On New Year’s Eve 2018, a man seriously assaulted a number of people at Manchester Victoria railway station – including one of the police officers who arrested him shortly after the attack began. I remember blogging about the incident, frustrated at the immediate calls for his extra-judicial murder and frustrate that many suggested that he’d “play the mental health card” or that him being ‘sectioned’ under the Mental Health Act was some kind of ‘easy way out’. We often see these things in cases of serious crime involving someone affected by their mental health. All normal so far.

Mahdi Mohamud was sentenced to life imprisonment today, with a recommendation from the judge that he serve a minimum of 11yrs. In addition, the judge imposed a so-called ‘hybrid order’ under s45A of the Mental Health Act 1983, which means that Mohamud will be detained in a psychiatric hospital in the first instance and this short post just seeks to explain what s45A does in practice, in the context of this particular case. In addition, I’d also like to do an element of “I told you so” because Mohamud has been fully convicted of a serious criminal offence and sentenced to imprisonment by a court. This demonstrates very obviously how suggestions of a ‘mental health card’ were premature; how such arguments were ignorant to start with; and it also shows that there is no ‘easy way out’ after a serious offence.

HYBRID ORDERS

Detention in hospital under s45A is something which can only happen after someone is convicted of an offence – it simply means: you’re guilty of something, but you’re also ill and you need hospital treatment before you can serve your sentence in prison. So this means, you go to hospital and if your treatment is complete before your sentence expires, you are then transferred to prison; but if you’re not fit for discharge, medically speaking, then you remain in hospital for treatment and are released once doctors authorise it.  Can seem complicated, but the idea here is this:  no-one convicted of a serious offence and found guilty of it should spend less time detained than someone who is / was not mentally ill.  Hence, if your hospitalisation is shorter than the sentence, you complete your ‘time’ with a spell in prison.

Use of these hybrid orders seems to be on the rise – they have existed on the statute book for years, but I’ve found myself mentioning them on social media or blogging like this, much more often in recent times.  When I first started blogging, it took about two years for a case to come to light that would highlight an example of it being used.

Being clear: you cannot be made subject to an order under s45A of the Act, unless you were criminally convicted after a court found you fully culpable or you pleaded guilty – that means guilty beyond all reasonable doubt of attempted murder. The court were not asked to consider the question of insanity – this is the idea that his mental illness entirely explained his actions. The judge remarked that it had no doubt contributed, including by disinhibiting him, but that he bore substantial culpability for his actions. This obviously came after the opportunity for a trail process in which Mr Mohamud could have pleaded not guilty to these offences, arguing that he was legally insane. (Insanity means that someone “did not know what they were doing or did not know what they were doing was wrong”, by virtue of a mental illness.) In fact, Mr Mohamud pleaded guilty to the charges after legal advice and psychiatric reports.

You may remember that he was ‘sectioned’ under the Mental Health Act the day after the attack – initially being admitted to hospital under a ‘civil’ section of the Act for assessment and treatment of his condition. He remained in hospital after he was charged with the offences and was then detained under the ‘criminal’ part of the MHA pending trial. This allows for full psychiatric reports to be produced, to assist the court and which influence how defence counsel structure their legal advice.

He pleaded guilty to the offences and is now stands convicted of them.

WHAT DOES THIS ALL MEAN?

Madhi Mohamud will continue to be detained in a psychiatric unit, for treatment of his mental illness – detention under a provision not yet used for him, because until yesterday, he wasn’t a sentenced criminal, he was on remand in a hospital.  He has been in a psychiatric unit since the day after the attack, under various pre-sentence provisions in Part III of the Act.  His father is reported to have written to the court, arguing that his son simply would not have committed the offences but for his illness – Mohamud himself obviously didn’t think this, because he didn’t argue legal insanity and pleaded guilty. So he has been sentenced to life imprisonment with a minimum recommendation that he serve 11 years in jail. This kind of sentence is normal where a life sentence is given out – a minimum tariff is applied before which release cannot be considered. The difference in this case, is the additional imposition of a s45A hybrid order, because of the ongoing need for treatment.

• If Mr Mohamud’s treatment in hospital takes less than 11yrs –
• He will be transferred on discharge to the prison system and serve the remainder of his time in jail.
• Even at 11yrs, he will then only be considered for release by the Parole Board who could chose to deny that release and he remains in jail – remember: it’s a LIFE sentence and the 11yrs was a ‘minimum’ recommendation.

• If Mr Mohamud’s treatment in hospital takes more than 11yrs (such things have been known) –
• Because this is a life-sentence case, he would remain in hospital beyond the 11yrs point, continuing to receive treatment for his mental health condition and no consideration will be given to his release until he is fit for discharge.
• Had he just been sentenced to 11yrs in prison, then he would have remained in hospital for treatment until fit for discharge, and been released from hospital in the normal way, his criminal sentence having already expired.

I hope that makes sense!

So this case serves to reminds us again – as do many, many others: being so seriously unwell because of a mental illness does that you require immediate admission to hospital under the Mental Health Act does not always mean you evade criminal liability for your actions. Some patients do, because they are legally insane, whilst others do not – if you’re interested in the insanity argument in practice, follow the current trial in Exeter of Alexander Lewis-Ranwell who is charged with murdering three elderly men. His defence is arguing that he was insane at the time and some doctors giving evidence support that view.

This is why it is never worth shouting with confidence the day after an incident about ‘playing the mental health card’ – Mr Mohamud was unwell, he remains unwell but he pleaded guilty to offences notwithstanding and will be detained for a long time as a convicted criminal.

Winner of the President’s Medal,
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award

All opinions expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2019

I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current.  Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.

Government legislation website – http://www.legislation.gov.uk