Hospital and Limitation Directions under section 45A of the Mental Health 1983, as amended in 2007, are commonly known as hybrid orders. Using this order, a judge can mandate that a convicted offender has hospital treatment whilst also giving a custodial sentence. Once treatment in hospital is completed, the offender can be transferred back to prison to complete their sentence.
For more information on hospital orders, please click here: Hospital Orders
What is needed in an expert report for a hybrid order to be given?
As with other hospital orders, expert evidence should focus on the defendant’s mental disorder, the nature and degree of this disorder, and appropriate treatment. Experts may give an opinion on which hospital order would be most appropriate. However, medical experts should bear in mind that hybrid orders also consider the need for a penal element of a sentence which is ultimately a matter for the court to decide.
Other considerations with hybrid orders
As Judge Bevan stated in his sentencing remarks in the case of R v Edwards, “I am conscious that a hybrid order creates immediately an internal tension because… a section 37/41 order is non-punitive, whereas a hybrid order is partially custodial”. Although medical experts are not expected to comment on the need for a penal element of a sentence, it should be noted that courts often heavily rely on medical evidence in such cases, particularly where the situation is complex or nuanced. This will also determine the manner of follow-up a patient receives; under a section 37/41 hospital order monitoring and support in the community will be provided by mental health services, whereas following release from a hybrid order this is ultimately a matter for probation.
How does a hybrid order end?
Unlike other hospital orders, a hybrid order is time-limited as mandated at sentencing. If the offender is still in hospital following a successful parole hearing or the end of the sentence, the section will be treated as a notional section 37 Mental Health Act as amended 2007, and can therefore end by first-tier mental health tribunal or discharge by the Responsible Clinician.
Leave from the hospital can only be given with permission from the Secretary of State and is unlikely to be given until the patient is nearing discharge.
This blog has been written by Dr Alexandra Blackman, Consultant Forensic Psychiatrist.