SQE1 FLK1

## Learning Outcomes

This article explains how the Alcock criteria regulate recovery for secondary victims in psychiatric harm claims and how those criteria are examined in SQE1 problem questions. It distinguishes clearly between primary and secondary victims, sets out the control mechanisms for secondary victim claims in negligence, and emphasises the need for a medically recognised psychiatric illness. It details the requirements of a close tie of love and affection, proximity in time and space, means of perception through unaided senses, sudden shock, and reasonable foreseeability to a person of normal fortitude. It analyses how the eggshell skull rule operates only after foreseeability is established, and how courts draw boundaries around concepts such as “immediate aftermath” and “direct perception.” It examines borderline scenarios involving rescuers, witnesses to destruction of property, and unwitting participants, showing when these actors are classified as primary or secondary victims. It reviews leading authorities such as Alcock, McLoughlin, Page v Smith, White, Walters, Ronayne, and Sion to illustrate successful and unsuccessful claims, and prepares you to apply each criterion methodically to multiple-choice and single best answer questions.

## SQE1 Syllabus

For SQE1, you are required to understand the legal requirements for secondary victims to recover damages for psychiatric harm in negligence, with a focus on the following syllabus points:

- the distinction between primary and secondary victims in psychiatric harm claims
- the Alcock control mechanisms for secondary victims: close tie of love and affection, proximity in time and space, and means of perception
- the requirement for sudden shock and foreseeability of psychiatric injury
- the application of these principles to factual scenarios and the main limitations on recovery for secondary victims
- the need for a medically recognised psychiatric illness (mere grief or distress is not sufficient)
- the boundaries of “immediate aftermath” and “unaided senses”, and how courts treat television or phone communication

## Test Your Knowledge

_Attempt these questions before reading this article. If you find some difficult or cannot remember the answers, look more closely at that area during your revision._

1. What are the three main Alcock criteria that a secondary victim must satisfy to recover damages for psychiatric harm?
2. Can a claimant who witnesses an accident on live television succeed as a secondary victim? Why or why not?
3. What is meant by a "close tie of love and affection" in the context of secondary victim claims?
4. Why is the requirement for "sudden shock" important in secondary victim claims for psychiatric harm?

## Introduction

Claims for psychiatric harm in negligence are subject to strict requirements, especially for those who are not directly involved in the traumatic event. The courts have developed specific "control mechanisms" to limit the class of claimants who can recover as secondary victims. These rules were set out in the leading case of Alcock v Chief Constable of South Yorkshire Police and are central to the SQE1 syllabus.

![Psychiatric harm claims by secondary victims, distinguishing victim types and summarising the Alcock criteria, application requirements, policy control mechanisms, and typical outcomes.](https://static.pastpaperhero.com/images/sqe1-flk1-claims-for-psychiatric-harm-alcock-criteria-for-secondary-victims_00.png)

_Psychiatric harm claims by secondary victims are summarised by reference to victim types, the Alcock criteria, application requirements, policy rationales, and outcomes._

Psychiatric injury must be medically recognised. Diagnosis such as post-traumatic stress disorder, pathological grief, and certain personality disorders qualify, whereas mere distress or normal grief do not. The harm must result from a sudden, shocking event (rather than gradual exposure over time), and only particular categories of claimant may recover when they were not themselves endangered.

> **Key Term: psychiatric harm**
> A medically recognised psychiatric illness caused by a sudden shocking event; grief or anxiety alone is insufficient.

### Primary and Secondary Victims

A person who suffers psychiatric harm may be classified as either a primary or secondary victim. A primary victim is someone directly involved in the incident or in the zone of physical danger. A secondary victim is someone who suffers psychiatric harm as a result of witnessing injury to another, but is not personally endangered.

> **Key Term: primary victim**
> A person who is directly involved in the traumatic event or is within the zone of physical danger.
> **Key Term: secondary victim**
> A person who suffers psychiatric harm from witnessing injury to another, but is not personally endangered.

For primary victims, the duty of care in relation to psychiatric injury is owed if physical injury was reasonably foreseeable, even if no physical injury occurs. This is the position confirmed in Page v Smith: foreseeability of physical harm suffices to ground a duty for psychiatric harm to primary victims. For secondary victims, however, the duty is more constrained and all the Alcock control mechanisms must be satisfied.

### The Alcock Criteria for Secondary Victims

To prevent unlimited liability, the courts require secondary victims to satisfy the Alcock criteria—also known as the "control mechanisms." All must be met for a claim to succeed.

> **Key Term: Alcock criteria**
> The set of legal requirements a secondary victim must satisfy to recover damages for psychiatric harm in negligence.

#### 1. Close Tie of Love and Affection

The claimant must have a close relationship with the primary victim. The law rebuttably presumes close ties of love and affection for parent/child relationships, married couples, and engaged couples. For other relationships—including grandparent/grandchild, sibling, and close friend—close ties are not presumed but can be proved on the evidence, for instance through cohabitation, shared life commitments, daily involvement, and the nature of the familial or personal bond.

The presumption is rebuttable; defendants may show that, despite the familial category, the ties were not close in fact. Equally, non-presumed relationships can succeed if the claimant proves genuine depth of affection. The proximity requirement becomes proportionally more relaxed in relation to the seriousness of the harm suffered by the primary victim: the more grave the injury or death, the wider the circle of those whose psychiatric injury may be regarded as foreseeable.

> **Key Term: close tie of love and affection**
> A strong, close personal relationship between the claimant and the primary victim, usually presumed for immediate family.

#### 2. Proximity in Time and Space

The claimant must be present at the scene of the incident or its immediate aftermath. The House of Lords in McLoughlin v O’Brian recognised that seeing close relatives at the hospital shortly after the accident, still in the condition they were at the scene, can qualify as the “immediate aftermath.” In contrast, identification of a body many hours later (as in parts of Alcock) is outside the aftermath.

“Immediate aftermath” is fact-sensitive. The Court of Appeal in Galli-Atkinson v Seghal accepted that a short interval followed by viewing the accident scene and a mortuary within about two hours could form part of one continuous aftermath. The further the time and the greater the separation from the event, the less likely proximity is established.

> **Key Term: proximity in time and space**
> The requirement that the claimant is physically present at the event or its immediate aftermath.

#### 3. Means of Perception

The claimant must directly perceive the event or its immediate aftermath with their own unaided senses—seeing or hearing it in person. Watching on television, hearing about it from a third party, or seeing edited news footage is not enough. Alcock emphasised that televised images (especially where individuals are not identifiable and the images are mediated) do not equate to direct perception. Real-time broadcasts still lack the immediacy and personal sensory impact required.

> **Key Term: means of perception**
> The requirement that the claimant witnesses the event or aftermath with their own senses, not through media or third parties.

#### 4. Sudden Shock

The psychiatric injury must result from a sudden, shocking event, not from a gradual process or ongoing stress. The courts have rejected claims based on a build-up over time (e.g. prolonged hospital vigils: Sion v Hampstead Health Authority). Conversely, a sequence of events forming a single horrifying episode can satisfy this requirement (e.g. Walters v North Glamorgan NHS Trust, where a mother’s experience over a short period culminating in the death of her baby was treated as a sudden shocking event). Courts have accepted aggregation of events over approximately 36 hours where each event constitutes a separate "sudden assault on the nervous system," but aggregation over longer periods such as two weeks has been rejected. In Liverpool Women’s Hospital NHS Trust v Ronayne, however, the Court of Appeal rejected attempts to aggregate a longer series of upsetting events absent a singular shock.

> **Key Term: sudden shock**
> A psychiatric injury caused by an immediate and horrifying event, not by gradual exposure.

#### 5. Reasonable Foreseeability

It must be reasonably foreseeable that a person of ordinary fortitude in the claimant’s position would suffer psychiatric injury. For secondary victims, foreseeability is assessed by reference to “normal fortitude.” Once the duty is established, the eggshell skull principle applies to the extent of injury (i.e. the defendant takes the claimant as found), but you must first meet this threshold of foreseeability of psychiatric illness.

> **Key Term: reasonable foreseeability (psychiatric harm)**
> The requirement that psychiatric injury is a predictable result for a person of normal fortitude in the claimant’s circumstances.

### Worked Example 1.1

A mother witnesses her child being struck by a car and suffers post-traumatic stress disorder. She was present at the scene, saw the accident happen, and had a close relationship with the victim.

> **Answer:**
> The mother is likely to satisfy the Alcock criteria: close tie of love and affection (parent/child), proximity in time and space (present at the scene), means of perception (witnessed with her own senses), sudden shock (immediate event), and reasonable foreseeability.

### Worked Example 1.2

A man learns by telephone that his partner has been killed in a workplace accident. He develops depression as a result.

> **Answer:**
> The claim is likely to fail. Although there may be a close tie of love and affection, the man was not present at the scene or immediate aftermath, nor did he perceive the event with his own senses.
>
> **Exam Warning:**
> For SQE1, be careful to distinguish between primary and secondary victims. The Alcock criteria apply only to secondary victims. Do not apply these requirements to primary victim claims. For primary victims, foreseeability of physical injury suffices for a duty in respect of psychiatric harm; for secondary victims, foreseeability of psychiatric injury to a person of normal fortitude is required, plus the control mechanisms.

### Application of the Alcock Criteria

The courts apply these criteria strictly. For example, in Alcock, claims by family members who watched the Hillsborough disaster on television were rejected because they did not witness the event with their own senses. In McLoughlin v O'Brian, the claimant succeeded because she saw her injured family in the immediate aftermath at the hospital.

It is important to differentiate mere bystanders from secondary victims with the requisite closeness and proximity. Bourhill v Young is often cited to emphasise that a person who is not in danger and lacks closeness to the immediate victim will not meet the foreseeability threshold.

For the “sudden shock” requirement, courts look for a specific, horrifying event rather than a chain of events spread over time. Walters shows that a short, continuous sequence culminating in tragedy can constitute a single shocking event; Ronayne and Sion illustrate the limits where gradual exposure is relied upon.

The Supreme Court has recently reinforced the tight limits of secondary victim recovery in the clinical negligence context. In Paul v Royal Wolverhampton NHS Trust [2024] UKSC 1, the court held that relatives who witness the death or injury of a loved one caused by an earlier negligent failure to diagnose or treat disease are not entitled to secondary victim damages. There must be a distinct external “accident” that the claimant perceives; the later manifestation of an untreated medical condition is not an accident for these purposes. Paul confirms that secondary victim claims in medical cases will succeed only where a genuine accident-type event is present, not merely a shocking crisis caused by the defendant’s earlier negligence.

Rescuers are not a special category outside primary/secondary victim analysis. In White v Chief Constable of South Yorkshire Police, rescuers employed at the scene failed because they were neither exposed to danger (as primary victims) nor did they meet the secondary victim criteria. A rescuer may qualify as a primary victim only if they were (or reasonably believed themselves to be) in the zone of physical danger. Historically, successful rescuer claims (e.g. Chadwick v British Railways Board) involved exposure to danger.

The courts have recognised limited recovery where psychiatric illness results from witnessing destruction of property. In Attia v British Gas plc, a woman returned home to find her house being destroyed by fire caused by the defendant's negligence; the Court of Appeal held that seeing one's property being destroyed can be sufficient to establish a claim for psychiatric injury, provided the claimant develops a recognised illness. Such claims remain exceptional and depend on proof of a recognised illness, causation, and foreseeability.

Assumption of responsibility can be relevant in special relationships. For example, prison authorities were held to owe a duty to take reasonable steps to prevent foreseeable psychiatric harm to a vulnerable inmate placed with a suicidal prisoner (Butchart v Home Office). Such cases often involve duties derived from established relationships (employer/employee, doctor/patient, custodial roles) rather than the Alcock mechanisms.

### Worked Example 1.3

A woman arrives at the hospital two hours after her husband and children are injured in a car accident. She sees them before they are treated and suffers psychiatric injury.

> **Answer:**
> The claim may succeed. The House of Lords in McLoughlin v O'Brian accepted that seeing family members in the immediate aftermath at hospital could satisfy the proximity requirement, provided the injured relatives remained in the condition they were at the scene.

### Worked Example 1.4

A sister arrives at the scene 45 minutes after her brother’s motorcycle accident. She first sees the crash site and then views him at the hospital, where he remains covered in debris and untreated. She develops a medically recognised psychiatric illness.

> **Answer:**
> The claim could succeed if evidence proves a close tie of love and affection (not presumed for siblings), proximity in time and space (scene and immediate aftermath), direct perception with unaided senses, sudden shock, and foreseeability to a person of normal fortitude. If the closeness of the sibling relationship is not established, the claim will fail at the first Alcock limb.

### Worked Example 1.5

A fiancé watches live television coverage that shows a stadium disaster as it unfolds. Although distressed, he did not see his partner specifically and only learned of her injury later.

> **Answer:**
> The claim is likely to fail. Television footage does not amount to direct perception with unaided senses, and identifiable personal impact was not perceived. Even if a close tie could be proved, the means of perception criterion is not met.

### Worked Example 1.6

A police officer works in a temporary mortuary later the same day and suffers psychiatric harm from the experience. He was not in danger and did not see the accident or its immediate aftermath.

> **Answer:**
> The claim is likely to fail under White. The officer is neither a primary victim (no danger) nor a secondary victim (no proximity to the accident or immediate aftermath; perception occurs too late and in a mediated context).
>
> **Revision Tip:**
> When answering SQE1 questions, check each Alcock criterion in turn. If any are not met, the claim will fail. Do not overlook the requirement of a medically recognised psychiatric condition and the sudden shock element. For primary victims, focus on foreseeability of physical injury; for secondary victims, apply the full control mechanisms and normal fortitude foreseeability.

## Key Point Checklist

_This article has covered the following key knowledge points:_

- The distinction between primary and secondary victims in psychiatric harm claims.
- The Alcock criteria for secondary victims: close tie of love and affection, proximity in time and space, means of perception, sudden shock, and reasonable foreseeability.
- The requirement that all Alcock criteria must be satisfied for a secondary victim to recover damages.
- The strict application of these control mechanisms by the courts to limit liability for psychiatric harm.
- The importance of direct perception and presence at the event or immediate aftermath.
- The requirement for a medically recognised psychiatric illness and the limits of recovery based on gradual exposure.
- Special contexts: rescuers (subject to primary/secondary framework), property destruction (exceptional), and assumption of responsibility in particular relationships.

## Key Terms and Concepts

- psychiatric harm
- primary victim
- secondary victim
- Alcock criteria
- close tie of love and affection
- proximity in time and space
- means of perception
- sudden shock
- reasonable foreseeability (psychiatric harm)


Claims for psychiatric harm - Alcock criteria for secondary victims