Driving in a crisis

We wholeheartedly commend Dr Sheridan on his recent article on fitness to drive ¹ and thank him for highlighting such an important issue.

All drugs acting on the central nervous system can potentially impair alertness, concentration and driving performance. This is particularly so at initiation of treatment, soon after and when dosage is being increased. Driving must cease if adversely affected. Doctors have a duty of care to advise their patients of the potential dangers of adverse effects from medications and interactions with other substances, especially alcohol. The Driver and Vehicle Licensing Agency (DVLA) has published a list of psychiatric conditions and the requirements for notification. Its directives make clear distinction between group 1 drivers (of cars and motorcycles) and group 2 drivers (of lorries and buses). To regain the licence, the DVLA must be satisfied that an improvement in the mental state has been achieved and a period of stability has been fulfilled, which varies for every condition and between groups 1 and 2. ² Crisis resolution teams deal on a daily basis with most of the psychiatric conditions which should be declared to DVLA, such as severe anxiety states or depressive illness, acute psychotic disorders of any type, hypomania/mania, chronic schizophrenia, personality disorders, and substance misuse. In addition, driving can be used as a means of suicide or as a means to harm others, which emphasises the need of a thorough assessment, accurate documentation and regular review. There are a number of incidences such as the tragic event of a mental health service user who lost control behind the wheel killing herself and two members of the public. ³

I believe the assessment of fitness to drive should be incorporated in day-to-day risk assessment and clearly documented at each contact with crisis team service users. This is core business of every professional who comes in touch with patients. Patients deserve to be advised with regard to DVLA regulations, and indeed should stop driving if deemed unsafe and advised to contact the DVLA accordingly. The General Medical Council advises clinicians to tell patients with conditions which are likely to impair their ability to drive to inform the DVLA. If, however, the clinician does not assess and monitor the particular risk, they would be failing in their statutory duty, irrespective of their need to break confidentiality or not. ⁴