Tania Clarence, 42, sobbed quietly as she appeared via video link at the Old Bailey, accused of killing her three-year-old twin sons, Ben and Max, and four year-old daughter, Olivia, at their London home.
In an unusual move, Judge Brian Barker, the Recorder of London, ruled that Mrs Clarence could be released from prison and enter a secure hospital under the Mental Health Act.
The decision came as it emerged in court that Mrs Clarence had attempted to take her own life following the deaths, and left a note saying “I can’t live with the horror of what I’ve done.”
Mrs Clarence was treated for cuts at St George’s Hospital in Tooting, south London, and charged on 24 April, two days after the bodies were found.
Judge Barker told the court: “It seems to me, having heard submissions on both sides and having discussed the matter with medical experts, there is an overriding need for immediate treatment in a secure setting.
“There is a combination of circumstances here that makes this an exceptional case and allows this court to take an exceptional course. It isn’t bail, but what we are doing is ordering for her to be subject to a Section 35 order under the Mental Health Act, so she can then be remanded effectively for review of her condition.”
Judge Barker said the order should be processed by the end of the day and the case would be reviewed again in 28 days.
Mrs Clarence looked pale and emotional as she watched the proceedings via video link from a green-curtained room at HMP Bronzefield in Surrey. She did not watch all of the hearing because the video link was needed by another court, but was told by her legal team that she was being sent to a hospital.
Gary Clarence, 43, her husband, was supported by friends as he sat in the public gallery during the bail hearing.
Mrs Clarence is accused of three counts of murdering a child between 20 and 23 April.
All three young children suffered from type 2 spinal muscular atrophy. Also known as floppy baby syndrome, the genetic condition leaves children with little control of their movements and can drastically shorten life expectancy.
Police were called to the family’s five-bedroom home in the London suburb of New Malden at 9:30pm last Tuesday where they discovered the children, who were pronounced dead at the scene.
The Old Bailey heard that post-mortem examinations suggested the three children had died from suffocation. But authorities are waiting for further tests, including toxicology tests, to be carried out before a final cause of death can be given.
Zoe Johnson QC, prosecuting, told the Old Bailey: “By way of preliminary statement, Dr Nathaniel Carey, the pathologist, has indicated that the provisional cause of death is probably suffocation. Whether that was associated with some form of intoxication is yet to be determined.”
The court heard that Mr Clarence, who works at City bank Investec, was in the family’s native South Africa with their eldest daughter, Taya, at the time of the deaths.
A plea and case management hearing will be held at the Old Bailey on 15 July.