SQE1 psychiatric harm: what you must know and how it is tested

SQE1 psychiatric harm questions test whether the claimant is a primary or secondary victim, because the test differs. The harm must be a recognised psychiatric illness, not mere grief or distress. Read it with the wider Tort guide.

SubjectTort (FLK1)

Key lawAlcock; Page v Smith; White v CC South Yorkshire

Question typeSingle best answer, five options

The rules to apply

The claimant must suffer a recognised psychiatric illness, such as PTSD, caused by the defendant's negligence. Grief and distress alone are not enough. The claimant must first show the usual elements of negligence.

A primary victim is within the zone of physical danger, or reasonably believes they are. If physical injury to them was reasonably foreseeable, they can recover for psychiatric injury even if it was not foreseeable that they would suffer psychiatric illness (Page v Smith). The eggshell skull rule then applies. A rescuer is a primary victim only if exposed to danger or reasonably believing they are (Chadwick v British Railways Board; White v Chief Constable of South Yorkshire).

A secondary victim suffers harm from witnessing harm to another. Under Alcock v Chief Constable of South Yorkshire, they must show: a close tie of love and affection with the person injured (presumed for spouses and parent and child, proved for others); closeness in time and space to the accident or its immediate aftermath; and perception with their own unaided senses (not television reports). A secondary victim must also be a person of reasonable fortitude, so the eggshell skull rule does not apply. The immediate aftermath can include the hospital some time later, if the victim is still in the state caused by the accident (McLoughlin v O'Brian). In Paul v Royal Wolverhampton NHS Trust the Supreme Court confirmed these control mechanisms and held that a secondary victim must witness an accident, or its immediate aftermath, involving a close relative. Relatives who saw a death caused by an earlier medical failure could not recover as secondary victims.

Traps examiners use

Treating grief or distress as enough.
Applying the Alcock tests to a primary victim.
Requiring foreseeable psychiatric injury for a primary victim. Foreseeable physical injury suffices.
Allowing a claim based on live television coverage.
Forgetting the close tie of love and affection for non-family claimants.
Ignoring time: the immediate aftermath is limited.

Worked question 1

Tom drives negligently and crashes into a bus shelter. Hannah stands 10 metres away and narrowly escapes, uninjured. She later suffers PTSD. Which statement is correct?

A. She can recover only if she proves a close tie of love and affection with someone injured.
B. She is a primary victim, since physical injury to her was reasonably foreseeable, and may recover if she suffered a recognised psychiatric illness.
C. She cannot recover, because she was not physically hurt.
D. She can recover only if she saw the crash on television.
E. She can recover only if she is a person of reasonable fortitude and the harm was foreseeable.

Answer: B. Hannah was within the zone of danger, so she is a primary victim (Page v Smith). The Alcock tests are for secondary victims, and A, D and E import them wrongly. Physical injury is not needed (C).

Worked question 2

A railway company negligently causes a crash. Dana's husband is seriously injured. She sees the wreckage on a news report within an hour, then reaches the hospital an hour after that, where she sees him still bloodied and in distress. She develops a psychiatric illness. Which statement is correct?

A. She fails because she first saw the crash on television.
B. She fails because she was not at the scene.
C. She may succeed as a secondary victim, as she attended the immediate aftermath and saw her husband with her own senses.
D. She succeeds automatically because she is a spouse.
E. She fails because the psychiatric illness was not foreseeable.

Answer: C. Her tie with her husband is presumed. Her seeing him at the hospital, in the state caused by the crash, falls within the immediate aftermath (McLoughlin v O'Brian). The television report does not count as perception, but it does not defeat her claim. D is wrong because the other Alcock elements must also be shown.

Checklist before you move on

Recognised psychiatric illness?
Primary victim: in danger, or reasonably believing so?
Secondary victim: tie, proximity, perception of an accident?
Rescuer: in danger?
Reasonable fortitude (secondary only)?
Accident or similar event (Paul)?

Test yourself on more original questions in our SQE1 practice questions.

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Questions

What is the difference between a primary and a secondary victim?

A primary victim is in physical danger from the defendant's negligence. A secondary victim is a bystander who suffers harm from witnessing harm to someone else and must satisfy the Alcock control mechanisms.

Can I claim for psychiatric harm seen on television?

Generally not. A secondary victim must perceive the event or its immediate aftermath with their own unaided senses.

Is grief enough to claim?

No. The claimant must suffer a recognised psychiatric illness.

Sources: SRA: SQE1 Assessment Specification (from 1 September 2026); Find Case Law (National Archives); BAILII. Checked 10 November 2026.