Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Assess how psychiatric symptoms, cognition, substances and treatment affect driving and safety-critical work, give current licensing advice, support proportionate occupational adjustment and disclose without consent only when a serious-harm or legal threshold justifies it.
Driving assessment begins with the task and current function. Confirm Group 1 or Group 2 licence, ordinary and professional mileage, vehicle type and recent collisions, near misses or police contact. Ask about concentration, reaction, judgement, impulsivity, hallucinations, delusional interpretation, mood, suicidal use of a vehicle, panic, dissociation, sleep, substance use and adherence. Review medicine initiation and changes, daytime sedation, blurred vision, tremor and hypotension. A diagnosis alone neither proves safety nor permanent unfitness.
For Great Britain, use the current DVLA Assessing fitness to drive guide and the relevant psychiatric-disorder standard. The duty to notify usually lies with the driver, and requirements vary by syndrome, severity, insight, stability, treatment and licence group. Group 2 standards are typically stricter because of vehicle size and passenger or occupational exposure. Northern Ireland uses the DVA and its procedures. Give explicit interim advice to stop when current symptoms or treatment make driving unsafe, even while formal criteria are checked.
Current symptoms, intoxication, sleep loss or treatment effects materially impair attention, judgement, perception, reaction or impulse control for the intended journey.
The current licensing guide indicates that the driver must tell DVLA or DVA, with details depending on condition and licence group.
The patient continues driving after clear advice despite a serious foreseeable risk, raising possible disclosure to the licensing authority without consent.
Work involves vehicles, machinery, heights, weapons, controlled drugs, vulnerable people or decisions where impairment could cause serious harm.
Symptoms and adverse effects have improved enough for task-specific review, adjustment and staged restoration rather than an all-or-nothing employment judgement.
DVLA covers Great Britain, whereas Northern Ireland drivers use DVA processes; similar clinical facts can require different forms and contacts.
Bus and lorry licensing usually demands stricter evidence and stability than car and motorcycle licensing because consequences and exposure differ.
Clinicians describe health and function; occupational health and employers assess job design, adjustments and organisational risk within their roles.
The justification for contacting a licensing body without consent is prevention of death or serious harm, not punishment for disagreement.
Temporary restrictions and graded return preserve safety while recognising that psychiatric symptoms and medicine effects often change with treatment.
Giving a remembered fixed driving ban without checking current DVLA or DVA guidance.
Failing to distinguish Group 1 from Group 2 licensing standards.
Assuming diagnosis alone makes a person permanently unfit to drive or work.
Advising notification but never checking whether the patient stopped driving.
Sending full psychiatric notes to an employer when a focused functional report would suffice.
Breaching confidentiality for occupational convenience without a serious-harm or legal basis.
Ignoring suicidal use of a vehicle while discussing routine licence paperwork.
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A patient with active psychosis has repeated near misses, refuses to stop driving or notify DVLA and plans to drive immediately. Persuasion has failed. What should the doctor do?
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes
Occupational assessment is job specific. Clarify essential tasks, shift pattern, fatigue, lone work, driving, heights, weapons, controlled substances, children, vulnerable people and rapid decision making. The treating clinician manages health and can describe functional limits; the employer or occupational physician determines workplace arrangements. With consent, provide the minimum information needed, often capability, restrictions, likely duration and review rather than detailed diagnosis or psychotherapy content. Consider Equality Act duties and reasonable adjustments without promising a particular employment outcome.
Safety and recovery can coexist. Temporary removal from night shifts, driving, weapons, operating machinery or unsupervised clinical practice may allow treatment and graded return. Assess professional reporting duties separately for regulated occupations and seek defence, occupational-health or regulatory advice when serious concern persists. Confidentiality may be overridden only on a defensible legal or serious-harm basis, not employer preference. Reassess after symptom stability, sleep recovery, substance treatment and medicine adjustment with evidence relevant to the actual task.