The ‘Hybrid Order’: Origins and Usage.

Enys Delmage, Tim Exworthy, Nigel James Blackwood

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


The hospital direction (Hybrid Order) was inserted into the Mental Health
Act (MHA) in 1997 (Crime (Sentences) Act, 1997). It enables higher
courts to direct hospital admission for offenders, whilst still imposing a
prison sentence. The origins of the ‘Hybrid Order’ and its patterns of
usage are examined. Comparisons are made with its Scottish equivalent,
Section 59A of the Criminal Procedure (Scotland) Act 1995. Both the
‘Hybrid Order’ and Section 59A have been used infrequently. This may
reflect the fact that they were strongly resisted on ethical grounds at their
point of inception and that they force the psychiatrist into the position of
‘punisher’, rather than ‘treater’. Since the 2007 Amendment of the MHA
in England and Wales which expanded the remit of the ‘Hybrid Order’ to
include all legal categories of mental disorder, not solely psychopathy, its
use has unsurprisingly increased – this article delineates the considerations
that need to be given in its recommendation.
Original languageEnglish
Pages (from-to)325-336
Number of pages12
Issue number3
Publication statusPublished - 16 Mar 2015


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