Reduce Workplace Mental Health Hazards With the Hierarchy of Controls for Psychological Safety

In 2012 the Chief Executive of France’s Telecom was forced to resign and six other company executives faced legal action following an investigation. Charges filed against the company were related to workplace bullying, harassment and toxic “management-by-terror” practices that were allegedly connected to more than 80 employees’ suicide attempts or deaths.

Several of the suicide notes written by those who died by suicide explicitly identified France Telecom as the sole cause for death due to “intolerable conditions.” During the summer of 2019, the Chief Executives were tried in a criminal case and in December they were found guilty, sentenced to prison and charged large fines. In other words, these executives were held accountable for the suicide deaths of their workforce because they contributed to the psychosocial hazards that caused fatal harm.

The increased attention to “workplace mental health literacy” and the urgency to get “troubled workers” to counselors may be a deflection from the importance of psychosocial hazards introduced at work. If workplaces believe that the mental health symptoms and suicide crises are only due to untreated or mistreated mental illnesses, they may be engaging in a “state of denial” about their own systemic contribution to the problems. One tactic used to minimize workplaces’ role is by medicalizing suicide as being the sole result of individual psychopathology rather than linking to their work life. It’s time for a broader framework.

Applying NIOSH’s Hierarchy of Controls to Psychological Safety

Without a doubt, NIOSH’s “Hierarchy of Controls” has been a game changer in safety. The framework forces companies to be proactive—to look at the construction plan and find simple ways to make the project safer. For instance, when working on a roof, management doesn’t rely on workers just being careful near the edge. Instead workers wear safety harnesses or a parapet wall is built at the edge so workers cannot fall off the roof.

Can this be applied the idea to mental health and suicide prevention? Of course.

Toxic work demands along with negative employee perceptions of the work environment have been historically underappreciated in the conversation about mental health promotion and suicide prevention; however, research connects a number of job stress-related factors to risk of suicide death and attempts, even when controlling for mental health problems. Researchers are clear, however, risk factors in the workplace can contribute to many health concerns, including suicide risk.

Many workplace well-being hazards and “job strain” put workers at risk for suicide and significant emotional distress. These hazards include but are not limited to:

• job design challenges
• low job control—lack of decision-making power and limited ability to try new things;
• excessive job demands and constant pressure/overtime;
• effort-reward imbalance related to perceived insufficient financial compensation, respect or status;
• job insecurity or perceived threat of job loss and anxiety about that threat;
• lack of job autonomy;
• lack of job variety; and
• toxic work-design elements (e.g., exposure to environmental aspects that cause pain or illness).
• toxic interpersonal relationships
• bullying, harassment and hazing at work;
• prejudice and discrimination at work; and
• lack of supervisor of collegial support—poor working relationships.
• family disruption
• work-family conflict (i.e., work demands make family responsibilities more difficult); and
• family-work conflict (i.e., family demands make work role challenging).
• lack of purpose or connection to mission
• heightened job dissatisfaction and the feeling of being “trapped”; and
• work is not meaningful or rewarding.
• other work-related health impacts
• work-related trauma (e.g., personal or seeing and accident or injury);
• work-related sleep disruption (e.g., due to unexpected overtime, extended or changing shifts); and
• work culture of poor self-care and destructive coping (e.g., alcohol and drug use).

Of these, job security has been associated with higher rates of suicidal thinking and issues with job control appear to be more connected to a risk of suicide attempt and death. Prospective evidence also indicates workplace bullying, especially physical intimidation, can lead to suicidal intensity.

Recommended Company Practices and Job Site Considerations

Improvements in the psychosocial conditions of work may improve well-being and prevent suicide. Adapting NIOSH’s Hierarchy of Controls, workplaces striving to prevent suicide can eliminate threats to psychological safety (e.g., bullying, toxic management practices, etc.) and substitute these unsafe practices with those that promote mental health and protective factors (e.g., cultivating a sense of belonging, volunteering, etc.). Building peer support or “buddy” programs is another tactic to help mitigate these hazards.

Redesigning work culture for optimal well-being might include making access to quality mental health care (e.g., Employee Assistance Programs) easier or changing the process of performance review to be more collaborative. Overtime policies should be mindful of how sleep deprivation and excessive work stress can lead to significant emotional and cognitive impairment.

Administrative controls can be adapted by allowing accommodations for workers to have time off to seek support or to temporarily decrease their work load as they are getting back on their feet. For workers who must travel frequently, look at policies and technology that allow them to have more time with family.

At the bottom of the hierarchy, encourage training for psychological safety and help workers develop individual practices of self-care (e.g., self-screening for alcohol use disorders). Another example of personal empowerment for mental health would be to offer onsite brown bag presentations to give workers better familiarity with how mental health services and addiction treatment work and when to use these resources.

Action Steps

By taking these steps, construction executives can begin to identify and then eliminate the psychosocial hazards that might be increasing risk.

Step 1: Listen

Start by asking workers through a survey or focus groups:

• What are the biggest psychosocial hazards?
• What are aspects of work that drive excessive distress or despair?
• What can be done to reduce their impact?

Step 2: Provide Processes for Concerns

Provide safe space for complaints and suggestions. Review whistleblower policies and complaint protocols to help ensure clear protections for those who report issues or wrongdoing. Protections are often needed for both the reporter and for the person who is the subject of allegations. Provide a transparent and fair process for resolving complaints, and incentives for working through things early on before they reach a more critical point.

Step 3: Encourage dialogue

Support constructive and courageous conversations. Hold quarterly town hall meetings on employee well-being. Encourage regular civil, honest and constructive dialogue about issues related to psychological safety. Ask employees for suggestions of topics to discuss before the meeting, and limit the agenda to the top three deemed most important. Make sure a strong facilitator (possibly external to organization) is on hand to help with any needed conflict resolution, negotiating and problem-solving.

Step 4: Bolster Protective Factors

Prioritize family well-being, sleep and community.

Step 5: Eliminate Hazards

Address job insecurity, job autonomy and job variety concerns. Face issues of workplace discrimination, bullying and harassment head on.

The most effective method of suicide prevention may be to mitigate psychosocial hazards. It’s not enough to connect people who are distressed to therapy. Safety conscious executives must also consider how best to reduce workplace drivers of emotionally unsafe environments.

Construction Industry Alliance for Suicide Prevention

Construction Working Minds

National Guidelines for Workplace Suicide Prevention