Voting Rights of Patients with Mental illness or intellectual disability
Dr Maria Clarke - Honorary Clinical Senior Lecturer Imperial College London
Dr Masum Khwaja – Consultant Psychiatrist West End Primary Care network and Honorary Clinical Senior Lecturer Imperial College London
Please feel free to use CNWL voting rights resources to promote voting rights in your own organisation.
“This is all about civil rights for all citizens; something I’m passionate about and why this is a very important initiative.” – Claire Murdoch, CNWL Chief Executive
The right to vote is a powerful symbol of inclusion or exclusion from society and is enshrined in the European Convention on Human Rights.
Historically mental health patients and those living with intellectual disability have been socially isolated, marginalised and disenfranchised.
Supporting the voting rights of patients promotes social inclusion and citizenship, challenges discriminatory and stigmatising attitudes all of which are likely to promote recovery.
Voting sends the clear message that the opinion of a person living with mental illness or intellectual disability is of equal value to that of anyone else.
Voting offers patients a political voice and an opportunity to influence government policy. A vote in this context is more than a choice of party or candidate; it is a motivation for politicians to understand and support issues relevant to those with mental illness.
Changes in the law (Representation of Peoples Act 2000, and Electoral Administration Act 2006) removed most of the legal barriers to voting for patients with mental health and/or intellectual disability, so that now all patients, bar the relatively small number of forensic patients convicted of a criminal offence and ordered to hospital by the courts, can vote.
Despite these changes in the law a significant number of mental health patients remain effectively disenfranchised by either a lack of knowledge of their eligibility to vote or of the voting process or by self-stigmatising attitudinal barriers (e.g. believing that their opinion is of little worth) and/or by symptoms such as anxiety or depression that may prevent them from registering or casting their vote.
A significant number of professionals also remain ignorant of the rights of patients to vote.
We therefore urge organisations and individuals working with patients with mental health problems or intellectual disability to support those patients who wish to exercise their democratic right to vote to do so.
In 2012 we published a paper 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 half as likely to register to vote and those who did register were half as likely to cast their vote as the general population. Patients on long stay rehabilitation wards were particularly disenfranchised. Only 12 per cent had made an active decision not to register to vote. The rest did not register either because they were unaware of their eligibility to vote or did not know how to register to vote. Results also indicated engagement in the political process in that 66 per cent of patients who were eligible to vote stated that they were interested in voting. Three barriers to voting were postulated: informational, psychological and physical.
The paper has been mentioned in the CQC report t Monitoring the Mental Health Act in 2011/12 (please see second chapter entitled Participation and Respect, voting on page 31).
Building up to the 2015 General Election we developed a CNWL strategy to promote voting rights in our inpatient units and community teams.
We produced a Trust Voting rights policy.
We then developed educational, promotional and informational resources such as posters, staff quizzes, patient and staff information leaflets, and a Voting rights film.
We produced a Voting Rights Recovery college module for patients and staff that utilised material available from Rock Enrol - engaging young people in democracy.
We worked closely with our communications department to develop a weblink to voting rights resources for staff and patients.
A campaign to support patients to register and to cast their vote should they wish to do so was formally launched by our CEO Claire Murdoch a few months prior to the 2015 general election.
Throughout the campaign we tried to encourage staff to systematically enquire whether patients under their care would like help to register and to cast their vote and if they did so to ensure that a support plan was in place.
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 posters at the European Congress of Psychiatry in Madrid in 2016 and published in The Journal of the European Psychiatric Association.
The limited number 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 patient awareness of their right to vote and staff knowledge of patients voting rights had improved in some areas since the 2012 general election.
CNWL, jointly with the Royal College of Psychiatrists, have continued to promote voting rights prior to local and national elections; most recently prior to the 2019 General Election.
We strongly believe that voting rights promotion strategy should be co-produced with patients and other stakeholders.
Coproduction of the CNWL voting rights strategy formed the basis of a presentation at the Royal Society of Medicine’s in July 2017. The presentation is available here: How coproduction is the key to the NHS five year forward view.
Dr Maria Clarke and Dr Masum Khwaja are members of the Cabinet Office's multiagency Accessibility of Elections working group, on which they represent 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.
Members include senior representatives from Mencap, United response, Rethink Mental Illness, Scope and RNIB.
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 previously supported Cabinet Office calls for evidence regarding accessibility to elections for disabled groups.
Survey (2017/18) was sent to MDs of NHS MH Trusts. The survey showed that only 9% of MHTs had a VR policy despite 66% considering VR promotion as very important/essential. Almost half of Trusts did not implement any VR initiatives prior to the 2015 GE (49%) or 2017 GE (47%).
The survey was presented as a poster at the 2019 RCPsych congress.
The survey will be repeated in late 2020/early 2021 and this time will be sent to CEOs of NHS MH Trusts. The plan is to process results and aim for publication prior to the deferred local elections (now listed for May 2021).
The repeat survey will, as the original survey was, be supported by Claire Murdoch (CNWL CEO and NHS England's National Mental Health Director), the Cabinet Office Accessibility of Elections working group, and by the Royal College of Psychiatrists.
Jed Boardman (Social Inclusion Lead RCPsych) wrote about our work in 2017: Making mental health patients’ voices heard in the 2017 general election
Jed has asked us to develop a permanent Voting Rights web site link on the RCPsych website; a piece of work we hope to complete in 2021.
Our 2012 paper was mentioned in the CQC report Monitoring the Mental Health Act in 2011/12 . Please read entitled Participation and Respect (second chapter), voting on page 31.
CQC have confirmed that: ‘Voting registration – and enabling patients to exercise their voting rights – remains one of our areas of focus in monitoring the Mental Health Act and wider inspection.’
Mat Kinton (MHA Policy analyst/CQC National MH Policy Advisor) is planning to produce brief voting rights guide (for inspectors/MHA Reviewers) in time for the May 2021 elections.
Together with CNWL Clinical Director for Rehabiliation Dr Shirish Bhaktal we facilitated research conducted by Benjamin Cubbs Coldron (University of Nottingham). The research was published in July 2020 in the Journal of Psychiatric Nursing: Supporting political rights for people in psychiatric rehabilitation: “Appropriate” political action in medicalized environments
- BBC News (2019)
- People in mental health units need a voice. That’s why I’m helping them to vote - Emily Reynolds in the Guardian (2019)
- Mental health patients are vital this election, if given the chance to vote - Dazed (2019)
- Univ. of Bristol Law School Blog: Mental disability and voting rights: Bridging the knowledge and uptake gap (2019)
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.
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.
Promotion of citizenship as an intrinsic therapeutic focus and activity routinely undertaken by services supporting people with mental illness and intellectual impairment. This should include supporting patients to register to vote and to cast their vote if they wish to do so.
A national network of interested professionals and service users.
Further promotional work is required to establish a deeper understanding of the benefits of promoting voting rights amongst patients, carers and clinical staff - some whom still do not appreciate the relevance of the issue to their clinical work with patients.
Produce 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.
Survey of carer’s knowledge of the voting rights of patients with the intention that this may offer insight into the feasibility of using carers to support patients to register and to vote.
- CNWL Voting rights policy
- CNWL Voting Rights Film
- BBC NEWS MEDIA FILM
- Information leaflet for patients about voting rights - May 2021 local elections
- Know your rights poster - May 6, 2021 Local Elections
- Voting rights staff quiz questions
- Voting rights staff quiz answers
- Voting Rights TO DO guide for staff - May 2021 Local Elections
- Guidance for staff who are supporting patients to register and/or cast their vote - May 2021 local elections
- Further guidance notes for staff
- May 2021: Easy read and pocket guides to voting