Stredwick, R. v

A hospital order under Mental Health Act 1983 section 37 is appropriate where the offender’s mental disorder is of a nature or degree requiring hospital treatment, treatment is available, and a hospital order is the most suitable disposal after considering the offence, antecedents and alternatives. A restriction order under section 41 may be imposed without limit of time where it is necessary and proportionate to manage risk and protect the public from serious harm.

A court cannot make a section 45A hospital direction if that disposal was unavailable to the original sentencing court.

In 2008, the appellant pleaded guilty to reckless arson endangering life and received an IPP sentence with a three-year minimum term. Approximately 11 years later, he sought leave to appeal out of time and to adduce fresh psychiatric evidence.

Three psychiatrists concluded that he had paranoid schizophrenia at the time of the offence, that he responded well to hospital treatment, and that a hospital-based disposal would better manage his needs and risk. The Crown did not oppose the appeal. The issue was whether the IPP sentence should be quashed and replaced by a hospital order under the Mental Health Act 1983 section 37 with a section 41 restriction order.

1. Appeal allowed. The court granted leave to appeal out of time and admitted the fresh psychiatric reports. It quashed the IPP sentence and substituted a hospital order under Mental Health Act 1983 section 37, with a restriction order under section 41 without limit of time.

2. The court followed the guidance in R v Vowles [2015] EWCA Crim. 45, [2015] EWCA Civ. 56. The available disposals included a section 37 hospital order and, where available, an IPP or other custodial sentence accompanied by a section 45A hospital direction. Although section 45A should ordinarily be considered first where a hospital order is required, it was not open to this court because it was unavailable when the appellant was sentenced in May 2008.

3. The conditions in section 37(2)(a)(i) were met. The fresh evidence established that the appellant had paranoid schizophrenia at the time of the offence and continued to suffer from it. Its nature and degree made hospital detention for medical treatment appropriate, treatment was available, and his response to Clozapine had materially reduced the risk to himself and others.

4. The court also held that section 37(2)(b) was satisfied. Although reckless arson was serious, there was no realistic alternative that would provide the treatment and support required while reducing risk. A section 41 restriction order without limit of time was necessary and proportionate to manage his mental health and risks and to protect the public.

• Court of Appeal (Criminal Division): Allowed the appeal, quashed the IPP sentence, and substituted a hospital order under the Mental Health Act 1983 section 37 with a section 41 restriction order without limit of time: [2020] EWCA Crim 650.
• Crown Court: The appellant pleaded guilty to reckless arson endangering life on 14 February 2008 and, on 14 May 2008, received an IPP sentence with a three-year minimum term less time on remand.