The hidden costs of disability institutionalization in Swedish history

Historically, disability institutions in Sweden were established on paternalistic grounds but, over time, were used to isolate people with severe disabilities, often driven by eugenic ideals. Little is known about how this institutionalization affected society. We study how the opening of disability institutions impacted the lives of people with disabilities (in terms of mortality) and the broader population (in terms of segregation and attitudes) between 1880 and 1960. We estimate the causal effects of institutionalization applying a staggered difference-in-differences approach to linked historical register data from decennial censuses and the death register. This approach exploits the gradual opening of 40 mental asylums over time in different parishes, using 10 and 20 km catchment areas. Our findings show that the establishment of a disability institution significantly reduced mortality among people with mental disabilities, lowering death rates by approximately 0.5 deaths per 100 relative to a mean of 2.55. The survival benefits were strongest for individuals without nearby relatives and for those above age 15, suggesting that institutions served as a critical substitute for weakening family care networks. These results challenge the prevailing view that historical disability institutions were uniformly harmful and indicate that, despite well-documented problems of overcrowding and eugenic practices, institutionalization could be life-saving, particularly for the most vulnerable. In our ongoing work, we examine spillover effects on the broader population, including changes in residential segregation and attitudes toward people with disabilities.