This guide is to assist medical practioners in assessing the fitness to drive of any individual. It also sets out the responsibilities and obligations of medical practioners.
This section covers:
The table below summarises the information outlined in this section. Practitioners should ensure that they are familiar with the guidance outlined in the entire section rather than relying solely on the table. The recommended minimum stand-down periods from driving and guidelines only apply where an individual's medical condition has been adequately treated and stability has been achieved so that road safety is unlikely to be compromised.
|Medical condition||Class 1 or class 6 licence and/or a D, F, R, T or W endorsement (see appendix 3)||Class 2, 3, 4 or 5 licence and/or a P, V, I or O endorsement|
|Mental disorder that may impair an individual's ability to drive safely||Whether an individual should or should not drive will be based on the assessment of the following factors, and how they affect an individual's ability to drive safely:
1 psychomotor functioning
3 mood (including suicidal ideation)
|Same factors to consider as lower licence classes and endorsement types, except consideration should be given to the type of driving the individual undertakes, and any personal safety risks to others. Generally higher standards apply to these drivers.|
|Severe chronic mental disorder||Driving should cease where an individual's ability to drive safely may be impaired. The individual is generally unfit to drive until effective treatment is in place, and a period of observation, usually six months, has been undertaken.||Driving should cease where an individual's ability to drive safely may be impaired. The individual is generally unfit to drive until effective treatment is in place, and a period of observation, usually 12 months, has been undertaken.|
The law requires:
Section 18 of the Land Transport Act 1998 also provides that a medical practitioner or registered optometrist who gives notice in good faith under section 18 will not be subject to civil or professional liability because of any disclosure of personal medical information in that notice.
Individuals other than those subject to section 19 of the Land Transport Act 1998: Medical practitioners can usually successfully negotiate short-term cessation of driving with patients. However, if longer periods are necessary, we recommend that medical practitioners advise their patients both verbally and in writing. We also recommend that the patient be told how soon they might expect to have this situation reviewed. If a practitioner suspects that a patient is continuing to drive against medical advice, they are legally obliged to inform the Agency under section 18 of the Land Transport Act 1998 (see section 1.4).
There have been rapid major advancements in the treatment of mental illnesses in recent years. However, it is unfortunately necessary to be mindful of the abundance of inaccurate information about mental illness that remains in the community. This misinformation is the legacy of an environment that socially excluded and removed people with mental illness. The government's Mental Health Strategy seeks to address this and reduce the negative impact of mental disorders by ensuring unwarranted barriers to participation in all aspects of life for people with mental illness are removed.
Individuals with a mental disorder should not automatically be considered unfit to drive: Medical practitioners should assess each individual and the manifestations of their mental disorder or treatment, considering the guidance in this section, to determine if they are fit or unfit to drive. Where appropriate, medical practitioners may need to refer the individual to a specialist or a mental health service provider.
The assessment of individuals with mental disorders is one of the more difficult aspects of determining fitness to drive. The effect of mental disorders on the ability to drive safely has not been determined with any degree of certainty, and fluctuations that may occur during a course of clinical illness make it inappropriate to set rigid rules. There are only a few recent studies in this area, which makes the medical practitioner's task in determining fitness to drive difficult.
While there is evidence that the prevalence of psychiatric disorders in crash victims is greater than estimates for the general population, not all psychiatric disorders appear to carry an increased degree of accident vulnerability (McDonald and Davey 1996). Personality disorders and alcohol abuse are seen in elevated numbers in crash victims, whereas anxiety and depressive disorders are not seen to be more prevalent than in the general population.
In the absence of clear information on the potential road safety risks, a commonsense approach should be undertaken. For instance, a person suffering an acute psychotic episode totally engulfed in delusions is likely to be dangerous while driving. Similarly, a person severely ill with anxiety or depression, whose reactions are retarded and who cannot concentrate or make decisions and who is absorbed in worries and problems, is unlikely to be a safe driver.
In some areas of mental health provision, a significant level of trust is established between a medical practitioner and their patient. In these circumstances, medical practitioners may wish to refer their patient to another medical practitioner for assessment, rather than risk damaging their practitioner-patient relationship.
This section outlines general advice on how to assess and determine fitness to drive for an individual with a mental disorder. Individuals who are assessed as unfit to drive using the assessment criteria below should be advised not to drive until:
The following checklist may be useful for medical practitioners to consider, in addition to the assessment above.
Does the individual have:
Medical practitioners should consider the following factors, if appropriate:
The ability to drive safely may be impaired by:
Individuals who are subject to elevated or depressed moods, and the behavioural manifestations of these, should be carefully assessed. Particularly consider whether:
Note: the effects of medications that may sedate are discussed below.
Individuals should be advised not to drive during periods of active suicidal behaviour or intent. The presence of suspected suicidal ideation should be carefully assessed, considering the intensity of suicidal ideas, impulsiveness, likelihood of attempt and imminence. Suicidal thinking may be an acute phase that subsides quickly, or may be ongoing.
The effect of medication should be carefully assessed, including the individual's likely compliance with their medication and any impacts on the individual's ability to drive safely. Consider:
Each patient should be individually assessed, taking into account the known profile of effects of the drug, the dose and the degree to which the illness is controlled.
Psychotropic medication can temporarily impair an individual's ability to drive safely. When starting most psychotropic medication or increasing a dose, a person should not drive until the side effects, such as perceptual or motor skills difficulties, are unlikely to affect the individual's ability to drive safely.
This is particularly important in conditions that fluctuate or are episodic, eg if the patient is able to judge when it is safe or not safe to drive. This should include consideration of the individual's history, eg whether they have a history of sudden unexpected onset of symptoms that could impair their ability to drive safely.
While not relating to the ability to drive safely, section 18 of the Land Transport Act 1998 requires medical practitioners to report any individual who poses a public safety risk by driving when advised not to. This can include the risk to individuals other than the driver for personal safety reasons.
For P, V, I or O endorsement holders, medical practitioners should consider any possible public safety risks that may occur because of the nature of work these endorsements entail. For example, all these endorsements can involve substantial contact with many strangers, a high-stress working environment and dealing with an individual in isolated circumstances. Medical practitioners should advise those individuals who may pose a risk to others, from a personal safety perspective, not to drive in these endorsement capacities.
The diagnostic criteria in section 8.1 should be used to assess individuals with severe chronic mental disorders that affect an individual's ability to drive safely. Examples of mental conditions that could impact on an individual's ability to drive safely are severe and ongoing anxiety or depression, severe chronic schizophrenia and severe bipolar disease. Individuals with severe chronic mental conditions should be given the recommended periods to refrain from driving outlined below.
Note that this section does not imply that all individuals with anxiety or depression or schizophrenia or bipolar disease should refrain from driving. This section only applies to those individuals who:
Where an individual's mental condition is severe and chronic and affects their ability to drive safely for extended periods, the individual is considered unfit to drive until effective treatment is in place and a period of observation, usually six months, has been undertaken. However, the time away from driving will depend on how the individual responds to treatment, and the likelihood of further relapses. A psychiatric assessment is required before allowing the patient to drive again.
Commercial driving can involve additional stresses that private drivers do not encounter, such as tight schedules, contact with the public and long hours. Any severe and chronic mental condition that impairs an individual's ability to drive safely for an extended period will render the individual unfit to drive for a period, usually 12 months. In exceptional circumstances, the return to commercial driving can be significantly less than 12 months but this will depend on:
Where it is recommended that an individual be granted a driving restriction of less than nine months, the medical practitioner may wish to write to the Chief Medical Adviser and outline the patient's circumstances, including the nature of the commercial driving that is generally undertaken, and the patient's prognosis.
Very few people who experience mental disorder or suicidal ideation are subject to the Mental Health (Compulsory Assessment and Treatment) Act 1992. The spirit of the Act is to facilitate treatment in the community wherever possible, to enable people to participate in their normal day-to-day activities. An individual can still drive under this Act unless:
Section 19 of the Land Transport Act 1998 (see appendix 2) applies to individuals subject to a Compulsory Inpatient Treatment Order or special patients, as defined in the Mental Health (Compulsory Assessment and Treatment) Act 1992. Section 19 places legal responsibilities on ‘persons in charge of a hospital’ and ‘Directors of Area Mental Health Services’ as follows:
Persons in charge of a hospital
Where a patient is subject to section 19 of the Land Transport Act 1998, the person in charge of a hospital is required to advise the Agency. An example notification letter is outlined in appendix 6.
Directors of Area Mental Health Services (DAMHS)
DAMHS have a range of actions to take, depending on the patient's circumstances and the type of licence the patient holds. Flowcharts A and B in appendix 7 outline the processes for section 19 of the Land Transport Act 1998 in respect to the two categories of licence classes and endorsement types.