The American Association of Suicidology (AAS), American Foundation for Suicide Prevention (AFSP) and United Suicide Survivors International (United Survivors), announced their collaboration and release of the first National Guidelines for Workplace Suicide Prevention on World Mental Health Day (Oct. 10, 2019). The guidelines — built by listening to the expertise of diverse groups like HR, employment law, employee assistance professionals, labor and safety leaders and many people who had experienced a suicide crisis while they were employed — aim to jump start the ability for employers and workplaces to become involved in suicide prevention in the workplace. For employers and professional associations ready to take the pledge and become vocal, visible and visionary, please visit WorkplaceSuicidePrevention.com.
Over two-thirds of the American population participates in the workforce; we often spend more waking time working each week than we do with our families. When a workplace is working well, it is often a place of belonging and purpose — qualities of our well-being that can sustain us when life gets unmanageable. Many workplaces also provide access to needed mental health resources through employee assistance programs and peer support. If we are ever going to get in front of the tragedy of suicide, we need to widen our lens from seeing suicide only within a mental health framework to a broader public health one. In other words, when suicide and suicidal intensity are seen only as the consequence of a mental health condition, the only change agents are mental health professionals, and the call to action becomes a “personal issue” that people take care of with their providers — but not all problems will be solved by getting a bunch of employees to counselors. When we understand suicide through a public health framework, many additional solutions are available. Through this broader lens, workplaces now understand the importance of a culture that contributes to emotional resilience rather than to psychological toxicity, and they can take steps to create a caring community of well-being.
Guidelines Development Process
After the CDC’s 2018 report that ranked suicide rates by industry, some employers started to feel more of a sense of urgency and requested tools to protect their workers from this form of crisis and tragedy. The Workplace Committee of the American Association of Suicidology resolved to do something more important: to create a set of National Guidelines for Workplace Suicide Prevention. Over the next two years, the group enrolled over 200 partners into the effort and subsequently forged a core partnership to conduct an exploratory analysis (the full 100-page report of findings can be found at www.WorkplaceSuicidePrevention.com). The ultimate purpose of this needs and strengths assessment was to guide the development an interactive, accessible and effective on-line tool designed to help employers and others achieve a prevention mindset and implement best practices to reduce suicide intensity and suicide death. Some of these best practices are about supporting despairing or grieving employees, and others are about fixing psychosocial hazards at work that can drive people to suicidal despair.
Goals and Target Audience
The collaborative partners’ goal is to enroll workplaces and professional associations to join in the global suicide prevention effort by building and sustaining comprehensive strategies embedded within their health and safety priorities. Across the United States, workplaces are taking a closer look at mental health promotion and suicide prevention, shifting their role and perspective on suicide from “not our business,” to a mindset that says “we can do better.” We hope this ground-breaking effort helps provide the inspiration and the road map to move workplaces and the organizations that support them from inactive bystanders to bold leaders.
Many different employer roles can benefit from these guidelines, including leadership, HR, community collaborators who will partner in the process, investors who can contribute resources for the development and sustainability of these guidelines, evaluators who can assess the effectiveness of workplace suicide prevention, peers (co-workers, family and friends) who want to help and many others.
The newly developed guidelines, designed to be cross-cutting through private and public sectors, large and small employers, and all industries will:
Give employers and professional associations an opportunity to pledge to engage in the effort of suicide prevention. Sign the pledge here: WorkplaceSuicidePrevention.com.
Demonstrate an implementation structure for workplace best practices in a comprehensive, public health approach.
Provide data and resources to advance the cause of workplace suicide prevention.
Bring together diverse stakeholders in a collaborative public-private model.
Make recommendations for easily deployed tools, training and resources for short-term action inside of long-term change.
Nine Recommended Practices
The exploratory analysis also uncovered a number of suggestions for nine areas of practice. They are:
Leadership: Cultivate a Caring Culture Focused on Community Well-Being
Assess and Address Job Strain and Toxic Work Contributors
Communication: Increase Awareness of Understanding Suicide and Reduce Fear of Suicidal People
Self-Care Orientation: Encourage Self-Screening and Stress/Crisis Inoculation Planning
Training: Build a Stratified Suicide Prevention Response Program
Peer Support and Well-Being Ambassadors: Set Informal and Formal Initiatives
Mental Health and Crisis Resources: Evaluate and Promote
Mitigating Risk: Reduce Access to Lethal Means and Address Legal Issues
Crisis Response: Prepare for Accommodation, Re-integration and Postvention
This exploratory analysis is a starting point to develop guidelines and best practices to help employers and professional associations aspire to a “zero suicide mindset” and implement tactics to alleviate suffering and enhance a passion for living in the workplace. The process identified high-level motivations for (predominantly around worker safety and well-being) and barriers (lack of leadership buy- in and resources) that prevent the establishment of national guidelines for workplace suicide prevention.
Acknowledgment: Thank you, Dr. Jodi Frey and Jon Kinning, for assisting in the preparation of this article.
The employee assistance program (EAP) might be one of the best-kept secrets for many employers. Instead, EAPs should be resources widely publicized to help encourage managers, employees and often their family members so that support services for personal and workplace problems can mitigate risk and promote vibrant workers. Many employers simply “check the box” when signing up for the EAP benefit, figuring health insurance will cover the mental health needs of their employees; however, most employers really don’t know what the EAP services entail or the value the services can bring to a workplace.
With that said, not all EAPs are created equal. EAP services vary greatly, including some or all of the following::
biospsychosocial assessments, including substance use assessments
individual and family counseling
financial and legal coaching and referrals for counseling
referrals for additional services, with follow-up
psychoeducation through workshops, newsletters and other communication for personal and workplace concerns, including stress management, parenting, mental health literacy, relationships and organizational change and individual crisis prevention, crisis response and support
mediation and team development
leadership consultation, coaching and development
fitness for duty evaluations
suicide risk assessment, treatment and “postvention” (i.e. what to do after a suicide)
staff training on best practices on how to support someone in distress
Sometimes, the services are cursory, such as a brief telephone assessment and referral by a contracted outside provider. Other EAPs provide robust and high-touch services like 24-hour support; on-line assessment and information; telephone and in-person assessment and counseling; on-demand crisis consultation; on-site workshops; mental wellness promotion; and much more. As with many things, you get what you pay for, so employers need to decide how much they are willing to invest in the mental wellbeing of their workers and conduct a cost-benefit analysis. However, EAPs, even more customized programs with onsite services, have been shown to be cost-effective to employers through the years.
Are EAPs Effective?
While the research on the effectiveness of EAPs is limited, studies have found that employees’ use of EAPs enhanced outcomes, especially in “presenteeism” (how healthy and productive employees are), life satisfaction, functioning and often absenteeism (Joseph, et al., 2017; Frey, Pompe, Sharar, Imboden, & Bloom 2018; Attridge et al., 2018; Richmond, et al., 2017). In one longitudinal, controlled study, EAP participants were more likely than non-EAP participants to see a reduction in anxiety and depression (Richmond, et al, 2016). Another matched control study found that users of EAP services often reduced their absenteeism more quickly than non-EAP users experiencing similar challenges (Nunes, 2018). In another longitudinal study (Nakao, et al, 2007), 86% of people who were suicidal when they engaged with their EAP were no longer suicidal at two years follow-up. Researchers have concluded that, while not all EAPs are created equal, they often provide accessible services that are effective at improving employee mental health and well-being.
Are EAPs Prepared to Support an Employer Facing an Employee Crisis With Suicide?
When it comes to the life-and-death issue of suicide, EAPs have the potential to provide evidence-based suicide prevention, intervention and postvention services to employers. The EAPs’ contribution to the comprehensive workplace suicide prevention strategy is essential, and many would benefit from annual state-of-the-art training in evidence-based methods of suicide risk formulation and treatment to help distressed employees get back on their feet. Social workers, who provide the majority of EAP clinical services in the U.S., often report having no formal training in suicide formulation, response and recovery (Feldman & Freedenthal, 2006; Jacobson et al., 2004), so annual continuing education on suicide intervention and suicide grief support is often helpful to providers. Once trustworthy and credentialed providers have been identified, they should be highlighted in the “suicide crisis” protocol, so that companies are not trying to do this leg work in the midst of a crisis.
If one of the main messages in suicide prevention is “seek help,” we need to make sure the providers are confident and competent with best practices approaches to alleviating suicidal despair and getting people back on track to a life worth living. Thus, dedicated employers will evaluate and even challenge their EAP providers to demonstrate continuing education in the areas of suicide prevention, intervention and postvention skills. In fact, some states are mandating that all mental health professionals, including licensed providers of EAP services, have some sort of continuing training in suicide risk formulation and recovery.
Do Employees Know About the Benefit of Their EAP?
In addition to making sure the providers have the needed skills, companies need to make sure that their employees know when and how to access the care. Recently, the American Heart Association and CEO Roundtable worked with experts in the behavioral health field to develop a white paper for employers, which includes seven specific actions employers can take to improve the mental health of their employees (Center for Workplace Health, American Heart Association, 2019). The report can be viewed online here. Dr. Jodi Frey, expert panelist for the report and internationally recognized expert in the EAP and broader behavioral health field recommends that “employers need carefully consider their workplace’s needs when selecting an EAP, and then should work with their EAP as a strategic partner to develop programs and communications that encourage utilization of the program and continued evaluation to improve services over time.” (Dr. Jodi Frey, personal communication, March 18, 2019).
Employers that are mindful of their workers’ well-being will continually promote well-vetted and employee-backed resources throughout the career of the workers. Leadership testimonials of the efficacy of the resources after the leaders have used them for their own mental health would bring credibility to the resources and model appropriate self-care to the employees. Bringing the resources on-site to the workers (and not waiting until the workers stumble upon the resources) is another way to break through the barriers to care. The Employee Assistance Society for North American (EASNA) developed a guide to help employers evaluate EAPs and determine appropriate vendors. The guide also can be used to help employers evaluate their current EAP and decide if needs are being met or if more attention to what services should be offered needs to be addressed. The guide can be downloaded free.
Are There Different Types of EAPs?
Much diversity exists in EAP structure and quality (Frey, et al, 2018). Some companies use internal EAPs, where providers are also employees of the company. This arrangement often provides the benefit of having an immediate resource that has clear knowledge of the company and industry culture. Evaluation of internal EAPs has found increased utilization, customization and supervisor referrals (Frey, et al, 2018); however, there are some drawbacks. Internal EAPs, because they are so closely connected to the company, run the risk of being perceived as having blurred lines of confidentiality and objectivity. By contrast, external EAPs are often more diverse and can respond 24/7 across a vast geography. Because of these benefits and consequences, many companies have moved to a hybrid model to get the best of both models.
Hybrid EAPs often have an internal employee to manage the EAP and to work with managers and employees on critical incident response, strategic planning and organizational change, and to provide onsite assessment and problem resolution. They can be an important ally for the employer to understand the potential for an EAP and to help evaluate whether EAP providers are effective in their response and offering high-quality services (Frey, 2017).
EAPs are most effective when they understand the industry and organizational culture, have business acumen and can adapt to changes in organizational structure (Frey, et al., 2017; Frey, et al., 2018). Thus, employers seeking to find a best fit for their employees will interview mental health providers about their knowledge of the unique stressors and strengths in the industry. Some industries (e.g., emergency responders and aviation) have gone so far as to credential mental health providers as being specialists in their industry to avoid a mismatch.
Case Study From the COO of a Construction Contractor
“We had an issue where our EAP was referring counselors outside of our healthcare providers, so, after the three free sessions, the participant learned they could only continue with the suggested provider at $150 a session; so the employees would drop out. My understanding is that counseling often takes around seven sessions to have a sustained impact, so, I put in a mandate with our HR team to renegotiate our EAP to ONLY refer in-network counselors, or they would pay for the continued care.
“We then incorporated our EAP into our safety program. When there is a serious accident, we deploy counselors and have our EAP involved for post-accident assistance to our employees. Accidents can bring up traumatic responses from our employees, and these experiences bring up memories from other accidents they may have been involved in or around. This cumulation of trauma can be highly distressing for them.
“In the early years, we had to work through the skepticism that the EAP would notify management of anyone that used the service. Since HIPAA came into play, we have less of this skepticism. The employees thought they would get fired or laid off first if they had issues.
“I’ve worked with our safety and wellness groups to actually pick up and call the EAP for someone in distress and get them on the phone. Once they lay the groundwork with the counselor, they hand the phone over and leave and let the employee get the help they need. This helps break down the stigma, and some people just don’t have the courage or have a mental block about picking up the phone for help. This has been VERY effective to get those in need the help they need.
“We promote our EAP in our weekly newsletter, and we also have business cards with the information, and we utilize hard-hat stickers that have all the information. This helps it be available when they need it.
“I’ve also encouraged our managers to use the system so they can promote it from their point of view. This also has helped remove the stigma around using the EAP. I also talk when in front of our employees about the program and educate them so they will use it. Our utilization rate is the highest in our EAP network, and I think this is the reason why.”
15 Questions Workplaces Should Ask to Strengthen the Mental Health Safety Net
Employers should remember they are the customers of their EAP, and they should do the due diligence to make sure they are getting the best benefit possible. Here are 15 questions employers should ask their EAP to get the best services possible:
What services does your EAP cover? Are these services available 24/7?
Who answers the calls of the EAP, and how are they trained and supervised? What professional and educational preparation and certifications do they have? Are they licensed?
How are counselors selected and trained? Are certain licenses and other credentials required to be a part of the EAP provider network?
What types of training have EAP providers received? Specifically, when was the last time they received training in suicide risk formulation and treatment?
How is your EAP reporting utilization? How does your workplace’s utilization rate compare with others in your industry and what can be done by the EAP and by you as the employer to encourage more utilization?
Do your employees know about your EAP services and how to access them?
For those who have used the EAP, how satisfied were they with the services? Did the services help with the problem for which they were seeking support?
When employees completed EAP services, did the EAP follow up (or attempt to follow up) with the employee to make sure all needs were met?
How does your EAP interact with health plans? Are EAP providers also providers of outpatient mental health, and, if not, are they well-versed in the benefits of employees to make effective and seamless referrals?
How is your EAP measuring outcomes? Can they also provide you with a return-on-investment (ROI) or other cost-benefit analysis?
How is the EAP promoting upstream mental health efforts like prevention, resilience, positive psychology and work-life integration?
Are there general mental health screening or other wellness tools the EAP can offer the workers to help them understand and monitor their mental wellness? Does the organization also assess its own culture of system-level mental wellness?
Does the EAP have experience serving clients in our industry? If yes, what are some recommendations to improve how EAP services are promoted and offered at our workplace?
Is the employer receiving regular reports (i.e., bi-annual, annual) from the EAP on utilization, presenting problems, satisfaction and other workplace outcomes?
Does the EAP provide manager or HR training on how best to support an employee experiencing a mental health or suicide crisis? Are there additional staff training on skills needed to identify and assist employees in distress?
In 2017, a 15-year-old girl from Bedford, PA, was trying to live an ordinary teenage life until her classmates began bullying her. They attacked her on social media sites like Facebook and Kik about her red hair and braces, some going as far as telling her that she should kill herself. Her mother remembers finding the young girl sobbing for hours because of what people were saying about her in school and online. Even though her mother took her phone and tried to comfort the girl, less than a week later she would die by suicide.
While the rate of death by suicide among teenage girls is at an all-time high, they’re not the highest risk demographic of the more than 40,000 people who die by suicide in the U.S. each year. According to the CDC, seven of 10 suicides in 2015 were men, making men 3.5x more likely than women to die by suicide. Now the third-leading cause of death among adults age 15-44 worldwide, the global rate of suicide will hit 1.53 million per year by 2020, which constitutes one death by suicide every 20 seconds, according to the World Health Organization.
Children as young as 11 are dying by suicide as a result of experiences on social media, and we know of at least three examples of children broadcasting their own death to live audiences using social media tools such as Facebook live, Twitter and YouTube.
How are leaders responding?
In response to these disturbing trends, Facebook has partnered with organizations like the National Suicide Prevention Lifeline to develop a set of tools intended to help individuals find resources and support who are considered “at risk” for self-harm.
The first of these tools is a new suicide-prevention feature on Facebook that uses artificial intelligence (AI) to identify posts indicating suicidal or harmful thoughts. The AI scans the posts and their associated comments, compares them with others that merited intervention and, in some cases, passes them along to its community team for review. The company plans to reach out to users it believes are at risk, showing them a screen with suicide-prevention resources including options to contact a helpline or contact a friend.
While in some cases the artificial intelligence software will notify the Facebook community if it flags a situation as “very likely urgent,” in most cases it will simply work in the background to offer messaging and advice to the friends and family of a person in need.
Dr. John Draper, of the National Suicide Prevention Lifeline, said that he feels that the software sounds promising. “If a person is in the process of hurting themselves and this is a way to get to them faster, all the better,” he told BuzzFeed News. “In suicide prevention, sometimes timing is everything.”
Facebook is also making certain suicide prevention organizations available via Facebook Messenger, its instant messaging app. Facebook users will be able to flag posts that they feel indicate “at risk behavior,” which Facebook will respond to with an on-screen option to receive suicide-prevention resources.
The three-year study looks at the social and environmental factors that contribute to suicidal behavior and describes correlations between public mood and suicide and how data from social media sources and weblogs (blogs) might be used to predict that behavior; their primary hypothesis being that social media variables are meaningfully associated with nationwide suicide numbers.
At the end of the study, the research team concluded that, “We found a significant association of social media data with national suicide rate, resulting in a robust, proof-of-principle predictive model,” and the team suggests social media data be used in future predictive modeling.
How suicide prevention advocates are using social media.
Sites like the Suicide Prevention Coalition of Colorado, the Mighty and To Write Love on Her Arms are also using social media to engage audiences with messages of help and hope.
The Suicide Prevention Coalition of Colorado, an organization of which the author of this article is a member, uses Facebook, Twitter and email newsletters as educational and communications tools to promote events, raise awareness of mental health legislation and bridge the gap between service providers across the state of Colorado that might not have the resources they need as solo practitioners.
With a Facebook following of more than 1.5 million and a Twitter following of nearly 300,000, they share individual stories of hope and recovery and work to destigmatize suicide and self-harm.
The Mighty is a blog with more than 5,000 contributors and 150 million readers that also gives people suffering from mental health disabilities a place to find resources, encouragement and support.
This site, like TWLOHA, focuses on shared experiences. Individuals struggling with disability, disease and mental illness write in and share their stories of hope and recovery.
Bell Canada, a telephone company in Canada, is running a “Let’s Talk” campaign dedicated to raising $100 million for mental health programs by 2020 and encouraging people to find the strength to come out and talk to someone if they find themselves struggling with thoughts of self-harm.
Twitter is a wonderful conversation tool where you can do a search for keywords like #SuicidePrevention and become a part of the conversation with leaders, educators, individuals struggling and those with experience. A continued effort to destigmatize mental health issues helps those struggling realize that there is help.
You can use social media to interact with your legislature. Most politicians today are active on social media, and some even have live events on social media, giving us the opportunity to ask them where they stand on issues such as mental healthcare as well as share our opinions on the issues.
You can share resources on social media, especially around the death of a celebrity, to help further the conversation online and help someone find resources who might not have the strength to ask for help.
On Sept. 3, 2015, a press release was issued by the Carson J Spencer Foundation; RK, a construction company in Denver; and the National Action Alliance for Suicide Prevention. This press release was timed to coincide with Suicide Prevention Month in September and World Suicide Prevention Day on Sept. 10 . This press release announced the distribution of A Blueprint for the Construction Industry: Suicide Prevention in the Workplace (aka The Blueprint). One year later, we believe that this document was a catalyst in developing a national movement in suicide prevention in construction. This articles tracks the milestones of this movement and future directions.
In 2010, the National Action Alliance for Suicide Prevention and its Workplace Task Force were launched in conjunction with World Suicide Prevention Day. The co-authors served as inaugural members of the Workplace Force. The Blueprint was intended to create awareness, generate advocacy and spur action in the construction industry around suicide prevention. In addition, The Blueprint provided a toolkit for how to discuss mental health and suicide prevention in the construction industry.
Equipped with The Blueprint, the co-authors began an initiative to break the silence and create a culture of caring. The co-authors sought to gain the attention of the construction industry through a media saturation campaign. The intent was to build a reproducible model within the construction industry that could subsequently be used as a reproducible model by other industries. In short, the coauthors sought to integrate mental health and suicide prevention in safety, health, wellness and employee benefit programs by framing the topics as the “next frontier in safety.”
The Centers for Disease Control and Prevention (CDC) published a report that placed the construction and extraction industry as second-highest in the nation for suicide rates.
But, a year later, The Blueprint has exceeded expectations. It spawned an outpouring of targeted action that is rippling throughout the construction industry. The impact has been felt in: publications, presentations, projects and partnerships.
The publishing of The Blueprint created demand for articles by major independent construction industry publications and those published by trade associations. There have been at least 28 unique articles published since the first one was posted online by the Construction Financial Management Association (CFMA) on Nov. 1, 2015.
These articles have included both in-print and online versions. The articles have begun to cross over from construction into architecture and engineering, to make this an issue that is being discussed in the integrated AEC industry. The articles have penetrated major industry brands, including Engineering News-Record (ENR); the Associated General Contractors of America’s Constructor; CFMA’s Building Profits; Associated Builders and Contractor’s Construction Executive; Construction Business Owner; and the National Association of Women in Construction’s Image.
Once articles were appearing in industry publications, it was easier to solicit presentations. The first presentation that Cal Beyer gave regarding suicide prevention was the September 2015 CFMA Southwest Regional Conference, where he included suicide prevention as part of his company’s commitment to Safety 24/7: safety at work, home and play. The second presentation he delivered was to the South Sound Chapter of the National Association of Women in Construction in November 2015 near Seattle. These two early successes made it easier to “sell” the concept of presentations.
Sally Spencer-Thomas presented at the January 2016 Men’s Health Conversation at the White House in January 2016, while Beyer presented at the pre-meeting at the Department of Health and Human Services. The next two presentations were led by Spencer-Thomas in February 2016 at an executive roundtable sponsored by Lendlease in Chicago and to the Associated General Contractors of Washington. More than 100 attendees heard Beyer’s presentation at the Pacific Northwest Forum of the National Association of Women in Construction in April 2016. Two sessions were facilitated at the CFMA Annual Conference in June 2016. Similar sessions were offered in Portland, OR, in June to the AGC of Oregon and in Boise, ID, in July for the Idaho Chapter of CFMA .
The marquee event was held in Phoenix on April 7, 2016, when more than 100 attendees participated in the CFMA’s Regional Suicide Prevention Summit. Similar summits are scheduled by CFMA chapters for Charlotte on Nov. 9, 2016, in Portland, on Nov. 16 and Chicago on Feb. 17, 2017. A series of summits have been proposed by numerous CFMA chapters in 2017, including: Denver; Washington, DC.; Indianapolis; Houston; and Las Vegas.
Projects and Partnerships
The first partnership was established with CFMA through publications — including the first article as well as two custom PDF publications highlighting both the “why” and “how” to address suicide prevention in construction companies. Moreover, CFMA launched the aforementioned Construction Industry Alliance for Suicide Prevention and created an executive committee task force.
Clare Miller, the Executive Director of the Partnership for Workplace Mental Health, has been distributing periodic updates on the construction industry to her organization’s members. A partnership was formed with the JP Griffin Group, an employee benefits consultancy in Scottsdale, AZ. The Griffin Group created artwork for four custom poster templates that has been provided to the construction industry at no charge. Hoop 5 Networks, an IT system consulting company from San Diego, provided web development services for the Construction Working Minds website maintained by the Carson J Spencer Foundation.
Union Pacific invited Spencer-Thomas and Beyer to present in Omaha at the Railroad Suicide Prevention Summit on Aug. 24, 2016, so that rail industry leaders could transfer the lessons learned from construction to their own industry. Likewise, the U.S. Department of Veterans Affairs requested the construction industry be represented at its roundtable on suicide prevention on Aug. 30, 2016. While Beyer was not able to attend, he invited representatives from the CFMA and ABC associations to attend.
Finally, the best example of the growing partnership is the creation of a construction subcommittee on the workplace task force of the National Action Alliance for Suicide Prevention. There are now nine members on this subcommittee, and it is the largest subcommittee of the workplace task force. These subcommittee members represent a broad cross-section of the construction industry. The nine subcommittee members are:
Cal Beyer; Risk Management Director; Lakeside Industries, Inc. (Issaquah, WA)
Dr. Morgan Hembree; Leadership Consultant; Integrated Leadership System (Columbus, OH)
David James; CFO; FNF, Inc. (Tempe, AZ)
Tricia Kagerer; Risk Management Executive; American Contractors Insurance Group (ACIG); Dallas.
Joe Patti; Vice President & CFO; Welsbach Electric Corporation (College Point, NY)
Christian Moreno; Vice President; Health Risk Solutions; Lockton Dunning (Dallas)
Bob Swanson; Retired President; Swanson & Youngdale, Inc. (Minneapolis)
Sally Spencer-Thomas, CEO, Carson J Spencer Foundation (Denver)
Bob VandePol; Executive Director, Employee Assistance program; Pine Rest Christian Mental Health Services (Grand Rapids, MI)
Michelle Walker; Vice President Finance & Administration; Spec ialized Services Company (Phoenix)
Thus, in less than one year, the construction industry has moved from not thinking about suicide prevention to being a leading industry in the effort. In fact, in May 2015, Forbes published an article called, “What Construction Workers Could Teach Other Industries About Mental Health Awareness.” This demonstrated how broadly this awakening and action has been felt.
This first phase of garnering awareness and political will is critical in starting this national movement. The next phase is to institutionalize these efforts by bringing best practices in suicide prevention to companies, researching outcomes to better understand what works and developing policy and procedures that support mentally healthy, resilient and psychologically safe workplaces.
(Adapted from A Manager’s Guide to Suicide Postvention in the Workplace: 10 Action Steps for Dealing With the Aftermath of a Suicide)
Death jars our concept of the way life is supposed to be. That dissonance is multiplied when the death is by suicide.
Following the tragedy of death by suicide, the workforce will include people whose personal struggles already leave them vulnerable and who now face increased risk for destructive behavior, including suicide. Tragedy can beget additional tragedies. Sometimes irrational blaming behavior includes violence. Sometimes suicide contagion, or “copycat suicides,” occur. How leaders respond (postvention) after death by suicide is critical to stopping that negative momentum.
“Postvention” can be prevention
Defined by the Suicide Prevention Resource Council as “the provision of crisis intervention and other support after a suicide has occurred to address and alleviate possible effects of suicide,” effective postvention has been found to stabilize community, prevent contagion and facilitate return to a new normal.
Coordinate: Contain the crisis. Like the highway patrolmen on-sight at a traffic accident, postvention aims to prevent one tragedy from leading to another and return normal progression as soon as is safely possible.
Notify: Protect and respect the privacy rights of the deceased employee and the person’s loved ones during death notification.
Communicate: Reduce the potential for contagion. Communicate, communicate, communicate meaningful information. Keep it simple. Make it practical. Focus on solutions to immediate issues. Repeat it. Repeat it again.
Crisis Care Network, the largest provider of critical incident response services to the workplace, developed a crisis communication process that has been helpful for business leaders. The acronym ACT describes a means of acknowledging, communicating and transitioning amid a crisis.
Have an accurate understanding of the facts and avoid conjecture.
Demonstrate the courage to use real language that names what occurred.
Acknowledge that the incident has an impact on team members and that it is okay that individuals will be affected differently.
Communicate pertinent information with both compassion and competence
In the absence of information, people create it. Providing information reduces the likelihood of rumors, builds trust and provides a sense of order that supports moving forward.
Although very difficult to do when affected by traumatic stress oneself, communicating with both competence and compassion demonstrates leadership effectiveness in a caring way. Employee assistance program (EAP) consultants often help business leaders by scripting and coaching their messaging.
Transition toward a future focus
Communicate an expectation of recovery. Those affected must gain a vision of “survivor” rather than “victim.” Research indicates that humans are an amazingly resilient species and overwhelmingly bounces back from adversity.
Communicate flexible and reasonable accommodations as people progress to a new normal. Employees should not all be expected to immediately function at full productivity (although some will) but will recover quicker if assigned to simple, concrete tasks. Structure and focus are helpful, and extended time away from work often inhibits recovery. “If you fall off a horse…..get back on a pony.”
Support: Offer practical assistance to the family and those affected.
Link: Identify and link affected employees to additional support resources and refer those most affected to professional mental health services.
How to lead effective suicide postvention was likely not part of most business leaders’ education or training. When these tragedies occur, leaders often engage their EAP to deploy critical incident response experts – behavioral health professionals with unique training in response to tragedies. These consultants will:
Consult with the organization’s leadership regarding crisis communication strategies that facilitate resilience
Draw circles of impact and shape an appropriate response
Let people talk if they wish to do so
Identify normal reactions to an abnormal event so that people don’t panic regarding their own reactions
Build group support
Outline self-help recovery strategies
Brainstorm solutions to overcome immediate return-to-function and return-to-life obstacles
Assess movement toward either immediate business-as-usual functioning or additional care. Following death by suicide, they will be especially attuned to assess others for risk of self-harm.
Comfort: Support, comfort and promote healthy grieving of the employees who have been affected by the loss. Critical incident response consultants will guide, coach, and script leaders regarding compassionate messaging. Leaders must “give permission” for help-seeking behavior.
Restore: Restore equilibrium and optimal functioning in the workplace.
Sensitively resume a familiar schedule. People do best when their natural rhythms kick back in. Routine. No surprises. One foot in front of the other, just like yesterday.
Facilitate successful completion of familiar tasks. Doing something tangible reduces that sense of powerlessness and helps people focus on what they can do, rather than panic about what they cannot. The structure of doing what one knows how to do is helpful in finding a “new normal.”
Lead: Build and sustain trust and confidence in organizational leadership. The team will never forget the leader’s response. Neither will the leader. Effective provision of both guidance and support will lead to the team feeling cared for in the workplace and result in loyalty and faith in their leadership’s abilities. People will go through the crisis with or without leadership. Lead them.
Honor: Prepare for anniversary reactions and other milestone dates. Mark these dates on the calendar and then respectfully acknowledge them in large or small ways. Honor those affected by the death.
Sustain: Move from postvention to suicide prevention.
All involved stakeholders will now own the fact that “it can happen here.” Use that momentum to keep others safer. Following death by suicide, leaders all become “first responders.” Rather than being overwhelmed by the first tragedy, they can prevent others.