Community Treatment Orders
Community Treatment Order (CTO)
If you are in hospital under Section 3 or 37, your responsible clinician can apply for you to be put on a community treatment order (CTO).
A community treatment order means you can leave hospital and be treated in the community so long as you follow certain conditions.
Your team discuss these conditions with you before you leave hospital.
If you become unwell, or you don’t follow your conditions, you may be asked to attend a community team base for a review.
If we can’t find a way to make your community treatment order work, or you are very unwell, you might be recalled to hospital.
You have the right to see an independent mental health advocate (IMHA) if you want help or advice.
Who decides you can have a community treatment order?
Your responsible clinician can arrange a community treatment order if they are sure you can get the treatment you need in the community.
An approved mental health professional needs to agree that a community treatment order is appropriate.
What CTO conditions involve
Community treatment order conditions include:
•seeing your responsible clinician if your community treatment order is going to be extended
•seeing the second opinion appointed doctor if asked
Other conditions might include living at a particular address, attending appointments for treatment, and staying in touch with your care team.
Your responsible clinician will discuss your conditions with you while you are in hospital.
If you want, you can ask your nearest relative or carer to be involved.
Before you leave hospital, your team will explain your rights. Ask your nurse or care coordinator if you do not have them.
We need your consent to give you medication. If you are too unwell to give consent, or you refuse to give consent, your doctor needs the agreement of a “second opinion appointed doctor” (SOAD).
This is an independent doctor who checks your views and wishes have been taken in to account, and ensures your treatment is appropriate.
If you refuse medication, you might need to go back to hospital. This is called being “recalled”.
If your CTO doesn’t work out
Speak to your care co-ordinator if you feel unwell, or you are struggling with any of the conditions of your community treatment order. Your responsible clinician might be able to change your conditions.
If you are very unwell, you might be recalled to a community team base for a review. This means we assess your mental health and discuss ways to make your community treatment order work for you.
If that doesn’t work out, or you are very unwell, your responsible clinician might recall you to hospital.
Recall to hospital
Going back to hospital only happens if we can’t find another way to make your community treatment work or your responsible clinician feels you are too unwell to be treated in the community.
If you are recalled, your care coordinator will give or post you a recall notice or leave it at your address.
You can make your own way back to hospital or ask a friend or relative to come with you.
If you are very unwell, an ambulance might bring you back to hospital.
When you arrive, a nurse will explain what is happening and answer any questions. To start with, you can be kept in hospital for up to 72 hours; the hospital team will assess your mental health and discuss your treatment options with you and your community team.
If we have serious concerns, the senior doctor on the ward and the approved mental health professional might decide your community treatment order is not working and you should stay in hospital.
If you are not willing to stay in hospital voluntarily, you may be kept in hospital under a section of the Mental Health Act.
How long your CTO will last
To start with, your community treatment order lasts up to six months. It can end if your responsible clinician decides it is no longer needed, or you appeal, and it is agreed that it should end.
Before your community treatment order ends, you will be invited to meet your responsible clinician.
If they think it you need to stay on a community treatment order, and it is the first time it has been extended, they can extend it for up to six months.
After that, your responsible clinician can extend your community treatment order for up to a year at a time.
All extended CTOs are reviewed by the Associate Hospital Managers (AHMs).
How extended CTOs are reviewed
Associate Hospital Managers (AHMs) are independent of Coventry and Warwickshire Partnership Trust.
If your community treatment order is extended, the AHMs will invite you to the hearing (meeting) and receive reports from your responsible clinician and care coordinator.
If you do not attend the hearing, the AHMs will look at reports from your doctor and care coordinator and decide if your CTO should continue.
Once they have made a decision, you will be told in person if you attend the hearing, or by letter afterwards if you do not attend.
How to appeal
If you disagree with the conditions of your community treatment order, or you want it to end, you or your nearest relative can appeal:
Mental Health Tribunal
An independent legal group who hears from you, your responsible clinician and your care coordinator at a meeting called a hearing.
Write to the MHA Office at your current hospital, or the one you were discharged from, to start an appeal.
Associate Hospital Managers (AHMs)
A group that runs similar meetings to the Mental Health Tribunal.
The official name for them under the Mental Health Act is hospital managers.
We call them Associate Hospital Managers or AHMs to avoid confusion with other managers.
To start an appeal, you can let the Mental Health Act office know that you want to appeal; by emailing firstname.lastname@example.org or write to:
Mental Health Act Office
Clifford Bridge Road
Getting help with an appeal
Your care co-ordinator can help you appeal - or your solicitor, if you have one.
You can contact our Mental Health Act office for an up to date list of solicitors that specialise in mental health law.
If you go to a tribunal and a solicitor represents you, you can usually get free legal help (Legal Aid).
You can also get free, independent and confidential help from an independent mental health advocate.
You can bring someone with you to hearings for support, such as a carer, friend or family member, however they are not allowed to speak on your behalf and the appeal panel needs to know in advance.