This article examines the exploitation of patient labour at Kew Cottages, Australia's first purpose-built state institution for people with learning disabilities. Analysing historical evidence for the period 1887-1950 shows that unpaid patient labour contributed significantly to the economy of the Cottages and so to the government department of which they were a part. It also argues that government failure to provide adequately for patient needs and to rectify unsafe working conditions further exploited working patients. The final section of the article examines why some patient-labourers may have chosen to work, arguing that the restrictive, materially impoverished and relatively isolated social world in which they found themselves were an important influence on their decisions to do so.