Safi, R. v

There is no fixed period after which a psychiatric report cannot support a hospital order under the Mental Health Act 1983. Whether earlier medical evidence remains sufficiently current depends on the facts, including evidence of any change in the offender’s condition.

Detention for medical treatment may be appropriate where continued medication is essential and there is reliable evidence that discharge would lead to non-compliance. A restriction order may be necessary to protect the public from serious harm even where prior sexual offending was physically limited. Serious psychological injury to vulnerable victims, and the risk that psychotic delusions may lead to more serious conduct, are material to that assessment.

The appellant had pleaded guilty to exposure and was committed for sentence. He was already subject to a hospital order following a separate offence of indecent assault. At the Crown Court, Judge Matheson QC made a fresh hospital order and added an unlimited restriction order under the Mental Health Act 1983.

The appellant appealed against sentence. He contended that the earlier psychiatric reports were too old to satisfy the requirement for two approved medical opinions, that hospital detention for treatment had not been justified, and that his offending did not create a risk of serious harm sufficient to warrant a restriction order.

The appeal therefore concerned the sufficiency and currency of psychiatric evidence, the need for hospital treatment, and the statutory public-protection threshold for an unlimited restriction order.

Decision

1. The appeal was dismissed. The Crown Court was entitled to make the fresh hospital order and to couple it with an unlimited restriction order.

2. Section 37(2)(a) of the Mental Health Act 1983 did not impose a fixed rule governing the age of psychiatric reports. The issue was fact-sensitive. Although there had been a significant interval since the reports of two earlier doctors, the judge could rely on the current evidence of Dr Etaluku and at least one earlier report. The appellant remained detained under a hospital order, and there was evidence that the nature of his condition had not changed.

3. The treatment condition for a hospital order was met. The appellant’s medication was an important part of treatment, and Dr Etaluku’s evidence was that discharge would lead him to stop taking it. Detention in hospital for medical treatment was therefore appropriate.

4. The restriction order met the test in section 41(1). Sexual offending which is relatively minor physically may nevertheless cause severe psychological injury. The court referred to Bowler (1994) 15 Cr.App.R (S) 78 as illustrating the need to protect vulnerable victims. More importantly, the appellant’s continuing psychosis, delusional beliefs concerning women, and lack of appreciation of his past conduct created a real risk that his future conduct could exceed the level of the offences already committed. There was thus a real risk of serious harm.

5. The later improvement in the appellant’s condition did not undermine the validity of the order when made. If future compliance with medication and avoidance of recreational drugs removed the risk, that matter could inform discharge decisions. It was not a reason for the appellate court to set aside the restriction order.

• Court of Appeal (Criminal Division) Dismissed the appeal against the fresh hospital order and unlimited restriction order.

• Crown Court at Middlesex Guildhall On 13 October 2005, Judge Matheson QC made a fresh hospital order and an unlimited restriction order under the Mental Health Act 1983.

• Horseferry Road Magistrates’ Court On 5 July 2005, committed the appellant to the Crown Court for sentence after his guilty plea to exposure.