Scandinavian Social Policy on Normalization and Deinstitutionalization

By Sydney Robinson 

Introduction

Institutionalization refers to the establishment of large-scale, state-run facilities designed to house and care for individuals with developmental disabilities [1]. Throughout much of the 20^th century, such institutions were viewed as progressive solutions that provided supervision, medical treatment, and protection to those deemed unable to live independently [2]. However, over time, they came to symbolize segregation and social exclusion rather than care and compassion. 

After World War II, Scandinavian countries, particularly Denmark, Sweden, and Norway, emerged as pioneers in social welfare reform [2]. Rooted in the principles of social democracy and equality, Scandinavian social policy became the foundation for major shifts in how societies conceptualized disability, care, and community. Normalization was central to their process of deinstitutionalization. Normalization challenged traditional notions of dependency and inspired the gradual dismantling of institutional systems across Scandinavia and beyond [3]. Scandinavian social policy evolved from institutionalization to normalization through legislative reform, grassroots advocacy, and a shift in societal values, leading to the deinstitutionalization movement that redefined disability rights and social inclusion. 

Historical Background

In the early 20^th century, institutionalization was widely regarded as a necessary, humane, and scientific approach to managing developmental disabilities [2]. Institutions were designed to provide treatment and safeguard individuals deemed vulnerable or socially unfit. Within the expanding welfare states in Scandinavia, institutional care was often justified as a form of collective responsibility, a moral duty of the state to protect and provide for all of its citizens [2].

Though deemed necessary by the state, the reality of institutional life was often bleak. Facilities became overcrowded, understaffed, and isolated from society, depriving residents of autonomy, privacy, and meaningful socialization [4]. Social scientists, families, and emerging disability advocates began to criticize the institutional system as dehumanizing and contrary to social welfare ideals [5]. These critiques set the stage for a new way of thinking about social welfare ideals based on participation and equality rather than protection and control. 

In the late 1960s, a political and ideological shift regarding normalization and deinstitutionalization occurred. At this time, normalization was not about closing institutions but rather served as a program to reform and improve institutions. In Norway from 1970 to 1989, the average number of patients per institution went from 60 to 25, and the staff-to-resident ratio increased threefold [6]. Additionally, a new social movement against the institutionalization of children became prominent, arguing that children should not grow up in institutions, and led to the number of institutionalized children to decrease dramatically. 

This graph by Tossebro et al., 2012 depicts the replacement of institutions for individuals with developmental disabilities with community care centers in Norway and Sweden from 1960 to 2005. Notice the significant downturn in the number of institutions from 1970 to 1990, marking the most significant period of disability policy transformation [6].

The concept of normalization emerged in the 1960s, led by Niels Erik Bank-Mikkelsen in Denmark and Bengt Nirje in Sweden [7]. They argued that people with disabilities should have access to everyday life patterns, housing, education, work, and leisure, consistent with social norms. Normalization represented not just a change in policy but a profound rethinking of human worth and dignity [7]. It reflected a shift from charity-based and medical approaches toward principles of autonomy, rights, and community.

Deinstitutionalization and the Implementation of Normalization

From the late 1960s forward, Scandinavia became a pioneer of deinstitutionalization and normalization. Large-state run facilities were closed, replaced by smaller-scale homes, and opportunities for integration into education, employment, and local life took place [6]. However, this implementation of normalization was not easy. Policymakers faced the challenge of balancing ideals of independence with the reality of the need for support by individuals with developmental disabilities. There were significant variations in timing and scope across Scandinavian countries, and resistance emerged from professionals accustomed to institutional practices and from local authorities concerned about resources and logistics [5]. 

In the 1970s and 1980s, local governments were assigned responsibility for an increasing number of welfare services [2]. Institutions were run by countries, but the question was raised as to what extent they actually provided specialized services to residents [2]. The shift from institutionalization to normalization and deinstitutionalization posed significant logistical and monetary hardships for smaller municipalities, though legislation and the larger societal shift towards inclusion helped this process significantly [2].

Despite these challenges, deinstitutionalization brought significant improvements in quality of life and social participation for many individuals. However, persistent issues, such as unequal access to services, ongoing discrimination, and limited funding, revealed that normalization remained an unfinished process requiring continuous attention. Even today, full normalization and social acceptance continue to evolve worldwide. Individuals with developmental disabilities still face daily stigma and discrimination, showing an urgent need for continued social reform and changes in public attitudes toward inclusion and acceptance. 

Broader Impact and Legacy

The Scandinavian model had far-reaching influence. The principle of normalization shaped international disability policy and informed the development of the social model of disability, which emphasized environmental and societal barriers rather than individual issues. These ideas later influenced global frameworks, including the UN Convention on the Rights of Persons with Disabilities (CRPD) and more [8]. Today, Scandinavian countries continue to develop their approaches to community inclusion and social acceptance. The legacy of normalization is still present in current debates over accessibility, personal assistance, and the balance between independence and care. 

Scandinavian reforms replaced the system of institutionalization with the principle of normalization, marking a fundamental shift from a model of care and protection to one grounded in rights, equality, and participation. Ultimately, this Scandinavian policy transformation demonstrates that social policy rooted in equality and human dignity can drive lasting systemic transformation, offering a model that continues to inform global disability rights movements today.

Citations

[1] Kangas, Anita, and Geir Vestheim. “Institutionalism, Cultural Institutions and Cultural Policy in the Nordic Countries.” Scandinavian University Press, April 6, 2011. https://www.scup.com/doi/10.18261/ISSN2000-8325-2010-02-08. 

[2] Tøssebro, Jan. “Scandinavian Disability Policy: From Deinstitutionalisation to Non-Discrimination and Beyond.” Alter10, no. 2 (April 2016): 111–23. https://doi.org/10.1016/j.alter.2016.03.003. 

[3] Herman, Ellen. “Normalization.” The Autism History Project, 2019. https://blogs.uoregon.edu/autismhistoryproject/topics/normalization/. 

[4] Karlsson, Riitta-Leena, and Jamie Bolling. “Freedom to Choose with Whom, Where, and How You Want to Live.” Edited by Emma Astrand and Mari Siilsalu. Independent Living Institute, 2022. https://www.independentliving.org/files/English-Freedom-to-choose-Deinstitutionalisation-Sweden.pdf. 

[5] Merrick, Joav, Peter Uldall, and Jakob Volther. “Intellectual and Developmental Disabilities: Denmark, Normalization, and de-Institutionalization.” Frontiers in public health, September 24, 2014. https://pmc.ncbi.nlm.nih.gov/articles/PMC4173222/. 

[6] Tøssebro, Jan, Inge S. Bonfils, Antti Teittinen, Magnus Tideman, Rannveig Traustadóttir, and Hannu T. Vesala. “Normalization Fifty Years beyond—Current Trends in the Nordic Countries.” Journal of Policy and Practice in Intellectual Disabilities 9, no. 2 (June 2012): 134–46. https://doi.org/10.1111/j.1741-1130.2012.00340.x. 

[7] Osburn, Joe, and Guy Caruso. “Some Effects of the Transition from Normalization to Social Role Valorization.” The SRV Journal, June 2011. https://socialrolevalorization.com/wp-content/uploads/2019/04/SRVJ_transition_normalization_to_SRV.pdf. 

[8] “Convention on the Rights of Persons with Disabilities (CRPD) | Division for Inclusive Social Development (DISD).” United Nations. Accessed October 16, 2025. https://social.desa.un.org/issues/disability/crpd/convention-on-the-rights-of-persons-with-disabilities-crpd.