Background: Issues of risk and safety can be challenging to discuss with forensic patients with an intellectual disability. Talking Mats is a visual communication tool that facilitates therapeutic conversations. Method: A pilot study, adopting an ethnographic approach, was used to evaluate Talking Mats. Interviews and video observations were conducted with nurses and forensic patients with an intellectual disability from two forensic wards in Scotland. Results: Exploratory evidence suggests that Talking Mats offers a non-biased platform to discuss potentially emotive issues around risk, safety, and wellbeing. Pre-existing notions of Talking Mats, staff availability, and the context of COVID-19 acted as barriers to adopting the visual communications tool. Conclusion: There is value in further research regarding communication tools to facilitate input on care planning and risk management for patients with an intellectual disability.