National Alliance on Mental Illness
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The Disenfranchisement of Persons with Mental Illness

By Ron Honberg, Deputy Executive Director for Legal Services
As the 2000 elections loom, 44 states still maintain restrictions of some kind on the rights of people with mental illnesses to vote. Many of these restrictions are contained in state constitutional provisions adopted more than 100 years ago when severe mental illnesses were poorly understood, and people who suffered from them were presumed to be hopelessly incapacitated for the rest of their lives. Since these laws were adopted, significant progress has been made in understanding and treating severe mental illnesses, and most people who suffer from these disorders are capable of exercising their right to vote. Despite this, the laws of many states still contain generalized restrictions on the rights of persons with mental illnesses to vote. A recent decision issued by a New Jersey Court offers hope that courts will interpret and apply these prohibitions in a narrow way.

A hotly contested election in Mercer County, New Jersey, provided the backdrop for the case. On election day, November 3, 1998, seven residents of Trenton Psychiatric Hospital submitted absentee ballots. The Mercer County Republican Committee wrote a letter to the Mercer County Board of Elections ("Board") challenging these ballots. The Committee based their challenge on a provision in the New Jersey Constitution stating that "no idiots or insane persons shall enjoy the right of suffrage." The Mercer County Democratic Committee joined the challenge.

The Attorney General of New Jersey advised the Board that the ballots should be counted, absent an adjudication of insanity or other documentary evidence of insanity or incompetency. However, the Board was unable to reach consensus on whether the five absentee ballots at issue should be counted, and referred the case to the Superior Court, Law Division ("lower court") for a determination.

After a hearing, the lower Court decided that the ballots should remain segregated and unopened until it was determined that the voters were competent at the time they cast their ballots. The voters appealed to the Superior Court, Appellate Division. They were represented in their appeal by New Jersey Protection and Advocacy , Inc. (NJPA). The Attorney General of New Jersey moved to intervene on behalf of the Mercer County Republican Committee ("challenger"), and the Superior Court, Appellate Division granted their application.

The Appellate Division reversed the lower court's decision and ordered the Board to open and count the ballots. The Court's decision was based on its recognition that voting is a fundamental right of citizenship in the United States and the individual states. As with all fundamental rights, the Court stated, "there can be no interference with an individual's right to vote, 'unless a compelling state interest to justify the restriction is shown.' "

In this case, the Court found that the challengers failed to show that the imposition of generalized voting prohibitions on residents of a state psychiatric hospital were necessary to justify the state's interest in protecting the integrity of the voting process. Citing language in New Jersey's commitment statute emphasizing that individuals committed to state facilities retain fundamental civil rights, including the right to vote, the Court held that residency in a psychiatric hospital, whether voluntary or involuntary, does not equate with lack of competency to vote.

Those challenging the right of individual residents of psychiatric hospitals to vote bear the burden of proving, by clear and convincing evidence, that these individuals lack the capacity to vote, the Court held. The challengers cannot meet this burden with generalized assumptions about the cognitive status of patients in psychiatric hospitals. The Court emphasized that "no presumption of incompetence arises from being treated at a mental institution." Rather, those challenging the right to vote must make a "particularized showing of incompetence."

Furthermore, the Court held, the burden of proving that individuals lack capacity to vote cannot be met with opinions proferred by laypersons. To make the particularized showing of incompetence required in this case, the challengers must bring forward expert testimony in support of their position. As no such showing was made in this case, the Court concluded that the lower court's decision to segregate and not immediately count the ballots was incorrect.

The decision in this case may properly be heralded as a victory for those advocating for the fundamental civil rights of persons with mental illnesses. However, as the Court did not rule directly on the voting restrictions contained in the New Jersey Constitution, the restrictions on voting set forth in Article 2, 1, 6 remain in effect. It was neither necessary nor would it have been prudent for the Plaintiffs to challenge the validity of the Constitutional provision in this case. Nevertheless, a genuine question can be raised concerning whether provisions restricting voting by persons with mental illnesses in state constitutions or statutes are compatible with fundamental rights protected by the Constitution of the United States and laws such as the Americans with Disabilities Act (ADA) enacted to give effect to these protections.

Historically, states have enjoyed the right to regulate elections and to set voter qualifications. However, the Supreme Court of the United States has recognized that voter qualifications established by states must be compatible with the Equal Protection guarantees contained in the 14th Amendment of the U.S. Constitution. The Supreme Court has not been willing in the past to categorize persons with disabilities as a protected class under the Equal Protection Clause. However, the Court has recognized voting as a fundamental right. Thus, laws infringing on these rights should properly be subject to strict scrutiny analysis by Courts reviewing them. Under strict scrutiny analysis, states must demonstrate that laws enacted to regulate voting are narrowly tailored to achieve compelling state interests.

Professor Kay Fletcher Schriner and colleagues have suggested that two state interests are relevant to laws restricting the right to vote: ensuring the intelligence of the electorate and ensuring the purity of the vote. Neither of these interests would appear to be so compelling to justify state laws that impose broad restrictions or prohibitions on voting by persons with mental illnesses.

In view of the significant progress that has been made in treating brain disorders such as schizophrenia and bipolar disorder, there is no justification for generalized assumptions that persons with severe mental illnesses, even those who are hospitalized, are any less capable of making informed political judgements than other Americans. Studies that have been conducted on the voting choices made by individuals with mental illnesses who are hospitalized support this position.

There is also little evidence to support the assumption that the majority of Americans are particularly well informed about the views and ideas of political candidates they elect to office. For example, a survey conducted during the 1992 Presidential campaign revealed that far more people (89%) knew that Vice President Quayle was feuding with television's Murphy Brown than knew then Governor Bill Clinton's record on the environment (19%).

States also have a compelling interest in ensuring that voters cast their ballots without undue influence or interference from others. However, broad restrictions or prohibitions on voting by persons with mental illnesses are not necessary to accomplish this objective. In the New Jersey case discussed above, the Respondents suggested that individuals confined in psychiatric hospitals are particularly vulnerable to fraud or undue influence by others preying upon them within the hospital environment. However, they offered no evidence in support of this contention. As all voters are potentially susceptible to fraud or undue influence, it seems unnecessary to single out persons with mental illnesses or other mental disabilities through the imposition of overly broad restrictions on voting.

Laws enacted to address compelling state interests must also be narrowly tailored and not unnecessarily broad to satisfy strict scrutiny analysis under the equal protection clause. Many existing state laws prohibiting or restricting voting by persons with mental illnesses would appear not to satisfy this requirement. For example, Maine's constitution contains a prohibition against voting by persons with mental illnesses under court-ordered guardianships. Interestingly, persons with other mental or cognitive disorders who are under court-ordered guardianships are not similarly restricted.

The Maine prohibition seems unnecessarily broad. Courts impose guardianships for a variety of purposes, including management of personal finances and treatment decision making. An individual who is placed under guardianship for one purpose may be perfectly capable of functioning in other areas of his/her life. Thus, a person under a limited guardianship for purposes of treatment or management of his/her financial affairs is not necessarily incapacitated for purposes of voting. A better approach would be to design a set of simple questions to evaluate the voting capabilities of all voters.


On the eve of the 2000 elections, too many states still have laws on the books imposing unnecessary restrictions on the right to vote for persons with mental illnesses. At a time of great hope and progress in treating these disorders, restrictions of this nature are both unfair and counter to the therapeutic and rehabilitative interests of persons with mental illnesses. Consumers, family members and other advocates should therefore work in concert with state legislators to repeal these discriminatory prohibitions. Advocates may also consider filing lawsuits to overturn or narrow the scope of these laws.