Mental wellbeing in the construction industry

JON OPPENHEIM: Hello, everyone. Welcome to our WTW Construction Blueprints podcast. I'm John Oppenheim, the North American Southeast region leader of WTW Construction, your podcast host. And I'm delighted to be joined by Erin Young.

In this episode, we're going to explore the mental health crisis in the construction industry. We're going to be addressing a few topics. And they'll include what is mental health, some facts and statistics on mental health, and then where do we go from here?

Erin is a senior director and mental health subject matter expert in WTW's health equity and well-being community. She helps clients address employee mental health in ways that are effective and take into consideration the unique needs for emotional health and wellness. Erin, could you tell us a bit more about yourself and your work in the mental health space?

ERIN YOUNG: Thank you so much, Jon. It is so great to be here. I'm excited to be part of this podcast and talking about mental health. So I am a clinical social worker by training. And what that means is that for the better part of my career, I've worked in direct practice with people from all walks of life, ages, backgrounds related to their mental health and also substance use disorder.

And throughout the time that I have spent working with people, mental health and the impact of mental health on all different facets of well-being has become a passion of mine. So after, direct practice, I spent some time on the insurance side helping to build programs and to work with clients around specific mental health or behavioral health programming. And I came to WTW maybe about a year and a half ago. And it has been super exciting to work with clients across the country and globally around promoting mental health equity and helping clients put into place effective mental health programs and awareness.

So I'm so excited to be here. But maybe before we get into some of the deeper details about mental health, Jon, can you tell me and some of the listeners a little bit more about the mental health crisis in the construction industry?

JON OPPENHEIM: Yes, sure. And again, thanks for the background Erin. And I'm excited to be here as well. Construction's made some really incredible advances in protecting the industry's workers from physical harm. And traditional industry loss control and safety efforts focus nearly entirely on physical loss and really greatly ignore mental health and wellness.

So it's true that conventional loss prevention could be improved. There is a need to look at workers' health and safety just more holistically, addressing not only physical welfare but mental and emotional well-being as well. Mental health affects worker safety.

Even if no actual illness is diagnosed, it's really easy to imagine how a worker's mental state might affect his or her ability to make good decisions and recognize potential hazards. When you think about it, the mind drives the activity of the body. To work safely, people need to be mindful of what they're doing. And that's part of the conversation on mental health.

Mental health is different from mental illness. And to get a better understanding of the differences amongst some of those terms, Erin, I'd like to pass it back to you for a moment.

ERIN YOUNG: Absolutely. So you've touched on a couple of really great and interesting points here. And I think it's so important for our listeners to have a great grounding in what those definitions are to help level set our conversation. So when we talk about mental health, we're not just talking about mental illness. Mental health is something that truly impacts all of us.

So oftentimes, we focus on words or diagnoses like depression or anxiety. But really, mental health refers to a state of successful balance under times of stress or pressure or in challenging circumstances. Now, mental illness, on the other hand, is a biological disruption. And it's a disruption in brain functioning that is persistent. And in some cases, it may be really severe for some people.

Now, mental illness is always a mental health condition. But struggling with mental health does not mean that someone is mentally-ill. Now, in both circumstances, altered mental health or mental illness are both conditions that are subject to successful treatment and care.

And as we talk a little bit more about this, we'll go back and forth probably between talking about mental health as a broader emotional range that impacts all of us and also talking about probably specifics around mental illness and treatment in that regard.

JON OPPENHEIM: Thanks for that. And I think really to give listeners a sense of prevalence and better understanding of the issues, I'd like to shift the discussion a little bit to just some facts and some statistics around mental health. And I'd like to kind of kick off the discussion to drill down to construction-specific, and then hand it over to you to just talk about maybe a broader conversation.

In construction you mention the word crisis. And it can't be any more accurate than crisis. We know that more than half, nearly 60%, of construction workers suffer from a mental health issue during their career. We also know that construction ranks number one of any industry in alcohol abuse and opioid misuse. And I think some of the most staggering statistics are around fatalities. With all the progress that we made, protecting workers from physical harm, we still lose approximately 10 per 100,000 of the workforce to job-site fatalities every year.

Tragically, the suicide rate in construction is among the highest of any industry. We lose more than five times the number of workers by suicide annually than job-site accidents. So just think about that. Suicide is nearly the number one most preventable cause of loss. As an industry, we're really better than this.

If improving and saving lives isn't enough of a reason to invest in mental health from a financial perspective, it's really a win-win for the worker and any company when they invest in workers' well-being as well. And some of the best companies on the planet invest in health and well-being of their workers throughout the entire day.

And then workers bring that additional health back to the job the next morning in the form of increased productivity, decreased injury and illness risk, decreased health care spending, and more engagement at their work. The World Health Organization estimates that companies see a $4 return in improved health and productivity for every $1 invested in the treatment and support of mental health.

Your thoughts, Erin?

ERIN YOUNG: That's incredible. So the staggering facts that you've provided around the construction industry are really, really remarkable. And to your point about the costs here that you just finished with, it's something that we have seen documented time and time again that not treating mental health is actually more costly than treating mental health and putting levels of preventative programming in.

But oftentimes, what I have found with clients is they feel stuck or unaware of how to begin approaching the profound need around mental health. And I'll go back. And I'll say that the mental health field as part of medicine is just now catching up to many of the physical medicine components that we see.

So we see a ton of investment and research and digital solutions, all kinds of stuff coming out for things like musculoskeletal issues or diabetes technology. But the mental health component of medicine is just really catching up to understanding with current research that mental illness and substance use disorder, as you mentioned, are a brain disease.

And these are things that require disease management. Mental health is not a moral shortcoming. It's not a failure. And the research is relevant and very exciting in this area.

And we know that those costs can go up if you're not treating mental health. You mentioned suicide as well. So suicide in the US is one of the top 10 leading causes of death. I think it's the 10th leading cause, specifically, of death in the US. And it accounts for more than one in every 100 deaths worldwide.

So to your point, we're seeing a high rate of suicides that are preventable. The approach that we should really take is that every suicide death is something that we can prevent. So what can we think about doing in that regard?

But some of the alarming stats that I've also come across are that three in five employees report that their anxiety or depression are going untreated. And when mental health concerns and mental illness go untreated, that results in higher rates of disability, higher rates of ultimately unemployment. And these trends are showing us that mental health is going to likely be one of the top short-term disability conditions in the coming years.

To make matters even more challenging, what we see are that anxiety and depression-- we'll talk about those. Because those are the most common diagnoses that we see-- are closely tied to life events-- so things like divorce, the onset of new medical issues, so like cancer or diabetes or heart disease, financial struggles, recessions, employment challenges. And when we see these things tie together, lifestyle risks end up becoming more risky when anxiety and depression aren't managed.

So we see higher rates of smoking, higher rates of alcohol and substance use disorder when people are suffering from anxiety and depression. And so all of this really kind of ties together into this holistic picture of how are we thinking about mental health? How are we thinking about it in a preventative way?

And I think one of the biggest challenges that we have seen in the mental health field is stigma and how stigma creates and drives silence and how it creates barriers for people reaching out to get treatment and also for employers being able to or being willing to take a step forward and put into place the programs that matter for their employees' mental health.

JON OPPENHEIM: Thank you for that. And we're going to get back to stigma in a moment. Because it's worth repeating. But we've talked a little bit about some of the statistics, some of the data that's out there.

We've talked about mental health, mental illness, well-being. So if we could talk a little bit more about, I guess, what are we doing about it? What are we doing about this as an industry? Maybe construction specifically, what are we doing about this, personally, if there are things to do about it personally? What are we doing about it professionally?

And I'd like to just offer a few things to you, Erin, for consideration. And some of your feedback, because just focusing on the industry itself, there's no doubt that the industry must work together to continue the progress if we're going to drive any of these efforts.

And I think part of it is the industry really needs to strive to change that, let's say, tough guy, tough girl culture through some education and awareness and training to one that maybe exhibits a little more acceptance, compassion, and understanding of mental illness. But just as importantly, I think we do need to, like you said, break down the stigma by talking about mental illness openly, honestly, in group settings, one-on-one, support each other to seek help for mental illness and by engaging with management and leadership and providing maybe some new and additional resources at work.

The substance abuse piece-- I think the industry as a whole needs to combat substance abuse, talk about it openly. It's a hazardous industry, hazardous industry that leads to injury that's oftentimes treated with medicine.

More often than not, that medicine will relieve pain associated with injury. However, there might be a perceived pain after the pain has actually gone. And that perceived pain may lead to addiction. That addiction may lead to a sense of depression. And that sense of depression can lead to suicidal ideation, which is worst-case scenario.

So do you have any additional thoughts on that?

ERIN YOUNG: Oh, my gosh. So what you are talking about is so important. And I think that one of the big challenges that I see and that I tackle with clients very frequently is that there is not just one thing that you can do around mental health. It's really a multifaceted approach to addressing it. And in some cases, and especially in an industry such as the construction industry that has a rich history of stereotypes, maybe it is male-dominated, whatever it may be, it's going to take time to begin to break down those barriers.

So I think you mentioned awareness. And I think awareness is so important. And starting with the message that it's really OK to not be OK and what that means to acknowledge that you need help, what it means to understand how you're feeling and put a label to it. So many don't know that the way they are feeling might be clinical depression. And they might not know that until they get into treatment.

But if you don't have the language around that, you don't know how to ask the right question. So awareness means education, educating people transparently with good, evidence-based and clinically-sound information that is available for people to digest and take in at either their own pace. Those are small and bit-sized chunks, but they're not overwhelming.

But also this means when we get into the work environment. We work with other people. So you mentioned this. We have employees. We have leaders. We have managers. And so there's some level of training that needs to take place. We need to train our work forces, our leaders, and our managers to be aware of what those mental health signs and symptoms look like, how to respond in cases of crisis, but also maybe in cases of concern not necessarily a full-blown someone is sitting in front of me who's suicidal. But there's many warning signs that oftentimes lead up to that. And early intervention and that preventative care is so important in getting the message out and getting people comfortable around decreasing the stigma with mental health.

And then I think it's also making sure that those people that are in those peer-to-peer relationships or the manager-to-employee relationships, they know how to access the resources if they're needed and what is available to them.

JON OPPENHEIM: Valid points. The industry can only do so much. You mentioned leaders and managers. And when you think about it, people are everything. And you really can't effectively run a business without a strong team behind it. And what I would recommend to those leaders or managers, is really just some temperature checks, one-on-one check-ins. Those give space for employees to share some of their concerns or equally some of their successes.

That to me, in turn, will help those managers run teams effectively. And to your point, those at risk, may be depressed. It could look a lot of different ways to a lot of different people, including maybe some decrease in productivity, irritability, agitation, increased lateness or tardiness to work, just general loss of focus.

And I think it's really important for the leaders and managers to understand mental illness can be completely debilitating. It's ideal to just be kind and willing to support and, to your point, guide people to be appropriate support that they need.

ERIN YOUNG: Absolutely. I think that that's such an important takeaway. And if listeners hear anything, it's so important to understand that if you haven't experienced a mental health symptom or a loved one that has one it can be very non-tangible to understand what that's like. When you break a leg, everyone can see that you've broken leg. And you might need help on crutches or getting around. But those mental health symptoms make everything so much more difficult for people. And that means things that might have been easy and simple before might feel insurmountable or like moving a mountain.

And so people can just have different capacities when they're struggling with an acute mental health symptom. And so I think that that's such a great point. And I'm so glad that you brought it up.

JON OPPENHEIM: Well, your point about broken leg, when we think about it, when someone breaks our leg and they have a cast put on all their friends, relatives, coworkers, come over to sine the cast. It's a big deal. When someone's suffering from a mental health issue or mental illness, people have a tendency of running away. It's the polar opposite.

ERIN YOUNG: We've seen that before. When I was working somewhere else-- and this is a little bit tongue in cheek. And I certainly don't mean to make light of it. But a colleague said almost exactly that. When you come back from surgery or from a cancer treatment or from other kind of illness, there's flowers and a balloon on your desk. But no one wants to come back to flowers in a balloon on their desk after they leave a psychiatric hospitalization.

But also, people don't know how to talk about it in a compassionate way. So this is where I think it's so important to be able to have that open dialogue, be able to start to think about the language that's being used. We haven't really talked much about language.

But so much of our colloquial dialogue is so stigmatizing for mental health-- like even just saying, well, oh, my gosh, that person is so crazy or that woman, she must be off her meds today. That's really stigmatizing. And we need to think about how we're compassionately approaching people. And that's language in our daily conversations. It's language in our one-to-one conversations with our leaders and employees and peers. It's a written language for employees to see in that kind of employee-facing communication.

These are all ways to start to break down the stigma and normalize that mental health isn't separate from physical health. Mental health is health. You can't separate the mind and the body. It's all together as you had mentioned before.

JON OPPENHEIM: Your point about language is very important. I think it's a rarity to walk out to a construction job site and not hear some type of inflammatory and discriminatory language quite frankly. But we need to understand, to your point, language matters. Calling a coworker crazy or a psychopath is stigmatizing language. And I do also think it's important to learn the protocol to report when toxic language is happening at a job site or toxic behavior is happening at a job site.

It could be related to physical safety. It could be a sexual harassment. It could be bullying. It could be racism. It could be sexism or any other discriminatory act. I think just mitigating toxic behavior at work creates just a safe and healthy workplace where people want to work.

ERIN YOUNG: I couldn't agree more. I think that is so interesting to think about. Because as we talk about mental health, and as I said just now and you said before, the mental health- mental health and physical health can't be separated. So many of these things are tied together.

So when I talk to clients, I like to help them understand that we're looking at a holistic picture of an individual. And that holistic approach to emotional health, physical health, social well-being, financial well-being, workplace safety, and the psychological safety at a workplace exactly what you're talking about, so important to think about when you think about taking care of the well-being, the total encompassing well-being of an employee.

JON OPPENHEIM: Yes. And to me, the workplace well-being the conversations around it in the past, it can be a little tricky. I think and I think some of the historical messaging may not be 100% accurate.

So when you think about it, we've all probably heard the workplace being starts with things like certificates of champions or motivational workshops or gym passes and exercise classes or maybe some like funky-looking breakout space or a trendy-named EAP program, some tech gadgets, or fruit platters, whatever it is being in options. It's all stuff that I think is really the easy to sell.

Some of those external solutions add, I think, to what is almost like a well-being veneer. But it might not be genuine. And I think there's a lot of companies out there that are falling into a little bit of a box check trap. And my opinion-- the workplace well-being starts with realistic workloads, some clarity of role, establish responsibilities and certainly boundaries. You need to have your feelings of value and appreciation and purpose, and very important, some capable leadership and management.

And to some of your earlier points, the language, concise communication-- super important-- as well as, let's face it, fair wages-- that's why people go to work-- and an overall safe environment for working.

ERIN YOUNG: It's like building your house on sinking sand. You need to have a foundation. So those curtains and your curb appeal can be wonderful. But if you don't have a foundation for that employee well-being, the rest of it's not going to matter. And so how do companies go about ensuring that the foundation of emotional well-being and well-being in general is in place. And I think that there's a lot of ways to do this. There's no one right way or prescriptive way.

But in my opinion, it's really making sure and in a deep look, lifting up the corners of the rug on the benefits that you're offering your company, really dusting off what some of those plans look like, and making sure that they're up to date, that they are in line with parity, that people have access to the services and the care that they need in the time that they need them, really making sure that there is rich and generous mental health and substance use disorder benefits available to people.

I think that is a place to start. And then the less tangible piece, even though the outputs are very impactful, are everything that you mentioned-- talking about assessing your culture, looking at how the environment is welcoming, compassionate, and inclusive for people who are struggling with mental health needs, making sure that the language, the communications are inclusive, all of those things. There's those tangible pieces. And then there's those less tangible pieces.

And there's a variety, a whole host of ways to go about assessing the whole employee well-being experience.

JON OPPENHEIM: Yes. And I do think that it's really-- it's not always fun to, let's say, lift the hood and see what's laying underneath it. But it's much better than throwing money away at solutions before you've even considered you can make a difference and start building a being strategy. And really, no one wants to waste their money on well-being.

And you don't want to be taken in by the trends and the certificates and those solutions until you really look strategically at where you are and what you need.

ERIN YOUNG: Absolutely, And it's so important to have a finger on the pulse of what employees need. Because employees, what we know is that cohorts need different things. The Boomer generation needs something different than the Millennial generation. Men need something different than women. Income brackets might need something different from each other.

And so it's really about doing that deep introspective look at your employees, what they need, how they're performing and thinking really meaningfully about where those well-being dollars are spent. So you're making the right choice. And you're making a high-value, high-impact decision to change that programming for employee well-being.

JON OPPENHEIM: We're certainly facing a crisis. But remember, mental illness is extremely prevalent in our society. And it's not just in construction. There's also an extremely high degree of successful treatment of mental illness through a variety of techniques that allow sufferers to make significant contributions and to live a long, fulfilling, productive, and happy life.

Before I close this out, Erin, do you have any closing comments that you would like to add?

ERIN YOUNG: Thanks so much, Jon. I would just say that altered mental health and mental illness can really cause profound suffering. And all people deserve to feel healthy and well. And that includes feeling mentally healthy and well. There is dignity in receiving care for your mental health. There are national resources available if you're ever in crisis.

For the global audience, there are country-specific resources available for you as well. And I would just familiarize yourself with what your companies are offering in terms of your mental health resources and benefits just to make yourself more aware and be a tool and a conduit for care for people who may be interacting with you as a peer or a leader day to day.

JON OPPENHEIM: Well, thank you very much, Erin. And we need to understand that there is also a shortage of licensed and credentialed therapists. That's a global issue. But we do need to teach those best positioned to identify at risk people or those suffering on how, where, and when to address the issues, but certainly, direct them to the appropriate resources as well, as you stated.

This does include some skills associated with prevention, intervention, and postvention. And leaders need to create a compassionate culture. This is more than as I said before, free lattes and allowing casual dress to work. If we're going to make an impact, we need to fight the mental health crisis in construction together. And together, we can make a difference. Together, we could improve and save lives.

Thank you again, Erin, for joining us. And thank you all for listening and stay well.

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