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Forty-five revolutions per minute: a qualitative study of Hybrid Order use in forensic psychiatric practice

Beech, V., Marshall, C. M., Exworthy, T., Peay, Jill and Blackwood, N. J. (2019) Forty-five revolutions per minute: a qualitative study of Hybrid Order use in forensic psychiatric practice. Journal of Forensic Psychiatry and Psychology, 30 (3). pp. 429-447. ISSN 1478-9949

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Identification Number: 10.1080/14789949.2019.1588910


Psychiatrists who recommend a Hybrid Order (Section 45A) as a disposal option at the point of sentencing accept that the convicted individual, as well as being mentally disordered and in need of treatment, is also culpable and deserving of criminal punishment. Ethical and clinical concerns have typically limited its clinical use. However, in 2015 the Court of Appeal specified in R v Vowles and others that the Hybrid Order disposal should be considered first in terms of potential mental health disposals. This judgement sets a high threshold for the use of the hospital order which has been the bedrock of inpatient forensic psychiatric practice since 1983. This study sought to explore the attitudes of consultant forensic psychiatrists towards the use of the Hybrid Order in the wake of the Vowles judgement. We interviewed 12 consultant forensic psychiatrists with longstanding experience of psychiatric sentencing recommendations. We found that the majority of consultants considered the Hybrid Order to be a valuable disposal option when used under specific circumstances. However, significant concerns were raised about its use in those with an enduring psychotic illness. Community aftercare arrangements for Hybrid Order disposals were viewed as inferior to community aftercare arrangements for Section 37/41 patients.

Item Type: Article
Additional Information: © 2019 Informa UK Limited, trading as Taylor & Francis Group
Divisions: Law
Subjects: R Medicine > RA Public aspects of medicine > RA1001 Forensic Medicine. Medical jurisprudence. Legal medicine
Date Deposited: 08 Mar 2019 14:42
Last Modified: 20 Oct 2021 02:36

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