In the first half of the 20th century, the practice of institutionalizing individuals with developmental disabilities was widespread in many countries. This trend was fueled by societal attitudes and a lack of understanding about these conditions. At the time, people with disabilities were often seen as “different,” and the idea of isolating them in large institutions was seen as a solution. Across Europe and North America, institutionalization rates were alarmingly high, with overcrowded, underfunded facilities often offering little more than basic care. By the 1950s, over half a million people with developmental disabilities were living in U.S. public institutions (National Council on Disability, 2009).
Life in these institutions was anything but easy. Residents were often placed in sprawling, state-run facilities meant to provide care, but in reality, these places were more about containment than support. Isolated from society, many institutions were located on the outskirts of towns or in rural areas, contributing to the deep segregation and marginalization of those living there. Inside, the daily routines were rigid and impersonal. Everyone followed the same strict schedules, regardless of their individual needs or abilities. Personal privacy was nearly nonexistent, as residents lived in crowded dormitories and had little control over their lives.
While some institutions provided basic healthcare and therapy, many others lacked the resources to address the complex needs of their residents. It wasn’t uncommon to hear of neglect, mistreatment, and subpar living conditions. Opportunities for socializing, learning, or meaningful work were few and far between. Residents were cut off from the outside world, and families often struggled to visit, either due to distance or restrictive policies. The focus of institutional care was paternalistic, emphasizing control rather than fostering independence or inclusion.
However, by the 1960s and 1970s, the tide began to turn. Advocacy movements and a growing recognition of human rights sparked a shift towards deinstitutionalization—moving away from large, isolated institutions and toward community-based care that offered more autonomy and integration (Taylor et al., 1994). This change wasn’t just about new policies; it reflected a profound shift in how society viewed disability. Advocates, families, and professionals began to challenge the outdated, inhumane model of care. They argued that individuals with developmental disabilities could live fulfilling lives in the community, with the right support, rather than being hidden away in institutions.
The civil rights movements of the 1960s and 1970s added fuel to this fire, pushing for equal rights for all people, including those with disabilities. Advances in psychology and social work also helped reshape the understanding of disability, emphasizing that with the right services and support, people could thrive outside institutional walls. The concept of “normalization” emerged, advocating for people with disabilities to have the same opportunities and rights as everyone else.
Legislation played a crucial role in the transition. Key laws like the Rehabilitation Act of 1973 and the Individuals with Disabilities Education Act (IDEA) in 1975 guaranteed that individuals with disabilities had the right to live, learn, and work in the least restrictive environment possible. These laws helped promote the closure of many large institutions in favor of community-based services.
The shift to deinstitutionalization marked a significant victory for autonomy and dignity, allowing people with developmental disabilities to live more independently, pursue education and employment, and engage in community life. However, this transition wasn’t without its challenges. The move from institutional care to community-based services required building a robust network of housing, vocational training, healthcare, and social support, which wasn’t always available or adequately funded. Some critics argue that in certain cases, the closure of institutions outpaced the development of community alternatives, leaving some individuals without the care they needed.
Nevertheless, deinstitutionalization represented a pivotal moment in how society approached care for people with developmental disabilities, shifting from isolation and neglect to inclusion and empowerment. It was a bold step toward treating people with dignity and recognizing their full potential within society.
