Background: Staff working on psychiatric intensive care units (PICUs) are routinely exposed to aggression or threats of aggression from the patients they care for. This phenomenon is identified as an ongoing factor that influences both work performance as well as staff sickness, and as such requires understanding and management.

Aims & method: This study utilized questionnaires assessing the extent to which PICU staff thought violence was a problem and how safe and supported they felt. Semi-structured interviews were conducted with five nurses to gather in-depth information on the factors involved in perceptions of safety and support.

Results: The analysis indicated that as a whole, staff feel safe and supported by their immediate team. Interview analysis produced two main domains and ten sub-domains of experiences that contribute to managing threats, these being grouped in either personal or systemic factors. It particularly highlighted that although patient aggression is a concern, the perception of threat most directly relates to beliefs about a lack of support from other teams and senior management, not the patients themselves.

Conclusions: More research and attention is needed on systemic factors in the management of threatening patients.