Dear Rt Hon Chris Grayling MP

We are writing to you regarding the Driver & Vehicle Licensing Agency (DVLA) medical guidelines in relation to Acute Psychotic Disorder and Schizophrenia. We believe the guidelines as they stand are not justified by the scientific evidence base, and furthermore appear to be in breach of the Equalities Act (2010). We are writing to ask you to review these guidelines in light of the scientific evidence, and to adapt the DVLA guidance for people with a diagnosis of Acute Psychotic Disorder and Schizophrenia from ‘Must not Drive’ to ‘Might be allowed to drive subject to medical advice and/or notifying the DVLA’, in line with the guidance for conditions such as dementia.

At present, the guidelines state that a person with a diagnosis of Acute Psychotic Disorder or Schizophrenia ‘must not drive’ and must notify the DVLA, and that licensing may only be considered if all of the following conditions are met:

• remaining well and stable for at least three months;
• adhering adequately to any treatment plan;
• regaining insight;
• being free from any medication effects that would impair driving, and
• subject to a specialist report being favourable.

1. We are aware of no scientific evidence which demonstrates that a diagnosis of Acute Psychotic Disorder or Schizophrenia would impair driving per se for everyone receiving these diagnoses, and would respectfully ask you to provide this. It is our view that there are indeed some instances where a person with one of these diagnoses may be judged not safe to drive, for example where their attention and short-term memory are impaired. This decision on licensing should be based on medical reports, on a case by case basis. However, in many others, and indeed arguably the vast majority of instances, a person may have one of these diagnoses and drive safely.This is partly owing to the fact that both Acute Psychotic Disorder and Schizophrenia span a wide range of symptoms. For example, a person with a diagnosis of Schizophrenia need meet only two of any of the following five symptoms: hallucinations, delusions, disorganized speech, disorganized or catatonic behaviour, and negative symptoms including emotional flatness, apathy or lack of speech1. The diagnosis covers a vast spectrum of human experience, with varied presentation, intensity and frequency. Some people with a diagnosis of schizophrenia may find that their experiences impair their ability to drive, but many others will not.
2. We also have concerns about the impact these guidelines may have on the recovery of those persons who have their licence removed, despite their diagnosis not affecting their ability to drive. There is evidence to show that for many people, finding or getting back to meaningful work or other valued activity can have a greater positive impact than any ‘treatment’2, and that recovery from mental ill health, including schizophrenia or psychosis, is based on family and social connections, and having a meaningful and valued role in one’s community3. For many people, especially those in rural locations, or those whose family, personal or financial responsibilities partially rely on driving, being able to drive safely is integral to their recovery. The automatic removal of licences for all persons with these diagnoses, regardless of their assessed ability to drive, has an arguably deep and nefarious impact on many individuals’ recovery.
3. Finally, we are concerned that owing to the lack of scientific evidence base to justify the de facto removal of licences for all persons with these two diagnoses, and without consideration of each individual case, these guidelines are discriminatory and in breach of section 15 of the Equalities Act.4

It is important that people with a medical condition have appropriate assessments to gauge their ability to drive safely. However, the DVLA also has a responsibility to ensure these guidelines are fair, proportionate, evidenced and in the best interests of the general public. In this case it seems that there is no scientific evidence base to justify the automatic revocation of licences for all persons with a diagnosis of Acute Psychotic Disorder or Schizophrenia. We would therefore respectfully ask you to review your guidelines in line with the scientific evidence base, so that the ability of persons with these diagnoses to drive is assessed and determined on a case by case basis.

Yours faithfully

Akiko Hart
ISPS UK (International Society for Psychological and Social Approaches to Psychosis), Hearing Voices Network England, Mind in Camden

Cllr Andrew Gordon, Vice-Chairman of the Housing & Community Committee and Chairman of the Health Partnership Board at Basildon Borough Council

The Association of Clinical Psychologists UK (ACP-UK)

Mark Allan, Hearing Voices Network England

Dr Philip Anscombe, Clinical Psychologist/Approved Clinician

Roya Afsharzadegan, West London Mental Health NHS Trust

 

1 http://www.who.int/mediacentre/factsheets/fs397/en/ and https://www.psychiatry.org/psychiatrists/practice/dsm

2 Cooke, A. et al (2017). Understanding Psychosis and Schizophrenia. British Psychological Society: Department of Clinical Psychology.

3 https://www.nice.org.uk/guidance/cg178

4 https://www.legislation.gov.uk/ukpga/2010/15/section/15