Know your rights

11CNWL promotion of voting rights for those living mental illness 2012-2017

Challenges to voting (2012)

In 2012 a paper was published in The Psychiatrist titled 'Uptake and knowledge of voting rights by adult inpatients during the 2010 UK General Election'

The paper showed that in patients in Westminster were 50 percent less likely to register to vote and those who did register were 50 percent less likely to cast their vote. Patients on long stay rehabilitation wards were particularly disenfranchised. There were three barriers to voting: informational, psychological and physical. The paper caught the attention of the CQC (please see second chapter entitled Participation and Respect, voting on page 31).

The paper also helped promote our work and of others including the Royal College of Psychiatrists and Rethink Mental Illness.

Our chief executive Claire Murdoch immediately recognised the benefits of promoting social inclusion. Her support led to the development of a CNWL strategy to promote voting rights.

CNWL strategy from 2012 to the 2015 General Election

We produced a Trust Voting rights policy, a film and other guidance and educational resources for staff and patients.

We organised a formal launch of the Trust Voting Right Strategy which was attended by Claire Murdoch, senior managers, clinicians and patients. At the launch, we explained the strategy, showed the film and ended with a question and answer session.

We developed educational, promotional and informational resources such as posters, staff quizzes, patient and staff information leaflets and a questionnaire to identify those who wanted help to register and/or vote.

We produced a Voting Rights Recovery college module for patients and staff that utilised material available from Rock Enrol! We also developed a link to the film from our Trust home page and to voting rights information and resources staff might find helpful.

We attempted to establish voting rights leads on each ward and team or at least one in each unit.

We tried to make sure that staff and patients were aware that staff would provide support for patients to register and to vote by linking support for voting rights to patients care plans.

We agreed designated voting rights day on which all Trust staff were asked to particularly focus on the issue of voting rights.

Joint promotion of voting rights with Royal College of Psychiatrist and Rethink Mental Illness

CNWL promoted the issue of voting rights nationally with Rethink Mental Illness and the Royal College of Psychiatrists

New guidance published to help give mental health patients a voice in 2015 General Election

Royal College of Psychiatrists Guidance 2015

Voting rights film

We produced a film on voting rights; the film is available online and we have encouraged other organisations to use the film in their promotional work on voting rights.

Do you know your voting rights?

Surveys/conference posters related to 2015 General Election

With services under pressure we weren't able to survey the numbers we had initially intended. Despite this we produced a few useful surveys that were presented as papers at the European Congress of Psychiatry in Madrid in 2016 and published in The Journal of the European Psychiatric Association.

The limited amount of people surveyed and the lack of previous surveys for comparison limited the interpretation of the findings. However, in general, the results together with informal feedback from staff and patients were promising in that more patients seemed to be aware of their rights to register to vote and staff knowledge had improved in some areas since our 2015 General Election voting rights strategy. The feedback and results also supported the need to continue to promote and support voting rights for patients living with mental illness. See below for full results and findings:

Knowledge and uptake of voting rights by psychiatric inpatients in Westminster, London during the 2015 UK General Election

Knowledge and uptake of voting rights by adults with mental illness living in supported accommodation in Westminster (London) during the 2015 UK General Election

Knowledge of patients’ voting rights amongst mental health professionals working in the London Borough of Westminster during the 2015 UK General Election

CNWL strategy pre European Union Referendum

Using the material we had produced, we promoted voting rights again prior to the European Union Referendum. 

CNWL strategy before the 2017 General Election

We used the resources developed to promote voting rights pre the 2017 General Election and once again worked with the Royal College of Psychiatrists and Rethink Mental Illness.

Jed Boardman, the Royal College of Psychiatry Social Inclusion Lead, produced an NHS mental health network article in May 2017 published in NHS confederation promoting voting rights.

Our work with the Cabinet Office

We are members of the Cabinet Office Multiagency Accessibility to ElectionsWorking Group; we represent ourselves and The Royal College of Psychiatrists.

Information about the Cabinet Office Working Group can be found on page five of the February 2017 ARENA article.

ARENA is a journal that offers help and advice for those involved in electoral administration.

Our work with the group is focussed on identifying and overcoming barriers to registration and voting experienced by people living with disabilities and an important aspect of the group is the sharing of knowledge and good practice.

We have developed a patient information sheet and questionnaire to identify those who wish to respond to the Ministerial Call for Evidence on Accessibility to Elections.

We support the recent Cabinet Office Call for evidence.

CNWL support co-production

We strongly believe that voting rights promotion strategy should be co-produced with patients and other stakeholders. The slides (and background) to our talk given in July 2017 at the Royal Society of Medicine’s event entitled ‘Managing Mental Health in the Community’ is available here:  How coproduction is the key to the NHS five year forward view

Media interest in voting rights

Media outlets such as Russia Today (RT) and The Guardian have published articles about voting rights, mentioning CNWL.

The Big Issue published a short opinion piece in March 2015. It isn't easily accessible online and so has been reproduced below.

The Big Issue- Vote for Good Mental Health

The right to vote is a fundamental human right and is enshrined in the European Convention on Human Rights. Diverse representation from all parts of the community is necessary if we are to build a fairer society. Yet those with mental health problems, despite having the right to vote, often don’t register or cast their vote. A significant number of mental health patients/service users remain unaware of their eligibility to vote, do not know how to register to vote, lack confidence to cast their vote or believe it is of no value to do so.

A survey of mentally ill in-patients in Westminster at the time of the 2010 general election revealed that in-patients who were eligible to vote were half as likely to register as the general election and half as likely to cast their vote once registered.

The Central and North West London Foundation Trust and the Royal College of psychiatrists are launching a campaign to promote the voting rights of people living with mental health problems. The message – that the opinion of a person with mental health illness is of equal value as that of others – challenges the stigma many people with mental health problems endure.

Voting gives mental health patients/service users a political voice and an opportunity to influence government policy. It is a powerful symbol of inclusion or exclusion from society. We should all support this campaign – it will create a healthier society for all of us.

Future plans

Further promotional work is required to establish a deeper understanding of the benefits of promoting voting rights amongst patients, carers and clinical staff - some who still do not understand the relevance of the issue to their clinical work with patients.

Ideally we would like Trusts nationally, the CQC, service users and carers groups to promote voting rights as a routine part of care planning. This would make sure that patients are routinely offered help to register and to cast their vote if they wish.

We are considering supporting a doctoral researcher at the University of Nottingham who is currently conducting research investigating the prevalence, nature and efficacy of NHS policies relating to supporting inpatients on medium to long stay wards, to register and vote in democratic elections in England. He has been working on this project with Peter Bartlett (Professor of Mental Health Law, Faculty of Social Sciences at the University of Nottingham) and Mat Kinton (National Mental Health Policy Advisor for the CQC).

We will shortly complete a continuing professional development module for the Royal College of Psychiatrists which will promote the knowledge of voting rights of those living with mental illness amongst psychiatrists.

We are planning a survey of carer’s knowledge of the voting rights of patients with the intention that this may offer a valuable insight into the feasibility of using carers to support patients to register and to vote.

We are soon to start a national survey promoting and benchmarking promotional activity on voting rights in mental health Trusts across England.

We are supporting a Cabinet Office Call for Evidence asking for views on how people with disabilities experience registering to vote and then once registered casting their vote.

CNWL voting rights resource link

2017 General Election CNWL Voting Rights Campaign Resources link

Contact details

If you would like further information or have any questions, please email Dr Maria Clarke or Dr Masum Khwaja who are consultant psychiatrists at the Trust and honorary clinical senior lecturers at Imperial College School of Medicine 

Dr Maria Clarke: maria.clarke@nhs.net

Dr Masum Khwaja: masum.khwaja@nhs.net