As healthcare organizations continue grappling with workplace violence, staffing shortages and burnout across behavioral health settings, leaders are increasingly focused on creating safer environments for both patients and caregivers.
Sarah Hollins, director of behavioral health services at WVU Medicine Camden Clark Medical Center in Parkersburg, W.Va., recently joined the upcoming “Becker’s Behavioral Health Podcast” to discuss how her frontline experience has shaped her leadership approach, what health systems still get wrong about workplace violence prevention and the strategies that have helped support and retain staff.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: You’ve built your career from frontline crisis services to leading behavioral health programs. How has that shaped the way you approach leadership today, especially around staff support and patient safety?
Sarah Hollins: Coming up through frontline crisis work has really shaped everything about how I lead. I’ve been in situations where staffing has been tight, acuity has been high and decisions have to be made quickly. So I don’t lead from a distance. I attempt to stay grounded in what the work actually feels like day-to-day.
When it comes to supporting staff, I focus on creating an environment where people feel both safe and set up to succeed. That means having realistic staffing plans, clear expectations and being visible and available to my team. If something isn’t working, I want to hear about it early and fix it quickly.
I also try to prioritize practical support by giving ongoing training and making sure staff have a voice in process changes. Retention and engagement come from people feeling heard and supported, not just managed.
On the patient safety side, my approach is very proactive and systems-focused. Frontline experience has taught me that most safety issues aren’t about individual failure, but gaps in processes, communication or environment. I try to look for patterns, not just isolated events, and push for standardization where it reduces risk while still allowing clinical judgment from frontline staff.
It’s also made me very focused on culture. In behavioral healthcare, safety is directly tied to how supported and prepared staff feel. You’ll often see me directly helping with patients and supporting my staff, including during codes and restraints. When teams trust their leadership and each other, they communicate better, respond earlier and prevent patient escalation.
Q: You’ve spent years focused on de-escalation and workplace violence prevention. What do you see changing right now, and where do you think organizations and health systems are still underprepared?
SH: Organizations are finally recognizing that workplace violence in healthcare, especially in behavioral health, is not just part of the job. There’s a much bigger focus on proactive prevention, staff training, environmental safety and building systems that support early intervention before situations escalate.
I’m also seeing a shift toward more data-driven approaches. Here at WVU Medicine, we have a workplace violence team at both the system and hospital level. Teams are looking more closely at patterns around incidents, triggers, staffing levels, patient acuity and response times instead of treating violent events like isolated occurrences.
Where I still think many organizations are underprepared is implementing all of that consistently. A lot of places have policies, but not all of them have a culture where staff truly feel supported reporting concerns or escalating safety issues in real time.
There’s also still a gap between training and practice. Annual de-escalation modules alone are not enough for high-acuity behavioral health environments. Staff need ongoing, hands-on training, interdisciplinary coordination and leaders who are actively involved in safety efforts, not just reviewing reports afterward.
Organizations also sometimes underestimate the impact repeated exposure to violence has on staff retention, morale and burnout. If employees don’t feel physically and psychologically safe where they work, it affects everything from engagement to patient experience and turnover.
Organizations doing this well are treating workplace violence prevention as part of their operational strategy and culture change, not just a regulatory requirement.
Q: What strategies have worked for retaining and supporting behavioral health staff?
SH: Retention really isn’t driven by one big initiative. It’s the cumulative effect of getting the day-to-day experience right for staff.
First, staffing and workload have to be realistic. You can’t retain people if they feel set up to fail every shift. We try to focus on aligning staffing models that look at acuity and volume, not just budget targets. Many members of my team are cross-trained to help alleviate with any shortages that may arise.
Frontline support from leadership also matters. I try to make it a priority to be visible, accessible and responsive to my staff when they raise concerns, whether that’s safety, workflow or morale.
We also try to invest heavily in ongoing development. We have several trainings every year on suicide prevention, and we’ve partnered with our local community-based mental health agency to provide stigma-reduction education across the organization. Many nurses in my unit have their certification in psychiatric nursing which ties in to that clinical ladder that we have here within our system.
Another big help is giving staff a voice in how the work gets done. The best ideas for improving flow, safety and patient experience almost always come from frontline staff. When they see their input turn into real change, engagement goes up.
From a well-being standpoint, I focus on practical supports, rather than just messaging things like using [paid time off] holiday time, creating debriefs after high-acuity events for units within our organization and normalizing the use of resources without stigma,
Behavioral health is a tough environment, and I think people understand that. But they want honesty about what’s being done to improve things.
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
