Behind the hardhats: High suicide rates plague the construction industry
A construction worker works on a new city hall on Sept. 21, 2023 in Huntsville, Alabama. Construction workers are at high risk of suicide, and the industry and outside groups are trying to take steps to address it. (Eric Schultz for Alabama Reflector)
Kenny Beck would wait every day for his supervisor John to pick him up and take him to work.
They would chat about different things on the way to the work site, where Beck did electrical work. More than anything else, John loved to talk about his arrowhead collection.
One morning, John didn’t show up. Beck had to get to work on time, so he drove himself in.
When he arrived, a co-worker approached him.
“Did you hear about John?” he asked.
John — an alias used to protect his family — had died by suicide.
“There’s an example of somebody you rode with to work, you talk with, make lunch with, everything else and never knew anything was wrong,” Beck said.
Men in the construction and extraction industry – such as carpenters, electricians, roofers and plumbers – have some of the highest rates of suicide out of any occupational group. According to a 2020 analysis of National Violent Death Reporting system data from 2016, the rate was 49.5 suicides per 100,000 civilian. The average for men in all occupations combined is 27.4 suicides per 100,000 people.
The suicide rate for women in the same type of occupations is 25.5 suicides per 100,000, and they make up just over 9% of the industry. That’s significantly higher than the average 7.7 suicides per 100,000 rates for women in all occupations.
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Alabama did not participate in the 2012, 2015 or 2016 National Violent Death Reporting System (NVDRS). Arrol Sheehan, public information manager for the Alabama Department of Public Health (ADPH), which collect suicide data in the state, said the state’s data on suicide by occupation may not be accurate. Izza Cagle, director of ADPH’s Data Management Division, said occupation and industry information is provided by informants at the time of death and may not be an accurate categorization of the decedent’s actual occupation or industry. Cagle said that suicides by construction workers in the state made up 8.6% of suicides in 2021.
Suicide rates vary by trade. For plumbers and pipelayers, it was 35.4 per 100,000 in 2016. For structural iron and steel workers, it was more than double that, at 79 suicides per 100,000 people.
Electricians, like Beck and John, have a suicide rate of 44 per 100,000 civilians, just under the industry average.
A CDC report that drew data from 17 states compared suicide rates between 2012 and 2015 across different occupations. It found that the suicide rate among construction workers rose from 43.6 per 100,000 in 2012 to 53.2 per 100,000 in 2015. That number was 49.5 suicides per 100,000 civilian in 2016, but CDC analyzed 32 states, instead of 17, and stated the data may not be comparable.
Tiffany Brightwell, president of the Associated Builders & Contractors, Inc. North Alabama Chapter, said that the industry provides a “perfect storm” for the alarming statistics.
The industry is primarily made up of males aged 20 – 50, a high risk group for suicide even without the demands of a construction job. In 2021, 79.6% of suicides involved men, according to the CDC.
The nature of the work can also be a factor.
“We often have irregular work hours, depending on weather, rain, summer heat, that sort of thing,” she said. “The physical demands of a project, sleep deprivation, physical exhaustion. A lot of these can create instability.”
Construction work can also be seasonal and unpredictable.
“Especially if you’re in different parts of the country that might face layoffs or seasonal work, the impact of somebody losing their job, losing their income, losing access to health insurance and benefits. Those are also things that increase the risk of suicide,” she said.
Tom Robinson, a safety and training coordinator for the Association of General Contractors (AGC) Alabama, said that he now hears more often from those in the industry about these deaths than he did before.
“We’re hearing more and more stories from contractors and from their safety people and from employees of friends, colleagues who have chosen to go down that road,” he said.
Health Insurance Access
Industries with seasonal and cyclical employment, such as the construction sector, typically provide limited access to health insurance.
In 2015, health insurance coverage among construction workers stood at 78%, lower than any other industry except agriculture. In the same year, 90% of workers across the United States had health insurance, according to the Center for Construction Research and Training.
Among those with coverage, 49% of construction workers received health insurance from their employer or union, 22% obtained it independently or through a family member’s employer and an additional 7% were covered by public programs.
Self-employed individuals in the construction field were even less likely to have insurance. Approximately 74% of them had some form of health coverage in 2015, which included personal plans, family member plans, or coverage from other sources like public programs.
In 2015, 33.7% of Hispanic construction workers who were wage earners had health insurance through their employment, while the figure was higher at 56.3% among their white, non-Hispanic counterparts.
Although women in the construction industry were less likely than men to have health insurance through their own employment, a larger percentage of women construction workers had employer-provided insurance in general (including coverage through their spouse’s employer) compared to male construction workers in 2015 (53.8% versus 48.6%, respectively).
Union membership significantly improved the odds of receiving employment-based health insurance, according to the Center for Construction Research and Training. Among construction workers who were union members, 72.2% had health insurance through their employment in 2015, in contrast to the 38.3% among non-union workers.
Jeff Tucker, business manager for the Alabama Carpenters’ Local Union 1209, said that their members have access to “one of the best [insurance] around,” through a Blue Cross Blue Shield plan. The contractors are responsible for paying those premiums, and nothing comes out of the workers’ pay.
“The contractor pays for the benefits — it’s in the contract. They pay for a pension, health and welfare, everything, and our training,” he said.
This disparity likely arises because health insurance contributions are negotiated within collective bargaining agreements in the unionized construction sector, and contractors typically make contributions to a multiemployer fund. The arrangement allows unionized construction workers to maintain coverage as they transition between employers and projects, which is common in the industry.
The likelihood of a company providing health insurance also increases with size. In 2015, only 26.4% of construction workers employed in companies with fewer than 10 employees received employment-based health insurance, whereas more than 70% of those in companies with 500 or more employees had such coverage. The construction industry is primarily composed of small businesses.
Several construction professionals said substance use disorder is an issue in the industry.
Construction workers have some of the highest rates of death from overdose compared to workers in other occupations, according to a CDC report. Among all occupations, construction workers had the highest rate of death from overdose, including overdose from heroin.
Stephen Payne was at another company when he heard about John. He said it also caught him by surprise. John had always been someone to help others, and it didn’t occur to Payne that John could’ve been struggling with something.
John helped Payne through his struggles with substance use, and Payne said that John could’ve fired him, but instead, John offered guidance.
“Instead of firing me or sending me home, he would actually try to talk to me, you know — ‘what’s going on,’ or ‘is everything okay’ — those type of things,” Payne said. “Not a lot of people in the construction business do that.”
The prevalence of workplace injuries could be an indicator for the increased rates of substance use disorder. Studies have shown that construction workers who were given opioid prescriptions for musculoskeletal pain faced a greater likelihood of prolonged opioid use. Approximately one-third of construction workers experience at least one musculoskeletal disorder (MSD). Opioid prescriptions are three times more common among construction workers with MSDs compared to those without such disorders.
Robinson, who also serves on AGC’s national task force for mental health and suicide awareness, said there’s a “culture of substance misuse and alcohol misuse in the construction industry.”
“I’m not saying that we’re the only ones who have that problem, but it can lend to that. Because of the physicalness of the work, there’s injury, there’s chronic pain. It really breaks down the body and so that leads sometimes to dependency on opioids or alcohol,” Robinson said.
He said one of the biggest challenges is breaking down the stigma around the mental health care in the industry. He said that the construction industry has an “old-school” mentality that promotes toughness and strength.
The general mentality, he said, between construction workers is that “we work hard, it’s very physical work and we’re strong, individualistic men, we don’t get help for things, we just deal with things on our own.”
“And that’s going to lend itself to things just building up, and building up and building up,” he said.
Payne said that many construction workers build their identity around being tough. At 45 years old, he said that his can’t do the things he was once able to do, and if his identity was wrapped around his job, he would have a difficult time.
“When you get to that age where you can’t perform that thing that makes up who you are, I think that can be a very depressing thing for a lot of men,” Payne said.
Mandy Kime, who has 20 years of construction experience and is a director of safety at AGC of Washington, said that she became aware of these statistics within the community about ten years ago.
When she started to introduce this issue to their association members, she was met with apprehension. She was told that “this is an at home thing;” “people’s mental health is their responsibility;” and “why are you bringing this up at work?”
Then she started sharing some of the statistics. During that time, she said there had been some on-the-job drug overdoses and suicide, and the association started pointing that out.
“You may think that this is a personal issue, however, it’s happening at work, and it’s being exacerbated at work,” Kime would tell people, or she would say, “You know, we have the potential to impact it positively at work.”
That’s when she started seeing the shift in people understanding the issue.
“In the last couple of years, I’ve seen more of a movement of construction employers and construction leaders saying ‘okay, enough is enough. We’re not going to sit back and let this just be a statistic,’” Kime said.
Kime, who serves on the national AGC task force for mental health and suicide prevention with Robinson, said that they are trying to create a clearinghouse of free resources for employers to deploy within their organizations. The goal is to help combat some of the cultural issues and bolster individual coping and resilience strategies.
In recent years, Kime said, more employers have been more open to programs on mental health.
“And by embracing those programs on mental health, they’re making it a lot easier for people to have these conversations in the workplace and rely on their teammates to look out for them, just like we want them to look out for each other’s physical safety,” she said.
Kime said that they are working nationally to create a training program for supervisors. Construction supervisors wear many hats, she said, and often oversee scheduling, budget, manpower and equipment. Adding mental health monitoring, she said, would be a burden without the proper training.
“Because a lot of times, people don’t want to say the wrong thing or do the wrong thing. They’re afraid that they’ll get themselves or their company in trouble, even though it may be well-intentioned, right? They’re trying to do the right thing,” she said.
Brightwell said that Associated Builders & Contractors (ABC) provides its members with access to “toolbox talks,” where workers gather as a group in the morning with their safety director or project superintendent to hold discussions, usually on preventing workplace injuries. Subjects include hardhat safety and heat illness prevention.
“So now, there are toolbox talks that are available that address mental health topics, suicide prevention, suicide awareness, that sort of thing, because we’ve really got to remove the stigma around talking about suicide,” she said.
She said that creating that awareness is key to removing the stigma around mental health care treatment. She said that it should be treated as an illness, and there are visible signs, or symptoms, that someone is going through a mental health crisis.
“Because when somebody dies from cancer, you don’t say they committed cancer, right? Cancer is a disease, so is mental illness,” she said. “So there are a lot of toolbox talks that talk about awareness.”
She said that it’s important to watch out for co-workers for visible signs, such as eating lunch alone, not talking to the group like they used to, and showing up to work with poor hygiene or in the same clothes as the day before.
“If they’re running a saw, you’re going to make sure they have on their safety glasses so that they don’t get something in their eye,” Brightwell said. “Why would you also not pay attention to things that might be a bigger danger to them?”
She said that ABC chapters also provide mental health counselors to its members, and these counselors have provided training on suicide awareness to their members.
Jesse Stutts, Inc, where John worked, provided a wallet card for their employees with a QR code that provides a direct line to their employee assistance program, where they can schedule a counseling session. They have also done hardhat stickers with a QR code with mental health resources, and that’s not just for the employees. The company tried to make these resources as accessible as possible, even providing it in Spanish. Beck said that if these resources save just one person, he’d be pleased.
“A lot of our contractors are starting to adopt more of a total human health perspective when it comes to taking care of your people. We want them to go home at least as good as they came to us at the beginning of the day, if not better and healthier,” Brightwell said.
Payne said that looking back, he’s glad attitudes around mental health and suicide prevention are changing. While there’s still a focus on getting the job done, he said he feels it’s his responsibility as a supervisor to watch for his workers’ health.
“A lot of times I can talk to a guy on the job site when no one else can. So I feel like that’s kind of our responsibility as a supervisor,” Payne said.
To small companies that may not have the same resources, Payne said that anybody can get to a place where they feel they have no way out.
“As a supervisor or as an owner, you could be that way out for that person,” he said.
Including John, three of the company’s employees have died by suicide. Beck, who now serves as safety director at Jesse Stutts, Inc, said they lost two others to suicide over the last 20 years.
Two others died by suicide, one within a week of retiring from the company. His son, who was also in construction, died by suicide shortly after.
“Again, all three of those people. No one ever knew anything was wrong,” Beck said.
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