Driving, mental illness and the role of the psychiatrist

Abstract

Objectives: Drivers with certain mental illnesses are obliged by the Driver & Vehicle Licensing Authority (DVLA) to stop driving and to report their condition. This study aims to quantify the number of psychiatric patients failing to meet the DVLA standards of ‘fitness to drive’ and to record how frequently psychiatrists failed to advise patients of these standards.Method: In this prospective descriptive study, 10 psychiatrists reported by questionnaire the diagnosis and driving status of all patients encountered over a four week period. They recorded their advice given to patients failing to meet the DVLA criteria of ‘fitness to drive’ and advice given when prescribing psychotropic medication.Results: Of 297 patients, 123 (41%) were drivers. 19/123 (13%) of drivers failed to meet the DVLA standards of ‘fitness to drive’. In 9/19 of these cases the psychiatrist did not advise the patient in line with the DVLA guidelines. This was especially the case for alcohol related disorders. Of drivers 49% were prescribed psychotropic medication with potential adverse effects on driving.Conclusions: Driving amongst mentally ill patients appears commonplace. In this study, 13% of drivers were considered by the authorities to be unfit to drive. Psychiatrists frequently used their own judgement when advising patients regarding driving. This arguably contravenes doctors' responsibilities to patients and has potential legal implications for both the patient and psychiatrist.

Canadian Psychiatrists' Current Attitudes, Practices, and Knowledge regarding Fitness to Drive in Individuals with Mental Illness: A Cross-Canada Survey

“…We found only 4 studies of psychiatrists' practices relevant to driving, all from Great Britain (3)(4)(5)(6). Of these, 2 described the practices of psychiatrists in regard to assessing driving competency (4,6).…”

“…We carried out an extensive review of the literature, using electronic databases (PsycINFO, MEDLINE, and Cinahl) and the following search terms: driving, fitness, and performance combined with the terms psychiatrist, survey, mental illness, and mental disorders. We found only 4 studies of psychiatrists' practices relevant to driving, all from Great Britain (3)(4)(5)(6). Of these, 2 described the practices of psychiatrists in regard to assessing driving competency (4,6).…”

“…Of these 23, 6 (26%) received advice from their GP and 2 (9%) received advice from their psychiatrist regarding the likely effects of their illness on driving. Finally, in a prospective descriptive study, Elwood followed 10 psychiatrists over a 4-week period and asked them to record the diagnosis and the driving status of all patients encountered (3). They were also asked whether they gave advice concordant with the DVLA guidelines and if not, why not.…”