Forensic Risk Assessment and Dangerous Driving

Abstract

Dear Editor: In the January 2005 pissue 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, 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).