Suicide in Construction: The Long Emergency

Learning from the Affected

The first of its kind, this was an assembly of experts, friends, and survivors sharing and planning how to save the lives of the sons and daughters doing our construction work. I got a glimpse into what makes someone suicidal, how to recognize those at risk, and learned ways to help. I found out that, for those contemplating death by suicide, "It's not a desire to die; it's a desire to escape." Those suffering from suicidal thoughts often feel their family and friends "can move on without me."

Two days ago, I met a gentleman with a tattoo of a semi-colon on his arm. This signifies a suicide survivor. I nodded and asked how he was doing. His answer: "Hey, thanks for recognizing that, and I am doing okay." We chatted about his story. I tried to direct the conversation to some positives in his life. Within an hour, I was speaking about that encounter with a new friend. He said, somewhat offhandedly, "I know the feeling; I have tried twice."

And that is the focus of this column—what I call a "long emergency" in the construction industry. We have collected enough data, and now, we need to react.

Facts To Ponder

Back to my notes and some resources for my readers. It might read rather oddly, but it's not about the format, is it? First, two important references confirm the threat of a worker dying by suicide versus a construction accident.

The construction industry has one of the highest suicide rates compared to other industries. ¹ In 2016, the suicide rate for men in construction and extraction occupations was 49.4/100,000—that is almost twice the total suicide rate for civilian working men (16–64 years old) in 32 states (27.4/100,000) and 5 times greater than the rate for all fatal work-related injuries in the construction industry in 2018 (9.5/100,000). ²

Source: Trudi McCleery, Scott Earnest, Christina Socias-Morales, and Elizabeth Garza, "Partnering To Prevent Suicide in the Construction Industry—Building Hope and a Road to Recovery," NIOSH Science Blog, Centers for Disease Control and Prevention (CDC), September 9, 2020.

Every year, more than 45,000 people die by suicide in America. If that number sounds striking, consider this: For every suicide death, there are 25 suicide attempts.

Source: Rheana Murray, "What Is It Like To Survive a Suicide Attempt?," Today, NBC, August 31, 2018.

Of those considering suicide, only .05 percent looked for help. Of that percent, 65 percent received treatment. Critical is the value of a friend or someone who cares because peer support is the most effective tool we have—friends helping out friends. This has been recognized for years in the United Kingdom and Australia. Mates in Mind "has empowered hundreds of organisations across the United Kingdom to tackle the silence surrounding mental ill-heath." A similar organization, Mates in Construction, which is in Australia, centers its focus on the fact that "construction workers are six times more likely to die by suicide than an accident at work."

I heard that shared experiences are very powerful; it confirms you are comfortable talking about the subject, and the listener will respond to that. So here is mine: Eric was a project manager on an overseas project. I spoke with Eric on a Thursday as we were planning on going diving the next time we met. We spoke for a half hour and agreed on the spot to visit. But he took his life that Saturday.

I had no idea he was contemplating suicide; I miss him still.

For further information, check out "Understanding the Suicidal Person" by Dr. Spencer-Thomas.

Suicide as a Solution

A common reason for suicide attempts is "I knew they loved me but couldn't feel it." It's hard for me to understand that emotion. At the conference, I also learned that someone considering suicide often just needs one person to care about them. If you recognize that someone is considering taking their life, talk to them, express your concern, and always follow up with an invite to coffee or dinner. They need to know that someone else cares enough, and they get a goal to survive for one more day.

When someone is considering calling the suicide hotline, it's not unusual for them to say, "The phone feels like a load of bricks." So, offer to help. "Let's call the suicide hotline together. Is now good?" or "I am going to make that call, hand you the phone, and step away so you can talk." Saying, "You should just call the suicide hotline," is the common—but wrong—approach. Those contemplating suicide need a friend with them, not on the other end of a phone. The trained hotline respondent will offer alternatives but help the individual make the call.

The national 988 Suicide and Crisis Lifeline is now operational; just dial 988. For more information on hotlines, see "Suicide Prevention Crisis Services: What To Expect" and "988: The Future of Crisis Services," both also by Dr. Spencer-Thomas.

Suicide Prevention Programs

If your construction company is considering a suicide prevention program, realize that three kinds of support at a construction site are needed. The awareness level person who is trained to know "something is off with that guy" is first. Just minimal training is needed on the contributors and signs someone may be at risk. In some countries, 35 percent of workers are trained in this area. Remember that peer-to-peer support is the most effective approach to helping someone.

Next is the connector. They have additional training on how to help. Often, they are identified with a sticker on their helmet everyone recognizes—this is a person workers can approach privately to talk. The job as a connector is a bridge to care, not to diagnose. On construction sites, the average is 1 connector for every 20 workers.

The next area of support is access to a counselor. This is someone trusted at the site to whom the connector can refer troubled workers for the help they need. One concern here is that mental health providers are very difficult to find, and few are going to school for that skill. Currently, there is a need for 6,400 providers in the United States.

The idea of having someone in construction claims management experienced in suicide prevention was raised at a recent conference. There is a link between pain management for an injured worker, the risks of addiction, and a need for specific case management. After an emergency room (ER) visit, a competent nurse case manager can reduce additional ER visits by half, often just by calling the worker to check in, to show someone cares.

I learned that the most common reason for a visit to the ER is "pain." Opioids are perfect for "feeling better," but after 6 days, on average, you're likely to be addicted. Without opioids and just Tylenol and ibuprofen, you recover 7 weeks faster. Both medications are three times better at pain relief than opioids. But again, you "feel nice" with opioids.

The best way to roll out a program is to start small and find some champions. Firms need to build capacity for mental health and suicide prevention. They must realize that this is life or death. A suicide survivor with a story to tell is a powerful start. I see the similarity to Alcoholics Anonymous using the power of peers, sharing, and daily support, like getting together in the morning for coffee. A specific target is for supervisors and foremen—help them understand and empathize. They are often the drivers of worker stress.

Another avenue for support involves employee assistant programs. Dr. Spencer-Thomas addresses these in "Evaluating Employee Assistance Programs."

Conclusion

Sadly, there are often no early warning signs for suicide; we cannot save everyone, and we need to plan for that at the construction site. My favorite line from a conference presenter was, "If you are doing well, it's up to you to help someone who needs it." I love that idea.

This column is about what I learned by becoming a "connector" and listening to the experts. I found out that asking if someone is suicidal will not trigger the act. Rather, it shows that at least one person cares.

There is progress in suicide prevention in construction. Suicide prevention is now being recognized by the US Department of Labor Occupational Safety and Health Administration in its documentation on preventing suicide in the construction industry. Also, some general contractors are bringing mental health counselors to projects to help. And that works. One top-10 construction firm brought a counselor to a site for a day a week to help. Within a few months, that person was working full-time helping others.

Also see "National Guidelines for Workplace Suicide Prevention Released."

So, progress continues, but more contractors and insurers must step up to help. This unique "long emergency" is something you cannot see, yet we are losing our workforce to it daily. As one conference speaker said, "If you are doing anything, you are doing it right." I would add: if you're not doing anything, shame on you.