Dwight, led a successful campaign to get the mentally ill out of America's prisons. Until the middle of the nineteenth century, mentally ill people were often abandoned by the state and jailed without having committed a crime. In prisons, they were often neglected at best and violently abused at worst. Following Dix’s campaign, the numbers of mentally ill people cruelly interred in American prisons fell dramatically. Various state governments opened hospitals and recovery facilities for those who suffered from mental health issues.

However, by the early-twentieth century, the abuse of inmates became common, especially at state-run mental health institutes, Stevenson notes. For instance, many inmates were given excessive doses of the controversial drug Thorazine, which led to terrible side effects. Further, many marginalized people such as those who were “gay, resisted gender norms, or engaged in interracial dating often found themselves involuntarily committed,” according to Stevenson. The abuses and injustices led to a demand for reducing involuntary and forced commitment into mental institutions in the 1960s and 1970s. While this was a much-need step, it coincided with a push on greater imprisonment rates, causing more mentally ill people to come in conflict with the law.

Since many de-institutionalized, poor, mentally ill people could not afford private treatment, they often found themselves on the streets in vulnerable situations, such as drug use and minor crimes, for which they were jailed. Thus, the heroic efforts of activists like Dix have been somewhat undone by a poorly thought-out policy for rehabilitating the mentally ill, especially from poor and minority backgrounds, as well as by a justice system oriented towards mass incarcerations. Stevenson suggests a multi-dimensional approach is needed to fulfill Dix's legacy of keeping the mentally ill out of prisons and meaningfully rehabilitating them.