A recent report from the U.S. Center for Disease Control (CDC) revealed that construction is one of the most at-risk industries for suicide.

After fisherman and farmers, construction workers commit suicide at the highest rate of any profession – 53.3 per 100,000. The study, which examined suicide risk by profession, found that of about 12,300 suicides in the 17 states studied, 1,324 people worked in construction and extraction (10.8 percent) and 1,049 (8.5 percent) worked in management, a category that includes top executives as well as others in management positions. Related to construction, jobs in architecture and engineering also had high rates of self-harm.

In light of the report's findings, the Construction Financial Management Association (CFMA) established the Construction Industry Alliance for Suicide Prevention with the goal of providing and disseminating information and resources for suicide prevention and mental health promotion in construction. Here, BUILDER talks with Stuart Binstock, CFMA president and CEO, about the problems facing construction workers and ways employers can prevent suicide.

Why is the rate of suicide so high among construction workers?
According to data from the Centers for Disease Control and Prevention, suicide ranks as the fourth leading cause of death for males ages 25 to 54 in 2014—the age bracket that comprises the majority of the construction workforce in the United States. The known contributing factors and many aspects of working in construction create a perfect storm of risk:
• “Tough guy” culture of fearlessness, stoicism, and recklessness
• High pressure environment of schedule, budget, and quality performance with potential for failure and resulting shame and humiliation
• Exposure to physical strain or psychological trauma
• Prevalence of alcohol and substance abuse
• Reassignment and travel to remote projects creating separation from family and friends
• Seasonal employment leading to a fragmented community and isolation
• Chronic pain from years of physical and manual labor
• Industry with the associated highest incidence of prescription opioid use
• Sleep disruption due to construction work schedules and rotating shifts
• Lack of access to mental health care and low utilization of employee assistance programs (EAPs)
• Stigma of mental illness
• Access to lethal means like pills and firearms

What types of workers are at risk?
In 2011, Business Insider found that supervisors of heavy construction equipment are 1.5 times more likely to commit suicide than people in other professions. A 2007 study in American Journal of Industrial Medicine shows the construction industry was at the highest risk of suicide among industrial groups. Research published in 2014 that examined suicide by occupational skill level in the Australian construction industry from 2001 to 2010 concluded that “low-skilled workers in the construction industry had elevated rates of suicide compared to skilled trades workers,” according to the abstract.

There are many suicide high-risk factors prevalent in construction. For instance, in this male-dominated industry, the stoic, macho “tough guy” culture creates barriers to seeking help and acknowledging emotional problems. The often physically challenging work makes employees prone to injuries and fatigue, which can cause chronic pain and could lead to physical strain, distress, and pain medication addiction. And, there’s potential for post-traumatic stress from psychological injury caused by witnessing traumatic life-threatening events.

In addition, the cyclical nature of work, regular lay-off periods, seasonal furloughs, and uncertainty of rehiring add to the list of risk factors. Some employees frequently travel from project to project across states and cities, leading to separation from their families and significant others.

What can construction firm owners do to stop the problem?
Consider the following steps to help develop a comprehensive and sustained model for addressing mental health awareness and advocacy in a construction firm.
--Assess company readiness. Start by assessing the company’s readiness to deal with mental health crises and suicide prevention interventions. Knowing the company’s preparedness will help determine how best to incorporate mental health services into the company’s wellness, safety, and employee benefits programs.
--Engage leadership. Changing the way the company views and addresses mental illness starts at the top. Consider hosting leadership roundtables to discuss how companies can share best practices and learn from one another.
--Make zero suicide the objective. Once company leadership understands the need for mental health awareness and suicide prevention, include Zero Suicide with the company’s Zero Incident and Zero Injury safety and health programs. Incorporate mental health and suicide prevention into Safety 24/7 programs designed to reinforce personal and family safety at home and at work.
--Educate employees and build a preventative culture. Continue to integrate mental health awareness into safety and wellness programs. For example, cover mental health and suicide prevention in company newsletters. Discuss topics like how to help a coworker during brown bag lunch meetings and toolbox talks. Recognize World Suicide Prevention Day with a workforce stand down on psychological safety.
Be sure to post National Suicide Prevention Lifeline contact information on bulletin boards, in locker rooms, and other public places. In addition, incorporate these resources into the employee handbook and regularly include the information in the company newsletter. Develop human capital risk management procedures that strengthen mental health awareness and promote suicide prevention throughout the hiring and onboarding processes. Also, incorporate protective factors into the company culture by:
• Increasing the focus on personal safety in addition to workplace safety
• Expanding collaboration and teamwork
• Creating engagement strategies to connect employees to the company’s mission
• Strengthening “buddy systems” by formalizing a trained and supervised peer support program
• Improving access to insurance and mental health care
• Providing visible and vocal leadership
Train supervisors. Offer ongoing skill-enhancement training to supervisors on such topics as how to identify risk factors and warning signs for suicide, or how to have conversations that help link employees in distress to life-saving care.
Improve awareness of and access to mental health care. Too often construction employees are underinsured or unaware of their mental health benefits. Creating a strong alliance with local mental health resources and the Employee Assistance Program (EAP) can increase the number of people who seek help.

How do you plan to create a “zero suicide” industry?
The best way to spread this work is peer to peer, leader to leader. By creating a community that is educated about the risks and signs of suicide prevention, we can all learn from each other and share best practices. We encourage construction firm owners to host executive roundtables of construction companies and suppliers within their regions to discuss this topic. Other examples of approaches to spread the word through the leadership network include the following avenues for an expanded dialogue:
• Trade/industry association presentations or training programs and publications/newsletters
• Professional, peer, or industry group discussions
• Insurance captive risk management roundtables

CFMA is also invested in working with other organizations to help spread the word throughout the industry and proudly welcomes and acknowledges the following Construction Industry Alliance for Suicide Prevention members:Associated Builders and Contractors (ABC)
Associated General Contractors of America (AGC)
The Carson J Spencer Foundation
Construction Industry CPAs and Consultants (CICPAC)
Mechanical Contractors Association of America (MCAA)
National Association of Surety Bond Producers (NASBP)
National Association of Women in Construction (NAWIC)
Perspectives, Ltd.