Being able to do activities is an inherent human need and essential to health and well-being. This chapter relates this need to the altered experience of activity participation for people who are patients within a psychiatric intensive care unit (PICU). It explains the negative impact of impaired functioning, occupational deprivation and boredom and the converse positive effect of adequate meaningful activity provision for patients, staff and the service as a whole. It discusses how engaging patients in activity can prevent, reduce and help to manage violence and aggression. This is balanced by a discussion of how enabling positive engagement through use of activity requires careful assessment, which includes considering the environment, different aspects of functioning such as sensory processing and the risks associated with the activities described herein. The chapter provides information on a wide range of activities for individual and group-based programmes, including enabling activity participation in seclusion and using sensory interventions.

Virtually all societies have found the need for containment and control of behaviour by physical means. The first words in any discussion about restraint must include the methods of avoiding the need for its use wherever possible. De-escalation, negotiation, meaningful activity programmes and the development of trusting relationships are the necessary first steps. This chapter focuses on the activity of restraint, assuming that due attention has already been paid to the methods of avoiding the need for its use.