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Friday, 24 April 2015

Cognitive impairment and voting: the capacity to be heard

Alexandra Richards

Who gets to Vote?
Image: Every Vote Counts
The upcoming election is an opportunity for the population to have their say in the future running of the country. We live in a democracy and the right to vote feels fundamental. But two thirds of all people in the UK with learning disabilities do not vote. Many may not even know that they are entitled to a vote. UK-based statistics are not available but research suggests that for individuals who have cognitive impairments of other causes (e.g dementia, brain injury), voting rates may be similarly low.

Though there are many jokes about the intellectual functioning of the average voter abound in the run-up to an election, the reality is that voting eligibility is not determined by intellectual ability. It appears though that this is not common knowledge. Many health and social care professionals (see here and here) are not fully aware that their clients are actually allowed to vote.  The presence of a cognitive impairment may make the process of voting challenging, but is this really sufficient reason to not support people from doing so? Assumptions about whether someone can and should vote may be informed by the ideas around their mental capacity.

The Mental Capacity Act (2005) supports adults who have an ‘impairment of or disturbance in the functioning of mind or brain’, who may lack the ability to make a decision. Capacity is assessed on an individual decision-basis, and with all available support the individual must demonstrate that they can do the following:

  • Understand the relevant information, including understanding the likely consequences of making the decision.
  • Retain that information.
  • Use or weigh that information as part of making the decision.
  • Communicate their decision. 

At face-value, the notion of assessing capacity to vote appears sensible. But when one considers how we might judge ability to ‘understand and retain’ the information relevant to the decision to vote, the process is not straightforward. Which information is most relevant? Would we expect someone to have read all of the party manifestos and to be able to recall this information? How would we expect someone to explain the ‘likely consequences’ of their voting choice? We certainly do not apply these criteria to people without disabilities and I imagine few could fulfil this criteria.

The available advice around voting capacity is often lacking or conflicting. The Mental Capacity Act explicitly does not cover voting.  It is however relevant to the decision of appointing a proxy. Intellectual functioning is not mentioned in the voting eligibility criteria set out by Government services or the Electoral Commission. The latter considers that votes must not be subject to any legal incapacity to vote’, and that ‘A lack of mental capacity is not a legal incapacity to vote’. The legal position from 2006 has been that ‘a person is subject to a legal incapacity to vote by reason of his mental state’ was abolished. On the other hand information provided by the Citizen’s Advice Bureau states that ‘people who have a severe mental illness and are unable to understand the voting procedureare ineligible to vote. An editorial in the British Medical Journal suggested ‘it seems inevitable that doctors will be asked to assess capacity to vote’ and expressed the need for advice. It may be necessary for voting information to explicitly state that a cognitive impairment does not preclude someone from voting to dispel eligibility myths.

My own experiences of working within a rehabilitation service for adults with acquired brain injury has highlighted to me the lack of awareness around voting eligibility and also issues of accessibility. Many of the service-users have significant cognitive impairments as well as communication and sensory difficulties. Our attention was drawn to the issue at the start of the year, at which point none of the residents where I work were actually registered to vote. Whilst all staff are committed to supporting social inclusion, we realised we had never considered voting as part of this. Inquiries to local candidates requesting clarification on eligibility and accessible information generated no responses. After informing ourselves of some of the information above, we made service-users aware of the election and their right to vote. For those interested, we have supported them to register. For many of the service-users, who are grappling with the consequences of their brain injury, the election does not appear to be a particular priority. However I do see it as within our remit, as professionals who seek to empower, to make the people we support aware of their rights and to actively promote these. I have been surprised by local politicians’ lack of interest in engaging with our service-users, who in addition to being a marginalised group, are also “untapped” voters. Whilst most people complain about the amount of election material they receive through their door, we have yet to receive any unsolicited information.

Given that people who have a cognitive impairment are legally entitled to vote, how can we assist them to understand and be involved in the process of voting? We need to promote voting, whilst also ensuring that individuals are not unduly influenced or exploited by others. Every Vote Counts campaigns to increase the rates at which people with learning disabilities are voting and encourages political parties to take note. At the time of writing the Liberal Democrats  and the Green Party  have released easy read accessible manifestos. Dementia-related organisations have also produced some advice regarding voting (see here and here).

More however needs to be done. The lack of awareness around voting eligibility represents one of the many ways that people with disabilities are unconsidered and alienated within our society. As frequent users of health and social care services, people with disabilities deserve the right to contribute to decision making that may have a considerable impact on them.  If politics appears too abstruse for someone with a cognitive impairment to follow, then this is a fault for political parties to address. Voting is not a matter of intellectual ability but of civil rights and we must promote inclusion for all.

Dr Alexandra Richards is a clinical psychologist working in neurorehabilitation. You can follow her on Twitter @allyfrichards.

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