Should the Mentally Impaired Vote?

Several states are reconsidering voting rights of the mentally impaired as a debate ensues about who should be able to vote. Bob Carolla of the National Alliance on Mental Illness is joined by NPR science correspondent Joe Shapiro to discuss the issue.

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MICHEL MARTIN, Host:

I'm Michel Martin, and this is TELL ME MORE from NPR News.

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MARTIN: people with diminished mental capacity.

Several states are considering laws that broaden or limit the voting rights of the mentally impaired. But who has the right to decide who is mentally fit to vote? Joining us now to talk about this is Bob Carolla of the National Alliance on Mental Illness. He oversees their stigma-buster program. He's on the line from San Diego.

And joining us in the studio is NPR science correspondent Joe Shapiro. Welcome, gentlemen. Thanks for joining us.

JOSEPH SHAPIRO: Thank you.

BOB CAROLLA: Thank you.

MARTIN: Now Mr. Carolla, older Americans have always been more likely to vote than younger Americans. Why do you think this issue is coming up now?

CAROLLA: Well, it's actually been simmering at local levels and in some states for quite a while, in states like New Jersey and in Maine, that it's focused primarily on people with mental illnesses, initially.

But I think that as elections get closer and, you know, we only have, you know, we can look at the 2000 presidential election and seeing how narrowly Florida could've swung in terms of determining our next president, I think there's been also greater focus on especially the elderly who may be in assisted living or nursing homes for physical infirmities. But also because of the aging process, there's - I think the popular perception sometimes is that, you know, they're not of a frame of mind to make informed decisions, which is not true both for that category as well as for people with mental illnesses.

MARTIN: But you figure just because the elections are so close now, our national elections are so closely decided that every vote counts, and now you feel that's why there's additional scrutiny on, you know, a pretty small part of the population. Why don't you, maybe let's - Joe, let's talk about that. Maybe it's not such a small part of the population.

The Alzheimer's Association estimates that about 4.9 million Americans have Alzheimer's. And is that number growing as a percentage of the population or is it, are we just more aware of people with Alzheimer's?

SHAPIRO: No. It's actually growing quite a bit as we have an aging society and people are living longer. And as you live longer, you have a greater chance of having some dementia.

And of people who live in assisted living, for example, assisted living is seen as a place where people who are not as incapacitated live - you know, they're more independent than, say, somebody who'd be at a nursing home.

But even in assisted living, half of the people in assisted living have some dementia. Some have pretty advance dementia. So there is this population of people, again, older people who do tend to vote in higher percentages than younger people.

A lot of people who are getting older - those numbers are growing and they are people with dementia and then you get these tricky questions of can people make the decision.

MARTIN: Now, clearly I think everybody would recognize that you could have a physical impairment and still be perfectly mentally capable of making a good decision about voting. But with dementia, is the opposite true, that you may have a mental impairment that might not show up in a physical disability?

CAROLLA: Sure. But it's also - it's hard to measure what is dementia.

MARTIN: Yeah. What is dementia? How do you measure it?

CAROLLA: It's hard to measure. You can be very clear one moment and not so clear on another. I'll tell you a story about my mother. In 2004, she moved from her home in Washington, D.C., where she lived for 50 years. She moved to another state. She moved to Maryland. She has been passionate about politics her entire life. My mother has dementia. We got an absentee ballot for her. She's voting in a new state. She reads the newspaper now, but she has trouble following the news. I didn't know because she really - does she really know what's going on?

She looked at the ballot, she knew these candidates, she knew who'd been in the House of Representatives and who is now running for the Senate. She knew her state. She knew the state legislator in this district in Maryland, even though she had not - only lived there for a year, because she had just been following the news for all these years. And it came to her and she knew who she wanted to vote for. The candidates she didn't know, she didn't vote. I was surprised. She can't - she - the other day, she didn't know how - she couldn't tell me how old she was, but this stuff that she'd followed for years popped up; she knew how she want to vote. If you gave her a test - if you gave her a test for dementia, you'd say, no, she can't vote. But when that ballot was in front of her, she knew even the state representative in this place that she had just moved into.

MARTIN: Now, Bob Carolla - go ahead.

CAROLLA: If I could add in too - we're talking about one of the fundamental rights of an individual. It goes to individual dignity, but also the ability to participate in our broader community, whether it's at the local level or the national level. And one of the most vital links to both mental health, as also physical health, is keeping connected - make - retaining that community connection.

If you go to a assisted living facility, or even a nursing home, there often is a current events discussion session. And to the degree that people are concerned about what happens with what is viewed as a marginalized population, it's - the concern is over manipulation or undue influenced by - oftentimes by campaign workers for a candidate...

MARTIN: Sure.

CAROLLA: ...looking to swing an election.

MARTIN: Sure. Those people are concerned about the integrity of the process.

CAROLLA: Right.

MARTIN: Right?

CAROLLA: But...

MARTIN: So you don't think that's a legitimate concern?

CAROLLA: Well, do you end up restricting the right to vote for the person who is being manipulated? Or do you actually need to focus on the person who is abusing that individual's own right?

MARTIN: Mr. Carolla, in states where people are interested in taking a look at this issue knew about the question of whether there's an impairment and whether people with any form of diagnosed impairment, whether it's mental illness or a dementia, should be allowed to vote, what are they thinking about doing? Is there a test, or are people are thinking about having some sort of a test, like in the way that there would be a driving test to see whether your eyesight is still adequate to the task of driving? Is that what we're talking about?

CAROLLA: Well, the American Bar Association currently has a committee looking at the question of whether there should be a standard. And I think what they may be leaning towards is something that tries to test whether or not there's a specific desire to participate in the voting process. And that's regardless of whether or not that is expressed verbally, with help or without help. But keep in mind, we don't have many tests other than needing to be age 18 to allow someone to vote.

We don't look at the motivations, the emotions or the reasons why an individual may want to vote across the population. There is no literacy test anymore, in part because that used to be imposed on - for racial reasons to discourage voting. About 50 percent - only about 50 percent of the American population votes in any election. We should actually be looking at ways to increase that participation rather than just decreasing it.

MARTIN: What about the question of people with - I know we're talking, we've been focusing on mainly the question of sort of diminished capacity due to aging. But what about - I think, obviously, Mr. Carolla, you're also interested in the question of mental illness. Are there specific efforts being made to ask people who have a diagnosed mental illness not to vote or people who have been diagnosed with severe mental illness or perhaps people who have been adjudged to be not responsible for criminal acts due to their mental illness?

CAROLLA: Well, it's actually - the direction has been not so much to restrict it because it comes as a surprise to many people that there are already restrictions in place. Some of it is through constitutional provisions and state constitutions that date back to the 19th century and speak in terms of insanity, idiocy or actually even imbecility - terms that no longer have much meaning in, you know, in current language. And when they did exist it was really more as a legal term and certainly not today as any kind of - having any kind of medical significance.

MARTIN: We're talking about the voting rights of Americans with various forms of mental impairment. With us to talk about this is Bob Carolla of the National Alliance on Mental Illness, and in-studio, NPR science reporter Joe Shapiro.

Joe, what about the hundreds of thousands of Americans living in nursing homes? How do those institutions facilitate the voting process for their residents? And are there concerns, as we've been discussing, about whether these residents are subject to manipulation.

SHAPIRO: And that's an - and that's been a question, oh, are they manipulated by family or campaign workers to vote in ways that maybe they wouldn't want to vote? But I did an interview in 2004 with Dr. Jason Karlawish at the University of Pennsylvania and he's done some studies of this. He's been very interested in this. And he did a survey of nursing homes in Philadelphia and he found, actually, the bigger issue was that it's often nursing home staff who decide who gets the vote and who doesn't. He found that was the case in about 80 percent of these nursing homes that he surveyed.

The staff sort of, almost sort of arbitrarily decide whether somebody's competent to vote. And it might be on something very subjective. They might ask, oh, who's running in this race or what are the issues, and nothing that really determines competency. You know, Bob was talking about how often we can - there's this danger that we pass laws and we really end up holding people to higher standards if they have a disability or if they have dementia.

MARTIN: It's an important and complex issue and I thank you both for speaking with us. NPR science reporter Joe Shapiro; he joined us here in the studio. And Bob Carolla. He oversees the stigma-buster program at the National Alliance on Mental Illness. He joined us by phone from San Diego. Gentlemen, thank you both so much for speaking with us.

SHAPIRO: Thank you.

CAROLLA: Thank you very much.

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