Mental disability and voting rights: Bridging the knowledge and uptake gap

By Prof Judy Laing, Professor of Mental Health law, Rights and Policy (University of Bristol Law School)

As the general election approaches and you consider whether to use your vote, spare a thought for the thousands of people who are detained in psychiatric hospitals or living in residential care/nursing homes, and who may not even realise that they are entitled to vote, or be given the opportunity to do so.

Government statistics suggest that there were 21,439 people reported as being subject to compulsory detention under the Mental Health Act 1983 on 31st March 2018, and over three quarters of these people were being detained in hospital in England.[1] The majority of these detained patients have the same right to vote as the general population, but they are one of the most disenfranchised groups in society.  Surveys have found that psychiatric in-patient uptake and knowledge of voting rights is generally poor. For example, a study on the general election in 2010 found that eligible psychiatric in-patients were half as likely to register as the general population; half as likely to vote if registered, and patients who had been in hospital for longer periods were particularly affected.[2] Moreover, research also suggests that knowledge of patients’ voting rights amongst mental health professionals could be improved.[3]

People with intellectual impairments living in residential care/nursing homes are also hugely disadvantaged and disenfranchised.  Lack of mental capacity does not preclude someone from being able to participate in the electoral process, as it does not equate to legal incapacity to vote.[4]  However, an article in the British Medical Journal a few years ago drew attention to the challenges faced by persons with learning disabilities in voting.[5] A UK study confirmed that people with intellectual disabilities are under-represented in the polls, and the likelihood of voting depends on the social setting and support. [6] For example, adults with learning disabilities who lived in a nursing home were far less likely to vote, than those who lived with at least one other adult who voted.[7] It is therefore incumbent on hospital/care home staff, relatives, and advocates to provide appropriate support to patients who may experience difficulties in communicating or have other barriers to registering and voting. For example, some people may need to be reminded to post their vote before the deadline or require assistance to get to the polling station on election day.

Charitable and patient support organisations such as the Alzheimer’s Society reinforce this message and provide resources on their website for dementia patients and their carers, to make sure that people with dementia have an equal voice.  Rethink Mental Illness provides further advice and Mencap (in conjunction with the Electoral Commission) has recently published an easy read guide to voting in the General Election.  Mental health social workers in particular are well placed to inform and advise patients about their right to vote. Bradford City Council has recognised this and recently launched a ‘promote the vote’ initiative.[8] All social work practitioners are encouraged to visit supported living homes for adults with learning disabilities, to talk to people about, and encourage them to exercise their right to vote.

It is vital for citizenship to ensure that people with mental disabilities are guaranteed the same political rights and entitlements. This is a fundamental principle of the United Nations Convention on the Rights of Persons with Disabilities, (UN CRPD) which promotes equal rights for all citizens, irrespective of mental or physical disability.  The UK signed and ratified the CRPD in 2009 and is therefore under an obligation to promote CRPD principles in all national laws, policies and procedures. This means taking appropriate measures to ensure that people with long-term mental disabilities are treated on an equal basis with others, and to remove any barriers that hinder their full and effective participation in society. Other key principles of the CRPD are respect for autonomy, equality of opportunity, accessibility, and full and effective participation and inclusion in society. Specifically, Article 29 guarantees the right to participate in political and public life, which includes ensuring that voting procedures, facilities and materials are appropriate, accessible and easy to understand and use.  If the UK government is serious about its commitment to the CRPD, then it must ensure that persons with mental disabilities are provided with information, opportunities and assistance to vote.

Supporting persons with mental illness or learning impairments to register and take part in the electoral process is essential in promoting their fundamental human right to participate in free elections, which is also enshrined in Article 3 of the European Convention on Human Rights. In Hirst v UK, the European Court of Human Rights indicated that the right to vote is not a privilege, however, there can be no blanket ban, and  prisoners should not forfeit their Convention rights simply because of their status as a detainee.[9] The same principle applies to detained psychiatric patients.

Enabling detained psychiatric patients to vote is also regarded by many as an essential component of recovery for people with mental illness. Undoubtedly, participating in the electoral and political process supports important principles of patient autonomy and empowerment, and it:

‘…may diminish a sense of exclusion and inequality that many people with mental health difficulties experience…..the right to vote and the process of voting …[conveys] meaning both to a person carrying the burden of mental illness and to society as a whole that one is of value not only in remission and well but also when one’s illness is active’.[10]

Health and social care providers/hospitals should provide timely and appropriate resources and training to enable staff to give accessible advice about who is eligible to vote, and offer appropriate support to patients to register and cast their vote. Central and North West London NHS Trust are leading the way in this regard in providing guidance to staff and patients on voting rights. The Trust has produced a range of leaflets and a co-produced video is available on their website that is designed to explain the registration and voting process to both patients and staff.[11] Sadly, however, these type of resources are not universally provided in all settings, and electoral information provided by the UK government is limited, and not always accessible, despite the government’s commitment to key human rights Treaties such as the UN CRPD.

So, as the countdown to polling day continues, and we reflect on our own ability to participate in the democratic process, we should not forget that there are many people with mental illness or learning impairments who face significant barriers to voting. This is a poor reflection on our democracy, and perpetuates the inequalities faced by persons with mental disabilities in our society. As the Central and North West London Trust website reminds us:

‘Social inclusion, tackling stigma, and empowerment are important principles for recovery from mental illness and ensuring patients are aware of their voting rights and are supported to participate in the democratic process is a powerful message to society as a whole that the opinion of those living with mental illness is of equal value to that of other members of our community.’[12]

[1] https://files.digital.nhs.uk/34/B224B3/ment-heal-act-stat-eng-2017-18-summ-rep.pdf.

[2] J McIntyre et al, Uptake and knowledge of voting rights by adult in-patients during the 2010 General Election (2012) 36 The Psychiatrist 126-130.

[3] T Maclaren et al, Knowledge of patients’ voting rights amongst mental health professionals working in the London Borough of Westminster during the 2015 UK general election (2016) European Journal of Psychiatry.

[4] Section 73 Electoral Administration Act 2006.

[5] M Redley et al, Voting and mental capacity (2010) 341 British Medical Journal 3405

[6] H Keeley, M Redley, ICH Clare, Participation in the 2005 general election by adults with intellectual disabilities (2008) 53 Journal of Intellectual Disability Research 175-8; See also E James et al, Participation of adults with learning disabilities in the 2015 UK General Election (2018) Tizard Learning Disability Review (April 2018) https://www.emerald.com/insight/content/doi/10.1108/TLDR-04-2017-0022/full/html.

[7] JH Karlawish, RJ Bonnie, PS Appelbaum, RA Kane, CG Lyketsos, PS Karlan, et al, Identifying the barriers and challenges to voting by residents in nursing home and assisted living settings (2008) 20 Journal of Aging and Social Policy 65-78.

[8] How social workers are supporting disabled people to exercise their right to vote at this election (2019) Community Care, available at https://www.communitycare.co.uk/2019/11/19/social-workers-supporting-disabled-people-exercise-right-vote-election/

[9] [2005] ECHR 681.

[10] J McIntyre et al, Uptake and knowledge of voting rights by adult in-patients during the 2010 General Election (2012) 36 The Psychiatrist 126-130, at 129.

[11] https://www.cnwl.nhs.uk/news/have-your-say-in-the-general-election-on-12-december-2019/.

[12] https://www.cnwl.nhs.uk/news/have-your-say-in-the-general-election-on-12-december-2019/.