What's the relationship between ableism and institutionalization?
By Carli Friedman | CQL Director of Research
Ableism, oppression against people with disabilities, is extremely common and impacts not only our interactions with others but also systems and social structures. Among others, attitudes impact how policies are made and how resources are allocated, for better or for worse. In many ways, the social devaluation of people with intellectual and developmental disabilities (IDD) and the resulting dehumanizing, oppressive, and ableist practices have their origins in institutionalization. For example, Trent (1994) notes that one of the first times people with IDD were recognized as a group and pathologized was during the rise of institutions in the United States. Historically, disability prejudice and institutionalization of people with IDD in the United States have often been intertwined.
Although deinstitutionalization of people with IDD is at an all time high, the legacy of institutionalization is far-reaching and many people are still institutionalized. For these reasons, the aim of this study conducted by CQL | The Council on Quality and Leadership was to explore the relationship between ableism and institutionalization of people with IDD. To do so, we conducted an analysis looking at the relationship between utilization of institutions by state (fiscal year 2015) and implicit (unconscious) disability prejudice data from approximately 350,000 people across the nation.
The average state had an implicit prejudice score of 0.50. (Implicit prejudice scores of 0 to .14 indicate no prejudice, .15 to .35 slight prejudice, .35 to .64 indicate moderate prejudice, while scores of .65 and above indicate strong prejudice.) We examined the relationship between disability prejudice and state institutional censuses (public and private), while controlling for state population. In doing so, we found the lower the state’s disability prejudice, the fewer people with IDD were institutionalized in the state, regardless of the size of the state (see figure below). For example, controlling for state size, a state with an average prejudice score of 0.52 is expected to have 704 people in institutions, while a state of the same size with a prejudice score of 0.58 is expected to have 1,621 people in institutions. When state population is controlled, states with little to no disability prejudice are not expected to have any people with IDD in institutions.
Relationship Between Disability Prejudice and Institutional Census
We also looked at the relationship between prejudice and institutional spending (public and private), controlling for state population and wealth. According to the model, the lower the state’s disability prejudice, the less the state spent on institutions, regardless of the state's wealth or size (see figure below). For example, controlling for state size and wealth, a state with an average prejudice score of 0.56 is expected to spend $104 million of public funds on institutions, whereas a state with an average prejudice score of 0.60 is expected to spend $225 million of public funds on institutions. When state size and wealth is controlled, states with little to no disability prejudice are not expected to spend public funds on institutionalization of people with IDD.
Relationship Between Disability Prejudice and Institutional Spending
These findings mirror past research conducted by Braddock and Fujiura (1991) which found that states that scored high in terms of civil rights and consumer advocacy directed more funding towards community-based settings. In addition, our analysis suggests “states that have higher than average institutionalization rates must also reexamine their practices, particularly because, based on our findings, it is likely they are also more prejudiced against people with disabilities. In addition to continued deinstitutionalization efforts, there must also be an intentional effort to rid all services and supports, institutional or community based, of the culture of custodial care.” (Friedman, 2019, p. 270)
- Braddock, D. & Fujiura, G. (1991). Politics, public policy, and the development of community mental retardation services in the United States. American Journal on Mental Retardation, 95(4), 369-387.
- Friedman, C. (2019). The Relationship between disability prejudice and institutionalization of people with intellectual and developmental disabilities. Intellectual and Developmental Disabilities, 57(4), 263-273. https://doi.org/10.1352/1934-9556-57.4.263
- Trent, J. W. J. (1994). Inventing the feeble mind: A history of mental retardation in the United States. Berkley: University of California Press.