The organized treatment of mental illness in the United States began in the early 19th century, a period when many states opened asylums to house individuals who at the time were understood to be suffering from insanity.

Early advocates believed that asylums offered a controlled environment for the development of “cures” for various forms of mental illness, which at that time was thought to be a type of disease requiring expert medical treatment. Led by Dorothea Dix, proponents of asylums “confidently and aggressively asserted that properly organized institutions could cure almost every instance of the disease.”

By the 1870s, however, the reformers’ vision had collapsed. Their notion that order and discipline could cure the “recently insane” proved inaccurate. Even individuals with less serious forms of mental illness did not respond as reformers had hoped, and for the more seriously ill, being sent to an asylum often ended up being a lifetime sentence.

By the early 20th century, even as many state asylums changed their names to “hospitals” to underscore their ostensible commitment to “curing” mental illness, asylums had devolved into largely custodial institutions.

A similar historical path was followed in Texas, which like many other Southern states began opening asylums just before or during the Civil War. Opened in 1861, the Texas State Lunatic Asylum was physically and programmatically modeled closely on the principles of the national movement for asylums. Renamed the Austin State Hospital in 1925, the institution suffered from overcrowding and underfunding through most of its existence.

Like other American asylums, its original mission of “curing” mental illness quickly gave way to the creation of a more custodial kind of institution, in which many patients lived out the remainder of their lives.

During his time as governor, James Stephen Hogg was receptive to increasing criticism from Progressive Era reformists of the conditions in the institutions. He didn't question, however, that institutions and asylums would remain the key sites for intervention and treatment.  

It was not until the emergence of a new reform movement in the early decades of the 20th century that that basic paradigm would be questioned.

Led by psychiatrists, psychologists, social workers, and former hospital patients (“survivors” in contemporary language), this movement denounced mental hospitals as ineffective and abusive, and insisted that the majority of patients could and should reside in their home communities. To do so would require new community-based services and a wholesale transformation in social conceptions of mental illness.

The very name of the movement – “mental hygiene” – sought to drive home these points. Its proponents argued that mental health and mental illness existed on a continuum shared by all people, and therefore the fostering of mental hygiene or “positive mental health” formed a wider imperative for society.

During the 1910s and ’20s, Ima Hogg would encounter the ideas and some of the key figures in this emerging movement due to her own struggles with depression. These experiences would lead Ima to resolve to bring mental health services and reforms to her home state of Texas.

Ima’s encounter with the movement also exposed her to the new brand of philanthropy that had emerged by the 1920s. These new, more "scientific" foundations embraced efficient management practices and targeted funds strategically toward carefully researched social problems. They were staffed by social science experts and tended to work closely with government agencies.

According to one historian, by the time of the Hogg Foundation’s creation in 1939-1940, “a symbiotic public-private process had emerged: foundations and private institutions tried to influence social policy and government spending by identifying a need, financing and organizing pilot programs, garnering public enthusiasm, and then turning to government agencies for continued funding and maintenance.”

This new paradigm for foundation work would greatly influence Ima’s thinking about the Hogg Foundation.