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This paper examines the implications for design of inpatient settings of community-based models of care and treatment of mental illness. The study draws on ideas from relational geographies and expands interpretations based on Foucault's writing. We analyse material from a case study which explored the views of patients, consultants, and other staff from a new Psychiatric Inpatient Unit in a deprived area of East London, UK. We discuss in particular: the tension between providing a caring and supportive institutional environment and ensuring that patients are returned to the community when they are ready; the links between an acute inpatient facility and its local community; the potential significance of the psychiatric hospital as a relatively stable feature in the otherwise insecure and unpredictable geographical experience of people with long-term mental illnesses. We discuss the relevance of these issues for design of new psychiatric inpatient facilities.