Dix conducted a statewide investigation of how Massachusetts cared for the insane poor. In most cases, towns contracted with local individuals to care for people with mental disorders who could not care for themselves, and who lacked family and friends to provide for them. Unregulated and underfunded, this system produced widespread abuse. After her survey, Dix published the results in a fiery report to the state legislature:
"I proceed, Gentlemen, briefly to call your attention to the present state of Insane Persons confined within this Commonwealth, in cages, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience."
The outcome of her lobbying was a bill to expand the state's mental hospital in Worcester. Her success in MA convinced her to continue the crusade throughout the rest of the US.