Sarah steps into her client’s apartment for a routine check-in, but something feels off. The client is unusually agitated, pacing and muttering under his breath. A door slams down the hallway, and the energy in the room shifts. Alone inside the home, Sarah feels a knot of instinct tighten - a signal that the situation could escalate quickly. In moments like this, she wishes someone knew exactly where she was and could respond if things went wrong.
This scenario plays out thousands of times each day across behavioral health programs in North America. Workers dedicated to helping others navigate mental health challenges, substance use recovery, and crisis situations often find themselves in unpredictable environments with limited backup support. When these professionals don’t feel adequately protected, the consequences extend far beyond individual discomfort.
The Reality of Working Alone in Behavioral Health
Behavioral health professionals routinely work in isolation, whether conducting home visits, responding to crisis calls, or meeting clients in community settings. Unlike hospital-based healthcare workers who have colleagues nearby, these professionals often spend their days moving between appointments with minimal direct supervision or immediate support.
The nature of their work adds complexity. Clients may be experiencing acute mental health episodes, dealing with substance withdrawal, or facing housing instability that creates volatile situations. Case managers, social workers, and counselors must navigate these challenges while building trust and providing effective interventions.
Many behavioral health workers describe feeling particularly vulnerable during evening or weekend shifts, when staffing levels are reduced and response times for emergency services may be longer. The combination of working alone and engaging with clients in crisis creates safety concerns that weigh heavily on staff morale.
The Numbers Behind the Exodus
Turnover rates in behavioral health regularly exceed those of most healthcare sectors. Published analyses place annual turnover between 30% and 60% [1]. National data show average turnover at 27.5% in 2023 [2].
Violence and threats are also far more common in behavioral health and social services. Surveys indicate that roughly 40% of healthcare workers experienced a violent incident within a two-year period [3], and 73% of all non-fatal workplace violence injuries in the United States occur in healthcare and social services [4].
Research links safety concerns to turnover outcomes, showing that workers who feel exposed to violence or threats report significantly higher turnover intentions [5].
Further, replacing staff is expensive. HR analyses demonstrate that turnover costs typically equal 6 to 9 months of salary for each departing employee [6], which for behavioral health positions often translates to between $15,000 - 25,000 per worker. Using this range, a program with 50 staff and 50% turnover would incur more than $400,000 in replacement costs annually.
Beyond finances, turnover disrupts therapeutic relationships, strains remaining staff, and forces clients to repeatedly restart care with new providers.
When Safety Fears Become Operational Problems
Safety concerns trigger operational disruptions far beyond turnover statistics. Staff who feel unsafe routinely experience higher stress, elevated burnout, and reduced productivity. Studies show a measurable correlation between unsafe work environments and increased turnover intentions among health workers [5].
When workers avoid evening shifts or high-risk home visits because they feel unsafe, programs face the choice of leaving clients underserved or placing heavier burdens on remaining staff. This intensifies burnout and accelerates further turnover.
Safety incidents also create liability exposure. Workers’ compensation claims and regulatory scrutiny can impose significant financial stress on health and social service organizations [7].
The Ripple Effect on Program Quality
High turnover undermines program quality. Behavioral health interventions depend on consistency and relationship-building. When staff leave frequently, clients lose stability and must restart care with new providers.
New hires rarely perform at full effectiveness immediately. It often takes several months for staff to learn organizational procedures, local resources, and client histories. During this period, service quality often decreases.
Research shows programs with stable staffing achieve better client engagement, more consistent outcomes, and reduced hospitalization rates [1]. When safety concerns drive turnover, programs lose the institutional knowledge required for high-quality behavioral health care.
Building Safety into Daily Operations
Improving safety requires both strategy and consistency. Modern safety tools give organizations the ability to support workers without creating an administrative burden.
Examples include:
Staff adoption increases when these tools integrate smoothly into existing workflows and genuinely make field and community work safer.
Creating a Culture Where Safety Enables Success
Technology only works if workers trust the system behind it. Strong safety cultures consistently include:
Programs that succeed in reducing turnover often have leadership teams that visibly prioritize safety as a core value.
Measuring the Return on Safety Investment
Safety investment produces quantifiable returns. Reduced turnover alone generates substantial savings. Beyond money, safer environments improve morale, productivity, retention, and overall service quality.
Organizations that develop a reputation for protecting staff often recruit more effectively. In today’s labor market, reputation is a competitive advantage.
Moving Forward With Purpose
The connection between safety and retention in behavioral health is clear. Agencies that invest in protecting workers maintain stronger teams, deliver better services, and fulfill their missions more effectively.
Workers like Sarah deserve support as they help vulnerable individuals navigate complex challenges. When organizations prioritize safety, staff feel valued, clients receive consistent care, and programs thrive.
Sources
[1] National Wraparound Initiative. Addressing the Behavioral Health Workforce Crisis. Portland State University.
https://nwi.pdx.edu/pdf/addressing-the-behavioral-health-workforce-crisis.pdf
[2] Open Minds. 2023 Turnover at Behavioral Health Facilities Decreases to 27.5 Percent.
https://openminds.com/market-intelligence/news/2023-turnover-at-behavioral-health-facilities-decreases-to-27-5
[3] Institute for Healthcare Improvement. Addressing Workplace Violence Starts With Better Data.
https://www.ihi.org/library/blog/addressing-workplace-violence-starts-data
[4] UNC Sheps Center. Workplace Violence in the Healthcare Sector Issue Brief.
https://www.shepscenter.unc.edu/wp-content/uploads/2025/01/Y10.01_Brief.pdf
[5] Frontiers in Public Health. Negative Behaviors and Turnover Intention Among Health Workers.
https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1493964/full
[6] Workable. The Cost of Replacing an Employee.
https://resources.workable.com/stories-and-insights/the-cost-of-replacing-an-employee
[7] American Hospital Association. The Burden of Violence to U.S. Hospitals and Health Systems.
https://www.aha.org/system/files/media/file/2025/05/The-Burden-of-Violence-to-US-Hospitals.pdf