## **Learning Outcomes**

This article outlines claims for pure psychiatric harm in negligence for SQE1 purposes, including:

- the definition of pure psychiatric harm and how it differs from consequential psychiatric injury in negligence problem questions
- the requirement for a medically recognised psychiatric illness, with examples of conditions that commonly qualify in exam scenarios
- the sudden shock requirement, its rationale, and how courts treat gradual stress or continuing trauma
- how to identify primary and secondary victims, including rescuers and unwitting participants, and why the classification matters for duty of care
- the Alcock control mechanisms for secondary victims—close tie of love and affection, proximity in time and space, and direct perception with unaided senses—and how to apply them step‑by‑step
- why simple grief, distress, worry, or ordinary bereavement are insufficient on their own to found a claim
- foreseeability tests for psychiatric harm: physical injury foreseeability for primary victims versus psychiatric injury to a person of normal fortitude for secondary victims
- operation of the eggshell skull principle once duty is established, and its impact on the extent of recoverable psychiatric damage
- treatment of claims arising from property destruction, anxiety about future illness, and assumptions of responsibility, and how these categories are likely to be examined

## **SQE1 Syllabus**

For SQE1, you are required to understand pure psychiatric harm in negligence and how duty of care is determined for primary and secondary victims, with a focus on the following syllabus points:

- the distinction between pure psychiatric harm and consequential psychiatric injury
- the requirement for a medically recognised psychiatric condition (or shock‑induced physical condition)
- the need for sudden shock as the cause of injury, and the limited situations where this is treated flexibly
- the difference between primary and secondary victims and how duty is established for each
- the control mechanisms for secondary victims (close tie of love and affection, proximity in time and space to the event or its immediate aftermath, and direct perception with unaided senses)
- foreseeability requirements: physical injury foreseeability for primary victims versus psychiatric harm foreseeability for persons of normal fortitude for secondary victims
- how the eggshell skull principle applies once duty is established
- how these rules affect the duty of care in negligence claims for psychiatric harm, including the position of rescuers, property destruction, anxiety about future disease, and assumption of responsibility

## **Test Your Knowledge**

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

1. What is the legal definition of pure psychiatric harm in negligence?
2. Which of the following is required for a successful claim for pure psychiatric harm?
   a) Any emotional upset
   b) Medically recognised psychiatric illness
   c) Gradual build-up of stress
   d) Simple grief
3. Which of the following best describes a secondary victim in psychiatric harm claims?
   a) Someone physically injured in an accident
   b) Someone who witnesses harm to a loved one and suffers sudden shock
   c) Any bystander who hears about an accident
4. Name the three main control mechanisms for secondary victims established in Alcock v Chief Constable of South Yorkshire Police.

## **Introduction**

Claims for pure psychiatric harm in negligence are subject to strict requirements. The law distinguishes between psychiatric injury suffered as a direct result of a traumatic event (pure psychiatric harm) and psychiatric symptoms that follow physical injury (consequential psychiatric harm). These controls exist to prevent the duty of care from expanding to an unmanageable class of claimants, while compensating those most closely and foreseeably affected. Understanding the categories of victims, the sudden shock requirement, and the Alcock control mechanisms is essential to correctly analyse duty in this area.

## Defining Pure Psychiatric Harm

Pure psychiatric harm refers to a recognised psychiatric illness suffered without accompanying physical injury. The law imposes specific requirements to limit claims and prevent an unmanageable number of potential claimants.

> **Key Term: pure psychiatric harm**
> A medically recognised psychiatric illness suffered as a result of a sudden, shocking event, without any physical injury.
>
> **Key Term: consequential psychiatric harm**
> Psychiatric symptoms that arise as a consequence of physical injury; these are treated as part of the physical injury claim.

Psychiatric damage may also include shock‑induced physical consequences (for example, a miscarriage precipitated by a shocking event). These are actionable where the shock meets the suddenness requirement and causation is proved.

### Medically Recognised Psychiatric Condition

To succeed in a claim for pure psychiatric harm, the claimant must prove they have suffered a medically recognised psychiatric illness. Mere emotions such as grief, distress, or worry are not sufficient.

> **Key Term: medically recognised psychiatric illness**
> A psychiatric disorder diagnosed by a medical professional, such as post-traumatic stress disorder (PTSD), clinical depression, or a specific anxiety disorder.

In practice, expert medical evidence is required to diagnose and link the condition to the event. Examples frequently accepted include PTSD, major depressive disorder, and certain anxiety disorders with a defined clinical profile. Pathological grief may qualify if evidenced as a diagnosable psychiatric condition; ordinary bereavement does not. Simple upset, fear, or insomnia of short duration will not meet the threshold.

### Sudden Shock Requirement

The psychiatric illness must be caused by a sudden, shocking event. The law does not generally compensate for psychiatric harm resulting from gradual exposure to distressing circumstances.

> **Key Term: sudden shock**
> A traumatic event or its immediate aftermath that causes an immediate psychiatric reaction, rather than harm developing over time.

Courts assess whether the claimant experienced a sudden, horrifying event or its immediate aftermath which violently agitates the mind. A continuous shock can be treated as a single event if the facts amount to one seamless, horrifying episode. By contrast, a prolonged, gradual deterioration (for example, repeatedly visiting a hospital over weeks and watching a loved one decline) will not normally satisfy sudden shock for secondary victims.

The requirement for “sudden shock” is most strictly applied to secondary victims. For primary victims, case law has recognised that psychiatric injury can follow exposure to danger over a period covering an incident and its immediate aftermath without a precisely instantaneous trigger. Shock‑induced physical conditions, such as a miscarriage, may be actionable if caused by a sudden event.

### Primary and Secondary Victims

The law distinguishes between primary and secondary victims when assessing claims for pure psychiatric harm.

> **Key Term: primary victim**
> A person directly involved in an incident, who is physically injured or was in danger of physical injury, and suffers psychiatric harm as a result.
>
> **Key Term: secondary victim**
> A person who witnesses injury to another or fears for the safety of another, and suffers psychiatric harm as a result, but was not in physical danger themselves.

This distinction drives the foreseeability test used to determine duty of care.

#### Primary Victims

A duty of care is owed to a primary victim for psychiatric harm if it was reasonably foreseeable that they might suffer physical injury. It is not necessary for psychiatric harm itself to be foreseeable. Once some personal injury was foreseeable, the law treats psychiatric injury to a primary victim in parity with physical injury. If established, the eggshell skull principle applies, meaning the defendant takes the claimant as found; the extent of psychiatric harm is compensable even if unusually severe.

### **Worked Example 1.1**

A driver is involved in a car accident caused by another's negligence. She is not physically injured, but develops PTSD from the shock of the crash. Can she claim for psychiatric harm?

> **Answer:** Yes. She is a primary victim because she was directly involved and at risk of physical injury. As physical injury was foreseeable, a duty of care is owed for her psychiatric harm.

#### Secondary Victims and the Alcock Control Mechanisms

Secondary victims face additional hurdles. The courts have established strict control mechanisms to limit claims by secondary victims, as set out in Alcock v Chief Constable of South Yorkshire Police.

To succeed, a secondary victim must show:

- a close tie of love and affection with the person injured or killed (presumed for spouses, parents, and children; others must prove it)
- proximity to the event or its immediate aftermath (in time and space)
- direct perception of the event or aftermath with their own unaided senses (not via television or other media)
- psychiatric harm caused by sudden shock

In addition, the psychiatric harm must be reasonably foreseeable in a person of normal fortitude in the claimant’s position. This “normal fortitude” threshold assesses the foreseeability of psychiatric injury for secondary victims. Once duty is established, the eggshell skull principle governs the extent of the harm actually suffered.

Proximity in time and space has practical limits. Being present at the accident or coming upon the immediate aftermath (for example, arriving at the scene or hospital very shortly after, before the situation has materially changed) may suffice. Viewing televised or recorded images will not, on ordinary facts, unless the broadcast is indistinguishable from direct perception of the event and shows recognisable suffering by individuals, which is rare in practice.

### **Worked Example 1.2**

A mother sees her child struck by a car and suffers a psychiatric illness from the shock. She was present at the scene and witnessed the accident. Can she claim?

> **Answer:** Yes. She is a secondary victim who satisfies the control mechanisms: close relationship, proximity, direct perception, and sudden shock. Psychiatric harm to a person of normal fortitude in her position is reasonably foreseeable.

### **Worked Example 1.3**

A fiancé watches live television footage of a stadium disaster. He suffers psychiatric illness but did not see any identifiable person he knows in danger. Can he claim?

> **Answer:** No. Watching the event on television is not direct perception with unaided senses, and there is no close tie demonstrated to an identified victim in danger. The Alcock controls are not met.

### **Worked Example 1.4**

A father reaches the hospital eight hours after his daughter’s accident and identifies her body. He develops a psychiatric illness. Is this within the “immediate aftermath”?

> **Answer:** Likely no on these facts. Eight hours is generally beyond the “immediate aftermath” unless the scene and circumstances still reflect the accident’s immediate state. Without temporal and spatial proximity, duty is not established.

### **Worked Example 1.5**

A homeowner returns to find her house ablaze due to negligent installation of heating equipment and develops a recognised psychiatric illness. There is no physical injury. Can psychiatric harm be recoverable?

> **Answer:** Potentially yes. Witnessing the sudden destruction of one’s property can, in principle, ground a claim for psychiatric illness, provided all elements of negligence and sudden shock are proved.

### **Worked Example 1.6**

A police officer attends a mass‑casualty incident hours after it occurs. She was never in physical danger. She later develops clinical depression from what she saw. Is she likely to recover as a rescuer?

> **Answer:** No on these facts. A rescuer not exposed to physical danger is treated as a secondary victim and must satisfy the Alcock controls. Absent proximity and direct perception of the event or its immediate aftermath, the claim will fail.

### Rescuers and other borderline categories

Rescuers who are themselves in the zone of danger are treated as primary victims. Where rescuers were not exposed to danger, they are secondary victims and must satisfy the Alcock controls. Claims by unwitting participants who reasonably believe they have caused injury to another may be allowed where that belief is reasonable and shock‑inducing. Anxiety related purely to a risk of future disease, without present injury or recognised psychiatric illness, is not compensable.

An assumption of responsibility can create a duty to protect against reasonably foreseeable psychiatric harm in specific relationships (for example, custodial authorities to vulnerable detainees). In such cases, duty arises from the relationship itself and the reasonable foreseeability of psychiatric harm to the claimant.

### **Worked Example 1.7**

Prison staff place a vulnerable inmate suffering depression in a cell with a suicidal prisoner. The inmate witnesses the suicide and develops a psychiatric illness. Can he recover?

> **Answer:** Yes. The custodial authority assumed responsibility to take reasonable care to avoid exposing a vulnerable inmate to foreseeable psychiatric harm. Duty is established on that basis and causation is a matter of proof.

### **Exam Warning**

> Claims for psychiatric harm will fail if the claimant cannot prove a medically recognised illness, or if the harm results from gradual stress or is not caused by a sudden event. Be careful to distinguish between primary and secondary victims and apply the correct tests. For secondary victims, check “normal fortitude” foreseeability, all Alcock controls, and whether the claimant’s experience qualifies as the event or immediate aftermath perceived with unaided senses.

### **Revision Tip**

> For SQE1, remember that simple grief, distress, or worry are not enough. Always check for a medically recognised psychiatric illness and the requirement for sudden shock. Distinguish foreseeability tests: primary victims require foreseeability of physical injury; secondary victims require foreseeability of psychiatric injury to a person of normal fortitude plus Alcock controls. Once duty is established, the eggshell skull principle governs the extent of the loss.

## **Key Point Checklist**

_This article has covered the following key knowledge points:_

- Pure psychiatric harm is a medically recognised psychiatric illness suffered without physical injury.
- Psychiatric injury must usually be caused by a sudden, shocking event; gradual development is generally excluded for secondary victims.
- Consequential psychiatric harm is treated as part of the physical injury claim.
- Primary victims are directly involved or at risk of physical injury; duty exists if physical injury was foreseeable, even if psychiatric injury was not.
- Secondary victims must satisfy the Alcock control mechanisms: close relationship, proximity in time and space to the event or its immediate aftermath, direct perception with unaided senses, and sudden shock, and psychiatric harm must be reasonably foreseeable in a person of normal fortitude.
- The eggshell skull principle applies once duty is established, so the full extent of psychiatric harm is recoverable even if unusually severe.
- Simple emotions such as grief or distress are not sufficient for a claim; medical evidence of a recognised illness is required.
- Rescuers outside the zone of danger are treated as secondary victims; those in danger are primary victims.
- Destruction of one’s property may, in principle, ground psychiatric harm if sudden shock and other negligence elements are proved.
- Anxiety about a future risk (without present injury or recognised psychiatric illness) is not recoverable.

## **Key Terms and Concepts**

- pure psychiatric harm
- consequential psychiatric harm
- medically recognised psychiatric illness
- sudden shock
- primary victim
- secondary victim

Claims for psychiatric harm - Definition of pure psychiatric harm