To most people, a mental health crisis means some kind of breakdown, possibly even leading to suicide. But in the context of the transport industry and driving, it can actually be the cause of a serious road accident if not spotted early and handled correctly by operators. We talk to two people who deal with the legal implications of this about what can be done to help avoid things coming to a head. Inspector Rik Wenham, who leads the Metropolitan Police’s Commercial Vehicle Unit (CVU), and barrister Charlotte Le Maire of LMP Legal, who defends commercial drivers in court, will be familiar to regular CM readers by now. They see many of the same situations from slightly different angles, but usually agree on the solutions.
From Wenham’s perspective, the crux of the matter is quite simple. “In this blokey industry, blokes are rubbish at talking,” he says. “People don’t realise how potentially lonely it can be in the cab of a lorry – for day drivers, let alone trampers,” he reminds us. “And if you’ve got something going on in your personal life, it’s only going to get magnified when you’re thumping out hundreds of miles a day with no-one to talk to.”
“Mental health problems can be just as debilitating at times as something physical,” Le Maire chimes in. “When you’re talking about anxiety, depression, and similar among drivers, as well as not fully concentrating, they may have things like panic attacks at the wheel, which can actually give them physical symptoms,” she says. “And that can make them a danger to themselves and everyone else on the road.”
For both our contributors, the biggest issues in this area come from medication – be it prescribed or otherwise. “The biggest one we see in the CVU is self-medicating,” Wenham tells us. “Drinking to sleep drinking to forget, taking drugs for the same reason, and then having an accident as a consequence of that. It doesn’t matter how bad your life is,” he cautions, “at that point it’s going to get significantly worse, because you will go to prison if you kill or injure someone drink- or drug-driving.”
To be clear, we’re not talking about people who wilfully drink or take drugs, then immediately get behind the wheel, having reached a point where they no longer care what happens. This is the more subtle stuff, which can end up being just as dangerous. “They’ve got whatever going on in their life, and they have a drink because they can fall asleep when they’ve had three-quarters of a bottle of whisky,” Wenham clarifies. “Then when they wake up and they start their shift, they forget they’re still going to test positive.”
“When you talk about substances and driving, people tend to think of things like cocaine or cannabis, but actually it’s about your prescription drugs as well,” Le Maire says, picking up the thread. “There are many substances that you shouldn’t be driving under the influence of, because they can cause drowsiness or make you zone out.”
This last point is particularly pertinent, and it’s not something many people would think to look out for when they start a new medication. They might also be surprised to find out what they’re actually taking. “I had a case around 18 months ago where the driver had been prescribed Rohypnol,” she continues. If that surprises you, you’re not alone – that was our reaction too. But in a clinical setting, Rohypnol is regularly used to treat anxiety, and if a prescription uses its generic name – flunitrazepam – very few of us would make the connection. In this instance, the drug was prescribed because other drugs were contraindicated by medications the driver was taking for physical ailments, but the consequences were disastrous. “He could see a set of red lights in front of him, but he couldn’t physically brake,” Le Maire says. “So he was awake, but the drug stops the signals being sent by your brain, so he was unable to move and somebody was killed.” This story triggers a whole list of questions, not least of which is why the doctor didn’t warn him this might happen. But in reality, the language used in a medical setting can end up confusing or misleading the patient as to what to expect. “I think the doctor had used the usual line about ‘if it affects you…’, but how do you know whether it affects you until it does?” Le Maire points out. “They may not have known the patient was an HGV driver, and the driver may not have thought about the need to disclose that.”
The very real fear of financial loss, or even loss of licence, may also mean a driver keeps quiet, especially if they think they’ll be alright – it’s not as if they’re taking something illegal, after all. “So overall, there’s a lack of education, and of asking the right questions from the medical side, along with a lack of education on the driver’s side,” Le Maire warns. “They might well assume that the GP wouldn’t have prescribed the drug if it was going to be a problem.”
Both Wenham and Le Maire have spent many hours presenting toolbox talks and training sessions to drivers and operators, and have learnt a lot in the process. “There’s an inherent distrust of employee assistance programs,” Wenham tells us. “Because they think it feeds into the HR food chain and they’re at risk of losing their job if they admit they need help.” That’s not to say that direct education isn’t vital, but there does need to be another option as well, something Wenham and his team have spent a great deal of time researching.
The solution they’ve come up with takes the form of a free service called Shout, an organisation the Met CVU has been working with to ensure it understands the particular challenges of the industry. “Shout is entirely text-message based; there isn’t the facility to make a phone call back,” Wenham assures us. “This makes it ideal for drivers. The biggest feedback we got when we were talking about this issue, especially from blokes, was the fear of being seen as weak, or being judged,” he explains. “Shout is anonymous, it’s free, and it won’t show up on your phone bill, regardless of your network provider.”
All Shout’s volunteers are overseen by clinically trained professionals, and the advice they offer is always targeted specifically to the individual. It’s also easy to signpost to drivers. “It only needs a discreet poster putting up,” Wenham advises. “The best place to put them, especially for blokes, is in the toilets.”
It works too. “We’ve had several people that have had the strength to tell us that they’ve contacted Shout because they were at breaking point,” Wenham reveals. “One bloke had his suicide notes written and was ready to go.” That driver remembered being told about Shout during one of Wenham’s toolbox talks – and “gave it one last chuck of the dice”. As a result, he’s still alive.
But it doesn’t end there. Employers also have a huge legal duty of care to be aware of their drivers’ state of mental health, something which posters alone won’t fulfil. “You need to be asking the right questions,” Le Maire says. “I have conversations with employers who aren’t sure if they’re allowed to ask about it, and who aren’t sure if they really need to know about prescription medication,” she continues. “The answer is absolutely you do; you’re protecting your staff, and you’re protecting the public.”
The incidence of drug-driving has soared recently. “Since lockdown, it has gone up around 450%,” Le Maire tells us. “And a lot of that is as a result of anxiety and depression becoming more prevalent.” Whether that’s a true increase, or the result of increasing awareness making diagnosis more frequent is difficult to say. But the end result is the same – more prescriptions being given.
The easiest way to implement a policy obliging drivers to disclose any medication is for operators to write it into their driver handbooks and employment contracts. “That way, if people don’t like it, they simply don’t sign up and work for you,” Le Maire says. “Because as an employer, you cannot afford not to know about these things. It’s critical.”
That isn’t enough on its own, however. While there is a defence for operators who ask drivers the right questions, but are still not told what’s happening, asking only on recruitment, or every six months, is often not enough to protect them. “You need to know your workforce,” Le Maire advises. “So if somebody comes in and they don’t look quite right, or they say they’re not feeling quite right, you should be asking if they’re okay to drive that day.”
Obviously this is more difficult when drivers are coming in at odd hours, or working away from base, but not impossible. “A lot of companies have apps now for when drivers do their walk-round checks,” she points out. “I’d just add a question like ‘Are you feeling fit to drive today?’ and get that ticked.” It’s all about doing what is “reasonably practicable”, as described in the Health & Safety at Work Act, Sections 2 and 3.
General education is the other vital piece of the jigsaw. “I stand in front of drivers a lot, and it is absolutely staggering how many don’t know what their obligations are healthwise, or what they are supposed to disclose.” Le Maire warns. “They have no idea what driving with certain medications in their systems can do. It’s not deliberate,” she assures us. “It’s just a lack of education and training – and that flows from the employer, I’m afraid. It’s an accountability issue.”
“I agree – and I think there’s a moral duty too – that you should monitor the welfare of your drivers,” Wenham adds. “And if you’ve got employee assistance programs, you should push them. But make it absolutely clear they’re not about having a sneaky peek into people’s lives,” he emphasises. “This is about helping them stay safe behind the wheel.”
- This article was previoulsy published in Commercial Motor, to subscribe see the latest Commercial Motor subscription offer
