Thankfully, after several weeks wait, my new driving licence came through the post with no time limits imposed. This is as it should be given that I haven’t had an episode since first being diagnosed 3 and a half years ago and that I’m fully compliant with my medical regime, don’t smoke and very rarely drink with no points on my licence and no driving offences committed. However, I had still been worrying about it.

Good news then! Hopefully some comfort to all of you out there worried about renewing your driving licence…..

First off, she just doesn’t consider that I have the illness: after all, she has known me since my eldest daughter was 3,( so for 6 years in total) and through all those years when my children were very, very young. Our children are the same age so she knows how stressful and difficult it can be but she thought I was rearing them perfectly well. She’s a child psychologist so has a good idea about what constitutes “good parenting” and what doesn’t. During this time, I wasn’t medicated so she knew me when I was supposedly “ill” and not on medication. She says it never crossed her mind that I was suffering from Bipolar as she says I never exhibited any signs. She considered me then and now to be completely competent at looking after the children.

She thinks I ought to go and get another opinion, as does my consulting psychologist as do two other doctors who I met over the summer and who witnessed me every day with my children for 2 weeks on holiday (I took the kids away on my own for 2 weeks and these doctors were staying in the same resort: our children got on famously). None of these people consider that I am ill.

Secondly, she has asked me what good the label has done for me. In her view, it is utterly pointless to give someone the lable of “Bipolar” as it doesn’t do the sufferer nor anyone else any good at all; it just causes numerous problems. She argues that the treatment would remain the same regardless of the label: ie an anti-depressant and a mood stabiliser. She says that many people she knows are on mood stabilising drugs but they haven’t been given (or don’t disclose) an official label. As such, they don’t have to go through the inconvenience, anxiety, pain and humiliation of informing insurance companies, the DVLA, their employer, friends, family etc or have it used against them in Children’s Act proceedings.  

My own view, having suffered so badly from the consequences of having been given the label over the past 3 years since being given the diagnosis is NO IT ISN’T HELPFUL AT ALL!!!

It has ruined my life – and I’m not exaggerating. My relationships with my husband, with some of our friends, with my work, with the Court hearing, with neighbours, with the children’s schools, with my son’s medical team: all of these relationships have been tested and to what end? None of them needed to know – it hasn’t helped any of them, nor me. If I had simply gone to the psychiatrist, quietly took  the recommended medication and kept my mouth shut, nobody would be any the wiser and my life might have stayed intact.

As it is, I took the view that I had to tell people as a “responsible” thing to do as I was “ill” and therefore people ought to know in case I had some kind of breakdown and then people would be able to know what to do. NONSENSE!!! They still don’t have a clue what to do if I become ill. They still don’t understand the illness in any event, nor do most of them take the trouble to try and understand it. My true friends couldn’t give a stuff anyway: they have all told me that they don’t care whether I have the illness or not, they treasure my friendship and that’s all they care about. My family are all convinced that I am not ill and are behind me regardless of what any medical team say: they love and support me. My employer still doesn’t know because I don’t feel I can risk my job: no matter what the legislation regarding Disability Discrimination, it isn’t going to make a blind bit of difference to whether or not I would remain employed. Yes I could sue, but where would that get me? A few months loss of earnings if I’m lucky and after I’d spent even more months in highly stressful litigation and incurring more legal fees. Pointless.

No, the only way to live with an illness like Bipolar is to keep it from everyone (except probably your blood family) or be so famous like Stephen Fry that nobody gives a stuff, least of all Stephen as he is already a success and has no children to worry about……..Good on him (and I mean that – I think the guy is great!) But I’m not in that position so, from now on, I’m going to keep quiet about it and pray that I don’t ever have to tell anyone else………………and maybe I can gradually rebuild my life.

I’ve continued driving whilst the DVLA are undergoing their investigations as to my fitness to drive. I know that I’m absolutely fine to drive, so I should have my licence re-issued as I pass all the tests i.e.:

• I have been well for 3 years
• I am fully compliant with my medication regime
• I do not abuse substances such as alcohol or illicit recreational drugs
• I don’t fall asleep from my sedatives whilst driving
• My judgement isn’t impaired unless its a white van driver behind me driving 2mm from my rear bumper – then there’s a slight wish to slam on the brakes and shout at him/her that I’m a crazy woman who he/she shouldn’t mess with…………………..only kidding…….

I think the following aspects of my driving should also be taken into account………………

• I don’t think that going 150 mph in a 30mph zone is ok……….
• I do think that anyone who goes 20 mph in a 30mph should be shot……well, ok shooting them’s a bit extreme…………maybe I could just through eggs at their back windscreen so that they’re forced to pull over and I can then get on my merry way………
• I do think that blasting up my favourite Killers song (Mr Brightside, for those of you who are interested) is a fantastic accompliment to my driving happiness levels. (As is Fat Boy Slim, Faithless, Primal Scream, Prodigy and loads of others as I am a musicaholic…..)
• I limit my caffeine intake whilst driving to 3 cups per hour ………………………………………………….!!!!!!!!!!!!!!!!! Is this an “illicit substance” for the purposes of the DVLA’s investigation???? Causes anxiety and mania???Affects concentration as your hands are too busy shaking so you can’t clutch the wheel properly…….
• I don’t think that I’m Jeremy Clarkson or any other celebrity who thinks that they are beyond the speed limits……………………………………………………..(PS I really like Jeremy Clarkson and would dearly love to go the speeds that he goes as I am an adrenaline junkie, but I reckon it would give the Judge too much to go on.)
• I don’t think that putting on my mascara, doing my nails or otherwise tending to my personal appearance is worth being pulled over for by the police
• I don’t yell down the phone at my ex-husband whilst not on a hands free device (although it has to be said that this affects my concentration momentarily as I imagine all the ways I’d like to throttle him……………..JOKE! I am NOT dangerous…..)
• Eating chocolate, crisps and sweeties is OK whilst driving as it increases my endorphin levels so that I am a happy bunny which means I can tolerate other people’s bad driving more easily……
• I have stopped talking to my lawyer whilst driving as this substantially increases my ability to concentrate and my anxiety levels due to the thoughts that the conversation I’m having is costing my £100 every half an hour I spend on the phone to him…………Bloody lawyers………

So, I will stick to my normal driving habits and hope that I’ll be given my new licence……….Watch this space.

There are various websites giving information about the DVLA’s rules with regards to drivers with mental health problems, including:

•  Rethink is an organisation for people suffering with a mental health illness – www.rethink.org http://www.rethink.org/living_with_mental_illness/everyday_living/driving/index.html (gives the rules but also tells you how to appeal if the DVLA refuse you a licence or revoke it.
• Open Up:Mental Health Media’s anti-discrimination toolkit project. 
  http://www.openuptoolkit.net/know_your_rights/driving.php
• MIND: The mental health charity: http://www.mind.org.uk/Information/Legal/driving.htm
• DVLA: The guidelines, “Guide to the current Medical Standards of Fitness to Drive” can be found on the DVLA website at http://www.dvla.gov.uk/ . They have produced a Form M1 which you can view and download here http://www.houlston.freeserve.co.uk/mentalhealthdvla.pdf
• DirectGov: the Government’s website giving information about Government departments: http://www.direct.gov.uk/en/Motoring/DriverLicensing/MedicalRulesForDrivers/DG_4022415

The law can be found in the Road Traffic Act 1988 and Part VI of the Motor Vehicles (Driving Licences) Regulations 1999 together with other regulations and guidelines for medical practitioners.

 Here is what the Bipolar Organisation ~( www.mdf.org.uk) says:

Driving – DVLA

Below is the current information from the DVLA on Psychiatric Disorders and what action needs to be taken.
If you have any queries about these you should contact the DVLA directly.

If you have a medical condition which has become worse since your licence was issued or you develop a new medical condition, you must inform the Drivers Medical Group of your condition, as it may affect your fitness to drive. Failure to do so is a criminal offence and is punishable by a fine of up to £1000.

Psychiatric Disorders

GROUP 1 ENTITLEMENT
ODL CAR, M/CYCLE

GROUP 2 ENTITLEMENT
VOC LGV/PCV

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).
Very minor short-lived illnesses need not be notified to DVLA. . (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.

Driving may be permitted when the person is well and stable for a period of 6 months. Medication must not cause side effects, which would interfere with alertness or concentration. Driving is usually permitted if the anxiety or depression is long-standing, but maintained symptom-free on doses of psychotropic medication, which do not impair. DVLA may require psychiatric reports.

NB. It is the illness rather than the medication, which is of prime importance, but see notes on medication.

ACUTE PSYCHOTIC DISORDERS OF ANY TYPE

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 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.

Driving must cease pending the outcome of medical enquiry. It is normally a requirement that the person should be well and stable for 3 years (i.e. to have experienced a good level of functional recovery with insight into their illness and to be fully adherent to the agreed treatment plan, including engagement with the medical services) before driving can be resumed. In line with good practice, attempts should be made to achieve the minimum effective anti-psychotic dose; tolerability should be optimal and not associated with any deficits (e.g. in alertness, concentration and motor performance) that might impair driving ability. Where in patients with established illness the history suggests a likelihood of relapse, the risk should be appraised as low (either in the treated or untreated state). DVLA will normally require a consultant report that specifically addresses the relevant issues above before the licence can be considered.

HYPOMANIA/MANIA

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 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).

Driving must cease pending the outcome of medical enquiry. It is normally a requirement that the person should be well and stable for 3 years (i.e. to have experienced a good level of functional recovery with insight into their illness and to be fully adherent to the agreed treatment plan, including engagement with the medical services) before driving can be resumed. In line with good practice, attempts should be made to achieve the minimum effective dose of psychotropic medication; tolerability should be optimal and not associated with any deficits (e.g. in alertness, concentration and motor performance) that might impair driving ability. Where in patients with established illness the history suggests a likelihood of relapse, the risk should be appraised as low (either in the treated or untreated state). DVLA will normally require a consultant report that specifically addresses the relevant issues above before the licence can be considered.

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.

Here is some advice from the following link on the Flesh and bones website: http://www.fleshandbones.com/readingroom/viewchapter.cfm?ID=994
 Do I have to inform the DVLA that I am taking antidepressants?
Straightforward anxiety and depression does not need to be notified to the DVLA. If there are problems relating to memory, agitation or suicidal thinking, then this needs to be notified. If the condition may make the driver dangerous, this must be notified, and the DVLA may then make  enquiries to decide whether the licence should be withdrawn. There is no obligation to notify the DVLA if you are taking antidepressants, providing you are aware that all medication can impair alertness, concentration and driving performance especially within the first month of starting medication  or increasing the dose. If you experience any problems then you should not drive. Sedative antidepressants are more likely to cause drowsiness, and antidepressants can interact with other drugs and tranquillizers as well as alcohol. In general, drivers with depression are safer when well and on regular antidepressant medication than when ill. If in doubt about your fitness to drive you should not drive and should notify the DVLA. It is the illness and the general condition that you suffer from that is the most important thing rather than the medication that you are taking.

I also found an article that said that the DVLA was setting up an independent review to look into the way medical conditions are assessed and their effects on an individual’s ability to drive.

In 2000 the Department for Transport set up a research programme into “Medical Fitness to Drive” with a number of important studies, including the attitudes of healthcare professionals towards giving advice. Areas of concern include the effects or side effects of medication. This was due to be completed in November 2005. I will look further into the results of this and post them on a separate post…………..

Well, there you go. Are there any readers who have had any experiences regarding their ability to drive and their encounters with the DVLA? Please do comment so that we can all see what the issues are and then how we may be able to address them.

 Thanks.

P.S. Any other music recommendations for driving to? No “air guitar” suggestions please as I try hard to keep my hands on the wheel at all times, even when gesticulating madly to my lawyer who can’t see what I’m gesticulating…………………