This chapter reconstructs the dynamics of the initial encounter between the British and the question of mental health illness in Palestine into the 1920s. Far from recapitulating a familiar narrative about the colonial introduction of psychiatry as a moment of rupture, it instead offers a multi-layered account of the opening of the first government mental health hospital at Bethlehem, in order to highlight how the British were in fact latecomers to an ongoing history of psychiatry in Palestine. Well before the British occupation of 1917, Palestinians had recourse to a range of medical and non-medical options for the management of the mentally ill, and those existing understandings, experiences, and institutions crucially shaped how the British responded to mental health illness across these formative years. As well as tracing the establishment of a key institution, this chapter also introduces a central figure in the history of psychiatry in mandate Palestine: Dr Mikhail Shedid Malouf.