Decarceration first began for me in 1964 when I was a young clinical psychology intern in the Department of Psychiatry at Brooklyn’s Maimonides Hospital. This was a full decade before the War on Drugs first spawned the epidemic of mass incarceration in America, the plague of prisons we are now trying to end. But that era has a lot to teach us about decarceration.

At that time millions of mentally ill people were confined in “asylums,” old psychiatric institutions filled with individuals –many of whom had been held behind locked doors and barred windows for decades. These institutions (both public and private) were infamous for their widespread neglect and abuse of patients. Back then the US had over a million adults and children in mental institutions with a rate of over 700 per 100,000 – the same rate that the US prison system would reach by the 1990’s.

The long struggle to reform practices in these institutions, and to reform a system which relied so heavily on confinement, led President John Kennedy to call for shutting them down altogether. Starting in 1961, hundreds of thousands of mental patients were being discharged “to community care.” There was widespread public and professional support for this idea and Kennedy’s policy – which was called “de-institutionalization” – the forerunner of today’s decarceration of prisons.

But how do you get that many people out of mental hospitals and what do you do with them when they come back to their communities? At the time, there was a promise to improve the care of the mentally ill through community care via the establishment of a nationwide network of community mental health centers. The National Community Mental Health Act was issued in 1961 to assure the transfer of mental health care to the community. A new and more humane system was supposed to replace the evils of the asylums, but it never came.

This earlier period of “decarceration” (a term first applied to mental hospitals) occurred prior to the availability of effective psychiatric medications to treat major psychoses and bipolar disorders. These medications had first been developed and introduced in the 1950’s and many were still in the testing stages, often with very troublesome side effects. So release from the old mental hospitals often left patients and their families holding the bag, having to deal with family members and their all-too-real problems on their own.

Despite all the public satisfaction at these patients’ release in large numbers – due partly to the huge savings in public funds unspent – how could they find a place in the outside world after their long stays in another world? Being who they were, where else could these sick patients go? As we talk today about the pending “decarceration” of millions of prisoners, all this begins to sound familiar.

In my 2011 book A Plague of Prisons: The Epidemiology of Mass Incarceration in America, I was faced with the need to come up with some new ideas about ending mass incarceration and a new language that would describe this change. When the word “decarceration” first occurred to me, I liked the sound of it. It suggested the undoing something bad, as in de-contamination, de- toxification, or even de-Nazification. I wondered, “is Decarceration even a word?” Three years ago, Wikipedia said that it wasn’t.

But to my surprise, I found over 10,000 hits on Google (and today that’s up to 30,000). Next I looked at Amazon for any books with the word “decarceration” in the title or subtitle, and I found over 20 titles that fit. The oldest among these, from 1971, was called Decarceration with the subtitle of Community Treatment of the Deviant: A Radical View, by the sociologist and UC San Diego Professor Andrew Scull. This book, and its updated 1982 edition, prefigured everything we need to know in our efforts to end mass incarceration in America.

In more recent years, political scientist and law professor Bernard Harcourt (then at The University of Chicago, now at Columbia) has been examining the relationship between imprisonment and the closing of mental hospitals. Harcourt came up with this concise picture of what was happening:


Harcourt’s data makes clear that the current prison system has largely taken the place of the old mental hospitals, incarcerating people at the same high rate of 700 per 100,000. Most of this earlier population of mental patients were abandoned to wandering the streets, hunkering down in any shelter they could find, trying but often failing to reconnect with family and friends in the outside world. And by the 1970’s, the streets were full of powerful drugs (heroin, crack, speed, psychedelics – plus black market psychiatric drugs) that soon became the only solace for these lost souls.

From De-Institutionalization to Decarceration

Now more than 50 years later, we face the prospect of ending mass incarceration in America, this time meaning the release of millions of prisoners to the community, back to the same neighborhoods they had left for prisons. I never would have imagined that today’s great new wave of decarceration would be a repeat of the shameful experience of de-institutionalization of the mental hospitals, a pattern of widespread denial of care and the abandonment of public responsibility for these most vulnerable of our citizens.

In this new era of decarceration the US Justice Department recently announced that 6,000 of Federal prisoners would be set free – the largest ever one-time release of any group of US prisoners. But warning signs are already going up that this “great release” may be a replay of the early period of de-institutionalization of the mental hospitals. Despite all the promises of good community care, the truth seems to be closer to the tale of abandonment we saw 50 years ago.

Now even the NYPD Commissioner Bill Bratton has picked this up. In recent comments at a New York Law School breakfast, he said that releasing prisoners would raise a host of new questions, likening it to the earlier mental health initiative in his native Massachusetts that left many mentally-ill people on the streets. “My concern,” Bratton said, “is that once again a well-intended societal effort is being rushed forward without the appropriate safety nets. Where are they all going to go? Where are the jobs? Where is the housing? Where is the ability to allow them to not become recidivists?”

It is clear we will need much more than the label of “decarceration” to meet this need – we will need a whole new movement, a movement in every community whose members go off to prisons in large numbers, only to return again and again. The good news is that this movement is in formation right now. We are learning to nurture the great asset that so many former prisoners can represent to their families and communities. We intend that this website, along with its social media and links to this growing network, will become that movement’s microphone. We welcome you to pick it up and have your say about what needs to be done and how we may do it.

About the author

Ernest Drucker

Ernest Drucker, PhD, is a Research Scientist and Professor of Public Health at New York University, College of Global Public Health; Professor Emeritus of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine; and Visiting Scholar at John Jay College of Criminal Justice, City University of New York. He is a licensed Clinical Psychologist in NY State, a founder of The International Harm Reduction Association and is active in global public health and human rights efforts in the US and abroad. Ernest is the author of A Plague of Prisons: The Epidemiology of Mass Incarceration in America (New Press, 2011), and Editor of Decarcerating America: From Mass Punishment to Public Health - The New Press 2018. He and Eli Susser founded in 2015.