Our position on Community Treatment Orders (CTOs)
Published December 14 2022
A Community Treatment Order (CTO) allows a person severely affected by mental illness to be treated and supervised in the community rather than in hospital. In December 2022, Rethink Mental Illness revised their position in relation to the use of CTOs.
A CTO means that the person must also keep to certain conditions while in the community. These conditions can include:
- Where a person can live
- Where they go for treatment
- Staying away from things that make the person unwell, such as alcohol or drugs
If a person breaks the conditions of their CTO they can be sent back to hospital.
Rethink Mental Illness has recently revised its position on CTOs.
This is in response to the high, disproportionate and rising rates of people from racialised and ethnic communities being placed on a CTO, as well as recent consultation with experts by experience. Although we recognise that for some people, particularly carers, CTOs can provide structured support in the community, this is a much smaller percentage of people than the many people who find CTOs cause fear and impede recovery.
Given this and the increasing disproportionate rates of people from racialised and ethnic communities on CTOs, we believe that an alternative non-coercive model is needed to provide care to everyone who is discharged from hospital.
We call for the immediate reform of Community Treatment Orders based on recommendations from the Independent Review and an eventual end to their use.
We understand that CTOs in some cases have provided a good alternative to detention in hospital, by ensuring that a person is supported with their mental health in their community. People tell us that being treated in the community is often preferable to being treated in hospital.
However, there are also many people who tell us that the threat of returning to hospital left them feeling fearful and hampered their recovery.
Rethink Mental Illness does not support the increasing and unnecessary use of compulsion and is deeply concerned about the rising rates of racialised and ethnic minority people being placed on CTOs.
We recognise that in the currently underfunded mental health and social care system, CTOs are unfortunately often a way to receive the necessary support for a person with severe mental illness living in the community and experiencing crisis. This is a view supported by some carers and relatives who see CTOs as key to helping their loved ones to stay in the community and avoid returning to hospital.1
We call for improved support for people discharged from hospital that provides choice, meets a person’s needs for as long as they need, is regularly reviewed, is planned for well in advance of discharge and is provided to everyone held under the Mental Health Act. Support after discharge must provide a person with tailored services to prevent their condition from deteriorating, including supported accommodation, support with medication use and support to achieve a person’s own recovery goals.
For services to be meaningful for everyone they must be culturally appropriate and trauma-informed, and we call on the government to invest in these services to ensure that racialised and ethnic minority communities are provided with the support they need.
Our ultimate aim is for CTOs to become redundant because there is robust, well-funded and available mental health support in the community, both in the NHS, and social care, for everyone discharged from hospital.
Footnotes:
1 CQC (November 2022) ‘Mental Health Act community treatments orders (CTO) – focused visits report’.