In English law, psychiatric injury (nervous shock) refers to a medically recognised psychiatric condition caused by a defendant’s tort. Mere grief, distress, or anxiety is not enough without a recognised disorder (for example, PTSD, major depressive disorder, or an adjustment disorder).
Definition and principles
Claims divide into primary victims and secondary victims. Primary victims are directly involved in the incident or within the range of foreseeable physical injury; ordinary negligence principles apply. Secondary victims are witnesses to injury to others and must satisfy control mechanisms: (i) a close tie of love and affection; (ii) proximity in time and space to the accident or its immediate aftermath; (iii) direct perception by sight or hearing (not via third-hand reports). Modern authority also emphasises the need for an identifiable accident or external event rather than a gradual realisation.
Common examples
Employee suffers PTSD after being involved in an explosion at work (primary victim).
Parent witnesses a child’s serious injury in a road traffic accident and develops a recognised disorder (secondary victim).
Rescuer directly exposed to danger at a disaster scene (often treated as primary depending on facts).
Claims failing where distress stems from news of injury, negligent information, or a prolonged deterioration without a single event.
Legal implications
Diagnosis must be a recognised psychiatric condition; expert medical evidence is standard.
For secondary victims, all control mechanisms must be met; bystanders with no close tie usually fail.
Causation and remoteness apply; the “egg-shell skull” rule means vulnerability does not defeat liability once duty and breach are established.
Limitation is generally three years from injury or date of knowledge (with court discretion to extend).
Practical importance
Plead whether the claimant is primary or secondary, set out the accident/event, the control mechanisms (if secondary), and provide early psychiatric evidence to confirm diagnosis and causation.
See also: Negligence; Duty of care; Secondary victims; Proximity; Rescuers; Pure psychiatric harm; Personal injury; Limitation.
A claimant suffered a minor head injury in a car accident, leading to severe depression and suicide. The court held that the suicide did not break the chain of causation as it was a foreseeable consequence of the depression caused by the defendant's negligence. Facts The claimant, Mrs Sylvia Whitehead, was a passenger in a car driven by her husband when it was involved in a collision caused by the negligence of the first defendant, Mrs Searle. Mrs Whitehead, then 63, sustained a minor head injury but subsequently developed a profound personality change and severe depression. Approximately three and a
Foster parents were assured they would not receive a known child abuser, but the council placed one who then sexually abused their own children. The parents suffered psychiatric injury and sued. The House of Lords held their claim was arguable. Facts The plaintiffs, Mr and Mrs W, were experienced foster parents. They specifically informed the defendant, Essex County Council, that they were unwilling to foster any child known or suspected to be a sexual abuser. The council, needing to place a 15-year-old boy, G, assured the plaintiffs that there was no history of such behaviour. In reality, G was a
A social worker, employed by a council but managed by an NHS Trust while working in an integrated team, was assaulted by a patient's relative. The Court of Appeal held the Trust owed her a direct duty of care as it had assumed responsibility for her safety. Facts The claimant, Mrs Selwood, was an experienced social worker and approved mental health professional employed by Durham County Council (the first defendant). She was seconded to the Tees, Esk and Wear Valleys NHS Foundation Trust (the Trust, the second defendant) and worked as part of an integrated multi-disciplinary Community Mental Health Team
The plaintiff, who was physically unhurt in a minor car accident caused by the defendant's negligence, suffered a recurrence of psychiatric illness (ME). The House of Lords held that where personal injury is foreseeable, a claimant is a 'primary victim' and can recover for psychiatric harm, even if that specific harm was unforeseeable. Facts The plaintiff, Mr Page, had suffered from myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome, for approximately 20 years, but it was in remission at the time of the incident. In 1987, he was involved in a car collision caused by the negligence of the
A mother suffered psychiatric illness after witnessing a 36-hour period of negligent medical care culminating in her baby's death. The Court of Appeal held this entire seamless period could constitute a single, shocking event, allowing her to claim damages for nervous shock. Facts The claimant, Mrs Walters, brought a claim for psychiatric illness (nervous shock) following the death of her 10-month-old baby, who was under the care of the defendant, North Glamorgan NHS Trust. The baby suffered a major epileptic fit and was taken to hospital. Due to a negligent failure to diagnose and treat acute hepatitis, his condition deteriorated
The plaintiff suffered severe nervous shock after seeing her seriously injured family in hospital, two hours after a road accident. The House of Lords held the negligent driver was liable, extending the duty of care to those witnessing the 'immediate aftermath'. Facts The plaintiff, Mrs McLoughlin, was at her home approximately two miles from the scene of a serious road traffic accident involving her husband and three of her children. The accident was caused by the negligence of the defendants. About two hours after the accident occurred, she was informed and driven to Addenbrooke’s Hospital. There, she saw her husband
Parents, wrongly accused of child abuse by health professionals, sued for psychiatric injury. The House of Lords held professionals owed no duty of care to parents in this context, as it would conflict with their paramount duty to protect the child's welfare. Facts This case comprised three conjoined appeals. In each, parents were wrongly suspected of abusing their children by medical professionals or social workers. In the case of JD, he was suspected of injuring his daughter. In the case of RK and MAK, they were suspected of fracturing their son’s skull. In the case of MK, a local authority
Parents of two teenagers crushed in the Hillsborough disaster claimed damages for the fear and terror their daughters suffered before death. The House of Lords held that pre-death terror, however awful, does not constitute a recoverable injury without accompanying physical harm. Facts The appellants were the parents and personal representatives of Sarah and Victoria Hicks, aged 19 and 15, who were tragically killed in the Hillsborough stadium disaster on 15 April 1989. The two sisters were in one of the central pens behind the goal when a fatal crush occurred. They both died from traumatic asphyxia. The appellants brought a
Four conjoined appeals tested employers' liability for psychiatric injury from workplace stress. The Court of Appeal, allowing three of the four appeals, established key principles for foreseeability and breach of duty, providing sixteen practical propositions for future stress-at-work claims. Facts This Court of Appeal judgment concerned four conjoined appeals (Barber, Hatton, Jones, and Baker) where employees had suffered psychiatric illness, allegedly due to stress from their work. The facts of the individual cases were: Barber v Somerset County Council: Mr Barber, a teacher, suffered a stress-related breakdown after taking on extra responsibilities in a struggling department. Despite representations to senior
A fire officer suffered psychiatric illness after attending a road accident where his son was the seriously injured, negligent driver. The court held that the son, as a primary victim, owed no duty of care for psychiatric harm caused to his father. Facts The claimant, Christopher Greatorex, was a leading fire officer. He was called to attend a serious road traffic accident. Upon arrival, he discovered that the person severely trapped in the crashed vehicle was his own son, John Greatorex, the first defendant. The son had been driving a car belonging to the second defendant, his friend Mr. Harrison,
