Novel technological interventions are increasingly used in mental health settings. In this article, we describe 3 novel technological strategies in use for management of risk and violence in 2 forensic psychiatry settings in the United Kingdom: electronic monitoring by GPS-based tracking devices of patients on leave from a medium secure service in London, and closed circuit television (CCTV) monitoring and motion sensor technology at Broadmoor high secure hospital. A common theme is the use of these technologies to improve the completeness and accuracy of data used by clinicians to make clinical decisions. Another common thread is that each of these strategies supports and improves current clinical approaches rather than drastically changing them. The technologies offer a broad range of benefits. These include less restrictive options for patients, improved accountability of both staff and patients, less invasive testing, improved automated record-keeping, and better assurance reporting. Services utilizing technologies need also be aware of limitations. Technologies may be seen as unduly restrictive by patients and advocates, and technical issues may reduce effectiveness. It is vital that the types of technological innovations described in this article should be subject to thorough evaluation that addresses cost effectiveness, qualitative analysis of patients’ attitudes, safety, and ethical considerations.

Aims: To conduct a survey investigating the provision of psychiatric intensive care within NHS medium secure units in England and Wales, gaining preliminary information about PICU size and clinical structure, and using this information to inform a discussion regarding PICU provision in medium security.

Method: A postal survey was conducted.

Results: A total of 30 MSUs were identified. The three groups of MSU differed significantly in size. Half of the MSUs surveyed either had a PICU or were developing one. There was a great variation in clinical service structure.

Discussion: There appears to be a growing trend for the provision of intensive care within medium security. Possible explanations for this movement are discussed. Reasons for PICUs not being developed are also explored. Forensic psychiatry needs to consider whether the national standards are appropriate for medium security. Further research is required to understand the reasons for the changing practice that we have identified, to develop a base of knowledge to inform service structure and to investigate the effects of different structures on clinical outcomes.