By Masum Khwaja
I have been involved in promoting the voting rights of mental health patients for 15 years now, and I regard this as an important issue for people with mental health difficulties, clinicians, policy makers and indeed for all of us in society who believe in social justice and wish to improve the lives of some of the most vulnerable people in society.
Why is it important to vote? ‘When we vote, our values are put into action and our voices are heard. Your voice is a reminder that you matter… and you deserve to be heard” (Meghan Markle); “Casting a ballot isn’t just something you do for yourself… it’s for our collective future” (Oprah Winfrey). The quotes are targeted particularly at marginalised communities and aim to convince the disillusioned that they must vote if they want their voice to be heard, that everyone’s opinion matters and is of value, and that only through voting can we bring about positive change and build a brighter future. The quotes hold a special meaning for me when I consider the voting rights of people with mental health problems, intellectual disability or cognitive impairment, all of whom remain especially vulnerable to social and political exclusion.
Citizenship-oriented care is a relatively new concept in mental health that “goes beyond clinical and personal models of recovery to recognise the negative impact of discrimination and disenfranchisement in populations with mental illness” and emphasises the benefits of “full and valued participation in society”. Measures that promote social inclusion and citizenship, and challenge mental health stigma and discrimination, are likely to improve the chances of recovery from mental illness. The right to vote is one such measure, and increasingly mental health clinicians and organisations are recognising the power of citizenship-orientated care to improve the lives of patients. If it were in my gift, citizenship-oriented care, and supporting patients to register and to vote, would be part of every patient’s care plan. We already support patients with accessing benefits, legal advice and employment so why shouldn’t we support them to register and to vote?
In the UK most of the remaining legal and procedural barriers to voting for patients with mental health and intellectual disability have been removed. All bar those convicted of a criminal offence can now vote, can register to vote while detained in hospital under civil sections of the Mental Health Act or on remand, can vote in person from hospital, register using a hospital address, or vote even if they have been deemed as ‘lacking mental capacity’.
Despite these legal changes people with mental health problems continue to have lower voting rates than the general population. A survey investigating knowledge of voting rights by adult inpatients during the 2010 UK general election found that inpatients in mental health hospitals in Westminster were half as likely to be registered to vote and, if registered, half as likely to cast their vote compared to the general population. This translated as a voting rate of only a quarter that of the general population. Of the patients who had not registered to vote, 88% cited a lack of relevant knowledge. The survey results suggest that besides the legal barrier to voting that remains for those convicted of a crime, there are other barriers that prevent patients from voting, namely informational, psychological and physical barriers. The authors suggested that these barriers might be overcome by supporting patients to register and cast their vote.
Following the survey, a voting rights strategy was developed which included encouraging mental health trusts to promote voting rights by actively supporting patients to register and to vote. The link includes results of the first national survey of the promotion of voting rights by mental health trusts (MHTs) undertaken in 2017/18. The survey showed that only 9% of MHTs had a voting rights policy and that almost half of MHTs had not implemented any voting rights initiatives prior to the 2015 and 2017 general elections. The survey was repeated in 2021, and the results this time were encouraging in that 24% MHTs now had a voting rights policy, another 39% were intending to develop one and 90% thought their Trust should support patients to register and to cast their vote. The surveys will be written up for publication later this year.
From 4 May 2023, voters in England will for the first time need to show photo ID at polling stations before being allowed to vote in local elections, police and crime commissioner elections, parliamentary by-elections and recall petitions. From October 2023 voter ID will also apply to UK general elections. Voter ID is a controversial measure and is opposed, amongst others, by the electoral reform society.The government believe that Voter ID is necessary to prevent voter fraud despite there being no evidence of widespread voter fraud in the UK. For example, in 2021 only 317 cases of alleged electoral fraud were investigated by the police with just one conviction, one acquittal, and one caution.
Voter ID is undoubtedly a significant additional barrier to voting that will disproportionately impact on more disadvantaged groups in society such as unemployed or disabled people who are less likely to have, or to apply for, the required photo ID. The Electoral Commission have information about what is acceptable photo ID and how to apply for a free voter ID document, known as a Voter Authority Certificate – for the upcoming 4 May 2023 local elections, the deadline to apply is 25 April (and you don’t need voter ID if you are voting by post).
The Elections Act 2022 which introduced voter ID also introduced measures to improve accessibility in voting, including providing each polling station with equipment that makes it easier for disabled people to vote independently and in secret, and an extension to the rules on who can act as a ‘companion’ to include anyone who is over the age of 18. This latter provision should make it much easier for mental health staff to support patients to vote in person at a polling station should they wish to.
For the time being, at least, voter ID is here to stay. This is one more reason why it’s important that, especially building up to the next general election, patients, carers, advocacy and service user groups (as well as professional bodies) continue to raise awareness of the importance of voting rights, and push for the development of local and national strategies to support people with mental health difficulties to register and vote.
If enough of us come together, and truly believe our voice matters, then one day we may have sufficient lobbying power to ensure politicians of all persuasions are motivated to understand the issues relevant to those living with mental health problems or intellectual disability. For more inspiration to get involved in promoting voting rights, watch this short film coproduced by Central & North West London Foundation Trust staff and patients, and this short film produced by the BBC.