Negligence: Psychiatric Injury

Psychiatric injury (often referred to in older cases as "nervous shock") is one of the most complex and contested areas of the law of negligence. The courts have developed restrictive rules about when damages can be recovered for psychiatric harm, distinguishing between primary victims (those directly involved in the traumatic event) and secondary victims (those who witness or learn about the traumatic event). This lesson examines the legal framework governing claims for psychiatric injury, including the key cases and the policy considerations that have shaped the law.

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What Is Psychiatric Injury?

In law, psychiatric injury means a medically recognised psychiatric illness or condition, such as:

• Post-traumatic stress disorder (PTSD)
• Clinical depression
• Anxiety disorder
• Pathological grief

Ordinary emotions such as grief, distress, or upset — however severe — are not sufficient to found a claim for psychiatric injury. The claimant must show that they have suffered a recognised psychiatric illness that has been diagnosed by a medical professional.

Key Definition: Psychiatric injury (formerly "nervous shock") is a medically recognised psychiatric illness caused by the defendant's negligence. Ordinary grief, distress, or emotional upset is not enough.

Page v Smith [1996] confirmed that psychiatric injury is a form of personal injury and is therefore actionable in negligence, provided the relevant requirements are met.

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Primary Victims and Secondary Victims

The law draws a fundamental distinction between primary victims and secondary victims:

Category	Definition	Requirements
Primary victim	A person who is directly involved in the traumatic event and within the range of foreseeable physical injury	Must show: (1) duty of care; (2) breach; (3) medically recognised psychiatric illness
Secondary victim	A person who is not directly involved but witnesses or perceives the traumatic event	Must satisfy the Alcock control mechanisms (see below)

flowchart TD
    A["Claimant suffers<br/>psychiatric injury"] --> B{"Was C directly<br/>involved in the<br/>event?"}
    B -- Yes --> C["PRIMARY VICTIM<br/>(Page v Smith test)"]
    B -- No --> D["SECONDARY VICTIM<br/>(Alcock control<br/>mechanisms)"]
    C --> E{"Was physical<br/>injury to C<br/>foreseeable?"}
    E -- Yes --> F["Duty of care<br/>ESTABLISHED<br/>— no need to prove<br/>psychiatric injury<br/>was foreseeable"]
    E -- No --> G["No duty of care"]
    D --> H{"Does C satisfy<br/>ALL Alcock<br/>criteria?"}
    H -- Yes --> I["Duty of care<br/>ESTABLISHED"]
    H -- No --> J["No duty of care"]

    style A fill:#1a5276,color:#fff
    style F fill:#27ae60,color:#fff
    style I fill:#27ae60,color:#fff
    style G fill:#c0392b,color:#fff
    style J fill:#c0392b,color:#fff

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Primary Victims

A primary victim is someone who was directly involved in the traumatic event and was within the area of foreseeable physical danger.

Page v Smith [1996]

Aspect	Detail
Facts	Mr Page was involved in a minor car collision caused by the defendant's negligence. He suffered no physical injuries, but the accident triggered a recurrence of chronic fatigue syndrome (CFS), a condition from which he had previously recovered.
Decision	The House of Lords held that Mr Page could recover for his psychiatric injury. As a primary victim (directly involved in the accident and within the area of foreseeable physical danger), it was not necessary to show that psychiatric injury was foreseeable — only that some form of personal injury was foreseeable.
Principle	For primary victims, if physical injury is foreseeable, the defendant owes a duty of care in respect of psychiatric injury as well, even if psychiatric injury was not itself foreseeable. This is an application of the thin skull rule.

Who Is a Primary Victim?

The courts have identified several situations where a claimant may be a primary victim:

1. Physical danger zone — The claimant was in the area of foreseeable physical danger (Page v Smith)
2. Reasonable belief of danger — The claimant reasonably believed they were in danger, even if they were not actually at risk (McFarlane v EE Caledonia [1994] — but note the claimant in this case was not held to be a primary victim because he was merely a bystander on a boat watching the Piper Alpha oil rig disaster)
3. Unwitting agent of harm — The claimant was an unwitting agent in causing harm to another person (Dooley v Cammell Laird [1951] — a crane operator whose crane dropped a load into a ship's hold where colleagues were working)

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Secondary Victims

A secondary victim is someone who was not directly involved in the traumatic event but who suffers psychiatric injury as a result of witnessing or perceiving it. The leading case is Alcock v Chief Constable of South Yorkshire [1992].

Alcock v Chief Constable of South Yorkshire [1992]

Aspect	Detail
Facts	The case arose from the Hillsborough disaster (15 April 1989), in which 96 Liverpool football fans were killed in a crush at Sheffield Wednesday's Hillsborough stadium. The disaster was caused by police negligence in crowd control. Relatives and friends of the victims who were at the ground, watching on television, or heard about the disaster on the radio, suffered psychiatric injury and claimed damages.
Decision	The House of Lords dismissed all the claims. None of the claimants satisfied the control mechanisms required for secondary victims.

The Alcock Control Mechanisms

The House of Lords in Alcock established three control mechanisms (or "proximity requirements") that a secondary victim must satisfy: