[Cover page]
PUBLISHED 2022
SUICIDE PREVENTION IN THE CONSTRUCTION INDUSTRY:
A Resource for Champions
[MassMen logo & MA DPH logo]

[Page 1]
SUICIDE RISK IN CONSTRUCTION
Working in the construction industry can take a significant toll on one’s health. If you’re familiar with construction, you know that it comes with numerous health and safety risks, from slips, trips-and-falls, to struck-bys, loud noises, electrical hazards, and more.  It’s a physically demanding job, but it’s also taxing on mental health and well-being. 
Each year, the rate and number of deaths by suicide among people in construction occupations are higher than any other occupational group. For many workers, there can be unpredictable schedules, varying job security, and limited benefits. The risk of substance use disorder stemming from pain management among workers also contributes to mental health risks. The COVID-19 pandemic has only added to these challenges for workers. However, by working together, you can play a part in reducing their risk for suicide.

Each year, the rate and number of deaths by suicide among people in construction occupations are higher than any other occupational group.
Among occupation groups, the Construction and Extraction group had the highest number of suicides (n=316), and the highest suicide rate (49.2 deaths/100,000 workers).
Among industry sectors, the Construction sector had the highest number of suicides (n=358), and the second highest suicide rate (42.3 deaths/100,000 workers), second only to Agricultural, Forestry, Fishing, and Hunting.
Data listed above is from the Occupational Health Surveillance Program, Massachusetts Department of Public Health “Data Brief: SUICIDES IN MASSACHUSETTS BY INDUSTRY & OCCUPATION: 2016-2019.”
[Page 2]
The Massachusetts Department of Public Health (DPH) Suicide Prevention Program (SPP) is committed to raising awareness of suicide as a public health problem, specifically within high-risk occupations and industries such as construction. Through the CDC Comprehensive Suicide Prevention Grant and state funding, DPH provides support to community agencies, education, and training for professionals and caregivers, and funds programs working with youth, veterans, and older adults.

ABOUT THIS RESOURCE
With insight from many individuals in the construction industry, DPH developed this resource for anyone that is working to champion mental health and suicide prevention in the workplace. This “champion” could be someone working in construction who is a trusted peer and leader, hoping to bring this issue to the forefront. Other examples of champions that could use this resource are:  
▶	Construction company owner or executive
▶	Construction company human resources professional
▶	Construction company project manager
▶	Safety manager or other construction site leader
▶	Employee Assistance Program (EAP) manager or company liaison
▶	Union leader or member
▶	Shop steward
▶	Trade association
▶	Worker center advocate

This resource is not a guide for implementing a specific suicide prevention program, since no one program fits every company, union, or organization. Instead, this resource provides a starting point for increasing awareness and bringing support and resources to construction workers through existing or new workplace connections.
ACKNOWLEDGEMENTS 
The Massachusetts Department of Public Health’s Suicide Prevention Program would like  to thank the stakeholders and interviewees that were involved in developing this resource:  Jim Barnett, former construction industry safety manager, J.J. Bartlett, Fishing Partnership,  Julie DeStefano, Gould Construction Institute, Greg Dodd, Teamsters Local 25, Jamie Evans, Turner Construction, Greg Beeman, Associated Builders and Contractors Massachusetts, Leslie Russell, TeamstersCare, and Larry Berkowitz, EdD and Michael Bonadio Jr, LMFT, Riverside Trauma Center, a service of Riverside Community Care. Michael Bonadio Jr. is also the Program Coordinator of the MassMen Project.
[Page 3]
What does it mean to incorporate suicide prevention into the health and safety program at the construction workplace?
KEY COMPONENTS OF SUSTAINABLE INITIATIVES 
Workplaces or work-related/industry groups (e.g., union, worker center, professional or trade organization), can be avenues for construction workers to feel informed, acknowledged, and supported in mental health. Making mental health and suicide prevention a sustainable, embedded part of the workplace culture takes time, investment in employees, and buy-in from many groups who interact with workers. 
Below is a list of key components of mental health support and suicide prevention in the workplace and long-term goals for each component. With these components as a priority, suicide prevention efforts will be sustainable and more likely to embed in the workplace long term.  
Awareness
Many in the construction industry are well aware of the risks and challenges of the work. The question champions should consider is what actions their company and/or union are taking to address the issue and even more importantly, is there awareness among employees that support is available?  
▶	Managers are aware of the commitment to mental health among workers as part of overall health and safety.
▶	Workers/employees are made aware of mental health resources and support regularly by a trusted peer and messages are reinforced at the leadership and/or managerial level.
▶	Workers/employees are regularly made aware
of sick leave policy, or policies around mental health leave so they can take advantage and access these benefits.
▶	Mental health and suicide prevention messaging is present and reinforced outside of the job site, such as at company-sponsored community events or union-led events.
[Page 4]
Training
Training on mental health and suicide should be multi-pronged so that leadership, managers, and trusted peers understand signs and successful interventions they can use to help colleagues. Training should be thought of as ongoing and not a one-time event.
▶	Leadership training incorporates mental health and suicide prevention awareness.
▶	Those in safety-related roles, such as Safety Directors/Managers and safety consultants, are trained on mental health safety and well-being as part of regular, required trainings.
▶	Trusted peers can access trainings on mental health and suicide prevention and there are avenues to communicate what they’ve learned to peers (peer-to-peer model).
▶	Trusted peers on job sites, such as a Shop Steward, are trained on mental health-related benefits available through any Employee Assistance Program (EAP) services.
Policies and Practices
Suicide rates were almost two times higher among workers in occupation groups with low percentages of workers covered by paid sick leave compared to workers  in occupation groups with high percentages of workers covered by paid sick leave.
A supportive paid sick leave policy is a critical first step in ensuring that workers have the tools and resources to stay well. Massachusetts has an earned sick time law that covers most employees. Some goals for taking the first step to address sick leave as it relates to mental health and suicide risk are:
▶	Policies for mental health and/or sick days are communicated at every level across the company.
▶	Trusted peers can gauge employees’ level of awareness of sick policies and deliver messaging appropriately.
▶	Review how mental health issues are discussed among employees as it relates to sick time and benefits.
Connection to Support and Resources
One challenge for many companies may be that employees are educated about the mental health resources that are available to them, but there is not a clear pathway to accessing those resources or the steps to accessing resources feels impossible to navigate alone. The goal for connecting employees is to:
Identify a trusted peer who can communicate about support or resources available to employees.
▶	Ensure trusted peers know relevant EAP information and/or can identify community members who know about accessible mental health resources.
▶	Provide trusted peers with opportunities to share information about mental health, like at toolbox talks and on-site lunches.
[Page 5]
Is my company or organization addressing mental health and suicide prevention?
COMPANY OR ORGANIZATION EVALUATION 
Take note of where your company or organization stands when it comes to addressing suicide prevention. What is working? What steps can you take to get started or build on existing efforts? 
Whether your company or organization already discusses suicide prevention, or the issue is being addressed for the first time, use the following questions to understand how you might move forward with mental health and suicide prevention efforts.
The Construction Industry Alliance for Suicide Prevention’s Needs Analysis Tool can help identify steps for leadership to take to implement  suicide prevention.
Leadership Buy-In and Training
▶	Who in leadership positions of your company, organization, or union are aware of suicide risk in the construction industry, if anyone? Have they acknowledged or addressed this issue among managers and employees?
▶	Are managers or other leaders encouraged and given tools to communicate company policies to the workers on their job sites?
▶	Are there opportunities for managers in safety-related roles to access training in mental health?
Employee Awareness and Communication:
▶	Is there employee-facing communication about mental health and suicide? Who delivers this information? Are they a trusted peer or someone in management position, outside of the company, or other? What trusted peer(s) could deliver this information, consistently?
▶	Are employees made aware of any existing EAP and other resources, if available?
▶	Have employees been informed of an EAP, professional organization, point person, or other resources to get information about mental health support?
[Page 6]
Employee Support:
▶	Do employee benefits programs provide information about mental health screening, referrals, and other resources?
▶	Are peers encouraged to check in with others and provide information about resources if someone is struggling?
▶	Is there an established point of contact for employees, when possible, if they need information about mental health benefits or resources?
▶	Is there an opportunity to engage a union about mental health and suicide prevention? If engaged with a union, how is the union working with trusted peers on job sites to promote mental health resources?
▶	Is there an opportunity to leverage a local trade association’s chapter that can provide training to trusted peers?
▶	Has the company considered holistic mental health, such as addressing stressors like financial management, safe and stable housing, food insecurity, and access to health care?
[Page 7]
What has worked for other companies?
BEST PRACTICES FOR REACHING AND ENGAGING CONSTRUCTION WORKERS
Research with stakeholders in the construction industry illuminated some best practices and steps companies or organizations can take to engage and support construction workers successfully. Resources connected to these best practices are linked below and can be found in the Resources section. 
Employee/worker learns about mental health resources from a trusted peer who uses simple messaging to connect with them.
Help workers designate or “elect” a peer or peers on site who can share information about available mental health resources, benefits, or support. Ensure this person is trusted and respected as a peer and is independent from leadership in the company. This could be a shop steward, safety lead, union representative, project manager, or simply a long-time worker who’s well-known and trusted by workers.
•	 Train them on available resources for employees and how to access
those resources, such as an EAP or MAP (Member Assistance Program), MA state benefits requirements, and company policies and practices when it comes to sick or mental health days, if available.
•	 Give them signage, handouts, info cards, toolbox talk guides, and/or other materials to post and share on site.
•	 Share widely that this trusted peer is available to anyone and everyone
on site who has questions or is looking for help.
▶	 Train the trusted peers on spotting mental health or suicide
risk signs in fellow construction workers while addressing
the importance of confidentiality.
▶	 Equip the trusted peer with confidence and encourage simple
ways that they can engage a peer who might be struggling—
smile, say hello, ask how they are doing/how their family is
doing, and ask if they need any help.
▶	 Give them simple referral pathways in case they talk with a
peer and the individual wants to access mental health support.
▶	 Give them simple quick steps to follow in case someone they
talk to is in immediate danger.
[Page 8]
Employees believe the company or organization is aware and working to address the mental health risks of the job.
▶	Get buy-in from company or union leadership.
•	 Share the data on the suicide rate in construction with leadership to help them see the continued issue of worker mental health.
•	 If working with company leadership, share the benefits of good mental health.
1.	Less turnover
2.	More productivity
3.	Less money spent on accidents/injuries
4.	Positive attitudes
5.	Employees recommending the workplace to peers
•	 Share the Snapshots of Success section in this resource tool for examples of the range of approaches that can work.
•	 Advocate for support, resources, and funds, if needed, to develop a program that will complement benefits or EAP services they might already provide.
▶	 Engage trusted communities and networks to build credibility and reach of efforts to support mental health.
•	 Reach out to unions and make sure their resources are clearly shared via respected, on-site peers.
•	 Give unions an opportunity and platform to share resources at meetings and community events.
•	 Inform trade associations about your efforts so they can advertise and support.
1.	Encourage them to offer and incentivize mental health first aid trainings.
2.	Ask them to share about mental health efforts and resources in communications and at community events.
3.	Suggest they engage professional/industry committees to start or support efforts that could be happening in
their companies.
▶	 Ask leadership to support in the background so that peers are at the forefront and the work is on-the-ground. Respectfully tell leadership that the most effective way to encourage workers to seek help is to make sure they know leadership supports mental health, but that leadership won’t find out or interfere if they share with a peer that they need help.
•	 Allow leadership to make a simple statement of support—such as acknowledging the well-known risks and challenges to mental health in the construction profession without patronizing workers. Consider company communications like company meetings and/or newsletters.
[Page 9]
Employees can access resources and support.
Identify and compile all the resources that might be available to construction workers on your sites:
•	Company benefits
•	Union benefits
•	Massachusetts state-required benefits
•	EAP or MAP
•	Trade association resources
•	Peer resources
•	 Community health centers, mental and
behavioral health centers and organizations
•	Men’s mental health services
•	Multilingual mental health services
•	 Mental health and suicide prevention hotlines
▶	 Promote help-seeking behaviors through signs on job safety
boards or other on-site places and messaging that trusted peers
reference and point-to during talks or presentations.
▶	 Prioritize connection for employees directly connecting to a resource that can navigate, coordinate, and provide support. If possible, create and/or share a trusted pathway for mental health referrals where workers showing signs of suicide risk can get started, either via EAP services, a community health center network, union or trade association services, or simply a crisis line like 988. Several crisis lines are listed in the Resources section.
•	 Understand which of the compiled resources give workers the best chance of accessing non-judgmental help and highlight those.
•	 Ask about where gaps and barriers in the resources exist and explore how they can be addressed with community partners and experts, like your EAP partner or a community health center professional.
1.	Is it difficult to get an appointment with a mental
health professional?
2.	Does insurance cover mental health appointments?
•	 Provide consistent and proactive education for employees about connecting to support and resources and the how to do so.
[Page 10]
SNAPSHOTS OF SUCCESS
Below are a few examples of Massachusetts companies and organizations that are tackling mental health and suicide prevention and the models they have found successful.
SNAPSHOT:
TeamstersCare - Union Model
Unions are a popular source of support and benefits for construction workers and 
other laborers. The Teamsters Union is one of the most well-known nationally and in Massachusetts. Because of their large membership and resources, Teamsters can provide a robust in-house mental health service called TeamstersCare. TeamstersCare employs mental health and substance use professionals who directly respond to the needs of their members. There are multiple effective characteristics of the TeamstersCare model. 
First, TeamstersCare works directly with Union members and never with employers. This helps create a safe environment for people who need suicide prevention services, reducing the fear that their employer might think they’re unfit for the job. Second, TeamsterCare professionals meet workers where they are—from showing up on the job site at 5 am to hand out flyers to following up directly by phone with members who they know need support. Third, TeamstersCare utilizes the Shop Steward model. Shop Stewards are elected by their peers and receive information and training about available EAP services and substance use disorder and mental health resources. Shop Stewards are the point person for peers on the job site and might also help run recovery groups. The effectiveness of Shop Stewards isn’t in knowing how to treat mental health issues, but in knowing how to spot signs a peer might be struggling, how to approach that person with kindness, and then know where to send them for support. 
While TeamstersCare might seem like an expensive, complicated model, these three elements of peer support, meeting workers where they are, and empowering a trusted peer with mental health information are ideas that can be repurposed in many different construction workplaces and settings.
[Page 11]
SNAPSHOT:
Turner - Large Construction Company Model
General contractors and construction management companies have an important role to play in making sure workers go home at the end of the day feeling physically and mentally well. Safety and Wellness leads within large construction companies can design programs that bring all their resources to bear on supporting mental health, suicide prevention, and substance use prevention and treatment sitewide. One large company leading the way in Massachusetts, Turner, conducted a thorough discovery of behavioral health policies and programs in the construction industry, benchmarking the current state of affairs and working to create an ideal mental health vision for their workers ever since. 
Having articulated a behavioral health mission statement, Turner then identified strategic buckets for action including awareness campaigns, behavioral health supports and resources, and connectivity. They’ve developed partnerships across multiple levels—from encouraging their corporate clients to have on-site mental health programs and clinicians to developing strategic visions of where their foremen and safety officers need to be in five years to best support worker well-being. They do lunches with the trades, toolbox talks, skills trainings for supervisors, stand downs on mental health, and bring well-being trailers to sites. 
Behavioral health is now built into all worker orientations, and peer-to-peer storytelling is key—Turner realizes that workers are more likely to hear a message about mental health from their peers than from a corporation. Getting clients on board is about helping them see on-site mental health programming as a tool for a sustainable and profitable business. They can use key performance indicators to track and see the impact of their behavioral health programming, just like they do with traditional worker performance plans. Across the board, Turner is all about communicating that promoting behavioral health in construction just makes good sense.
[Page 12]
SNAPSHOT:
Fishing Partnership - Community Navigator Model 
Connecting employees to community resources and services is crucial to supporting employees’ mental health on and off the job site. But it can be difficult for companies and organizations to stay knowledgeable about community resources and how to connect employees to these services. A community navigator model, in which trusted community members act as a bridge to the community and its resources, can help employees navigate barriers to accessing these resources. The navigator model is also valuable in industries where employees change jobs often and at workplaces that lack a human resources department and employer-provided healthcare services and benefits. 
Similar to construction, the fishing industry often requires employees to move from job to job, and work long and irregular hours that make it a challenge to access consistent healthcare services. To serve the needs of fishermen and their families in coastal towns across Massachusetts, Fishing Partnership Support Services provides community navigators to connect fishermen to health care coverage, primary care providers, and other health-related programs. Navigators live and work in the same communities as the fishermen they serve. 
This model creates trust and legitimacy, both of which are necessary components 
to effectively engage with families to provide desired and needed support. Fishing Partnership’s Navigators are Certified Community Health Workers and are trained to help fishermen and their families navigate the healthcare system and link them to resources necessary to improve their health and well-being. They receive regular training in Suicide Prevention (including QPR: Question, Persuade & Refer) and work with clinical professionals from Riverside Trauma Center to provide on-call support to help fishermen cope with accidents at sea and other traumatic events.
[Page 13]
RESOURCES
TRAINING RESOURCES AND GUIDES
Massachusetts Department of Public Health Suicide Prevention Program (SPP)
The following trainings are offered by the Massachusetts Department of Public Health Suicide Prevention Program (SPP). Details on the audience and training objectives are below. The SPP manages a DPH Suicide Prevention Training Calendar which offers courses throughout the year at a nominal fee to ensure availability to anyone looking  to learn more about suicide prevention.
Mental Health First Aid (MHFA)
Audience: Everyone (Gatekeepers)
Duration: 8 Hours
Aim:  Skills-based training course that teaches participants how to identify, understand, and respond to signs of mental illness and substance and disorders.
Question, Persuade, Refer (QPR)
Audience: Everyone (Gatekeepers)
Duration: 1 – 2 Hours
Aim: Decrease stigma, increase identification
Description:  Trains gatekeepers (anyone in a position to recognize the warning signs of a crisis) to recognize the warning signs of suicide, how to offer hope, and how to get additional help.
National Safety Council
NSC offers an employer guide for addressing workplace mental health.
LivingWorks 
LivingWorks is the world’s leading suicide intervention training company. They offer an array of training programs that meet every need. Their organizational trainings help build a powerful safety network for employees and those they support.
The Construction Industry Alliance for Suicide Prevention (CIASP) has partnered with LivingWorks to offer a free 60 – 90-minute LivingWorks Start online suicide prevention training.
[Page 14]
Suicide Prevention Resource Center (SPRC)
The Suicide Prevention Resource Center (SPRC) is the only federally supported resource center devoted to advancing the implementation of the National Strategy for Suicide Prevention. SPRC offers consultation, training, and resources to enhance suicide prevention efforts in an array of settings, including organizations that serve populations at risk for suicide.
A Manager’s Guide to Suicide Postvention in the Workplace
Postvention is the support offered after a suicide to affected individuals or the workplace. This guide from the National Action Alliance for Suicide Prevention provides workplace leaders with clear action steps for suicide postvention, including immediate, short-term, and long-term responses to help employees cope with the aftermath of the traumatic event.
NATIONAL INITIATIVES FOR SUICIDE 
PREVENTION IN CONSTRUCTION
CPWR - The Center for Construction 
Research and Training
CPWR works to reduce occupational injuries, illnesses, and fatalities in the industry by collaborating with partners on research and training. CPWR offers training resources on mental health  and addiction.
Construction Suicide Prevention 
Partnership (CSPP)
A project of members representing small companies, subcontractors, building trades, unions, and others who are promoting mental wellness on and off the job site. Resources include toolbox talks, flyers, action plans for companies, and more.
Construction Industry Alliance for Suicide 
Prevention (CIASP)
CIASP provides an implementation guide that breaks down integrating suicide prevention into three levels. Other CIASP resources include training (see LivingWorks above), a Needs Analysis and Implementation Tool, toolbox talks, videos, business cards, key tags, and posters for download.
CIASP Mental Health Screening from MindWise –
SafeBuild Alliance offers materials such as hard hat stickers, signs, toolbox talk guides, and more.
[Page 15]
LOCAL MASSACHUSETTS ASSOCIATIONS WITH ACTIVE 
SUICIDE PREVENTION EFFORTS
ABC (Associated Builders and Contractors) Massachusetts 
ABC Massachusetts has a partnership with the American Foundation for Suicide Prevention to “improve the mental health of construction workers through effective suicide prevention education, intervention and postvention strategies; to encourage, equip and empower mental health champions in the workforce; and to introduce collaboration between ABC and AFSP chapters nationwide.”
Association of General Contractors of MA
AGC of MA provides toolbox talks and a guide for talking with construction workers about mental health and suicide. 
MENTAL HEALTH AND SUICIDE PREVENTION 
RESOURCES FOR INDIVIDUALS
Below is a list of resources that can be disseminated and shared. The list should  
be part of other company, union, and/or organization-specific resources disseminated 
to employees.
MassMen   mass.gov/MassMen 
The MassMen website promotes wellness and empowers working-age men across Massachusetts to take action to feel better emotionally, physically, and spiritually. The website includes a mental health self-screening tool, videos, resources, and guidance for loved ones. 
988: Suicide and Crisis Lifeline   988Lifeline.org or mass.gov/988
The 988 Suicide and Crisis Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week, in the United States. If you call 988 when in Massachusetts, you will be directed to a lifeline specialist at one of our five crisis centers.
Massachusetts Substance Use Helpline   HelplineMA.org (800)-327 5050 The Helpline is the only statewide, public resource for finding substance use treatment, recovery, and problem gambling services. Helpline services are free and confidential. Trained Specialists can help you understand the treatment system and your options.
Intimate Partner Abuse Education Program (IPAEP) 
mass.gov/service-details/intimate-partner-abuse-education-program-services The mission of Intimate Partner Abuse Education Program (IPAEP) Services at the Massachusetts Department of Public Health is to promote the safety of domestic violence victims. The program works with certified IPAEP programs across Massachusetts to hold individuals who use violence in their relationships accountable for their actions and to help them change their behavior.