In the 19th and early 20th centuries, access to health care in Finland was very much dependent on one’s wealth. As the majority of people in this predominantly agrarian country were poor at this time, the mentally disordered typically lived within the local community, either with their own family, or in receipt of a rudimentary form of municipal poor relief. The main argument of the author is that the management of mental illness in Finland was very tightly linked to social class. Rather than being just one factor among other significant determinants shaping mental health care in Finland, it was actually intrinsic to the very establishment of public mental health care itself. What this meant in practice was that, until the mid-20th century, most mental patients were from the disadvantaged classes. Why this was the case is the principal question addressed in this chapter.