In most cases, involuntary patient are discharged from Approved Treatment Centres back into the community before the 45 day period is up. Most patients respond to treatment quite quickly or alternatively change their view about the need for the treatment and accept it voluntarily. 'Voluntary' means that the patient has been given information about the treatment, its benefits, risks, discomforts (including side-effects) and any reasonably available alternatives to the treatment and the patient chooses to accept the treatment without unfair pressure or influence.

However, if the doctors believe the person should continue to be detained and treated after the first 45 days, an application can be made to the Guardianship Board for a Continuing Detention Order [Mental Health Act 1993 s 13]. A Continuing Detention Order can only be made where the following factors are present:

An application for a Continuing Detention Order can only be made by the Public Advocate or authorised people from the Approved Treatment Centre.

A Continuing Detention Order lasts for a maximum period of twelve months or such lesser period as the Board determines, after which the order automatically expires unless a further application to the Board is made and a further Continuing Detention Order is made.

During a period of detention under a Continuing Detention Order the patient cannot be treated for her or his mental illness unless the Guardianship Board has authorised such treatment.[Mental Health Act 1993 s.19] Exceptions to this limitation are urgent treatments needed for the protection of the patient or other people where it is not practicable to obtain the Board's authority. Because the Guardianship Board is available 24 hours a day all year round it is unlikely it will be impractical to seek authorisation from the Board. A medical practitioner or the Director of the Approved Treatment Centre can only make applications for treatment under a Continuing Detention Order on a form available from the Board.