It is well known that construction has the second highest rate of suicide among major industries. Medical and mental health professionals lament the barriers to care seeking. Improving access to medical and mental health care can help impact quality of life and reduce suicide risk. Research shows that males are less likely to seek medical and mental health care services than females. This is a significant factor in an industry like construction that is considered “male dominated” in terms of the percentage of males in the workforce.

The Kaiser Family Foundation is a leading nonprofit organization dedicated to nonpartisan health policy analysis, polling and journalism. In 2019, KFF summarized the disparity by gender and race/ethnicity of not having a personal doctor or health care provider.

The National Alliance on Mental Illness reports in Mental Health by the Numbers that the average delay between onset of mental illness symptoms and treatment is 11 years. NAMI further highlights that more than half (55.2%) of the persons in the United States with mental health conditions in 2019 did not receive treatment for mental health conditions.

Moreover, NAMI reports the annual treatment rate among adults with any mental illness in the United States has major gender disparity with males at 36.8% compared to 49.7% for females. Similar disparities were observed for race/ethnicity and mental health treatment rates as seen in the KFF data for percentage of the population without a primary doctor:

• Non-Hispanic Asian: 23.3%;
• Non-Hispanic white: 50.3%;
• Non-Hispanic black or African-American: 32.9%;
• Non-Hispanic mixed/multiracial: 43.0%; and
• Hispanic or Latino: 33.9%.

Major Barriers to Care Seeking Among Construction Workers

This list has been developed from experience in construction consulting to companies and working for a contractor. It is important to consider which of the barriers may be relevant among a company’s workforce to design an effective strategy for overcoming these barriers to care seeking. Just some of the barriers to seeking care include1:

1. self-reliance and stoic “rough-and-tough” culture;
2. not wanting to appear vulnerable or admit weakness;
3. not seeking help as a socialized response from a young age in many families;
4. self-stigmatizing beliefs and being ashamed about what others will think fear of negative outcomes;
5. frequent changes in project work locations, making it hard to find a convenient medical provider;
6. transient workforce with a certain percentage being travelers who move from job to job; and
7. difficulty getting appointments at the end of a workday when care providers may not be open.

Importance of Trust to Remove Barriers to Care Seeking

An important step is developing a caring safety culture that is focused on building trust among the workforce. Mike O’Neil, director of risk management, Lakeside Industries, Inc. (Issaquah, Washington) describes how “managing worker injuries over the years changed dramatically.” According to O’Neil, “the old school method of telling someone to ‘rub dirt on it’ and get back to work might have reduced the [injury reporting data], but it did not help in developing methods and practices for recognizing hazards and protecting workers.” O’Neil describes the importance of reducing barriers to care seeking by “encouraging openness in reporting injuries, near hits and hazards that creates trust. Trust is one of the most important tools in eliminating the barriers that prevent workers from getting the preventative medical and mental health assistance they need.”

Treating Mental Health Like Physical Health to Promote Care Seeking

Another company that is intentional about promoting trust among the workforce to promote care seeking is RK Industries (Denver). Lisa Ponder, vice president of human resources says “mental health awareness and suicide prevention have been priorities at RK for several years. Human resources business partners and safety professionals are all trained to respond to both mental health and substance abuse situations in the workplace—and they do so on a regular basis. RK speaks about and responds to mental and emotional health in the same ways we do physical health to ‘normalize’ the former.”

“From their first day at work, at our new hire orientation, RK employees know they have someone to talk to and resources available to them to support their mental and emotional health, as well as solid medical insurance options,” says Ponder. “RK includes mental health education and encourages field construction workers to seek help when they need it.”

RK Industries removed barriers to improve access to care in 2020 by:

• communicating to employees how to access the existing telehealth option;
• moving all mental health providers “in network” to make it easier for employees to find mental health help and/or to keep the mental health provider they have been working with; and
• allowing all biometric screening to be completed by personal physicians rather than at company wellness events.

Additional Best Practices for Removing Barriers and Improving Access to Care

Numerous contractors committed to improving access to care provided additional ideas for removing barriers to care:

1. expanded education for employees on Employee Benefits;
2. invited spouses and domestic partners to attend Employee Benefit Open Enrollment meetings;
3. changed Employee Assistance Program provider;
4. expanded the number of EAP counseling sessions per issue/concern;
5. offered telehealth options for physical and mental health services;
6. provided explanations of how to access benefits in jobsite meetings to reach more employees;
7. expanded number of “in-network” mental health counselors;
8. negotiated increased no deductible preventive care services in employee benefit plans;
9. reduced co-pays for in-network providers;
10. incentivized participation of wearable monitors for tracking of wellness activities;
11. provided apps for mental health counseling services; and
12. offered apps for mindfulness, resiliency and well-being.

There is no one magic formula for removing the stigma and other barriers to care that keep workers from seeking and accepting help. Companies have many options available to them to help reduce barriers that keep workers from seeking mental and medical health care services that can improve quality of life and overall well-being.