September Is Suicide Awareness Month
COVID-19, Mental Health and Suicide Prevention
By NASSCO Health and Safety Committee Chair Tad Powell, P.E., Senior Associate, Hazen and Sawyer
In a season of uncertainty, information overload, and stressful changes, it is no wonder that there is concern about a rise in mental health issues and even suicide. With the onset of COVID-19 lockdown back in March of this year we have seen millions lose their jobs, businesses and homes, children pulled from their school systems, disrupted routines and increased social isolation, while simultaneously losing many outlets typically used to cope with stress. Not to mention the potential to contract a life-threatening disease. The combination of stressors may result in a “perfect storm” when it comes to a risk of suicide says Mark Reger, PhD, Chief of Psychology Services at the VA Puget Sound Health Care System in Seattle and an Associate Professor of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine.
Knowing this, we should be concerned for our employees, and our construction workers in particular. Even without introducing COVID-19 into the mix, research shows that the construction industry sees the second-highest rate of suicide. Unfortunately, working in construction inherently involves most risk factors that we know contribute to suicide risk including chronic pain from manual labor, low or inconsistent pay, an isolating role, sleep disruption and mental health stigma among many others. We have also learned that construction work comes with another danger: increased risk of drug abuse.
Because these roles tend to be physically demanding and dangerous at times, research shows that construction workers are much more likely than other professionals to misuse opioids, cocaine, and marijuana. In fact, construction workers use prescription opioids more often than all other professions combined—about 1.4% more, federal survey data shows. The concern with opioid use is that those who regularly use these prescription drugs have a 75% increased likelihood of making a suicide plan and are twice as likely to attempt suicide as people who did not report any opioid use. Because determining the intent behind an opioid-overdose fatality can be difficult, the result is most likely an underreporting of opioid-overdose deaths from suicide. In order to prevent such deaths, we need to better understand how these overdoses occur both in intentional and accidental deaths. This could be the difference between patients with chronic pain management who accidentally overdose or those with a primary opioid use disorder (OUD).
Despite the ambiguity in determining opioid-overdose fatalities, data strongly suggests that the proportion of these deaths that are suicides are considerable. After studying nearly five million veterans, research shows that among persons with OUD the suicide risk is six times greater than that of the general population. They found that OUD more than doubled the risk of suicide among women and increased the risk among men by 30%.
Not only do we need to strongly consider opioid misuse in our workplaces, but we also have to recognize the stigma surrounding mental health both in the industry, and with men generally. More than ever our leaders in the workplace need to be aware of the effects these combined factors can have on mental health and create a supportive environment for employees through these uncertain times. While we may not be able to address every issue our employees are facing, we can be aware, be willing to have open conversation and begin implementing help in our workplaces. Creating a caring culture and having bold leadership are critical components of suicide prevention.
Many of the warning signs for an individual at risk of suicide begin with behavioral changes. Things to keep an eye out for are:
- the “top performer” who starts making mistakes;
- the “safety star” who has a series of near misses;
- the punctual employee who starts arriving late regularly;
- the crew member with perfect attendance who repeatedly does not show up for work; and
- the “team player” who is suddenly angry or combative
Part of recognizing these warning signs is first having a relationship between employees, and between management and employees. Once managers, supervisors and crew members are educated on what to look out for, it does not require much restructuring of processes to be able to pay attention to these in coworkers.
Throughout the COVID-19 pandemic we have seen data showing that young adults are most affected by the stress of the pandemic and that those ages 18-24 reporting suicidal thoughts doubles that of the general population. One particularly eye-opening figure shared by Forbes was that text messages to a federal disaster distress hotline increased more than 1000% in July 2020. The hotline run by the Substance Abuse and Mental Health Services Administration reported 20,000 texts in April 2020 compared to just 1,790 texts in April of 2019.
Forbes also shared that the long-term psychological consequences of collective traumas, such as with a pandemic like COVID-19, can last a decade or more. One CDC expert who manages hurricane response teams tells us that mental illness and substance abuse are the primary long-term effects of such disasters. With this in mind we have to be prepared for the psychological toll we will see for some time following this pandemic.
Psychologist Jill Harkavy-Friedman, PhD, Vice President of Research at the American Foundation for Suicide Prevention says that while the media has reported several stories of tragic suicides linked to Covid-19 recently, we are two years away from having data on the actual impact Covid-19 is having on our nation’s suicide rate. She also emphasized it is not a given that suicide rates will increase. If you look at the Great Recession of 2008 when we had about 4.8 million people lose their jobs, you will notice that we did not see the suicide rate skyrocket, Harkavy-Friedman points out, adding “We’re much more resilient than we give people credit for.” And while it hasn’t increased yet, we also know that it could increase in the months to come and it is always something to take seriously.
There are recommendations that the World Health Organization and the Mayo Health Clinic have for coping with the stress of this pandemic. WHO recognizes that there is a near-constant stream of news reports relating to COVID-19 and recommends that you seek information updates only once or twice daily from trusted sources. Mayo Health Clinic encourages people to take care of their physical health by getting enough sleep, participating in regular physical activity, eating healthy, avoiding alcohol, and limiting screen time. As much as possible they also encourage you to keep your regular routine and connect with others, even virtually.
They also recommend getting help when you need it. One of the best things our workforce can offer its stressed employees is an employee assistance program to get counseling or other assistance when needed. Seeing as the after-effects of this pandemic will follow us for years to come, the workforce needs to prepare for that and take the first steps in caring for their employees. While it is possible that your organization has not experienced an employee suicide up until this point, it does not mean there have not been near misses. The problem with our work culture is the stigma against talking about these mental health issues, so Risk Managers, Safety Officers and HR may never become aware of these near misses and, as a result, never look to prevent it. Let’s assume with all of the current risk factors in place and the overall danger to our construction workers that this is something to be taken seriously and put steps in place to prevent the tragedy we hope will never happen.
RK, a construction company, spoke to NPR about the suicide prevention model they implemented after several co-workers took their own lives. Some important measures they implemented include 24-hour access to counseling services, lenient leave policies and crisis training for managers. Most important, the company emphasized, was embracing much open discussion on mental health. In fact, these discussions have become a regular part of their toolbox talks. After implementing these changes not only have they seen a positive response from their workers taking advantage of therapy and other benefits, but other companies have begun copying RK’s approach. These are only a few ways that we as an industry can reach out to our employees and care for their well-being, but they are a great place to start.
If you or your workplace are looking for references as a starting point, the CDC and Prevention has developed a technical package titled Preventing Suicide: A Technical Package of Policy, Programs, and Practices which is also available in Spanish. You can also go to the Suicide Prevention Resource Center and view their suggestions as well as Question Persuade Refer (QPR) for individual or organization training. Links for each resource are below:
https://www.nejm.org/doi/full/10.1056/NEJMp1801417(link is external)
https://www.npr.org/2020/05/12/854380904/researchers-worry-pandemic-will-lead-to-a-spike-in-suicide-rate(link is external)
https://news.un.org/en/story/2020/03/1059542(link is external)
https://www.apa.org/monitor/2020/06/covid-suicide(link is external)
https://www.forbes.com/sites/nazbeheshti/2020/05/28/10-eye-opening-statistics-on-the-mental-health-impact-of-the-coronavirus-pandemic/#87d951f2df0b(link is external)
https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/mental-health-covid-19/art-20482731(link is external)
https://www.irmi.com/articles/expert-commentary/suicide-in-construction-industry(link is external)
https://www.assp.org/news-and-articles/2019/03/11/suicide-in-the-construction-industry-breaking-the-stigma-and-silence(link is external)
https://www.ehstoday.com/construction/article/21919003/suicide-in-the-construction-industry-the-silent-killer(link is external)
https://www.webmd.com/mental-health/addiction/news/20191030/construction-workers-at-very-high-odds-for-opioid-and-drug-abuse#1(link is external)
https://www.npr.org/sections/health-shots/2019/12/12/783300736/a-construction-company-embraces-frank-talk-about-mental-health-to-reduce-suicide(link is external)
https://www.cdc.gov/violenceprevention/suicide/fastfact.html#:~:text=CDC%20has%20developed%20a%20technical%20package%2C%20Preventing%20Suicide%3A,multi-level%20and%20multi-sectoral%20approach%20within%20communities%20and%20states.(link is external)
https://www.sprc.org/settings/workplaces(link is external)