Nicholas Williams began to panic when his construction equipment malfunctioned.
He was 65 feet off the ground, and less than two months into the new job, when he became stuck in a lift basket.
When another lift basket rose up to rescue him, Williams had no choice but to jump into the other functioning piece of equipment. The incident was so traumatizing, he began seeing a therapist for anxiety shortly after.
Williams has worked in the construction industry for more than a decade now. In the years following the lift incident, heavy objects have fallen on him, and he’s been in emergency rooms with colleagues who survived dangerous accidents. He has consoled family members whose loved ones were injured on the job and has conducted post-incident inspections and interviews after construction-related accidents.
“What we do is dangerous work, and if you don’t have the right amount of support and resources at your fingertips, the anxiety about how dangerous what we do is could be overwhelming,” he said. “Making sure that people have access to resources to make sure that they’re able to talk about those things is huge.”
But there aren’t many spaces where construction workers can safely speak about the anxiety that develops from the unique challenges on the job, and mental health experts say that’s one reason why suicide rates among construction workers are so high. Now they’re working doggedly to develop formal ways to address the problem.
“You’re looking at a proud group of people who pride themselves on the work they do,” said Dan Lester, director of field diversity, inclusion and culture for Clayco, a real estate, architecture, engineering, design-build and construction firm, who attended the summit. “But it’s a culture that is not used to sharing feelings and talking about issues in a male-dominated industry. But we’re now realizing that that might not be the best way to do it.”
The construction industry has the highest suicide rate when compared to any other industry, with 53 suicides per 100,000 workers, according to the Centers for Disease Control and Prevention. That means deaths by suicide are five times higher than all construction-related deaths combined, according to the CDC. A 2020 study found 83% of construction workers had experienced a mental health issue.
Many construction industry professionals turn to drugs and alcohol to cope with stress and chronic physical pain while working long hours in a dangerous and fast-paced job. Construction employees use substances at nearly twice the rate of the national average, and are among the most adversely affected by the opioid crisis, since so many are prescribed opiates for pain. Almost 3 in 4 injured construction workers were prescribed a painkiller in 2016, according to CNA Financial, and just over 1% of construction workers have an opioid use disorder, almost twice the national average, according to the National Safety Council.
The problem has become so prevalent that a Colorado-based psychologist, Sally Spencer-Thomas, convened a conference in Denver in late May, that drew hundreds of leaders from the construction and health care industries to bring attention to the issue, discuss root causes, examine lessons learned and develop possible ways to help prevent suicides and other mental health problems in the industry.
Dan Carlin, founder and CEO of JobSiteCare, which cares for injured workers, and Cal Beyer, vice president of Workforce Risk & Worker Mental Wellbeing for Holmes Murphy & Associates, an insurance brokerage company, helped shape the agenda and recruited many sponsors and attendees.
“The reason why the conference needed to happen was because there has been a lot of really important local activity and innovative approaches but they weren’t all connected,” said Spencer-Thomas, who lost her brother to suicide in 2004. “People didn’t necessarily know what the other was doing, and when you look at social movements and how they evolve, at some point everybody gets connected, and they get organized, and the power is so much greater.”
Many construction workers were relieved to talk about the issue at such a large scale, yet many were disappointed that the topic was not widely recognized until just a few years ago.
During the conference in May, construction workers and managers cited a long list of factors that are contributing to the mental health crisis in construction including: low morale, tight deadlines, job insecurity and constant displacement from rotating assignments.
The “pull yourself up by your bootstraps” mentality, and the bullying that sometimes occurs when construction workers reach out for help, are also leading to the stigma on mental illness in the industry. Caregiving requirements, rising inflation, social unrest, and other issues outside the workplace can compound stressors on the construction site, which can lead to unsafe working conditions, they also said.
When Lester was a freshman in college, he was struggling academically, under pressure from participating in football and experiencing racism in the community. The issues piled up, and even though he was already trained in suicide prevention and had helped others who were suicidal, he found himself “spiraling” and seriously considering suicide in a dark room that year.
But suddenly, his phone rang, and the sound broke the silence. It was a friend, who had called to check on him that day.
“He asked me to come out,” Lester said. “I didn’t tell him what was going on. But he picked up the phone because he thought about me, and I’m so glad that he did. When I share my story, my challenge to those folks who I share it with is, ‘Hey, will you be the one that makes the call or sends the text message?”’
“There’s still not many people who know how bad this is — even in the industry … because part of this process is feeling alone, feeling alienated, feeling like nobody else struggles with it,” he said, after the conference. “If we realize that the majority of people are struggling with something, somewhere, there should be a way for us to normalize those conversations.”
There is more conversation about substance use in the construction industry, because of drug testing requirements by construction jobs, but not the same level of attention placed on other mental health issues, said Sean Villard, division safety manager at Swinerton, a construction company in Arvada.
Some participants in the two-day summit emerged with resolve to train construction industry supervisors and elevate their personal stories to show vulnerability and increase the likelihood of others reaching out for help. There will be a focus on increasing conversations about mental wellness, such as by discussing these issues during construction safety week or at ribbon cutting ceremonies, to establish an overall “culture of care.” Construction workers who have adequate training or feel comfortable discussing mental health discussions could wear colored stickers or other cues to indicate that they’re someone safe to approach if a colleague is in need.
Summit attendees are also calling for better access to qualified care, a move away from awareness to action and new policies that reflect the actual needs of the industry, including a focus on mental health emergencies and what steps should commence after a mental health-related incident.
Local advocates are calling for more programs like Heritage CARES, which offers a virtual support program for those struggling with substance use disorders, stress, suicidal ideation and other mental health concerns.
Construction workers are often advised to call their company’s employee assistance program for mental health help. But getting an appointment can be difficult and so usage rates for such programs are at 0.5% to 1%, according to Michael Gifford, president and CEO of Associated General Contractors of Colorado. Heritage CARES’ program, similar to the employee assistance program, has a utilization rate of 10%, he said.
Summit attendees suggest that skill building should start early on, in school, or early on in a construction worker’s career and that there should be more mental health resources for Spanish-speaking employees. Supporting the mental health of construction workers’ loved ones, and identifying how mental and emotional wellbeing are linked to workforce shortage concerns could help make the case when pitching new programs as possible solutions, summit attendees said.
Several people interviewed for this story said the need to focus on “psychological safety,” a shared feeling that workers can be honest about their struggles and that managers will support them, is crucial to reducing the high rates of suicide. Psychological safety has gained traction in recent years, Lester said, but not in the construction industry.
“You can have all the tools and resources available to employees whether it’s your employee assistance plan or telemedicine or counseling,” said Saralyn Crock, area vice president of Gallagher Benefit Services, which offers insurance, risk management and consulting services. “If the environment does not provide safety, psychologically, for an employee to be able to reach out then all the tools and the resources are somewhat all for naught.”
There may be a long road ahead for industry professionals and their allies, but construction workers, like TJ Lyons, said they’re relieved to have seen progress in recent years. The Occupational Safety and Health Administration is now using its own website to distribute information about suicide and other mental health concerns in the construction industry. And larger general contractors now have wellness coaches and mental health counselors on some sites, he said.
Lyons, a safety manager based in New York, lost his good friend to suicide four years ago. Just before his death, his friend was living in a remote part of Japan, drinking heavily and working as a project manager on a high-pressure $80 million construction project.
“In retrospect, it’s so much easier to figure out those little indicators, and that’s really one of the things that we need to get in this field: to be able to recognize those indicators before it gets to a death,” said Lyons, who attended the summit last month.
After his friend died, Lyons began researching suicide and its effects on people in the construction industry. Since then, he’s written articles and has led presentations to educate others about the issue. During a recent presentation, Lyons added a slide about suicide and how it affects construction workers, as he always does. A leader at an electrical company asked Lyons to skip the slide, because a colleague had died recently by suicide and emotions were still high.
Lyons said he understood the concern, but that he would not gloss over it, because more attention and communication are needed to make major advancements to help reduce the prevalence of mental health issues in the construction industry.