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18/02/2026
Introduction
On 18 April 2016, at the age of 48, John Jones QC, international criminal law silk, tragically took his own life. His death resonated across the Bar, and my colleagues in Chambers who work in this field will have known him well. Our condolences go out to John’s family and friends, for whom no doubt these past nine years have been unspeakably difficult. In the interest of neutrality, I will refer to John for the remainder of this article as Mr Jones.
Facts
Mr Jones came under the care of the Defendant, Dr Stephen Pereira, a consultant psychiatrist at the Nightingale Hospital, in January 2016. He was experiencing severe anxiety and insomnia after returning to London from The Hague. Dr Pereira’s working diagnosis was bipolar affective disorder, but Mr Jones doubted this and, in March 2016, emailed requesting to stop the prescribed medication, citing its “catastrophic effect” on his memory and concentration. Dr Pereira’s secretary replied, authorising discontinuation of the medication.
On 21 March 2016, Mr Jones’ parents telephoned Dr Pereira, with Mr Jones audible in the background. They reported that Mr Jones was in crisis and sought urgent hospital admission. A follow-up email warned that he was a danger to himself and in “a terrible place”.
Mr Jones was admitted to the Nightingale Hospital on 22 March 2016. On or around the same day, Dr Pereira went on a three-week period of leave but neglected to inform Mr Jones. Care was transferred to another consultant, Dr Bakshi, but Mr Jones received no explanation of the nature, purpose and benefit of his admission.
A handover discussion took place by telephone between Dr Pereira and Dr Bakshi, with no written record made by either doctor. Mr Jones was put back on the previously prescribed medication.
The Evidential Lacuna
In respect of the period from 23 March to 10 April 2016, virtually no evidence was before the Court surrounding Mr Jones’ care. This was because of a confidential settlement reached between the Claimants and the originally second and third Defendants – Dr Bakshi and the hospital – which involved no admission of liability and meant Dr Bakshi’s care was effectively off-limits. The limited evidence available during this period showed that Mr Jones had declined group therapy but accepted one-to-one cognitive behavioural therapy (CBT), receiving two mindfulness sessions.
Dr Pereira resumed care on 10 April 2016. Apart from the two mindfulness sessions, Mr Jones received no psychotherapy, despite Dr Pereira having considered it an important part of Mr Jones’ treatment and having told the inquest that psychological intervention “could have made a huge difference.”
On 11 and 12 April, Dr Pereira reviewed Mr Jones as an inpatient. They discussed psychotherapy and Mr Jones indicated he might consider one-to-one therapy. Dr Pereira amended his working diagnosis to obsessive ruminations.
On 14 April, Mr Jones’ father contacted Dr Pereira, reporting a “relapse…into the deepest despair and depression.” A meeting on 15 April took place between Dr Pereira, Mr Jones, and his family, with Mr Jones said to be in a bad way. He was to decide over the weekend whether to remain as an in-patient and access group therapy or to be discharged to outpatient care. He spent the weekend with his family and returned to the hospital on Sunday evening.
Early on Monday 18 April 2016, Mr Jones died at West Hampstead station following a collision with a train. No suicide note was found, but CCTV footage indicated purposeful movements and emotional composure.
First-Instance Decision of Bourne J
Fact-finding
The Judge found significant inconsistencies between Dr Pereira’s evidence at trial and at the inquest, describing parts of his evidence as “emphatic and self-serving”. He emphasised the difficulty created by the evidential lacuna (my term), which prevented any real assessment of the care provided whilst Dr Pereira was away. The judge held, on the balance of probabilities, that Mr Jones was suffering a depressive reaction to past and present stressful events and did not have bipolar affective disorder.
Breach
The Claimants alleged several breaches of duty. Three were upheld:
Dr Pereira acted negligently in not informing Mr Jones that he would be unavailable for three weeks.
2. Inadequate handover (Breach 2). The telephone handover to Dr Bakshi was insufficient, and making no adequate written record was a departure from reasonable standards.
3. Failure to arrange psychotherapy promptly on return (Breach 3).
On resuming care on 11 April, Dr Pereira negligently failed to set out a clear pathway for Mr Jones to begin psychotherapy.
Other alleged breaches – such as the incorrect working diagnosis and the lack of detailed discussion with Mr Jones about admission – were found non-negligent.
Causation
This is where the case ultimately collapsed. In respect of each of the three breaches of duty, the Claimants failed to prove causation:
1. Breach 1, although showing a “surprising lack of empathy,” was not proven to have caused measurable harm.
2. The evidential lacuna meant it was impossible to determine whether any shortcomings in the period under Dr Bakshi’s care were attributable to Breach 2.
3. Even if psychotherapy had been arranged promptly on 11 April, the judge could not conclude that Mr Jones would have had even one session before 18 April, nor that such a session would have prevented his suicide.
Contributory Negligence
Following a review of the authorities including Corr v IBC Vehicles Limited [2008] 1 AC 884, Reeves v Metropolitan Police Commissioner [2000] 1 ACT 360 and PPX v Aulakh [2019] EWHC 717 QB, the judge concluded that Mr Jones had not lost autonomy when he took his own life. Had liability been established, he would have applied a 25% reduction.
Court of Appeal (Nicola Davies LJ, Baker and Nugee LJJ)
The Claimants appealed on three grounds.
Grounds 1 and 2: Causation
The Claimants argued that the Judge’s causation reasoning was illogical, because psychotherapy was a central part of the treatment plan for both bipolar disorder and post-traumatic depression. Therefore, a competent handover should have included a plan for psychotherapy.
They also relied on the Judge’s counterfactual findings, in which he had suggested that, had the correct working diagnosis been made, psychotherapy would have started much earlier.
The Court rejected these arguments. The Judge’s counterfactual analysis was irrelevant because of his unappealed finding that the bipolar diagnosis was defensible. In a politely veiled criticism, Nicola Davies LJ opined that the Judge’s counterfactual opinion had been unnecessary. Ultimately, the evidential lacuna had made it impossible for the Judge to determine whether omissions by Dr Bakshi were attributable to Dr Pereira or to her own independent decisions.
Material Contribution
At trial, the Claimants had submitted that if the Judge was unable to decide that question on the balance of probabilities, he should consider the ‘material contribution’ test identified in Bailey v Ministry of Defence [2009] 1 WLR 1052. The Judge held that that material contribution did not arise because it was possible to decide the case on the balance of probabilities.
On appeal, the Claimants took a different approach, arguing that given the number of overlapping factors, the material contribution test was appropriate notwithstanding that the “but for” test could be satisfied. The Court rejected this as contrary to the settled state of the law.
Contributory Negligence
Given its conclusions on causation, the Court did not consider it necessary to address this ground.
Comment
It is not hard to see why this case failed on causation. In a personal injury claim, where a tortious injury causes severe depression culminating in suicide (see, for example, Corr), causation may be more straightforward. But in the clinical negligence context, a claimant must prove that, but for a particular failing in psychiatric care, the individual would not have taken their own life. This will almost always present an evidential challenge given the complex, multi-factorial and often poorly understood psychological landscape that leads a patient to suicide.
A key learning point for claimant practitioners is the strategic risk of entering confidential settlements with some defendants but not others. Whilst securing some damages early may be attractive to the client, proper consideration must be given to any harm that could be done to the remaining claim. It will usually be sensible to seek independent counsel’s advice on any partial settlement.
Defendant practitioners will conversely see this as an example of the merits of advising clients on strategic early settlement in a multi-defendant claim. It is also (yet another) reminder of the importance of diligent record-keeping and structured communication between medical professionals, particularly in the psychiatric field.
Practitioners interested in the development of this area of law may wish to read “By Their Own Hand: Self[1]Inflicted Harm and the Law” by Lady Justice Philippa Whipple, to whom I served as Judicial Assistant prior to coming to Chambers. Originally the 2024 PIBA annual Richard Davis Lecture, this can now be found in the Journal of Personal Injury Law, Issue 1 2025 (Sweet & Maxwell).
