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DVLA Medical Rules

Last Updated February 2005

PSYCHIATRIC DISORDERS

GROUP 1 ENTITLEMENT
ODL –CAR, M/CYCLE

ANXIETY OR DEPRESSION
(without significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts).

DVLA need not be notified and driving may continue. (See note about medication in appendix at end of this Chapter).

MORE SEVERE ANXIETY STATES OR DEPRESSIVE ILLNESSES

(with significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts)

NB: For cases which also involve persistent misuse of or dependency on alcohol/drugs, please refer to the appropriate section of Chapter 5. Where psychiatric illness has been associated with substance misuse, continuing misuse is not acceptable for licensing.

Driving should cease pending the outcome of medical enquiry. A period of stability depending upon the circumstances will be required before driving can be resumed. Particularly dangerous are those who may attempt suicide at the wheel.

ACUTE PSYCHOTIC DISORDERS OF ANY TYPE

Driving must cease during the acute illness. Re-licensing can be considered when all of the following conditions can be satisfied:

a)	Has remained well and stable for at least 3 months.
b)	Is compliant with treatment.
c)	Is free from adverse effects of medication which would impair driving.
d)	Subject to a favourable specialist report.

Drivers who have a history of instability and/or poor compliance will require a longer period off driving.

HYPOMANIA/MANIA

Driving must cease during the acute illness. Following an isolated episode, re-licensing can be reconsidered when all the following conditions can be satisfied:
(a) Has remained well and stable for at least 3 months.
(b) Is compliant with treatment.
(c) Has regained insight.
(d) Is free from adverse effects of medication which would impair driving.
(e) Subject to a favourable specialist report.

REPEATED CHANGES OF MOOD: Hypomania or mania are particularly dangerous to driving when there are repeated changes of mood. Therefore, when there have been 4 or more episodes of mood swing within the previous 12 months, at least 6 months stability will be required under condition (a), in addition to satisfying conditions (b) to (e).

CHRONIC SCHIZOPHRENIA &
Other Chronic Psychoses

The driver must satisfy all the following conditions:

Stable behaviour for at least 3 months.
Is adequately compliant with treatment.
Remain free from adverse effects of medication which would impair driving.
Subject to a favourable specialist report.

Continuing symptoms: Even with limited insight, these do not necessarily preclude licensing. Symptoms should be unlikely to cause significant concentration problems, memory impairment or distraction whilst driving. Particularly dangerous, are those drivers whose psychotic symptoms relate to other road users.

DISORDER

GROUP 1 ENTITLEMENT
ODL –CAR, M/CYCLE

DEMENTIA OR ANY ORGANIC BRAIN SYNDROME

It is extremely difficult to assess driving ability in those with dementia. Those who have poor short-term memory, disorientation, lack of insight and judgement are almost certainly not fit to drive.

The variable presentations and rates of progression are acknowledged. Disorders of attention will also cause impairment. A decision regarding fitness to drive is usually based on medical reports.

In early dementia when sufficient skills are retained and progression is slow, a licence may be issued subject to annual review. A formal driving assessment may be necessary. (See Appendix 1 & 2)

LEARNING DISABILITY

severely below average general intellectual functioning accompanied by significant limitations in adaptive functioning in at least 2 of the following areas: communication, self-care, home-living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health and safety.

Severe learning disability is not compatible with driving and the licence application must be refused. In milder forms, provided there are no other relevant problems, it may be possible to hold a licence, but it will be necessary to demonstrate adequate functional ability at the wheel.

DEVELOPMENTAL DISORDERS

includes Asperger’s Syndrome, autism, severe communication disorders and Attention Deficit Hyperactivity Disorder.

A diagnosis of any of these conditions is not in itself a bar to licensing. Factors such as impulsivity, lack of awareness of the impact of own behaviours on self or others need to be considered

BEHAVIOUR DISORDERS

includes post head injury syndrome, personality disorders, and Non-Epileptic Seizure Disorder

If seriously disturbed e.g. violent behaviour or alcohol abuse and likely to be a source of danger at the wheel, licence would be revoked or the application refused. Licence will be issued after medical reports confirm that behavioural disturbances have been satisfactorily controlled.

Appendix

PSYCHIATRIC NOTES

The 2nd EC Directive requires member states to set minimum medical standards of fitness to drive and sets out the requirements for mental health in broad terms.
The Directive makes a clear distinction between the standards needed for Group 1 (cars and motorcycles) and Group 2 (lorries and buses) licences, the standards for the latter being more stringent due to the size of vehicle and the greater time spent at the wheel during the course of the occupation.
Severe mental disorder is a prescribed disability for the purposes of Section 92 of the Road Traffic Act 1988. Regulations define "severe mental disorder" as including mental illness, arrested or incomplete development of the mind, psychopathic disorder or severe impairment of intelligence or social functioning. The standards must reflect, not only the need for an improvement in the mental state, but also a period of stability, such that the risk of relapse can be assessed should the patient fail to recognise any deterioration.
Misuse of or dependency on alcohol or drugs will require the standards in this chapter to be considered in conjunction with those of Chapter 5 of this publication.

MEDICATION

Section 4 of the Road Traffic Act 1988 does not differentiate between illicit or prescribed drugs. Therefore, any person who is driving or attempting to drive on the public highway, or other public place whilst unfit due to any drug, is liable to prosecution.
All drugs acting on the central nervous system can impair alertness, concentration and driving performance. This is particularly so at initiation of treatment, or soon after and when dosage is being increased. Driving must cease if adversely affected.
The older tricyclic antidepressants can have pronounced anticholinergic and antihistaminic effects, which may impair driving. The more modern antidepressants may have fewer adverse effects. These considerations need to be taken into account when planning the treatment of a patient who is a professional driver.
Anti-psychotic drugs, including the depot preparations, can cause motor or extrapyramidal effects as well as sedation or poor concentration, which may, either alone or in combination, be sufficient to impair driving. Careful clinical assessment is required.
The epileptogenic potential of psychotropic medication should be considered particularly when patients are professional drivers.
Benzodiazepines are the most likely psychotropic medication to impair driving performance, particularly the long acting compounds. Alcohol will potentiate the effects.
Doctors have a duty of care to advise their patients of the potential dangers of adverse effects from medication and interactions with other substances, especially alcohol.
Drivers with psychiatric illnesses are often safer when well and on regular psychotropic medication than when they are ill. Inadequate treatment or irregular compliance may render a driver impaired by both the illness and medication.

CONFIDENTIALITY

When a patient has a condition which makes driving unsafe and the patient is either unable to appreciate this, or refuses to cease driving, GMC guidelines advise breaking confidentiality and informing DVLA. [GMC Confidentiality Handbook]

PATIENTS UNDER SECTION 17 OF THE MENTAL HEALTH ACT

Before resuming driving, drivers must be able to satisfy the standards of fitness for their respective conditions and be free from any effects of medication, which will affect driving adversely.

Crown Copyright - Driver and Vehicle Licensing Agency Swansea SA6 7JL

Original Document available at: http://www.dvla.gov.uk/at_a_glance/ch4_psychiatric.htm