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If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

BIRMINGHAM, Ala. — Frank Wampol had a dark realization when he came across some alarming data a few years ago: Over die from suicide annually — the number who die from work-related injuries, according to several studies. That’s considerably more than the in the general population.

“To say this is a crisis would be an understatement,” said Wampol, vice president of safety and health at , a construction company based in Birmingham with over 10,000 employees.

Since then, the company has added mental health first-aid training for on-site supervisors and distributed information about suicide prevention to laborers in the field. The efforts are part of a larger push led by the industry and supported by unions, research institutions, and federal agencies to address construction workers’ mental health.

But initiatives to combat this mental health crisis are tougher to implement than protocols for hard hats, safety vests, and protective goggles. And some of the potential solutions, such as paid sick leave, have drawn pushback from the industry as it eyes costs.

Safety experts have long been concerned about the physical hazards of construction work. The “Fatal Four” hazards are falls, electrocutions, being struck by an object like a brick or a crane boom, and getting caught between two objects, according to the .

Only in recent years have the psychosocial hazards of construction work moved onto the public radar. Studies paint a grim picture, said Douglas Trout, an occupational medicine physician and deputy director of the Office of Construction Safety and Health at .

In addition to high suicide rates, drug use is rampant, especially opioids such as heroin and fentanyl. A from the Centers for Disease Control and Prevention found that construction ranks highest in overdose deaths by occupation.

“Rates of suicides and overdose deaths are some of the worst outcomes related to mental health conditions,” Trout said. “And unfortunately, these are the more measurable ones.”

Less measurable but also prevalent among construction workers are anxiety and depression, which often remain undiagnosed. Almost half of construction workers have experienced symptoms of both, a rate higher than that of the general U.S. population, according to a by the Center for Construction Research and Training, an arm of North America’s Building Trades Unions. But fewer than reported seeing a mental health professional, compared with , according federal statistics.

The combination of high-hazard environments and organizational factors puts construction workers at particular risk for mental health issues, Trout said. Construction is a high-stress occupation involving long hours, extended separation from family and friends, and low job security due to the industry’s cyclical nature.

Even though health insurance and workers’ compensation are offered by some contractors, paid sick leave for laborers, craft workers, and mechanics is not standard. While 18 states and Washington, D.C., have approved laws requiring paid sick leave and federal contractors have to offer it, the mandates don’t apply to many construction workers. And industry advocates are such legal requirements, claiming they don’t fit the transient and seasonal nature of construction work.

If workers get injured, they often “try to tough it out and get back to the job as quickly as possible,” said Nazia Shah, director of safety and health services at the , the country’s largest construction trade association.

To manage pain from injuries, workers often resort to prescription opioids. Some then develop a dependency and turn to street drugs. “It’s a vicious cycle,” Shah said.

If a worker is fatigued, distracted by pain or personal issues, or impaired by some type of substance, the results can be catastrophic, said Wampol, a 20-year industry veteran who went into construction after retiring from a career as a firefighter and paramedic.

The biggest step, Shah said, is “breaking the stigma and normalizing conversations around mental health.”

The hurdles are particularly high in this male-dominated field, where harassment and bullying are common and speaking up about emotional hardships is often considered a sign of weakness, Shah said.

Several organizations, including , have created short “toolbox talks” to review the signs and symptoms of mental health issues, the risks of self-medicating with drugs and alcohol, and the resources available through health insurance and employee assistance programs.

Some, such as the , hand out hard-hat stickers, cards, and “hope coins” — small tokens that symbolize support. They all serve as conversation starters and include information on the in English and Spanish.

Many contractors hold regular stand-downs, with supervisors halting work at a construction site to provide on-the-spot training related to a specific mental health issue. Others, such as BL Harbert, offer health education fairs and team with local health clinics for lunch-and-learn events.

But Stanley Wheat, an on-site safety manager at BL Harbert, said that even the best policies, procedures, and training materials won’t stick without making an effort on the ground. “A PowerPoint presentation alone won’t cut it. You’ve got to know your people, and you’ve got to engage them.”

Wheat, a military veteran who has worked in construction for over two decades, said it’s important to make rounds several times a day at a job site — getting to know the workers and observing changes in their behaviors.

“You start noticing the guy who’s isolating himself, sitting alone at lunch, not talking with anybody,” he said.

Wheat can relate. His uncle died by suicide, but his family would never talk about it. During his time in the military, Wheat said, he went to rehab for drug and alcohol addiction. He dropped out of college to work in construction.

“I’ve been there,” he said. “I skinned my knuckles. I pulled my back. I worked injured.”

Wheat tries to strike up conversations with workers who he thinks are having a rough time. He listens, sometimes shares his personal story, and suggests resources for help.

Peer-to-peer support is among the more promising concepts in the effort to curb the mental health crisis in construction. Workers often don’t want to talk with management or outsiders, Trout said, “but they usually trust each other.”

One successful model is , a program for mental health and suicide prevention that originated in Australia in 2008. The idea is to train on-site personnel — workers, foremen, superintendents — to spot and support co-workers in crisis, offer a confidential space to talk, and guide them to help if needed. The volunteers, called “connectors,” are typically identified by green hard hat stickers. Efforts are underway to bring a formalized Mates program to the U.S., Trout said.

Other, often small and local initiatives are being implemented, too. Some contractors have hired full-time wellness coordinators or bring mental health care providers to construction sites so employees can start appointments immediately. A few companies have put dedicated trailers on their job sites that serve as quiet rooms, with lounge chairs, board games, and video consoles, so workers can take a moment to decompress.

Many contractors also have added naloxone — an emergency medication used to reverse opioid overdoses, often known by the brand Narcan — to on-site medical kits.

Going forward, as President-elect Donald Trump takes office next week, the industry faces major uncertainties, including possible ripple effects from tariffs, mass deportations, tax cuts, and deregulation.

No matter what comes, Wampol said, the construction industry needs to understand that the investment in mental wellness and suicide prevention programs creates “a healthier, more productive workforce” — and, ultimately, a better bottom line.

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