Ten years ago, a close friend of mine—let’s call him Paul—reached out to me. Paul worked as an executive at a local construction company. He was a gregarious and socially confident man who spent his free time with friends or at the gym. He volunteered as a mentor to younger men and worked to maintain a spiritual connection. From the outside, his life looked pretty good. We sat together over coffee as he told me his story.

“I don’t know what’s wrong with me,” Paul began. Beneath the despair, his voice reflected surprise.

This was the third time in his life that he had had thoughts of suicide, but this time was different. The first 2 times had occurred during Paul’s active alcoholism. Now, he had been sober for a dozen years and looked to be, by all accounts, quite successful. He was gainfully employed and had an active social life. Yes, he was a single parent with sole custody, but he had a great relationship with his teenage daughter. They lived in an affluent neighborhood. Paul admitted that his problems were “luxury problems”—he needed to replace their pool pump, for example.

But the darkness was closing in at an alarming rate. “And the scariest thing is, I don’t know why.” The night before, he spent 2 hours curled up on the living room
floor sobbing uncontrollably. Fortunately, his daughter had been at a friend’s house. “I need to pull it together,” Paul told me. “We just broke ground on 2 new projects totaling hundreds of millions of dollars. I can’t lose it now. People are counting on me.” He shook his head. “Men don’t get depressed. I mean, maybe small, weak men. But I have everything going for me. What the hell is wrong with me? Why can’t I just snap out of it?”

Paul felt comfortable confiding in me because he knew my story, my past experiences with alcoholism, depression, and suicidal ideation. In spite of this knowledge, I could see the shame and embarrassment on my friend’s face.

Depression is a serious mental disorder that affects millions and devastates tens of thousands of American lives every year. In 2017, for example, an estimated 11 million U.S. adults had at least 1 major depressive episode that included severe impairment.¹ While I did not know it at the time, according to a report published by the Centers for Disease Control and Prevention (CDC), the construction and extraction industry has the highest suicide rate (for males) of any industry.²

An Industry-Wide Epidemic

Annually, more construction workers die from suicide than every other workplace-related fatality combined. In 2018, OSHA reported 1,028 construction deaths.³ The CDC reported that in 2015—the most recent statistics available—1,411 people in the construction and extraction industry committed suicide.⁴ The data cited by OSHA for those 2018 statistics reported 51 intentional deaths in the construction industry.⁵ The discrepancy is due to location: The 51 intentional deaths acknowledged by OSHA occurred at work. Suicide is an increasing concern in the construction industry as a whole, not focusing on any particular type of industry.

Though we rarely openly discuss the topic of depression and suicide in our industry, the epidemic is so pervasive that OSHA has added a section to its website providing resources for suicide prevention in the construction industry.⁶ (In addition to hotlines and helplines for those in need, the page includes resources for coworkers, managers, and industry associations.)

Because most suicides do not happen at work, many employers do not consider depression and suicide an industry problem or an occupational hazard. As a result, suicide prevention generally is not included in a company’s safety program or policy. And the epidemic is global: In the United Kingdom, male construction workers take their lives at 3.7 times the national average; in Australia, construction workers are 70% more likely to
commit suicide.⁷

With few procedures in place to prevent these deaths, our industry is failing its employees. Armed with these facts, the mental health and well-being of our employees is as vital as any other fit-for-duty check. Unfit workers, whether mentally or physically distressed, are a danger to themselves and others.

Risk Factors: A Culture of Silence

Why do so many construction workers take their own lives? As it turns out, several factors contribute to the high number of suicides. Statistically, men between the ages of 45 and 54 are most likely to kill themselves, regardless of occupation,⁸ and our industry heavily employs this demographic. Construction encourages a tough-guy attitude; a stigma of weakness surrounds depression and suicide, so many who suffer do not seek help. Construction sites do not tend to encourage diversity; good-natured banter often escalates to bullying or harassment. The transient nature and irregular hours of construction work also contribute to stress—seasonal layoffs, inconsistent pay, and limited access to healthcare exacerbate any life challenges.⁹ As a country, we are also facing an opioid crisis. Legitimate treatment of pain management can turn into abuse and addiction. In fact, according to the CDC, 25% of people receiving long-term opioid pain management struggle
with addiction.¹⁰

Man up, Soldier on

White men¹¹ between the ages of 25 to 54 account for the bulk of all suicides. Therefore, it is not surprising that male-dominated industries (like construction) report a higher rate of suicide than most. According to the U.S. Bureau of Labor Statistics (BLS), 90% of U.S. construction workers are men¹² between the ages of 25 and 54.¹³ Among this particular demographic, a pervasive machismo exists. Pressure to “act like a man” pervades the industry and often discourages those entertaining suicidal thoughts to seek help.¹⁴ Furthermore, harassment and bullying are woven into the fabric of toxic masculinity. According to an international study, one-third of construction workers experience workplace bullying.¹⁵

A Feeling of Disconnectedness

According to the Construction Industry Alliance for Suicide Prevention (CIASP), the very nature of construction work predisposes workers to suicidal ideation. “Moving from jobsite to jobsite can create an environment in which workers are not as connected to their families, each other, or a workplace community. Coupled with working long or irregular hours, sleep patterns can be impacted, causing sleep deprivation and mental and physical exhaustion.”¹⁶ Lack of sleep, limited or no access to reliable healthcare, and feelings of isolation—moving from site to site, losing touch with family and a home-base community—all contribute to the risk of developing anxiety and depression. Add to that seasonal layoffs or an economic downturn, and construction work becomes even more unpredictable. Job loss leads to lack of income, but it also eliminates health benefits and access to Employee Assistance Programs (EAPs). This feeling of a lack of control can blossom into hopelessness, leaving a worker with the thought, “I only see one way out.”

The recent COVID-19 pandemic caused global distress. Many construction workers were laid off as jobsites closed, and those required to report to work often experienced anxiety about exposure to the virus. A survey by Construction Dive revealed that 78% of contractors reported their biggest COVID challenge—the aspect of the crisis that most affected their business—was dealing with anxious employees.¹⁷

Drug and Alcohol Abuse

Not surprisingly, Paul and I fit right into the construction-worker demographic. White, middle-aged ex-football players who were taught to tough out the pain. Years of substance abuse (in my case, alcohol) compounded our struggles with depression.

Though alcohol is a depressant, people prone to substance abuse typically feel an opposite reaction when they drink—alcohol serves as an energy source. For the average temperate drinker, an alcoholic beverage or 2 brings a feeling of relaxation and calm (because it is a depressant). But alcoholics feel stimulated by alcohol. After a few drinks, they see the world more clearly and can often execute simple motor skills (billiards, darts, bowling—even operating a vehicle) more efficiently than when no alcohol is in their system. But it is a depressant, and alcohol eventually depresses both the physical body and mental state.

For me, drinking started with fun. It moved to fun with problems, then problems with fun. Eventually, the fun vanished, and alcohol left nothing but problems. It is no secret that alcohol and illicit drug use are prevalent throughout the construction industry. The National Drug-Free Workplace Alliance (NDWA) cited the construction and mining industries as having the highest rate of heavy alcohol use for full-time adult workers.¹⁸ This same survey determined that construction workers also have one of the highest rates of illicit drug use. Recently, however, the correlation between substance abuse and suicide has become more pronounced.

America’s Opioid Addiction

Illicit drug use and alcohol consumption significantly impact our industry. Though different chemicals affect the body differently, any substance abuse eventually takes its toll, causing physical, mental, and emotional damage to the user. Our nation’s growing opioid addiction has infiltrated all industries, and construction workers—already prone to on-the-job injuries—are no exception.

The Center for Construction Research and Training (CPWR) published a report regarding opioid use and overdose fatalities at worksites. The foreword includes the following disclaimer: “Section 1 examines a small subset of construction workers who died of an overdose: those who died on a worksite. These are figures for which we have national data, but there is not equivalent national data yet about how many of the 130 Americans who die each day from an opioid overdose work in construction.”¹⁹ Just as OSHA does not report on suicides in the industry unless they occur on the job, opioid use and drug overdoses are similarly underreported. The report states unequivocally, however, that “risk of overdose fatality and opioid use was higher in construction than in
other industries.”²⁰

Many of us know someone who has struggled with addiction. Some recover, but many do not. Take Leo, for instance.

Leo and I worked at the same company some years ago. As a prerequisite to getting hired, Leo passed a pre-employment drug screen. He had been on the job about a month when he suffered a significant lower leg injury after falling approximately 5 feet off a ladder. During the initial investigation, we determined he had met all applicable safety requirements and adhered to all regulations. While managing the subsequent injury treatment and insurance claim, however, we learned that he had methadone in his system at the time of the incident.

Methadone, part of the opioid drug family, is often prescribed as a treatment protocol for heroin and narcotic pain medication addiction. While generally considered safer and less addictive²¹ than many opioids, methadone treatment is not without risk. Common side effects of methadone include anxiety and nervousness, restlessness, and drowsiness. More serious side effects include fainting, lightheadedness, and dizziness; hallucinations or confusion; seizures; and severe drowsiness.²²

Could any of these side effects have contributed to Leo’s fall from a ladder? Absolutely.

During the incident investigation, a witness reported that Leo had complained of being tired that day; he had not gotten enough sleep the night before. The witness understood the common machismo of his coworker and figured this was just another typical day working in the field. Maybe it was lack of sleep, or maybe it was a side effect of the methadone; we will never know.

Leo’s injury recovery progressed fairly quickly, and he returned to work before any lost-time took effect—good news for him and for our employer. He maintained his income, allowing him to support his wife and their toddler, while our employer saw the return-to-work program functioning as intended: maintaining employee productivity.

But Leo experienced a minor setback while recovering from his lower leg injury. We spoke during this time, and I learned that Leo also suffered from depression. He believed it stemmed from a previous sports-related injury that significantly impacted his physical, mental, and emotional health. According to Leo, that injury eventually led to a painkiller addiction, which intensified his depression.

Leo declined the offer to contact our employer’s EAP. I shared my own experience around alcohol dependence (and how I recovered), but Leo was not interested in pursuing rehabilitation. Our employer eventually fired Leo for repeated and unexpected absenteeism, and he and I lost touch.

A few months later, I received word that Leo had taken his own life.

The Financial Cost to Employers

Obviously, any loss of life is a horrific tragedy. But in addition to the human cost, suicide and depression take a significant financial toll on our industry.

Substance abuse, whether it leads to suicidal ideation or not, costs employers millions each year. Workers impaired by drugs or alcohol cause serious damage to businesses. According to the NDWA, these employees have increased absenteeism, lower productivity, higher healthcare costs, higher workers’ compensation claims, and more on-the-job injuries and incidents.²³ In order to maintain a safe and productive work environment, employers must take action to stop substance abuse. A substance abuse testing program is often the cornerstone of this initiative. (For help implementing a substance abuse testing program, contact your insurance provider.)

A 2016 study published in Suicide and Life-Threatening Behavior, the official journal of the American Association of Suicidology, reported that the total national cost of suicides and
suicide attempts in the United States exceeded $93.5 billion.²⁴ Lost productivity accounts for the majority of that number. As the construction industry accounts for 20% of the nation’s suicides, we, as a group, are losing approximately $18.7 billion a year to this epidemic in lost productivity alone.

Moving Forward: Solutions

Paying Attention

While an ounce of prevention may be worth a ton of cure, in the case of suicide, prevention is the only option. A company’s financial, organizational, hazard, and strategic risk are all impacted by the mental well-being of its workforce. As an industry, we must address mental health and wellness at a grassroots level.

New Hires

Our industry frequently performs background checks, pre-employment drug screening, and physical fitness reviews. Including a mental health questionnaire on employee risk assessments may shed light on potential problems before they claim the life of the employee. For example, an employee states that he can lift 25 pounds over his head repeatedly without difficulty, or that he can stand for extended periods in extreme climates. Why do we not ask if he has ever suffered from claustrophobia? If working in tight areas causes extreme distress or panic, we should know this before sending him into a confined space.

Should we eliminate prospective hires if we have concerns about their mental wellness? Absolutely not. This is not meant to serve as a discriminatory tool. But if a new hire reports a fear of heights, he should not be assigned to build scaffolds. Maybe he is better suited to forklift operation. The goal is that every new hire succeeds in the organization. With the culture of machismo that exists on construction sites, many men would rather tough it out than talk about their fears or anxieties.²⁵ But stress and anxiety cause heightened cortisol levels, and chronically raised levels take their toll on both physical and mental health.²⁶ And what helps us relax? Drugs and alcohol.

Ongoing Support and Wellness Programs

A strong correlation exists between physical health and mental fitness. Harvard Medical School reported a striking comorbidity between chronic pain and depression.²⁷ According to the study, people suffering from chronic pain are 3 times more likely than the general population to develop psychiatric symptoms. Further, depressed patients are 3 times more likely to develop chronic pain. Leo recalled that his depression began only after his sports injury (which resulted in chronic pain).

Even employees without chronic pain will experience sore muscles and achiness from time to time; it is a byproduct of construction work. Employers can encourage healthy habits to treat and manage pain and stress by providing available resources. Many construction companies have pre-shift stretching sessions, but what about post shift? Most athletes know to stretch after a workout; the physical demands placed on a construction worker’s body warrant attention, as well.

What about diet and nutrition? A meta-analysis (including 21 studies across 10 countries) published in Psychiatry Research found a correlation between a Western diet and an increased risk of depression.²⁸ Take a look at the food trucks around construction sites: burgers, burritos, pizza. Day after day, month after month, year after year, poor nutrition and the physical stresses of construction work add up. Rather than treating the stress with pain medication or a few beers after work, can your organization take proactive measures? Seek out healthier food truck options, or provide vending machines stocked with healthy snacks.

Executive buy-in is key when developing a successful mental and emotional wellness program within your organization. Encourage open and honest discussions about mental health and suicide. Be proactive in assisting your employees’ mental well-being. Top-down leadership is necessary; work with your human resources (HR) department and EAP provider. We can break the macho stereotyping of our workforce. One person can make a significant difference, and as those singularities unite, it creates a movement—a movement that may prevent the suicide of someone you love and value.

Eliminating the Stigma

Leo, Paul, and I walked similar paths. For me, seeking a solution for my alcoholism and underlying depression saved my life. Leo chose not to treat either condition. My journey led to a 12-step recovery program and personal therapy. These worked for a while. But, like Paul, I experienced a recurrence of depression well into sobriety.

Depression, suicidal ideation, addiction, and other mental health conditions often present life-long challenges. I have never known anyone to recover from these conditions alone. Often, support must continue for years—or longer, depending on the condition. Talk therapy, 12-step programs, inpatient treatment, medication—every avenue must be made available to those suffering from suicidal ideation. For some, joining a church or civic group works as a mood-booster: helping others takes us out of ourselves. Immediate emergency medical care may be needed in certain cases, as well.

To regulate my mood, I continue to take an active role in my recovery from alcoholism. Paul’s doctor referred him to a psychiatrist. Paul needed medication to help regulate his brain chemistry, just as diabetics need insulin or cardiac patients require a statin. One of the goals of this article is to normalize the discussion around mental wellness. Let us eliminate the shame of seeing a therapist or needing psychotropic medication. Create an atmosphere of trust and openness in your organization.²⁹ Arm your HR department with resources. Train your foremen to recognize signs of substance abuse, depression, and suicidal behavior. Teach them to take action. (Resources are listed at the end of this article.)

What Can I Do for My Employees Today?

Following the CDC’s alarming report regarding the high suicide rates in the construction industry, the Construction Industry Alliance for Suicide Prevention (CIASP)³⁰ was formed. CIASP provides information, resources, and training to the construction industry, with the goals of eliminating the stigma associated with suicide and mental health issues, as well as offering relevant and implementable tools.

CIASP, a nonprofit organization, suggests that suicide awareness and mental health fitness be addressed on several levels. Raising awareness is not sufficient; as employers, we should offer resources for those in need, create a culture in which it is acceptable to discuss mental health concerns, and do what we can to decrease the inherent risks present in our industry. CIASP coined the phrase STAND up for suicide prevention.

S – creating safe cultures
T – providing training to identify and help those at risk
A – raising awareness about the suicide crisis in construction
N – normalizing conversations around suicide and mental health
D – decreasing the risks associated with suicide in construction³¹

CIASP offers (free of charge) a suite of integration tools to incorporate suicide prevention and mental health awareness into your company’s existing safety policy. Begin with the “Mental Health & Suicide Prevention for Construction Companies: Needs Analysis & Integration Checklist”³² to determine your current level of preparedness. This worksheet provides questions to assess your company’s mental health culture, as well as action steps to implement a more rigorous mental health and suicide prevention safety plan. Follow the checklist with CIASP’s “Three Levels of Integrating Suicide Prevention in Your Company”³³ packet.

CIASP’s Integration Resources page³⁴ also includes tools for prevention, intervention, and post-intervention; resources for veterans; and a link to extensive opioid-related issues and statistics.³⁵ From this page, access, download, and immediately incorporate reproducible toolbox talks, wallet cards, posters, and more.

CIASP offers myriad resources, many of which are self-explanatory and easy to incorporate (like the toolbox talks). If you need assistance creating a more robust and dedicated initiative, contact CIASP directly. You can join the cause by standing up for suicide prevention today.

The author would like to thank CIASP for its input on this article.

WHERE TO FIND HELP

Please seek help if you are suffering. You are not alone. The following services are free and confidential.

National Suicide Prevention Lifeline: 24 hours a day, 7 days a week, 365 days a year

Added July 2022: 988 has been designated as the new three-digit dialing code that will route callers to the National Suicide Prevention Lifeline. While some areas may be currently able to connect to the Lifeline by dialing 988, this dialing code will be available to everyone across the United States starting on July 16, 2022. 

Call: 1-800-273-8255
Para espanõl: 1-888-628-9454
Deaf and hard of hearing: 1-800-799-4889
Online chat: suicidepreventionlifeline.org/chat
Website: https://suicidepreventionlifeline.org
Crisis Text Line: text HOME to 741741

Veterans Crisis Line: For Veterans, active duty members of the military, or those concerned about one; 24/7 services
Call: 1-800-273-8255 (press 1)
Text: 838255
Deaf and hard of hearing: 1-800-799-4889
Online chat: www.veteranscrisisline.net/get-help/chat
Website: www.mentalhealth.va.gov/suicide_prevention

Substance Abuse and Mental Health Hotline (SAMHSA’s National Helpline): 24/7 information service for individuals and family members facing mental and/or substance use disorders. English and Spanish.
Call: 1-800-662-4357
TTY: 1-800-487-4889
Website: www.samhsa.gov/find-help/national-helpline

Alcoholics Anonymous (AA): AA is a fellowship of men and women who share their experience, strength, and hope to help others recover from alcoholism. Access multilingual online meetings or connect with someone who can help with your drinking problem.
Online meetings: https://aa-intergroup.org
Find local A.A. resources: www.aa.org

Narcotics Anonymous (NA): If you think you have a problem with drugs, NA can help. Find meetings and helplines in your community.
Website: www.na.org/meetingsearch

Thank you to CIASP for their input on this article. To access additional resources or make a tax-deductible donation, please contact CIASP directly. Call (609) 799-7900, email info@preventconstructionsuicide.com, or visit www.preventconstructionsuicide.com.

ENDNOTES:

1. “Major Depression,” National Institute of Mental Health (NIMH), www.nimh.nih.gov/health/statistics/major-depression.shtml.
2. Peterson C., et al., “Suicide Rates by Major Occupational Group – 17 States, 2012 and 2015,” Morbidity and Mortality Weekly Report (MMWR) 67, http://dx.doi.org/10.15585/mmwr.mm6745a1.
3. U.S. Department of Labor, “Commonly Used Statistics,” OSHA, www.osha.gov/data/commonstats.
4. Peterson C., et al., “Suicide Rates by Major Occupational Group – 17 States, 2012 and 2015,” MMWR 67, http://dx.doi.org/10.15585/mmwr.mm6745a1.
5. U.S. Department of Labor, “Injuries, Illnesses, and Fatalities,” U.S. BLS, www.bls.gov/iif/oshwc/cfoi/cftb0330.htm.
6. U.S. Department of Labor, “Preventing Suicides,” OSHA, www.osha.gov/preventingsuicides.
7. Chesterfield, Peter, “It’s Past Time to Build Better Mental Health in the Construction Industry,” BRINK, www.brinknews.com/its-past-time-to-build-better-mental-health-in-the-construction-industry.
8. “Suicide Statistics,” American Foundation for Suicide Prevention (AFSP), https://afsp.org/suicide-statistics.
9. “Suicide in the Construction Industry: Breaking the Stigma and Silence,” American Society of Safety Professionals, www.assp.org/news-and-articles/2019/03/11/suicide-in-the-construction-industry-breaking-the-stigma-and-silence.
10. U.S. Department of Health and Human Services, “Promoting Safer and More Effective Pain Management,” CDC, www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-Patients-a.pdf.
11. “Suicide Statistics,” AFSP, https://afsp.org/suicide-statistics. It is worth noting that the study identifies the following racial groups: White, Black or African American, and Asians and Pacific Islanders. AFSP adds, “Note that the . . . CDC records Hispanic origin separately from the primary racial or ethnic groups of White, Black, American Indian or Alaskan Native, and Asian or Pacific Islander, since individuals in all groups may also be Hispanic. Overall, across groups, the rate of suicide for non-Hispanics was 16.42 and the rate for Hispanics was 7.20.”
12. U.S. Department of Labor, “Labor Force Statistics from the Current Population Survey: Employed Persons by Industry, Sex, Race, and Occupation,” U.S. BLS, www.bls.gov/cps/cpsaat17.htm.
13. U.S. Department of Labor, “Labor Force Statistics from the Current Population Survey: Employed Persons by Detailed Industry and Age,” U.S. BLS, www.bls.gov/cps/cpsaat18b.htm.
14. Chesterfield, Peter, “It’s Past Time to Build Better Mental Health in the Construction Industry,” BRINK, www.brinknews.com/its-past-time-to-build-better-mental-health-in-the-construction-industry.
15. “Preventing Bullying in the Construction Industry,” GoContractor (blog), https://gocontractor.com/blog/why-bullying-in-construction-is-a-problem.
16. “Build Awareness,” CIASP, https://preventconstructionsuicide.com/Build_Awareness.
17. Goodman, Jenn, “How to Ease Workers’ Anxieties about Returning to the Jobsite,” Construction Dive, www.constructiondive.com/news/managing-absenteeism-and-uncertainty-on-the-jobsite/577170.
18. “Industry Statistics,” NDWA, www.ndwa.org/drug-free-workplace/industry-statistics.
19. Dong, Xiuwen Sue, Raina D. Brooks, and Chris Trahan Cain, “Overdose Fatalities at Worksites and Opioid Use in the Construction Industry,” CPWR: Quarterly Data Report (2019), www.cpwr.com/sites/default/files/publications/Quarter4-QDR-2019.pdf, 1.
20. Dong, Xiuwen Sue, Raina D. Brooks, and Chris Trahan Cain, “Overdose Fatalities at Worksites and Opioid Use in the Construction Industry,” CPWR: Quarterly Data Report (2019), www.cpwr.com/sites/default/files/publications/Quarter4-QDR-2019.pdf, 2.
21. U.S. Department of Health and Human Services, “Methadone,” Substance Abuse and Mental Health Services Administration
    (SAMHSA), www.samhsa.gov/medication-assisted-treatment/treatment/methadone.
22. Cunha, John P., “Methadone Hydrochloride,” RxList, www.rxlist.com/methadone-hydrochloride-side-effects-drug-center.htm.
23. “The Importance of Workplace Drug Prevention,” NDWA, www.ndwa.org/dfwp/the-importance-of-workplace-drug-prevention.
24. Shepard, Donald S., et al., “Suicide and Suicidal Attempts in the United States: Costs and Policy Implications,” Suicide and Life-Threatening Behavior 46.3 (2016): 352-362, https://onlinelibrary.wiley.com/doi/epdf/10.1111/sltb.12225.
25. While this article refers to men in the construction industry, these same concerns surround women, though the rate of suicide among women in construction is around 1% (as opposed to the 20% of male suicide decedents in the industry). Source:
    Peterson C., et al., “Suicide Rates by Major Occupational Group – 17 States, 2012 and 2015,” MMWR 67, http://dx.doi.org/10.15585/mmwr.mm6745a1.
26. “Chronic Stress Puts Your Health at Risk,” Mayo Clinic, www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037.
27. “Depression and Pain,” Harvard Health Publishing: Harvard Medical School, www.health.harvard.edu/mind-and-mood/depression-and-pain.
28. Li Y., et al., “Dietary Patterns and Depression Risk: A Meta-Analysis,” Psychiatry Research 253 (2017): 373-382, https://doi.org/10.1016/j.psychres.2017.04.020.
29. After an employee committed suicide, RK, a construction company, incorporated suicide prevention measures as part of its company culture. Noguchi, Yuki, “A Construction Company Embraces Frank Talk About Mental Health to Reduce Suicide,” NPR, www.npr.org/sections/health-shots/2019/12/12/783300736/a-construction-company-embraces-frank-talk-about-mental-health-to-reduce-suicide.
30. CIASP, https://preventconstructionsuicide.com.
31. “STAND UP for Suicide Prevention,” CIASP, https://preventconstructionsuicide.com/STAND_UP_for_Suicide_Prevention.
32. “Mental Health & Suicide Prevention for Construction Companies: Needs Analysis & Integration Checklist,” CIASP,
    https://preventconstructionsuicide.starchapter.com/images/downloads/Integration_Resources/construction_industy_alliance_
    for_suicide_prevention_needs___integration_checklist.pdf.
33. “Three Levels of Integrating Suicide Prevention in Your Company,” CIASP, https://preventconstructionsuicide.starchapter.com/images/downloads/Integration_Resources/ciasp___3_integration_levels.pdf.
34. “Integration Resources: Implement a Suicide Prevention Program in the Workplace,” CIASP, https://preventconstructionsuicide.com/Integration_Resources.
35. “Opioid Resources: Resources to Prevent Opioid Deaths in Construction,” CPWR, www.cpwr.com/research/opioid-resources.

ADDITIONAL RESOURCES FOR THE READER:
This manual includes statistics, risk factors, checklists, toolbox talks,and resources for next steps: “A Construction Industry Blueprint:Suicide Prevention in the Workplace.” National Action Alliance for Suicide Prevention. https://theactionalliance.org/resource/construction-industry-blueprint-suicide-prevention-workplace.

Suicide Prevention Lifeline’s free, reproducible wallet cards (in English and Spanish) and 1‑pager on warning signs and what to do if you suspect someone is considering suicide: “Media Resources.” Suicide Prevention Lifeline. https://suicidepreventionlifeline.org/media-resources.

Reproducible Opioid Deaths in Construction Hazard Alert.” CPWR.
www.cpwr.com/sites/default/files/publications/Opioids-Hazard-Alert.pdf.

Resources for the prevention of substance abuse and mental disorders, including workforce training and education: “Prevention of Substance Use and Mental Disorders.” SAMHSA. www.samhsa.gov/find-help/prevention.

A multi-pronged approach to addressing suicide in the workplace and community: Stone, Deb, Kristin Holland, Brad Bartholow, Alex Crosby, Shane Davis, Natalie Wilkins. “Preventing Suicide: A Technical Package of Policy, Programs, and Practices.” CDC. www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf.

Crisis line contact information, risk factors and warning signs,and industry-specific resources:“Preventing Suicides.” OSHA. www.osha.gov/preventingsuicides.

A comprehensive, actionable plan for construction companies implementing a suicide prevention plan: Spencer-Thomas, Sally. “Construction + Suicide Prevention: 10 Action Steps Companies Can Take to Save Lives.” Construction Financial Management Association (CFMA). https://preventconstructionsuicide.starchapter.com/images/downloads/constsuicprev10actionsteps.pdf.

Find out where to get help, how to start a conversation, information on trainings and programs, statistics, international programs, and more: “Suicide Prevention Resources.” CPWR. www.cpwr.com/research/suicide-prevention-resources.

Bibliography
“Build Awareness.” CIASP. https://preventconstructionsuicide.com/Build_Awareness.

Chesterfield, Peter. “It’s Past Time to Build Better Mental Health in the Construction Industry.” BRINK. www.brinknews.com/its-past-time-to-build-better-mental-health-in-the-construction-industry.

“Chronic Stress Puts Your Health at Risk.” Mayo Clinic. www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037.

CIASP. https://preventconstructionsuicide.com.

Cunha, John P. “Methadone Hydrochloride.” RxList. www.rxlist.com/
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“Depression and Pain.” Harvard Health Publishing, Harvard Medical School. www.health.harvard.edu/mind-and-mood/depression-and-pain.

Dong, Xiuwen Sue, Raina D. Brooks, and Chris Trahan Cain. “Overdose Fatalities at Worksites and Opioid Use in the Construction Industry.” CPWR: Quarterly Data Report (2019). Accessed May 13, 2020.
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Goodman, Jenn. “How to Ease Workers’ Anxieties about Returning to the Jobsite.” Construction Dive. www.constructiondive.com/news/managing-absenteeism-and-uncertainty-on-the-jobsite/577170.

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