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Intermediaries, psychiatrists and psychologists getting their acts together in the interests of the vulnerable

Published online by Cambridge University Press:  23 July 2026

Keith J. B. Rix Open the ORCID record for Keith J. B. Rix [Opens in a new window]  and
Tina Pereira
Keith J. B. Rix*
Affiliation:
A Door Tenant in the Chambers of Mark Love, Inner Temple, London; a Visiting Professor of Medical Jurisprudence at the University of Chester Medical School; an Honorary Associate Professor at Norwich Medical School, University of East Anglia; a retired psychiatrist; and a co-editor of Rix’s Expert Psychiatric Evidence (Cambridge University Press). He has been awarded honorary fellowships of the Faculty of Forensic and Legal Medicine of the Royal College of Physicians and the Expert Witness Institute.
Tina Pereira
Affiliation:
An Honorary Research Fellow, Centre for Language and Communication Science Research at City St George’s, University of London. She is an intermediary in the justice system in England and Wales, working with people who have neurodevelopmental conditions. She is a member of the Ministry of Justice’s Registered Intermediary Reference Team and a member of The Advocate’s Gateway management committee. She delivers bespoke training to a range of audiences.
*
Correspondence Keith J. B. Rix. Email: ProfessorKeith.Rix@2drj.com
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Summary

The role of the intermediary in legal proceedings in England and Wales is traced back to a recommendation in 1989 that there should be an ‘interlocutor’ for vulnerable people involved in criminal proceedings. This article sets out the statutory and procedural provisions for the appointment and deployment of intermediaries. The functions of the intermediary in legal proceedings are described and illustrated with cases from the authors’ experiences and legal judgments handed down in criminal, family and immigration and asylum proceedings. Suggestions are made as to how psychiatrists can best assist the courts when it is considered that the appointment of an intermediary is necessary. Attention is drawn to the importance of psychiatrists, psychologists and intermediaries working collaboratively with each other and with other professionals in order that vulnerable people who have communication difficulties, whether as a result of age, some form of mental disorder, intellectual disability, deafness or for some other reason, can be assisted so as to participate effectively and without disadvantage in legal proceedings.

Keywords

Intermediaryjusticedeafnessexpertvulnerability

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BJPsych Advances , First View , pp. 1 - 13
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
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© The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

LEARNING OBJECTIVES

After reading this article you will be able to:

  • • understand how the role of the intermediary in legal proceedings has evolved and is evolving

  • • contribute to justice for vulnerable people with communication difficulties through collaboration between psychiatrists, psychologists, intermediaries and other professionals

  • • write reports, as experts in psychiatry or psychology, that ensure the optimal assistance by intermediaries to vulnerable persons in legal proceedings.

‘An application for an intermediary must have an evidential basis. This will commonly take the form of a cognitive report and, if authorised, an intermediary assessment. Other evidence may come from the social worker or the Children’s Guardian. The court can also take account of submissions on behalf of the vulnerable person, and from the other parties, as they may have their own perspectives on the overall fairness of the proceedings. This reflects the collaborative nature of the task of identifying and making adjustments for vulnerability.’

(Lord Justice Peter Jackson in M (A Child: Intermediaries) [2025])

Some individuals struggle to communicate in police interviews, courts and tribunals. Vulnerability in relation to giving evidence in criminal courts in England and Wales was recognised as long ago as 1989, when recommendations for an ‘interlocutor’ were made by the Advisory Group on Video Evidence (1989). Although this recommendation was not implemented, just under 10 years later the Speaking up for Justice report (Interdepartmental Working Group on the Treatment of Vulnerable or Intimidated Witnesses in the Criminal Justice System 1998) progressed this further, recommending legislation that would make provision for an ‘intermediary’ to facilitate giving evidence, which in turn gave rise to the enactment of the Youth Justice and Criminal Evidence Act 1999 (YJCEA). Criminal Practice Directions 2023 (CrimPD), para. 6.1.3 defines vulnerability in the following terms:

‘“Vulnerability” may arise by reason of age, but also encompasses anyone who may not be able to participate effectively if reasonable steps are not taken to adapt the court process to their specific needs’ (www.judiciary.uk/wp-content/uploads/2023/04/Criminal-Practice-Directions-2023-1.pdf).

In England and Wales an intermediary is a trained communication specialist who facilitates two-way communication between a vulnerable individual and the court to ensure that the communication process is as complete, coherent and accurate as possible (Crown Prosecution Service 2022). They facilitate communication with witnesses and defendants who have communication needs. Their primary function is to improve the quality of evidence and aid understanding between the court, the advocates and the witness or defendant. They are independent of parties and owe their duty to the court (CrimPD 6.1: ‘Vulnerable people in the courts’).

Box 1 provides definitions and descriptions relevant to the concept of vulnerability as it is recognised in criminal and family proceedings in relation to the role of the intermediary. Although there are obvious and important differences between criminal and family proceedings, the reasons for the appointment of intermediaries, and their function in assisting those with communication difficulties facing legal proceedings, are essentially the same and in a family case (West Northamptonshire Council v KA [2024]) (‘West Northamptonshire’) the court considered that the guidance of the Court of Appeal (Criminal Division) in a criminal case (R v Thomas (Dean) [2020]) (‘Thomas’) was applicable to the consideration of the same issues in the family justice system, albeit the court needed to have close regard to the nature of the case and the evidence with which the individual needed to engage.

BOX 1

Definitions and descriptions relevant to the concept of vulnerability as it is recognised in criminal and family proceedings

From the Youth Justice and Criminal Evidence Act 1999:

‘16 Witnesses eligible for assistance on grounds of age or incapacity.

  1. (1) For the purposes of this Chapter a witness in criminal proceedings (other than the accused) is eligible for assistance by virtue of this section –

    1. (a) if under the age of 18 at the time of the hearing; or

    2. (b) if the court considers that the quality of evidence given by the witness is likely to be diminished by reason of any circumstances falling within subsection (2).

  2. (2) The circumstances falling within this subsection are –

    1. (a) that the witness –

      1. (i) suffers from mental disorder within the meaning of the Mental Health Act 1983, or

      2. (ii) otherwise has a significant impairment of intelligence and social functioning;

    2. (b) that the witness has a physical disability or is suffering from a physical disorder.

[…]

  1. (5) In this Chapter references to the quality of a witness’s evidence are to its quality in terms of completeness, coherence and accuracy; and for this purpose ‘coherence’ refers to a witness’s ability in giving evidence to give answers which address the questions put to the witness and can be understood both individually and collectively’.

From the Family Procedure Rules 2010, Part 3A: ‘Vulnerable persons: participation in proceedings and giving evidence’:

‘3A.7 When deciding whether to make one or more participation directions the court must have regard in particular to –

[…]

  1. (b) whether the party or witness –

    1. (i) suffers from mental disorder or otherwise has a significant impairment of intelligence or social functioning;

    2. (ii) has a physical disability or suffers from a physical disorder; or

    3. (iii) is undergoing medical treatment;

  2. (c) the nature and extent of the information before the court;

[…]

  1. (f) the age, maturity and understanding of the party or witness;

[…]

  1. (j) any characteristic of the party or witness which is relevant to the participation direction which may be made’.

In Northern Ireland, the Justice Act (Northern Ireland) 2011, s12, by amending the Criminal Evidence (Northern Ireland) Order 1999, has made similar provisions for the use of intermediaries for persons aged under 18 years whose effective participation is compromised by their level of intellectual ability or social functioning (art. 21BA(5)) and for adults with mental disorder or who otherwise have a significant impairment of intelligence and social functioning and are unable to participate effectively (art. 21BA(6)). In Ireland, there are no particular statutory provisions dealing with vulnerable defendants (other than children). In the Isle of Man, there are no specific provisions for vulnerable defendants but the courts have shown willingness to accommodate intermediaries and make adjustments. In Scotland, the Vulnerable Witnesses (Scotland) Act 2004, which provides for various ‘special measures’, and the Vulnerable Witnesses (Criminal Evidence) (Scotland) Act 2019 have no provisions for the use of intermediaries but ‘special measures’ are available.

Statutory and procedural provisions

The YJCEA introduced a range of special measures, including section 29(2), which defines the function of an intermediary (Box 2).

BOX 2

Section 29 of the Youth Justice and Criminal Evidence Act 1999

‘29 Examination of witness through intermediary.

  1. (1) A special measures direction may provide for any examination of the witness (however and wherever conducted) to be conducted through an interpreter or other person approved by the court for the purposes of this section (‘an intermediary’).

  2. (2) The function of an intermediary is to communicate –

    1. (a) to the witness, questions put to the witness, and

    2. (b) to any person asking such questions, the answers given by the witness in reply to them, and to explain such questions or answers so far as necessary to enable them to be understood by the witness or person in question

[…]

  1. (5) A person may not act as an intermediary in a particular case except after making a declaration, in such form as may be prescribed by [Criminal Procedure Rules], that he will faithfully perform his function as intermediary’.

In criminal courts in England and Wales

The intermediary special measure was first introduced in criminal courts in 2004 for witnesses only via the Witness Intermediary Scheme (Ministry of Justice 2024a), which matched registered intermediaries with witnesses based on the vulnerable person’s individual communication needs and the intermediary’s professional skills.

For the next 20 years or so, intermediary provision for defendants was inconsistent and often left to the discretion of individual judges. A practice direction, Criminal Proceedings: Further Directions [2007], set out vulnerable defendant provisions and these provisions are now incorporated in CrimPD 6 (‘Vulnerable people and witness evidence’). The practice direction CrimPD 6.1.1 requires the court to take ‘every reasonable step’ to encourage and facilitate the participation of any person, including the defendant. This includes enabling a witness or defendant to give their best evidence and enabling a defendant to comprehend the proceedings.

The provisions of the YJCEA, s29, do not apply to defendants (CrimPD 6.2.3). However, the court may direct the appointment of an intermediary to assist a defendant in reliance on its inherent powers (CrimPD 6.2.4).

Family courts in England and Wales

In family proceedings, the Family Procedure Rules 2010 (FPR 2010) (SI 2010/2955: www.legislation.gov.uk/uksi/2010/2955/contents) set out a range of provisions, of which the provision of an intermediary is one. Under Part 3A (‘Vulnerable persons: participation in proceedings and giving evidence’) the court has a duty to consider the vulnerability of parties and witnesses, to consider how a party can participate in the proceedings and to consider how a party or witness can give evidence. In such cases, and where the individual is, or is at risk of being, a victim of domestic abuse (Domestic Abuse Act 2021, ss.62–64), the court must consider whether it is necessary to make one or more ‘participation directions’ such as to provide an intermediary to help a party or witness to participate in proceedings or be questioned in court. There is a general discretion to ‘make provisions’, but directions can only be made when they are necessary. In order to act proportionately, the court first has to consider whether a protective measure short of a direction is enough (CXC v Clarke [2024]) (‘CXC’).

Although they may assist a party or witness to participate more generally in proceedings (FPR 2010, rule 3A.8(1)(d)), the primary function of an intermediary, as defined by FPR 2010, rule 3A.1, is limited to the process of communicating/explaining questions to a party or witness within the court process, and the communication of such answers that they may give (Box 3). It is not a general witness support role (CXC).

BOX 3

The intermediary within the meaning of the Family Procedure Rules 2010

Part 3A – Vulnerable persons: participation in proceedings and giving evidence, rule 3A.1:

‘“intermediary” means a person whose function is to:

  1. (a) communicate questions put to a witness or party;

  2. (b) communicate to any person asking such questions the answers given by the witness or party in reply to them; and

  3. (c) explain such questions or answers so far as is necessary to enable them to be understood by the witness or party or by the person asking such questions’.

(SI 2010/2955: www.legislation.gov.uk/uksi/2010/2955/contents)

HMCTS intermediary services and approved intermediaries

In 2022, recognising the disparity of access between witnesses and other vulnerable people in the justice system and the need for consistency across jurisdictions, the Ministry of Justice introduced the Her Majesty’s Courts & Tribunals Service (HMCTS) appointed intermediary scheme (HMCTS 2022a), enabling defendants in criminal cases, respondents in the Family Court and other parties to access intermediaries. Intermediary services are now provided by Ministry of Justice approved service providers, consisting of either larger companies or cooperatives or self-employed individuals (HMCTS 2022b). In practical terms, the two schemes currently run separately, but at the time of writing this article, a justice-wide intermediary review is being carried out.

Intermediaries are neutral, non-partisan officers of the court. They are not expert witnesses, although many have specialist knowledge and skills in a range of specialisms, nor are they appropriate adults, McKenzie friends or supporters (Plotnikoff Reference Plotnikoff and Woolfson2015). Box 4 describes these and some of the other supporters available to assist vulnerable people in legal proceedings. Unlike other supporters or court ‘associates’ who work alongside vulnerable people, intermediaries generally bring expertise from the fields of speech and language therapy, education, psychology, etc. They receive additional training in courtroom processes, procedures and practices, enabling them to apply and transfer knowledge and skills from their base profession to the courtroom context. Thus, by combining their knowledge of the nature and effects of a vulnerable person’s specific vulnerability with their professional responsibilities and legal duties to act as officers of the court, they are well placed to facilitate communication in this specific, boundaried legal context.

BOX 4

Some of the supporters available to assist vulnerable people in legal proceedings

Appropriate adult A parent, guardian, social worker or trained volunteer who safeguards the rights, welfare and communication of children (under 18) or vulnerable adults during police detention or interview so as to ensure that procedures are fair and that the suspect or detainee understands their rights.

Deaf interpreter A person who accurately and impartially facilitates communication between deaf individuals and hearing professionals in legal proceedings, often by translating British Sign Language (BSL) or other sign languages into spoken English.

Interpreter Someone who provides accurate, impartial language assistance to non-English speakers, allowing them to understand and participate effectively in legal proceedings.

Litigation friend An adult appointed by the court or through a certificate of suitability to conduct legal proceedings on behalf of a child (under 18) or a ‘protected party’ (an adult lacking mental capacity as determined by the application of the provisions of the Mental Capacity Act 2005) and whose responsibility is to act in the person’s best interests, make decisions and conduct the case fairly.

McKenzie friend A lay person who provides moral support for a litigant, taking notes and giving advice on issues that the litigant may want to raise in court, but other than in exceptional circumstances they cannot speak on behalf of the litigant in court. Their name comes from the case of McKenzie v McKenzie [1970] 3 All ER 1034, a divorce case in which the judge refused to allow Mr McKenzie to have a friend sitting with him. The case went to appeal and it was held that the judge should not have refused the right of the litigant to be accompanied by a friend.

Official Solicitor A solicitor who acts as a litigation friend for a child (under 18) or a ‘protected party’ (an adult lacking mental capacity as determined by the application of the provisions of the Mental Capacity Act 2005) who cannot represent themselves in court and is appointed as a last resort when no one else is able or willing to act for the person. The Official Solicitor often instructs a firm of solicitors to fulfil this function.

The scope of this article

The guidance in this article applies to England and Wales and, to the best of our knowledge, it is up to date as of April 2026. Readers in other nations are encouraged to investigate the position in their jurisdictions. Given how rapidly provisions are introduced, adapted and developed in this evolving field of professional practice, readers are advised to combine reading this article with a search for new legislation, case law and professional guidance.

Knowledge of vulnerability and the role of allied professionals within the legal system – in practice

Fact-finding by judges or juries is essential to the process of delivering justice. In the case of a vulnerable person, the judge or jury must be confident that common ground is established and that the person effectively understands the terms that legal professionals are using, as well as the concepts and legal processes involved in their case. Furthermore, as the court has said, ‘Advocates must adapt to the witness, not the other way round’ (R v Lubemba; R v JP [2014]) (‘Lumemba’).

Box 5 gives examples of intermediary functions, and several cases have further clarified the role of the intermediary:

  • • general support, reassurance and calm interpretation of unfolding events (R OP v Secretary of State for Justice [2014] EWHC 1944 (Admin));

  • • skilled support and interpretation with the potential for intervention (R (OP)): this includes communicating questions put to the defendant (the same point applies to complainants and other witnesses), communicating their answers to any person putting the questions and explaining such questions or answers so far as is necessary to ensure that they are understood by the defendant or the person in question;

  • • ensuring that questions were simple and that the defendant (or to complainants and witnesses in other cases) had adequate time to respond (R (AS) v Great Yarmouth Youth Court [2011]) (‘Great Yarmouth’);

  • • being able to alert the court to the difficulties the defendant (or to complainants and witnesses in other cases) faced in answering them (Great Yarmouth);

  • • helping the trial judge and counsel in establishing what types of question were likely to cause misunderstanding and how to avert them (R v Cox [2012]);

  • • in a trial involving a young child, the intermediary was described as ‘someone to befriend and help him, both during the trial itself and in preparation for it’ (R (C) v Sevenoaks Youth Court [2009]).

BOX 5

Examples of an intermediary’s functions

  • • A person charged with having sexual intercourse with a minor may be assisted by an intermediary to understand the concept that this includes sex with a minor even though that interaction might have been initiated by the minor. With this new information, the defendant may change their plea. Their acquisition of this knowledge may assist the court when sentencing them.

  • • Legal professionals with little experience of working with deaf clients could benefit from recommendations by intermediaries on maximising communication efficiency (lighting, acoustics, distance, eye contact, etc.).

  • • An intermediary can create a colour-coded easy-read timeline using keywords, dates and events (and iconic line drawings if needed), to assist a vulnerable person with an intellectual disability to give evidence and be cross-examined in court. This is especially relevant in relation to questions about the abstract concept of ‘time’, e.g. when allegations/events occurred over a period of time. All communication aids such as timelines are fully disclosable to the court if requested.

  • • An intermediary can assist in enabling a vulnerable defendant understand judicial directions to the jury, where the jury may need to consider concepts of conditionality, e.g. ‘if X is not the case, then consider Y’. Again, visual communication aids may need to be considered to make abstract, intangible concepts concrete and tangible, thus facilitating more complete understanding,

  • • An intermediary can assist a witness or party to negotiate the process of being questioned remotely and to participate in the hearing to the fullest possible extent (Re S (Vulnerable Parent: Intermediary) [2020]).

  • • An intermediary whose expertise is with the hearing impaired can explain that ‘gossip’ within the deaf community (e.g. at a Deaf Club) refers not to an occasional surreptitious misdemeanour, but to the lack of privacy that is possible when all conversations in British Sign Language (BSL) are seen by all other BSL users.

Specialist deaf intermediaries are themselves deaf and highly skilled at communicating with language-deprived deaf people in a legal setting. Insofar as an intermediary should be matched to the needs of the vulnerable person, this means that, whether or not it is suspected that a deaf individual has a mental disorder, a psychiatrist or psychologist can recommend consideration of the appointment of a deaf intermediary.

Psychiatrists, clinical psychologists and intermediaries – a shared aim

The task of identifying and making adjustments for vulnerability is a collaborative one (M (A Child: Intermediaries) [2025]) (‘M (A Child)’). Intermediaries, experts (psychiatrists and clinical psychologists) and lawyers should work together. Collaboration between allied professionals in the courts and tribunals is crucial. A lay advocate, expert witness, intermediary, interpreter, supporter, McKenzie friend, etc. all have distinct roles that are discrete and well-defined. The roles and professionals are not interchangeable. Although all work towards enabling a vulnerable person to participate to the best of their ability, one cannot be substituted for another.

Box 6 gives an analysis of a question put by counsel that demonstrates where misunderstandings may arise.

BOX 6

Analysis of a fictitious question put by counsel that demonstrates where misunderstandings may arise

‘Is it not the case that you cared less whether your failure to report your father’s drug use left your teenage son at greater risk of being groomed and going on to display his own inappropriate behaviour?’

The neurolinguistic skills required to answer this question are significant:

  • • Can the vulnerable person understand double negatives?

  • • Do they understand the word ‘groomed’ in this context?

  • • Do they understand the implied meaning of ‘inappropriate behaviour’?

  • • Do they understand the implied timeline (from vulnerable person’s childhood, to the present, to son’s future)?

  • • Do they understand cause, effect and consequence?

  • • Can they consider abstract concepts and questioning?

  • • Do they know that children’s behaviour is influenced by both close and extended family?

  • • If this had been a written question, would they have been able to read it?

  • • Is the client motivated and willing to answer the question?

  • • Is the client emotionally stable enough to answer the question?

Sometimes communication issues arise in appeal cases. In the case of a deaf or hard of hearing person, questions may arise such as:

  • • was an interpreter needed and present?

  • • what sort of interpreter was required for this deaf person?

  • • was the interpreter a registered British Sign Language (BSL) interpreter or registered lipspeaker, experienced and provided with sufficient preparatory information?

  • • did the interpreter have sufficient understanding of the topic to be able to interpret the question?

  • • were there any linguistic or cultural differences that meant an interpretation or translation needed further discussion with the legal professionals?

  • • have the interpreter and intermediary liaised with one another if both were instructed in the case? This is because an intermediary may need to simplify and/or amend the court’s wording in line with a vulnerable person’s understanding prior to an interpreter interpreting the information.

An intermediary or a deaf intermediary is best placed in such a case to collate the information from the other allied professionals and ensure that it is used in the best interests of both the vulnerable person and the legal professionals.

The test for having a conviction overturned on the basis that the appellant did not have the assistance of an intermediary is whether the absence of an intermediary had such an effect on the trial process as to render the applicant’s conviction unsafe (R v FGH (Rev1) [2024]). Where it is the basis of an appeal against conviction that the appellant should have been afforded the assistance of an intermediary, the psychiatric or psychological expert must be able to explain what difference the assistance of the intermediary would have made.

Who is instructed and when in the proceedings varies from case to case. Sometimes communication difficulties are so immediately evident that a report from an intermediary is commissioned at an early stage in proceedings. Permission is required to use an intermediary but not to obtain an intermediary’s report (CXC). Sometimes such difficulties are less obvious and they are first detected when a psychiatrist or psychologist is instructed. To some extent, whether the opinion of the professional, be they a psychiatrist, psychologist or intermediary, is final or provisional will depend on what other reports, if any, are available.

The Legal Aid Agency pays for an assessment by an intermediary, and HMCTS pays for their attendance at court to assist defendants. HMCTS pays for both assessment and attendance in family courts. In the case of witnesses, the Crown Prosecution Service pays for reports and attendance.

The role of the psychiatrist or psychologist

An intermediary is not to be appointed on a ‘just-in-case’ basis, nor is the recommendation of a psychologist or psychiatrist determinative (R (Ahmadzai) v London Borough of Newham [2024]) (‘Ahmadzai’). The bar for the appointment of an intermediary is a high one, at least in criminal cases (R v Rashid [2017]), and it needs to be clear that all other adaptations to the hearing or trial process would not sufficiently ensure effective participation (Thomas). Decisions on the use of an intermediary require evidence to establish that their use is necessary; it is not sufficient to assert that the party or witness will be assisted by the support of an intermediary – the test is whether it is ‘necessary’ (Re X & Y (Intermediary: Practice and Procedure) [2024]) (‘X & Y’). The court has said that ‘necessary’ falls: ‘somewhere between “indispensable” on the one hand and “useful”, “reasonable” or “desirable” on the other hand, having “the connotation of the imperative, what is demanded rather than what is merely optional or reasonable or desirable”’ (Re H-L (Expert Evidence: Test for Permission) [2013]). Whether that means that ‘nothing else will do’ would require consideration of the other means by which fair participation can be achieved. A simple assertion that the party had a diagnosis with no supporting evidence of the diagnosis or the impact on the party of that diagnosis in terms of their ability to participate is not enough (X & Y). It is not enough that it would be helpful (CXC). An application for an intermediary must have an evidential basis, commonly in the form of a cognitive report (M (A Child).

Identifying vulnerability: pre- and mid-trial

In a case in which it is fairly obvious to a psychiatrist or psychologist that the subject of their report has a communication difficulty, it is advisable to ask the instructing solicitor or prosecution caseworker if there is an intermediary’s report or if one has been commissioned. There have been cases where a hearing or trial has taken place at which it is discovered that the psychiatrist or psychologist has not seen the intermediary’s report (or vice versa, as happened in one case (Oxfordshire County Council v A Mother [2024])).

In a criminal case, subtle communication difficulties may emerge in the assessment of fitness to plead and stand trial. When it is the evidence of a psychiatrist that a defendant is not fit to plead and stand trial, the court will want to know whether, if special measures are adopted, the defendant might be fit to plead and stand trial. In such a case the psychiatrist should always consider the appointment of an intermediary as one of the possible special measures that can be deployed to enable a defendant to be fit to plead and stand trial. It may be advisable to provide only a provisional opinion to the effect that the defendant will possibly, or probably, be fit to plead and stand trial if special measures are applied and advise the instruction of an intermediary. The psychiatrist should then be prepared to finalise their opinion having regard to consideration as to whether an intermediary is of the opinion that if an intermediary is appointed they would be able to address the deficits identified. Even in cases where a psychiatrist remains of the opinion that a defendant is unfit to plead and stand trial, the court might decide otherwise and in such a case it may then be necessary to appoint an intermediary to consider the significance of the evidence that led to the psychiatrist’s opinion of unfitness.

Where a vulnerable person’s communication difficulties only emerge during the course of a trial, either because they were not detected earlier or because the court had directed to proceed without an intermediary, an intermediary might need to be appointed mid-trial.

A psychologist might likewise find communication difficulties emerging only in the course of the psychological assessment. Communication difficulties may be revealed in language and verbal proficiency tests, social and observational assessments, cognitive screening and executive functioning tests.

A recommendation by a psychiatrist or psychologist has to be reasoned sufficiently for the court to judge the likelihood of finding the appointment of an intermediary necessary and with careful attention to cognitive impairments evident on psychological testing or a mental state examination extended to include a detailed cognitive assessment: ‘The question for a judge when considering an application to appoint an intermediary revolves around the quality of the evidence a vulnerable person can give or impediments to essential elements of their participation in proceedings, balanced with the overriding objective and costs proportionality’ (Ahmadzai). Furthermore, the court will need to know why special measures, such as modified ways of framing questions and regular breaks, will not be sufficient; a protective measure short of a direction may be enough (CXC). Also, regard should be had to how considerations may apply to different elements of the proceedings: out-of-court meetings, listening to evidence, reading evidence, giving evidence (M (A Child)).

The role of formulation, assessment and standardised tests

It should be clear from the diagnosis or diagnostic formulation whether the subject of the report has a mental disorder within the meaning of the Mental Health Act 1983, a significant impairment of intelligence and social functioning or a characteristic that is relevant to the participation direction which may be made, the last requiring the most careful description if there is no mental disorder or significant impairment of intelligence and social functioning. Until the relevant vulnerability is identified, the court cannot decide what protective measures are required (CXC). A failure by a psychologist or a psychiatrist to properly diagnose and analyse a person’s needs will not establish a requirement for an intermediary (Ahmadzai).

By reference, for example, to aspects of history taking, mental state examination or psychological observation, or performance on particular tests, it is then necessary to explain how the disorder, condition or characteristic is likely to affect the person’s ability to give evidence, particularly with reference to their: (a) response to questioning; (b) concentration and attention; (c) ability to communicate; and (d) interaction with other people (Rix Reference Rix, Nathan, Rix, Mynors-Wallis and Craven2020) and having regard not only to the assessment of the relevant circumstances of the individual, but also the circumstances of the particular trial (X & Y). It has to be a relevant vulnerability (CXC). Put otherwise, any difficulty experienced by the party must be considered in the context of the actual proceedings that he or she faces. In one case involving care proceedings in the Family Court, the court had regard to the fact that previous proceedings of various forms had taken place and no issue appeared to have been identified in the hearings or reports going back several years in relation to these proceedings and earlier proceedings relating to other children in the family even earlier (X & Y). There was no supporting evidence of the mother’s diagnosis of mental illness or of its impact on her ability to participate.

By contrast, in one case the Court of Appeal decided that it was wrong not to have appointed an intermediary even having regard to the fact that the appellant had appeared in court on four previous occasions, that on one occasion he had been convicted after a trial at which he had given evidence without the assistance of an intermediary, that there had been no appeal against the safety of that conviction, and that his prepared statement provided to the police during interview demonstrated he had sufficient understanding of the issues and an ability to provide instructions to solicitor to allow him to conduct his case (TI v Bromley Youth Court [2020]).

If subsequently an intermediary is instructed, it is advisable to seek permission from the instructing solicitors to discuss the case with the intermediary.

Box 7 sets out the key points for psychiatrists assessing vulnerable parties for the courts.

BOX 7

Key points for psychiatrists conducting psychiatric assessments of vulnerable people for the courts

Psychiatrists should:

  1. (1) ask whether there is an intermediary’s report;

  2. (2) if an intermediary’s report is available prior to assessment, read it and modify the assessment to take into account the strengths and weaknesses identified in it and any techniques or strategies it advises, as optimising communication and understanding can facilitate the psychiatric assessment;

  3. (3) provide only a provisional report if they consider an intermediary’s report essential,

    1. (i) explaining exactly why they consider a report from an intermediary essential and with particular attention to cognitive testing;

    2. (ii) identifying with careful attention to detail those features of the person’s vulnerability that may necessitate the assistance of an intermediary in order for their participation to be effective;

    3. (iii) specifically addressing the ability of the party or witness to (a) understand the proceedings, and their role in them, when in court; (b) put their views to the court; (c) instruct their representative(s) before, during and after the hearing; and (d) attend the hearing without significant distress;

    4. (iv) explaining why they consider that any special measures short of an intermediary’s assistance might be insufficient;

    5. (v) explaining how they consider that an intermediary might assist;

    6. (vi) acknowledging that this is the best assistance that they can provide in the circumstances, and that they may be wrong about the need for an intermediary, about the significance of the person’s vulnerabilities and about what the intermediary might achieve, deferring to the intermediary’s specialist assessment and acknowledging that ultimately it is for the court to decide whether an intermediary is necessary;

  4. (4) if in doubt, recommend an intermediary assessment; the intermediary who assesses would give an opinion on whether intermediary assistance is relevant – it may be that the intermediary advises that input would not improve participation;

  5. (5) in the event that an intermediary assessment is ordered, ask that their provisional psychiatric report is made available to the intermediary;

  6. (6) ask their instructing solicitors for permission to discuss the case with intermediary.

Instruction, assessment and the intermediary’s report

An intermediary for a witness is usually instructed through the police or Crown Prosecution Service, whereas it is typically the court that is involved for all other vulnerable people. Once a referral is received, an intermediary assesses the vulnerable person’s communication and interaction needs in the context of the court (Ministry of Justice 2024b), a very defined, delineated and highly atypical environment. Understanding and communication are dependent on a person’s immediate context, the unfolding discussion, the speaker’s language skills and the vulnerable person’s physical and emotional state (Wehmeyer Reference Wehmeyer, Buntinx and Lachapelle2008; Mondada Reference Mondada2011). A good intermediary assessment should consider all those factors, and the recommendations made usually make provisions for the dynamic, ever-changing aspect of human understanding and communication. Whereas a psychologist’s report is often based on standardised assessments, an intermediary’s report primarily focuses on functionality in the context of the court. As an application for an intermediary must have an evidential basis, commonly in the form of a cognitive report (M (A Child), the intermediary should ask whether such a report has been prepared.

An intermediary assessment mainly looks at functional understanding and communication in the context of legal settings; standardised assessments are not ordinarily used. Therefore court-related understanding and communication difficulties are sometimes identified by intermediaries, who are specifically looking for functioning and participation in that context. The report usually answers three questions. It opines on first, whether the vulnerable person has the ability to understand and communicate to give evidence in court in the case, second, whether the use of an intermediary is likely to improve the quality of that person’s participation, and third, whether recommendations regarding special measures and other adjustments to enable best communication with the person should be made.

An intermediary assessment is not necessarily a one-time event: it is dynamic and ongoing. Verbal or written addenda and recommendations can be made mid-trial as needed, depending on the vulnerable person’s continuously changing communication and interactional needs. Additional recommendations not previously agreed can be advised if appropriate. Alternatively, previously agreed but now redundant recommendations may subsequently need to be advised as irrelevant. Intermediaries are therefore well placed to make informed real-time recommendations about the attentional, environmental and sensory challenges a vulnerable person would experience.

The ground rules hearing and the intermediary’s input during proceedings

Intermediaries usually convey their recommendations at the ‘ground rules hearing’ (GRH), at which the court decides what special measures, additional measures or other reasonable adjustments, if any, should be implemented, and in written or verbal reports to the court, so as to allow the vulnerable person to participate fully in the proceedings.

A GRH must always be considered in a case involving a young or otherwise vulnerable defendant (CrimPD 6.4.1), and where the court directs that questioning will be conducted through an intermediary, the court must hold a GRH at which the intermediary is required to be present (CrimPD 6.2.10). A GRH is expected ‘in every case involving a vulnerable witness, save in very exceptional circumstances. If there are any doubts on how to proceed, guidance should be sought from those who have the responsibility for looking after the witness and or an expert’ (Lubemba). The GRH ‘should cover […] the general care of the witness, if, when and where the witness is to be shown their video interview, when, where and how the parties (and the judge if identified) intend to introduce themselves to the witness, the length of questioning and frequency of breaks and the nature of the questions to be asked’ (Lubemba).

An intermediary for a witness comments on special measures to improve the quality of the person’s evidence, including commenting on cross-examination questions so they are put in a developmentally appropriate manner, crucial in enabling understanding (Myers Reference Myers2017). In relation to a defendant or other party, if one is instructed for more than evidence only, an intermediary provides contemporaneous intervention in situ, as the trial progresses in real time. As well as simplification of relevant proceedings and legal arguments, rewording of complex directions and explanation of legal concepts, intermediaries provide input in less conventional ways. They may use appropriate court-agreed communication aids (YJCEA, s.30) to assist understanding, often creating them contemporaneously, assessing their usefulness and relevance as the need arises. Writing (in the form of keywords), simple line drawings, colour and highlighting can be utilised to supplement spoken language, assisting understanding and facilitating a vulnerable person’s communication and participation.

Recommendation of an order for an intermediary to be appointed for a whole trial must be supported by reasons as to why attendance for parts of the trial might not be sufficient (West Northamptonshire). In one case the inquisitorial, problem-solving nature of the care proceedings in the Family Court demanded that no form of adaptation to the court process lesser than a ‘whole trial’ intermediary order would suffice, in the context of the parents’ vulnerabilities, to ensure that they were not disadvantaged as a result of their cognitive, communication and intellectual difficulties (‘learning disability’) (Re O & Y (Parents with Learning Disability: Intermediaries) [2024]).

The intermediary in court

An intermediary for a defendant will probably sit beside the defendant, including in the dock themselves, or otherwise beside the defendant, which has wide-ranging advantages. It immediately puts an intermediary in a privileged position whereby they are able to gain a useful functional perspective of the physical, interactional and communication barriers to which the vulnerable person is exposed, in that ecologically unique context. This close working environment, experienced by no other court professional, permits an intermediary to observe a vulnerable person’s individualised responses and reactions to a range of stimuli that, by their association with the person’s traumatic history, can trigger particular emotional or behavioural reactions, thereby improving their evidence-based knowledge of the person’s functioning in that niche environment.

In court, intermediaries employ strategies to manage attention and regulate sensory and emotional changes, if needed, all of which enable a vulnerable person to participate in their own trial/hearing more effectively, including instructing their legal team in an informed manner. Legal advocates and all other court staff usually sit with their backs to a defendant. However, because of their unique positioning in the dock alongside the vulnerable person, or adjacent to them elsewhere, intermediaries are accurately able to interpret a vulnerable person’s non-verbal communication, take measures to rectify any barriers and/or use interventions to facilitate effective participation.

Evidence giving is a highly stressful and anxiety-provoking phenomenon (Doak Reference Doak2008) and when questioning of vulnerable people triggers flashbacks to, or other reliving of, traumatic experiences, intermediaries may utilise grounding techniques to mitigate the effects of flashbacks. Strategies to regulate emotions and minimise the impact of hyper- and/or hypo-sensitivities can be extremely useful in maintaining equilibrium such that a vulnerable person can continue to participate effectively in their own trial.

Illustrative cases

The role of the intermediary is illustrated in R v Dixon (Jordan) [2013] EWCA Crim 465 (Box 8), where reference was made to how the intermediary’s assistance contributed to the defendant’s ability to participate meaningfully in his trial, and in R v De Zoysa [2025] (Box 9), where the Court of Appeal found that every possible step that could be thought of was taken to ensure that the defendant’s participation met the strict requirement of a fair trial. The case in Box 10 (Leicestershire County Council v Amy [2024]) is an example of how the ability of parents to participate effectively in family proceedings came about through the collaboration of, and the court’s assistance from, a specialist clinical psychologist for deaf people and a deaf intermediary.

BOX 8

An intermediary’s assistance in support of the defendant in court: R v JD [2013]

The appellant had an IQ of 68–71, a history of hyperactive conduct disorder and communication difficulties. The judgment describes what his intermediary did:

‘She maintained a visual record to enable the Appellant to follow the evidence; she wrote simple sentences for him; and she held twice daily meetings with the Appellant outside court to summarise past and future events in the trial; she assisted him with a vocabulary folder to explain more difficult concepts; and she was eventually able to explain satisfactorily to him what the role of the jury was […]’ (para. 94);

‘Steps were taken by the intermediary to provide real assistance to the Appellant in explaining to him what was happening and simplifying the court process [and] to ensure that the Appellant could follow in simpler terms what was going on’ (para. 96).

BOX 9

Steps taken to ensure the defendant’s full participation in their trial: R v De Zoysa [2025]

Louis de Zoysa was charged with the murder of police sergeant Matthew Ratana. PS Ratana was a custody sergeant and was shot twice by Mr de Zoysa in a police holding cell. A third shot hit a wall. The fourth shot ricocheted and hit Mr de Zoysa’s neck, dissecting his left carotid artery and resulting in a stroke and some permanent brain damage. As a consequence, Mr de Zoysa has considerable communication difficulties. He has what have been described as ‘receptive and expressive aphasia, and apraxia of speech, as well as some cognitive impairment’. The court said that these mean he has some difficulty both in understanding language spoken to him and in finding the appropriate spoken language to respond, as well as in making the sounds of words he intends to articulate. In childhood he was diagnosed as having autism spectrum disorder.

A fitness to plead hearing took place and Mr de Zoysa was found fit to plead and fit to stand trial. The judge’s directions included a ground rules hearing and the provision of an intermediary, to ensure that Mr de Zoysa was able to play a full part in the proceedings.

An intermediary’s report set out Mr de Zoysa’s ‘considerable difficulties in consistently understanding spoken sentences, processing and retaining verbal information and communicating his own thoughts and memories’. It stated that these difficulties ‘could be ameliorated to a degree by the use of visual support for what was said to him’.

A number of adaptations to the proceedings were envisaged by the judge. These included ‘trial at a venue that required no more than 10 minutes travel, physical reworkings to the court room, and simplification of the case beyond what would ordinarily be expected – such as, to a high degree, in the language to be used at all points in the trial, including the opening, agreed facts, formulation of questions to Mr de Zoysa and directions to the jury. The intermediary was to have a prominent role’.

The Court of Appeal found that every possible step that could be thought of was taken to ensure that Mr de Zoysa’s participation met the strict requirement of a fair trial. It said that ‘with the benefit of a retrospective view it was plain that the judge’s directions were effective. Counsel on both sides used plain language and an appropriate pace. The conduct of the cross-examination of the applicant was commendable. The court days were truncated whenever required. Counsel prepared straightforward written documents, including, for example, simplified versions of submissions. The intermediary ably assisted the applicant throughout the preparation of the case, the trial and his evidence’.

The intermediary provided a written update report twice, close to the start and the end of the trial. The first summarised the positive impact of the steps taken by the judge to ensure that Mr de Zoysa’s understanding was maintained. They included providing a simple introduction to each stage of the proceedings, directed at the dock. Mr de Zoysa was given in writing the day before the proposed events for each day and they were explained in meetings with defence counsel as well as by the intermediary. The judge reinforced these repeating what was proposed immediately before it happened at the start of the day’s hearing. The simplified form in which spoken information was being communicated in the trial, not just directly to Mr de Zoysa himself, was noted by the intermediary. In the second report the intermediary observed that Mr de Zoysa was able to understand the contrasting positions of the prosecution and the defence when stated separately, although he could not follow the more complex content even when simplified verbally and with the support of visual aids. The intermediary said that he was fixated on a few topics. There were times when the intermediary was concerned about the level of Mr de Zoysa’s energy and focus, but it was observed that the short breaks temporarily refreshed him.

Mr de Zoysa was able to give evidence, over the course of three mornings with frequent breaks, ‘consistent with his defence of diminished responsibility, with careful adjustments to the process including the availability of a white-board for him to use and breaks whenever required’. The court observed that the intermediary was actively involved throughout and how ‘the questioning on the limited issues was prepared by counsel skilfully so that the applicant did not have to listen to, comprehend, and then answer conceptually complicated or detailed questions. To the contrary, all topics were broken down into simple and short questions’.

BOX 10

Supporting deaf parties in court: Leicestershire County Council v Amy (Re Lack of Multiagency Approach to Deaf Parents) [2024]

The mother was described as profoundly prelingually deaf, with no hearing, and she was not a very able lip reader. She was severely disabled by significant symptoms of depression, anxiety and agoraphobia. A key point made by the intermediary, Dr Sally Austen, was that she communicated expressly through speech which was unclear and in 2016 she had virtually no signing skills. She said that her lipreading at best allowed ‘50% of words to be understood, but this required very good concentration and confidence. She was likely to be understanding significantly less than 50% of what was being said’. Her need for a lipspeaker who was willing to augment communication with writing and her need for an intermediary were highlighted by the court. The father had a little hearing that helped him process speech, but he was not able to hear on the telephone. He was described as ‘severely to profoundly’ deaf. Previously, he had expressly communicated through speech, but the court observed that despite referring to himself as a non-signer, he did use some formal sign.

The parents, the court and all the parties had, in these proceedings, and in the previous proceedings, what the court described as ‘the very helpful expert input of Dr Sally Austen, who is a Specialist Consultant Clinical Psychologist for Deaf People’. She provided specialist cognitive functioning assessment reports on both parents.

At the outset, the court acknowledged that ‘the understanding of, identification, booking and confirmation of the right interpreters for each of these parents had come about through a combination of the parents’ legal teams, the Deaf intermediary Chantelle De La Croix’s advice and the court checking to make sure that the named type of interpreters were the correct ones’.

The mother had the benefit of two Sign Supported English (SSE) interpreters throughout the hearing, and her deaf intermediary. The father was supported by two Lipspeaking with SSE interpreters. The contribution of the professionals was described by the court as ‘invaluable’.

Conclusion

The common goal towards which experts and intermediaries work is the effective participation of a vulnerable person in legal proceedings and, in doing so, consideration of each other’s roles and responsibilities is crucial. The intermediary’s role has become more established since inception, but its focus has always been on optimising understanding and communication, a two-way process, between a vulnerable person and legal professionals. Evolving into and being recognised as a new profession might be a logical next step.

MCQs

Select the single best option for each question stem

  1. 1 The Youth Justice and Criminal Evidence Act 1999:

    1. a provides for a defendant in criminal proceedings to be assisted by an intermediary

    2. b applies only to persons under the age of 18 years

    3. c provides for the appointment of an intermediary if the person’s vulnerability is a result of physical disability or disorder

    4. d excludes accuracy as a consideration when referring to the quality of evidence

    5. e requires the court to take ‘every reasonable step’ to encourage the participation of any person.

  2. 2 The function of the intermediary:

    1. a is to assist a vulnerable witness in adapting to the demands of communication in the courtroom

    2. b includes assisting a witness or party to negotiate the process of being questioned remotely

    3. c does not extend to assisting a party more generally in legal proceedings

    4. d does not extend to enabling a defendant to understand judicial directions to the jury

    5. e is to assist a witness or defendant just in case there are communication difficulties.

  3. 3 A ‘ground rules hearing’:

    1. a need not always take place in the case of a young defendant

    2. b does not always require the attendance of the intermediary

    3. c is expected, without exception, in every case involving a vulnerable witness

    4. d is limited to consideration of communication difficulties

    5. e should cover the general care of the witness.

  4. 4 About the evidential basis for the appointment of an intermediary:

    1. a a psychiatric report is required

    2. b usually, establishing this depends on the application of standardised tests by an intermediary

    3. c it commonly calls for a cognitive assessment

    4. d it is established on the assertion by either a psychiatrist or a psychologist that a party or witness will be assisted by the support of an intermediary

    5. e the criteria are set out in Youth Justice and Criminal Evidence Act 1999.

  5. 5 Where a psychiatrist is instructed to prepare a report in a case where the appointment of an intermediary is an issue:

    1. a the psychiatrist assists the court by advising that it is reasonable to appoint an intermediary

    2. b the psychiatrist should defer to the intermediary as to whether any special measures short of the assistance of an intermediary might be sufficient

    3. c the report should not be prepared until an intermediary’s report has been obtained

    4. d it is not necessary to refer to the definition of mental disorder in the Mental Health Act 1983 (or equivalent legislation)

    5. e communication difficulties may be revealed in language or verbal proficiency tests.

MCQ answers

  1. 1 c

  2. 2 b

  3. 3 e

  4. 4 c

  5. 5 e

Acknowledgements

This article was originally conceived by Sally Austen, Akinkunmi Odutola, Tina Pereira and Keith Rix, but Dr Odutola made no further contribution to the article. We are particularly grateful to Dr Austen, who was intended to be a co-author and who contributed to the first draft of the article but has had to withdraw from authorship. She was primarily responsible for content relating to deaf people and intermediaries in general. Dr Austen is a consultant clinical psychologist who works mainly in deaf mental healthcare. She is co-editor of Deafness in Mind (Wiley, 2004), Deafness and Challenging Behaviour (Wiley, 2006) and Working with Deaf and Hard of Hearing Clients (independently published, 2021).

We are also grateful for the very helpful suggestions of the anonymous reviewers of this article.

The judgments that are the source of the illustrative cases in Boxes 8, 9 and 10 are © Crown copyright. Access to these has been through the website of the British and Irish Legal Information Institute (BAILII). In accordance with its reproduction and copyright policy we therefore identify BAILII as the source of these and advise readers that these judgments are freely available on the BAILII website: https://www.bailii.org/.

Author contributions

T.P. was primarily responsible for setting out the history of the development of intermediary services and describing how intermediaries operate. K.J.B.R. contributed to the history of the development of intermediary services, incorporated material from judgments and case law and synthesised the contributions of S.A. (who had to withdraw from authorship), T.P. and himself for the first draft. K.J.B.R. finalised the article in the light of the recommendations made by the anonymous reviewers.

Funding

This work received no specific grant from any funding agency, commercial or not-for-profit sectors.

Declaration of interest

None.

Footnotes

*

K.R.’s contributions to this article are based on his presentation ‘Collaboration between psychiatrists and intermediaries: facilitating justice for the vulnerable’ at The Intermediary Cooperative Conference ‘Collaboration: a cooperative approach to achieving fairer justice’ at the University of Liverpool’s Department of Law and Social Justice on Friday 27 June 2025.

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