Page v Smith is a landmark decision in the English law of negligence dealing with the foreseeability of psychiatric injury, particularly where the claimant is a primary victim with a pre-existing vulnerability. The judgement created a significant distinction between primary and secondary victims in claims for psychiatric harm, setting a lower threshold of foreseeability for the former.
This case is often studied alongside Alcock v Chief Constable of South Yorkshire and later cases like Rothwell v Chemical & Insulating Co, as it both expanded and later saw restrictions in its application.
Facts of Page v Smith
The claimant, Mr Page, and the defendant, Mr Smith, were involved in a minor road traffic accident. Although the collision caused no physical injuries to either party, it did have a serious effect on Mr Page’s health.
For around 20 years before the incident, Mr Page had suffered from myalgic encephalomyelitis, also known as chronic fatigue syndrome (CFS). At the time of the accident, his condition was in remission and symptoms had been sporadic.
Several hours after the crash, Mr Page began to feel exhausted. Following the accident, his CFS became chronic and permanent, leaving him unable to work full-time in the future.
Mr Smith admitted negligence in causing the accident, but disputed liability for the psychiatric injury. He argued that such psychiatric harm was not reasonably foreseeable and therefore not recoverable in law.
Procedural History
- Trial Court: Found in favour of Mr Page, holding the defendant liable for the psychiatric injury.
- Court of Appeal: Overturned the trial court’s decision, finding that psychiatric harm was not reasonably foreseeable in the circumstances.
- House of Lords: The matter was referred for final determination.
Issues Before the House of Lords
The main legal issue was:
- In negligence claims involving psychiatric harm to a primary victim, is it necessary to show that psychiatric harm itself was reasonably foreseeable?
- Or, is it sufficient to show that some form of personal injury (physical or psychiatric) was foreseeable?
A related question was whether Mr Page’s pre-existing condition (CFS) was relevant to the issue of foreseeability or only to the extent of damages.
Legal Context – Primary vs Secondary Victims
Before Page v Smith, the leading principles for psychiatric injury were shaped by Alcock v Chief Constable of South Yorkshire, which had set strict requirements for secondary victims (bystanders or those witnessing harm to others).
- Primary victims: directly involved in the incident and exposed to danger.
- Secondary victims: witnesses or indirect participants, subject to stricter tests (e.g., proximity in time and space, close ties of love and affection, foreseeability of psychiatric harm).
The House of Lords had to determine which category Mr Page fell into and which foreseeability standard applied.
Page v Smith Judgement
By a bare majority (3–2), the House of Lords found in favour of Mr Page.
Majority Opinion (Lord Lloyd, Lord Browne-Wilkinson, Lord Ackner)
- Mr Page was a primary victim: He was directly involved in the accident, not merely a witness.
- For primary victims, it is enough that some form of personal injury (physical or psychiatric) is foreseeable; it is not necessary to separately establish foreseeability of psychiatric injury.
- The test is: “Could the defendant reasonably foresee that his conduct would expose the plaintiff to the risk of personal injury, psychological or physical?”
- If the answer is yes, the defendant is liable for the full extent of the injury, even if the actual harm is psychiatric and even if the claimant had special vulnerabilities.
- The Thin Skull Rule (or Eggshell Skull Rule) applies – the defendant must take the claimant as found, including pre-existing conditions.
- The “reasonable fortitude” requirement (that a claimant be of ordinary mental resilience) does not apply to primary victims.
Minority Opinion (Lord Keith, Lord Jauncey)
- Disagreed with lowering the foreseeability threshold for primary victims.
- In all psychiatric injury cases, the type of harm (psychiatric) must be foreseeable, not just the possibility of some injury.
- A plaintiff’s unusual susceptibility should be relevant at the duty of care stage, not only at the assessment of damages.
- On the facts, given the minor nature of the collision (no physical injuries, only moderate vehicle damage), psychiatric injury was not foreseeable.
- Therefore, they would have upheld the Court of Appeal’s decision in favour of the defendant.
Conclusion
The decision in Page v Smith fundamentally shaped the law on psychiatric injury in negligence by lowering the foreseeability requirement for primary victims. It affirms that if any personal injury is foreseeable, the defendant can be liable for psychiatric harm, even when the claimant has unusual susceptibility.
While it has been restricted in scope by later decisions, Page v Smith remains a cornerstone case in English negligence law, marking a clear doctrinal divide between primary and secondary victims and demonstrating the enduring application of the thin skull principle to psychiatric injury claims.
