The Andrea Cutler case presented Nottingham Crown Court judge Gregory Dickinson with a dilemma over how to sentence her for the brutal killing of Belper grandmother Sandra Bainbridge in December 2013.
It was a question of balancing the need to protect the public from a dangerous woman with the need to ensure she received treatment for her mental illness.
In the end, it boiled down to the simple choice of whether to send Cutler to prison for life or back to the secure unit of a hospital, where she had been treated since last June.
And Judge Dickinson was persuaded by expert evidence given by eminent London-based psychiatrist Dr Philip Joseph, who stressed that the cause of the killing was Cutler’s mental illness, which needed to be properly treated.
Said Dr Joseph: “With life imprisonment, there is a real risk that she would stop her medication, which she would be entitled to do, and so pose a significant risk of violence to other prisoners and to herself,” said Dr Joseph.
“Indeed, when she was originally remanded to prison for this offence in 2013, some of the other prisoners were frightened of her.
“I would be surprised if she ever agreed to take her medication. However, with a hospital order, under the Mental Health Act, she would be compelled to take her medication.”
Dr Joseph said Cutler’s illness meant she was “irrational and unable to control her actions”.
“Had she not been mentally ill, I cannot see how this could have possibly happened.
“With proper medication, there is a low risk of her committing violent offending. Since her treatment, it has begun to sink in what she has done.”
Dr Joseph said that, without treatment, Cutler was dangerous and said the risk she posed was more connected to her mental illness than her use of illicit drugs.
“She has behaved in a bizarre, erratic and aggressive manner, making deluded accusations, including threats to kill her parents,” he said.
“She can react in a very unpredictable manner, and satisfies the test of dangerousness. There is a realistic possibility she will behave violently in the future. But if she takes her medication and doesn’t take illicit drugs, she would not present an appreciable risk to the public.”
The judge agreed that Cutler will be more effectively managed in a secure hospital, rather than in prison.
In his summing-up, he said: “My first instinct was to impose life imprisonment, to lock her up and throw away the key.
“But Andrea Cutler has a long-standing mental illness, which was the cause of her terrible actions.
“This illness is characterised by paranoid and delusional beliefs and chaotic behaviour, and she is liable to compulsive action and outbursts of aggression. She has no insight into her condition, which is why she refused to take her medication and did not co-operate.
“Without her mental illness, I would give life imprisonment. But since last June, when she was transferred to the secure unit of a hospital, she has responded to medication.
“She will remain in that psychiatric unit for the foreseeable future. She must not be released until she poses no significant risk to the public. If and when she is released, the greatest possible protection to the public must be put in place.”
For Cutler, Tony Badenoch (defending) insisted that placing her in hospital, rather than prison, was”not the easy way out”.
“It is the right outcome, based on medical opinion,” said Badenoch. “But for her illness, this would never have happened.
“Since her treatment at the psychiatric unit started last June, Andrea Cutler now has some recognition of what she did, and expresses her remorse.”