January 2023 Vol. 78 No. 1


Mental Health Issues, Suicides Reaching Crisis/Epidemic Levels

Harry Miller | Vice President, Director of Safety and Labor Relations, SAK Construction 

(UI) — When I began my career in construction over 30 years ago, mental health and suicide were not on anyone’s list of concerns in our industry. Now, as a safety director, I strive each day to protect our workers from this hidden threat that has risen to become a crisis in our industry.

Like others in safety, I spend the majority of my time focusing on the tangible issues plaguing our industry. Those visible, daily hazards on our job site include important safety concerns such as confined space entry, traffic control, fall protection and PPE, to name a few. Each day we strive to ensure our workers return home safely to their families. 

Naturally, when I was asked to write this article, I started by researching one of my company’s biggest, visible concerns, confined space entry. Each year we hear about needless casualties of workers entering confined spaces who are not properly trained or have the correct equipment. 

However, when I reviewed the safety statistics, it was clear that mental health issues and related suicides are now becoming an epidemic plaguing our construction industry that many may not fully understand. 

When I speak about mental health issues to our crews and the industry, I emphasize that two major issues appear to be driving the increased rates of diagnosis: a lack of recognition and opioid use. Before we can begin to address the issue, our industry needs to recognize mental health problems and adequately train our workers to discuss them openly. 

The alarming problem with mental health is that low detection is leading to a rapidly rising rate of suicides in the construction industry. The Centers for Disease Control and Prevention (CDC) recently found that in 2015, suicide rates were highest among males in the Construction and Extraction occupational group (53.2 per 100,000 civilian non-institutionalized working persons. 

Incredibly, this number is four times higher than the national suicide average. Additionally, suicide rates are five times higher than overall construction deaths, so based on that fact alone, it qualifies as one of the OSHA Focus Four hazards. 

High suicide rates 

So, why is the suicide rate so high in construction? Experts believe that many contributing factors affect these statistics, but one that stands out is the lack of recognition of mental health problems in the industry. Construction is historically a male-dominated industry with a “tough guy” mentality and reputation. I’ve often witnessed societal pressures specifically encouraging men not to show emotion or weakness because they believe their peer group would not understand and may view them as weak. 

Combined with the fact that many in construction work remotely and are away from home, mental health issues are aggravated when isolated and separated from the support of friends and family. This feeling of isolation can often lead to additional personal issues, including gambling, infidelity, and drug or alcohol abuse. Lastly, the pressure of construction jobs to meet tight schedules, as well as concerns about job security, constantly adds fuel to the fire. 

Another major contributing factor is construction workers’ use of opioid-based drugs. Construction work is a physically demanding profession that takes its toll on a person’s body. Many construction workers suffer from chronic pain that for years was treated with potentially addictive opioid-type drugs, and unfortunately, now the industry has the highest use of prescription opioids. 

We read every day about the opioid addiction crisis in the U.S. and the devastation it is causing. In general, construction workers have nearly twice the rate of substance abuse versus the national average. According to data from the National Survey on Drug Use, conducted by the Substance Abuse and Mental Health Administration, nearly 15 percent of all construction workers in the U.S. have a substance abuse disorder compared to 8.6 percent of the general adult population. Other revealing statistics from this study pertaining to construction workers include: 

  • 12 percent have an alcohol use disorder compared to 7.5 percent nationally 
  • 16.5 percent reported heavy alcohol consumption within the past month, which is nearly twice the average of all full-time workers surveyed 
  • 11.6 percent reported illicit drug use within the past month 
  • 14.3 percent were diagnosed with a substance use disorder in the past year – more than 1.5 times the average of  all full-time workers surveyed 
  • 2.3 percent have a marijuana use disorder 

Opioid epidemic 

Still, it is the opioid epidemic that has hit the industry the hardest, and workers in this field are among the most susceptible to opioid abuse. It is estimated that roughly 1.3 percent of construction workers have an opioid use disorder, almost twice the national average, according to a report from the National Safety Council. 

It does not help that so many in construction are continuously prescribed opioids to deal with their pain. Almost three out of four injured construction workers were prescribed a narcotic painkiller in 2016. Opioids account for 20 percent of the total spending on prescription drugs in the construction industry, a higher amount than any other industry, according to a report by CNA Financial. 

Opioids are a “gateway drug” that often starts the journey to long-term addiction. In many cases, a worker will become addicted to a prescription and turn to other drugs for pain management when it runs out. These non-prescription and often illegal drugs result in overdose deaths and suicides using those same drugs. 

A recent study from Washington University in St. Louis measured the risk of developing opioid use disorder among more than 19,000 union construction workers, from January 2015 to June 2018. 

Researchers found that construction workers prescribed opioids for musculoskeletal pain had a significantly higher risk for long‐term opioid use and developing opioid use disorder. Annually, 15 percent of workers who were prescribed opioids became long‐term users. Also, long-term users were nearly 10 times as likely to develop opioid use disorder. 

What can we do to help? Start by increasing awareness so everyone can help recognize this issue. If you do not know, you cannot help. 

Encourage workers to reach out when in need. Find employee assistance programs that will work with your company and safety team to create an anonymous source for workers to get help when needed. Discuss the different resources openly with your workers and ensure th eresources are readily available. 

Tthe most powerful tool we have as an industry is to educate workers about the mental health issues plaguing our industry and eliminate the stigma. Create toolbox talks to “normalize the conversation,” because progress cannot be made without a cultural change in construction. The greater the education and understanding, the closer we will get to eliminating the stigma that keeps workers from facing their inner demons. 

I hope you will agree that this is a critical safety topic for the construction industry’s future. We will have a breakout session at the Underground Construction Technology (UCT) Conference & Exhibition in February in the Rehab Zone area. Please come to learn more about the issues, some solutions and resources to help end the epidemic.

HARRY MILLER is vice president and director of safety and labor relations at SAK Construction in O’Fallon, Mo. Hired in 2015, he is credited with elevating SAK’s safety programs to one of the industry’s best safety programs. Before SAK, Miller worked as a division safety manager with Black & Veatch, a global engineering, consulting, construction and operations company. 

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