Suicide prevention in the construction workplace A huge THANK YOU to MHA and the Seeds Conference Committee for their: Recognition that my industry has a problem Opportunity to apply my industry thoughts to ALL workplace environments

Let’s go back 35 years Mental Health Association of Arizona The challenges Struggle for recognition of mental health challenges Struggle for parity with physical illness Struggle for STIGMA elimination The successes Declaration of May as Mental Health Month in AZ Parity recognition = footing with physical Annual “Seeds” conference established in May!!

Fast forward to Fall, 2015 Construction Financial Management Association SW Regional Conference Construction in “Top 9” industries for Suicide Deaths Time to attack this industry issue; started in Phoenix, AZ First Construction Industry Suicide Prevention Conference

Fast forward to July, 2016 Center for Disease Control comes out with report Suicides by industry segments Suicide deaths highest per 100,000 employees Farming, forestry, fishing 84.5 per 100,000 Construction Construction/Extraction 53.3 per 100,000 Architect/Engineering 32.2 per 100,000 Suicide deaths by the numbers – Construction/Extraction ranks #1

Why the workplace? “The workplace is the last crucible of sustained human contact for many of the 30,000* people who kill themselves each year in the US. A co-worker’s suicide has a deep, disturbing impact on work mates. For managers, such tragedies pose challenges no one covered in management school.” Sue Shellenbarger, Wall Street Journal (2001) *Current statistics put the number of REPORTED suicides deaths at 45,000+

Why is this a construction issue? 2nd leading cause of death for men 25 - 54 78% of suicides are by men More people die of suicides than in auto accidents More likely cause of construction worker death than falls Suicide CAN BE preventable Part of a Safety 24/7 , Zero Injury & Incident Culture Work, Home & Play Personal responsibility & crew accountability

Why construction – check out the risk factors! Stoic, “old school”, “tough guy”, “suck it up” culture/mentality Promotion of supervision without leadership training High Pressure/Low Margin for Error

Why construction – check out the risk factors! Family separation and isolation with travel Sleep disruption/deprivation due to shiftwork

Why construction – check out the risk factors! Seasonal layoffs and end of project furloughs Tolerant culture of alcohol and substance abuse

Why construction – check out the risk factors! Chronic pain Access to lethal means

Why construction – check out the risk factors! Skills gap to do something else; trapped in job with no way out and needing to provide for family Poor access to and/or Utilization of Behavioral Health Care

How our industry – and YOUR businesses should approach this issue: Upstream / Midstream / Downstream Approaches

Upstream – Leading indicators GOALS: Build Protective Factors Prevent Problems Identify & Promote Resources ACTIONS: Leadership Engagement Integrate with safety, health, wellness and employee benefits, coordinate with labor unions Creating social networks within the workplace (Peer Support) Nurture mental health literacy Teach life skills

Midstream – Leading indicators still GOALS: Early Identification Link to Care ACTIONS: Learn warning signs and responses (Gatekeeper training) Screenings – mental health to go along with biometrics 3. Include mental health as part of performance management 4. EAPs & Employee Benefits: Do they provide access to Quality Mental Health Services? Know & communicate benefit programs to employees

Downstream – Lagging indicators GOALS: Manage crises Restore functioning ACTIONS: Restrict Access to Lethal Means Know resources to contact (lifelines, postvention) Dignity & Empowerment Grief & Trauma Support

We strive to educate our employees: What are the warning signs? performance: Increased tardiness/absenteeism Decreased productivity Increased conflict among co-workers Near hits, incidents and injuries Decreased problem-solving ability Decreased self confidence

More warning signs we discuss Noticed by co-workers, friends & family: Appearing sad or depressed most of the time Talking about feeling trapped, wanting to die, being a burden, feeling hopeless or helpless Extreme mood swings Increased drug or alcohol use (self-medicating) Sleeping too much or unable to sleep Acting anxious, agitated or reckless Withdrawing They may be able to keep “performing” well at work through these issues which is why relationships at work are important, so that these warning signs can be noticed! !

“The Wall” – trying to see beyond the obstacles Mental Illness Loss Identity Family Health Relationships Financial Issues Work

Opioid Addiction – we know this is an issue in our industry - - yours? National epidemic 90+ deaths daily in US (estimated, likely far higher) Life expectancy in US falls second year in a row 1,000+ ER visits per day 6 in 10 Overdose deaths are prescription painkillers or heroin Quadrupled since 1999 Affects 7 out of 10 workplaces Total overdose deaths in 2015 = 52,404 Those at risk of mental illness more susceptible to addiction

Opioid Addiction In addition to immediate physical dangers, indirect risks exist: Engaging in risky behaviors (removes inhibitions) Criminal behaviors to support addiction Shame quickly leads to downward cycle of depression, anxiety Like other addictions, successful treatment possible with early intervention, behavioral therapy, removing shame/stigma

Efficacy of pain mediations Acute pain

TEATER HEALTH SOLUTIONS Workplace actions Protect employees by directing occupational medical providers to reduce opioid prescribing Update Drug and Alcohol policy to: Do random testing on employees in safety-sensitive positions Refer positive tests to an EAP that can evaluate and treat Educate employees about the dangers of opioids TEATER HEALTH SOLUTIONS

FIELD/PROJECT MANAGEMENT Suicide Prevention is a TEAM effort – How to apply to your workplace structure CORPORATE LEADERSIP HR & SAFETY FIELD/PROJECT MANAGEMENT

Organizational Role: Safety Upstream, midstream & downstream opportunities Make Suicide Prevention a Health & Safety Priority Incorporate into Toolbox Talk subjects Add to daily JHA process: “Is everyone physically and mentally ready to work today?” Add questions to Near Miss & Incident/Accident investigations and reports to address

Organizational Role: Safety Critical Incident Debriefing: A critical incident is any situation faced by individuals that causes them to experience unusually strong emotions which have the potential to interfere with their ability to think clearly. Need to have: Notification process Follow up process Referral as necessary

Organizational Role: Managers/Foremen/Superintendents Front line interface with employees Observe performance, changes in behavior Build relationships, trust, opportunities for sharing Likely who “first report” of concern would go to Gatekeeper Training: Warning Signs Referral process

Organizational Role: Managers/Foremen/Superintendents Supervisory Training including: Relationship building with employees Identifying and dealing productively with disciplinary issues (using as a learning/building opportunity, not destructive) Importance of teams/bonds – creating peer support systems – considering in dispatch/scheduling Promote “My Brother’s Keeper” mentality – watching out for each other

Organizational Role: HR Addressing ADA, HIPAA concerns: ADA really REQUIRES intervention when an employer is made aware of a health issue (mental health included) Reduces risk of litigation as employee can be assisted to restore them to fully functioning – if it is ignored, and gets worse resulting in termination – litigation much more likely Accommodations only have to be reasonable HIPAA – primary importance in EAPs – educate employees that all information they provide to EAPs is confidential

FNf Construction, inc. PUTTING Suicide prevention INTO ACTION

TEATER HEALTH SOLUTIONS Posters Newsletters Weekly Health Alerts Wellness Program EAP IDShield/LegalShield Wallet Cards Company Charge Card Sleeves TEATER HEALTH SOLUTIONS

FNF’s Safety Director commented:  I’m trying to get to know everyone in the field, work history, family, hometown, etc. Trying to build that relationship not only to get the most out of each employee but also to establish their trust that if someday they needed to reach out to me for assistance in this area they would.

RESOURCES Where to get help Next steps TEATER HEALTH SOLUTIONS

www.cfma.org/suicideprevention

Alliance Members

www.CFMA.org/suicideprevention

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