A Blueprint for Preventing Suicides in Construction

None of the men died on the job, but the suicides left the commercial roofing company’s president and co-owner, Christee Holbrook, hyperaware that in the construction industry, “If you stay in business long enough, it will happen to you.”

In fact, men working in construction die by suicide at four times the rate of the general population, and since the Centers for Disease Control and Prevention started comparing suicide rates by industry in 2016, construction has consistently ranked No. 1 or No. 2.

More construction workers die by suicide each year than by falls or electrocutions, or being struck by or caught in objects on the worksite—the Occupational Health and Safety Administration’s “focus four”—combined.

Yet when one of Holbrook’s suicidal employees “started showing signs of mental illness and started just falling apart before our eyes … we didn’t know what it was at the time,” she said. “I thought he was just going through a divorce.”

Although suicide is not a new problem for the construction industry, mental health and safety experts have noted that the field is dominated by male employees, who traditionally have been reluctant to talk about mental health and other problems that can lead to suicide.

With approximately 5,000 suicides among construction workers reported every year, mental health professionals and some industry executives like Holbrook have begun to embrace the notion that workplaces need to be proactive in preventing mental-health-related deaths among their employees. To do that, those experts advise, construction firms should count suicide and mental health as workplace safety issues and make awareness and prevention as much a part of training and discussions as jobsite hazards like electrocutions and falls.

“We came to believe that the workplace is the most cross-cutting system for suicide,” said psychologist Sally Spencer-Thomas, a leader of Construction Working Minds, a group that focuses on suicide prevention, mental health awareness and addiction recovery. “Most (construction workers) are out of the education system and are not in the health-care system, but they’re working. That seems like the most important gap to fill.”

Cal Beyer, vice president of workforce risk and worker well-being for insurance brokerage Holmes Murphy, which counts construction as a specialty, has proposed a three-tier approach to filling that gap: “The companies that are addressing this are acknowledging there is a problem; taking time to understand it; then doing something about it.”

Industrywide, many trade associations, unions, construction firms, nonprofits, mental health providers and government agencies are offering training, materials and campaigns—like Construction Suicide Prevention Week from Sept. 4-8, when construction firms are asked to “stand down” for 15 to 20 minutes each day to talk about suicide prevention.

Like others involved in raising awareness about suicide prevention, Holbrook incorporates that message in toolbox talks year-round. She also occasionally interrupts the workday with offers of stress-reducing perks like on-site massages; actively advertises the mental health services that her company’s health insurance provider covers; and makes it her business to notice when an employee seems down or whose behavior has changed.

“I did a lot of crying” after the suicides among her employees, recalled Holbrook, who also is the safety committee chair for Associated Builders and Contractors Mississippi. “That was then. My goal (now) is to figure out what we can do to help going forward, how we can be prepared.”

While the media are quick to publicize the number of construction industry suicides when the government issues statistics pointing to the scope of the problem, much more is needed to quell the number of deaths each year. This report from ConstructioNext offers comprehensive information on mitigating suicide risk among construction workers, with the hope of saving lives.

Following are four detailed steps, along with resources and tips, that mental health professionals and construction industry leaders have identified as important in the effort to prevent suicides among construction employees.

Step 1. Acknowledge the problem

Spencer-Thomas, whose only brother died by suicide in 2004, said construction workers regularly tell her that their mental health issues and thoughts of suicide coincide with feelings of overwhelming stress.

“Construction is a very unique industry” that requires employees to work long shifts and sometimes to travel to jobsites where they may not have easy access to their regular doctors or the company of their family and friends, said Samantha Melchor-Frost of HealthSource Solutions in Columbus, Ohio. Melchor-Frost, an exercise physiologist and wellness program manager for a number of large construction firms, noted that contractors also regularly lose their income when a job wraps up or the seasons change. Plus, she said, their jobs are physically demanding and they suffer frequent injuries.

Those injuries can lead to alcohol use and the abuse of painkillers, added homebuilder Brandon Bryant, who recalled a trade partner who got into a skateboarding accident that landed him in the hospital one weekend. Still, he reported for work the next day—aided by painkillers, to which he became addicted. He eventually lost his job.

“Alcohol and drugs are still the elephant in the room,” noted Beyer, a former risk management director for a Washington-based paving contractor. A prevailing attitude on some jobsites, Beyer said, is, “I don’t care about what you do on your personal time as long as you show up for work.”

But he added that drug use leads to sleep deprivation and lack of focus, and pointed to National Safety Council data showing that 19% of construction workers are substance abusers compared with 8.5% of workers in other industries.

Beyer also pointed to the prevalence of bullying on jobsites.

“It’s such an issue in construction, where people are made fun of for making a mistake,” he said. “People are ridiculed when they join a crew; it’s an antiquated construction mentality.… There will always be a degree of that because of that tough-guy mentality, (but) it doesn’t get anyone anywhere.”

Still, jobsite concerns aren’t the only ones that drive employees to suicide. Holbrook recalled approaching a roofer who seemed depressed, only to learn that his mother had been murdered and he had found the body. She offered him time off and referred him to a counselor, and he eventually returned to work.

“We all know what jobsite hazards are, but we don’t talk about the psychosocial hazards that employers put upon their workers,” Spencer-Thomas said. Workers are “way more likely to die from the psychosocial causes, not slips and falls and ladders. Like divorce. Would divorce have happened if they hadn’t spent so much time away from a spouse?”

Beyer agreed. “It’s important to say this is a very complex issue,” he said. “There’s not one single cause. It’s a nexus or confluence of risk factors, industry and cultural factors, and some company and job factors where a person works. There are job task and environmental factors, lifestyle and worker choices. When we just say ‘the culture,’ we’re missing some of the possible other solutions.”

One overall cultural barrier to spreading awareness about suicide is the reluctance of construction workers to talk about personal issues at work, the experts said.

“It’s a tough-guy culture, that machismo culture where they don’t want to talk about concerns that they have because it’s not an industry that is open to that,” noted Karena Lorek, director of OSHA’s Kansas City area office.

Still, said Beyer, change is possible. “Get the company leaders together; let’s acknowledge there is a problem; let’s get leaders to do something about it, create an action plan, change our culture,” he said.

Step 2. Talk about it

Talking about suicide prevention does not result in more suicides, prevention experts agreed. Likewise, asking someone who threatens suicide to talk about why will not push the person over the edge.

“It’s not talking about it that’s hurting people,” Lorek said.

In fact, engaging someone in a discussion about personal problems often can ease the burden, said Sonya Bohmann, executive director of the Construction Industry Alliance for Suicide Prevention.

Substance Abuse and Mental Health Services Administration

“In 80% of the cases, you can talk someone off of that crisis moment and get a commitment to safety and help them figure out how to get the resources they need,” Bohmann said. The first step in that scenario, she said, is to dial 988, the national suicide crisis line.

It’s a mistake for employers—or anyone—to do nothing when it’s clear an employee needs help, Bohmann said.

“Inactivity, not acknowledging when something has happened, creating a culture where people don’t feel comfortable having the conversation, sweeping things under the rug—these are mistakes to avoid,” she said.

Bohmann added that jobsite and safety supervisors “should be always talking about it. We should be starting that conversation. Don’t be afraid if you see someone’s change in personality. Never be afraid to ask somebody, ‘Are you OK?’ If they’re not, ask them: ‘Are you thinking of taking your own life? Are you making a plan?’ This helps destroy the stigma, and it creates an ally.”

Beyer said too many in the industry believe it’s not appropriate to talk about suicide at work.

“People (used to say), ‘Don’t go there, it’s a possible liability; don’t talk about mental health in the workplace,’” Beyer said.

But Bohmann disagreed: “If you get one person to open up, you’ve just saved a life.”

It can be difficult to get contractors, particularly men, who often pride themselves on being independent and self-sufficient, to talk about suicide, the experts said.

“The tough-mindedness … is really their superpower,” Spencer-Thomas said of contractors. “You can’t do this work unless you are tough and strong and stoic and decisive, a good problem solver, courageous, fearless. But like all superpowers, there’s an underbelly—our vulnerability that’s related to our strength. And the thing that they do … is the most likely to kill them.”

Holbrook said she eased her crew into these tough conversations “gently.”

“When I started doing it, they were looking at each other,” Holbrook said. “But now they’re used to it and most of them are pretty forthcoming. … The key is starting out slowly and introducing (the topic) and then keep on with consistency. They don’t look around at each other like we’re all crazy like they did when we started talking about it.”

Level Up Consultants

Mandy McIntyre, of Level Up Consultants in Cleveland, noted that adding discussions of suicide prevention to toolbox talks is a nonthreatening way to get contractors to examine their feelings. “You’re not bringing everyone together for a ‘Kumbaya,’” said McIntyre, the former vice president of a Cleveland-based roofing company. “You’re getting everyone together for a safety topic.”

Spencer-Thomas encourages employers to recruit employees and guest speakers with lived experience to share their stories during staff meetings and toolbox talks.

That is how homebuilder Bryant started his company’s mental health initiative for employees and trade partners. At first, he struggled to get his staff of tough, independent construction workers to talk to him. “It’s hard to reach out to people and say, ‘Hey, anybody willing to talk about mental health?’” he said. “We needed some volunteers.”

Bryant became the first volunteer.

He didn’t plan to kill himself, Bryant told his crew. “I don’t remember exactly what went down in the moment,” he said, when he bundled “a year’s worth of pressure, of not being good enough, of not being able to provide,” and jumped in his pickup “on the verge of doing something stupid” during the housing crisis of the mid-2000s.

His guardian angel talked him out of it, Bryant recalled, and instead of gunning the accelerator, he drove to meet some friends and told them everything: about his struggling company; his wife’s decision to take a good job three states away; his newborn baby; the conflicts he was having with others; his bitterness and anger.

“I never felt more supported and loved,” he shared with his employees.

“It (was) hard reliving it,” Bryant said, but sharing his story prompted several others on his crew to open up about their own struggles.

“Two employees called me the next day and said, ‘Thank you for sharing. Here’s what’s going on with me. … If you’re struggling, I feel better about my struggle.’”

Bryant added: “I want to make this a place they can come and be who they are.”

The Cost of Saving a Life

Trade associations, unions and government agencies regularly fill orders for free posters or will send a speaker to talk at a construction company staff meeting about mental health or suicide prevention.

Some services, like mental health first-aid training, could cost upward of $2,000 per person, but those who are certified can then train others in a company at no charge.

Still, said Bryant, “I’ve never seen it as a cost.”

“Shutting down operations for a few hours a month for suicide-themed toolbox talks or staff meetings means a bit of lost production,” Bryant said, but he added, “It’s an investment in people. I never look at it as what the cost would be. My answer is: I don’t think there is one.”

The aftermath of an employee suicide, on the other hand, can be costly. The Centers for Disease Control and Prevention has estimated that suicide costs American businesses a collective $70 billion a year, mostly in medical costs, lost worker hours and insurance, and recruiting and in training replacement employees.

The company may have to shut down temporarily or allow workers to take liberal leave as they grieve; bring in counselors; and respond to inquiries from the media and the public.

A suicide often results in increased absenteeism, loss of focus among those who knew the deceased, more visits to mental health professionals, potential legal action, increased fighting among employees and higher drug and alcohol use, Beyer said.

In addition, construction firms can experience employee resignations, workers’ compensation claims, challenges when recruiting, dissatisfied customers, damage to the corporate reputation, missed deadlines and even lawsuits from victims’ families that claim the company did not act to prevent the death.

Bryant said preventing suicides helps a company avoid most of those costs. “If I can take (someone) off the job for two days” and offer help that prevents a suicide, Bryant said, “that’s an investment and that’s money in my pocket.”

Indeed, two Australian researchers estimated that for every dollar an employer invests in a suicide prevention effort, it will reap more than $1.50 in benefits from the impact of the program.

And while employees who do not need assistance in the moment might not absorb the information, others will act on it instead of on their dark thoughts, Lorek said.

Lorek met a safety director who talked about the signs of suicide during a staff meeting and got a phone call shortly after from an employee who said he was on the side of the road and he wanted to jump into traffic. He told the safety director, “I need help,” and he got it.

“You never know who will hear the information and the life that can be saved,” Lorek said. “If just one person can hear that message, maybe one person’s life can be saved.”

Some construction safety directors are certified in “mental health first-aid,” which prepares them to have conversations with employees who have problems or suicidal thoughts. But not all companies have safety directors, so Melchor-Frost encourages her clients to get many supervisors and other employees trained in suicide prevention tactics so someone with a certification is always around the jobsite or office when an employee needs to talk.

Melchor-Frost urges her construction clients to communicate with employees about suicide in three ways. First, jobsite supervisors incorporate mental health topics into weekly or monthly toolbox talks and staff meetings. Second, they post banners, posters and newsletters, in English and Spanish, around all jobsites with information about resources for employees who might be having suicidal thoughts. The posters include the nationwide suicide crisis phone number, 988. Melchor-Frost said she hangs signs around fence lines and even in bathroom stalls. “What better way to find out what’s happening than when you’re sitting on the toilet?” she asked.

The third way Melchor-Frost’s clients engage employees in discussions about suicide, she said, is to gather the whole workforce together in a break tent to hear information about how to tell if a co-worker is suffering from depression or thinking about suicide and what to do if they spot it.

Bohmann noted that “posters are a pretty big deterrent” but suggests that managers go even further. She suggests passing out coins with “988” on them or offering another pocket-size keepsake that employees can carry with them.

Managers who talk to their employees about their personal problems that seem hopeless could discover reasons for poor job performance—reasons that the employer might be able to resolve, Beyer said.

“It could be a car bill; someone has a $2,600 car (repair) bill but has $81 in the bank and can’t get to work without a car,” Beyer said, recalling a situation one of his employees faced when he worked in construction. “We found him transportation, some workers who were willing to pick him up. … It turns out he was a really good worker when he didn’t have to worry about how he’d get to work tomorrow.”

But be discreet, Lorek advised: Such conversations are best conducted in private. “A big thing is to listen to them,” she said. “Sometimes they just need someone to listen to them, expressing that concern, that caring.”

McIntyre agreed.

“People who die by suicide, they die from mental illness,” said McIntyre. “When someone gets to that point where they’re contemplating suicide,” she said, “these are cries for help. The problem is …t hose cries for help are unanswered. … Do the work before it elevates to suicide. … Mental health awareness is so important in being proactive so we’re not working together after a tragedy; we’re working together before tragedy strikes.”

Step 3. Offer resources

If a supervisor or colleague witnesses symptoms like extreme mood or behavior changes, or if anyone at work suspects a colleague might be considering suicide, they should know what steps to take to get the person help, the experts said.

Training employees is key to ensuring that when someone reaches out for help, others know how to help.

At Appleton, Wisconsin, general contracting company Boldt, 90 employees are trained in-house to offer informal, peer-to-peer counseling. The firm started its “Gatekeeper” program in 2021 with employees who volunteered to learn how to help co-workers on jobsites. The job of the gatekeepers, who are not trained in therapy and wear purple stickers on their hardhats, is to listen to co-workers and refer them to help when they need it.

During toolbox talks and staff meetings, managers should teach all employees the emergency phone number—988—to reach trained suicide counselors who can say the right things and ask the right questions during a crisis, Melchor-Frost advised.

In addition, managers and supervisors should know what kinds of resources their company offers employees seeking mental health counseling.

Some, but not most companies—especially smaller construction firms—have on-site therapists, robust employee assistance programs and even medical professionals on site.

Absent that, managers and supervisors should be able to immediately find contact information for mental health professionals in the community by keeping a list at the ready. At a minimum, everyone in the company should know to dial 911 in an emergency and 988 when they hear the word “suicide” from a coworker.

Employee assistance programs offer free counseling to workers, but they are largely underused, possibly because many employees believe EAP counselors share their personal information with their companies, Beyer explained.

That’s not true, so spreading accurate information among employees about the confidentiality of counseling sessions could mean more of them will seek therapy if they need it, Beyer said.

In fact, it’s possible that many employees do not even realize their companies have EAPs or that their health insurance covers the cost of appointments with therapists.

But not all EAPs are created equally, Beyer noted. A few serve employees at their workplace; others have counselors who meet face-to-face; while some offer only virtual or telephone meetings. Beyer said he recommends that construction companies contract with full-service EAPs, even if few employees used them pre-pandemic.

He also said EAPs with automated answering services sometimes require employees to wait for a callback or stay on hold for up to half an hour. “If an employee experiences that kind of delay, they’re not likely to call back. This is not effective; they think nobody cares.”

Advertising the services the EAP offers can boost its use, Beyer said. Employees respond well when their companies let them know that “everyone has a role to play in suicide prevention and that our company is committed to connecting you with resources,” he suggested.

Outside of EAPs, Beyer said companies across industries have expanded their lists of in-network mental health providers since the pandemic to make it easier for employees to afford care.

He pointed to some firms whose insurance plans cover behavioral health services, like addiction recovery, as well as mental health therapy. And some are adding caregiving services to help employees who are dealing with the illness of a spouse or child.

“Those types of caregiving resources are designed to take the burden off of the employees,” Beyer said.

Step 4. Prepare for the worst

Despite their best efforts to prevent suicides among their workers, some will lose employees in that way.

The experts advise managers and owners to have a plan ready in case that happens.

In a spring 2021 article in the Construction Financial Management Association publication, Building Profits, Beyer and co-author Bob VandePol, founder of VandePol Crisis Response Services in Holland, Michigan, noted: “Depending on your company’s response (to a crisis), you and other leaders will either create a sense of, ‘We will never let that happen again’ or, ‘This company will never be the same.’”

They advise managers to address the crisis immediately: “The tragedy and its aftermath will not go away if ignored,” the authors wrote. In the absence of involved leaders, they said, employees “will feel as though insult has been added to injury” and could blame their employer for the incident.

Beyer and VandePol suggested that employers invite mental health professionals to the jobsite to talk with employees post-incident—or arrange for virtual and phone meetings for those who want to talk.

These pros should already have a relationship with the company, the authors said, because “in the immediate aftermath of a tragedy is no time to search for a counselor.”

McIntyre agreed. “When you’re going through a crisis, you’re in this spiral. To have to go out and find out where to go? Have mental health options (at the ready).”

And leaders should acknowledge to employees that the incident has had an impact on the team and on them and keep communication flowing as details come out and decisions are made.

Good communication and an effective recovery plan will inch the workforce back to normal quicker, Beyer and VanderPol said.

Bohmann called the work of leaders in the aftermath of a suicide “post-vention.”

She said employers should be flexible with employees who need extra time off. And that should be part of a plan that outlines how leaders will operate—a plan that is decided when the company is not in crisis.

In the aftermath of the suicides at Graham Roofing, Holbrook recalled, she continually assured her employees that “It’s OK not to be OK. It’s OK to ask for help.”

McIntyre said the aftermath of a tragedy calls for leaders to examine what they might have done differently to get a different outcome.

And she said any company that does not have a suicide prevention program in place should take the statistics to heart—and make a plan.

“How are we going to address this and meet people on their worst day with dignity and respect and partnership and the best resources that we have vetted and have a relationship with?” Spencer-Thomas asked. “We need to be prepared with a plan and a relationship to the resources so (they are in place) when things are bad: a mental health emergency, a suicide, a near death, an overdose.”

In the end, Bryant said, promoting suicide prevention at work could change the reputation of the construction industry, which suffers from more suicides than almost any other.

“We can make this an industry that shows we take care of our people,” he said, noting the struggle most construction firms have recruiting and retaining laborers. “In 20 years, if we focus as much on mental health safety and wellness as we do to putting guard rails up, our industry will be attractive.”

Suicide Warning Signs

• Talking about wanting to die.
• Feeling guilt or shame.
• Worried about being a burden to others.
• Feeling hopeless.
• Having no reason to live.
• Extreme sadness, anxiety or rage.
• In unbearable pain, emotional and physical.
• Changes in behavior.
• Taking dangerous risks.
• Withdrawing from friends.
• Giving away cherished items.
• Mood swings.
• Eating or sleeping more or less.
• Abusing drugs or alcohol.

Source: National Institute of Mental Health

Language to Use

Those who encourage employers to talk to their crews about suicide say it’s important to choose the right words. Some examples:

• Say died by suicide, not committed suicide. “Committed” is a word that denotes crime or insanity, as in “committed murder” or “was committed to an institution.”
• Avoid referring to a suicide attempt as “failed” or “successful.”
• Someone who has attempted suicide or thought about it has “lived experience.”
• Anyone who has lost a friend or loved one to suicide is a “loss survivor.”

Resources

• National Suicide and Crisis Lifeline: Dial 988
• Crisis Text Line: 741741
• American Foundation for Suicide Prevention
• Construction Industry Alliance for Suicide Prevention
• Construction Suicide Prevention Week
• Construction Working Minds
• LivingWorks Start
• National Alliance on Mental Illness
• Occupational Safety and Health Administration
• United Suicide Survivors International
• Workplace Suicide Prevention