Can You Have a CDL with Mental Illness: Navigating the Intersection of Mental Health and Commercial Driving

Operating a commercial vehicle is a demanding and risky occupation. To ensure the safety of drivers and the public, the U.S. Department of Transportation (DOT) requires that drivers are mentally fit-for-duty. But can you have a CDL with mental illness?

Certain mental health conditions can result in the denial of a CDL, including depression, attention deficit hyperactivity disorder (ADHD), dementia, bipolar mood disorder, schizophrenia, and more. But exceptions and accommodations can be made.

In this blog, we explore the concerns about mental illness and operating a commercial vehicle (CMV), how the severity and nature of the illness can impact eligibility for a CDL, and tips for obtaining a CDL with mental illness.

Understanding CDL

Driving a truck or other CMV requires knowledge, experience, skills, and physical and mental fitness. To obtain a CDL, an applicant must pass a state-administered knowledge and skills test and undergo a DOT medical examination. The examination is performed before a CDL is issued and every two years thereafter.

The medical exam follows guidelines for physical and mental fitness issued by the Federal Motor Carrier Safety Administration (FMCSA) and is performed by a DOT-certified medical examiner.

Once certified as medically fit, a driver must submit the medical examiner’s certificate to their state DMV stating they are medically certified to operate a CMV.

The Intersection of Mental Illness and CDL

Mental illness is of particular concern to regulatory bodies and the transportation industry due to the characteristics that mentally ill drivers may exhibit, such as aggression, hostility, impulsiveness, disregard for laws, and more – all significant risk factors for accidents.

Role of Mental Health in Safe Driving

The relationship between mental health and (un)safe driving has been well documented. A 2021 study by the National Institutes for Health (NIH) showed that mental disorders of depression, hysteria, social mental deviation, paranoia, schizophrenia, and hypomania in individuals with a history of driving accidents led to meaningful differences from individuals without a history of driving accidents. According to the study:

• Human behavioral factors are the main reasons for 60% of driving accidents and are effective factors in 95% of them.
• Depression and anxiety in truck drivers increase the chance of a driving accident by 3.6 times.
• The drivers’ personality characteristics, stress levels, and human behavioral factors determine a driver’s accident history or the lack of it.

Unfortunately, mental illness also increases the risk of drug and alcohol abuse:

• According to American Addiction Centers, 27.6% of truck drivers admit to consuming drugs, mainly amphetamines (21.3%) and cocaine (2.7%).
• A 2018 study by the NIH found that 19% of truck drivers binge drink while 9.4% drink every day,

For these reasons, the DOT and FMCSA impose strict medical examination requirements before a driver is certified mentally fit to operate a CMV and obtain a CDL.

The FMCSA Regulations Regarding Mental Health

FMCSA regulations have evolved over time to include a range of mental health conditions of clinical significance that may disqualify a driver from obtaining a CDL.

Per FMCSA, there are three categories of risk associated with psychological disorders:

1. The mental disorder, including symptoms and/or disturbances in performance that are an integral part of the disorder and may pose hazards for driving.
2. Residual symptoms occurring after time-limited reversible episodes or initial presentation of the full syndrome that can interfere with safe CMV driving.
3. Psychopharmacology, as many psychotropic medications can compromise performance to the degree that CMV driving would be hazardous.

Can You Have a CDL with Mental Illness

Can you have a CDL with mental illness? The answer depends on the severity and nature of the mental illness.

Case-by-Case Analysis

Any presentation of risk factors for mental illness based solely on diagnosis by a medical examiner will not result in automatic exclusion from CMV driving and obtaining a CDL. Before medically disqualifying a driver, FMCSA guidelines require all medical examiners to assess the seriousness of the diagnosis on a case-by-case basis. Careful consideration is also given to any disqualifying medications, side effects, and interactions of medications.

Mitigating Circumstances and Accommodations

A medical examiner may make accommodations for individuals who want to hold a CDL. For example, a driver with ADHD or depression may still be eligible for a CDL based on a medical examiner’s assessment of that person’s treatment plan, how effective it has been, and if the medication has any side effects. An assessment of that person’s ability to safely operate a CMV may also be made.

Similarly, a medical examiner may make accommodations for an individual who takes DOT-disqualifying medications, such as anti-depressants or anti-psychotics, if a letter is obtained from their physician stating that the condition is managed, or if any medication would not impair safe driving.

Steps for Obtaining a CDL with Mental Illness

Mental illness is not always a disqualifier for obtaining a CDL. With the right support and guidance, drivers can take steps to manage their illness, pass a DOT medical examination, and obtain a CDL.

Meeting with Healthcare Providers

If a person has a mental health illness or suspects they might have one, it’s important to consult with a healthcare provider to obtain proper diagnosis, treatment, and long-term care.

Being transparent can ensure the best outcome. Individuals should be clear about their desire to obtain a CDL and have an open and honest conversation about their options with a healthcare provider.

Medical Examination and Certificate

Before obtaining a CDL, an individual must be certified by a DOT-certified medical examiner and obtain a medical certificate for CDL. During the exam, the medical examiner will evaluate a person’s physical and mental fitness, abilities, medical history, strength and stamina, functional limitations, and drug and alcohol use. The exam will also include a drug and alcohol test.

Results are shared with the FMCSA regardless of whether the individual passes or fails.

If the individual passes the medical exam, they are issued a Medical Examiner’s Certificate (MEC). The exam is valid for up to 24 months. Medical examiners are required to keep a MEC on file for three years.

To prepare for the exam, drivers should provide current documentation detailing their medical history and prescription drug use. To aid the process, it’s also recommended to bring records of recent office visits and a signed letter from a physician stating that the individual can perform tasks (including driving safely) despite mental illness.

Follow-Ups and Management of Illness

Follow-ups with a healthcare provider, the right medication, therapy, and other management strategies are essential to ensuring safe driving and maintaining CDL eligibility. DOT medical exams are repeated every two years, so consistency is important.

The Stigma Surrounding Mental Illness and CDL

Mental health challenges in the trucking industry are on the rise. But for men, who dominate the profession, the notion of experiencing mental illness can be particularly terrifying. Over six million men suffer from depression per year, but male depression often goes underdiagnosed. And when mental health symptoms do occur, they are often masked by unhealthy and unsafe coping behaviors such as alcohol and drug use.

Ignoring mental illness is dangerous and could lead to denial of a CDL or worse. What can CMV drivers do if they are struggling?

There are no awards for suffering. Like any other medical condition, drivers should seek the help of a professional. Employer-sponsored wellness programs, primary care doctors, and therapists can all help get drivers to understand what they are dealing with, and why, and develop a treatment plan.

Maintaining contact with loved ones, eating a healthy diet, and exercising moderately can also help.

But to truly combat the stigma of mental illness, employers must acknowledge the challenges of being a truck driver and commit to providing confidential access to workplace wellness programs, mental health resources, and counseling.

Steering Forward: Embracing Mental Health in the Commercial Driving Industry

Mental health can be a disqualifying condition for obtaining a CDL. However, exceptions and accommodations may be made.

Furthermore, through awareness and access to mental health resources, drivers and the trucking industry can help support the mental and occupational health needs of drivers – and ensure safe, accident-free highways.

If you are looking to optimize your occupational health screening programs, connect vulnerable workers to resources and services, and ensure compliance with regulations and guidelines, contact us to learn more about how Acuity can help.

Learn more about Acuity Occupational Health Services and Case Management Services.