Gregg Martin had reached his breaking point. Ten years after leading the engineering effort that enabled the 2003 invasion of Iraq, the two-star general watched with rage as the country descended into turmoil. At the same time, as president of the National Defense University, Martin became increasingly agitated at the slow bureaucracy of U.S. military institutions. His long undiagnosed mental illness was about to metastasize with a vengeance. “The stress was like pouring buckets of gasoline on my bipolar flames,” Martin says.

“And so I erupted into a wildfire that was uncontrollable and my bipolar just took off,” he adds. “By 2014, I was acutely manic—some would call it medically insane.”

As Janisha Johnson lay in bed at her Cleveland childhood home at the end of 2016, she grappled with the sudden passing of her mother, who was her biggest cheerleader. Minutes turned into hours. “I dreamt I was in a dark hole that I fell in and there was nothing around for me to grab onto.” After the funeral, upon returning to Southern California, where she worked as a project superintendent for Hensel Phelps Construction Co., Johnson found herself feeling empty and disconnected. Years before, Johnson’s mom had encouraged her to leave home and pursue her career on the West Coast. “The reason why I was in California was because of her, and she’s no longer there.”

When Janisha Johnson moved to Los Angeles from Cleveland, she became the first Black female project superintendent at Hensel Phelps.
Photo by Janisha Johnson/Hensel Phelps

Shawn Nehiley found, after years of prescription drug use to ease the pain from a back injury on the job, that his source of legitimate meds was cut off. By then physically addicted, he turned to other means to avoid withdrawal. He had a wife, two kids and a home, but addiction ran his life. “You justify everything you say you’ll never do—every line I said I wouldn’t cross,” he says. “You say you won’t take that money out of the bank, but then you do. It was a horror show. It was like being in the middle of a tornado that you can’t get out of.”

These intense journeys into darkness are just a few of the thousands that were rarely spoken of or even recognized as a problem in earlier decades of construction, where toughness was prized and relied upon by employers. Now these voices are raised not in a chorus of desperation or despair, but as part of an industry-wide effort to destigmatize mental health issues. Employers of all sizes, open shop and union, working in partnership with associations and safety professionals, are confronting the twin epidemics of suicides and overdoses.

Gregg Martin energizes troops with the 130th Engineer Brigade as they prepare to convoy to the Kuwait-Iraq border on the eve of the Iraq invasion in 2013.
Photo by Tom Sawyer

Pandemic Reframes Mental Health

The greater focus on mental health began gradually in the mid-2010s with a renewed focus on preventing suicide. “There were a few key turning points in this movement,” says Cal Beyer, vice president of workforce risk and worker wellness at CSDZ and a longtime advocate for mental wellbeing in the industry. “First, when we called suicide prevention the next frontier in construction safety. Second, when we reframed safety 24/7 not as focusing on getting people home safe at the end of the shift, but rather, getting people back to work safe from home. And, third, in embracing holistic safety, which is wellbeing, encompassing the physical and mental aspects of safety.”

But then the COVID-19 pandemic hit, which “drew a lot of eyeballs to mental health and suicide, and there was just a timing thing that things finally clicked,” says John Killin, executive director of the Associated Wall and Ceiling Contractors of Oregon and SW Washington.

“There was no longer the ability to justify the line between home life and work life, and so that allowed for more conversations” about holistic mental wellbeing, says Kabri Lehrman-Schmid, a superintendent with Hensel Phelps Construction Co. in Seattle. As a result, “over the last year as a company, we developed a corporate rollout and managerial training for mental health and suicide prevention in support of our people.”

Mandi Kime, director of safety for AGC of Washington, adds, “it also became less taboo to talk about the fact that we were suffering—because we were all suffering. I noticed dramatically in those first several months folks reaching out to me at AGC saying, ‘what else is there that I can use to talk to my team about how to take care of themselves?’” 

Construction’s growing sensitivity to mental health and wellness parallels a national crisis. Prior to the pandemic, one in five people experienced mental health issues, making it more common than cancer, diabetes or heart disease, says Darcy E. Gruttadaro, director of the center for workplace mental health at the American Psychiatric Association Foundation (APAF). But since the pandemic, more than a third of those surveyed by the U.S. Census Bureau and Centers for Disease Control (CDC) said they had symptoms of anxiety or depression in the prior seven days—and for people between the ages of 18-29, it reached 55%. In a separate survey conducted by the CDC in June 2020, 13.3% of respondents said they increased substance use, and 21.7% of people deemed essential workers had seriously considered suicide.

According to another CDC report published last year, people working in the construction and extraction occupations have the highest rates of suicide compared to any other field. The CDC found suicide rates of 49.4 per 100,000 among men in those occupations, and 25.5 per 100,000 among women—nearly twice the rate of any other occupation. 

The data points to a striking conclusion: “More people die in construction of suicide than they do of accidents in an industry that historically” is very dangerous, says Bill Barr, chair of the Construction Suicide Prevention Partners, a taskforce based in Portland, Ore. “We’re not there all the way, but we’re getting better in our ability to talk about an issue that used to be way under the table.”

Dave Drinkward, president and CEO of Hoffman Construction Co. and a member of CSPP, says there’s been a broad movement towards expanding holistic safety beyond physical hazards to include mental health and psychological safety. In 2019, Hoffman launched its Tough Enough to Talk campaign, which “focused on normalizing conversations around mental health as a starting point and turning the traditional stigma around these issues on its head and saying, ‘tough people don’t hide these issues. Tough people talk about them,’ completely flipping that around.”

Cal Beyer (right) discusses mental health and suicide prevention with Mandi Kime (left) and others at a roundtable hosted by AGC of Washington for ENR.
Photo by Scott Blair/ENR

As commander of the 130th Engineer Brigade tasked with training and deploying thousands of troops to provide engineering support for the U.S. Army’s invasion of Iraq in 2003, Martin is as tough as they come. He credits his meteoric rise and success in the military in part to the manic phase of his undiagnosed bipolar disorder, which seemingly imparted him with superhuman energy and intensity. His success led to his selection as ENR’s Award of Excellence winner in 2004. But after returning stateside that same year, a nearly year-long depressive stage took over.

Still, it would be 10 years before his supervisors and colleagues finally acknowledged that there was something wrong. In 2014, the Chairman of the Joint Chiefs of Staff ordered him to resign and seek help. “He definitely did the right thing for me,” Martin says. “He got me medical help and got me out of the fire zone.” 

After two years of depression, delusions and “suicidal ideations every day,” he was prescribed lithium and began his recovery process. “I had to figure out how to crawl, walk, run again, how to make friends, how to live with my wife in a normal way,” he says.

This April, Martin revealed the extent of his illness and recovery in an article for the military journal Task & Purpose. “My life is so much better now that I’m getting help. My mission is sharing my bipolar story, to help stop the stigma and save lives,” he says. 

Like Martin, many of the industry’s biggest wellbeing advocates are survivors of mental health issues and substance misuse, or have been impacted by it through family, friends or coworkers. 

For example, Dave Argus has made it his business to help recovering drug addicts find successful careers in the construction trades. After seeing a family member battle addiction for years, Argus, who is director of operations at Karas & Karas Glass Co., vowed to help others get back on their feet. In recent years, Argus has welcomed dozens of clean and sober former addicts to join the South Boston contractor’s union crews. 

Associations, contractors, unions and other organizations have created a proliferation of hardhat stickers, wallet cards, posters, placards and other messaging to boost mental health awareness and suicide prevention.

The program works with local unions—including ironworkers, glaziers and carpenters—to offer recovering addicts a probationary one-year union membership at first-year apprenticeship rates. Participants go to support meetings and are tested regularly. Although guidelines are in place to keep people on track, Argus says that adopting a culture of caring is what brings people suffering from addiction out of the shadows and back to life.

“I have 18 guys in my program right now,” he says. “They call me every Friday night. They’re like family. They know I love them.”

Michael Bassett, a 48-year-old union ironworker, was one of the first people in the program when he came onboard six years ago. He had recently wrapped up a ten-year federal prison sentence, which he says was “all due to drugs and alcohol.” While in a halfway house, he got connected with Argus.

“Not too many people would take a risk on a guy with a past like mine,” he says. “I’m forever grateful and wouldn’t be where I am without them. Last year, I was able to buy a new truck. I have two daughters. I have a fiancé. That just wouldn’t happen unless someone gave me a chance.”

Also in the program are brothers Jared and Devin Hasek. Growing up, they did drugs together. Jared ended up serving prison time and after he got out, he transitioned to a halfway house where he vowed to get clean. Although he was able to land a job working at a deli, he couldn’t make enough to pay rent. Homelessness was a real possibility.

But then Argus called the house looking for workers. Says Jared: “I was very fortunate to be in the right place at the right time. He was willing to take a chance on me when no one else would.” 

Five years later, Jared is still with Karas & Karas. He owns a home and has two kids. A few years ago, he was able to help his brother Devin get sober and arranged for him to go to work at the company as well. While Jared appreciates being given the opportunity, he says that continued support is what has made the difference. 

Dave Argus of Karas & Karas Glass proudly hires recovering addicts, offering them careers in the construction trades and a path to a new life.
Photo by Bruce Buckley

“When I show up, they don’t just tell me what to do,” he says. “They ask how life is. How your family is doing. It lets you know that they actually care about you.”

Unions have also been a big part of the support system. When Argus wanted to start offering jobs to recovering addicts, he turned to Nehiley, then a business manager with Ironworkers Local 7 and now president of the Ironworkers District Council of New England. Nehiley understood what addicts face. 

Years earlier, after being prescribed OxyContin for his back injury, Nehiley found himself trapped in a cycle he couldn’t break. He didn’t want to go on workers’ comp because he wouldn’t earn hours toward his pension, his annuity and his health and welfare benefits. “I didn’t want my family to lose their medical insurance, so I worked hurt on the pills for 10 years,” he says.

 Eventually, Nehiley turned to pill mills or buying them off the street. To evade detection at work, he would sometime use someone else’s urine to help him pass drug tests. Nehiley tried detox facilities four times and was kicked out of his house multiple times. Eventually, his back problems were so bad that he couldn’t work at all, even on pain pills. Finally, he was given approval for surgery. “Within a couple of weeks, I was in rehab,” he recalls. “I got clean, and I haven’t used again.”

Shawn Nehiley battled opioid addiction for a decade following a worksite injury. Today, he is sober and serves as president of Ironworkers District Council of New England.
Photo by Bruce Buckley

Sober now and working in a union leadership role, Nehiley is committed to changing attitudes within the industry about recovering addicts. He says that, when he was using, the stigma around drug abuse prevented people from reaching out for help. To break down the barriers, he worked with another sober business agent to start AA meetings at the hall. “I became the guy people could trust,” he says. “If someone came into the hall and needed help, I got them the help they needed and never said a word to anybody.”

The dangers of addiction have become almost impossible to ignore. Within the general population, 2020 was the worst year on record for overdose deaths in the U.S., according to CDC data. Overdose deaths surged to 93,000 last year, up a stunning 29% from 2019. Earlier studies show construction work is among the occupations most prone to overdose deaths. 

Today, Nehiley talks about addiction and depression at every union meeting. The local’s employee assistance program (EAP) is actively involved in offering direct help to members and conducting training sessions for apprentices. “Our EAP comes in and tells them that if you’re feeling depressed or anxious, don’t sit at home in silence—make the phone call to your EAP,” he says.  “We saw a huge jump in people calling about depression and anxiety and trying to get help before it became a full-blown addiction.”

But just having an EAP often isn’t enough. Experts advise organizations to also audit their mental health resources. “Go kick the tires and be secret shoppers” with your company’s EAP, says Sally Spencer Thomas, a clinical psychologist who began working in suicide prevention after her brother died of suicide. “Go call them, even go take a session or two and ask them all kinds of questions,” Thomas advises, and then pass that information along to employees so they know what to expect when they call for help.

In a study, Pulse Survey on Mental Health in the Construction Industry 2021, to be released later this year, more than 70% of nearly 1,000 respondents said their company recognizes the benefits of an EAP, and more than 60% said their organization promotes such programs. Sponsored by the Construction Financial Management Association (CFMA) and CSDZ, and conducted by Gruttadaro of AFAP with CSDZ’s Beyer, the study also showed that only 22.4% said there’s been a measurable impact from the use of EAPs.  

Getting Into the Field

In May, the annual Construction Safety Week event emphasized the connection between physical and psychological safety at the jobsite. “At that critical moment when you’re supposed to tie off 50 ft off the ground, you’ve really got to be focused and present,” says Michael McKelvy, president and CEO of Gilbane and the 2021 Safety Week chair. “Holistic safety, from mind to body, connecting it all in spirit, will make you safer.”

But employers should no longer expect their workers to leave personal problems at the jobsite turnstile, says Greg Sizemore, chairman of the Construction Industry Alliance for Suicide Prevention (CIASP) and vice president of health, safety, environment and workforce development at Associated Builders and Contractors (ABC). He calls that expectation “archaic.”

Beyond the societal impacts, there is a business case for bolstering mental health. “Studies indicate there’s $193 billion of lost earnings every year as it relates to things like, ‘I’m too depressed to come to work,’” Sizemore says. Other research points to tens of billions of dollars in lost productivity annually. 

The cost to treat underlying chronic health conditions such as diabetes is two to three times higher in individuals with a mental health or substance abuse condition, which can become a concern for companies that provide health care benefits, says Gruttadaro.

Campaigns to promote wellness and mental health take many forms.

Hensel Phelps placed posters in porta johns geared towards specific groups, such as minorities and LGBTQ+ workers, so QR codes could be scanned out of public eye.
Photo courtesy Hensel Phelps

In 2018, the Pennsylvania House of Representatives unanimously approved a resolution that declares the last full week of July Construction Opioid Awareness Week. As part of that effort, the Keystone Contractors Association, whose members include both union and non-union shops, provides a toolkit to construction employers, including a Substance Use Cost Calculator. It provides information on the cost to a business of substance use in their workplace. 

Via its website, CIASP provides resources and information for firms large and small “to implement a mental health program inside your organization. And the beautiful thing about what’s out there is every bit of it’s free,” Sizemore says. An interactive needs analysis tool “tells you exactly what you should do and ties it to a free resource on our website” including toolbox talks, signs and placards. “We’re continuously adding resources as they’re developed with our partners,” he adds. 

Many toolbox talks and other programs emphasize peer-to-peer interactions that can guide workers to pick up on subtle cues if someone is having a performance issue, says Troy Hendricks, safety director with mechanical contractor Holaday-Parks Inc. The training “gives you the intuitiveness to ask questions and be a little bit more personal with that individual, because there might be something going on and it opens the doors to some good conversations that they might need help.”

Colin McShane, a commercial painter in Philadelphia and member of IUPAT District Council 21, recently began opening up about his past addiction to help others recover. 
Photo by Bruce Buckley for ENR

Those conversations don’t need to be framed in mental health lingo, which can be off-putting to people “in an industry like construction,” says Gruttadaro. “You can use backdoor language like ‘if you’re not sleeping well, if you’re feeling stressed.’”

Building up a “buddy system” is another effective method. Comprised of influential workers who may be good listeners or have some lived experience with mental health or addiction issues, the buddies can resolve up to 80% of mental distress right at the peer level, avoiding medical appointments and associated absenteeism and costs, says Thomas. “It’s low intensity intervention and high impact, which is always great.” 

In many cases, it only takes one coworker or manager to make a life-changing difference. Colin McShane, a commercial painter in Philadelphia and member of IUPAT District Council 21, was an opioid addict even before he started working in construction. He says he managed to hide his addiction from management for four years, until one day when he came to work noticeably high. “It was the only time I was almost incoherent on a jobsite,” he recalls.

McShane says a foreman, who grew up in the same neighborhood and was also a recovering addict, was the one to step in and offer help. “He knew my past,” he recalls. “He took me under his wing. He got me to go to meetings and stay sober. Now, he’s one of my best friends. He’s the godfather to one of my children.”

Two years after he got sober, McShane says he took the opportunity to be part of the solution. During an OSHA 30 session on the topic of drugs and alcohol, the trainer asked if anyone in the room had dealt with addiction. McShane decided to share his story. “I wanted people to know that you don’t have to be quiet and hide it,” he says. “They gave me a chance. I went away and I got sober.”

Mental health advocate Cal Beyer highlights suicide prevention at a toolbox talk at a jobsite in Bellevue, Wash.>
Photo by Mike Shute

Expanding to a National Scope

Mental health consultant Thomas is currently piloting a national mental health training program, Construction Working Minds, tailored to fit into a typical one-hour lunch break at the jobsite. In partnership with the Johnson Depression Center in Aurora, Colo., Thomas has so far trained around 1,000 employees from co-sponsors Lend Lease, Hensel Phelps and the International Association of Sheet Metal, Air, Rail and Transportation Workers, and hopes to have around 20,000 trained by the end of the pilot in around 18 months.  

Still another effort has been to incorporate wellness into safety training. In Washington state, ABC, in partnership with AGC and other groups, successfully lobbied for passage of HB 2411, which requires mental health training to be deployed through the OSHA 10- and 30-hour safety classes that are already required, says AGC’s Kime. “It gives us a standardized baseline of information on things that we want every worker in the industry to know,” she adds. 

Even with training, employees may need an extra nudge before asking for help. To overcome this hesitation, Hensel Phelps provides direct access to hotlines and other information in private locations. “If it’s on the wall of a lunchroom, that’s hard for somebody to go up to and necessarily access,” says Lehrman-Schmid. Instead, the firm placed posters inside porta johns, including ones specifically geared towards diverse groups such as LGBTQ+. “So you’re not only providing the direct link. You’re also targeting people who have different experiences in a way that’s safe,” she says. 

Eliminating toxic work environments and discrimination are also key to addressing well-being. “The interplay between psychological safety and having an inclusive environment,” says Lehrman-Schmid, “needs to go hand-in-hand with the discussion of mental health.”

To that end, AGC of Washington pioneered the Culture of Care program that the association adopted nationwide last year. The program aims to create diverse and safe work environments free from harassment, hazing and bullying—and that in turn could help make a dent in construction’s shortage of skilled workers. 

Sizemore puts it this way: “Do we ever really think we’re going to solve that problem” if parents and kids choosing careers see that construction “allows that kind of garbage to happen on their projects?” Over the next year, ABC will roll out its pilot Total Human Health program to address all aspects of worker well-being. “Every contractor should be held accountable to how they address the total human health,” he adds.  

Even with all of the resources available, some staff still are afraid to seek help. When asked if employees in their organization needing help with mental health or substance abuse disorder concerns were likely to seek care, just 25.5% of respondents in the Pulse Survey said yes, and 31% said no. The biggest impediments to seeking care included shame/stigma, judgment by peers and fear of negative job consequences. 

Columbia uses app to provide wellness and mental health info to employees, and tracks team challenges for prizes.
Image courtesy Columbia Construction Co.

“This is where leadership matters,” Guttadaro says. She recounts the story of a CEO who told his team he wouldn’t be in the office one morning because he has an appointment with his therapist. “What a great way to send the message that getting the help he needs is a sign of strength.”

Hensel Phelps’ programs weren’t yet available when Johnson went through her crisis after her mother’s passing. Her path to recovery and dealing with her grief began by working with a spiritual-based counselor that her church pastor had referred her to. Now, five years later, Johnson has become a peer advocate to help others get through traumatic experiences. “I’m able to connect with individuals and have more empathy for them,” she says. “I’m able to share every tool that I’ve used in my toolbag to get through it.” 

There are also firm-wide alternatives to traditional EAPs that use a spiritual approach. Since 2009, electrical contractor Kortman Inc. in Phoenix has provided employees with an EAP-type program based on the chaplaincy model, where a certified pastor stops by the office or jobsite once a week to conduct brief wellness checks that can turn into longer conversations when an employee is in need, says Karl Kortman, CFO. The pastor is also available “basically 24/7” by phone or text, he says. 

In Boston, Columbia Construction Co. is trying another alternative approach by partnering with Wellness Workdays to pilot a program that brings wellness coaching for one day a week at two of its jobsites. After several months “it’s being so well received that we are planning to move it to other job sites and even bring it here to the [main] office in September,” says Bill Aalerud, senior vice president of Columbia. The firm also provides a wellness app portal through Wellness Workdays that includes mental health and financial wellness resources along with team fitness challenges where workers can win prizes. 

United Group Services in Cincinnati realized that it needed to take proactive steps to concurrently address suicide prevention and addiction by creating an amnesty program stating that if an employee comes forward before there’s an issue—such as a crime or an accident—and the employee allows management to help them, UGS will protect their job and help the worker get rehabilitated. Kevin Sell, chief vision officer for UGS, says the amnesty program is a necessary part of an all-encompassing “total employee health” policy, rather than just a traditional safety policy.

Sell, who is helping pilot ABC’s Total Human Health Initiative, says contractors need to rethink risk around employees who are current or former addicts. “Is it not a bigger risk if we leave it up to our policy and just say, ‘That’s it, you’re gone?’ That just doesn’t work,” he says. “If you lose your job, you lose purpose,” which could lead to more addiction or possible suicide risk. 

And even if contractors don’t feel a moral obligation to care, Sell says there is a business case. “There’s a financial obligation because, what are we looking for? People who want to come to work every day,” he says. “One of the big things for a recovering addict is steady employment, so they have purpose. If we’re ignoring that, then shame on us.” 

While employers can do their part to “rehabilitate rather than terminate,” Sell admits that getting owners to join in the effort is a significant challenge. A company can implement an amnesty program, but an owner may have strict policies in place which state that any worker who tests positive must be removed from a site.

“Unless your customer recognizes your amnesty policy, you really can’t put them back on that site because you’ve signed a contract saying you won’t,” he says. “Unfortunately, that supersedes everything.”

Some unions are also grappling with their own policies around drug testing and policing. Nehiley says a purely punitive approach is not effective. “You already feel like a piece of dirt and then you fail a drug test and you can’t go to work for 30 days,” he says. “You fail another and you can’t go to work for six months. Fail a third and you’re out for a year. Those things stop people from reaching out for help.”

Nehiley says those policies still exist, but his union does what it can to minimize the damage. “If they fail a drug test, I do what I can to get them treatment and get them back to work safely,” he says. 

Despite the progress being made in these and other outside-the-box programs, Beyer still sees much more work to be done to address mental well-being.

“I’m proud of how our industry has responded to the challenge,” Beyer says. “But we can’t take our pedal off the metal. We can’t ease up on our efforts.”