No matter the industry, there comes a time when an organization has to deal with mental health concerns and the threat of workplace violence. A growing concern among employers throughout the U.S., violence against workers can happen in or out of the workplace and ranges from threats and verbal abuse to physical altercations.

According to the Occupational Safety and Health Administration (OSHA), more than two million U.S. workers are victims of workplace violence every year. While incidents can arise at any organization some industries, such as healthcare, are at an increased risk.

According to the U.S. Bureau of Labor Statistics (BLS), healthcare workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence in 2018. BLS data also shows that highest rates of injuries caused by workplace violence occur in the healthcare and social service industries which are five times as likely to suffer a workplace violence injury than workers overall.

According to The National Institute for Occupational Safety and Health (NIOSH) there are four types of workplace violence security professionals need to be aware of when thinking about prevention.

• Criminal Intent: A violent incident where a perpetrator has no legitimate relationship to the business, such as robbery or trespassing.
• Customer/Client: The violent person has a legitimate relationship with the business, such as in healthcare. Could be the customer, client, patient, student, etc.
• Worker-on-Worker: The perpetrator is an employee or past employee that attacks or threatens other current or former employees in the workplace.
• Personal Relationship: The violent person doesn’t have a relationship with the organization, but has a personal relationship with the intended victim, who is an employee.

Diana Kaip-Townshend, Captain of Sparrow Health System’s Department of Public Safety (DPS), says workplace violence not only affects employees, it can also have backlash on the organization itself. Kaip-Townshend says employees who are victims of workplace violence use more sick time, which causes staffing challenges and can affect employee morale.

“Workplace violence has a significant impact on employees and organizations as a whole,” Kaip-Townshend says. “Employees who are consistently exposed to workplace violence can burn out easier or are at increased risk for mental health concerns. Working in a violent setting can cause stress, anxiety and even job dissatisfaction and, in time, could lead to quitting and changing careers.”

Jim Sawyer, Security Director at Seattle Children’s Hospital, says when it comes to preventing burnout — especially among healthcare staff — having enough resources is key.

“To avoid burnout, you want to hire enough quality people to maintain support,” he says. “You have to support people because it’s no fun getting spit on and kicked, it’s tough.”

Employee turnover is another monumental obstacle that the healthcare industry faces. According to Sawyer, Seattle Children’s Hospital has about an 80% turnover rate for mental health professionals and burnout plays a big role.

“I would say, without question, the mental health crisis today is the most challenging it has ever been in U.S. history,” Sawyer says. “15 years ago, I would get one suicidal kid coming through our ER every week, now we can get 30 in a night. It is a huge challenge for healthcare, hospitals and staff.”

To help combat turnover, Sawyer says organizations have to find creative ways to hold on to their good workers. At Seattle Children’s Hospital, Sawyer says further education and advanced certifications are promoted for security professionals.

“We want to give them a path toward growth, we’ve had some good success,” Sawyer says. “These initiatives are more important now than ever before."

The role leadership plays

John Rodriguez, Founder of Empathic Security Cultures, LLC and former healthcare security executive, says the number one critical component to workplace violence prevention and a psychologically safe workplace is the degree and quality of trust employees have towards leadership.

“Without leadership’s understanding, involvement and continuous support to create and maintain a security culture, the security professional can do just so much with best efforts and intentions — and have some degree of success,” he says.

Sawyer agrees saying without leadership being on board, the organization will be headed for disaster.

“If you don't have leadership with 100% buy-in, you better pass out some butter and honey, because you’re toast,” he says.

Sawyer continues that in order for leadership to promote a culture of violence prevention or mental health awareness, they need to adopt a philosophy of zero incidents versus zero tolerance.

“Zero tolerance is a nice word. It makes you sound tough, but it is science fiction,” he says. “At hospitals, we have to tolerate a lot because of those we serve. So you need to adopt a zero incidents philosophy, which means having enough resources on hand to ensure the safety of both staff and patients.”

Providing support

 An important aspect of workplace violence prevention and mental health awareness is making sure employees that have experienced or witnessed violence are given the support they need. The type of incident and its severity will drive what support services are needed for involved individuals.

“Having a comprehensive security culture will minimize events from occurring, but they are no guarantee for preventing things from happening,” Rodriguez says. “The culture will drive respect, care, empathy and compassion amongst the workforce over time.”

Another important aspect to consider, Rodriguez says, is the psychological impact bullying and social/psychological threats that occur in the workplace have.

“These may not lead to fatalities or physical injury but can lead to anxiety, fear, depression and other symptoms that affect employees overall physical, emotional and psychological wellbeing,” he says. “And all these impact the profitability of the company via turnover, absenteeism, quality, effort and commitment.”

Another way organizations can support workers is to create an environment that encourages reporting of incidents. Building that culture of trust takes time and the right structure, leadership, consistency, fairness and credibility among the workforce and leadership.

“For so many years, caregivers have underreported workplace violence because they feel it is part of the job,” Kaip-Townshend says. “It is not part of the job, and no one should have to get used to it. That is something that we need to ingrain in our employees and organizations.”

Part of promoting a culture that encourages incident reporting includes adopting a philosophy of strong documentation, Sawyer adds.

"It’s like the Chinese proverb, ‘the faintest ink is better than the best memory,’” Sawyer says. “Strong documentation promotes worker safety, promotes patient safety and will actually promote staff retention.”

While workplace violence and mental health issues remain a concern in healthcare and other industries, with strong leadership, proper support, training and education, organizations can be better prepared to face these challenges.