treatment Order (CTO)

What a CTO means

Returning to hospital

Getting help and having a say

What you can do next

More useful links