✘- Must not drive

! - May continue to drive subject to medical advice and/or notifying DVLA

✓- May continue to drive and need not notify DVLA

Anxiety or depression – mild to moderate

	Group 1 car and motorcycle	Group 2 bus and lorry
Without significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts	✓- May drive and need not notify DVLA. See Appendix EF for medication considerations relevant to driving.	✓- May drive and need not notify DVLA. For other cases, refer to ‘severe’ below. See Appendix EF for medication considerations relevant to driving.

PersistentIf there’s persistent alcohol and/oror drug misuse or dependence

• Seedependence, see Chapter 5
• .

  If psychiatric illness has been associated with substance misuse, continued misuse contraindicates driving or licensing

licensing.

Severe anxiety or depression

Note:Effects effects of severe illness are of greater importance for their relevance to driving than medication – see Appendix EF, for the additional considerations on medication.

	Group 1 car and motorcycle	Group 2 bus and lorry
Significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts	✘- Must not drive and must notify DVLA. Particular danger would be posed by those who may attempt suicide at the wheel. Licensing may be granted after 3 months if: ■ the person has been well and stable ■ the person has adhered to previously agreed treatment programmes and ■ is not suffering from medicinal side effects that would affect alertness or concentration	✘- Must not drive and must notify DVLA. Particular danger would be posed by those who may attempt suicide at the wheel. Licensing may be granted after 6 months if: ■ the person has been well and stable ■ the person has adhered to previously agreed treatment programmes and ■ is not suffering from medicinal side effects that would affect alertness or concentration DVLA may need reports from a specialist in psychiatry. Driving is usually permitted after 6 months if the anxiety or depression has been long-standing but symptoms are under control and if maintenance on a dosage of psychotropic medication does not cause impairment.

Psychotic disorder – including acute episode

PersistentIf there’s persistent alcohol and/oror drug misuse or dependence

• Seedependence, see Chapter 5.

• If psychiatric illness has been associated with substance misuse, continued misuse,misuse contraindicates driving or licensing.

	Group 1 car and motorcycle	Group 2 bus and lorry
	✘- Must not drive during acute illness and must notify DVLA. Licensing may be considered if all of these conditions are met: ■ remained well and stable for at least 3 months ■ adheres to any agreed treatment plan ■ free from any medication effects that would impair driving ■ subject to a suitable specialist report being favourable A lack of insight which impacts upon the ability to drive safely would be a bar to licensing. Drivers with a history of instability and/or poor engagement with treatment will be required not to drive for a longer period before any relicensing.	✘- Must not drive during acute illness and must notify DVLA. Licensing may be considered if all of these conditions are met: ■ remained well and stable for at least 12 months ■ adheres to any agreed treatment plan ■ free from any medication effects that would impair driving ■ subject to a favourable report from a specialist in psychiatry A lack of insight which impacts upon the ability to drive safely would be a bar to licensing. The minimum effective antipsychotic dosage should be sought, in line with good practice. Drug tolerability should be optimal and not associated with any deficits that might impair driving, such as to alertness, concentration or motor performance. Established illness with a history suggesting a likelihood of relapse: the risk of this needs to be considered low. DVLA will normally require the report of a specialist in psychiatry that specifically addresses the above issues as relevant to driving before it may grant a licence.

Hypomania or mania

PersistentIf there’s persistent alcohol and/oror drug misuse or dependence

• Seedependence, see Chapter 5.

• If psychiatric illness has been associated with substance misuse, continued misuse,misuse contraindicates driving or licensing.

For Group 2 bus and lorry driving, in both stable and unstable conditions:

• the minimum effective dosage of any antipsychotic medication should be sought, in line with good practice.practice Drug- drug tolerability should be optimal and not associated with any deficits that might impair driving, such as to alertness, concentration or motor performance
• established illness with a history to suggest a likelihood of relapse: the risk of this must be considered low.low

	Group 1 car and motorcycle	Group 2 bus and lorry
Stable There must be no driving during any acute illness.	✘- Must not drive and must notify DVLA. Licensing may be considered if all of these conditions are met: ■ remained well and stable for at least 3 months ■ adheres to any agreed treatment plan ■ free from any medication effects that would impair driving ■ subject to a favourable report from a suitable specialist A lack of insight which impacts upon the ability to drive safely would be a bar to licensing.	✘- Must not drive and must notify DVLA. Licensing may be considered if all of these conditions are met: ■ remained well and stable for at least 12 months ■ adheres to any agreed treatment plan ■ free from any medication effects that would impair driving ■ subject to a favourable report from a specialist in psychiatry A lack of insight which impacts upon the ability to drive safely would be a bar to licensing. See note above for both stable and unstable conditions.
Unstable 4 or more episodes of significant mood swing in the previous 12 months. Particular danger would be posed by driving if there is hypomania or mania with repeated change of mood. In all cases, there must be no driving during any acute illness.	✘- Must not drive and must notify DVLA. Licensing may be considered if all of these conditions are met: ■ remained well and stable for at least 6 months ■ adheres to any agreed treatment plan ■ free from any medication effects that would impair driving ■ subject to a favourable report from a suitable specialist A lack of insight which impacts upon the ability to drive safely would be a bar to licensing.	✘- Must not drive and must notify DVLA. Licensing may be considered if all of these conditions are met: ■ remained well and stable for at least 12 months ■ adheres to any agreed treatment plan ■ free from any medication effects that would impair driving ■ subject to a favourable report from a specialist in psychiatry A lack of insight which impacts upon the ability to drive safely would be a bar to licensing See note above for both stable and unstable conditions.

Schizophrenia – and other chronic relapsing/remitting disorders

PersistentIf there’s persistent alcohol and/oror drug misuse or dependence

• Seedependence, see Chapter 5.

• If psychiatric illness has been associated with substance misuse, continued misuse,misuse contraindicates driving or licensing.

	Group 1 car and motorcycle	Group 2 bus and lorry
There must be no driving during any acute illness Driving would be particularly dangerous if psychotic symptoms relate to other road users	✘- Must not drive and must notify DVLA. Licensing may be considered if all of these conditions are met: ■ remained well and stable for at least 3 months ■ adheres adequately to any agreed treatment plan ■ free from any medication effects that would impair driving ■ subject to a suitable specialist report being favourable Continuing symptoms: even with limited insight, continuing symptoms do not necessarily preclude licensing. However a lack of insight which impacts upon the ability to drive safely would be a bar to licensing. Symptoms should be unlikely to cause significant concentration problems, memory impairment or distraction while driving.	✘- Must not drive and must notify DVLA. Licensing may be considered if all of these conditions are met: ■ remained well and stable for at least 12 months. A longer period of stability may be required if there is a history of relapses ■ adheres to any agreed treatment plan ■ free from any medication effects that would impair driving ■ subject to a favourable report from a specialist in psychiatry Further: ■ the minimum effective dosage of any antipsychotic medication should be sought, in line with good practice Drug tolerability should be optimal and not associated with any deficits that might impair driving, such as to alertness, concentration or motor performance ■ established illness with a history to suggest a likelihood of relapse: the risk of this must be considered low A lack of insight which impacts upon the ability to drive safely would be a bar to licensing.

Neurological developmental conditions

	Group 1 car and motorcycle	Group 2 bus and lorry
Any neurological developmental conditions including attention deficit hyperactivity disorder (ADHD), autism spectrum condition and other related conditions	! - May be able to drive but must notify DVLA if condition affects the ability to drive safely. A diagnosis of any of these conditions is not in itself a bar to licensing. DVLA must be notified if there are any significant issues with the following, either singly or in combination, to a degree that would raise concerns about an individual’s ability to drive safely. These are: ■ attention and concentration ■ memory ■ behaviour and awareness of how this impacts on others ■ ability to regulate emotions ■ ability to make considered decisions without being impulsive ■ insight and understanding ■ ability to anticipate the actions of others ■ cognitive flexibility ■ sensory processing (increased sensitivity to sensory stimuli - for example, light, sound, etc) ■ motor coordination and control If your patient is diagnosed with a neurological developmental condition but has passed a driving test, the attributes for safe driving will already have been demonstrated at that time. DVLA will only need to be notified if there is a change to their condition, or if you have any concerns around their ability to drive safely. DVLA must be informed if prescribed medication or any side effects of the medication are likely to impair safe driving.	! - May be able to drive but must notify DVLA if condition affects the ability to drive safely. A diagnosis of any of these conditions is not in itself a bar to licensing. DVLA must be notified if there are any significant issues with the following, either singly or in combination, to a degree that would raise concerns about an individual’s ability to drive safely. These are: ■ attention and concentration ■ memory ■ behaviour and awareness of how this impacts on others ■ ability to regulate emotions ■ ability to make considered decisions without being impulsive ■ insight and understanding ■ ability to anticipate the actions of others ■ cognitive flexibility ■ sensory processing (increased sensitivity to sensory stimuli - for example, light, sound, etc) ■ motor coordination and control If your patient is diagnosed with a neurological developmental condition but has passed a driving test, the attributes for safe driving will already have been demonstrated at that time. DVLA will only need to be notified if there is a change to their condition, or if you have any concerns around their ability to drive safely. DVLA must be informed if prescribed medication or any side effects of the medication are likely to impair safe driving.

Cognitive impairment (not mild dementia)

	Group 1 car and motorcycle	Group 2 bus and lorry
No likely driving impairment	✓- May drive and need not notify DVLA.	✓- May drive and need not notify DVLA.
Possible driving impairment	! - It is difficult to assess driving ability in people with CI. DVLA acknowledges that there are varied presentations and rates of progression, and the decision on licensing is usually based on medical reports. Considerations include: ■ poor short-term memory, disorientation, and lack of insight and judgement almost certainly mean not fit to drive ■ disorders of attention causing impairment A formal driving assessment may be necessary (see Appendix GH). A licence may be issued subject to review.	! - It is difficult to assess driving ability in people with CI. DVLA acknowledges that there are varied presentations and rates of progression, and the decision on licensing is usually based on medical reports. Considerations include: ■ poor short-term memory, disorientation, and lack of insight and judgement almost certainly mean not fit to drive ■ disorders of attention causing impairment A licence may be issued subject to review.

PersistentIf there’s persistent alcohol and/oror drug misuse or dependence

• Seedependence, see Chapter 5.

• If psychiatric illness has been associated with substance misuse, continued misuse contraindicates driving or licensing.

Dementia – and/or any organic syndrome affecting cognitive functioning

	Group 1 car and motorcycle	Group 2 bus and lorry
	! - May be able to drive but must notify DVLA. It is difficult to assess driving ability in people with dementia. DVLA acknowledges that there are varied presentations and rates of progression, and the decision on licensing is usually based on medical reports. Considerations include: ■ poor short-term memory, disorientation, and lack of insight and judgement almost certainly mean no fitness to drive ■ disorders of attention cause impairment ■ 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 GH).	✘- Must not drive and must notify DVLA. Licensing will be refused or revoked.

Learning disability

Definition of severe learning disability followed by DVLA

Significantly below average general intellectual functioning, accompanied by severe limitations in adaptive functioning in at least 2 of these areas:

• communication
• functional academic skills
• self-care
• work
• home-living
• leisure
• social/interpersonal skills
• health and safety
• self-direction

	Group 1 car and motorcycle	Group 2 bus and lorry
Mild or moderate learning disability Learning difficulty is not included. Dyslexia, dyscalculia, and so on, are no bar to ordinary Group 1 licences being awarded after successful driving tests, and DVLA need not be informed	! - May be able to drive but must notify DVLA. Licensing will be granted provided there are no other relevant problems. DVLA may require an assessment of adequate functional ability at the wheel. The DVSA driving test is considered the arbiter as to whether the condition affects the ability to drive safely.	! - May be able to drive but must notify DVLA. Licensing may be granted provided there are only minor degrees of learning disability and the condition is stable with no medical or psychiatric complications.
Severe	✘- Must not drive and must notify DVLA. Licensing will be refused.	✘- Must not drive and must notify DVLA. Licensing will be refused.

Behavioural disorders – including post-head injury

	Group 1 car and motorcycle	Group 2 bus and lorry
Severe disturbance with syndrome post-head injury, for example	✘- Must not drive and must notify DVLA. Licensing will be refused or revoked if there is serious disturbance – for example, violent behaviour or alcohol abuse likely to be a source of danger at the wheel. Licensing may be granted after medical reports confirm satisfactory control and stability of behavioural disturbances.	✘- Must not drive and must notify DVLA. Licensing will be refused or revoked if there is serious disturbance – for example, violent behaviour or alcohol abuse likely to be a source of danger at the wheel. Licensing may be granted if a specialist confirms satisfactory control and stability.

Personality disorders

	Group 1 car and motorcycle	Group 2 bus and lorry
Severe disturbance	! - May be able to drive but must notify DVLA. Licensing will be refused or revoked if there is likely to be danger at the wheel. Licensing may be granted if behavioural disturbance is: ■ not related to driving or ■ not likely to adversely affect driving and road safety	✘- Must not drive and must notify DVLA. Licensing will be refused or revoked if there is likely to be danger at the wheel. Licensing may be given consideration if behavioural disturbance is: ■ not related to driving or ■ not likely to adversely affect driving and road safety and ■ a specialist confirms stability