“Mental Health and Suicide Prevention” was a presentation at the American Society of Safety Professionals (ASSP) annual meeting held in early June in San Antonio, TX. Karen Forner, a lawyer, and Mike Ellis, safety manager for Apollo and Apollo Mechanical Contractors, were the speakers. This column, depicting the case of a fictitious construction worker, is based on information presented at this session.
More construction employees are lost to death by suicide than any other cause. The rate of suicides in construction is five times greater than the rate for all fatal work-related injuries. In 2021, 48,183 people died by suicide. Mike Ellis lost a brother to suicide. And the night before this presentation, an Apollo employee was found off-site, in a car, dead – yet another suicide by a construction employee.
Why does the construction industry have a suicide rate much higher than other industries? Let’s examine the fictitious case of Ned Roof for factors, symptoms and behaviors.
Ned was 27 years old with nine years’ experience in construction. He got his first construction job straight out of high school and had no college education. His salary was less than $45,000 per year. The typical worker who has mental health issues is age 18-39, with no college education, and earns less than $45,000 per year.
After almost a decade in construction, Ned believed he could handle any problem that came his way. That includes the chronic pain he suffered in his lower back from a variety of tasks – lifting cement bags, standing on ladders for long periods of time, scrambling across roofs with no fall protection, and balancing himself and twisting in awkward positions while framing, balancing on wood beams.
For years Ned suffered no pain on the job. But working for one small contractor after another as a “jack of all trades” handyman the pain crept in. It was minor and tolerable at first, but increased with the years to the point it affected his sleep. His pain combined with financial worries had him tossing and turning and often getting by with four or five hours sleep. He was taking prescription sleeping pills, but they didn’t ease his worries about layoffs and the high-pressure schedule he faced. The push to put up houses didn’t mix well with Ned’s perfectionist personality.
Ned, a young father with three children, took his family responsibilities seriously and knew he needed to make more money. He was considering changing careers; he was still young. And he didn’t like the isolation and separation from his wife and children when projects took him away from home for weeks at a time.
The pressure Ned put on himself to be the family provider, to tough out the pain, to build a house as perfectly as possible, and to go through with a career change began to eat at him. He found himself feeling badly for no apparent reason; feeling angrier over little things that used to not bother him, like trash on the worksite or the lack of “thank you’s” or encouragement from his supervisor.
He was more aggressive, more tense or nervous. He spent less time with coworkers and ate lunches alone. Ned also lost interest in things he like doing. He was playing less with his kids; stopped hunting and fishing; and found himself drinking more beers almost every night.
This change in behavior was noticed by his young wife. “What’s the matter with you? You’re getting a beer belly and you look like you’re having no fun. Everything alright at work?” “I’m fine. It’s all good.”
Ned’s denial extended to refusing to get help. “Behavioral health care? Don’t know what it means and I don’t need it.”
Coworkers saw changes in Ned, his withdrawal from the lunch crowd, sometimes looking distracted or lost in thought, complaining about his bad back, upset at bad housekeeping he blamed on the crew being lazy. His mood kept even his friends at bay. And his supervisor had no training in the warning signs of mental health decline. He avoided Ned as much as he could, as long as Ned didn’t screw up.
Ned got a prescription for opioids for his back pain, which didn’t mix well with alcohol. He started forgetting things, like one of his boys’ pee wee game or what his wife asked him to pick up on the way home from work. He was having trouble relating to the family. Felt he was a burden on them, and not holding up a man’s financial responsibility to his family. He was confused and uncertain about changing careers; it would be a step back to get ahead later. He took more oxy pills to feel better.
One day on the jobsite a coworker got in Ned’s face. “What’s the matter with you? You’ve changed, man. You act like you’ve got the weight of the world on your shoulders. We all got a job to do here. Just do it.”
That was the trigger. That night after his kids and his wife went to bed, Ned went outside and got in his car. He sat there thinking, “There’s no way out. This pain won’t go away. I don’t have time to start a new career. I’m letting the family down. I’m not the same person. Drinking too much. The guys don’t like me.” He gulped some beer, dug into his bag of oxy pills, swallowed a big handful, and washed it down with more beer. In the morning his wife found Ned slumped against the driver’s side door. The doors were locked. She yelled and pounded on the windows. Ned didn’t move.
Construction industry risk factors for suicide: tough person culture, chronic pain, sleep problems, isolation/separation, layoffs, prevalent drug/opioids and alcohol abuse; high-pressure schedules; lack of leadership training; and reluctance to seek help.
Signs to look for in someone who may be having a mental health crisis, that could lead to a suicide attempt: withdrawal from friends and family; depression; substance abuse; experiencing mental and possibly physical pain; loss of emotional control; denial; behavior changes; loss of self-esteem. There can be many other clues.
According to the Centers for Disease Control and Prevention (CDC), 53.3 construction workers out of every 100,000 fall to suicide each year. A stark difference to the overall suicide rate of 12.93 people per 100,000 in the United States.
Suicide Prevention Lifeline: 1-800-273-8255
National Alliance on Mental Illness: NAMI.org / 800-950-6244
National Action Alliance for Suicide Prevention: ActionAllianceForSuicidePrevention.org / 202-572-3784