Medically recognised psychiatric harm

What is medically recognised psychiatric harm in negligence?

Psychiatric illness suffered through perceiving traumatic events. May also include a shock-induced physical condition.

Can a claimant recover in negligence for ordinary fear, distress or grief without a recognised psychiatric illness?

No. Negligence liability for psychiatric harm does not arise from ordinary fear, distress or mental grief alone Hinz v Berry

What must a claimant prove about the nature of psychiatric harm in negligence?

A medically recognised psychiatric illness or sufficiently material shock-induced physical condition.

Can a shock induced physical condition qualify as psychiatric harm for negligence purposes?

Yes. A shock induced condition such as a heart attack or miscarriage may qualify, provided the shock and resulting physical injury are sufficiently material.

What did Mazhar Hussain v Chief Constable of West Mercia establish about shock-induced physical conditions?

Minor physical symptoms are insufficient; numbness caused by anxiety and stress was not sufficiently material.

What is the first step when analysing a negligence claim for psychiatric harm?

The first step is to identify whether the claimant is an actual victim, a primary victim, a secondary victim or someone relying on assumption of responsibility.

Who is an actual victim in a negligence claim involving psychiatric harm?

An actual victim is a person who suffers physical injury, either alone or together with consequential psychiatric harm.

How does an actual victim claim for psychiatric harm in negligence?

By bringing an ordinary negligence claim for personal injury, which may include psychiatric injury resulting from the physical injury.

Does an actual victim need to satisfy the special control mechanisms for primary or secondary victims?

No. A claimant who has suffered physical injury brings an ordinary personal-injury negligence claim, including any consequential psychiatric harm.

Who is a primary victim in a negligence claim for psychiatric harm?

A primary victim is someone who suffers psychiatric harm because of a reasonable fear for their own physical safety while involved in the traumatic event.

What test determines whether a psychiatric-harm claimant reasonably feared for their own safety as a primary victim?

An objective test.

What is meant by the ‘danger zone’ in psychiatric-harm negligence claims?

An area in which a claimant is involved in the traumatic event and exposed to, or reasonably believes themselves exposed to, physical danger.

Must a primary victim in a psychiatric-harm claim suffer physical injury?

No. A primary victim is exposed to danger or reasonably fears physical injury but suffers psychiatric harm without necessarily suffering physical injury.

What did Dulieu v White establish about primary victims in psychiatric-harm claims?

Pregnant barmaid feared for her safety when carriage crashed into the pub treated as a primary victim.

Are rescuers automatically treated as primary victims in psychiatric-harm negligence claims?

No. Rescuers receive no special status and must establish they qualify as primary victims.

Are bystanders automatically treated as primary victims in psychiatric-harm negligence claims?

No. Bystanders receive no special status and must independently satisfy the requirements for primary-victim status.

What question should be asked when deciding whether a rescuer is a primary victim of psychiatric harm?

The court should ask whether the rescuer was actually exposed to physical danger or reasonably feared for their own physical safety.

Are rescuers penalised for voluntarily entering a dangerous situation when claiming psychiatric harm?

No. Rescuers are not given automatic special status, but they are not penalised merely because they voluntarily entered the danger.

What did Cullin v London Fire & Civil Defence Authority establish about rescuers and psychiatric harm?

A firefighter endangered during a rescue qualified as a primary victim.

What type of harm must a primary victim prove in a negligence claim for psychiatric injury?

Medically recognised psychiatric illness or a sufficiently material shock-induced physical condition.

Who is a secondary victim in a negligence claim for psychiatric harm?

A secondary victim is someone who suffers psychiatric harm through fearing for another person’s safety after witnessing a traumatic event or its immediate aftermath.

Is a secondary victim normally within the physical danger zone in a psychiatric-harm claim?

No. A secondary victim is not personally involved in the event or exposed to physical danger.

Whose safety does a secondary victim fear for in a psychiatric-harm claim?

A secondary victim fears for the safety of another person, normally a close relative or someone with whom they share a close tie of love and affection.

What harm must a secondary victim prove in a negligence claim?

A secondary victim must prove a medically recognised psychiatric illness or a sufficiently material shock-induced physical condition.

Must psychiatric harm suffered by a secondary victim result from a sudden shock?

According to Paul, a secondary victim’s medically recognised psychiatric harm does not have to result from a sudden shock.

Which case established the principal control mechanisms governing secondary-victim claims for psychiatric harm?

Alcock v Chief Constable of South Yorkshire Police, arising from the Hillsborough disaster, established the principal secondary-victim control mechanisms.

Are rescuers automatically treated as secondary victims in psychiatric-harm negligence claims?

No. Rescuers receive no special status and must satisfy the ordinary requirements for secondary-victim status.

What did White v Chief Constable of South Yorkshire Police establish about rescuers and psychiatric harm?

In White v Chief Constable of South Yorkshire Police, police officers who suffered PTSD after Hillsborough but were not themselves in physical danger were treated as secondary victims.

What did McFarlane v EE Caledonia Ltd establish about rescuers and primary-victim status?

In McFarlane v EE Caledonia Ltd, a rescuer on a boat near a disaster was a secondary rather than primary victim because he had no reasonable fear for his own safety.

What is a “medical-crisis” case in the law of psychiatric harm?

A medical-crisis case involves a relative witnessing a patient’s illness, collapse or death resulting from an earlier negligent medical diagnosis or treatment.

What did Paul v Royal Wolverhampton NHS Trust establish about psychiatric harm suffered by relatives witnessing a medical crisis?

Paul v Royal Wolverhampton NHS Trust held that doctors do not ordinarily owe a duty of care to relatives who suffer psychiatric harm from witnessing a patient’s medical crisis.

Why was no duty owed to the relatives in Paul v Royal Wolverhampton NHS Trust?

The relatives witnessed deaths resulting from earlier negligent medical misdiagnoses, but the doctors had not assumed a duty to protect those relatives from psychiatric harm.

Does a doctor generally owe a duty to protect a patient’s relatives from psychiatric harm caused by witnessing a medical crisis?

No. A doctor does not generally owe the patient’s relatives a duty to protect them from psychiatric harm caused by witnessing the patient’s medical crisis.

How are medical-crisis cases distinguished from accident cases in psychiatric-harm negligence?

An accident is an unintended and unexpected external event, whereas a medical crisis is the manifestation of an internal illness or condition following earlier negligence.

Does the Alcock framework apply to all traumatic medical events?

No. According to Paul, the Alcock framework applies to accidents rather than ordinary medical crises, although an accident may occur in a medical setting.

Can an accident occur in a medical setting for psychiatric-harm purposes?

Yes. A medical setting does not prevent an event from being an accident if it is an unintended and unexpected external event.

Why is proximity to an external traumatic event important in psychiatric-harm claims?

Proximity to an external traumatic accident is central to distinguishing a recognised secondary-victim accident claim from an excluded medical-crisis claim.

What foreseeability question determines whether a duty is owed to a primary victim of psychiatric harm?

The court asks whether physical injury to the claimant was reasonably foreseeable as a result of the defendant’s negligence.

Must psychiatric injury itself be foreseeable for a claimant who qualifies as a primary victim?

No. For a primary victim, reasonable foreseeability of physical injury is sufficient.

What happens if physical injury to a primary victim was not reasonably foreseeable?

If physical injury was not reasonably foreseeable, the defendant does not owe the claimant a duty as a primary victim.

How does the thin-skull rule apply to a primary victim’s psychiatric harm?

Once physical injury was reasonably foreseeable, the defendant must take the primary victim as found and may be liable for the full extent of the psychiatric harm.

What did Page v Smith establish about foreseeability and primary victims?

Foreseeable physical injury is sufficient for a primary-victim duty, even where the claimant instead suffers or experiences a worsening of psychiatric illness.

What happened in Page v Smith?

A minor road collision caused no physical injury but worsened the claimant’s ME; foreseeable physical injury was sufficient to establish the relevant duty.

How should a court establish a primary-victim duty where an existing psychiatric-harm precedent applies?

Where an existing precedent governs the facts, the court should apply that precedent.

How should a court establish a primary-victim duty where no existing psychiatric-harm precedent applies?

Where there is no existing precedent, the court should apply the limbs of the Caparo test.

Which criteria determine whether a duty is owed to a secondary victim of psychiatric harm?

A secondary victim must satisfy the Alcock criteria concerning foreseeability, close ties of love and affection, and proximity in time and space.

What type of harm must be reasonably foreseeable in a secondary-victim psychiatric-harm claim?

Medically recognised psychiatric harm must be reasonably foreseeable in a person of ordinary fortitude.

What is the “person of ordinary fortitude” test in secondary-victim psychiatric-harm claims?

The court asks whether a person of ordinary psychological resilience in the claimant’s position might foreseeably have suffered psychiatric harm.

What did Bourhill v Young establish about foreseeability of psychiatric harm?

Bourhill v Young illustrates that no duty is owed where psychiatric harm to a person of ordinary fortitude was not reasonably foreseeable.

How does the thin-skull rule apply to a secondary victim of psychiatric harm?

Once psychiatric harm to a person of ordinary fortitude is foreseeable, the defendant must take the claimant as found and may be liable for their full psychiatric injury.

Which case illustrates the thin-skull rule in a secondary-victim psychiatric-harm claim?

Brice v Brown illustrates that the thin-skull rule applies once psychiatric harm to a person of ordinary fortitude has been established as foreseeable.

Must an accident be objectively horrifying for a secondary victim to recover psychiatric-harm damages?

No. According to Paul, the accident itself does not have to be objectively horrifying.

What relational proximity must a secondary victim establish under the Alcock criteria?

A secondary victim must establish a close tie of love and affection with the person endangered or harmed in the accident.

In which relationships are close ties of love and affection rebuttably presumed for secondary-victim claims?

Close ties of love and affection are rebuttably presumed between parent and child, spouses, and engaged couples.

Which case is associated with presumed close ties of love and affection and the immediate aftermath of an accident?

McLoughlin v O’Brian, in which a mother saw her injured family shortly after the accident, represents the outer limit of acceptable immediate-aftermath proximity.

Are close ties of love and affection presumed between siblings in psychiatric-harm claims?

No. Siblings must provide evidence that their relationship was particularly close.

Are close ties of love and affection presumed between grandparents and grandchildren in psychiatric-harm claims?

No. Grandparents and grandchildren must prove that they shared a particularly close relationship.

Which case confirms that some relatives must prove particularly close ties of love and affection?

RE (A Child) v Calderdale and Huddersfield NHS Foundation Trust confirms that relationships such as siblings or grandparents and grandchildren do not carry an automatic presumption.

What did McCarthy v Chief Constable of South Yorkshire establish about close ties of love and affection?

In McCarthy v Chief Constable of South Yorkshire, a half-brother successfully proved a sufficiently close relationship with the accident victim.

What spatial and temporal proximity must a secondary victim establish under Alcock?

A secondary victim must be sufficiently close in time and space to the accident or its immediate aftermath.

How must a secondary victim perceive an accident or its immediate aftermath?

A secondary victim must see or hear the accident or immediate aftermath through their own unaided senses.

Which cases establish the requirement that a secondary victim perceive the event with their own senses?

McLoughlin v O’Brian and Alcock v Chief Constable of South Yorkshire Police require direct sensory perception of the accident or immediate aftermath.

What did Taylor v A Novo (UK) Ltd establish about temporal proximity in psychiatric-harm claims?

In Taylor v A Novo (UK) Ltd, a daughter who witnessed her mother’s death weeks after the original accident was too remote from the accident in time.

Does a delay between the defendant’s negligent breach and the eventual accident automatically prevent a secondary-victim claim?

No. According to Paul, a gap between the negligent breach and the accident does not itself bar recovery where the required proximity to the accident is established.

What floodgates concern supports restrictions on psychiatric-harm negligence claims?

Courts fear that allowing broad psychiatric-harm claims could create an indeterminate and excessively large class of potential claimants.

Which case is particularly associated with the floodgates concern in psychiatric-harm claims?

Alcock v Chief Constable of South Yorkshire Police is particularly associated with concern about opening the floodgates to extensive liability.

Why are fraudulent claims used as a policy argument for restricting psychiatric-harm liability?

Psychiatric harm has historically been perceived as easier to fabricate or exaggerate than physical injury.

What is meant by “crushing liability” as a policy concern in psychiatric-harm claims?

Crushing liability refers to the risk that defendants could face an overwhelming number and scale of claims arising from a single traumatic event.

When may assumption of responsibility provide a duty to prevent psychiatric harm?

Assumption of responsibility may create a duty where the claimant is not an actual, primary or secondary victim because they were neither involved in nor witnessed an accident.

What duty may arise through assumption of responsibility in psychiatric-harm negligence?

A defendant may owe a duty not to cause reasonably foreseeable psychiatric harm where the defendant has assumed responsibility for protecting the claimant from that harm.

What is the key foreseeability requirement in an assumption-of-responsibility psychiatric-harm claim?

Psychiatric injury to the particular claimant must have become reasonably foreseeable in the context of the relationship between the parties.

What did Walker v Northumberland County Council establish about occupational psychiatric harm?

Walker v Northumberland County Council established that an employer may owe a duty once psychiatric harm from workload becomes reasonably foreseeable.

Why was the first breakdown in Walker v Northumberland County Council not actionable?

The employee’s first breakdown was not reasonably foreseeable, so the employer was not in breach in relation to it.

Why was the second breakdown in Walker v Northumberland County Council actionable?

After the first breakdown, further psychiatric harm from the employee’s workload was foreseeable, so the employer owed and breached a duty concerning the second breakdown.

What relationship commonly gives rise to assumption-of-responsibility claims for psychiatric harm caused by occupational stress?

The employer–employee relationship commonly gives rise to duties concerning reasonably foreseeable psychiatric harm caused by occupational stress.

Which case illustrates an employer–employee psychiatric-harm claim involving occupational stress?

Waters v Commissioner of Police for the Metropolis illustrates an occupational psychiatric-harm claim within an employer–employee relationship.

Which case illustrates an assumption-of-responsibility relationship between doctor and patient concerning psychiatric harm?

AB v Leeds Teaching Hospital NHS Trust illustrates a doctor–patient relationship capable of supporting a duty concerning psychiatric harm.

Which case illustrates an assumption-of-responsibility relationship between the police and an informant?

Swinney v Chief Constable of Northumbria Police illustrates a police–informant relationship capable of supporting an assumption of responsibility.

How is foreseeability assessed in an employer’s duty concerning occupational psychiatric harm?

Foreseeability depends on the interaction between the claimant’s characteristics and the demands placed upon them by their employment.

Which case identifies factors relevant to the foreseeability of occupational psychiatric harm?

Barber v Somerset County Council identifies factors relevant to whether an employee’s psychiatric harm was reasonably foreseeable.

How does the nature and extent of an employee’s work affect foreseeability of psychiatric harm?

Particularly heavy, prolonged or emotionally demanding work may make psychiatric harm more reasonably foreseeable.

Why are an employee’s visible signs of stress relevant to foreseeability of psychiatric harm?

Signs of stress may alert the employer that the employee is at risk of suffering a psychiatric illness.

How do an employer’s size, scope and resources affect its duty concerning psychiatric harm?

The employer’s size, operational scope, available resources and practical capacity to respond are relevant when assessing what reasonable steps should have been taken.