Community Treatment Orders (CTOs): What They Are and How They Affect Your Care
What if mental health treatment was no longer a personal choice but a legal requirement? Many people dealing with mental health challenges are motivated to follow through with their treatments and can experience life-changing benefits as a result. But for others, especially those dealing with a severe mental health illness and/or repeated hospitalizations, following a treatment plan on their own may be especially challenging.
Community Treatment Orders (CTOs) or Assisted Outpatient Treatment (AOT) as it is more commonly known here in the United States, is a legal framework that aims to find a comfortable middle-ground between long-term hospitalization and independent living.
Having a legal framework in place to manage mental health care can sound controversial, but CTOs have come to play a major role in supporting sustainable recovery.
On this page, we will take a deep dive into:
- What Community Treatment Orders or CTOs are
- When a CTO can be implemented
- Eligibility criteria for CTOs
- How long a CTO lasts
- Benefits and Risks
- Patient rights vs. CTO
- Get more information and help for a CTO
What Is a Community Treatment Order?
A Community Treatment Order is a legal framework that allows courts to order people with serious mental health illnesses to follow mandatory and supervised treatment, typically therapy and medication management, within a community environment, as opposed to being continually hospitalized.¹
The idea is to help clients create a more stable life through structured treatment in the least restrictive environment possible, and avoiding repeated hospitalizations. This approach is ideal for people who have a history of being unable to stick to treatment or are at risk of deteriorating mental health, especially people with severe mental health disorders. It helps to ensure clients don’t pose any risks to themselves or others as they’re being closely monitored.
The term ‘Community Treatment Order’ is most commonly used in the United Kingdom and Australia. In the United States, it’s known as Assisted Outpatient Treatment or AOT, although sometimes you may also hear it being referred to as ‘Mandatory Outpatient Treatment (MOT) or Outpatient Civil Commitment. Even though the names can vary from place to place, the core idea is the same – finding a balance between a patient’s autonomy and much-needed ongoing mental health care.
How Does a Community Treatment Order Work?
The court will evaluate whether the client meets the eligibility criteria for AOT. If they do, the court then orders that the client be committed to the care of a specific state, regional, or local mental health facility. On rare occasions, they may require treatment at a private healthcare facility.
Anyone who has personal contact with the client and is above 18 years of age, can make a referral for an AOT program.² This can include:
Family (parent, spouse, sibling, adult child)- A person with whom the client lives
- Treatment providers
- Parole/probation officer assigned to the client
Are All Patients Eligible for Assisted Outpatient Treatment?
In general, clients must meet the following criteria to become eligible for Assisted Outpatient Treatment:3,4
They should be at least 18 years of age- Suffer from a mental illness
- Be unlikely to survive in the community without supervision based on a clinical evaluation and their condition is deteriorating or without AOT they are likely to experience conditions that could cause grave disability or serious harm to themselves or others.
- Has had a history of non-adherence to treatment for the mental health disorder which has caused:
- Two hospitalizations for mental illness in the preceding 36 months or
- One act of violence towards self or others, or threats of serious physical harm to self or others, within the preceding 48 months
- Has shown unlikeliness to voluntarily engage with recommended outpatient treatment
- Is most likely to benefit from Assisted Outpatient Treatment
How Long Does Assisted Outpatient Treatment Last?
Typically an initial Assisted Outpatient Treatment order can last for up to a year. A psychiatrist will carry out an evaluation before the expiry of the treatment to determine whether a renewal is recommended. The court will then decide whether the treatment should be continued.
What Is Covered Under an Assisted Outpatient Treatment plan?
The exact structure of the treatment plan can vary. In general, expect therapy sessions, medication management, intensive case management support, and sometimes, housing assistance if needed.
Benefits and Risks of Assisted Outpatient Treatment
Assisted Outpatient Treatment is court-ordered to ensure the client’s mental health and well-being and prevent relapses or further deterioration of their mental health. To understand an AOT better, it’s important to make sense of the benefits as well as the potential risks.
Benefits of AOTs
1. Improved Treatment Adherence
Some of the most important beneficiaries of the AOT program are clients who find it challenging to stick to their treatment. The structure and consistent support provided through AOT can help clients establish new patterns of behavior. AOT has been shown to improve both appointment and medication adherence by more than 20% at both the 6-month and 12-month follow-up marks.⁵
2. Reduced Hospitalization Rates
Evidence suggests that Assisted Outpatient Treatment can be profoundly beneficial in reducing the need for hospitalization both during and after the treatment. AOT has been linked to a decrease in hospitalization by as much as 85% and a decrease in days spent in the hospital by 44%.⁶
3. Reduced Incarceration
Because AOT programs focus on providing stable and consistent care, the research suggests that these programs have been effective in reducing arrests by nearly two-thirds in any given month and reducing the chance of being arrested for a violent offense by 88%.
4. Decreased Homelessness
AOT programs are able to connect individuals with housing resources where needed, facilitating stable living situations and significantly reducing rates of homelessness.
5. Cost-Effective Care
Even though the state may need to invest significantly in AOT programs, the clients can find the care cost-effective in that it helps reduce the need for hospitalization or emergency interventions.⁷
6. Improvement in Symptoms and Increased Quality of Life
AOT programs are associated with improvements in symptomatology and patient reports of improved mental health outcomes and feelings of satisfaction in life.
7. Community Integration and Family Support
By providing support while allowing individuals to remain in their communities, AOT helps clients maintain relationships within their social circle and the community at large, and carry out their regular activities and responsibilities.
AOT also benefits families by providing resources to navigate the mental health challenges of their family members more seamlessly and access legal support.
Assisted Outpatient Treatment is court-ordered to ensure the client’s mental health and well-being and prevent relapses or further deterioration of their mental health. To understand an AOT better, it’s important to make sense of the benefits as well as the potential risks.
Risks of AOTs
Some experts have raised potential concerns about AOTs. For example, some people may perceive an AOT as an infringement of their personal freedoms, and so may not view the order as positive or beneficial. Others view AOTs as being vulnerable to potential overreach by the judiciary or treatment providers.
The efficacy of AOTs can also be impacted by the quality and availability of community-based mental healthcare centers, and so the outcomes may vary. Despite the risks, AOT has proven to be an invaluable tool when supported by personalized, high-quality expertise with a recovery-based approach.
Can You Refuse Treatment Under an Assisted Outpatient Treatment Order?
An Assisted Outpatient Treatment program is court-mandated for people with serious mental health disorders who aren’t able to follow through with involuntary treatment plans. In other words, when a court orders an AOT, it has determined after carefully evaluating the evidence, that AOT is the best choice for a client for their personal health and well-being.
In case you have been ordered to comply with AOT, and you believe that it’s the wrong decision, you can challenge the order via the legal process.
How to Challenge a CTO
Challenging a CTO involves filing an appeal with the court to kickstart the process. Consult with your lawyer or public defender for specific information on how the process works in your jurisdiction, and how you can best defend your appeal. You may need to schedule a hearing and ensure you have evidence and expert testimonials to support your appeal.
In case a client doesn’t comply with any part of their treatment plan, even after they’ve discussed the necessity for the same with their treatment provider, they may be ordered into mandatory hospitalization depending on their current mental health evaluation.
Seek Guidance About Assisted Outpatient Treatment Today
If you’re looking for information or support for compliance with your Assisted Outpatient Treatment order, we can help.
At Mission Connection, we provide a safe, supportive, and compassionate community, where you can heal and recover under the expert care of our licensed mental health professionals.
We are able to provide personalized care in compliance with the terms of your AOT order so you can rest assured you’re in the right hands. Our treatment approach includes:
- Personalized Treatment Plans: We align our care approach with court mandates to ensure individuals receive support tailored to their specific requirements.
- Therapy and Counseling: Our sessions are focused on long-term recovery, not just temporary symptom relief, so you can maintain the benefits for longer. Sessions include skills-building and goal-setting, so you can look forward to a life of hope and meaning.
- Medication Management: Our licensed psychiatrist will ensure you’re receiving the right medication for your mental health needs and will continue to update your treatment plan based on your progress.
- Case Management: We have dedicated case managers on hand to ensure you’re taken care of every step of the way, and you have all the resources you need when you need them.
- Flexible Scheduling Options: We offer convenient scheduling options for both in-person and telehealth sessions, giving you a lot of flexibility in terms of booking appointments.
- Clear Documentation and Reporting: We maintain in-depth documentation of all aspects of your care, your participation, and your progress, in compliance with your court order.
What makes Mission Connection different is our commitment to treating you as an individual with a unique story and not just another court mandate. Our goal also is not about simply meeting legal requirements. Our ultimate aim is to support you toward building a life, with meaning and purpose, where you won’t need to rely on AOT orders for your well-being.
Contact us today at 866-602-9619 or visit our ‘get started’ page to schedule your initial assessment. Our intake team is experienced in working with AOT orders and will support you every step of the way.
Allow our compassionate and well-trained professionals to make a positive difference in your mental health journey.
References
- ASPE Office of the Assistant Secretary for Planning and Evaluation. (2024, August 8). Evaluation of the Assisted Outpatient Treatment Grant Program for Individuals with Serious Mental Illness. https://bhsd.santaclaracounty.gov/get-therapy-and-support/learn-about-assisted-outpatient-treatment-aot
- County of Santa Clara Behavioral Health Services. (n.d.). Learn about Assisted Outpatient Treatment (AOT). https://bhsd.santaclaracounty.gov/get-therapy-and-support/learn-about-assisted-outpatient-treatment-aot
- Assisted outpatient treatment – NYC health. (n.d.). Welcome to NYC.gov | City of New York. https://www.nyc.gov/site/doh/health/health-topics/assisted-outpatient-treatment.page
- County of Santa Clara Behavioral Health Services. (n.d.). Learn about Assisted Outpatient Treatment (AOT). https://bhsd.santaclaracounty.gov/get-therapy-and-support/learn-about-assisted-outpatient-treatment-aot
- Critical gaps in assisted outpatient treatment research in the United States. (n.d.). PMC Home. https://pmc.ncbi.nlm.nih.gov/articles/PMC11489247/
- https://aspe.hhs.gov/sites/default/files/documents/80d688432865e71adcb9ca865081cf42/aot-grant-program-smi-outcome-report.pdf
- Swanson JW, Van Dorn RA, Swartz MS, Robbins PC, Steadman HJ, McGuire TG, Monahan J. The cost of assisted outpatient treatment: can it save states money? Am J Psychiatry. 2013 Dec;170(12):1423-32. doi: 10.1176/appi.ajp.2013.12091152. https://pubmed.ncbi.nlm.nih.gov/23896998/
