In 1841, a Boston schoolteacher named Dorothea Dix set out for the local jail to teach a Sunday School class. What she discovered there changed history.

Dix was horrified to find mentally disabled people crammed into unheated, unsanitary quarters with all kinds of criminals.

Her revulsion and crusading spirit ignited a social movement that spurred the creation of "asylums" - places of refuge - all over the nation for people with mental disorders.

The asylums themselves ultimately became scandalously overcrowded, abusive and in need of reform. And in the late 20th century, the mental hospitals emptied out. But in their place, jails have once again become the institutional answer to mental illness.

"We've sort of gone back to the Dorothea Dix days," says Richard Elliott, a psychiatrist at the Mercer University School of Medicine.

A few decades ago, most people with chronic mental illness wouldn't have been on the streets or in jail. They would have been locked in state psychiatric hospitals like Central State in Milledgeville.

What happened in the interim is commonly described with a four-dollar word: Deinstitutionalization. It means taking people out of the institution.

In theory, with community-based mental health treatment and modern medications to control the symptoms of psychosis, most people with mental illness could function fine at home. There was no longer a need to confine sick people for life. And many did well. But many others did not.

"We deinstitutionalized people with the best of intentions," says Dr. E. Fuller Torrey, a leading national advocate for mentally ill people and their families. "Basically we opened the doors and waved goodbye and said, 'If you'd like to get some treatment that's fine. We'll be glad to provide it, but that's up to you.'"

In most places, however, adequate community services never materialized to follow up on the released patients.

Torrey says the result was a huge upsurge in the number of homeless, hallucinating, hurting people wandering the streets, either unable to find treatment or refusing to seek it.

"One predictable consequence is that an increasing number of these discharged patients ended up in jail," Torrey wrote in a 1998 study. "The three largest de facto psychiatric inpatient facilities in the United States are now the Los Angeles County jail, the Rikers Island jail in New York City and Cook County jail in Chicago."

Another trouble, Torrey says, is that when deinstitutionalization began, mental health professionals and policymakers did not yet understand something important about the way mental illnesses affect the brain. Through technology such as magnetic resonance imaging, neuroscientists now understand that the brains of people with schizophrenia and manic depressive illness are different. The diseases impair a section of the brain governing insight.

"They have damage to the parts of the brain that we use to think about ourselves," Torrey says. "So almost half of people with this illness are sitting out there saying, 'Look, there's nothing wrong with me.' As I've been told 100 times if I've been told once, 'Doc, if you'll just stop the CIA from sending those messages to me, I'll be fine. But I don't want your damn medicine, and I don't need it. There's nothing wrong with me.'"

Finding the leverage to get them into treatment became more difficult, because the law changed, too.

Civil liberties advocates, responding to human rights abuses in the commitment of mental patients, fought to make it much more difficult to involuntarily hospitalize someone for a psychiatric disorder.

"We changed the laws to make it virtually impossible to treat anyone against their will, even if they have no awareness of their illness," Torrey says.

Numerous court decisions over the years have reinforced the principle that people with a mental disability have a right to be treated in the least restrictive appropriate setting.

One of the most recent rulings, the Olmstead decision, grew out of a Georgia case. It is named for Tommy Olmstead, now the Bibb County Commission chairman. From 1995-99, he was commissioner of Georgia's social services agency, the Department of Human Resources. During his tenure, the department was sued by two state hospital clients who said Georgia had violated their rights under the Americans with Disabilities Act by keeping them in a hospital when they wanted to be served in a community setting.

In 1999, the U.S. Supreme Court ruled in favor of the clients, but also said the resources of the state must be taken into account.

"You can only put them out as funds become available. And that's what we were doing," Olmstead says. But he acknowledges that during his years at DHR, furnishing resources for his agency was not high on Gov. Zell Miller's agenda.

"His thrust was education, education, education - not mental health," Olmstead says. "I haven't seen a governor come along since Ernie Vandiver that really had mental health on the top of their agenda. ... The real problem is, mental health is way down on every politician's scope."

Bibb County Probate Judge Bill Self says that in trying to correct one problem, society has created another. Self presides over involuntary commitment hearings, the legal procedures under which people may be compelled to get mental health treatment against their will. He sends people for treatment, only to see them return quickly - oftentimes, mentally unstable.

"We don't want to ever again become a state where you can simply lock someone away in a mental institution for life," he says. But he added, "The pendulum has swung too far the other way.

"The idea of treating the patient in the least restrictive environment ... is intended to be the least restrictive environment appropriate to the needs of the patient. But so much pressure is put on the treatment professionals at the hospitals to get the patients out of the hospitals that I fear that becomes the primary goal instead of appropriately treating the patient," he said.

In a recent letter to state lawmakers, Self wrote, "In many ways, we've gone from the 'locked cage' to the 'revolving door,' still leaving the vulnerable of our society poorly served in any meaningful sense."

Elliott says deinstitutionalization may not be the best term for what has happened. He calls it "trans-institutionalization."

"Nobody was really deinstitutionalized," he says. "They were trans-institutionalized to other institutions, like nursing homes or jails."