Needs of healthcare workers regarding aggression prevention in Flemish high-security forensic psychiatric centers: A qualitative focus group study

Preventing patient aggression toward healthcare workers in forensic psychiatric centers (FPCs) is essential, as incidents of aggression can greatly impact staff well-being and patients’ therapeutic progress. The risk of aggressive behavior is further heightened by the presence of multiple psychiatric disorders, violent criminal histories, and a high risk of recidivism. This study sought to identify the needs of healthcare workers regarding aggression prevention and to link them to practical measures within the current aggression prevention policy. Four focus groups with 26 employees from two high-security FPCs in Flanders highlighted the importance of self-confidence in detecting, preventing, and responding to aggression. This self-confidence was found to be not solely an individual competency but appears to be shaped in part by relational security, team climate, and organizational support. A supportive work environment in which uncertainties, feelings of safety, and support needs can be openly discussed, is therefore essential. Practical recommendations were formulated according to three prevention levels, addressing policy deficiencies and better aligning prevention strategies with the operational needs of employees.