Cal Beyer, director of risk management for Lakeside Industries in Issaquah, Washington, was leading a Toolbox Talk on mental health and suicide prevention at a construction company when an attendee asked him for support with the depression he was experiencing. When Beyer asked if the man was thinking about self-harm or suicide, the employee disclosed that he was feeling suicidal. Through direct questioning, Beyer learned that while the employee did not have a specific plan to end his life, he said he would take a prescription medicine overdose to attempt suicide, as he did not have access to a gun. The employee refused to call his doctor or a suicide prevention lifeline, but he was willing to phone his wife and ask for her help in keeping his medications locked up until he felt better. With her support, his medications were placed in safe storage and he called his doctor to get the help that he needed.
The risk of suicide that this employee experienced is not unusual, especially in the construction industry. A recent CDC report affirms that suicide rates vary by industry and occupation. Based on data from 32 states, the suicide rate for males in 2016 in the United States was 27.4 per 100,000. But for males in construction, the suicide rate was 45.3 per 100,000.
Why Suicide Prevention is Important in the Workplace
Although employers must ensure they aren’t intruding into the personal lives of their employees, there is a place for suicide prevention strategies in the workplace as part of a company’s overall health and safety programs, because preventing suicides is something everyone can address. In particular, workplaces can focus on addressing Item 7 in the CDC’s recommendations below to “reduce access to lethal means among persons at-risk.”
Someone considering suicide usually thinks about it multiple times over the course of their life, especially when they are going through difficult periods. Suicidal thoughts are not uncommon. According to estimates, 4% of adults and 10% of adolescents considered suicide in the last year.
Thinking about suicide (known as “suicidal ideation”) can become a way to cope with adversity, albeit in an unhealthy way. Suicidal thoughts can provide relief from pain—“if I am not here anymore I won’t have to feel this anymore.” Using suicidal ideation as a coping mechanism is not dissimilar to using alcohol or drugs as a form of self-medication to dull emotional pain, and, like alcohol or drug use, if this thought process is recognized and addressed, it can be replaced with healthier coping strategies.
But when suicidal thoughts are not replaced with hope they can gradually evolve into a more concrete plan for suicide: rehearsing one’s suicide can reduce the fear of death, so those at risk of suicide become more capable of acting on their plans over time. In general, there are two things about people who have plans to end their lives:
- They are ambivalent about dying—what they want is to end their pain and the things happening in their lives that are causing it, and
- The decision to act on a plan can be very impulsive because the person who is at risk is at the height of emotional distress, in some cases in a “hypnotic” state, and definitely not thinking logically.
Because of this, putting a barrier between a suicidal person and the means they can use to end their life may save their life. This is called “lethal means safety” and it is a well-known strategy in the suicide prevention field.
What Workplaces and Employers Can Do to Support Suicide Prevention
There are several things that workplaces can do to promote lethal means safety that should not raise the hackles of human resource specialists. These suggestions were developed with input from Beyer.
1. If the workplace provides easy access to lethal means, it is important to consider how access to those lethal means are managed when individuals are at risk of suicide. Make sure to discuss suicide prevention and develop a plan before times of crisis.
For example, law enforcement officers are at higher risk for suicide related to the routine exposure to trauma in the line of duty, which often results in post-traumatic stress. They are required to use firearms as part of their jobs, but how is this managed if an officer is in emotional distress? Is suicide prevention training for officers a regular part of what is discussed among cadets and more experienced officers? How are officers instructed to assist each other in the removal of firearms when an officer is in crisis? These are essential questions for law enforcement agencies to consider when developing their lethal means safety and suicide prevention plans.
2.Ensure the Employee Assistance Programs and other resources use safety planning interventions that address suicide prevention. The safety planning intervention is brief and can be used by trained lay people and clinicians to substantially reduce someone’s risk for suicide. It creates a collaborative, dynamic plan to help the person who is at risk identify ways to make their environment safer walk themselves back off the cliff of acting on suicide. A well-implemented safety planning intervention enlists trusted allies (family, friends) to support the individual who is at risk by removing access to means that are readily available to that person to end their life. This is not the employer removing means. Instead, the counselor the employer has hired works with the employee in crisis and their family and friends to take this life-saving step.
Other ideas include:
- partnering with workers compensation and employee health benefits insurance carriers to identify alternative pain management strategies; and
- coordinating with health benefit administrators to reduce the number of opioids and the quantities approved in the prescription medication formulary pre-approved for outpatient and inpatient procedures.
3.Just as workplaces promote flu shots and other public health and wellness messages, they can display information about suicide prevention via stickers and posters, and distribute postcards outlining universal steps to lock and limit access to lethal means including medications and firearms. More than two-thirds of firearm fatalities are suicides, and gun owners in distress are at a higher risk of dying by suicide. But how many people have unlocked medications and unlocked firearms in their homes, including guns used for home defense? The public is not receiving critical life-saving information about the risks of these home safety failures that are responsible for the vast majority of suicide attempts, as well as roughly 70% of suicide deaths in the United States.
Additional steps include:
- conduct Toolbox Talks for employees to teach about the risks associated with opioids and other prescription and OTC medications;
- share information with employees and families regarding take-back programs for unused medications;
- share prescription and firearm lock box information at employee health and wellness fairs as well as employee benefit insurance open enrollment sessions;
- reduce quantities kept in-house of common OTC medications with known toxicity;
- model safe small quantity storage practices or prescription lock boxes in the workplace for the shared “community” OTC pain reliever bottles frequently kept in break rooms; and
- consider the pros and cons of providing Naloxone/Narcan kits for the reversal of opioid overdoses in the workplace or on project sites.
Many states allow the sale of Naloxone/Narcan without a prescription, or have a standing order embedded in the state law allows pharmacies to provide this opioid antidote under specified circumstances or restrictions.
Suicide prevention needs to be a part of workplace safety culture. Talk about mental health challenges, suicide prevention and the possibility of recovery even in the most difficult of circumstances. Talk about the courage it takes to seek help, especially in male-dominated industries. It’s a culture shift but one that needs to happen. And as the story of the employee who talked to Beyer at a Toolbox Talk demonstrates, it will happen when everyone starts talking more in these ways. It needs to start with leadership—kudos to the construction industry for leading the way.
For additional information and suggestions about keeping workplaces and homes safe, visit the Safer Homes Suicide Aware program.
