Psychiatric inpatients who manifest challenging behaviour may require placement in an intensive or special care unit. This applies in both general and forensic psychiatry. Such units provide high levels of staff with low levels of interpersonal interaction with other patients and reduced stress. Levels of coercion are greater in these units and may involve the use of enforced medication, segregation, seclusion and physical and occasionally mechanical restraint. Much debate focuses on the ethics of such coercion. However, it is also necessary to consider the effects of not using such procedures on the health and safety of the patient and others. All methods of coercion have advantages and hazards. Methods vary across the world, and it is not self-evident which ones may be preferable ethically, with much being dependent on national and cultural tradition. Lengths of stay are much longer in forensic psychiatric hospitals, including in their intensive or special care units. Psychiatry is not alone in requiring such units; intensive care units are also needed in general medicine. Over the last year, general and forensic psychiatry and indeed general medicine have adapted to the impact of the COVID-19 pandemic with cases having been noted in forensic psychiatric hospitals and prisons.