Expert Q&A: How can we prevent suicide in construction?

Dr. Dan Carlin, founder and CEO of JobSiteCare

Sobering fact: Construction has among the highest suicide rate of any industry, with 53.2 suicides per 100,000 workers. According to the Centers for Disease Control and Prevention (CDC), deaths by suicide are five times higher than all construction deaths combined.

To get a sense of the problem and what can be done about it, and in honor of national Mental Health Awareness Month, we talked with Dr. Dan Carlin, founder and CEO of JobSiteCare, to find out how the implementation of telehealth and on-the-ground medical services on construction sites can reduce stigma, increase connection and impact how workers can reach out for care.

Dr. Carlin was among a selection of professionals to take part in the first-ever conference to address this issue – The Construction Working Minds Summit – which took place in Denver on May 17-18. 

Following is an excerpt of our discussion. 

CONEXPO-CON/AGG 365: Statistics show that suicide among construction workers is a serious and stubborn problem. Why?

Dr. Carlin: One reason is construction has always had a culture of ‘toughness.’ Another aspect of that culture says, ‘we’re gonna get this done on time’ … productivity at any cost. After that, you layer in some stuff that’s very unique to the industry.

First, jobs always come to an end. Maybe it’s seven months or two years, but eventually, every job is gone. And if you’re a skilled laborer, you’re always looking for the next job, and sometimes it means leaving your family for stretches while you work hundreds of miles away.

CONEXPO-CON/AGG 365: How does that affect the suicide rate in construction?

Dr. Carlin: In those cases, construction workers lose their social network. When they leave home, they’re separated from a bunch of their communities - family, friends, church, hobby buddies.

Then add the use of drugs and alcohol. They’ve always been a part of the construction culture and it’s not a coincidence.

It’s also a fact that people who are in chronic physical pain often use alcohol and drugs for relief. If a construction worker is say, 45 years old, there are a lot of miles on that body. There’s a lot of arthritis, low back pain, and so on. So now you’ve got a population of people who are in physical pain as a result of their work.

And how do they treat pain? They’re not going to talk about it with other people on the road, but they might go to a bar and start drinking, or worse, a liquor store and back to their hotel room. Their normal support network is not there.

CONEXPO-CON/AGG 365: How important is a support network in these cases?

Dr. Carlin: Under normal circumstances, your spouse or significant other might say, “Hey, I noticed you’re drinking a lot these days, what’s going on?” You have that person who’s constantly observing you, and caring about you.

But when you’re away from home for long periods of time, you lose that part of your support system, and maybe no one’s really noticing any changes in your behavior.

Often when these individuals do call home for support, it’s not what they get. Instead, they might get a list of problems and concerns that they’re not there to help deal with or control. That can be very stressful. The reaction for some might be to not call home so often, and things gets worse from there. They’re not getting a lot of connection, they might be self medicating, and they’re alone most of the time.

This is where construction is so dangerous because all the underpinnings that keep people reasonably balanced have been removed, while all the risk factors – such as drugs, alcohol and loneliness – have been magnified.

There’s a feeling of powerlessness when they’re not at home, can’t fix the problems there, and that can lead to guilt and depression. If a person is prone to organic depression, meaning their brain is naturally predisposed to it, you have the makings of all the preconditions for suicide.

CONEXPO-CON/AGG 365: Are there other aspects of construction that put workers at greater risk?

Dr. Carlin: Yes, construction workers are, in fact, successful at suicide more so than other people. Why? Risk factor number one is that construction is a male-dominated industry and men are much more successful at committing suicide than women. Women often signal and distress call before an attempt, and they often use a near-lethal means, such as drugs, as their method.

Men tend to commit suicide using definitive means, so they’re more often successful.

CONEXPO-CON/AGG 365: What are some ways the industry is working to bring help to construction workers who might be contemplating suicide?

Dr. Carlin: I run a company called JobSiteCare. We provide concierge care for injured workers. We use telemedicine care networks, but we’re like the village doctor for construction. If you’ve got a problem and you’re on one of my construction sites, I’m the guy you’re going to call.

Suicide prevention is now part of our practice. We need a system to surveil the construction community for at-risk folks. That can be done in part by educating our workforce that every worker is part of the solution, every individual is keeping an eye out for each other. We’ve got to convert that workforce into a community. That’s how you prevent suicide.

CONEXPO-CON/AGG 365: How does JobSiteCare work?

Dr. Carlin: We are an end-to-end concierge medical practice for injured workers. We use telemedicine to be at the job site when you get injured and then we organize and oversee your entire recovery. We pick the specialists, make sure you’re responding to therapy, make sure you get a ride to physical therapy and so on.

We’ve found that when a worker is injured on the job, as an employer you have 48 hours to demonstrate that you care about them. If you miss that window, there’s a greater than 50% probability they’re going to go to a lawyer, and that can lead to expensive lawsuits.

We help with the demonstration of caring, which then reflects positively on the employer.

CONEXPO-CON/AGG 365: How can construction firms get involved?

Dr. Carlin: Usually, the general contractor contracts with us to care for a particular worksite or workforce in a particular region. We charge them a fixed fee based on past losses and safety records. We negotiate an annual contract, so there’s no incentive to make cases last any longer than they need to. In contrast, billing on a case-by-case basis drives a lot of the dysfunction in workers comp claims and can result in an OSHA recordable incident.

CONEXPO-CON/AGG 365: What you’re describing sounds like an approach that could solve a lot of problems in the medical field.

Dr. Carlin: Absolutely, yes. That is the vision. Primary care has almost vanished for a lot of people, but an easy place to access it is through work. I do see a natural pathway in the years ahead that will start in occupational medicine and eventually migrate to primary care.

Primary care does really well when there’s continuity to it. When someone’s actually monitoring your blood pressure, or your blood sugar, or your depression over time, the outcomes are way better. We’re not there yet, and we’ve got a ways to go.

CONEXPO-CON/AGG 365: What’s the most important message you’d like to get out on this topic?

Dr. Carlin: It’s here to stay. Mental health and caring for your workforce is not a transient issue, so move now to put the right resources in place. The technology’s there and this is a corner of medicine that’s ripe for improvement. We need to do so much better than we’re doing.