Claims for psychiatric harm - Rescuers and bystanders

Learning Outcomes

This article examines how English negligence law regulates claims for psychiatric harm by rescuers and bystanders, including:

• the classification of rescuers as primary victims by reference to actual or reasonably perceived danger, the "zone of danger" concept, and the consequences this has for duty of care and foreseeability
• the strict Alcock control mechanisms governing secondary victim claims (close ties of love and affection, proximity in time and space, and direct perception with unaided senses) and how these apply to rescuers and bystanders
• foreseeability requirements for primary and secondary victims, including the distinction between foreseeability of physical injury and foreseeability of psychiatric harm in a person of normal fortitude
• the "sudden shock" requirement, the meaning of the "immediate aftermath", and how leading cases such as Walters, Sion, and Ronayne demonstrate the limits of recovery for gradually developing conditions
• the limited circumstances in which special relationships and assumption of responsibility (for example, employer–employee or custodial situations) can found liability for psychiatric harm
• the policy reasons behind restricting claims by professional rescuers and mere bystanders, and how these policy concerns influence the courts’ approach to modern case law such as White and Alcock
• the analytical steps appropriate for SQE1 problem questions, from identifying whether the claimant is a primary or secondary victim through to applying the control mechanisms, foreseeability tests, sudden shock requirement, and any relevant policy arguments.

SQE1 Syllabus

For SQE1, you are required to understand the legal framework for claims for psychiatric harm, especially as it applies to rescuers and bystanders, with a focus on the following syllabus points:

• the distinction between primary and secondary victims in psychiatric harm claims
• the legal status and requirements for rescuers to claim for psychiatric harm
• the strict criteria for bystanders and the policy reasons for limiting liability
• how to apply the relevant legal rules and principles to realistic problem scenarios
• the Alcock control mechanisms and their operation: close tie of love and affection (presumed for parents, children and spouses but otherwise to be proved), proximity in time and space to the event or its immediate aftermath, and direct perception with unaided senses
• the “sudden shock” requirement and how courts have treated aggregated or prolonged exposure (compare Walters with Sion and Ronayne)
• foreseeability differences: for primary victims it is sufficient that physical injury is foreseeable; for secondary victims psychiatric harm to a person of normal fortitude must be foreseeable
• the modern approach to rescuers: no special status absent danger (White), but recognition of primary victim status where rescuers are in actual or reasonably perceived danger (e.g. Chadwick)
• how assumption of responsibility can arise in limited relationships where vulnerability to psychiatric harm is known (e.g. employer/employee), and its limits.

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 must a rescuer show to be classified as a primary victim in a psychiatric harm claim?
2. Which legal test determines whether a bystander can recover for psychiatric harm?
3. True or false? A bystander who witnesses a traumatic event involving strangers can claim for psychiatric harm if the harm was foreseeable.
4. What is the main policy reason for restricting claims for psychiatric harm by bystanders?

Introduction

Claims for psychiatric harm by rescuers and bystanders are tightly controlled in English law. The courts have developed strict rules to limit liability for psychiatric injury, especially where the claimant is not physically injured. Understanding the distinction between primary and secondary victims, and the special position of rescuers and bystanders, is essential for SQE1.

Psychiatric harm in negligence requires a medically recognised psychiatric illness caused by a sudden shocking event; grief, distress or ordinary sorrow are not enough. Where psychiatric harm follows physical injury to the claimant, it is treated as consequential loss and governed by ordinary negligence rules. The present article focuses on pure psychiatric harm (no physical injury) in the contexts of rescuers and bystanders, where the courts have introduced control mechanisms to confine recovery.

Key Term: rescuer
A person who voluntarily attempts to assist or save others in danger as a result of the defendant’s negligence.

Key Term: primary victim
An individual directly involved in an incident, who is physically injured or placed in danger of physical injury by the defendant’s negligence.

Key Term: secondary victim
A person who suffers psychiatric harm as a result of witnessing injury to others, but who is not themselves in physical danger.

Rescuers and Psychiatric Harm

Rescuers are people who attempt to help others in danger or distress following an incident caused by the defendant’s negligence. The courts have historically shown sympathy to rescuers, but the current law sets clear limits on when a rescuer can recover for psychiatric harm.

To succeed in a claim for psychiatric harm, a rescuer must be classified as a primary victim or satisfy the strict requirements for secondary victims.

If a rescuer is exposed to actual or reasonably perceived danger of physical injury, they are treated as a primary victim. In this case, it is enough that physical injury was foreseeable, even if only psychiatric harm occurs. The “zone of danger” includes circumstances where the rescuer reasonably believes they are at risk of physical injury.

This approach accords with the broader primary victim rule confirmed in Page v Smith: if it is reasonably foreseeable that the defendant’s negligence might cause physical injury to the claimant, the defendant owes a duty in respect of psychiatric harm, even if psychiatric injury (not physical injury) results. In the rescuer context, courts have recognised primary victim status where rescuers have entered dangerous situations or reasonably believed they were in danger (e.g. rescuers working near unstable wreckage).

If a rescuer is not exposed to danger, they are treated as a secondary victim and must satisfy the strict control mechanisms for secondary victims. In practice, professional rescuers or emergency workers who assist from outside the zone of danger rarely satisfy these secondary victim requirements, as they typically lack the necessary close tie of love and affection to the primary victims and often do not meet the proximity and perception criteria.

Worked Example 1.1

A police officer attends the scene of a major accident and helps victims, but is never in physical danger. He later develops post-traumatic stress disorder. Can he claim for psychiatric harm?

Answer:
The officer is not a primary victim because he was not in danger. He is a secondary victim and must meet the Alcock criteria (close tie of love and affection, proximity, direct perception, and foreseeability). As he is unlikely to satisfy these, his claim will fail.

Additional points on rescuers

• Reasonably perceived danger suffices. A rescuer who reasonably believes they are in danger of physical injury is treated as a primary victim, even if the danger later turns out not to have been real.
• Assumption of responsibility in particular relationships can create a duty to avoid psychiatric harm where vulnerability is known. For example, an employer or custodial authority may owe a duty to take reasonable steps to avoid exposing a known vulnerable person to a foreseeable risk of psychiatric harm. This is exceptional and fact-specific, and does not confer a general special status on all rescuers or employees.
• Rescuers are not treated as consenting to risk merely because they act bravely. Separate issues of consent and contributory negligence may arise where rescuers are injured, but these do not erode the primary/secondary victim analysis for psychiatric harm.

Worked Example 1.2

A firefighter enters a smoke-filled flat to rescue occupants. Though he is not physically injured, he later develops a recognised psychiatric illness. Is he a primary victim?

Answer:
Yes. He was in the zone of physical danger (and at least reasonably perceived such danger). As a primary victim, it is sufficient that physical injury was foreseeable; he can recover for psychiatric harm even though he suffered no physical injury.

The Modern Approach: White v Chief Constable of South Yorkshire Police

The leading case is White v Chief Constable of South Yorkshire Police. The House of Lords held that rescuers who are not in actual or reasonably perceived danger cannot claim as primary victims. They must instead meet the requirements for secondary victims, which are rarely satisfied.

White also makes clear that employees do not enjoy special status merely because psychiatric harm occurred during the course of employment. Claims by professional rescuers who were not in danger failed; those claimants did not meet the Alcock control mechanisms. The decision aligned the law on rescuers with the general primary/secondary victim distinction and reflected floodgates and fairness concerns.

Earlier sympathy for rescuers (e.g. compensation for those exposed to hazardous rescue conditions) does not bypass the need to show danger for primary victim status, or satisfy the secondary victim criteria otherwise. Where rescuers are within the danger zone (or reasonably believe themselves to be), they remain eligible as primary victims.

Exam Warning

The courts no longer give rescuers special status for psychiatric harm claims. Unless the rescuer is in danger, they must satisfy the same strict criteria as any other secondary victim.

Bystanders and Psychiatric Harm

Bystanders are people who witness traumatic events but have no close relationship with the victims and are not in danger themselves. The courts are reluctant to allow claims by bystanders for psychiatric harm.

Key Term: bystander
A person who witnesses an incident but is not involved, not in danger, and has no close relationship with the victims.

The courts require bystanders to satisfy the secondary victim criteria, which include:

• a close tie of love and affection with the primary victim (presumed for parents, children and spouses; otherwise to be proved)
• proximity to the event or its immediate aftermath
• direct perception of the event (not via media)
• foreseeability of psychiatric harm in a person of normal fortitude

If these are not met, the claim will fail. This reflects the approach in Alcock v Chief Constable of South Yorkshire Police and subsequent authorities that have clarified elements of proximity and perception.

“Immediate aftermath” has been interpreted strictly. In McLoughlin v O’Brian, a claimant who encountered her injured family at hospital shortly after the crash, still in the same condition as at the scene, recovered as she came upon the immediate aftermath. By contrast, in Taylor v A Novo (UK) Ltd, a shock suffered days later when a claimant witnessed a secondary event (unrelated in time and place to the original negligence) was too remote; the “immediate aftermath” requirement was not satisfied.

Direct perception with unaided senses excludes claims based on televised or internet coverage. Live broadcasts showing distress at a scene will not suffice unless the claimant directly perceives the accident or immediate aftermath involving identifiable individuals; indirect communication or later news is insufficient.

The foreseeability requirement for secondary victims focuses on a person of normal fortitude in the claimant’s position. If psychiatric harm to a person of normal fortitude was not reasonably foreseeable, no duty arises. Once duty is established, the eggshell skull principle applies to quantum, so a claimant’s particular susceptibility may increase the extent of recoverable loss.

Worked Example 1.3

A passer-by witnesses a serious car accident involving strangers and later suffers psychiatric illness. Can she claim for psychiatric harm?

Answer:
No. As a bystander with no close relationship to the victims, she cannot satisfy the secondary victim criteria. Her claim will fail.

Worked Example 1.4

A mother arrives at hospital within an hour of a negligent crash and sees her child still in the same state as at the scene (covered in oil and mud). She later suffers a recognised psychiatric illness. Can she recover?

Answer:
Yes, if she satisfies the Alcock control mechanisms. A close tie of love and affection is presumed. She encountered the immediate aftermath and directly perceived the consequences with unaided senses. Psychiatric harm to a person of normal fortitude in her position is reasonably foreseeable.

Worked Example 1.5

A pregnant bystander hears a crash from a distance and later sees blood on the road but did not witness the accident or its aftermath with identifiable victims. She develops shock and suffers a stillbirth. Can she recover?

Answer:
No. She was outside the zone of danger and did not directly perceive the accident or its immediate aftermath involving identifiable individuals. Psychiatric harm in her position was not reasonably foreseeable to the defendant.

Sudden Shock Requirement

The psychiatric harm must result from a sudden, shocking event. Gradual development of psychiatric illness from ongoing exposure will not suffice. The courts have rejected claims based on prolonged distress without a sudden shock (e.g. Sion v Hampstead Health Authority, Liverpool Women’s Hospital NHS Trust v Ronayne). However, a sequence of events over a short period may be treated as a single horrifying event where there is continuity and suddenness (e.g. Walters), underscoring that the evaluation is fact-sensitive but remains tightly confined.

Key Term: sudden shock
A psychiatric injury caused by a single, traumatic event, rather than by a gradual process.

Nuances and limits for bystanders

• Media reports are insufficient. Watching events on television or via the internet does not meet the direct perception requirement.
• The immediate aftermath must be closely connected in time and place to the accident, and involve direct sensory perception of the consequences.
• Foreseeability is judged by reference to a person of normal fortitude. A claimant’s unusual vulnerability does not expand the duty; if duty is established, the eggshell skull rule may then affect the extent of damages.

Related contexts

Although the focus here is rescuers and bystanders, courts have occasionally recognised psychiatric harm in other contexts:

• Witnessing destruction of one’s own property (e.g. severe fire damage) may, in principle, support recovery where a recognised psychiatric illness results and negligence is proved.
• Anxiety alone about future disease, without current actionable damage, is not compensable (e.g. pleural plaques and anxiety about future illness).

These categories are constrained by causation, remoteness, and the requirement for a medically recognised condition.

Policy Reasons for Limiting Claims

The courts restrict claims by rescuers (not in danger) and bystanders to avoid unlimited liability and to keep the scope of duty of care manageable. The limitation reflects concerns about:

• floodgates: risk of indeterminate liability to a wide class of witnesses
• evidential and causation difficulties in psychiatric harm
• the need for proximity and direct perception to confine liability to those most closely and immediately affected
• fairness between defendants and claimants, ensuring liability aligns with reasonably foreseeable harm

This calibrated approach aims to balance fairness to claimants with the need to prevent an unmanageable number of claims, while maintaining coherence in negligence principles.

Revision Tip

For SQE1, always check whether the claimant was in physical danger (primary victim) or is a secondary victim. Only primary victims can claim without meeting the strict secondary victim criteria. For secondary victims, work through Alcock in order: tie of love and affection; proximity in time and space; direct perception; and foreseeability to a person of normal fortitude. Confirm the “sudden shock” requirement.

Summary

Key Point Checklist

This article has covered the following key knowledge points:

• The distinction between primary and secondary victims is essential in psychiatric harm claims.
• Rescuers can claim as primary victims only if they are in actual or reasonably perceived danger.
• Rescuers not in danger and bystanders are treated as secondary victims and must satisfy strict criteria.
• The courts require a close tie of love and affection, proximity (to the event or immediate aftermath), direct perception with unaided senses, and foreseeability to a person of normal fortitude for secondary victims.
• Psychiatric injury must be a medically recognised condition caused by a sudden shocking event; gradual onset does not suffice.
• Media coverage (TV or internet) does not meet the requirement of direct perception; proximity is interpreted strictly.
• Once secondary victim duty is established, the eggshell skull principle affects quantum, not duty; for primary victims, foreseeability of physical injury suffices.
• Policy reasons limit claims by rescuers (not in danger) and bystanders to prevent unlimited liability and maintain coherence in negligence.

Key Terms and Concepts

• rescuer
• primary victim
• secondary victim
• bystander
• sudden shock