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The Capacity to Vote of Persons With Serious Mental Illness

Mr. Raad is affiliated with the College of Physicians and Surgeons, Columbia University, New York City. Dr. Karlawish is with the Department of Medicine, University of Pennsylvania, Philadelphia. Send correspondence to Dr. Appelbaum, Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute, 1051 Riverside Dr., Box 122, New York, NY 10032 (e-mail: psa21{at}columbia.edu).

OBJECTIVE: Despite legal protections, persons with mental illness continue to experience discrimination that limits their access to voting in elections. In response, a number of states have adopted individualized functional determinations of mental capacity to vote. A 2001 federal court decision offered clear criteria for determining voting capacity that are based on understanding the nature and effect of voting ("the Doe standard"). This study explored the performance on these criteria by a sample of individuals with serious mental illness. METHODS: The Doe standard has been operationalized with the Competency Assessment Tool for Voting (CAT-V) along with measures of reasoning and appreciation. Performance was assessed with the CAT-V in a sample of 52 community-dwelling persons with serious mental illness and then compared on measures of cognition, verbal IQ, and symptom severity. RESULTS: The interview questions were scored with good interrater reliability and took an average of less than five minutes to administer. Performance was high, with 92% scoring a 5 or 6 out of 6 possible points on the Doe-standard criteria. Performance did not correlate with cognition, verbal IQ, or symptom severity. CONCLUSIONS: The CAT-V is an easy and efficient method of determining voting capacity according to the Doe standard. Assuming that the high scores in this sample are confirmed in other groups, in general it may be appropriate to assume that even persons with serious mental illness are capable of voting. When a person's capacity to vote is called into question, screening instruments such as the CAT-V may be useful to guide an assessment.

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