Background: Pica is a very dangerous form of self-injurious behaviour because one occurrence can be lethal. Dealing successfully with dangerous pica in a large institution requires a high level of administrative support. It cannot be relegated to each psychologist to write a programme. A written behaviour programme is only one component of long-term treatment. Method: This study describes an intervention for people with intellectual disabilities and pica that included comprehensive management of the environment as well as behaviour treatment over a 9-year period. Results: Over a 9-year period, nine surgeries for pica-related incidents occurred prior to intervention; over the 9 years of intervention, pica surgeries were eliminated. Eighty-five percent of participants experienced a 75-100% reduction in pica. Sixteen participants still had restrictive procedures including oral hygiene, overcorrection, contingent personal restraint, contingent mechanical restraint and visual screening with goggles. All continuous mechanical restraint that had been used in baseline was eliminated. Conclusion: People with intellectual disabilities and dangerous pica can be protected on a long-term basis from serious harm if proper management and clinical interventions are both employed. Although restrictive interventions were used on a long-term basis, they were contingent upon a pica incident or pica attempts, which occurred much lower than in baseline sessions. Resident rights were protected throughout the intervention.