Publications and Research

Document Type


Publication Date



Background: With one in every 108 Americans behind bars, the deinstitutionalization of prisons is a pressing issue for all those facing the daunting challenges of successfully reintegrating ex-offenders into both their communities and the larger society. Given the strong evidence that treatment services, such as mental/behavioral health, alcohol/substance abuse, and primary healthcare may reduce recidivism, the large number of prisoner releases highlights the need for adequate treatment services in the community. It is within this context that the current study aims to examine the effects of prison deinstitutionalization on community based intervention modalities.

Methods: This study set out to address a set of fundamental research questions in the current climate of reversing the 40-year upward trend in prison population. This thread of inquiry is based on a hydraulic model of institutionalization of transinstitutionalization. This hydraulic framework posits that there are many overlaps between public safety and mental health needs, and that psychiatric institutionalization and penal institutionalization are functionally dependent. Longitudinal data with annual standardized measures such as rates and percentages for this change modeling were obtained from a number of national data programs for all 50 states. Our analytical focus concentrated on the second half of the decade of the 2000s.

Results: Change in the state imprisonment rate was negatively correlated with change in the rate of substance abuse treatment admissions (r = -0.24; p < .05) and the change in the rate of inpatient admissions in state psychiatric hospitals (r = 0.10; p > .05) as predicted. However, only the bivariate association between imprisonment and substance abuse treatment admissions attained the conventional threshold of statistical significance. Holding constant the direct and indirect effects of changes in the rates of violent crime and illicit drug use, change in prison population was negatively associated with changes in the rate of substance abuse (unstandardized coefficient = -0.891; p < 0.05) and mental health admissions (unstandardized coefficient = -0.509; p > 0.05) in the community.

Conclusion: By using a path analysis of the hydraulic model, we argue that social systems, similar to water moving in closed tubes, aspire to equilibrate. In other words, a decrease in prison population will not go without a corresponding increase in community mental health and substance abuse services. Social voids like those created by deinstitutionalization must be filled; and with states deinstitutionalizing offenders the toll is on their corresponding communities to address the needs of those offenders who are reentering after being incarcerated. In devising a policy and practice strategy to address the projected increase in the reentry population, leadership within communities for social and supportive services to ex-prisoners, specifically treatment services should be of primary concern.


This article was originally published in Health and Justice, available at DOI 10.1186/s40352-015-0021-7

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.