Care, Education, and Treatment Reviews and the Dynamic Support Register: A Guide for Families & Individuals
Last updated: May 2026. This content is reviewed in line with NHS guidance.
If you or someone you support is in crisis, please contact 111 (option 2 for mental health), your local crisis team, or Samaritans on 116 123.
Navigating the mental health system can be overwhelming, especially when you or someone you care about is autistic or has a learning disability. You might have heard professionals mention acronyms like "C(E)TR" or the "DSR", but it is not always clear what these mean in practice. This guide breaks down what these terms mean, who they are for and how they can help ensure you or your loved one gets the right support.
I have been involved in hundreds of Care, Education, and Treatment Reviews (CETRs) as a panel member. That means I have been into many long-stay hospitals across the UK and supported families and patients within the community. I have personally seen how being on the Dynamic Support Register (DSR) and having a CETR can help an individual receive the support they need.
What is the Dynamic Support Register (DSR)?
The DSR is a list, held locally by the NHS, of autistic people and people with a learning disability who may be at risk of needing hospital care for their mental health. When a person agrees to be on the DSR, their risk is assessed and recorded to help keep them safe. The professionals involved in their care are recorded so that, if there is an escalation or hospital admission, they can be quickly brought into a meeting to discuss the person's needs and how to transition them safely back into the community. It can also bring in a key worker if they are a child or young person 18 (or up to the age of 25 if they have an education and healthcare plan).
Rather than an admission to a hospital happening and then professionals scrambling to find out:
Which school does this person attend?
Who is this person's occupational therapist?
Who is this person's psychologist or psychiatrist?
Who is the commissioner?
Who is their social worker?
Who is their care coordinator?
How do we find them? How do we get that detail quickly to avoid delays? It's all written down in a system, so we can get in contact sooner. We can find out what led to this crisis and what we can do to best support them. If they're a child, a key worker can be a vital professional who can make sure that things get coordinated across different services so that actions actually happen. Lastly, it can mandate a CETR where autism and learning disability professionals come in to review the person's care and make sure it is appropriate for their autism and learning disability.
How does the DSR label admission risk?
It uses four colour-coded categories to show the level of risk:
Blue - the person is currently in hospital.
Red - the person is very likely to need hospital care soon.
Amber - the person is at risk of a hospital stay if they do not receive support quickly.
Green - the person's risk is being managed well at home.
C(E)TRs records are stored on the DSR so the team supporting someone can see action plans and any interventions to date.
How to get on the DSR
You should be able to self-refer onto the DSR as the person themselves or a family member via your local authority's Local Offer website if they are a child (simply google your area followed by ‘local offer’), and from your local authority's website if they are an adult. That is the law. However, we know that as of 2026, self-referral processes are not listed consistently across the country. You can also be referred by a professional. Someone who works with the person or their family members may recommend they go on the DSR to help manage their risk.
What is a C(E)TR?
A Care (Education) and Treatment Review - usually shortened to C(E)TR - is a meeting held for an autistic person or someone with a learning disability who is in hospital, or at risk of being admitted to hospital, for their mental health.
A C(E)TR is there to check that the person is safe, that the care they are getting is right for them, that there are good plans in place for the future, and that any problems with their health, safety or care are sorted out. The goal is to create a plan to avoid a hospital stay, or to reduce the length of a stay if they are already admitted, by ensuring decisions are based on the individual's specific needs.
The meeting brings together the person, the people who support them, the professionals delivering their care, and an independent panel. This panel always includes a clinician, an expert by experience, and a chairperson.
A C(E)TR is for children and young people, which is why professionals involved in their educational needs also attend. For adults, the meeting is called a Care Treatment Review (CTR) and does not include the educational component.
When is a C(E)TR triggered?
The offer of a C(E)TR is required if an inpatient admission has occurred or is very likely. They are also used in the community to prevent an admission, to ensure an admission to hospital is genuinely necessary and has a good plan, or after hospital admissions (followed up according to specific time scales set out in NHS policy). If someone is not thought to be at risk of hospitalisation, they will not need a C(E)TR unless their risk level changes.
How to request a C(E)TR
A C(E)TR can be requested by the person themselves, a parent or carer, or a professional involved in their care (such as an advocate, hospital care team, or social worker). An individual will only have one if their risk indicates it would benefit them.
A C(E)TR only goes ahead with the person's consent. The person and their family can be present to talk through their needs. If the person wants a C(E)TR but cannot attend, a pre-approved professional can advocate for them in the meeting instead.
If the individual is unable to provide consent, someone who is nominated to make decisions in their best interest may be able to give consent on their behalf. A child under the age of 16 can consent to their own treatment if they're believed to have enough competence and understanding to fully appreciate what's involved in their treatment.
Requests can be made through lead professionals involved in the person's care, such as social workers, SEN Keyworkers, or a care co-ordinator/Lead worker. The professional will then contact the commissioner to raise the request.
What happens after the meeting?
After the meeting, copies of the C(E)TR action plan are provided to everyone who attended and to any other relevant teams involved in someone's care. They are also added to the person's DSR records. The person can request a copy of the C(E)TR even if they were not present for the meeting.
If you’d like to know more about your or your child’s rights when being supported through these processes we’ve put together some useful resources including our guide to the Mental Capacity Act, your Human Rights and the Equality Act.
A Note from Neurodiverse Training
At Neurodiverse Training, we know that navigating systems like the DSR and C(E)TR process can feel daunting. As a neurodivergent-led team, we believe that understanding your rights and the tools available to you is a crucial part of advocacy. We hope this guide provides some clarity.
If you are a professional looking to better understand how to support autistic individuals and people with learning disabilities, we offer specific training on this topic - our Inpatient Services and Reducing Harm course.
Our team has deep expertise in this area - multiple members of our team work as chairs, clinical experts, and experts by experience on C(E)TR programmes. We have also worked on national DSR and C(E)TR guidance, legislation, and training.
Explore our training courses or contact us to see how we can help your team.
Glossary of Terms:
- CAMHS: Child and Adolescent Mental Health Service.
- CTR / C(E)TR: Care Treatment Review (for adults) / Care, Education and Treatment Review (for children and young people).
- DSR: Dynamic Support Register.
- EHCP: Education, Health and Care Plan - a legally binding document that shows the needs of a child or young person whilst they are in education (up to age 25).
- IAS: Information and Advice Service - a statutory service providing information and advice to children, young people and their families.
Admission Avoidance Documents by Area:
- Dorset
- Cornwall & Isles of Scilly
- Bristol, North Somerset, and South Gloucestershire
- Gloucestershire
- BANES, Swindon and Wiltshire
- Devon
- Somerset
- Bournemouth, Christchurch and Poole
Useful Links and Resources:
- CETR Explainer Video
- DSR Explainer Video
- A Family Survival Guide
- Ask Listen Do - Information and resources for people with a learning disability, autistic people, families and paid carers.
- Autism Keyworker Pilot - As of 2020, the key worker is a pilot, although there should be key workers in all areas by 2023.
- Contact - A national charity offering advice, information and support on all issues relevant to parent carers of children with additional needs.
- Healthwatch - An independent organisation that feeds back on health and social care commissioned services.
Working within learning disability and autism services? Our e-learning (each with a certificate of CPD hours) equips teams to understand the people behind the process. Mental Health in Autistic Young People is a strong starting point for clinical and support staff.
Training a service or team? See team licences →