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Each year, the month of May sheds light on mental health awareness. As May 18 marks Mental Health Action Day, there’s a heightened effort to shift mental health awareness into action for one's mental health as well as the support of others. To learn more about the startling statistics surrounding mental health and suicide in the construction industry, BUILDER turned to Dr. Sally Spencer-Thomas for insight.

Spencer-Thomas is a clinical psychologist, mental health advocate, and researcher who is dedicated to the mission due to the suicide death of her brother. With a goal of giving a voice to those who have lived through depression, addiction, and the impact of suicide, she aims to leverage their wisdom to develop programs and strategies that empower cultural and systemic changes in workplaces, education, and communities.

Dr. Sally Spencer-Thomas
Courtesy Dr. Sally Spencer-Thomas Dr. Sally Spencer-Thomas

An accomplished speaker with a TEDx talk and a White House address, Spencer-Thomas is also the lead author on the National Guidelines for Workplace Suicide Prevention. She has worked hand in hand with construction clients—including JE Dunn, Hensel Phelps, Sundt, and others—to overcome the barriers of mental health stigma that are especially prevalent in the building industry.

Spencer-Thomas also has partnered with the NAHB to conduct a pilot program, “Blueprint for Worker Well-Being,” with the North Carolina Home Builders Association. She shares more on the program below.

BUILDER: How can discussions about mental health and well-being be normalized in the residential construction industry?

Spencer-Thomas: The best way to normalize conversations about mental health and well-being is to do so in small groups with trusted facilitators. The first step is to bring awareness to the issues through data. We need to give concrete data about how different trades are impacted by things like suicide, addiction, and overdose. It's best when we do live polling in large groups, and we can see in real time that everyone in the room has been touched in some way—either they've experienced it, or they've lost a loved one to suicide or overdose or the consequences of addiction, or they've been a primary caregiver for someone who has been fighting through these issues.

Once we have the data, and we break them up into small groups and create a safe space, almost everybody has a story to share. And that's when we start to shift culture. That’s when they start to realize this is a human issue—not an 'us' versus 'them' issue. That’s when they start to wonder—'what can I do to help?'

BUILDER: Why is there a mental health stigma when it comes to construction workers?

Spencer-Thomas: Mental health 'bias'—as I like to call it—exists because of misinformation and myths about what causes mental health challenges and what types of 'troubled people' (the 'others') have mental health challenges. When it comes to a community that is valued for its tough-mindedness, its stoicism, and its ability to solve problems, this bias is particularly strong. It's strong because people have been valued for their ability to deal with high levels of stress and to solve difficult challenges. People have been valued for their ability to make difficult decisions and be the one that people turn to; not the one who leans on others for support. So, due to all of these factors, construction workers are the least likely to reach out for support even when the situation can be catastrophic. They're more likely to 'white-knuckle it' through very difficult situations until the situations become life threatening.

We break this bias by getting construction workers to talk openly about their experiences with depression, anxiety, addiction, and trauma. Once they know they're not alone, once they know that others like them have similar experiences, the bias is reduced. People see others in their community that have suffered and have the courage to reach out and get support and find a pathway into recovery. This sense of community gives others a sense of safety to disclose as well.

BUILDER: What are some of the stats surrounding mental health and suicide for the industry?

Spencer-Thomas: The main data that people refer to comes from a series of reports from the Centers for Disease Control and Prevention. For three reports, they ranked industries by rates of suicide, and construction has been No. 1 or No. 2 on that list ever since they started publishing it in 2016. These reports got the attention of a lot of people. Within that list, there is a ranking of the different trades as well. We can see that there is great variability between the highest-ranking trades, which include roofers, iron workers, and millwrights, and some of the lower-ranking trades, but all of them are above the general population.

The other statistic that gets people's attention is when you compare the number of suicide deaths in construction with the number of jobsite fatalities. There's about 1,000 people who die in the construction industry on jobsites each year from slips, falls, electrocution, and so on. In the same year, there will be a well over 5,000 construction workers who die by suicide, and well over 14,000 construction workers who die from an overdose.

Given that the construction industry puts a high priority on worker safety, these data are alarming and have really galvanized companies and unions to be proactive.

BUILDER: What prompted the pilot program with the NAHB and the North Carolina Home Builders Association? How is it progressing?

Spencer-Thomas: United Suicide Survivors International, a Colorado-based nonprofit has partnered with our company to develop a program called Construction Working Minds. The forward-leaning leaders of the NAHB learned of the statistics several years ago and started taking action steps to inform their chapters of this significant health crisis of the construction workers and discovered that they wanted to do more than just share death data.

Over the years we have done general awareness sessions and have created some videos about mental health in the construction industry. In 2021, the leaders decided to go another step to do a deeper dive with a Needs and Strengths Assessment effort to understand why home builders might have increased risk and what they might need to help support their mental health. In addition, we also implemented a toolbox talk program, as well as a storyteller program.

The Needs and Strengths Assessment included a survey, focus groups, and interviews. The engagement distribution was a bit of a challenge, but the findings were meaningful. The data showed us that the members of the North Carolina Home Builders Association were impacted by stress of the work and often held stigmatized views on mental health conditions and suicidal thoughts, which are significant barriers in engaging them proactively.

However, there was interest from the members in how they might get more clarity on how best to access resources to support others. In the storytelling part of the pilot, we worked with two leaders within the North Carolina Home Builders Association to help empower them to share meaningful stories of living through mental health challenges or being impacted by someone else's addictive behavior and suicide. These storytellers went through a storytelling retreat, and at the end they were able to disclose a brief and powerful story from their lives that made the case for taking action in mental health promotion in construction. These brief videos have now been shared within the chapter and nationally, modeling for others how these issues show up in people's lives and what people can do to make a difference.

Finally, from July 2021 to January 2022, there were 39 mental health toolbox talks that went out to the membership from topics ranging from sleep and anxiety to much more. These toolbox talks impacted almost 9,000 recipients with an average of 95 clicks to download each toolbox talk suite. That’s pretty significant engagement.

BUILDER: What can builders do to begin developing a mental health and suicide prevention awareness program?

Spencer-Thomas: Our suggestion is that they start by listening to their people, just like the North Carolina chapter did. Understand where the gaps are and create awareness and opportunities for small group conversations. Once you’ve identified a problem within the home builder community, people want to solve that problem. People want to know what to do if they're worried about themselves or somebody else.

Leaders should get to know the mental health resources—whether it's an employee assistance program, crisis resources like 988, or your local mental health county center. It’s best to proactively get familiarity, so that when there is a crisis moment, leaders know what to do. They know what to expect from the mental health support services, and they have built relationships with these organizations so that there's a smooth transition into support.

One of the biggest things that employers and builders can do is really start to drive a culture of care. Make it normal that people reach out to one another, check in with each other, offer peer support, and be knowledgeable and open to understanding what people need when they face tough times.

When builders and employers are serious about this, they develop a comprehensive and sustainable strategy, based on the nine practices of the National Guidelines for Workplace Suicide Prevention. In 2022, a certification process called H.O.P.E. Certification was developed for coaching and recognition to organizations who successfully implement these best practices over the course of a year. Just like we certify organizations for being environmentally friendly through LEED certification, we certify them for being mentally healthy. This is the future of health and safety in construction.