Earlier this year, the Health in Construction Leadership Group (HCLG) (www.healthinconstruction.co.uk) held its second industry summit. OSH leaders from all of the major construction firms decided that in their efforts to tackle occupational disease, mental health required particular effort.
Mates in Construction
The Mates in Construction (MiC) programme was established in Australia in 2008 to tackle the higher-than-average suicide rate among the industry's workers. Every year, 190 of them take their own lives; they are six times more likely to die from suicide than an accident at work; and the industry's young workers are twice as likely to take their own lives as other young Australian men.
MiC is an integrated programme of training and support, which aims to raise awareness of the sector's high incidence of suicide, make it easy for people to find help and ensure that the support offered is practical and professional. The training falls into three categories: general awareness, which is delivered to at least 80% of workers on site; "connector" training, in which those who volunteer to become connectors are trained to keep someone in crisis safe and find them professional help; and ASSIST workers (mental health first-aiders) who will listen to people's concerns and respond appropriately. More than 100,000 people have been trained under the programme.
"We measured the Australian model against what we have here," says Martin Coyd of the scheme's soon-to-be-launched UK variant, "working with organisations like Mental Health First Aid England, the Samaritans and Public Health England. We won't be changing much about the Australian model, and we are not creating anything new.
"It's a simple education programme, under which we train 'connectors' in a three-hour course to spot the signs that someone may need help. Their primary role is simply to listen. There will also be mental health first-aiders, who will do a two-day course to be able to offer more help. The job of both is to get people with problems the help that they need."
Andrew Cox, health, safety, environment and quality director for contractor FM Conway, told the event: "In construction, we don't discuss mental health issues at all. There is still a stigma attached to that area. But there are a lot of benefits to business if we can get it right."
So far, so commendable -- but skeptics might ask why this latest drive to "sort out" mental ill health at work will be any different from the many others that have been attempted before. According to the UK government's 2014-15 Labour Force Survey, the estimated number of new cases and incidence rate of work-related stress, depression or anxiety had remained "broadly flat" for more than ten years. This is despite the huge number of campaigns, initiatives and publications on mental health from employers' bodies, unions, trade associations and membership organisations such as IOSH and the Chartered Institute of Personnel and Development.
Not all the work has been in vain, though, because it has laid the foundation for what is happening now. Martin Brown, health and safety director at London's Crossrail rail project, says: "Over the past ten or 15 years there has been more awareness-raising and acceptance of mental health problems. In the past, after the world wars, for example, those who were on the front line were not allowed to show stress. We now live in more enlightened times -- we are more confident talking about it and take a more understanding approach."
This better understanding of mental ill-health and greater willingness to discuss it are what lie behind the approach adopted by the HCLG, as well as organisations in other industries. Martin Coyd, regional head (Europe) of health and safety at Lend Lease, says: "We recognised that we needed to do something, but also that there was a risk of us all doing something different, which, however well-intentioned, will cause confusion. People get fed up with lots of competing systems and approaches. This way, we are implementing a mutually shared and cohesive approach, which is transferable from company to company and project to project."
That approach is mental health first aid. It has been around for more than ten years but is now gaining traction, after huge success in Australia -- where it originated -- and endorsement by no less than the First Lady of the United States, Michelle Obama (bit.ly/1O3XWT3).
It works on the same basis as physical first aid: mental health first-aiders are trained to spot the signs of emerging mental health distress in others and encourage them to seek professional help. It is a peer-to-peer approach, with colleagues speaking to colleagues in a non-judgmental and supportive way that is intended to catch problems early.
"It was started in Australia by a woman who had experienced mental health problems at work," explains Andy Flockton, a lead trainer with Mental Health First Aid England (MHFA), which runs courses throughout the UK. "She deteriorated, took time off, and then came back to work. The whole time she was unwell at work, nobody talked to her, or called her when she was off, or engaged with her when she came back. Her colleagues all obviously knew what the problem was, and she knew they knew.
If you are coming from a position of concern, it's about acting on the distress the person is in and asking 'are you OK?'
"She and her partner subsequently did some research and found that the level of awareness of mental health issues in the workplace was very low, as were the levels of confidence about what to do about it. So they decided to do something to ensure others didn't go through the same experience. She figured: we have first-aiders for physical issues so why not for mental health issues also?"
One of the most successful operators of the approach is also in Australia. The Mates in Construction programme was set up to address the high rate of suicide among workers in the Australian building industry. The HCLG has based its programme for the UK construction industry on the Australian model and will launch it this summer (see panel above).
Crossrail has already launched its own mental health first aid programme. "We didn't want a corporate approach, where HQ was telling people what to do," says the company's occupational health and wellbeing specialist, Christina Butterworth. "Colleagues will have the banter, knowledge and cultural understanding to get through to those in trouble."
Crossrail worked with business psychologists Robertson Cooper to develop a six-step programme on mental health, incorporating work by the Trade Union Congress. "The steps are: having a common terminology -- being clear about what we think wellbeing is in the organisation and how we talk about it," says Butterworth, "putting governance and assurance around it -- making [mental wellbeing] a focus of our plans and strategy for the coming year; aiming to have mental health first-aiders and wellbeing champions on every site; providing information via a collaborative website full of evidence-based information; developing skills so we can manage individuals who may have mental health problems; and signposting to professional treatment services."
So far, Crossrail has trained 16 mental health first-aiders and is now publicising their availability to its workforce of around 750. The approach is also starting to be picked up by its first-tier contractors.
London's transport operator Transport for London's (TFL) scheme began as a 12-month trial that ended in April this year. Members of the organisation's staff disability network, WellMent, attended a mental health first aid training course and with support from the TfL occupational health function's counselling and trauma service (CTS) developed a two-day training course which they delivered to 30 staff who had been chosen from volunteers -- the selection process included psychometric testing -- as "peer helpers".
The peer helpers' details are listed on TfL's MHFA register which is displayed in the foyers of its buildings and on its intranet. They are expected to attend at least two of the four half-day supervision and training sessions TfL plans to run quarterly each year.
The helpers may be called on to aid colleagues with confidential "support sessions" for up to two weeks, after which they must refer the colleague to professional help either inside our outside TfL. Ben Gatty, peer support coordinator, describes the support sessions as "probably the least used aspect of MHFA, although perhaps the one that gets the most attention".
The other valuable aspects of the peer supporters' work, says Gatty, are encouraging mental wellbeing by modelling it themselves, informal support to colleagues who seem low or stressed and by promoting mindfulness and good sleep habits. "Informal chats can make a big cumulative difference to the daily round," he notes.
The organisation intends to recruit another 40 peer helpers this financial year.
The individuals who become involved in mental health first aid are mostly self-selecting and are often those whom people go to anyway, including HR professionals and administrators. Individuals who have experienced mental ill-health themselves often come forward, because they feel they can share their experiences in a positive way. Most volunteers are women -- something that MHFA England, an initiative floated by the Department of Health and since spun off as a community interest company, is keen to address.
"The challenge for us is to get more men to come forward," says Flockton. "Women are more likely to be diagnosed with depression than men, because they will talk about it. Men, unfortunately, are more likely to kill themselves. How do we get more men to speak up? Because once they do, they are generally very good at getting others to speak up. Those who have had problems themselves and come through them are particularly appealing to other men in getting them to open up."
The first-aid framework succeeds because it is familiar and, in terms of training people, suits all levels. As Steve Hails, formerly OSH head at London's Crossrail train line and now director of health, safety and wellbeing at the city's Thames Tideway Tunnel construction project, points out: "For physical injuries you have emergency first-aiders and fully-trained first-aiders on site -- we are looking to do the same for mental ill-health. People sign up voluntarily to be part of it and are trained to deal with immediate mental ill-health issues."
But, as in some cases when it comes to providing physical first aid, won't people be reluctant to get involved for fear of saying or doing the wrong thing? Not according to Flockton: "If you are coming from a position of concern, it's about acting on the distress the person is in and asking 'are you OK?' There's nothing wrong with that. People sometimes think they might be prying, that it's none of their business, but the worst thing is for people to say or do nothing."
Both Flockton and Butterworth emphasise that what commonly causes those in trouble the most stress is thinking they are going to be judged. Usually, they just want someone to listen, or have a supportive conversation with. They don't want to be thought of as weak -- a common concern in construction, Hails points out, because of the vocabulary that is often used: "Guys are told to 'man up' or 'get a grip'. This compounds the problem and the stigma, and is something that [the peer-to-peer approach] is designed to address."
The MHFA England model teaches first-aiders about the risk factors, causes and symptoms of anxiety disorders, depression and psychoses and how to approach people they believe need support and where to direct them for specialist help, where appropriate.
For most conditions, first-aiders are asked to follow a set of steps summed up in the acronym ALGEE:
Assess risk of suicide or self-harm
Give reassurance and information
Encourage the person to get appropriate professional help
Encourage self-help strategies.
Another concern commonly voiced by employers who have, hitherto, placed mental health in the file marked "too difficult", is that many problems originate outside the workplace and are not their responsibility. Brown agrees it can be complicated when external influences intrude. "You want to help people but it's not your job to control what happens outside work," he says. "Crossrail and TfL carried out some research into fatigue among shiftworkers and we found something surprising: the seven-hour-shift people were more tired than the 12-hour-shift people because the former used the extra time off to go out socialising more and do more activities. So simply reducing the length of shifts was not the answer."
Flockton agrees that separating life and work is not feasible. "Only 25% of mental health problems in the workplace are work-related," he says. "Work is often the trigger but not necessarily the direct cause. Most organisations are realising that this doesn't matter because they have invested in the person, and that you can't separate life and work -- or physical and mental health. Dealing with one and not the other will have limited effectiveness."
Top level support
And so back to the numbers: the UK government has underlined its intention to reduce the number of people lost from the workplace due to mental health conditions by spending £43m on a series of pilot programmes to test what works best.
The then minister with responsibility for health and safety, Justin Tomlinson, told the first construction health summit in January: "We understand early intervention is key, and part of your challenge is to recognise that and signpost people towards this government support early on."
In February, the then prime minister David Cameron announced that an extra £1bn a year would be provided for the NHS to enable it to put mental and physical health on an equal footing.
The HCLG will be playing its part by developing and implementing a cohesive approach to educating the construction sector and conveying the message to its 2.6 million workers that it's OK not to feel OK, and that there is support available.
The peer-to-peer/mental health first aid approach is working well in other sectors, too -- Unilever and Barclays are among businesses adopting it. As Andy Flockton says: "It can work anywhere. Look at the armed forces: they've done excellent work in the field of mental health. If the 'hard and macho' military can get over the belief that mental ill health is a sign of weakness and shouldn't be talked about, then we all can."