MHA 1983 s45A

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Mental Health Act 1983
(as amended)

Law as at 19/11/11 unless otherwise stated under "Amendments" heading

Part III contents

35, 36, 37, 38, 39, 39A, 40, 41, 42, 43, 44, 45, 45A, 45B, 46, 47, 48, 49, 50, 51, 52, 53, 54, 54A, 55

All Parts

I, II, III, IV, 4A, V, VI, VIII, IX, X, Schedules


See also:

Changes made by Mental Health Act 2007

Related cases

Any cases with a hyperlink to this legislation will automatically be added here. There may be other relevant cases without a hyperlink, so please check the mental health case law page.

  • AG's ref (no 54 of 2011) [2011] EWCA Crim 2276 — (1) The restricted hospital order was quashed and a six-year IPP imposed. The judge had failed to take into account the differences between the two regimes: (a) release on licence from IPP depends on lack of danger for any reason, whereas release from hospital order depends on lack of danger for medical reasons only; (b) an IPP licence can be revoked for danger resulting from crime, whereas a conditional discharge can only be revoked if the medical condition relapses. It was essential in this case that the power to recall upon criminal relapse was available. (2) The s45A hybrid order regime would have been perfect in this case, but it is only available to those subject to imprisonment; however, the defendant was under 21 and imprisonment is only available to those 21 or over (the court recommended that this be reconsidered). (3) The notional determinate term of 12 years was not unduly lenient. (4) The hearing was adjourned in order to allow for an immediate s47 transfer ..→
  • AG's reference (no 91 of 2014) sub nom R v Joseph Williams [2014] MHLO 137 (CA) — The trial judge had imposed a sentence of 14 years' imprisonment, together with with a s45A hospital order and limitation direction, on an offender (W) who had pleaded guilty to attempted murder. Following an AG's reference the Court of Appeal held that: (1) The appropriate range was 17-25 years, the starting point was 20 years after a trial, and the judge was not at fault for reducing the sentence by six years given the unusual facts of the case that related to W's mental health. (2) It was not certain that the offence was motivated by antipathy to V's sexual orientation; it could equally have been the case that W did not want to share his flat with anyone. (3) As the judge considered that W's dangerousness was not confined to his mental illness, he should have passed an extended sentence to protect the public in the event that the criteria for the hospital order and restrictions were no longer satisfied, but the offender remained a risk to the public. (4) An extended period of ..→
  • R v Ahmed [2012] EWCA Crim 99, [2012] MHLO 178 — (1) The appellant sought a s37/41 restricted hospital order in place of an IPP sentence. (2) The Responsible Clinician argued for a s45A hybrid order, for reasons summarised by the court as follows: 'The appellant is an illegal immigrant. In order to be discharged from hospital he would have to undergo a period of controlled supervision. This would be in appropriate accommodation. Dr Swinton tells us that this is not an option open to an illegal immigrant like the appellant. Thus he cannot be discharged into the community because he cannot undertake the necessary conditioning which would satisfy the hospital that he was safe to be left in the community on his own. As a consequence he has to remain in hospital and he will take up a bed, apparently permanently. This is damaging to the wider public interest. If a section 45A order were made, then although the appellant would receive precisely the same treatment under a section 47 transfer as he currently does, a discharge can ..→
  • R v Anderson (Darren Gabriel) [2013] EWCA Crim 2212, [2013] MHLO 134 — Appellant sought restricted hospital order, in place of IPP and s45A hybrid order, but was unsuccessful.
  • R v Fort [2013] EWCA Crim 2332, [2013] MHLO 111 — (1) The sentencing judge erred in concluding that the appellant would continue to pose a significant risk of serious harm to members of the public occasioned by the commission of serious offences, even if his mental disorder were to be cured or substantially alleviated, and therefore erred in imposing a sentence of custody for life as opposed to a s37/41 hospital order. (2) The judge's order under s45A was unlawful, because such an order could not be made on someone who was under 21 at the time of conviction (and was thus being considered for a sentence of custody for life, as opposed to a sentence of imprisonment, as would be the case on a person over 21 at the date of conviction).
  • R v House [2007] EWCA Crim 2559 — (1) The judge was plainly right to pass the sentence of two concurrent life sentences with a s45A order; (2) a minimum term should be specified unless the punitive and retributive element required detention for life and, on the facts, a 9-year minimum term would be set.
  • R v Jenkin [2012] EWCA Crim 2557, [2012] MHLO 141 — Having pleaded guilty to GBH with intent (for gouging his girlfriend's eyes out), the appellant was sentenced to life imprisonment with a six-year minimum term, combined with a hospital direction and limitation direction under s45A MHA 1983. He appealed against sentence, arguing for a restricted hospital order or alternatively an IPP sentence. (1) A hospital order means that 'release is dependent on the responsible authority being satisfied that the defendant no longer presents any danger which arises from his medical condition': this would be inadequate as, irrespective of his delusional disorder, the appellant posed a significant risk of serious harm to the public. (2) A life sentence should be reserved for those cases where the culpability of the offender is particularly high or the offence itself particularly grave (R v Kehoe): both those limbs were met in this case. (3) The s45A hybrid order was appropriate as the criteria were met and the disorder was treatable, but when ..→
  • R v M [2014] EWCA Crim 1641, [2014] MHLO 143 — "The Advice on Appeal submitted on behalf of the applicant contains two grounds: first, that the judge was wrong in principle to make a s45A hospital and limitation direction when the conditions for making a restriction order under section 41 were not met; and second, that a section 37 order was the appropriate order. Those orders and directions refer to the provisions of the Mental Health Act 1983, as amended by the Mental Health Act 2007. The Registrar has also referred the making of the Victim Surcharge Order to the full court on two separate issues."

Cases from the new database whose pages contain a link to this page:

Case Sentence Summary
R v Fisher [2019] EWCA Crim 1066 Summary of MH sentencing guidance - life sentence replaced with s37/41 Having summarised the Sentencing Council's Definitive Guideline for Manslaughter (in force 1/11/18) and the relevant available disposals under the MHA, the Court of Appeal revoked sentences of imprisonment and replaced the life sentence with a s37/41 restricted hospital order.

See also

[The chapter/paragraph numbers which appear below (if any) refer to the 2008 versions of the Code of Practice and Reference Guide.]


Power of higher courts to direct hospital admission

45A.[1]—(1) This section applies where, in the case of a person convicted before the Crown Court of an offence the sentence for which is not fixed by law—

(a) the conditions mentioned in subsection (2) below are fulfilled; and
(b) [...][2] the court considers making a hospital order in respect of him before deciding to impose a sentence of imprisonment ("the relevant sentence") in respect of the offence.

(2) The conditions referred to in subsection (1) above are that the court is satisfied, on the written or oral evidence of two registered medical practitioners—

(a) that the offender is suffering from [mental disorder];[3]
(b) that the mental disorder from which the offender is suffering is of a nature or degree which makes it appropriate for him to be detained in a hospital for medical treatment; and
[(c) that appropriate medical treatment is available for him.][3]

(3) The court may give both of the following directions, namely—

(a) a direction that, instead of being removed to and detained in a prison, the offender be removed to and detained in such hospital as may be specified in the direction (in this Act referred to as a "hospital direction"); and
(b) a direction that the offender be subject to the special restrictions set out in section 41 above (in this Act referred to as a "limitation direction").

(4) A hospital direction and a limitation direction shall not be given in relation to an offender unless at least one of the medical practitioners whose evidence is taken into account by the court under subsection (2) above has given evidence orally before the court.

(5) A hospital direction and a limitation direction shall not be given in relation to an offender unless the court is satisfied on the written or oral evidence of the [approved clinician who would have overall responsibility for his case],[3] or of some other person representing the managers of the hospital that arrangements have been made-

(a) for his admission to that hospital; and
(b) for his admission to it within the period of 28 days beginning with the day of the giving of such directions;

and the court may, pending his admission within that period, give such directions as it thinks fit for his conveyance to and detention in a place of safety.

(6) If within the said period of 28 days it appears to the Secretary of State that by reason of an emergency or other special circumstances it is not practicable for the patient to be received into the hospital specified in the hospital direction, he may give instructions for the admission of the patient to such other hospital as appears to be appropriate instead of the hospital so specified.

(7) Where such instructions are given—

(a) the Secretary of State shall cause the person having the custody of the patient to be informed, and
(b) the hospital direction shall have effect as if the hospital specified in the instructions were substituted for the hospital specified in the hospital direction.

(8) Section 38(1) and (5) and section 39 above shall have effect as if any reference to the making of a hospital order included a reference to the giving of a hospital direction and a limitation direction.

(9) A hospital direction and a limitation direction given in relation to an offender shall have effect not only as regards the relevant sentence but also (so far as applicable) as regards any other sentence of imprisonment imposed on the same or a previous occasion.

(10)-(11) [...][3]


  1. Crime (Sentences) Act 1997
  2. Criminal Justice Act 2003
  3. 3.0 3.1 3.2 3.3 Mental Health Act 2007 s1 & sch 1, s4, s10, s55 & sch 11; Mental Health Act 2007 (Commencement No.7 and Transitional Provisions) Order 2008 wef 3/11/08 Cite error: Invalid <ref> tag; name "MHA" defined multiple times with different content