As of 1933, the authorities radically extended the austerity measures in the psychiatric hospitals that had already been introduced in the Weimar Republic in accordance with political guidelines. Patients' living conditions were made worse by overcrowding, staff cuts and reductions in the nursing rates.

Patients who were not fit to work and those regarded as incurable were particularly affected by the cutbacks. Their exclusion began long before the Second World War. In 1938, the state of Saxony introduced a deficiency diet for non-working institutional residents along the lines of the Pirna-Sonnenstein institution.

»Aktion T4« took the step from exclusion to the systematic killing of people who were unfit to work, needed more care and who were regarded as »disturbing«. By filling in the registration forms to record the »euthanasia« victims, the doctors in the institutions played a part in the murders. Their data formed the basis of the selection decisions regarding the life and death of the patients.