History of CNWL promotion of Voting Rights 2010-2020

Date: 25.11.2020

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 modify any of the CNWL voting rights (VR) resources, for which links have been given below, for use in your own organisation.

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 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 and was mentioned in their report Monitoring the Mental Health Act in 2011/12  (please see second chapter entitled Participation and Respect, voting on page 31).

Over the next three years, 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 and a  voting rights film

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 to cast their vote.

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 organised a formal launch of the Trust Voting Right Strategy which was attended by our CEO Claire Murdoch, senior managers, clinicians and patients.

We worked closely with our communications department to develop a weblink to the voting rights film and guidance on our Trust home page.

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

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 more patients seemed to be aware of their rights to register to vote, and staff knowledge had improved in some areas, since the previous election.

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, jointly with the Royal College of Psychiatrists and Rethink Mental Illness, have continued to promote voting rights prior to local and national elections and 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. 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

Dr Maria Clarke and Dr Masum Khwaja are members of the Cabinet Office Multiagency Accessibility to Elections 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). 

Claire Murdoch (CNWL CEO and NHS England's National Mental Health Director) has agreed to promote the survey via a weekly NHS England circular to CEOs.

Adrian James President of the RCPsych is supportive of the issue and has provided us with a strongly worded statement of support for us to use in promoting the survey (and our work in general).

Our 2012 paper was mentioned CQC report Monitoring the Mental Health Act in 2011/12  (please see above).

Mat Kinton (MHA Policy analyst/CQC National MH Policy Advisor) has 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 is planning to produce brief voting rights guide (for inspectors/MHA Reviewers) in time for the May 2021 elections.

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.

Adrian James President of RCPysch Statement of support


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

The first two articles below suggest that the national promotional survey has already impacted on MHTs commitment to VR as a figure of 21% (compared to the 9% in our survey) was given in the article for the number of MHTs that have ‘any policy in place to support’ mental health service users voting rights.

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.

Do you know your 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.

If you would like further information or have any questions, please email Dr Maria Clarke or Dr Masum Khwaja

Dr Maria Clarke:  maria.clarke@imperial.ac.uk

Dr Masum Khwaja: masum.khwaja@nhs.net