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Part 1: The Evolving Ransomware Threat Landscape

  • Davy J
  • Mar 19
  • 7 min read

Updated: Apr 5

The behavioral health sector is facing a rapidly escalating threat from ransomware attacks. In recent years, cybercriminals have increasingly targeted healthcare and behavioral health organizations, knowing that these entities hold extremely sensitive patient data and often have limited cybersecurity defenses. For behavioral health providers—from small clinics to large networks—the impact of a ransomware incident can be devastating, disrupting care delivery and compromising patient trust.


Ransomware’s Impact on Behavioral Health 


Ransomware is a form of malware that encrypts an organization’s data and demands a payment (ransom) for the decryption key. In healthcare, ransomware incidents have surged by 32% in the last year alone, making healthcare the third most-targeted industry globally (Ransomware Infographic: Alarming Rise in Healthcare Attacks). Behavioral health providers are very much part of this trend. Attackers are drawn to the wealth of confidential psychotherapy notes, treatment records, and personal information that behavioral health organizations maintain. A single attack can freeze access to critical patient information, forcing providers to cancel appointments or revert to paper records—directly impacting clinical outcomes and safety. For example; in late 2023, a threat group claimed to have stolen 72 GB of data from Greater Cincinnati Behavioral Health Services (Ransomware Groups Attack 3 Healthcare Providers) – underscoring that no behavioral health provider is off-limits.


Rising Frequency and Costs


The numbers paint a stark picture of the growing threat. The U.S. Department of Health and Human Services (HHS) reports a 93% increase in large healthcare breaches overall from 2018 to 2022 – including a 278% spike in ransomware-related breaches (Coordinated Privacy and Security Partnerships in Healthcare Cyber). Ransomware now accounts for roughly one-quarter of all reported data breaches (Verizon 2023 Data Breach Investigations Report: 74% of breaches involve human element - Help Net Security). The cost of these attacks is rising as well: the average ransomware incident in healthcare leads to over 17 days of downtime (Ransomware attacks cost healthcare $21.9B in downtime), crippling operations. In a recent extreme case, a major healthcare payment network attack disrupted service for one-third of Americans (Infographic: 5 Fast Facts On Healthcare Ransomware Attacks | HealthLeaders Media), highlighting how widespread the fallout can be. Beyond the operational disruption, data breaches can carry hefty financial penalties and recovery costs. A 2023 industry report found the median cost per ransomware breach has more than doubled in two years, with losses ranging from $1 to $2.25 million (Verizon 2023 Data Breach Investigations Report: 74% of breaches involve human element - Help Net Security). In behavioral health, where margins are often thin, such costs and prolonged downtime can be catastrophic. Notably, paying the ransom is no guarantee of recovery – on average, healthcare organizations that paid only restored about 65% of their data (Ransomware Statistics, Data, Trends, and Facts [updated 2024]). This underlines the importance of strong backups and recovery capabilities.



Infographic on healthcare ransomware: 5 facts with illustrations of locks, computers, and charts. Text mentions data loss and response tips.
Figure: Five fast facts illustrate the scope of ransomware in healthcare. For example, healthcare organizations saw 50% more ransomware encryption events than the global average in 2023, and on average lose 20% of their sensitive data in each attack. Such statistics underscore what’s at stake for patient privacy and safety.

Key Vulnerabilities in Behavioral Health 


Why are behavioral health providers at risk? For one, many behavioral health clinics are small to mid-sized organizations operating under tight budgets with lean IT support (Do These 5 Things to Enhance Cybersecurity in Behavioral Health – Xpio Health). Limited resources often mean fewer security measures. Common vulnerabilities include:


  • Unpatched Systems & Software: Outdated software is a known weak point—hackers often exploit old, unpatched vulnerabilities. (Recall the WannaCry attack of 2017, which spread through unpatched Windows systems; organizations that kept up with updates were spared (Do These 5 Things to Enhance Cybersecurity in Behavioral Health – Xpio Health).)


  • Phishing and Human Error: Cybercriminals frequently gain entry through staff mistakes, like clicking malicious email links or attachments. The “human element” is a factor in 74% of breaches (Verizon 2023 Data Breach Investigations Report: 74% of breaches involve human element - Help Net Security). Busy clinicians and staff may not spot a sophisticated phishing email, especially without regular training and alerts.


  • Weak Authentication: Many providers still rely on simple single-factor logins. Without multi-factor authentication (MFA), a stolen or guessed password can give attackers free rein in your network.


  • Third-Party Vendors: Behavioral health agencies rely on electronic health record (EHR) systems, billing software, and other third-party services. A security breach at any connected vendor (for example, an EHR provider or billing company) can cascade down to your organization if connections aren’t secured and monitored.


  • Sensitive Data as Leverage: Behavioral health records (clinical notes, therapy notes, psychiatric evaluations, etc.) are among the most sensitive in healthcare. Attackers know organizations might be willing to pay ransom to prevent public exposure of such private information. This “double extortion” tactic—stealing data before encrypting systems and threatening to leak it—has hit behavioral health particularly hard. One international example is the 2020 Vastaamo breach in Finland, where hackers dumped thousands of psychotherapy records when the clinic refused to pay (Vastaamo data breach - Wikipedia).


Executive Recommendations: Immediate Risk Mitigation


The evolving threat landscape demands prompt action, especially from executives and decision-makers in behavioral health. Here are five high-impact steps leaders should verify right now:


  1. Back Up Critical Data Offsite – Maintain encrypted backups of patient records and critical files, stored securely offline or in the cloud (isolated from your main network). Regularly test your ability to restore these backups. This ensures you can recover data quickly without having to pay a ransom.

  2. Enable Multi-Factor Authentication (MFA) – Require MFA for email accounts, EHR systems, remote logins, and any application containing patient data. Even if an employee’s password is stolen via phishing, MFA can block the attacker from accessing the account (Do These 5 Things to Enhance Cybersecurity in Behavioral Health – Xpio Health).

  3. Update and Patch Systems – Apply all security updates for your operating systems, EHR software, and devices. Automate updates wherever feasible and keep an inventory of systems to ensure none are overlooked. Many attacks exploit known flaws that patches fix (Do These 5 Things to Enhance Cybersecurity in Behavioral Health – Xpio Health). An hour spent updating now can thwart a disaster later.

  4. Educate Your Workforce – Train and remind staff about phishing scams and cybersecurity best practices. Make sure everyone knows how to spot suspicious emails and how to report them. An informed team is your first line of defense. In one case, a vigilant employee’s awareness saved a behavioral health agency from a costly ransomware attack (Do These 5 Things to Enhance Cybersecurity in Behavioral Health – Xpio Health).

  5. Conduct a Security Risk Assessment – Request an up-to-date cybersecurity risk report for your organization. Identify top vulnerabilities (if you haven’t formally assessed risks this year, now is the time (Ransomware Attack on Maryland Psychotherapy Provider Results in HIPAA Penalty)) and prioritize fixing them. Not only is this a best practice, it’s also a HIPAA requirement – failing to do so can lead to fines if a breach occurs (as one behavioral health clinic learned the hard way after an OCR investigation) (Ransomware Attack on Maryland Psychotherapy Provider Results in HIPAA Penalty).


By taking these steps, behavioral health organizations can significantly reduce the likelihood and impact of ransomware attacks. In an environment where threats evolve constantly, leadership commitment to these basics sets the tone for a more secure operation.


A Note to Leaders – Security as a Strategic Priority


Ransomware is not just an IT problem; it’s an enterprise risk that affects clinical outcomes, financial stability, and organizational reputation. Behavioral health executives should treat cybersecurity as a strategic priority. That means asking tough questions (“Are we prepared for a cyber incident? When did we last test our backups and response plan?”) and fostering a culture of accountability and cyber awareness at all levels. Also, keep in mind that a ransomware attack involving patient information will trigger breach notification requirements under HIPAA and state laws – executives must be prepared to communicate quickly and transparently with patients, regulators, and the public. Having a well-rehearsed incident response and communication plan is as important as the technical measures. While cyber insurance can help with financial losses, it may only cover a portion of the damages (Ransomware Statistics, Data, Trends, and Facts [updated 2024]) and cannot restore lost trust. Prevention and preparedness are far better investments.

Each of the subsequent parts of this series will delve deeper into building cyber resilience—from real-world incidents to best practices and team empowerment. Stay proactive and informed.


To continue learning how to protect your organization, subscribe to our newsletter for ongoing insights on emerging threats. If you’re unsure about your clinic’s ransomware readiness, consider booking a consultation for cybersecurity assessment. You can also download our free Ransomware Readiness Checklist to start evaluating your defenses today. Protect your behavioral health practice now—before the next attack strikes.





References




“Verizon 2023 Data Breach Investigations Report: 74% of Breaches Involve Human Element.” Help Net Security, https://www.helpnetsecurity.com/2023/06/06/verizon-data-breach-investigations-report-2023-dbir/#:~:text=This%20rise%20in%20cost%20coincides,of%20the%20top%20cyberattack%20methods. Accessed 17 Mar. 2025.


“Ransomware Attacks Cost Healthcare $21.9B in Downtime.” Becker’s Hospital Review, https://www.beckershospitalreview.com/cybersecurity/ransomware-costs-healthcare-21-9b-in-downtime.html#:~:text=,at%2027%20days%20in%202022. Accessed 17 Mar. 2025.



“Ransomware Statistics, Data, Trends, and Facts [updated 2024].” Varonis, https://www.varonis.com/blog/ransomware-statistics#:~:text=22,%28HHS. Accessed 17 Mar. 2025.




“Ransomware Attack on Maryland Psychotherapy Provider Results in HIPAA Penalty.” HIPAA Journal, https://www.hipaajournal.com/green-ridge-behavioral-health-hipaa-penalty/#:~:text=In%20December%202019%2C%20OCR%20initiated,308%28a%29%28I%29%28ii%29%28B. Accessed 17 Mar. 2025.





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