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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 MSUssurveyedeitherhadaPICUorweredevelopingone.Therewasagreatvariationinclinicalservicestructure. 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.

Hot beds of forensic psychiatry: Psychiatric intensive care units within medium security