Aggression in Psychiatric High and Intensive Care Wards: A Mixed Methods Study of Incidence and Professionals' Reflections

This mixed methods study investigates aggression in acute psychiatric care, focusing on both incidence and professional reflections across 23 High and Intensive Care wards in the Netherlands. Using a sequential explanatory design, quantitative data on aggressive incidents were collected over 12 months and followed by qualitative focus groups with nurses and team leaders. Aggression, predominantly physical and often targeting staff, was frequently reported, while the cause of incidents was unknown in 31.6% of cases, highlighting the need for improved risk management and early recognition. Despite an emphasis on de-escalation, restrictive measures remained predominant, and emotional consequences for staff, such as humiliation and trauma, were significant. Team culture and management's response to incidents, especially through structured reporting and reflection, were identified as key factors in improving care quality and safety. The findings underscore the importance of fostering a supportive team culture, implementing proactive risk management strategies, and encouraging multidisciplinary collaboration. This study provides practical guidance for clinicians, nurses, and managers in acute psychiatric care, aiming to reduce aggression and enhance both staff and patient well-being. Finally, the results highlight areas where further research is needed, particularly regarding the causes of aggression and the effectiveness of preventive interventions.