Overview

Recent case law has significantly reshaped the landscape of psychiatric injury claims arising from clinical negligence. In particular, the Supreme Court’s decision in Paul v Royal Wolverhampton NHS Trust [2024] has clarified, and in many respects restricted, the scope of secondary victim claims in a clinical context.

The courts have since begun to interpret and apply this ruling, especially in relation to whether a “medical crisis” can constitute the kind of “accident” required for a secondary victim claim. This has important implications for claims brought by family members who witness distressing medical events caused by negligent treatment.

Alongside this, the Supreme Court has revisited the doctrine of illegality (ex turpi causa) in the context of psychiatric patients. This raises complex questions about whether claimants can recover damages where their own unlawful acts, committed as a result of negligent psychiatric care, have caused harm to others.

Together, these developments mark a tightening of legal boundaries around psychiatric injury claims, both in terms of who can claim (secondary victims) and when claims may be barred on public policy grounds (illegality).

Learning Objectives

By the end of this session, participants should be able to:

• Understand the legal framework governing secondary victim claims
• Recall the key requirements for establishing secondary victim status.
• Explain how these principles apply in clinical negligence cases involving a primary victim.
• Distinguish between an “accident” and a “medical crisis”
• Analyse how the courts differentiate between sudden external events and the progression of illness.
• Assess why this distinction is critical following Paul.
• Evaluate the viability of secondary victim claims post-Paul
• Identify the limitations imposed by the Supreme Court.
• Determine whether, and in what circumstances, such claims may still succeed in clinical negligence cases.
• Examine the current scope of the illegality defence in psychiatric negligence claims
• Understand how the defence has been applied in recent Supreme Court authority.
• Assess the role of public policy in limiting recovery.
• Assess whether illegality operates as an automatic bar
• Critically evaluate whether psychiatric patients who harm others due to negligent treatment are always prevented from bringing claims.
• Consider factors that may influence the court’s approach, including culpability and the nature of the negligence.