Psychiatric injury

Liability for psychiatric injury in negligence depends on whether the claimant is a primary victim (within the zone of foreseeable physical injury) or a secondary victim (witnessing harm to another). Primary victims need only prove physical injury was reasonably foreseeable; psychiatric harm need not be separately foreseeable (Page v Smith). Secondary victims must satisfy the restrictive Alcock control mechanisms: (1) close tie of love and affection with the injured person; (2) proximity in time and space to the accident or immediate aftermath; (3) direct perception with unaided senses; (4) sudden shock causing (5) recognised psychiatric illness. These policy-driven restrictions prevent indeterminate liability by limiting the class of potential claimants beyond ordinary foreseeability principles.

Alcock v Chief Constable of South Yorkshire Police [1992] 1 AC 310: Established the five cumulative control mechanisms for secondary victims following Hillsborough disaster claims. Created the modern framework requiring proximity of relationship, time/space, direct perception, and sudden shock—pure foreseeability insufficient.

Page v Smith [1996] AC 155: Primary victims need only establish foreseeability of physical injury; psychiatric harm automatically recoverable even if unforeseeable. Created binary distinction making physical proximity determinative of recovery rights.

White v Chief Constable of South Yorkshire Police [2001] 1 AC 455: Rescuers and employees have no special status—must qualify as primary victims (in danger) or satisfy Alcock as secondary victims. Closed off attempts to create privileged claimant categories.

McLoughlin v O'Brian [1983] 1 AC 410: Extended 'immediate aftermath' to hospital arrival two hours post-accident where claimant saw injured family in original state. Represents high-water mark of liberalisation before Alcock retrenchment.

Paul v Royal Wolverhampton NHS Trust [2024] UKSC 1: Confirmed Alcock's rigidity; mother witnessing negligent stillbirth not a primary victim despite physical involvement in delivery. Supreme Court deferred reform to Parliament, entrenching restrictive framework.

Courts first classify the claimant: were they within range of foreseeable physical injury? If yes, apply Page v Smith—duty established, all personal injury recoverable. If no, apply Alcock's five-stage test sequentially. For relationships, spouse/parent-child presumed close; others must prove special bond. For proximity, presence at scene or immediate aftermath (before material alteration) required—typically under two hours. Perception must be direct sensory, not television/communication. The psychiatric harm must result from sudden shocking event, not gradual realisation. Finally, claimant must have recognised psychiatric illness (PTSD, clinical depression), not mere grief. Failure at any stage defeats claim. Alternative routes exist via assumption of responsibility or employment duties, but courts resist expansion post-Paul.

Students wrongly apply Alcock to primary victims—remember Page v Smith requires only foreseeable physical injury. Conversely, don't assume foreseeability alone suffices for secondary victims. Primary victim status requires actual risk of physical harm, not mere proximity or involvement. All claimants need recognised psychiatric illness—grief/distress never compensable. 'Immediate aftermath' is narrow: two hours maximum, before scene alteration. Television/phone notification fails the direct perception requirement. Post-White, rescuers get no special treatment. Consider alternative duties (employer, clinical negligence) outside Alcock framework.