Why a Comprehensive Approach Is Needed to Change Life-Threatening Problems
The construction industry is at heightened risk for mental health problems, substance abuse, and suicide. These conditions can be devastating to employees and their families, and can be very costly and disruptive to workplaces. For these reasons, a comprehensive and sustained strategy for mental health promotion and suicide prevention is needed. This guide is a call to action for all those ready to implement tactics to improve the mental health of their employees and ultimately save lives.
The Upstream, Midstream, Downstream Parable
Imagine you are walking along a river and hear a cry for help from someone drowning. You are startled but energized as you dive into the water to save him. Using all of your strength, you pull him to shore and start administering CPR. Your adrenaline is racing as he starts to regain consciousness.
Just as you are about get back on your feet, another frantic call comes from the river. You can’t believe it! You dive back into the river and pull out a woman who also needs life-saving care. Now a bit frazzled but still thrilled that you have saved two lives in one day, you mop the sweat from your brow.
When you turn around, however, you see more drowning people coming down the river, one after another. You shout out to all the other people around you to help. Now there are several people in the river with you – pulling drowning people out left and right.
One of the rescuers swims out to the drowning group and tries to start teaching them how to tread water. This strategy helps some, but not all. Everyone looks at each other, completely overwhelmed, wondering when this will stop.
Finally, you stand up and start running upstream. Another rescuer glares at you and shouts, “Where are you going? There are so many people drowning; we need everyone here to help!” To which you reply, “I’m going upstream to find out why so many people are falling into the river.”
When it comes to suicide prevention and mental health promotion, most of the focus is on pulling people out of the water. Many find themselves exhausted while resources are depleted, and everyone keeps throwing in the life preservers and performing other heroic deeds.
Upstream interventions – like shifting culture, promoting wellness, and making environmental changes – can help prevent people from falling into the stream in the first place. If we are only focused on the downstream rescue, then we will never get ahead of all the crises demanding our attention.
We must find a balance between upstream, midstream, and downstream approaches.
This guide is divided into three sections:
- Part I is about Upstream tactics – What do we need to do to bolster protective factors and prevent mental health problems from surfacing in the first place?
- Part II covers Midstream tactics – How do we identify employees who may be facing overwhelming life challenges or who are in the early stages of a mental health or substance abuse problem?
- Part III suggests Downstream tactics – What do we need to do to respond effectively when mental health or suicide crises occur?
Assess Needs & Strengths
Successful companies take time to listen to employees and build the buy-in needed for change before taking any action. The following approaches can help provide insight into the biggest areas of concern – where the largest pockets of resilience are vs. opportunities for change – and how best to start:
- Oversee focus groups of 10-15 people who represent critical groups within the company.
- Perform in-depth interviews with key stakeholders and influencers including business leaders, HR directors, safety directors, and others.
- Conduct surveys to measure knowledge, attitudes, and behaviors around mental health and suicide within the organization.
Questions to Ask:
- Is mental health discussed in the workplace? Is it discussed with the same rigor as physical health or safety?
- How do mental health problems show up at this workplace?
- What groups are having the most trouble?
- When are people experiencing the most stress?
- Where are our biggest gaps in meeting the needs of people in distress?
- What do people think of the mental health services offered to employees?
- What are the barriers to accessing mental health care services?
- What are our company’s strengths in supporting employees going through overwhelming life challenges?
- What are our big goals around making things better?
- How do we integrate mental health into our culture of health and safety?
- Where should we start?
In addition, evaluators might also look at measuring knowledge around mental health and service resources, stigma, and help-giving or help-seeking. These measures will provide a more global picture of the impact your company’s efforts have, had, or will have.
As you review each of the following action steps, consider your company’s readiness for, and resistance to, change; then, complete the worksheet.
After these preliminary steps are taken, consider how your company can overcome resistance, build a team to form an implementation strategy, and then roll out each component in a coordinated fashion.
Upstream Prevention Fosters Protective Factors & Prevents Problems
Step 1: Cultivate Bold Leadership
Internal champions who will lead the effort of mental health promotion and suicide prevention are essential. Ideally, these champions are C-suite executives who comfortably and confidently:
- Acknowledge that employees are experiencing overwhelming life challenges, mental health conditions, and substance misuse disorders.
- Assess their own and their company’s readiness for change by reflecting on self-assessment tools.
- Disseminate bold messages about the company’s priorities for mental health promotion and suicide prevention. These leaders are visible, vocal, and visionary, and they talk about how a focus on wellness and a culture of care will benefit the whole organization.
- Reassure employees that the company will support those who proactively reach out for mental health support.
- Allocate resources for training, marketing, program evaluation, and mental health services.
- Host a leadership roundtable for executives to start a dialogue and share best practices.
- Share personal recovery stories and role model help-seeking.
- Provide tips on how to share stories of recovery: carsonjspencer.org/get-support/sharing-our-stories.
Step 2: Improve Mental Health Literacy
Too often, our reluctance to talk about mental health and suicide stems from fear, which stems from ignorance – “we fear what we don’t understand.” Providing education and awareness can help reduce this fear and replace it with a reassuring reality.
Mental health literacy is education about three things:
- Knowledge about mental health conditions and substance misuse disorders
- Familiarity with mental health resources, support tools, and treatment options
- Stories of hope and recovery
Of these three, the last is the most powerful. Getting to know people who have lived with depression, anxiety, addiction, and suicidal thoughts does more to overcome the stigma than anything else.
Here are some ways to increase mental health literacy (also see resources below):
- Give toolbox talks on psychological safety topics
- Offer Mental Health First Aid
- Gain firsthand familiarity with mental health services
- Call the National Suicide Prevention Lifeline
- Visit local mental health treatment facilities and addiction recovery centers
- Ask your Employee Assistance Program (EAP) providers to present lunch and learn sessions on mental health and coping topics
Step 3: Teach Coping Skills for Life Challenges
New employee orientation, onboarding, supervisor training, executive coaching, and ongoing wellness workshops help employees at all levels integrate their mental health practices into their overall health, fitness, and interpersonal functioning. Completing workshops in these areas can be incentivized as part of a wellness contest among work teams or to meet engagement goals for health insurance, and can be offered in person or online.
Potential Workshop Topics:
- Building stronger families
- Conflict resolution/anger management
- Emotional intelligence
- Healthy sleep
- The food-mood connection
- Stress management/time management
- Parenting skills
- Money matters: financial planning and values
- Pain management
- Responsible drinking
- Mindfulness and meditation
Larger employers can offer ongoing services or support groups onsite to help employees learn healthier lifestyle and mental health coping skills:
- Yoga classes
- Grief support groups
- Chair massages
- New parenting transition support
- Life coaching
- Healthy snack kiosks
- Wellness assessments
Step 4: Build a Caring Culture
Many construction companies have already committed to fostering safety at all times, but few have taken mental wellness into account. A common aspirational goal in the safety culture is “Zero Incidents.” Yet, when many people consider Zero Suicides as a goal, they are met with doubt that it could ever be so.
What if we believed it were possible and did everything in our power to get there? What other number of suicides is acceptable? In order to build a caring culture, workplaces need to integrate psychological safety into overall health and wellness priorities:
Develop an awareness theme for the year and weave it into many aspects of the company culture. For example, some companies have used “You can’t fix your mental health with duct tape” and drive their employees to the humorous and effective Man Therapy program.
You can also participate in awareness campaigns:
- National Alcohol Screening Day (April)
- Mental Health Awareness Month (May)
- National Anxiety Screening Day (May)
- Suicide Prevention Awareness Month (September)
- World Suicide Prevention Day (September 10)
- National Depression Screening Day (October)
- International Survivors of Suicide Loss Day (November)
- Tie mental health messages into holidays, seasons, and company milestones
- Have fun and find creative ways to tie mental health to things like “National Donut Day,” “Black Friday,” or “Groundhog Day”
Publish educational articles in your company newsletter. Sample approaches include:
- Interview mental health providers (e.g., company’s EAP, Crisis Hotline, community mental health clinic, addiction recovery treatment center).
- Provide answers to FAQs about talk therapy, medication, or hospitalization for mental health conditions.
- Educate about common experiences like depression, trauma, and alcohol dependence.
- Share personal stories from employees (with permission) who have gone through difficult mental health experiences and are now thriving.
Create opportunities for real social networks to form. The definition of a true support person is one with whom you feel comfortable being vulnerable. This level of trust will only develop if the company culture values this support and provides safe opportunities for connection. Retreats, family/staff picnics, volunteer projects, fun outings, etc., all help employees begin to develop healthy bonds and see each other as a whole person rather than just a member of the work team.
Develop a “buddy check” program that goes beyond physical safety. A formal peer support program is one of the best ways to promote a caring culture.
Many military and first responder communities have discovered this type of program is often the key to building a link in the chain of survival, especially among their stoic, “tough guy” cultures where men in particular are reluctant to seek professional mental health services.
Four areas of focus are necessary for a positive peer support program:
- Effective recruitment of peer supporters. Begin with peer nomination and managerial staff endorsement to recruit natural helpers, trustworthy confidants, and people who model mental wellness. A formal application process should follow in order to gauge commitment, fit, and readiness.
- Ongoing peer support training covers such topics as active listening, confidentiality, crisis response, and much more. Continuing education helps keep peer supporters’ skills sharp and knowledge up-to-date.
- Ongoing peer and professional supervision and consultation by a licensed mental health professional is essential. Peer supervision helps peer specialists learn from each other.
- Evaluation of the program’s success by tracking its use, identifying issues, and measuring satisfaction for continuous quality assurance.
Midstream Intervention Identifies Concerns Early & Refers Qualified Resources
Midstream approaches help detect emerging mental health and suicide problems before they become life-threatening. The goal is to identify people who are experiencing distress or even a fleeting thought of suicide, and triage them to the least restrictive and most effective forms of care.
Step 5: Promote Employee Assistance Programs & Other Mental Health Services
EAPs are a valuable asset to the workplace. They help employers by offering such services as psychological assessment and short-term counseling, managing critical incidents, and conducting “fitness for duty” evaluations. EAP providers can be critical consultants when an employer is concerned about a staff member’s safety and can help develop reintegration plans for employees on medical leave due to a mental health problem.
Integrate mental health services into new employee orientation sessions. Also, have providers on hand to answer questions about confidentiality, process, and outcomes. And, remind employees about mental health benefits at annual benefit renewal meetings.
Make accessing mental health services easy and understandable. Position the call to action as a reasonable thing to do to take care of overall health, family wellbeing, and workplace functioning:
- Hang posters about EAP and other mental health services on the back of bathroom stalls, in work trailers, in break rooms, or on company billboards.
- Give people a chance to “check it out” first before they commit by offering a drop-in session where the provider comes to the company or does a “walk-about” around the office or in the field.
Incorporate mental health resources into an annual health fair. Bring in exhibitors not only from mental health and addiction treatment centers, but also from peer support groups, volunteer placement agencies, spiritual and life coaches, massage therapists, and other alternative forms of emotional support.
Frame the annual health fair as something that strengthens employees and their families. Make it family friendly – inflate a bouncy castle, serve pancakes, and play with pets. Incentivize participants to visit all exhibitors by giving them a “passport.” As they visit each exhibit, they receive a stamp or sticker, and those who complete their passport are entered into a drawing for a desired prize.
Step 6: Screen for Mental Health Conditions & Substance Misuse
Just as we screen for blood pressure, cholesterol, and body mass index, we can also screen for things like depression, anxiety, and alcohol misuse. Self-screening often provides important early identification for employees who are struggling and wondering, “How bad is it?”
As with most public health problems, early detection of mental disorders is critical to obtaining the best prognosis and subsequent treatment. Unfortunately, sometimes mental health conditions and suicidal thoughts fester because people are too ashamed to admit they need help. During this time, the problems can become catastrophic, like a metastasized cancer.
Treating a highly suicidal individual is much more invasive and complicated than treating someone in the early development of the problem. Thus, as with many types of cancer, frequent and regular screenings can help catch problems early.
Like other medical checkups, mental health screenings work best when they are repeated over time and considered a “standard practice” of an overall health care routine. Screening provides a universal tool; it can be used to help detect signs and symptoms of a much larger issue for everyone in a company. Screenings should not offer a diagnosis, but rather a quick snapshot that helps sort a population between low-risk and high-risk.
Screening tools must provide a call to action. In addition to sorting employees by level of risk, these tools must also give the participants suggestions for next steps – contact the EAP, employ specific self-care strategies, call the hotline, join a support group, etc.
Screening itself serves as an intervention strategy and communicates to employees the importance of mental health. When people reflect on their answers to the questions, they often have a meaningful internal dialogue about how they will respond; this process raises self-awareness to the conscious level.
Here are suggestions on how best to integrate screening for mental health into your workplace:
- Encourage your male employees to take the Man Therapy 20-Point Head Inspection.
- Participate in National Depression Screening Day held annually on Thursday of the first full week in October, and National Alcohol Screening Day held annually on Thursday of the first full week in April. Visit mentalhealthscreening.org/programs/initiatives for more information.
- Encourage employees to take a quick, anonymous mental health assessment at helpyourselfhelpothers.org.
- Learn how to build a customized screening program for your company at mentalhealthscreening.org/programs/workplace.
Step 7: Train Supervisors & Others on How to Have Difficult Conversations
The goals and model of cardiopulmonary resuscitation (CPR) are parallel to the framework of many suicide prevention trainings. In addition to the widespread trainings of CPR that began in the mid-20th century, the core of CPR’s success was an evidence-based protocol, behavioral rehearsal, and instructor feedback. The result? Bystander interventions have increased substantially as people felt capable and charged with the responsibility to intervene.
Consequently, the survival rate also increased. Before CPR, people who witnessed a life-threatening heart attack or drowning looked on helplessly; today, many know what to do and act quickly to save a life.
Just like CPR, real suicide prevention training goes beyond knowledge of risk factors and warning signs. Participants must practice the art of active listening, ask difficult questions (“Are you thinking of suicide?”), and refer people to qualified resources. These skills need to be refreshed on a regular basis so that employees feel confident and competent.
The goal is to empower the workforce to step in when someone is just starting to become overwhelmed or show initial signs of mental health concerns, and compassionately connect them to support at this early stage.
Here are some suggestions on how to build skills:
Offer a general awareness training to all staff. Here are some evidence-based training programs that can be completed in two hours or less, have minimal costs, and are adaptable to the particular culture of the company:
- Working Minds: workingminds.org
- QPR Institute: qprinstitute.com
- LivingWorks SafeTalk: www.livingworks.net
Integrate a manager’s training into new supervisors’ leadership training. More extensive programs, such as Working Minds and Wellness Works, go into greater depth about how to navigate these difficult conversations, especially when a performance issue is involved.
Downstream Intervention Responds to Mental Health & Suicide Crises with Compassion, Dignity & Effectiveness
Step 8: Promote the National Suicide Prevention Lifeline
The National Suicide Prevention Lifeline (NSPL) represents the prevailing network of hotlines today. While it’s used by people in crisis, more often people who support those in crisis call to create a safety plan. This tool is one of the most cost effective ways employers can promote safety.
Calls to this national toll-free number, 1-800-273-8255, are funneled through a network to local call centers across the U.S. During calls, the crisis call counselors listen empathically and empower callers to make decisions that resolve the crisis. They offer information and resources as well as help callers craft plans for how they will prevent, cope with, or get help for suicidal behavior.
Research shows that most suicide crises are time-limited and result in impaired problem-solving. For these reasons, people in crisis are often more open to outside intervention.
But the resource needs to be ready when callers need it, not when it’s convenient for the providers. When help is available 24/7 from anywhere, the hotline option removes the barriers of cost, travel, and waitlists to provide people in crisis an immediate response.
For callers who are in an acute life-threatening situation, call centers can engage in more aggressive interventions, such as tracing calls and sending emergency personnel.
This anonymous and confidential resource also offers specific services for veterans and people who speak Spanish. There is now an online chat option and a wealth of crisis response information via suicidepreventionlifeline.org. And, since the hotline is supported by the federal government, all promotion collateral is free.
Here are ways that workplaces can promote the National Suicide Prevention Lifeline:
- Order wallet cards in English and Spanish to include in new employee orientation packets and to distribute during benefit renewal meetings.
- Be sure to emphasize that your company is committed to supporting the psychological safety of its employees and their families. Mention that if an employee (or are someone he or she cares about) is ever in a mental health crisis to call the National Suicide Prevention Lifeline.
- To download wallet cards, visit suicidepreventionlifeline.org/media-resources.
- Put posters on the back of bathroom stalls, work trailers, staff break rooms, or on company bulletin boards with this logo: suicidepreventionlifeline.org/media-resources
- Promote the National Suicide Prevention Lifeline and answer questions during safety trainings.
Step 9: Manage Behavioral Health Crises in the Workplace
When an employee is experiencing a mental health crisis, there are many things employers can do to help them get well.
Work collaboratively with the employee to create a safety plan. One helpful tool is www.my3app.org.
Determine and communicate the level of privacy and confidentiality, as well as who should be included in the employee’s support team. Ask what the employee thinks would be most helpful. If the employee wants, consider involving employee union representatives as advocates in the process.
If employee performance is perceived to be affected by mental health or suicidal behavior, employers must address the performance issue the same way in which they would if no mental health issues were present. However, a conversation about underlying distress may lead to alternative solutions to the problem that might be more fruitful than just addressing the behavior.
Review your policies: What is the procedure for when someone is having a significant mental health issue that requires medical leave? How is he or she reintegrated into the workforce during recovery? Are accommodations negotiated?
Major mental health conditions are as debilitating as cancer or a heart attack; medical leave policies should not discriminate.
Reduce access to lethal means when suicidal thoughts are intense. Encourage employees to remove guns and pills from the home and to refrain from accessing elevated work and recreational areas during crisis periods.
Have a plan in place to provide extra support during economic downturns; layoffs and furloughs can be triggering events for people who are already vulnerable to suicide.
Step 10: Provide Effective & Compassionate Grief & Trauma Support After a Suicide Death
While preparing for a worst-case scenario is difficult, it is even more difficult to react in the middle of a crisis for which you did not prepare.
- Encourage crisis management team to review “A Manager’s Guide to Suicide Postvention in the Workplace.”
- Learn how to communicate safely and effectively after a suicide death.
- Familiarize yourself with how to lead through a crisis from R3 Continuum.
Refer to resource list above.
Today, people with mental health conditions and suicidal thoughts face the same stigma, misperceptions, and discrimination that cancer patients faced 40 years ago; they too were blamed for their health problems and were socially isolated. However, today, cancer survivors are our heroes.
To effect that change, we made significant gains in decreasing the stigma and increasing hope by educating the public about cancer and celebrating the many stories of recovery. We need to do everything in our power to prevent mental health problems and suicidal thoughts from emerging. We can “clean up our environment,” educate, and inspire – but sometimes people are still going to have challenges.
Then, like with cancer, we need to aggressively conduct screening strategies to catch the early progression of their illness and refer them to appropriate levels of mental health care. Also akin to cancer, even when all the appropriate prevention steps are taken, people are still going to be affected by mental health issues. When that happens, we need to stand in solidarity to help those in need fight for their lives.
Many of us do not flinch when we think about eradicating cancer. Let’s have that same commitment to eradicating suicide. Not one more life should be lost to suicide.
Editor’s Note: This article has been reformatted from its original version found at www.cfma.org/suicideprevention.
Copyright © 2017 by the Construction Financial Management Association (CFMA). All rights reserved. This article first appeared in January/February 2017 issue of CFMA Building Profits magazine.