PSYCHIATRIC PATIENTS (DRIVING LICENCES) (Hansard, 11 April 1972)

§ Mr. Christopher Woodhouse (Oxford)

As is commonly the position with Adjournment debates, I wish to draw attention to one or two cases which, although limited in number and perhaps unusual, raise general principles. The treatment of psychiatric patients has been revolutionised in the last generation, but there remain some points at which the law has been left behind by current psychiatric practice. One of these concerns the grant or refusal of driving licences to psychiatric patients.

As I understand the situation, the law at present derives from Section 100 of the Road Traffic Act, 1960, which was brought up to date but was not substantially altered by the Act of 1969. The Section says that an application for driving licence must include a declaration whether the applicant is suffering or has suffered from any prescribed disability or from any other disability likely to cause the driving of a vehicle by him in pursuance of the licence to be a source of danger to the public… 1222 If that is the case, the law lays down that the authority shall refuse to grant the licence". That is mandatory and is not within the discretion of the licensing authority. If the psychiatric patient already has a licence the licensing authority may in the circumstances described after inquiry revoke it, and this is discretionary and not mandatory.

The "prescribed disabilities" are defined in the Motor Vehicles (Driving Licences) Regulations, 1970, paragraph 22(1)(b) of which includes among the specified disabilities mental disorder for which the applicant for the licence or as the case may be the holder of the licence is liable to be detained under the Mental Health Act, 1959, or is receiving treatment as an in-patient in a hospital or mental nursing home within the meaning of the Act. It is evident from that interpretation of the law that a psychiatric patient who is either subject to an order under the 1959 Act or who is an in-patient—even a voluntary or informal in-patient—cannot have a driving licence at all; but if he is not subject to such an order nor is an in-patient, he may have a driving licence.

If I understand the law aright, this seems to place an undue restraint on the judgment of the doctor, or alternatively tempts the doctor to act against his own better judgment. It is the opinion of qualified psychiatrists with whom I have been in touch—and I understand this is a view widely endorsed among members of the Royal College of Psychiatrists—that in present day circumstances, with the available treatment in psychiatric cases, so sophisticated as it now is, neither the fact of being detained under the Mental Health Act, 1959, nor the fact of being an in-patient at a psychiatric hospital need necessarily be a bar against driving a motor vehicle.

The senior psychiatrist at Warn ford hospital in my constituency with whom I have been in touch has drawn my attention to cases of informal or voluntary patients who come to the hospital in their own cars and who drive them regularly without let or hindrance, and without suggestion of risk to anyone. Their cases, it seems to me, do not differ in any medical sense from those of patients subject to orders under the 1959 Act, the latter being detained for reasons quite 1223 separate from any consideration of their fitness to drive or responsibility on the road. The same psychiatrist has also drawn my attention to the case of a former patient of his, which will be known to the Minister, of a man now living elsewhere, but who at one time lived in my constituency, who was put under an order under the 1959 Act some years ago. He has been treated with injections of Modecate and is now leading a normal life. He is married and is in regular employment and for that employment needs to be able to drive a car, but because of the serious offence which he committed some years ago and which led to the order under the 1959 Act, both my informant and the psychiatrist now in charge of this man's case have agreed not to seek termination of the order under the 1959 Act until the slowly diminishing doses of his drug treatment can be cut out altogether without detriment to his health. This is clearly a matter which should be left in the judgment of his doctors.

All this has nothing to do with his ability to drive a car safely, which is not in question, and which is necessary for his employment and which in turn is a necessary part of his rehabilitation.

However, the licensing authority where he now lives has decided, on the basis of the information which his doctors have been statutorily obliged to supply, although it is in their judgment quite irrelevant, that he should be disqualified from driving and that the licence he already held should be withdrawn.

The man's doctors are therefore put in the potentially dangerous position of having to consider whether it would be better to end detention under the Act earlier than would be clinically desirable or else to allow patients to lose their livelihood because of regulations which those doctors regard as out of date in the light of modern psychiatric treatment. It seems to me possible—and I know that some psychiatrists fear this possibility—that if they make a wrong decision they may be liable for civil damages in the event of an accident.

Obviously, it is necessary to balance the requirements of road safety against the interests of the patient and, where there is doubt, the general safety must 1224 be paramount. But all risk could be removed by making the licensing authority's decision discretionary instead of mandatory and ensuring that the authority should be advised by the appropriate medical officer of health in consultation with the patient's doctor or psychiatrist, subject to a third opinion in case of disagreement.

In this case there would be greater flexibility of treatment and an increase rather than a decrease of road safety because the doctor's dilemma would be removed. He would not be faced, as he is now, with the choice of either condemning the patient to unemployment when he considers that employment would be valuable for his rehabilitation, or alternatively restoring his freedom prematurely—I use the word not in terms of road safety, but in terms of the patient's recovery.

The psychiatrist at the Warneford Hospital, whom I have quoted already, has said in a letter to me: I am personally a great believer in us psychiatrists having the means of keeping a certain grip on patients who can live functionally in the outside world and drive with perfect safety, but who might, in certain ways, misbehave or act contrary to their own best interest if the grip were removed from them. In many cases I am sure it would be impossible to justify the keeping of this grip if it involved the gross disability of not being allowed to drive". I do not wish to press particularly the individual case which has led me to raise this subject, but I hope that the Minister will give sympathetic consideration to the argument that I have received from the psychiatrist concerned, which is clearly of general application, which reveals a certain obsolescence in the existing law, and which I believe it would be to the advantage both of psychiatric treatment and of general road safety to have removed.

§ The Under-Secretary of State for the Environment (Mr. Eldon Griffiths)

I am most grateful to my hon. Friend the Member for Oxford (Mr. Woodhouse) for raising the question of the issue of driving licences to psychiatric patients. I very much appreciated his advance warning to me of some of the arguments that he would be deploying, in order that I might be able to give him a somewhat fuller reply than sometimes happens in these 1225 late Adjournment debates. I can appreciate his concern about this matter. But, before commenting on the points which he has made, it would be helpful if I reminded the House of the general background to the law relating to disabilities and driving.

My hon. Friend is concerned that the present law operates harshly in relation to certain individuals. We are of course very conscious about the rights of the individual but, when it comes to motor cars which can be lethal weapons, there can be no inherent right for anyone to hold a driving licence. In 1971 some 7,700 people were killed on our roads and a third of a million were injured. The safety of other road users therefore has to be considered as well as the rights of the individual. When there is a conflict between the convenience—or indeed the needs—of the individual and the interests of road safety, we have a duty to see that the latter prevails.

Ever since driving licences were first issued in their present form over 40 years ago, it has been considered necessary to lay down basic rules defining those disabilities, physical or mental, which by their very nature involve risks to road safety. These disabilities are eyesight below the prescribed standard, epilepsy, liability to giddiness or fainting, and certain mental disorders or defects.

Until 1970, it had always been accepted that those who were unfortunate enough to have the particular disabilities I have mentioned—they are referred to as "bar disabilities"—should be precluded altogether from driving. But since 1970 epilepsy has ceased to be a complete bar. The law has been made more flexible in the case of epilepsy precisely because we know much more about the effects of the disability and because advances have been made in techniques to control it. That is the sort of argument that my hon. Friend was putting. In the case of epilepsy it is one which has had its effect.

Broadly, the situation now is that whilst epilepsy remains a "bar" disability, a person with epilepsy who can satisfy one of the local authorities—which at present act as agents of my right hon. Friend in his capacity as licensing authority—that he has been free from attacks whilst awake for at 1226 least three years is able to qualify for the grant of a licence.

This relaxation of the law was arrived at only after very careful consideration by a panel of eminent consultants, under the Chairmanship of Dr. Denis Williams of the National Hospital, which recommended that, in order to avoid hardship to the individuals concerned where this was not absolutely essential in the interests of road safety, the long established bar to driving could be relaxed. At the same time, however, it was recommended—I think perfectly reasonably—that the relaxation should continue to be kept under review. To that end the panel has been re-constituted under Dr. Denis Williams' chairmanship and he and his eminent colleagues continue to give us the benefit of their advice in connection with driving and epilepsy. I should like to take this opportunity to pay tribute to the part which they have played and the invaluable help which they continue to give to us.

Epilepsy is not, of course, the issue which my hon. Friend raised, but I have mentioned it solely to demonstrate that we are ready to be flexible where it can be shown that flexibility is consistent with safety. I am therefore quite ready to accept my hon. Friend's contentions to this extent.

I agree there have been sufficiently impressive advances in psychiatrict knowledge and treatment to justify our taking a very careful look at the present bar on driving on those with mental illness who are receiving treatment in hospital or who are liable to be detained in mental illness hospitals. The terms of the present regulations were drafted some 10 years ago and since then, as my hon. Friend said, there have been signifiicant changes in the pattern of treatment of these illnesses—involving, for example, increasing movement of patients between out-patient and in-patient care and increasing sophistication in the methods of treatment.

My hon. Friend is therefore quite right when he says that we should question whether the present regulations are still valid. He was concerned, of course, with what might be described as a borderline case. I should remind him that decisions to refuse driving licences which are taken 1227 by the agent councils are not final. Unless the person concerned admits that he has a "bar disability"—one of those I have mentioned—then they are open to challenge in the magistrates' court; and if someone with a disability considers he has been treated harshly, it is open to him to appeal to his local magistrates to review the position. The courts are subject to the same law which binds the licensing authority—and it is with the state of the law that my hon. Friend and I are particularly concerned.

It is important to recognise that the individual's position in relation to his right to drive under the law is safeguarded by the appeal provisions. My hon. Friend suggested that some people detained by orders under the Mental Health Act are detained for reasons quite separate from fitness to drive, which is a perfectly proper point. I would agree with him that a high intelligence is not required to pass the driving test provided that the candidate can learn how to obey the rules of the road. Many psychiatric patients are quite capable of doing this, but a driving test finds out only about competence to drive at the time the test is taken. It does not and cannot ensure that drivers will for ever afterwards continue to drive to the safe standards they were required to display in order to pass the test.

This, as I see it, is the heart of the matter for these with mental illness. They may be very competent in handling their vehicles and they may well know all that is necessary to be known about road safety procedures. But can we be sure that they will always behave as rationally as any mentally healthy driver whenever and wherever they drive? Unless their medical advisers can confidently answer "Yes" to that question, I suggest that we nearly always have to conclude that, in the interests of other road users, they must not normally be allowed behind the wheel.

My hon. Friend has also suggested that the present regulations may have an inhibiting effect on specialists who are called upon to make recommendations relating to the lifting of restriction orders on their patients. This is because psychiatrists may be put into the very difficult position of either having to bring detention under the Act to an end before it 1228 is clinically desirable to do so or of having to allow their patients to risk losing their livelihood if that livelihood involves driving.

I sympathise with the dilemma, and I am willing to look for a solution to it; but I think that such cases must be very rare. When they do occur, those concerned with making recommendations are called on to weigh conflicting considerations relating to the patient's well being. If the law were expressed differently and, for instance, the responsibility of advising the licensing authority were placed entirely, as has been suggested, on the patient's medical advisers and the licensing authority's medical referee, I suggest that there would still be a dilemma. The considerations might not be the conflicting considerations relating to the particular patient's well being, but there might still be the conflict between the interests of the patient and those of road users generally.

Nevertheless, we are ready to look again at the terms of the regulations, and to do so very carefully, in the light of what my hon. Friend has said and in terms of the advances which have been made in the treatment of mental illnesses. My hon. Friend will understand that we shall not be able to do this overnight. However, I assure him that we shall most certainly consider whether any changes of the kind which he has proposed are appropriate in the circumstances.

I cannot promise that, following the review, changes will necessarily follow. Treatment in mental illness hopsitals is given for a wide range of psychiatric conditions, and it will be particularly necessary, in any review, to make sure that, in trying to improve the position of those who could be argued to be on the borderline of the existing regulations, we do not at the same time make it possible for those who are clearly unfit to drive to obtain licences. I am sure that my hon. Friend would not wish that to happen.

My right hon. Friends, the Secretaries of State for Health and Social Services and for the Home Department are also concerned in this matter. We shall, of course, have to consult them in detail and take professional advice.

Thorough consideration is bound to take time. While I cannot guarantee that there will eventually be any significant 1229 relaxation, I can and do undertake that the terms of this bar to driving will be thoroughly reviewed. We shall do this in the context of the advent of driving licences being issued for life. In this regard, we shall need to keep a specially close watch on the balance between personal wishes and public safety. Of course, safety must come first. However, I 1230 assure my hon. Friend that we shall try to draw the balance as fairly as we can, taking note of the considerations which he has so eloquently and properly placed before the House tonight.