Health systems are grappling with a troubling reality: In 2023, the total cost of violence to hospitals was estimated at $18.27 billion, including the cost of treatment for victims, security staffing and violence prevention training — and not accounting for the long-term effects violence can have on an already strained workforce.
To combat this challenge, particularly in emergency departments and inpatient psychiatric units, Roanoke, Va.-based Carilion Clinic launched a behavioral health security specialist pilot in January 2025 with six specialists at its Roanoke facility. The system expanded the program to its New River Valley facility in April 2025, placing five specialists at the hospital, Lisa Dishner, DNP, RN, senior director of nursing for the department of psychiatric and behavioral health medicine, told Becker’s.
In Roanoke, staff injuries fell by 70%, police and security calls dropped 80%, and workers’ compensation payments declined 69%, generating $2,800 in savings. The Christiansburg, Va.-based New River Valley facility saw a 90% reduction in staff injuries, a 62% drop in police and security calls and a 96% decrease in workers’ comp payments, saving $8,770.
“These kinds of [roles] can demonstrate that there’s a meaningful change and an ability to manage a lot of the present difficulties that the health system is facing,” Robert Trestman, MD, PhD, professor and chair of the Carilion Clinic and Virginia Tech Carilion School of Medicine Department of Psychiatry and Behavioral Medicine, told Becker’s.
The security specialist role sits in a purposeful middle ground. These specialists are non-sworn security personnel who do not carry firearms and are not trained as police officers, he said. Unlike traditional security officers, however, they are embedded directly into the treatment team, spending roughly 80% of their time on the inpatient mental health unit.
Specialists complete Crisis Prevention Institute training through Carilion Clinic, Crisis Intervention Team training through the police academy and unit-based orientation alongside mental health clinicians. Total training time is about 80 hours, according to police captains. Some specialists previously worked as psychiatric technicians before transitioning into the role, according to Dr. Dishner.
Crucially, they do not look the part of security. Specialists wear polo shirts and are positioned as part of the care environment rather than an enforcement presence, Dr. Trestman said. The role focuses on de-escalation as a primary tool, with training in verbal techniques and relationship building.
“While they are trained in safety and physical protection, they do not immediately turn to that as the treatment of first choice; rather, they see themselves as part of the treatment team to keep a safe environment for everyone,” he said.
The program’s success is not simply about adding a new job title. How the role is defined, how candidates are selected and how specialists are trained and integrated into care teams are all critical variables, Dr. Trestman said.
The results show up not just in injury and call data, but in individual patient outcomes.
One case captures the model in action: A complex pediatric patient who had a history of rapidly escalating and requiring physical restraints. During one escalating event, the behavioral specialist — already present in the unit — worked alongside staff to de-escalate the situation by speaking with the child. Restraints were avoided entirely, and the patient ultimately was transferred to residential treatment.
“The team, through their relationship building and time on the unit, has been able to quickly intervene with verbal escalations to prevent further escalation requiring restraints,” Dr. Dishner said.
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