Supporting patients in mental health services to their right to vote

In the 2010 general election, the voter turnout was 65%. This was also the percentage of patients surveyed in one trust who were interested in voting. So, what percentage did? 

It was a mere 14% (New Statesmen 2019) and when this was examined, one of the conclusions was this “may reflect a lack of knowledge not only on the part of the patients but also on the part of the professionals involved in their care” (McIntyre et al 2012). Patients had wrongfully believed they could not vote, or were unaware of the registering to vote, or that they could use the hospital address to register. And there had been little help to allow them access this basic democratic right. 

An example of best practice in promoting patient’s rights is from Central and Northwest London who have developed a strategy to assist voting in the Trust.

Promoting individual rights to support social inclusion is a key mental health nursing competency (Health Education England, 2020). This includes supporting people with severe mental illness to exercise their right to vote. Whilst the date for the next general election is not yet confirmed, to avoid dissolution of parliament this must be before January 2025. A general election is likely to be called soon. Are you and your trust ready to help increase the patient vote?   

Background

Voting can be viewed as a sign of social inclusion and increasing enfranchisement in people with SMI is part of reducing social stigma in this area.  The electoral commission (2021) found that voting is still seen as important. In this report respondents viewed voting as a way of engaging with democracy and as a demonstration of agency.  

Whilst there is a need for further research, it is indicated that mental health nurses do not have good knowledge of the rights to vote regarding the people they care for.  Furthermore, there is evidence that mental health nurses are not regularly having conversations with patients about their voting rights and what support is available to exercise these rights (Winchester, Majid and Kumar, 2021). Inaccurate beliefs from mental health nurses included: certain diagnosis prevent people from voting and people require evidence of mental capacity to vote.  It also appears that mental health nurses are not talking to patients about their rights with regards to voting.  

Voting rights and the Mental Health Act (1983 Amended 2008)

It is important that mental health nurses are aware that the majority of adults who are UK citizens detained under a Section of the Mental Health Act (1983 Amended 2008) (MHA) retain their right to vote; this is outlined in the Representation of the People Act (2000). This means that detention under the MHA is not itself a barrier to voting. The exception to this rule is some forensic sections of the MHA and there is further information about this in the table below. Despite the right to vote many people detained under the MHA experience barriers that reduce their opportunity to exercise this right. 

It is concerning that the new requirement to present photographic identification (ID) when voting in England may present as a further barrier to people with severe mental illness.  IFF (2021) research found that those with a severely limiting disability are less likely to have photographic ID that those without. Being less likely to own photographic ID is also likely to disadvantage those who are unemployed and have lower qualifications. Worryingly, the research into who owns voter ID is likely to underestimate the impact on populations such as those hospitalised with ill health, in long term residential care and those who are vulnerably homed / homeless.  It is likely that people with SMI are going to be disadvantaged by the introduction of voter ID.   

Forensic mental health care and voting

It is also important to be aware that the right to vote does not extend to some forensic sections of the Mental Health Act.  Certain sections of the Act are a barrier to voting and this includes adults detained under a S37 and S48. Disenfranchisement of those detained on forensic sections of the MHA has been criticised as a breach of the Human Right Act (1998). More on the call to address this issue can be found here: Patients or prisoners? Time to reconsider the voting rights of mentally disordered offenders.

What can mental health nurses do

Mental health nurses have the most frequent contact with people experiencing severe mental illness. This means as a profession we have a real opportunity to promote patient voting rights. Mental health nurses need to have good knowledge of voting rights and how people with severe mental illness can exercise these. 

All mental health nurses need to know how to support people to access their voting rights either in person, by proxy or via a postal vote.  We would encourage the use of local methods of dissemination to share this information (such as multi-disciplinary team meetings; ward meetings; teaching sessions etc.). 

Mental health nurses should give all patients the right to talk about their voting rights. This should be revisited as necessary and supported with accessible and easy read information that individuals can come back to. Discussions around voting should be documented and organisations should be encouraged to include evidence of these discussions as part of their care planning / admissions templates. 

Mental health nurses need to encourage anyone registered to vote to have up to date knowledge on voter ID. There is a full list of acceptable ID here: Accepted forms of photo ID | Electoral Commission. Acceptable photo ID does not have to be in date, but does need to have a photo that has a current likeness. For those who do not have appropriate photo ID with a current likeness and who are registered on the electoral roll it is possible to apply for a voter authority certificate (also known as voter ID). It is important that healthcare staff are aware that people who are homeless and or living in hospital can apply to join the electoral register and how to do this.

We can also encourage people with experience of mental health difficulties to engage with: The Centre for Mental Health (@centreforMH) who are carrying out research on the barriers people with mental health difficulties from voting. This can be accessed here: Tell us about any barriers you face in voting  - Centre for Mental Health and is open to the 11 March. 

References

IFF Research (2021). Photographic ID Research – Headline Findings. The Cabinet Office (PDF).

Health Education England (2020). Mental Health Nursing. Competence and Career Framework (PDF).

Rees, G. and Rees, J. (2016).  Patients or prisoners? Time to reconsider the voting rights of mentally disordered offenders. BJPsychBulletin 40(4): pp. 169-172.

The Electoral Commission (2021). Electoral Commission Report. The Future of Voting (PDF).

Winchester, M., Majid. And Kumar, A. (2021). Evaluating patients and healthcare professionals’ understanding of voting rights for patients in government elections.

New Socialist (2019) Mental Health Vote 2019: Get Involved.

McIntyre, J., Khwaja, M., Yelamanchili, V., Naz, S. and Clarke, M., 2012. Uptake and knowledge of voting rights by adult in-patients during the 2010 UK general election. The Psychiatrist, 36(4), pp.126-130.