With the development of ‘moral treatment’ at the beginning of the nineteenth century in Europe, occupying the mentally ill became considered key to their recovery. By the early twentieth century ideas about the importance of work were being systematised as occupational therapy. While one recent collection, edited by Waltraud Ernst, has sought to explore the history of this development, including in colonial contexts, the role of work as an element in the treatment of the mentally ill has been neglected by historians. This paper seeks to develop this growing awareness of the role of work therapy by examining its importance in a number of institutional contexts in the Middle East from the late nineteenth century to the middle of the twentieth. The lack of any provision of employment for the institutionalised mentally ill was one of the major critiques made by the British of the Abbassia asylum at Cairo before F.M. Sandwith assumed control of the institution in 1884, and once in control, Sandwith and his successors stressed the mental, social, and economic benefits of putting patients to work. At Asfuriyeh in Beirut, too, work was central to the experience of the patients, who actually helped in the construction of the hospital and landscaping of the site. Their employment was considered to bring many benefits, both to the patients and the institution itself, but putting patients to work was far from uncontroversial, being resisted by ‘lazy and phlegmatic’ – as hospital authorities saw it – patients themselves, and protested by their relatives. Finally, the case of government mental hospitals and prison mental wards in British Mandate Palestine offer something of a counterexample to the other institutions. Employing patients in these institutions appears to have been of much less significance, and this paper explores why, in spite of numerous connections between these institutions and those at Cairo and Beirut, ideas about the importance of work to the recovery of the mentally ill were not taken up and put into practice in Palestine.