In England, a depressed mother has been sentenced to a hospital order for killing her three disabled children.

Tania Clarence, who admitted the manslaughter by diminished responsibility of Olivia, four, and three-year-olds Ben and Max at their home in New Malden, southwest London, over the Easter holidays will not be released until she has recovered from her mental illness.

Mrs Clarence was sentenced at the Old Bailey, where she was flanked in the dock by her solicitor, who was allowed to remain beside her, and two medical professionals. She spoke only once to confirm her name.

Imposing the order as her husband, Gary, looked on, Judge Mr Justice Sweeney said: "The evidence of your diminished responsibility is clear and convincing.

"The reports make clear that you were mentally ill at the time, suffering a major depressive episode. It's equally clear that you are still mentally ill now.

"The prosecution accept that you loved all four of your children. Indeed, there is substantial body of evidence that they were happy and well looked after and you were grief-stricken that Olivia, Max and Ben were destined to die early and before you."

He said the mother of four became "overwhelmed" by the enormous challenge of coping with her children and witnessing medical interventions and procedures she felt were unnecessary.

And while the Old Bailey was "not the forum" to judge the conduct of the health professionals and social workers involved with the family, the effect of their actions on Clarence's state of mind was an "important factor".

The family's solicitor described it as "one of the saddest" cases to come before the criminal courts.

Lawyer Richard Egan said: "The Clarence family, and in particular Tania Clarence, dedicated their lives to the care and welfare of their three severely disabled children.

"Her love, commitment and tenacity in the face of the overwhelming responsibilities such care entailed was extraordinary.

"Ultimately, her story of dedication and love became a story of despair and utter hopelessness."

He said "lessons need to be learned" from the tragedy, adding: "Tania's depression was certainly not assisted by the constant pressure placed on the family by some individuals within the medical profession and social services who could not agree with Tania and Gary Clarence's stance of prioritising quality of life for their children and who were not readily willing to submit the children to operations and other interventions that they felt were not appropriate in the circumstance."

He said Mr Clarence was assisting Kingston Borough Council in their review of the circumstances of the case but wanted to make clear that allegations of neglect had been "wholly unfounded".

The three children had suffered from the condition SMA type 2, a life-limiting genetic condition which leaves children with little or no control of their movement.

The court was told the Clarences repeatedly clashed with doctors during a long history of the children's medical treatment in and out of hospital. These disputes coincided with difficulties with social workers.

Kingston Council said they had always sought to make sure the family "were fully supported".