Safety Leader

A Spotlight on Mental Health: The holistic Total Worker Health approach addresses emotional well-being

Getty images / mustafahacalaki
Getty images / mustafahacalaki
Published On
Nov 15, 2021

It’s not news that construction work can be physically dangerous—there are roughly 150,000 construction-site injuries every year, according to the Bureau of Labor Statistics. What’s less documented is the toll construction work, electrical contracting included, can take on workers’ emotional well-being. Suicide has become a leading cause of death for construction workers, especially for men in the industry. This fact is leading top occupational safety and health professionals to argue for a more holistic approach to worker safety that considers mental health risk factors and obvious physical hazards.

Research by the Centers for Disease Control and Prevention (CDC) in 2016 outlined just how serious mental health challenges can be for those in the building trades. The extraction (which includes mining, oil and gas work) and construction industries lead most others in the rate of suicide among workers. The rate for men in these fields—at 49.4 out of every 100,000—was almost twice the total for civilian working men in the 32 states included in the data. That figure is also five times greater than the rate for all fatal work-related injuries in the construction industry in 2018.

Researchers point to a range of causes for why male construction workers are at such higher risk of taking their own lives.

“Transient work sites, traveling for work, extended unemployment and increased pressure to produce have increased employee issues on the job in dealing with companies and the stress that causes on family life at home,” said Wesley Wheeler, director of safety for the National Electrical Contractors Association.

Jonathan Oppenheim, Atlantic-South regional construction leader with the global construction-­focused insurer Willis Towers Watson, also cited several additional factors contributing to the especially high suicide rate in the industry. These include the following:

  • An occupational culture that values toughness, which can lead individuals to be less likely to seek help and assistance.

  • A high degree of substance abuse—construction tops all other industries in drug and alcohol abuse, Oppenheim said. The wear and tear that work can take on the body can lead to a dependence on opioids to handle the resulting pain.

  • Potentially limited access to medical care, including mental health services. Busy work schedules also can limit the time available to see a provider.

  • Feelings of shame and fear that can be associated with mental illness can keep workers from reaching out when help is needed.

Natalie Schwatka and Liliana Tenney are faculty members at the Colorado School of Public Health and the school’s Center for Health, Work and Environment in Aurora, Colo. Their research, primarily focused on their state, has helped identify how mental health issues can play out in real life.

“The environment in which you work really influences how healthy you can be,” Schwatka said.

Difficult work situations also can create a feedback loop, in which work conditions can impact family life, creating issues that then further influence behavior on the job, a situation she saw in her own work in the field.

“People were coming to work with behavioral health conditions, and they weren’t getting help,” she said. “We found that employees who are stressed are significantly more likely to have a workplace injury.”

According to Tenney, COVID-19 has brought added attention to mental health concerns.

“We have a spotlight on mental health now,” she said. “More than ever, workers are suffering these high rates of depression and there are high rates of opioid addiction. Employers now need to step up.”

Wheeler seconded this assessment of COVID-19’s impact.

“COVID has helped to identify the social aspect and interaction that workers need to be productive and engaged,” he said. “The social distancing due to COVID has increased this separation anxiety and, unfortunately in some cases, increased the workload. With construction workers who have been identified as essential workers, COVID has been the reason many employers have established new protocols addressing safety on the job site.”

Awareness of the significance of mental health issues among construction workers has grown over the last two decades. Over that time, the CDC’s National Institute for Occupational Safety and Health developed the Total Worker Health (TWH) approach to help employers understand ways workplaces can impact workers’ mental and physical well-­being. This also includes ways to better address other changes occurring among the construction industry’s workers.

“The TWH approach asks us to consider changing worker demographics. In construction, especially, the workforce is aging,” Schwatka said. “Using the TWH approach, we can think about how we can design a workplace that’s safe for everyone and about giving those in the industry the resources to deal with the chronic health problems they can have. Using this kind of approach is likely more effective than just focusing on safety issues alone.”

TWH goes beyond the kind of employee assistance programs that many employers have offered for decades. Instead of a discrete, one-off benefit that puts the responsibility for seeking out help on individual employees, TWH emphasizes raising the importance of mental health throughout an organization. This means ensuring executives and supervisors work to create a supportive company culture and that employees, themselves, have a voice in how TWH plans are created.

“Worker and management participation are essential in developing and managing TWH programs because no one knows what the day-to-day experience is better than the workers,” Tenney said.

This means inviting representatives across job titles to identify specific challenges and to serve as champions as these efforts are rolled out. Over time, those representatives also can provide a continuous feedback loop, “so, when things go wrong, those workers are able to come back with how it all went.”

Willis Towers Watson has partnered with Suicide Awareness Voices of Education (SAVE) to develop TWH training specifically for construction-related companies. Dubbed Ideal Body Environment and Mind (IBEAM), the program incorporates instructional videos, live presentations and face-to-face teaching modules to communicate its holistic approach to workplace health—mental and physical—to construction industry workers, supervisors and executives. The CDC has referred to the program as “a promising practice for the industry to adopt,” according to Oppenheim.

“We are currently piloting the entire IBEAM platform,” Oppenheim said in late September. “The feedback received  so far from pilot participants has been fantastic. Our expectation is that the pilot phase will be concluded in the next 60 to 90 days, with the entire platform rolled out during the first quarter of 2022.”

IBEAM training sessions are moderated by Dan Reidenberg, SAVE’s executive director and the managing director of the National Council for Suicide Prevention. They include three tiers of modules aimed toward specific employees within an organization.

  • IBEAM Executive is designed for principals, owners, senior stakeholders and others responsible for driving culture and providing access to resources and support. This module emphasizes the importance of a commitment to eliminate stigma and assure adherence to appropriate policies, procedures and protocols for mental wellness and suicide prevention.

  • IBEAM Supervisor is directed toward project foremen, job site supervisors, safety personnel, human resource professionals and others responsible for safety and well-being. This is the most intensive of the three tiers, focusing on how to talk to at-risk people, along with listening and directing those in need, which requires an understanding of what resources are available and how to access them.

  • IBEAM Workforce is a 30-minute session intended for the entire labor force that covers mental health and well-­being awareness and education. The five videos included in this module could be tied to new employee orientation. They’re intended to establish a base-level awareness of mental health issues and resources.

While TWH initiatives could be seen as adding to an employer’s workload, there seems to be little evidence of resistance against such programs, though aspects of implementation have raised concern.

“There has been pushback where there have been issues with confidentiality,” Tenney said. “The TWH community has been very responsive to, first, safety is the No. 1 priority, and when we’re asking employees about mental health, confidentiality is very important.”

Even with the changes that a shift toward TWH approaches can require in specific procedures and general outlook, they are gaining some favor among construction management, Wheeler said.

“Employers are open to addressing and assisting employees with the TWH issues since they have a huge investment in them,” he said. “Keeping workers healthy and content can lead to more productive and safer workers on the job. Keeping stress away from the workers allows them to focus on the tasks at hand.”

Schwatka said she’s actually seen a great deal of support among the companies she’s spent time with over the last six to seven years.

“I’ve worked with a lot of construction employers, both union and nonunion, in all trades,” she said. “The industry was so ready to tackle culture. They’re really looking to the next level. A lot are now focusing on expanding how workers can go home healthier than they were when they showed up. They’re actively seeking ways to have that conversation.”

While Tenney echoed her colleague’s assessment to a degree, she noted that progress in employee mental health efforts currently correlates strongly with a company’s size.

“The larger companies in the industry are still doing more,” she said. “There’s room to get smaller companies and contractors in the room. There’s still a gap in the type of companies being served, so there’s still more work to do.”

About the Author

Chuck Ross

Freelance Writer

Chuck Ross has covered building and energy technologies and electric-utility business issues for a range of industry publications and websites for more than 25 years. Contact him at chuck@chuck-ross.com.

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