## Introduction

Grievous bodily harm (GBH) is a serious non-fatal offence under the Offences Against the Person Act 1861 (OAPA 1861). Case law explains GBH as “really serious” harm, following DPP v Smith. It sits above actual bodily harm (ABH) in terms of severity and can be charged under section 18 (with intent) or section 20 (without intent to cause GBH but with intention or recklessness as to some harm). Both sections also cover “wounding”.

GBH is not limited to physical injury. Severe, medically recognised psychiatric injury can also amount to GBH. Getting the elements right—what counts as “really serious” harm, the actus reus and mens rea, and how causation works—matters for charging, defending, and sentencing decisions.

## What You’ll Learn

- The statutory framework for GBH under OAPA 1861 sections 18 and 20
- What “really serious” harm means and how courts assess it
- The difference between GBH and “wounding”
- Actus reus: direct and indirect infliction, “cause” vs “inflict”, and causation rules
- Mens rea: intention for section 18, and intention/recklessness to some harm for section 20
- When psychiatric injury counts as GBH and the evidence needed
- Key cases including DPP v Smith, Bollom, Burstow/Ireland, Eisenhower, Mowatt/Parmenter, Blaue, and Roberts
- Practical steps for selecting the correct charge and preparing evidence

## Core Concepts

### Statutory Framework: Sections 18 and 20 OAPA 1861

- Section 18: “Wounding or causing GBH with intent.” This requires proof that the defendant intended to cause GBH (or intended to resist or prevent lawful arrest while causing a wound or GBH). Maximum sentence: life imprisonment.
- Section 20: “Wounding or inflicting GBH.” No need to prove an intention to cause GBH. It is enough that the defendant intended or was reckless as to causing some physical harm. Maximum sentence: five years’ imprisonment.

Post–R v Burstow, “inflict” in section 20 largely aligns with “cause”, so GBH can be proved without showing an assault or battery in the strict sense.

### What Counts as GBH?

- Definition: DPP v Smith confirms GBH means “really serious” harm (R v Saunders accepts “serious harm” is an adequate direction).
- Examples often treated as GBH: fractures, deep or multiple lacerations, stab or bullet wounds, significant head injuries, and any injury with serious impact (even if not permanent).
- Context matters: R v Bollom allows the court to consider the victim’s age and health, and whether multiple injuries together amount to GBH. What is “really serious” for a child or elderly person may differ from an adult in good health.
- Not necessary for harm to be permanent: injuries that heal can still be GBH if they were “really serious” when sustained.

### Wounding vs GBH

- Wounding: any break in the continuity of the whole skin (both layers). Internal bleeding or a ruptured blood vessel without a skin break is not a wound (R v JJC (A Minor) v Eisenhower).
- A charge can be made out by proving either a wound or GBH. A relatively modest cut that breaks the skin may satisfy “wounding” even if it is not GBH.

### Actus Reus: Causing or Inflicting GBH

- Direct infliction: punches, kicks, stabbings, or weapon use leading to really serious harm.
- Indirect infliction: can arise where the defendant’s conduct causes the victim to suffer serious harm without direct contact (e.g., scaring someone into a dangerous escape where serious injury was reasonably foreseeable—see R v Roberts; older authority includes R v Halliday).
- “Inflict” vs “cause”: after R v Burstow, “inflict” in section 20 does not require technical assault or battery; it broadly means “cause”.
- Psychiatric injury: GBH can be caused without physical force if the defendant causes a serious, medically recognised psychiatric condition (R v Ireland; R v Burstow).

### Causation and the “Thin Skull” Rule

- Factual causation: the “but for” test (often illustrated by R v White).
- Legal causation: the defendant’s act must be a substantial and operating cause of the harm (R v Smith). Subsequent medical treatment will rarely break the chain unless it is so independent and potent that the original wound is no longer operative (R v Cheshire).
- Thin skull rule: take the victim as you find them; pre-existing vulnerabilities do not reduce liability (R v Blaue).

### Mens Rea: Section 18 vs Section 20

- Section 18 (intent): the prosecution must prove an intention to cause GBH (or intent to resist arrest while causing a wound/GBH). Oblique intent may suffice: if GBH was a virtually certain result and the defendant appreciated that (R v Woollin), a jury may find intent.
- Section 20 (maliciously): it is enough that the defendant intended or was reckless as to causing some physical harm (not necessarily GBH). R v Mowatt and DPP v Savage; Parmenter confirm that foresight of some harm is required for section 20 (subjective recklessness).

### Psychiatric Injury as GBH

- Recognised condition: severe psychiatric injury (e.g., major depressive disorder, PTSD) can be GBH if medically recognised (R v Ireland; R v Burstow).
- Proof: expert evidence (usually a psychiatrist/psychologist) is needed to show a clinical condition and that it is serious.
- Not enough: transient emotions such as fear, panic, or distress without a recognised diagnosis.

## Key Examples or Case Studies

### DPP v Smith [1961] AC 290

- Issue: Meaning of GBH.
- Held: GBH means “really serious” harm.
- Takeaway: The jury assesses seriousness objectively; no need for permanence.

### R v Bollom [2003] EWCA Crim 2846

- Issue: Assessing seriousness in context.
- Held: Consider the victim’s age and health, and cumulative effect of injuries.
- Takeaway: Injuries to a very young or vulnerable victim may amount to GBH when the same injuries might not for a healthy adult.

### R v JJC (A Minor) v Eisenhower [1983]

- Issue: What is a “wound”?
- Held: A wound requires a break in the continuity of the whole skin; internal bleeding alone is not a wound.
- Takeaway: Precise medical evidence matters when charging “wounding”.

### R v Ireland; R v Burstow [1998] AC 147

- Issue: Psychiatric injury and “inflict”.
- Held: Serious psychiatric injury can be GBH; “inflict” can mean “cause” and does not require assault/battery.
- Takeaway: GBH can be proved without direct physical contact if severe psychiatric harm is caused.

### R v Mowatt [1968] and DPP v Savage; Parmenter [1992] 1 AC 699

- Issue: Mens rea for section 20.
- Held: For section 20, the defendant must intend or foresee some physical harm (not necessarily serious harm).
- Takeaway: Section 20 stops short of requiring intent to cause GBH.

### R v Blaue [1975] 1 WLR 1411 and R v Cheshire [1991] 1 WLR 844

- Issue: Causation, thin skull, and medical treatment.
- Held: Victim’s vulnerabilities do not break the chain; medical treatment rarely does unless it is independent and overwhelming.
- Takeaway: Liability remains where the original injury is an operating cause.

### R v Roberts (1971)

- Issue: Victim’s response and foreseeability.
- Held: If the victim’s reaction (e.g., jumping from a moving car) is reasonably foreseeable, the chain remains intact.
- Takeaway: Indirect injury can still be attributed to the defendant.

## Practical Applications

- Selecting the charge:
  - Consider the injury: Is it a wound (break in the skin) or GBH (“really serious” harm)? Use medical reports.
  - Assess intent: Evidence of planning, weapon selection, threats, or repeat blows may point to section 18.
  - If intent to cause GBH cannot be proved, consider section 20 (intent/recklessness as to some harm).

- Evidence to gather:
  - Medical evidence: precise description of injuries; whether the skin was broken; radiology reports for fractures; psychiatric reports for any recognised condition.
  - Scene and timing: CCTV, witness statements, 999 calls, and any footage showing the degree of force or use of weapons.
  - Defendant’s words and conduct: threats, messages, or admissions before/after the incident that point to intention.
  - Causation factors: whether the victim’s reaction was foreseeable; whether medical treatment was ordinary and competent.

- Charging tips:
  - Plea strategy: Prosecutions may charge section 18 with section 20 as an alternative count, depending on evidence of intent.
  - Wounding vs GBH: Where the harm is short of “really serious” but there is a clear skin break, “wounding” under section 20 (or section 18 if intent is proved) may be appropriate.
  - Psychiatric injury: Only proceed for GBH where there is a clear, medically recognised condition with expert support.

- Directions to the jury:
  - GBH means “really serious” harm, assessed objectively.
  - For section 20, it is enough that some physical harm was intended or foreseen; for section 18, the defendant must have intended GBH (or intended to resist arrest while causing a wound/GBH).

- Sentencing overview:
  - Section 18: maximum life imprisonment, reflecting the higher culpability due to intent to cause GBH (or intent to resist arrest while causing such harm).
  - Section 20: maximum five years’ imprisonment.
  - Actual sentence depends on harm, culpability, use of weapons, sustained attack, victim vulnerability, and mitigation.

## Summary Checklist

- GBH = “really serious” harm (DPP v Smith); permanence is not required.
- Sections 18 and 20 both cover GBH and wounding; the main difference is intent.
- Wounding requires a break in the whole skin (Eisenhower).
- Section 18: intention to cause GBH (or intent to resist arrest while causing wound/GBH).
- Section 20: intention or recklessness as to some harm (Mowatt; Savage; Parmenter).
- Psychiatric injury can be GBH if a recognised medical condition is caused (Ireland; Burstow).
- Causation: apply “but for” and substantial and operating cause; thin skull rule applies (Smith; Cheshire; Blaue).
- Use clear medical and expert evidence to classify injuries and prove the elements.

## Quick Reference

| Concept                  | Authority                          | Key takeaway                                                        |
| ------------------------ | ---------------------------------- | ------------------------------------------------------------------- |
| Meaning of GBH           | DPP v Smith; R v Saunders          | GBH = (really) serious harm; permanence not needed                  |
| Wounding                 | R v JJC (A Minor) v Eisenhower     | Requires a break in the whole skin                                  |
| s.18 mens rea            | OAPA 1861 s.18; R v Woollin        | Must intend GBH (or intent to resist arrest causing GBH/wound)      |
| s.20 mens rea            | OAPA 1861 s.20; Mowatt; Parmenter  | Intend or foresee some physical harm                                |
| Psychiatric GBH          | R v Ireland; R v Burstow           | Serious, medically recognised condition can be GBH                  |
| Causation and thin skull | R v Smith; R v Cheshire; R v Blaue | Original injury must be substantial/operating; take victim as found |


GBH in UK Law: Definition, s18 vs s20, Elements and Cases