A Construction Approach to Suicide Prevention

This article is about mental health and suicide - if you require support the MATES in Construction 24/7 support line: 1300 642 111 and Lifeline 13 11 14

Suicide and suicide behaviours are major issues facing the Australian community. In 2018 Australia’s suicide rate was 12.1 for every 100,000 accounting for more than 3,000 premature deaths (ABS, 2019). The Australian Government Productivity Commission (2019) has estimated that the annual cost of suicide behaviour to the Australian economy is between $16B and $34B. Analysis by Kinchin and Doran (2017) estimated the cost of suicide behaviours within the Australian workforce alone to be $6.73B in 2014 health dollars. They also highlighted that investments in workplace suicide prevention programs such as MATES in Construction would come with a significant positive return on investment.

Anyone who have attempted or lost to suicide knows how impossible it is to place a number or cost on the experience. Suicide has a profound impact on individuals and communities well beyond other types of losses because suicide often impose a portion of rejection, guilt and “if only” emotions on those left behind. Over my past 12 years with MATES in Construction I have spoken to managers and workers who have told me of workplaces that never became the same after being affected by suicide.

Mental health and suicide prevention is not just nice to haves in the workplace, it is important to meet legal liabilities, financial incentives and moral obligation. It is increasingly becoming part of the social license to operate. This article will focus on mental health and suicide prevention in the construction industry and point to the Australian Building and Construction Industry Blueprint for Better Mental Health and Suicide Prevention and the MATES in Construction program as good starting points.   

Mental Health in the Construction Industry

A recent study of construction managers by Professor Alan Patching of Bond University highlights how the competitive structure of the Construction industry impacts on stress levels amongst project managers. Tight budgets and time frames on projects were identified as significant issues causing stress amongst this group of workers.

Work by late Associate Professor Allison Milner (University of Melbourne) have highlighted how occupational skill levels amongst construction workers impact of suicide risk amongst construction workers with lower skilled workers, particularly operators and labourers being of particularly high risk. The may suggest that the culture created by the competitive and time poor industry, impacts across the construction industry (Milner, Niven, & LaMontagne, 2014). Professor Milner also undertook a qualitative analysis of 34 randomly selected construction suicides and found issues such as the transient work experience (lack of steady employment) and workplace injury as significant work related causes (but also mental illness, relationship breakdown, child custody issues and substance abuse. (Milner , Maheen, Currier, & LaMontagne, 2017).

Recent, and yet to be published, research by Dr Victoria Ross at the Australian Institute for Suicide Research and Prevention, studying 1600 Queensland apprentices have identified significant levels of bullying (30% of apprentices had experienced bullying) and suicide ideation (35% of apprentices reported suicide thoughts within the preceding 12 months). A large proportion of the bullied apprentices reported being unemployed and experiencing significantly lower mental health wellbeing than other apprentices. Unfortunately, this research is also visible in the suicide rates amongst Queensland construction workers where the age profile for suicides are is significantly younger than other employed men in Australia (Maheen & Milner, 2017):

The manifestation of these reports is generally seen as higher suicide rates amongst construction workers versus other employed men. While suicide rates have been decreasing over time, they are still unacceptable high. The research has also shown us that interventions must be directed towards ALL in the industry, perhaps with the greatest focus on apprentices and lower skilled workers (example is for Queensland Construction workers):

The Australian Building and Construction Industry Blueprint for Better Mental Health and Suicide Prevention

The recent draft report by the Australian Competition Commission into mental health highlights the importance of the workplace in mental health. It calls for programs such as MATES in Construction to be implemented across worksites. It is also proposed that workplaces that implement mentally healthier policies should get rebates in workers compensation premiums and other incentives.   

The Construction industry has been proactive in this space for decades.  The industry designed the MATES in Construction program 12 years ago, long before workplace suicide was discussed generally. This program structure has since been replicated by Incolink in Victoria creating the Bluehats program, the UK construction industry creating Mates in Mind and New Zealand implementing MATES in Construction. 

In September 2016 MATES in Construction jointly with beyondblue convened a leadership roundtable in Sydney including business leaders, unions, employer and industry support organisations such as MATES in Construction, OzHelp Foundation, Foundation House, Incolink and beyondblue.

The industry decided it wanted to be industry leaders and tasked MATES in Construction and beyondblue to lead the development of a road map for better mental health and suicide prevention. The industry wanted a leading edge, evidence based and useful standard to work towards and suggested that the process should include a level of accountability to drive the process.

In April 2019 the Australian Building and Construction Industry Blueprint for Better Mental Health and Suicide Prevention was launched at Queensland Parliament. The document is an open guide that will allow companies of any size in the industry to engage and improve. It is endorsed by both employers and unions in the industry as a common starting point. Business who partner in the blueprint agrees to participate in the accountability by reporting activity to an independent 3rd party, University of Melbourne. 

You can find the blueprint here: https://www.constructionblueprint.com.au/

This process is now staring to be rolled out across the industry. MATES in Construction with the support of Construction Skills Queensland and the Commonwealth Government provide support to business of all sizes who wish to implement the blueprint by having specific industry engagement officers. 

The Blueprint calls for proactivity across five areas. The activities in each area will naturally depend on the nature and size of the business, but the intention of the document is to promote an integrated and rounded response to get the widest possible impact. The five areas are:

While MATES in Construction supports business across the model, our primary focus is on improving Mental Health and Suicide Prevention and Facilitate Early Intervention and Treatment.

The MATES in Construction Program

MATES in Construction was created in 2008 as an industry response to a 2006 study into suicide in the Queensland’s Commercial Building and Construction industry highlighting high rates of suicide amongst workers within the industry (Australian Institute for Suicide Research and Prevention, 2006; Heller, Hawgood, & De Leo, 2007). 

It is a program offered at no charge to all construction business and workers across Queensland, NSW, South Australia, ACT, Western Australia, the Northern Territory and most recently New Zealand.

MATES in Construction is a comprehensive and multimodal industry based intervention program and has been described in detail elsewhere (Martin & Gullestrup, 2014; MATES in Construction (Aus), 2016). The organisation mission is to:

• Raise Awareness of suicide as a preventable issue faced by the industry by providing training and information to workers
• Build stronger and more resilient worksites by establishing peer support networks on sites consistently across industries
• Connect workers in need to appropriate help and support through the peer network and by operating a 24/7 support line and offering case management support to workers
• Inform industry to improve mental health and reduce suicide through research in partnership with leading researchers.

The training components of the MATES in Construction program is primarily focused at three levels:

• General Awareness Training – a one-hour suicide literacy program
• Connector Training – a four-hour gatekeeper program including Livingworks safeTALK
• ASIST Worker Training – a 16-hour Livingwworks suicide intervention training program.

The peer network is based on trained Connectors and ASIST workers who acts as volunteers in their workplace. These volunteers perform their role for the MATES in Construction organisation and not in their employed capacity. These volunteers are the key to the fabric of the MATES in Construction program. The volunteer network is supported by a 24/7 support line, Field Officers and Case Managers. 

Evidence base for MATES in Construction

MATES in Construction is one of the best evaluated workplace-based suicide prevention programs globally. 

It is established that General Awareness Training raise awareness about suicide as a preventable problem and that workers becomes sufficiently motivated to volunteer for further training (Gullestrup, Lequertier, & Martin, 2011; Ross, Caton, Gullestrup, & Kolves, 2019; Tynan, et al., 2018).

It is also established that workers who participate in the MATES in Construction training programs have increased mental health and suicide literacy, feel more empowered and preparedness to offer and seek help following General Awareness Training (Gullestrup, Lequertier, & Martin, 2011; King, et al., 2018; King, et al., 2019) and following the more advanced Connector and ASIST workers training (Gullestrup, Lequertier, & Martin, 2011; Ross, Caton, Gullestrup, & Kolves, 2019).

There is also some evidence to suggest that the collective sum of activities within the MATES in Construction programs could have long term positive impact on industry culture around mental health and suicide prevention stigma, help seeking and help offering (Sayers, Rich, Rahman, Kelly, & James, 2019; Ross, Caton, Gullestrup, & Kolves, 2020) and even suicide rates (Martin , Swannel, Milner, & Gullestrup, 2016; Maheen & Milner, 2017) and suicide behaviour (Doran, Ling, Gullestrup, Swannell, & Milner, 2016).

If this article awoke emotions you find difficult to deal with, please remember that support is available:

MATES in Construction 24/7 support line: 1300 642 111

Lifeline 13 11 14

Works Cited

ABS. (2019). 3303.0 Causes of Death, Australia, 2018. Canberra: Australian Bureau of Statistics. Retrieved January 12, 2020, from https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2018~Main%20Features~Intentional%20self-harm,%20key%20characteristics~3

Australian Government Productivity Commission. (2019). Productivity Commission Mental Health Draft Report Volume 1. Canberra: Commonwealth of Australia.

Australian Institute for Suicide Research and Prevention. (2006). Suicide in Queensland's Commercial Building and Construction Industry. Brisbane: Australian Institute for Suicide Research and Prevention. Retrieved January 12, 2020, from http://micaus.bpndw46jvgfycmdxu.maxcdn-edge.com/wp-content/uploads/2016/03/2006-MIC_AISRAP-Report.pdf

Doran, C. M., Ling, R., Gullestrup, J., Swannell, S., & Milner, A. (2016). The Impact of a Suicide Prevention Strategy on Reducing the Economic Cost of Suicide in the New South Wales Construction Industry. Crisis, 37, 121-129.

Gullestrup, J., Lequertier, B., & Martin, G. (2011). MATES in Cnstruction: Impact of a multimodal Community-Based program for Suicide Prevention in the Construction Industry. International Journal of Enviromental Research and Public Health, 8, 4180-4196.

Heller, T. S., Hawgood, J. L., & De Leo, D. (2007). Correlates of Suicide in Building Industry Workers. Archives of Suicide Research, 11(1), 105-117.

Kinchin, I., & Doran, C. M. (2017). The Economic Cost of Suicide and Non-Fata;l Suicide Behaviour in the Australian Workforce and the Potential Impact of a Workplace Suicide Prevention Strategy. Internatoinal Journal of Environmental Research and Public Health, 14(347).

King, T. L., Batterham, P. J., Lingard, H., Gullestrup, J., Lockwood, C., Harvey, S. B., . . . Milner, A. (2019). Are Young Men Getting the Message? Age Differences in Suicide Prenveiton Literacy among Male Construction Workers. International Journal of Enviromental Research and Public Health, 16, 475.

King, T. L., Gullestrup, J., Batterham, P. J., Kelly, B., Lockwood, C., Lingard, H., . . . Milner, A. (2018). Shifting Beliefs about Suicide: Pre-Post Evaluation of the Effectiveness of a Program for WOrkers in the Construction Industry. International Journal of Environmental Research and Public Health, 15, 2106.

Maheen, H., & Milner, A. (2017). Suicide in the construction industry: Report submitted to MATES in Construction by Deakin University. Brisbane: MATES in Construction. Retrieved January 3, 2020, from http://micaus.bpndw46jvgfycmdxu.maxcdn-edge.com/wp-content/uploads/2015/11/17584-mic-qld-Deakin-report-volume-2-297x210mm-v10.pdf

Martin , G., Swannel, S., Milner, A., & Gullestrup, J. (2016). MATES in Construction Suicide Prevention Program: A Five Year Review. Journal of Community Medicine and Health Education, 6(4), 465.

Martin, G., & Gullestrup, J. (2014). Help-Seeking and Men: An Innovative Suicide Prevnetion Program from the Construction Industry. In D. Lester, J. F. Gunn, & P. Quinnett, Suicide in Men: How men differ from women in expressing their distress (pp. 332-352). Springfield Illinois: Charles C Thomas.

MATES in Construction (Aus). (2016). Retrieved January 12, 2020, from www.matesinconstruction.org.au: http://matesinconstruction.org.au/

Milner , A., Maheen, H., Currier, D., & LaMontagne, A. D. (2017). Male suicide among constructoin workers in Australia: a qualitative analysis of the major stressors precipotating death. BMC Public Health, 17(584).

Milner, A., Niven, H., & LaMontagne, A. (2014). Suicide by Occupational skill level in the Australian construction industry: data from 2001 to 2010. Australian and New Zealand Journal of Public Health, 38(3).

Ross, V., Caton, N., Gullestrup, J., & Kolves, K. (2019). Understanding the Barriers and Pathways to Male Help-Seeking and Help-Offering: A Mixed Method Study of the Impact of the MATES in Construction Program. International Journal of Environmental research and Public Health, 16(2979).

Ross, V., Caton, N., Gullestrup, J., & Kolves, K. (2020). A longitudinal assessment of two suicide prevention training programs for the construction industry. International Journal of Enviromental Research and Public Health, 17.

Sayers, E., Rich, J., Rahman, M., Kelly, B., & James, C. (2019). Does Help Seeking Behaviour Change Over Time Following a Workplace Mental Health Intervention in the Coal Mining Industry. Journal of Occupational and Enviromental Medicine, 61(6), 282-290.

Tynan, R. J., James, C., Considinde, R., Skehan, J., Gullestrup, J., Lewin, T. J., . . . Kelly, B. (2018). Feasibility and acceptability of strategies to address mental health and mental ill-health in the Australian coal mining industry. International Journal of Mental Health Systems, 12(66).