DONALD J. GARVEY, CIH, CSP, FAIHA, is currently the senior industrial hygienist for construction at Merjent Inc. He has also worked as a construction industrial hygienist at 3M and the St. Paul Companies, chaired the AIHA Construction Committee, and won the Construction Committee’s 2020 Rochelle Crew Memorial Award.
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Mental Health in Construction
Who are you more likely to find at a construction site—a person needing CPR or a person who needs an intervention for suicide or another mental health crisis? Unfortunately, it is more likely to be the latter.

In the construction industry, occupational health professionals are generally aware of and engaged in efforts to protect workers from physical illnesses such as silicosis and hearing loss, with the aim of getting these workers home safely from work. Mental health crises, including suicidal ideation, suicide attempts, and deaths by suicide, occur more frequently than physical occupational injury and illnesses. However, occupational health professionals rarely discuss such issues with their peers or, more importantly, with construction workers. In this case, the occupational health professional needs to help get workers back to work safely from home.
While I am not a credentialed psychologist, sociologist, or mental health professional, I am a Certified Industrial Hygienist and a Certified Safety Professional who has worked in the construction industry for 30 years. Regrettably, I also have the personal experience of knowing an outstanding construction safety professional, coworker, and close friend who died by suicide several years ago. Therefore, my concern for mental health among the construction workforce is both professional and personal. THE STATISTICS Suicide is a major public health concern in the United States. According to data from a 2018 National Center for Health Statistics brief, the age-adjusted suicide rate increased 33 percent between 1999 and 2017, from 10.5 to 14.0 deaths by suicide per 100,000 standard population. The brief stated that the rate increased by about 1 percent per year from 1999 to 2006, and by about 2 percent per year from 2006 to 2017. The situation is even more dire in the construction industry. According to a CDC study that analyzed violent deaths in 17 U.S. states for the years 2012 and 2015, the construction and extraction segment was the occupational group with the highest rate of male suicide—rising from 43.6 to 53.2 deaths by suicide per 100,000 civilian working persons. Suicide rates for women in this occupational group could not be calculated due to small sample sizes. The CDC study found that in 2012 and 2015, respectively, 1,009 and 1,248 construction workers died from suicide. While we must be careful when comparing data across studies surveying different populations through different methodologies, archived Department of Labor data shows that, for 2012 and 2015, 849 and 937 construction workers across the U.S. died from occupational injuries, respectively. This comparison indicates the impact of suicide on the construction industry and the urgency for occupational health professionals to address the issue. SUICIDE RISK FOR CONSTRUCTION WORKERS The construction industry has virtually every risk factor for suicide. Construction work sites often foster a stoic “tough guy” culture. Travel between construction jobs separates families and isolates workers. Long hours and night shifts cause sleep disruption and deprivation. Seasonal layoffs and end-of-project furloughs result in workers frequently being at risk of losing income, healthcare benefits, and employee assistance programs that provide access to mental health assessments and counseling.
The construction industry has virtually every risk factor for suicide.
Construction workers also have one of the highest occupational injury rates, causing many workers to suffer from chronic pain. Chronic pain patients are at especially high risk for suicide, partly because they are often prescribed opioid medications, which can be abused. Accidental or intentional opioid overdose is another health crisis that construction workers are disproportionately at risk for. CDC has reported that out of all occupational groups, construction workers are proportionally most at risk for dying from opioid overdose.
In addition to prescription opioids, construction workers disproportionately abuse alcohol and other substances. One study, using combined data from 2008–2012, found that 16.5 percent of construction industry workers reported heavy alcohol use, well above the national average of 8.7 percent and the second highest of all industries. Note that substance abuse itself is a mental health crisis and a risk factor for suicide: all of the above factors combine to put construction workers at exceptionally high risk.
HOW TO PROTECT WORKERS The first step for occupational health professionals toward preventing suicide in the construction industry is to think of and treat mental illness like we do physical illnesses. This requires that the stigma around suicide be removed, meaning in part that occupational health professionals must pay special attention to language: we do not say someone committed cancer or committed a brain tumor. Mental health advocates usually employ the term “died by suicide” instead of “committed suicide.” This does not impose culpability on people who have lost their lives due to suicide and allows health professionals to acknowledge the illness or health condition they suffered from.
To help prevent deaths from suicide, occupational health professionals must recognize the signs that someone may attempt suicide and intervene early. The University of Washington School of Social Work has developed a toolkit for suicide prevention, which includes the five-step LEARN framework.
LEARN LEARN instructs observers concerned about suicidal people to look for the signs, empathize and listen, ask directly about suicide, remove the dangers, and take the next steps:
Look for the signs: Occupational health professionals should recognize behavioral indicators that a person may be considering suicide. These include talking and joking about death; expressing feelings of hopelessness, depression, and anxiety; changes in personality, outlook, or work performance; social isolation; and reckless behavior.
Empathize and listen: If you notice a worker exhibiting warning signs, you should have an empathic conversation with that worker. Give the worker your full attention. Acknowledge his or her feelings. Do not judge the worker or try to “fix” his or her problem.
Ask directly about suicide: Asking about suicide will not plant the idea in the worker’s mind. Be prepared for long silences or for the worker to answer “yes.”
Remove dangers: Putting time and distance between a person at risk for suicide and the method he or she plans to use can save a life. Ask the person how and when he or she will attempt to take his or her life. Remove this worker’s access to anything he or she could use in the attempt.
Next steps: After this conversation, you should get help immediately. The Suicide Prevention Lifeline is (800) 273-8255. Press 1 for resources for veterans and 2 for resources in Spanish. Do not leave the person alone. Call 911 if necessary.
STAND UP The Construction Industry Alliance for Suicide Prevention (CIASP) has also compiled resources designed specifically for the construction industry, including video presentations, downloadable posters, a free webinar, and training documents. Occupational health professionals may find these useful to construct suicide prevention policies for both their construction work sites and offices.
CIASP calls on you to STAND up to prevent suicide in the construction industry. STAND is an acronym for safe, training, awareness, normalizing, and decreasing:
Safe: Occupational health professionals must help create safe work site cultures where employees feel comfortable asking for help for themselves or others.
Training: To this end, workers must also be educated on how to recognize warning signs or help others at risk.
Awareness: Spreading the message of the suicide crisis in the construction industry and methods of prevention helps to inform and recruit members of the community.
Normalizing: Talking about suicide, suicide prevention, and mental health helps to raise this status as health and safety priorities.
Decreasing: CIASP’s goal is to lower the risk of suicide in the construction industry.
Occupational health professionals should help ensure workers’ awareness of and access to the workplace’s mental health benefits, employee assistance programs, and resources such as the National Suicide Prevention Lifeline. Suicide prevention efforts should be ongoing, but you can make a particular point of discussing the issue with workers every September 10, World Suicide Prevention Day.
CDC: Morbidity and Mortality Weekly Report, “Suicide Rates by Major Occupational Group—17 States, 2012 and 2015” (November 2018).
CDC: Morbidity and Mortality Weekly Report, ”Occupational Patterns in Unintentional and Undetermined Drug-Involved and Opioid-Involved Overdose Deaths—United States, 2007–2012” (August 2018).
The Center for Behavioral Health Statistics and Quality Report: “Substance Abuse and Substance Use Disorder by Industry” (April 2015).
Construction Industry Alliance for Suicide Prevention.
Forefront Suicide Prevention Toolkit.
National Center for Health Statistics: “Suicide Mortality in the United States, 1999–2017” (PDF, November 2018).
U.S. Bureau of Labor Statistics: “Census of Fatal Occupational Injuries (CFOI) – Archived Data.”