When thinking about how best to approach behavioral health in the workplace, a simple parable is useful. Imagine the following:
It’s a beautiful day, and you are taking a stroll along a river. All of a sudden you hear a cry for help — someone is drowning! You don’t waste any time as you dive into the water and save him. You pull him ashore and perform CPR. Your heart pounds as he starts to regain consciousness. Wow. You feel great about yourself — you just saved someone’s life. Just as you are about get back on your feet, another frantic call comes from the river. You can’t believe it! You dive back in the river and pull out a woman who also needs life-saving care. Now a bit frazzled, you mop the sweat from your brow. No sooner can you catch your breath when you see even more drowning people coming down the river. One after another. You shout out to all the other people around, “Help me! Help me! We have people drowning in the river!” People come running from all directions. Now it’s chaotic as everyone is frantically pulling drowning people out left and right. One of the rescuers swims out to the drowning group and tries to start teaching them how to tread water. This strategy helps some, but not all because it turns out it’s really hard to learn how to tread water when you are drowning. Everyone looks at each other, completely overwhelmed, wondering when this will stop. Finally, you jump out of the water and start running upstream. Another rescuer glares at you and shouts, “Where are you going? There are so many drowning people; we need everyone here to help!” To which you reply, “I’m going upstream to find out who is pushing all of these people into the river.”
Upstream, midstream and downstream approaches are needed to prevent suicide, help people through mental health challenges and bolster resilience.
- Upstream strategies build protective factors that can mitigate risk, such as creating a sense of belonging, eliminating stigmatized language and actions, building resilience through life skills and mental hardiness, and enhancing mental health literacy.
- Midstream methods help identify people in emerging risk to link them to appropriate support before the issues develop into a suicidal crisis. Midstream strategies include screening for mental health conditions and suicidal thoughts, promoting and normalizing many types of help-seeking behavior, and training populations on how to have difficult suicide-specific conversations.
- Downstream approaches are needed on how best to respond when a suicide crisis has happened including acute thoughts of suicide, suicide attempts or suicide death. How can we approach these crises with dignity and empowerment instead of fear?
Upstream approaches are the most effective way to cultivate resilience at work while also mitigating suffering. One example of how upstream approaches help with downstream workplace problems is the U.S. Air Force’s Suicide Prevention Program. After a five-year period of rising suicide rates, the U.S. Air Force committed to implementing a comprehensive suicide prevention program (Knox et al, 2003). This decision occurred even though Air Force rates were comparatively lower than that of other military branches. Strong and visible support from the Air Force Chief of Staff provided the top down endorsement that encouraged other leaders to discuss the various aspects of suicide prevention and reminded leaders about their roles and responsibilities to prevent suicide.
The upstream, midstream and downstream strategy consisted of the following five components implemented over a five year period.
- Changing social norms through marketing community awareness.
- Educating community members through education, training and preventive services.
- Improving surveillance through the development of a well-integrated database and community action information board.
- Implementing a critical incident stress management protocol.
- Integrating all human services including training among the chapel program, mental health services, financial counselors, career counselors and health providers.
When the Suicide Prevention Program started, suicide was the second leading cause of death for the 350,000 Air Force members (with a suicide rate of 15.8 per 100,000). After the implementation of the program, the suicide rate fell to 3.5 per 100,000, the lowest rate on record. The rates of violent crime, family violence and deaths due to unintentional injuries also experienced statistically significant declines at the same time as the interventions.
The researchers concluded that the desirable outcomes beyond suicide were impacted because of the upstream components of the program. It’s possible for all companies, including construction contractors, to implement some of these techniques.
Top 10 Tactics to Build a Resilient Workforce
1. Develop a wellness task force or, even better, integrate resilience into your safety committees. Let these internal champions lead the conversation by regularly asking “What more can we do to improve our emotional well-being?”
2. Regularly review mental health resources not only for crisis intervention capacity but also for what they can add to your resilience building plan. A good Employee Assistance Program (EAP) or local community mental health organization should be well-versed in positive psychological safety practices and have resources and tools to share. If not, consider switching providers.
3. Bring representatives in from the EAP or local mental health groups to facilitate casual wellness briefings. Bring healthy food and even chair massage providers to emphasize how emotional wellness is part of overall health. Topics to cover during these workshops may include emotional intelligence, conflict resolution, mindfulness and how to practice happiness. Not only will these skills help employees bounce back from tough times, but they also help put a face to the mental health providers and increase the likelihood of easier referrals later on, when needed.
4. Each year, review how the company is doing from upstream, midstream and downstream perspectives.
5. Doing good, feels good because when we show kindness to others, our brain releases all types of feel-good chemicals. According to recent research by Deloitte and Network for Good, volunteering and workplace philanthropy are leading ways to improve employee engagement, productivity and morale.
6. Well organized, trained and supervised peer support efforts are one of the most cost-effective ways to bolster resilience in the workplace. Peers are often the first to notice when coworkers are struggling. Early intervention in the form of compassionate, active listening often resolves the majority of stressors before they evolve into something much more serious.
7. Embedding discussions about resilience in toolbox talks, a well-established and respected safety ritual, helps connect the dots between physical and psychological safety. Basic mental health literacy topics such as depression, anxiety, substance use and trauma can be shared in this forum along with what resources exist and how to use them.
8. Empower workers to get screened and engage in behaviors that help fix problems when they are strong, just like we do with other health issues such as cancer and heart disease. The free program Man Therapy uses humor and digital media to draw men in to a website portal where they can self-screen for depression, anxiety, substance use, and anger and then get triaged to resources for self-care, peer care, professional care or crisis care. Another option is a free tool from Screening for Mental Health.
9. Leaders throughout the company should be trained not only on how to notice employees who are distressed and link them to supports, but also how to cultivate wellness at the work group level. According to Judge (Ret.) Mary McClatchey, the peer accountability of a work team can be the motivation needed for many. Additionally, supervisors can learn how to effectively integrate messages of emotional support when a performance problems are present without losing standards of excellence.
10. Vocal, visible and visionary leadership is needed to make an upstream resilience mindset work. Leaders who are invested in the well-being of their employees should consider how best to recognize and reward employees who make their total wellness a priority for themselves and their team. Leaders who model emotional health and are able to talk about why mental fitness matters to them and their company will be more successful in recruiting and retaining talent and having safer, more productive and more dedicated staff.
Check out part one of this two-part series, which addresses the importance of building a resilience workplace as a means of incorporating suicide prevention into safety, health and wellness programs for your construction company.
