A hospital order is a court-issued directive under Section 37 of the Mental Health Act 1983 that sends a person convicted of a criminal offence to a psychiatric hospital for treatment instead of prison. It applies when a court determines that the person has a mental disorder serious enough to warrant hospital admission and that detention for treatment is the most appropriate way to deal with the case. The order initially lasts six months, and it can be renewed if clinicians determine that continued treatment is necessary.
How a Hospital Order Works
When someone is convicted of an offence punishable by imprisonment, the court has the option of making a hospital order rather than imposing a standard sentence. The key idea is that the person’s mental health condition is better addressed through psychiatric care than through punishment. A magistrates’ court can even make a hospital order without formally recording a conviction if it is satisfied the person committed the act in question.
Before making the order, the court needs written or oral evidence from the clinician who would be responsible for the person’s care, confirming that a hospital bed is available and that the person can be admitted within 28 days. If there is a gap between the court hearing and admission, the court can direct that the person be held in a place of safety in the meantime.
Medical Evidence Required
The court must be satisfied, based on evidence from at least two registered medical practitioners, that the person is suffering from a mental disorder of a nature or degree that makes hospital treatment appropriate. At least one of those doctors must be approved as having special expertise in psychiatry. Both must agree that hospital admission, rather than prison, is the right course of action given all the circumstances of the case.
How Long a Hospital Order Lasts
A Section 37 hospital order lasts for an initial period of six months. At the end of that period, the responsible clinician can renew it for another six months. After that second period, renewals happen in 12-month blocks for as long as the clinical team determines the person still meets the criteria for detention. Each renewal requires the clinician to confirm that the person continues to need treatment in hospital and that it cannot safely be provided in any less restrictive way.
This means there is no fixed maximum duration. Some people are discharged within months; others remain in hospital for years. The timeline depends entirely on clinical progress and risk assessment.
Restriction Orders: Section 41
In more serious cases, the Crown Court can add a restriction order under Section 41 on top of the hospital order. This happens when the court considers the person poses a risk of serious harm to the public. A restriction order fundamentally changes how detention works.
Under a standard hospital order, the clinical team and hospital managers have the authority to grant leave, transfer the patient, or discharge them. With a restriction order in place, none of those decisions can happen without the consent of the Secretary of State for Justice. The patient has no automatic expiry date on their detention, and the Secretary of State retains the power to recall the person to hospital at any time, even after conditional discharge. In practical terms, a restriction order means much tighter government oversight over every step of a person’s progress through the system.
Treatment and Consent
Patients detained under a hospital order can be treated for their mental disorder without their consent in certain circumstances. For most psychiatric medication, the clinical team can treat without consent for the first three months. After that, either the patient must agree to continue treatment or an independent doctor must certify that the treatment should be given, even without the patient’s consent, because it is likely to help their condition or prevent it from getting worse.
Some treatments have stricter rules. Procedures that are particularly invasive or irreversible, such as neurosurgery for mental disorder, always require both the patient’s informed consent and independent certification. There are also emergency provisions allowing immediate treatment without these safeguards when it is necessary to save a life, prevent serious deterioration, or stop the person from being a danger to themselves or others.
Discharge and Appeals
A patient on a standard hospital order (without a restriction order) can be discharged by their responsible clinician, by the hospital managers, or by the Mental Health Tribunal. The tribunal is an independent judicial body that reviews whether the legal criteria for continued detention are still met. Patients can apply to the tribunal during each period of their detention.
For patients subject to a restriction order, the discharge process is more limited. The Secretary of State can authorize discharge, either absolutely or conditionally. Alternatively, the tribunal can order discharge if it finds the patient no longer meets the criteria for detention. Conditional discharge means the person is released into the community but remains subject to conditions, and they can be recalled to hospital if those conditions are breached or their mental health deteriorates.
Patient Rights Under a Hospital Order
People detained under a hospital order retain several important legal rights. They have the right to apply to the Mental Health Tribunal for a review of their detention. They also have access to an Independent Mental Health Advocate (IMHA), a professional who is independent of the hospital and can help patients understand their rights, participate in decisions about their care, and make their views heard in reviews and hearings.
Patients can also nominate someone to act on their behalf in exercising certain rights, such as applying to the tribunal. Family members and carers, while not decision-makers in their own right, should be consulted and involved in care planning where appropriate.
Recent Legal Reforms
The Mental Health Act 1983 has now been updated through new legislation that received Royal Assent in 2025. The reformed Act is designed to give detained patients a greater say in their treatment, reduce racial disparities in detention rates, and ensure that any period of detention is focused on genuine therapeutic benefit and kept as short as possible.
Key changes include statutory care and treatment plans that give every detained patient a real voice in their care, stronger roles for families and carers in treatment decisions, and expanded rights for children and young people. The role of IMHAs is being broadened to offer more support and representation. Importantly, courts will no longer be able to hold someone in prison as a place of safety while they wait for a hospital bed to become available, addressing a longstanding concern about people with serious mental illness being held in inappropriate settings.