Letters to the Editor
Forensic Risk Assessment and Dangerous Driving
Dear Editor: In the January 2005 issue of the Canadian Journal of Psychiatry, risk assessment in psychiatric practice is reviewed. Four helpful articles provide general psychiatrists with an up-to-date, current overview of forensic practice and risk assessment.
In particular, “The Clinical Use of Risk Assessment,” by Graham Glancy and Gary Chaimowitz, carefully reviews the current practice of acting on a risk assessment and the duty to protect a specific population at potential risk of physical threat or injury (1).
But what about the risk to the general population from forensic patients as a result of their dangerous driving behaviours? Under the 2000 Canadian Medical Association guidelines (2), general physicians as well as general psychiatrists are mandated to report drivers with psychiatric illness to their local ministry of transportion when the illness is thought to interfere with their ability to drive a motor vehicle safely. Unfortunately, no clinically useful instruments are readily available to guide clinicians in this important risk assessment.
Current findings from a metaanalysis of the world literature on driving risk and psychiatric illness reveals significant findings related to substance use but a deficit in other diagnostic categories that are relevant to forensic psychiatry (3). In particular, there are no significant data available to guide clinicians regarding the degree of risk associated with a diagnosis of antisocial personality disorder and driving. This lack of available evidence-based data relating to psychopathy is compounded by inherent difficulties faced by forensic psychiatrists in clinical practice. There appears to be an inherent conflict in asking leading questions regarding potentially dangerous driving styles that may inhibit open disclosure about other more immediately relevant clinical forensic issues.
McGill University is currently conducting a Canadian-based survey on psychiatrists’ knowledge of and practice in psychiatric illness driving and reporting styles (4). It would be interesting to compare a representative group of forensic psychiatrists’ current practice of reporting high-risk drivers, during the course of their clinical practice, with a sample of more general psychiatrists not engaged in forensic work.
The development of a simple screening device for problem driving would be useful to all physicians in everyday practice. Such an instrument might have a place in the overall forensic risk assessment. As Glancy and Chaimowitz note in their article, “Further instruments should be established and well validated” (1, p 13). We are currently developing a clinical screening instrument, the Jerome Driving Questionnaire, that we hope will be useful in general clinical practice, as well as in more specialized areas such as forensic work. Preliminary data indicate that this instrument shows clinically useful correlations with on-the-road driving assessments, made by experienced driving instructors, of driving risk in nonclinical populations of novice drivers (5).
References
1. Glancy G, Chaimowitz G. The clinical use of risk assessment. Can J Psychiatry 2005;50:12–7.
2. Canadian Medical Association. Determining medical fitness to drive. A guide for physicians. 6th ed. Ottawa (ON): CMA Publications; 2000.
3. Trul V. Immortal. Impairments, diseases, age and their relative risks of accident involvement: results from a meta-analysis. Norway: Institute of Transport Economics 2003. Contract GMA1/2000/27043 S12.319837. Available: www.immortal.or.at/index.php. Accessed 2005
Feb 03.
4. Menard I, Korner-Bitenky N. Views, attitudes, knowledge and practices of psychiatrists regarding assessment of driving competence among those using psychotropic medications and experiencing psychiatric conditions that potentially affect safe driving. Candrive Newsletter 2004;Nov:6–7. Available: www.candrive.ca/En/Communication/newsletters.asp. Accessed 2005 Feb 03.
5. Jerome L, Segal A. Driving Behaviour and Training. Proceedings of the 2nd International Conference on Driver Behaviour and Training; 2005 Nov 15–17. Forthcoming.
Laurence Jerome, MB ChB, Msc, MRCPsych, FRCPC
London, Ontario
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