Why Worker Resilience, Mental Health, and Suicide Prevention Matter
Sally Spencer-Thomas | June 28, 2019
Safety professionals are keenly aware of job-related injury and mortality data; however, many are not taking into consideration how mental well-being is playing a role in injuries and death. Nor has much attention been given to the impact of psychosocial hazards at work.
For example, a November 16, 2018, study published by the Centers for Disease Control and Prevention (CDC), Suicide Rates by Major Occupational Group—17 States, 2012 and 2015, found that, in their large national sample, 20 percent of all men who died by suicide in the United States were in the construction/extraction industry. In 2017, 47,173 people in the United States died by suicide, 27,404 of them were men ages 20–64. If 20 percent of these men were in construction/extraction, we can estimate that over 5,000 men working in construction/extraction died by suicide, and yet—historically—these and other high-ranking industries have not focused on this form of death. Why?
One reason is that the Bureau of Labor Statistics only tracks deaths that happen on a worksite, and most suicide deaths happen elsewhere. Furthermore, when a workplace fatality happens, the cause is almost always determined to be "accidental" and a deeper investigation into an intent to die is not undertaken. The remedy in these cases is then to do more safety training.
When we look at the fatal occupational injuries, however, the first two most common (transportation incidents and falls) are also common ways people think about taking their lives. Thus, it is possible that some if not many of these workplace fatalities are actually suicide deaths, which then means that safety training may not be effective in preventing them.
Because emotional health is so related to job performance, it is helpful to examine the ways that experiences such as depression, anxiety, addiction, and suicidal thoughts can lead to safety challenges at work.
Unmanaged Mental Health Conditions and Suicidal Safety Concerns
Having suicidal thoughts and symptoms of illnesses, such as depression, anxiety, and addiction, can be intense, and trying to hide them from other people can make them all-consuming. For example, racing or intrusive thoughts as experienced by people living with bipolar condition, trauma, or thought disorders, such as schizophrenia, can be very distracting. This distraction can interfere with decisiveness, awareness of surroundings, and problem-solving. Impulsivity, impaired perception agitation, tunnel vision, distorted thinking, and paranoia are also common symptoms of several mental health conditions. When left untreated, these symptoms can interfere with workplace security, productivity, and morale.
Healthy sleep patterns are essential to overall health, vibrancy, and coping, and yet sleep disorders are common in many forms of mental illness and experiences of suicidal intensity. Insomnia is present in many forms of mood, anxiety, and substance use disorders. People living with depression often experience lethargy and what is known as anhedonia—the inability to feel pleasure. Sometimes extreme fatigue can result in microsleep, where the brain involuntarily goes "off-line" to a sudden sleep state for a matter of seconds. This state can have disastrous consequences for many safety-conscious professions.
Unlike broken bones and stitches, internal injuries (e.g., psychological trauma, etc.) and illnesses (e.g., depression, etc.) often go unnoticed by others. Because people often experience discrimination and prejudice for having a mental health condition, people are inclined to "white knuckle" through their symptoms and are highly reluctant to reach out for help. Sometimes, especially when it comes to addiction, problems are occurring within social groups of workers, and patterns of enabling and covering up for one another can further hide the problems. Eventually, however, the symptoms can become too much to push aside and are subsequently identified through some performance-related concerns, such as absenteeism, presenteeism (showing up physically to work but unable to perform), low productivity, or poor safety. Because the symptoms have been left to fester, by the time they are noticed under disciplinary circumstances, they are usually "stage 4" symptoms—meaning they are deeply entrenched and potentially fatal. Thus, one of the key mindset shifts for workplaces is giving workers opportunities for earlier symptom identification and intervention.
When mental health challenges reach crisis levels, other physical health challenges such as those involving pain, gastrointestinal problems, and poor heart functioning can result. Conversely, when people are experiencing physical issues like chronic pain or other disability, their worlds can start to collapse. Many experience emotional anguish because they can no longer do the things they have done in the past and their social networks shrink. Without intervention, this spiral of suffering can lead to significant worker impairment.
In extreme situations, when people are overwhelmed by the emotional pain in their life, they can find themselves believing that the only way they can get out of this pain is to die. Sometimes, they often consciously or subconsciously start to take more risks or even practice suicidal behavior as they test out their capacity for self-harm. We have emerging evidence that many more people are walking around our workplaces experiencing suicidal thoughts than we have realized.
As discussed in a 2018 presentation at the American Association of Suicidology's national conference in Washington, DC, 38 percent of their national sample of construction/extraction workers had at one point in their career experienced suicidal thoughts (compared to 6–14 percent in the general population). These workers may semiconsciously disregard safety protocol because they are teetering on the precipice of wanting to live and wanting to end their suffering through suicide. Probably more than our data would show, more than a handful of the "accidental deaths" in our workplaces have varying degrees of intent.
Action Steps Workplaces Can Take To Bolster Psychological Safety
Getting ahead of a suicide crisis means building better awareness, protective factors, and strategies to help people catch emerging problems earlier in the process. The following are some examples.
Toolbox Talks
Many companies are now integrating mental health and suicide prevention topics by developing toolbox talk briefings that educate the workforce on what to look for and what to do (e.g., Construction Working Minds).
Tackle Prejudice by Educating and Inspiring the Workforce
Too often, our reluctance to talk about mental health and suicide stems from fear, and this fear is the result of ignorance—we fear what we don't understand. Providing education and awareness can help reduce this fear and replace it with a reassuring reality.
Mental health and suicide prevention literacy is education about the following three things.
- Knowledge about mental health conditions and substance use disorders, especially alcohol and opioid use, as well as how these are connected to other health issues like pain and sleep dysregulation
- Familiarity with mental health resources, support tools, and treatment options
- Stories of hope and recovery
Of these three, the last is the most powerful in creating change. Facts and frameworks are helpful, but getting to know people who have "lived expertise" with depression, anxiety, addiction, and suicidal thoughts does more to undo stigma than all other methods.
Develop a Training Program
Just like CPR, everyone should get some basic mental health awareness and skills. The more people know of these, the more "eyes we have on the playing field," and the more likely someone will notice and take action when needed. Indeed, research supports the conclusion that greater awareness of symptoms of suicidality is associated with greater help-seeking.
Managers, peer supporters, wellness coordinators, safety managers, and the like can get advanced mental health and suicide prevention awareness/skills and psychological first aid skills. This tier is like the EMT level of the comprehensive suicide prevention community. They are the ones people turn to to see if problems can be resolved with basic active listening, empathy, empowerment, and caring follow-up, or if a more rigorous intervention is needed.
Kick the Tires of the Available Mental Health Services
Local mental health services and Employee Assistance Programs (EAPs) are valuable assets to the workplace. They help employers by offering psychological assessment and short-term counseling, managing critical incidents, and conducting "fitness for duty" evaluations, to name a few services. EAP providers and industry-specific mental health experts can be critical consultants when an employer is concerned about a worker's safety and can help develop reintegration plans for employees who have needed to go on medical leave due to mental health conditions.
The problem with most EAPs is that they are a hidden benefit. Most people don't know how to access their EAP or what services are offered. Furthermore, not all EAPs are equal—some provide state-of-the-art care in a wide range of services, while others just provide superficial, short-term, and inadequate referral services. Therefore, the first step in promoting mental health services like EAPs or other community mental health centers is to "kick the tires" a bit. Personally investigate and even partake in the services to understand the experience, then you will be in a better position to either advocate for better services or be an informed liaison to the existing services. Once a quality mental health provider has been identified, the resources need to be promoted regularly through multiple communication channels along with on-site opportunities to meet providers and ask questions.
Promote Crisis Resources
The National Suicide Prevention Lifeline represents the prevailing network of hotlines today. Calls to this national toll-free number, 1 (800) 273–TALK (8255), are funneled through this network to local call centers across the United States, based on the area code of the caller. During calls, the crisis call counselors listen empathically and empower callers to make decisions that resolve their own crisis. They offer information and resources and help callers craft plans for how they will prevent, cope with, or get help for their emotional crisis.
Similarly, the Crisis Text Line also offers immediate support during any type of crisis. Just like the National Suicide Prevention Lifeline, the Crisis Text Line is free and offers 24/7 support for those in crisis. People in crisis and the people who are supporting them just text HELLO to 741741 from anywhere in the United States to connect by text to a trained crisis counselor.
Summary
In conclusion, workplaces are arguably the most impactful system to improve adults' emotional well-being. By proactively increasing protective factors and reducing toxicity, job strain, and the effects of workplace trauma, workplaces can reduce the risk of catastrophic outcomes of unaddressed mental health conditions and suicidal despair. When workers are suffering, workplaces can help them identify emerging concerns and can link them to appropriate resources before these issues become life-threatening. Finally, should workplaces experience a mental health crisis or suicide, leadership can help facilitate support for people experiencing subsequent hardship, grief, and trauma.
References
M.P. Cheltenham, A.E. Crosby, and J.J. Sacks, "Incidence of Suicidal Ideation and Behavior in the United States, 1994," Suicide and Life Threatening Behavior, Summer 1999, pg. 131–140.
D. de Leo and D. Murray, "Suicidal Behavior by Motor Vehicle Collision," Traffic Injury Prevention, September 2007, pg. 244–247.
S. Binstock, C. Carlough, A. Gai, K. Gardner, and S. Spencer-Thomas, "You Can't Fix Your Mental Health with Duct Tape: Continuing the Conversation of Suicide Prevention in the Construction and Extraction Industry," presentation at the American Association of Suicidology's national conference in Washington, DC, 2018.
C. Koch, "Sleeping While Awake," Scientific American, November 1, 2016.
B. Bartholow, W. LiKamWa McIntosh, C. Lokey, F. Luo, S.M. Marsh, C. Peterson, P. Schumacher, D.M. Stone, H. Tiesman, and A. Trudeau, "Suicide Rates by Major Occupational Group—17 States, 2012 and 2015," Morbidity and Mortality Weekly Report, November 16, 2018, pg. 1253–1260.
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