Turning compassion into practice: How can we make community treatment requirements work for those in the revolving door?
“Addiction isn’t a choice. It’s a disease. People need trust, not punishment.”
— L*, Revolving Doors lived experience member
On 29 October 2025, Revolving Doors convened the fourth of our Beyond the Cycle roundtables. Held in the Jubilee Room of the House of Commons and chaired by Professor Dame Carol Black, the event brought together people with lived experience, policymakers, academics (including Mental Health Treatment Requirement Evaluation author Matthew Callender) and senior leaders across health and justice to discuss how to make Community Treatment Requirements (CTRs) work for people in the revolving door.
Community Treatment Requirements encompass Mental Health, Drug Rehabilitation, and Alcohol Treatment Requirements (MHTRs, DRRs and ATRs), aiming to reduce the likelihood of reoffending by supporting people with the root causes of their behaviour. However, the use of Community Treatment Requirements has declined by around 50% over recent years, with sentencers lacking information about CTRs and losing confidence in the real value they offer.
“Treatment needs to be personal, not procedural.”
The roundtable began with insights from two members of Revolving Doors’ lived experience team.
M* shared her experience of a Mental Health Treatment Requirement (MHTR). She described it as “surface-level”, and more a compliance exercise than genuine care. Her story illustrated a recurring theme across the justice system: short-term, clinical treatment, detached from people’s real lives. She called for trauma-informed support, properly trained staff and consistent therapy that treats people as individuals, not cases.
L*, who had completed both a Drug Treatment and Testing Order and its modern equivalent, a Drug Treatment Requirement, spoke about the vital importance of continuity, and the difference made by having one trusted worker:
“Every time a worker changes, you have to start again. You lose trust, and you lose progress.”
Both L* and M* emphasised the same thing: that recovery is contingent on relationships and consistency, not compliance and punishment.
Breaking down barriers
“Addiction and mental health issues are chronic conditions. People need sustained, integrated care — not fragmented projects.”
“We’re still piloting the same ideas we know already work, we just haven’t funded them properly yet.”
Dame Carol Black challenged the false divide between mental health and substance use treatment, describing it as a “structural blind spot” that prevents holistic recovery.
She outlined a “fidelity model” of care. This is best described as ‘one person, one worker, one journey’, and requires trust and accountability running through every stage, from court to community.
Participants from across Probation, NHS England, HM Prison and Probation Service, the Department for Health and Social Care, and the voluntary sector echoed this. The barriers are well known:
- Fragmented and short-term funding
- Over-reliance on performance metrics
- Limited understanding of treatment among sentencers
- Lack of national standards for trauma-informed work.
Joining up health and justice
A strong theme throughout the roundtable was the urgent need for joint commissioning between health, justice and local authorities.
Despite clear evidence that around 80% of people with drug dependence also experience mental ill-health, combined orders (for example, MHTR plus DRR) remain rare and poorly coordinated. Successful examples were shared where both orders were commissioned through the same provider, creating smoother journeys and better outcomes.
Those at the roundtable also highlighted how valuable peer-led recovery communities can be, serving as the missing link between treatment and long-term support.
“Signposting isn’t enough. People need someone who walks with them.”
Mental Health Treatment Requirements (MHTRs)
Participants agreed that while Community Treatment Requirements have strong potential to address the root causes of offending, they can only succeed within a system designed around continuity and trust.
Short-term pilots and fragmented commissioning can mean that people begin to make progress only for support to fall away when funding ends.
Primary MHTRs tend not to be offered to those with recent histories of suicide attempts or psychosis. But often those with these issues are not deemed suitable for a secondary MHTR. Similarly, the 12 sessions of therapy, typically offered to those on a primary MHTR are often inadequate to meet the needs to those with complicated histories of trauma – but again they are not seen as suitable for a secondary MHTR.
Expanding access to secondary MHTRs would open up more opportunities for meaningful, sustained recovery. However, this is currently hindered by structural barriers, particularly the reluctance of some psychiatrists to deliver treatment under court direction. Overcoming these systemic obstacles requires joint leadership from health and justice, underpinned by stable, multi-year funding and a shared commitment to person-centred care.
A shared commitment to change
The roundtable produced a shared set of priorities for reforming Community Treatment Requirements:
- Personalised, trauma-informed care at the heart of every order
- Continuity of worker with one key relationship, not a revolving door of staff
- Long-term, sustainable funding, not annual cycles
- Joint commissioning across health, justice, and local government
- Early intervention at the point of sentencing
- National standards for trauma-informed and therapeutic practice
- Lived experience embedded in defining success.
Looking ahead
Our roundtable series has shown the value of bringing together people with lived experience sit at the same table as policymakers and practitioners. The message is clear: we cannot punish our way out of offending driven by substance use or mental ill-health.
The next phase of this work will focus on translating these insights into practice, building models of community treatment that reflect the realities and complexities of recovery and where treatment is the foundation of change, not an afterthought.
