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The Royal College of Psychiatrists Improving the lives of people with mental illness

Surge in mental health Community Treatment Orders

Embargoed until 07 September 2010

The Mental Health Alliance has published a report today (7 September 2010) showing that thousands more people than expected have had Community Treatment Orders (CTOs) imposed on them when they were discharged from detention in hospital under the Mental Health Act.

CTOs, which came into effect in England and Wales in November 2008, set out conditions that patients must comply with, including taking their medication. They are being imposed at ten times the expected rate. Rather than the Department of Health’s estimate of 400-600, some 4,000 CTOs were issued in the first year. This number is estimated to have risen to 7,000 by July 2010, with some 4,000 to 5,000 patients under a CTO at that date.

Alison Cobb, Chair of the Mental Health Alliance, said: "We are concerned about the large numbers of people made subject to CTOs, given their coercive nature and the limited international evidence for positive effects. It is particularly worrying when people tell us about not getting the support they need or feeling stigmatised. We need to understand more about why so many CTOs are being imposed, and what impact they are having on people’s health and quality of life. We also need to know more about people’s progression off CTOs."

International research suggests that CTOs may be helpful for a particular group of people with multiple hospital admissions, but it is unclear how far it is the provision of intensive help and sustained monitoring that determines positive outcomes, and whether it is necessary to have a compulsory community order to achieve that.

Key findings from the report include:

  • In a consultation with over 9,000 psychiatrists, most of the 533 who responded thought that Supervised Community Treatment (SCT) was a useful option
  • There is very little information about the impact of CTOs on people’s quality of life. Some people report having a better quality of life being supported in the community while others find CTOs stigmatising, intrusive and not backed up with support
  • Serious concerns include the overall increase of people under compulsory treatment, disproportionate use of CTOs for people from black and minority ethnic communities, possible use of SCT to discharge people earlier than they should be, shortcomings in community support, and delays in obtaining second opinions from doctors to certify medication treatment after one month under a CTO.

The report’s author, Simon Lawton Smith, Head of Policy at the Mental Health Foundation, said: "The evidence on use of CTOs is only slowly emerging, and these are preliminary findings. But there is enough evidence to show that not everyone discharged from hospital under a CTO is getting the support they need to return successfully to the community. Much more needs to be done to ensure that CTOs are only imposed in strict accordance with legal requirements and are backed up by proper care and support."

For further information, please contact:
Sarah Nevins
Press & Social Media Officer
Telephone: 020 3701 2543
Claire McLoughlin
Media & Communications Manager 
Telephone: 020 3701 2544
Out of hours contact number: 07860 755896



A full copy of the report, Mental Health Alliance Briefing Paper 2: Supervised Community Treatment, can be downloaded from the Mental Health Foundation at or the Mental Health Alliance at


Note to editors:

The Supervised Community Treatment (SCT) powers of the Mental Health Act 2007 came into effect on 3 November 2008. Under these powers, certain patients in England and Wales subject to detention for treatment in hospital under the Mental Health Act 1983 may be placed under SCT upon discharge, through being given a Community Treatment Order (CTO).


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