Mr Bates and the post office: The implications of the UK post office scandal for the taxonomy of trauma

More than 900 UK sub-postmasters and postmistresses wereprosecuted for stealing money because of incorrect information provided by a computer system called Horizon, accounting software developed by Fujitsu. The Post Office itself brought many of the cases to court, and between 1999 and 2015, it prosecuted 700 people – an average of one person a week. Another 283 cases were brought by other bodies, including the Crown Prosecution Service. Many of those convicted went to prison for false-accounting and theft. Many were financially ruined. Other sub-postmasters accused, but not prosecuted, were forced to replace financial shortfalls with their own money or had their contracts terminated. What is so shocking about these cases is that it now appears that the Post Office was aware of the flawed software at the time of these prosecutions, but deliberately concealed the Horizon failings, withheld this evidence and proceeded with prosecutions regardless. The Criminal Cases Review Commission (CCRC) described the scandal as ‘the most widespread miscarriage of justice the CCRC has ever seen, and represents the biggest single series of wrongful convictions in British legal history’. In 2024, the UK Prime Minister Rishi Sunak described the scandal as ‘…one of the greatest miscarriages of justice in UK history’. ¹

In 2017, 555 sub-postmasters led by (now) Sir Alan Bates, a North Wales postmaster whose contract had been terminated by the Post Office in 2003, led a group action against the Post Office in the UK High Court. In 2019, the Court ruled that the contracts between sub-postmasters and the Post Office were unfair, and that Horizon ‘contained, bugs, errors and defects’. The case was settled for £58 m leaving the Claimants with only £12 m after legal costs. This ruling, however, presented the postmasters with an opportunity to challenge their convictions and, in 2020 led the UK Government to launch an independent inquiry into the scandal. As of April 2024, what had now been upgraded into a Statutory Public Inquiry, remains ongoing and the Metropolitan Police have launched a criminal investigation into the conduct of Post Office executives and the software provider Fujitsu. The scandal was dramatised in an ITV drama in 2024 which galvanised UK public opinion and brought the scandal to worldwide attention. ²

There is a paucity of information regarding the effects of wrongful conviction on the mental health of individuals and those close to them and much of the literature comes from the USA. ³ There is to our knowledge only one previous study of the mental health effects of the wrongful conviction on sub-postmasters and postmistresses involved in the Horizon scandal. ⁴

Method

Since May 2021, personal injury medico-legal assessments were undertaken by one of the authors (P.F.), at the request of solicitors representing some of those falsely accused and convicted of offences by the post office. Their convictions had been quashed in the court of appeal. We wanted to demonstrate to what extent, and in what way their mental health had been adversely affected as a result of their experiences and how any psychopathology sat with the conventional classification of traumatic events.

The group comprised 16 individuals, age range 35–70 years, 5 women and 11 men. Ten had brought claims for Malicious Prosecution. The remaining six sub-postmasters were part of the historical financial shortfalls scheme set up for those who had not been prosecuted but were applying for compensation.

Assessments were undertaken remotely and included collateral history supplied by a family member. ICD-10 diagnostic criteria were employed.

Results

All of the cases revealed evidence of psychopathology at the time of the allegations or convictions and continued to varying degrees subsequently.

A diagnosis of Posttraumatic Stress Disorder (PTSD) was made in five cases, adjustment disorder in two cases, dysthymia in one case, and depressive illness in eight cases. In only four cases of depression and PTSD, the disorders were resolved.

Three of the five cases of PTSD had evidence of a past psychiatric history prior to becoming sub-postmasters: this included depression, impulsive overdose, eating disorder, problems related to gambling and abuse of alcohol and cocaine.

Of the 10 convicted sub-postmasters, four spent periods in prison and the remaining six were given suspended or community sentences. Those in prison were often separated from young children by distance or withholding family members. Permission was given by members of the group for their details to be shared anonymously.

No table of demographic details and diagnoses can adequately begin to describe the human suffering caused by the Post Office debacle. Below are two case vignettes that illustrate the enormity of this human tragedy and the injustice suffered.

Discussion

The actions of the Post Office have led to loss of jobs, bankruptcy, criminal convictions, prison sentences and at least four suicides. This was reflected in our sample where high rates of psychopathology were found in those who had been accused of taking money due to faulty software as well as those who had been wrongly convicted. These findings are consistent with the only other study of the psychological effects on sub-postmasters which found high rates of psychopathology in both accused and convicted individuals. ⁴

Existing diagnostic criteria were limited, and in our view, failed to capture the suffering of individuals who had endured such complex trauma prompting us to employ a narrative description which included the effects on family members in addition.

The diverse and complex psychopathology of the postmasters and their families raises important and fundamental issues regarding the current taxonomy of stress-related disorders and the way in which lawyers and the courts use a psychiatric diagnosis in litigation. There has been an unhealthy tendency in the UK courts for advocates to argue that if a claimant does not have PTSD, and does not meet the formal diagnostic criteria of ICD or DSM, they are not, therefore, mentally ill and therefore undeserving of legal redress and compensation. A consequence of this is that advocates for the Claimant will often try and ‘shoe-horn’ a victim into a diagnosis of PTSD which doesn’t bear up to critical scrutiny potentially undermining their case.

Expert opinion within the trauma field is divided regarding the classification of PTSD as to whether this should remain unchanged, the criteria narrowed or broadened, or whether new diagnostic categories should be introduced. ⁵ The important point is that reactions to traumatic events are subject to great individual variation and go well beyond the boundaries of the narrowly defined criteria of PTSD. At present, the diagnostic alternatives are inadequate. A clear diagnostic framework to describe the sub-postmaster's psychopathology should be agreed before any cases go to court to not only capture and acknowledge the extent of their distress but also to spare them further suffering and humiliation under cross-examination. The academic literature and laboratory, and not the courtroom should be the arena to argue psychiatric nosology.

The PTSD diagnosis remains the ‘gold standard’ of trauma diagnoses, especially in the courts, bringing legitimacy and credibility to individual suffering. ⁶ However, an ICD-10 (F43.1 post-traumatic stress disorder) diagnosis leaves little ‘wiggle-room’ for manoeuvre and is unforgiving of anyone not fitting its strict diagnostic criteria. ⁷ PTSD was originally conceived to describe the symptoms of combatants in the Vietnam War, it is contextually and culturally neutral and although it works for traumatic events such as combat, accident, or sexual assault, our experience is that it is less effective, and indeed often fails to capture the distress and suffering caused by other types of trauma. ⁸ This matters because a diagnosis of PTSD has become the principal way to get a patient's distress acknowledged in social terms, to receive psychological therapy, as well as compensation, benefits and practical support. But when a victim's condition does not qualify for this diagnosis, the alternatives are poor.

The F43.0 acute stress reaction is a transient disorder that develops in an individual without any other apparent mental disorder in response to exceptional physical and mental stress and that usually subsides within hours or days, which of course is wrong when the condition persists after months. ⁹

Another alternative is either F43.2 adjustment disorder which is a temporary condition expected to disappear in some months’ time and is a product of life's normal stressors, for example, divorces and other social disturbances and should subside in 6–9 months, which also makes this diagnosis unattractive or the F43.9 reaction to severe stress, unspecified, lacks any definition whatsoever. ¹⁰

Finally, ICD-10 F62.0, Enduring personality change after a catastrophic experience, demands a duration of 2 years alteration of personality following a traumatic event, but makes no reference to the extent or severity of this change and will not appear in ICD 11.^11,12

These alternative diagnoses are arguably ‘soft’ in comparison to PTSD and often fail to do justice to a victim's suffering leaving the lawyer, therapist, psychologist, or psychiatrist with little alternative than to resort to the PTSD diagnosis to give a patient legitimacy, it may be a poor representation of the symptoms described and become subject of dispute between expert witness’ in court, adding further to the suffering of already traumatised individuals. Just because an individual doesn’t meet PTSD diagnostic criteria, doesn’t mean they haven’t been mentally scarred by traumatic events.

The sub-postmasters are illustrative of this conundrum. They have been damaged psychologically in a variety of ways and the ‘ripple effect’ of their trauma transmitted to family members and loved ones, themselves vicariously traumatised. Moreover, trauma begets further trauma, false accusations and convictions made against the sub-postmasters have resulted in bankruptcy, relationship breakdowns, and in many cases the victimisation and social exclusion of entire families.

The trauma suffered by the sub-postmasters was atypical of classical PTSD and in our study, only 5 out of 14 met PTSD diagnostic criteria. Moreover, notwithstanding the diversity of symptoms, the stressor itself, wrongful conviction by the criminal justice system, arguably fails to meet the PTSD stressor criterion. Our current nosology simply doesn't cater for the sub-postmasters.^7,8

Our concern is that these anomalies lend themselves to exploitation in court and lawyers will hire experts to ‘shoehorn’ claimants into PTSD diagnosis, only to be potentially challenged by the defence resulting in potential further humiliation, trauma and implied dishonesty. We argue that diagnostic issues need to be resolved before any hearing to avoid further distress to claimants. ¹³

A formal psychiatric diagnosis may help an individual in terms of treatment, but when they come before the courts, given the diversity of psychopathology seen in our cases, we argue that a trauma narrative is far more helpful than an ICD or DSM diagnosis in helping establish quantum. This is similar to the trend in UK Coroners’ Courts where a categorical cause of death is increasingly employed instead of, or alongside a short-term conclusion. ¹⁴ An agreed view on both sides of the courtroom regarding the victim's condition before the event (in this case, the accusation of wrongdoing), subsequent to the event, and most importantly, the extent of any enduring, objectively verifiable change they have undergone, in lifestyle, personality or social circumstance, including impact on family and loved ones, should determine quantum, without recourse to any specific psychiatric diagnosis. ¹⁵

Outside the courtroom the psychopathology of the sub-postmasters is a timely opportunity to widen the PTSD debate currently raging in the trauma field about trauma taxonomy, namely, whether the boundaries of the stressor criterion should be widened, further narrowed them, left as they are, or abandoned completely. ¹⁶

Alternative diagnoses for stress-related disorders are inadequate and won't impress the courts. We propose that for legal purposes the narrow classification of trauma, and certainly the stressor criterion be abandoned in the interests of justice in favour of a new category of post-traumatic disorders, or PTDs that embraces the narrative concept, leaving more specific diagnoses such as PTSD out of the courtroom for what they were originally intended, namely identifying homogenous groups of patients for research purposes, establishing pathophysiology and improving management and treatment. For legal purposes, all psychiatric diagnoses should be in a formulation that details the social, financial and other impacts of the condition including other established psychiatric diagnoses such as depression, which affected 50% of the subjects in our study.

Limitations of the study

This is unashamedly an opportunistic, observational study. Diagnosis was based upon clinical judgement, albeit through the lens of a highly experienced senior clinician. However, we believe that the plight of the postmasters has valuable lessons to teach the trauma field as a whole and the public interest surrounding the scandal demands their voice be heard.

Conclusions

Whilst more research is clearly needed to explore the psychiatric consequences of false convictions, ¹⁷ the Post Office scandal clearly exposes the fault lines and problems around the diagnosis of PTSD and psychological trauma and the uses to which it is put. The ‘stressor’ criterion in current diagnostic classification for PTSD should either be broadened to include the ignominy of false accusation or false conviction, other ‘non-normal’ stressors and their sequelae, or, in our view, abandoned completely as no matter how broadly defined, can never account for every eventuality and will always lead to the exclusion of traumatised and deserving individuals. Disputes over classification should not be permitted to further traumatise the sub-postmasters or any other victims for that matter, and we believe the psychiatric issues should be resolved out of court employing a formulation-based approach, rather than PTSD or other categorical diagnoses which fail to capture the individual suffering of these victims and their families.