An unusual criminal case has recently featured in the Court of Appeal which I thought was worth noting. In 2006, Paul Crerand was sentenced to life imprisonment after a brutal attack with a hammer on an elderly victim. It was noted at the point of sentencing, he had previously been convicted for several violent offences, including arson where a petrol bomb was thrown and where boiling water containing sugar was used to attack another prisoner whilst he was in prison for arson, leading to a further and longer sentence. As such, when he was convicted of assault with intent to cause grievous bodily harm, he was sentenced in 2006 to life imprisonment with a minimum period of two years and eight months.
The full appeal judgment is available to read and it does contain detail I won’t be covering in this post.
NEW PSYCHIATRIC EVIDENCE
The appeal offered up medical evidence not available to be made known to the original trial judge. The Court of Appeal went out of its way not to criticise the original judge or the sentence imposed because the defendant had been unwilling to undergo medical assessment. Some mental health considerations had featured at the time, but refusal to engage meant it wasn’t able to be given the necessary weight. Whilst imprisoned, the appellant was transferred (under s47 MHA) to Ashworth Hospital, one of four high security hospitals in the UK and has now been in receipt of treatment for a prolonged period following the concerns and assessment done in prison. As a result of this, an appeal against sentence was heard with new medical evidence for a number of reasons.
The judgment covers the timeline of offences before conviction in 2006, as well as the timeline of how concerns about his mental illness were identified and then managed whilst in the prison estate. It led to an outcome which I find interesting not only for it’s rarity, but also because of how long has passed since the original events – almost sixteen years since the original sentence. The life sentence originally imposed has now been quashed and a restricted hospital order (s37/41 MHA) has been instated instead. The argument for this goes way beyond simply reflecting the high likelihood he had an un-diagnosed condition at the time of the various offences and that the hospital order would better reflect this: it’s about future proofing the ability of agencies to manage his ongoing detention and care, along with a suitable process of discharge that can not only take account of his mental health, but provide a post-discharge mechanism which ensures support with a safety net of being recalled to hospital if required.
FUTURE PROOFING
The argument about replacing the life sentence with a restricted hospital order is therefore not just about the nature or place of detention: the appellant remaining in Ashworth under a s47/49 transfer order or him remaining there under a s37/41 order both result in him still being there and receiving treatment. What differs significantly, however, is the way in which any consideration may be given in the future to him moving on from hospital, if that is ever deemed appropriate. A life-sentence prisoner’s release is governed by the Parole Board who cannot consider such matters if the prisoner is detained elsewhere under the MHA. If that prisoner were however considered a patient by being detained there under the hospital order, release is then governed by the mental health tribunal system (part of Her Majesty’s Court Service) as well as by the NHS clinicians in charge of his care, subject to the Ministry of Justice’s mental health unit, which oversees aspects of leave, transfer and discharge under the MHA on behalf of the Secretary of State for Justice. (All ‘restricted’ patients are subject to this – whether transferred from prison or directly hospitalised by a criminal court.)
If someone is a transferred patient under s47/49, they cannot be considered for Parole until transferred back under s50 MHA – this is was the legal mechanism used to transfer Pete Sutcliffe, the Yorkshire Ripper, from Broadmoor to prison where he remained until he died. The court heard that Mr Crerand is unlikely to ever be transferred back and that even if he were, he would no doubt relapse and require further transfer to hospital before the Parole Board could hear the case. Even then, release from prison on licence means nothing for ongoing mental health care, post-release. The Court noted Mr Crerand’s history of violence seems highly likely to be connected to untreated schizophrenia and that prison was not a great environment for him. Since being treated in Ashworth, medication compliance has been good and he is stable there – so much so, he is cared for on a medium dependency ward which is a slightly lower level of therapeutic security within the high secure setting. The medical reports state he will need ongoing mental health treatment for the rest of his life and that the best way to ensure this, is the hospital order for any ongoing detention he may still require; but it would also ensure that in the event of him being suitable for discharge, the legal regime in the MHA would ensure support of a community mental health team and a safety net of recall to hospital.
CONDITIONAL DISCHARGE
Patients who are discharged from hospital after a s37/41 order are not just released with an offer of mental health care in the community. They are almost always released under a mechanism known as conditional discharge outlined in s42 MHA. The conditions might include a residence requirement, being available for medical examination, possibly drug or alcohol testing and so on. Where community clinicians are not satisfied conditions are being adhered to, they can ask the MoJ mental health unit to issue a warrant of recall, under s42(4) MHA and this allows the patient to be returned to hospital and again be a restricted patient. This appeal argues that such a regime is in the appellant’s and the public’s interests, to minimise risk of further violent incidents and hasten the man’s access to urgent mental health care, if required.
For all these reasons as well as others outlined in the judgment, the Court of Appeal quashed the life-sentence and instated a restricted hospital order. Mr Crerand remains where he is, in receipt of care. But whatever happens from here, the legal mechanism overseeing subsequent considerations is more appropriate than it was before. None of this now means he isn’t considered to have been convicted of the original offence on the victim in 2006. This is not an insanity case and he remains convicted and guilty of the attack – it merely replaces one sentence with another because it is now seen as more appropriate on the basis of new evidence recently offered. It still means that if any release should occur – something which seems far from certain if you read the whole judgement – then he will be subject to Multi-Agency Public Protection Arrangements, or MAPPA as well as the recall to hospital afforded by condition discharge.
An interesting appeal case and I thought it offered opportunity to explain a bit of the reasoning behind how the system makes these decisions to balance punishment for offences, with public protection and an individual’s right to treatment and care. It doesn’t mean things always work perfectly, of course.
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2022
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 – www.legislation.gov.uk
Mental Health Cop 