R v Alfie Turner

Where a sentencing court is considering a hospital disposal for manslaughter by reason of diminished responsibility, it must first consider whether a Mental Health Act 1983 section 45A hospital limitation direction is appropriate. A section 37 hospital order follows only if it is not. The penal element, the gravity of the offence, dangerousness and the release regime must all be weighed; release arrangements are not decisive alone. The judge must consider the whole evidence and is not bound by psychiatric opinion. Severe mental illness, even if causative, does not necessarily eliminate responsibility. A medium assessment of retained responsibility and a discretionary life sentence with a minimum term will stand where the judge has balanced the medical and factual evidence and the sentence is not manifestly excessive.

This was an appeal against sentence. The appellant had pleaded guilty in the Crown Court at Basildon to manslaughter by reason of diminished responsibility and two counts of possessing an article with a blade or point. The judge imposed a discretionary life sentence with a hospital direction and limitation direction under section 45A of the Mental Health Act 1983, with a minimum term stated as eight years less 304 days, and concurrent nine-month sentences for the weapons offences.

The appellant argued that the judge should instead have made a hospital order under sections 37 and 41, or alternatively that the minimum term was manifestly excessive. The central issues were the proper choice between a hybrid order and a restricted hospital order, and the assessment of retained responsibility.

The appeal was dismissed. The sentence remained a discretionary life sentence, not a determinate sentence. The minimum term was properly understood as seven years and 61 days after credit for time spent on remand; release was not guaranteed.

1. At step 4 of the manslaughter guideline, where a hospital disposal may be appropriate, the court must consider the available options in sequence. Under section 45A(1) of the Mental Health Act 1983, it must first consider whether the mental disorder can appropriately be dealt with by a hospital limitation direction. If that is inappropriate, it must then consider, having regard to section 37(2)(b), whether a hospital order is the most suitable disposal.
2. Following Vowles [2015] EWCA Crim 45 and Edwards [2018] EWCA Crim 595, the penal element of sentence remains important. The graver the offence and the greater the risk to the public on release, the greater the emphasis to be placed on public protection and the release regime. Release arrangements are relevant but are not the only factor, and sound reasons are required before departing from the usual course of a disposal with a penal element.
3. The sentencing judge had to consider all the evidence and was not bound by psychiatric opinion. The judge was entitled to conclude that a hybrid order better addressed treatment, recall and wider public protection, notwithstanding that all experts considered the statutory criteria for a restricted hospital order satisfied.
4. The fact that the offence would not have occurred but for mental illness did not necessarily absolve the appellant of responsibility. The judge was entitled to assess retained responsibility as medium, having regard to the appellant’s preparation, weapons, targeted and calm attack, attempts to reload the crossbow, and misleading post-offence accounts. The resulting starting point and minimum term were not manifestly excessive.

The observation in Ahmed [2016] EWCA Crim 670 that hospital-order release arrangements might provide greater public protection was not a general rule. The assessment remained fact-sensitive.

• Court of Appeal (Criminal Division): appeal against sentence dismissed; the discretionary life sentence and minimum term were upheld. [2025] EWCA Crim 1867.
• Crown Court at Basildon: the appellant pleaded guilty to manslaughter by reason of diminished responsibility and two bladed-article offences. A discretionary life sentence with a section 45A hospital and limitation direction was imposed, with a minimum term and concurrent sentences for the weapons offences.