Caring for patients in behavioral health settings requires a level of clinical nuance, interdisciplinary coordination, and safety infrastructure that sets it apart from nearly every other hospital environment. The patient population is complex, lengths of stay are longer, and the emotional and physical demands on staff are significant. For nursing leaders in these settings, workplace violence isn’t a hypothetical risk. It’s a daily operational reality.
A recent Canopy webinar brought together Jeanne Venella, Senior Director of Clinical Strategy at Canopy and a career emergency nurse, and Patrick Loney, Chief Nursing Officer at UCLA's Resnick Neuropsychiatric Hospital, for a candid conversation about what it takes to build a staff safety program in behavioral health. What emerged was a practical framework built on data, interdisciplinary teamwork, and a commitment to continuous improvement.
Understanding the Distinct Challenges of Behavioral Health
The behavioral health patient population looks fundamentally different from a med-surg or ICU population. Lengths of stay can stretch from days to months. More than half of patients at Resnick are admitted involuntarily. Many arrive after extended stays in the emergency department, sometimes lasting several days, meaning they reach the unit already frustrated, anxious, and in crisis.
"If you come from the ED and you had a three or four day boarding experience, you're at maximum anxiety and frustration," Loney noted. "If we don't explain things well to them and partner with them and make them the center of the conversation, things don't go well."
In this environment, de-escalation isn’t just a skill, but a constant practice. The line between patient experience and staff safety is thinner than in most other clinical settings. For nursing leaders, that means the standard hospital safety protocols can fall short.
The Case for Restraint Reduction
One of the most striking outcomes from UCLA's Resnick Neuropsychiatric Hospital is an 80% reduction in restraints over the past several years, achieved without a corresponding increase in staff or patient injuries.
"We were worried," Loney acknowledged. "If you restrain people less and do all these interventions, would you see an increase in violence? I'm happy to say that in keeping with the literature, you actually see a safer environment and fewer restraints."
The work behind that number is multifaceted. UCLA implemented trauma-informed care principles, expanded de-escalation training, and hired a behavioral analyst whose work with staff on behavioral plans and patient triggers has been, in Loney's words, "dramatic" in its impact on both outcomes and staff burnout.
UCLA also created a program called RAD stories, which stands for Restraint Avoidance and De-escalation. Staff can nominate a colleague who demonstrated a best practice in de-escalating a patient or finding an alternative to restraints. Nominees are recognized in the weekly safety meeting and featured in a newsletter, creating a peer learning loop that reinforces positive behavior rather than focusing on what went wrong. "Every week they get nominated and shared in this meeting, and then we publish a newsletter," Loney explained. "We're learning from each other."
The lesson for behavioral health leaders is that upstream investment in de-escalation and trauma-informed approaches doesn’t increase risk. It reduces it, for both patients and staff.
Building a Safety Infrastructure That Holds
At UCLA, the foundation of their safety program is the Safer U initiative, a system-wide steering group that includes staff from facilities, environmental health and safety, and nursing leadership, with executive sponsorship from the chief nurse executive. Rather than operating as a standalone safety committee, Safer U takes action by using staff-reported concerns and data to prioritize interventions and shepherd through safety initiatives using existing organizational resources.
"It's the convening body that helps take the priorities that staff have come forward with and our data, and helps prioritize the work," Loney explained. "It gives us organizational leverage to get these things done."
That structure translates directly into how safety is managed day to day. Every morning at 9:30, an interdisciplinary safety operations meeting brings together the CMO, CNO, social work leadership, security, environmental services, and unit charge nurses to review the previous 24 hours. Restraints, assaults, patient boarding status, facilities issues, and staff well-being are all on the agenda. When a staff member has been assaulted, the meeting includes a standard check: did a leader reach out to offer support?
"You would hate to have somebody not be supported if there was an event," Loney said.
This real-time quality improvement model means that process changes happen quickly, before the details fade and the window to act closes.
Safety Metrics That Drive Improvement
In behavioral health, the right staff safety metrics are not always the same as those used in other clinical settings. At Resnick, key indicators include assaults on staff, assaults with injury, restraint and seclusion rates, emergency intramuscular medication use, culture of safety survey results, first-year turnover, and missed work days.
"We look very carefully at assaults on staff and assaults on staff with injury as some of our key nurse-sensitive indicators," Loney explained. "But also patient experience results, culture of safety surveys, whether leadership is responsive to needs, whether people feel comfortable reporting, and whether they feel that improvements are made when there are reports."
That last point matters. In behavioral health settings, where underreporting is a persistent challenge, creating a culture where staff trust that reporting leads to real change is foundational to having any meaningful data at all.
Safety Technology as Part of a Larger Workplace Violence Solution
Technology plays a role in UCLA's safety approach as one component of a larger program, not a standalone solution. Any new technology has to fit into that broader approach, not replace it.
When wearable duress buttons were introduced, the staff needed to understand how they connected to the bigger picture of safety. Now, according to Loney, they are strongly embraced.
"It took a minute to get everybody thinking about the mobile duress button, but they really, really like them," noted Loney.
Resnick has been using Canopy Protect as their connected safety platform for more than five years. Canopy Buttons, the wearable duress devices used across the system, are deployed on higher-risk units and in the ED, and a new psychiatric hospital currently under construction will have the technology throughout. Venella described the Canopy Button as "an airbag, it's on you, it's behind your ID badge for when you need it." The value in a behavioral health setting is particularly clear: the ability to call for help discreetly, without alerting an agitated patient or interrupting care, and with colleagues and security simultaneously notified.
For that technology to work, the right people need to be behind it. Beyond the technology itself, Venellla noted: "the collaborative approach between security, operations, and nursing is the most successful. When it's the collaborative interdisciplinary approach, it really unites the teams together on the mission of keeping patients safe and keeping staff safe."
Building a Comprehensive Staff Safety Program
For behavioral health leaders building or rebuilding a safety program, Loney's advice is straightforward: start with the data.
"The data is telling us where we need to focus," he said. "The staff data around engagement surveys, culture of safety surveys, and turnover. Our safety nurse-sensitive indicators. We look at our data and say, what is it telling us? And then we see if our frontline staff agrees."
From there, the work is layered and ongoing. Hiring the right people, building a robust onboarding and residency program, investing in de-escalation training and trauma-informed care, creating real-time feedback loops between leadership and frontline staff, and aligning goals across governance structures so that interventions have organizational leverage rather than existing in silos.
"I look at this as never-ending work," Loney said. "If you don't get that stuff right, you start seeing people not showing up to work, being sick more, or they just soldier on. And I think we're at a crossroads now where we can't just soldier on."
Cultivating Safer Behavioral Health Environments
The safety challenges in behavioral health are complex. But as UCLA's experience demonstrates, they are also addressable through a combination of leadership commitment, interdisciplinary collaboration, data-driven decision-making, and a willingness to listen to the people closest to the problem.
When staff feel supported, when reporting is encouraged rather than feared, and when technology and training work together rather than in isolation, the outcomes follow. Restraints go down. Injuries decrease. Staff stay engaged. And patients receive care from teams that feel equipped to deliver it.
As Loney put it: "If you have better safety, you have better patient experience, and you also have staff who want to stay engaged and work for many years at the same place."
Watch the Webinar Recording
Check out the full webinar recording for further insights into the unique challenges and tactics for building a workplace violence solution in a behavioral health unit.
