Community Treatment Orders

What is a Community Treatment Order (CTO)?

A Community Treatment Order (CTO) is a legal order made by the Mental Health Review Tribunal or by a Magistrate. It sets out the terms under which a person must accept medication and therapy, counselling, management, rehabilitation and other services while living in the community. It is implemented by a mental health facility that has developed an appropriate treatment plan for the individual person.

A CTO authorises compulsory care for a person living in the community. If a person breaches a Community Treatment Order, by not complying with the conditions of the Order, the person may be taken to a mental health facility and given appropriate treatment, including medication.

CTOs can be made for any period of time up to twelve months. It is possible for a person to have more than one consecutive CTO.

When may the Tribunal make a CTO?

The Tribunal may make a CTO:

• for a person who is detained in or a patient in a mental health facility, or
• for a person who is not in a mental health facility.

A CTO may be made in the following circumstances and may replace an existing order (s51(5)):

• by a Magistrate under s33 of the Mental Health (Forensic Provisions) Act 1990
• by the Tribunal following a mental health inquiry;
• on a review of a patient by the Tribunal;
• on an application to the Tribunal.

Who can apply to the Tribunal for a CTO?

The following persons may apply for a CTO (s51(2)):

• the Authorised Medical Officer of a mental health facility in which a person is detained or is a patient;
• a Medical Practitioner who is familiar with the clinical condition of the person;
• a Director of community treatment of a mental health facility who is familiar with the clinical condition of the person; or
• a designated carer or principal care provider of the person.

How does the Tribunal decide about a CTO application?

The Tribunal must be satisfied that:

• the person would benefit from the CTO as the least restrictive alternative consistent with safe and effective care; and
• the mental health facility has an appropriate treatment plan and is capable of implementing it; and
• if the person has been previously diagnosed as suffering from a mental illness, there must be a history of refusal to accept appropriate treatment.

The provision is essentially the same as the previous provision in the 1990 Act. So for example, the if an application was made in respect of a person who had for the first time been diagnosed as suffering from a mental illness, the Tribunal might decide that they would benefit from a CTO as the least restrictive alternative consistent with safe and effective care. If the person has previously been diagnosed then the requirement concerning “previous history of refusal to accept appropriate treatment” must be satisfied.

A person has a previous history of refusing to accept appropriate treatment if:

• the person has previously refused to accept appropriate treatment; and
• there was a relapse into an active phase of mental illness when treatment was refused; and
• the relapse was followed by mental or physical deterioration justifying involuntary hospital admission (whether or not there has been such an admission); and
• care or treatment in hospital resulted in, or could have resulted in, an improvement in or recovery from the symptoms of the mental illness.

When does a CTO come to an end?

A CTO can be made for a period of up to 12 months and ends on the date stated on the order, or if no date is specified, 12 months after the order was made. If you are applying for a further CTO, a hearing should be held before the current order ends to ensure continuity of care. However, an application can be made for a new order if a previous CTO has expired.

A CTO will also end if:

• the Director of the mental health facility revokes the CTO;
• the person successfully appeals to the Supreme Court; or
• the Tribunal revokes the CTO; or
• the Tribunal orders that it has no effect.

A CTO has no effect while an affected person is detained in a mental health facility or is a voluntary patient, or has been admitted after a breach of a CTO (s60).

Appealing against a Community Treatment Order (s67)

If the order was made by the Tribunal the affected person may appeal to the Supreme Court if:

• the term of the CTO exceeds 6 months or no term is specified on the order, against the duration of the order; or
• on any question of law or fact arising from the order or its making.

If the order was made by a Magistrate, the Tribunal may hear the appeal.

Clients should be referred to the Mental Health Advocacy Service (Legal Aid) for advice on 9745 4277 or refer to the Tribunal if he or she is subject to a Magistrate’s order.