THE MENTAL

HEALTH CRISIS AND

THE CONSTRUCTION
INDUSTRY
How Work Culture and Work Structure Impact
Psychological Health and What Management Practices
Can Be Adopted to Address the Issue

August 26th, 2022

Student ID: 2714223

Adam Smith Business School, University of Glasgow

Master of Business Administration (MBA) - 2021/2022

Supervisor: Dr. Melanie Simms

Word Count: 7,996

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Table of Contents
Introduction ........................................................................................................................... 2

The Research .......................................................................................................................... 5

Why Should Construction Companies Care About Mental Health? .......................................... 6

What Can Construction Companies Do to Improve Mental Health in the Workplace? ............. 9

Obstacles When Implementing MH Policies in Construction Companies ................................ 15

Ways Forward ...................................................................................................................... 19

Awareness and Stigma Elimination .................................................................................... 19

Provide Support................................................................................................................. 20

Incentives .......................................................................................................................... 21

Policy Implementation....................................................................................................... 22

Buy-In ................................................................................................................................ 22

Monitoring ........................................................................................................................ 23

References ............................................................................................................................ 25

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Introduction

The construction industry is one of the most dangerous industries not only for the
hazardous tasks associated with projects, but also because of the frequency of incidents seen
annually (Zhou et al., 2015; Ringen et al., 1995). Because the industry is still dangerous, special
focus has been placed by government agencies and companies through the years to improve
and ensure the safety and physical wellbeing of workers. However, with all these safety efforts,
the mental health of construction workers is still poor (BC Building Trades, 2020). Mental
Health (MH) issues are defined as mental disorders or disabilities such as anxiety, depression,
stress, suicidal thoughts, or even the inability of people “to cope with the stresses of life, realize
their abilities, learn well and work well, and contribute to their community” (World Health
Organization, 2022). In the United Kingdom, general mental health cases have been rising since
2009 (Shaw, 2019). Having experience in the construction industry in the United States and
having experienced the mental health strain that comes from that type of work, I wished to
understand what the construction industry mental health environment looks like in the United
Kingdom. The industry possesses some of the highest rates of suicide of any industry, over
three times higher than the national average in the UK (Burki, 2018; Chan et al., 2020) – also a
common statistic in other parts of the world (Nwaogu et al., 2020; Neis & Neil, 2020). Research
shows that 97% of UK construction workers have suffered from stress in the last year and
quarter of construction workers have had suicidal thoughts (CIOB, n.d.a). Other reports (Rees-
Evans, 2020) show that the main mental health triggers in construction come from things such
as work-related stress, long hours, being away from family, financial conditions, poor clarity of
role. Mental health issues not only have a negative impact in the overall wellbeing of workers,
but it also affects their productivity at work costing companies and the economy millions of
pounds every year (Rees-Evans, 2020). Mental health and physical health problems are
responsible for over 38 million workdays lost every year in the UK, of which approximately 17.9
million come from stress, anxiety, and depression (Health and Safety Executive, n.d.). These
statistics indicates that there is a mental health crisis in the construction sector, and it is
important for employers to take the lead in cultivating this change.

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Many of the mental health issues seen in the industry come from the nature of the
work, work conditions of employees, and is worsened by the stigma around mental health and
vulnerability (Rees-Evans, 2020) – which is a big challenge as this stigma often ranks last in
companies’ list of priorities for addressing mental health (Coe et al., 2021).

Some factors that influence and affect the mental health state of workers in the
construction industry can be linked to the culture in the workplace. Two of these factors include
the ideology of an “ideal worker” (Davies & Frink, 2014) and the machismo culture in the
industry, which per se may not directly affect mental health, but stimulates an environment
with problematic characteristics. Davies and Frink (2014) discuss the origins of this idea, which
can still be seen in many, if not most industries, including construction. This idea dates back to a
post-World War America and, in essence, it praised the worker who would put personal life
behind their professional one. It regards this behavior as “manly”, which can be seen in the
“macho culture” of construction where workers feel pressured and responsible for being the
“breadwinner” of their home and pressured to conform to that ideology. Additionally, workers
feel that admittance of mental health problems, or perhaps even physical issues, is a sign of
fragility and weakness that would prevent them from fitting into the “ideal worker” mold,
which essentially expects workers to not need rest and repair and hold work paramount.
Understanding the “ideal worker” concept and how it is present in the construction industry is
important for it is part of the foundation of a culture that stigmatizes vulnerability and
weakness, and that prioritizes work above personal life. This culture is a big obstacle in the
addressing the mental health crisis seen in many parts of the world today.

In this document, I challenge the macho culture – or culture of machismo – seen in the
industry and how it differentiates from a simply masculine culture, where masculinity refers to
the attribution of activities and performances that are generally associated with traditional
men, and machismo with the pride in hypermasculinity and exaggerated “manly” acts (Mosher,
2012). Rees-Evans (2020) claims that the “macho” culture of the industry worsens mental issues
that workers are facing because it prevents those affected from speaking up about it and
seeking help. This document discusses how the industry has fallen into a more macho culture,
which is problematic because it values toughness and risk-taking (Mosher, 2012) – behaviors

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that often keep men from regarding mental health as important and seeking help when needed
(Potts et al., 1991; Reid et al., 2018), and it highlights recommendations on how that problem
can be addressed.

Although the report is primarily focused on the UK, globally, the industry presents
higher suicide rates than other industries (Nwaogu et al., 2020; Neis & Neil, 2020; Chan et al.,
2020). These rates are primarily due to characteristics of construction jobs that contribute to
the development and worsening of psychological problems – anxiety, depression, and stress –
that can lead to suicide (Nwaogu, 2020). Studies show that psychosocial hazards within the
construction industry – excessive workloads, conflicts, poor management, role ambiguity, etc.
(OSHA Europe, n.d.) – are positively related to mental health problems (Sun et al., 2021). So
why should companies care about improving the mental health environment for employees?
What can they do to address this issue? And what are some of the obstacles to be expected in
the implementation of strategies to battle mental health problems in construction?

This report aims to help general contractors, as well as other construction industry-
leading companies, mitigate and assist in issues related to the mental health of workers.
Drawing from a review of existing studies, this document (1) highlights some of the reasons
why construction employers should be involved in and committed to the betterment of mental
health in the workplace; (2) looks at different policies and practices that companies can use to
change the culture surrounding mental health and facilitate the improvement of conditions that
can help mitigate the risks of work-related psychological disorders; (3) outlines some of the
challenges and obstacles that might be expected when developing mental health policies and
implementing initiatives for change; and (4) provides a framework that can be used to help
guide companies in creating a thorough and effective mental health plan to address the
problem.

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The Research

Having identified mental health as a major problem in this sector, I undertook a survey
of existing studies primarily from academic papers and practitioner reports. These documents
were used to help identify a relationship between mental health issues in the construction
industry, the structure and operations of the workplace, and potential challenges in the
implementation of practices to address the problem. Using literature databases such as Google
Scholar, the University of Glasgow Online Library, Emerald Insight, Science Direct, the Chartered
Institute of Building, and the Construction Industry Training Board, articles focusing on Mental
Health and the Construction Industry were collected for analysis.

There are a limited number of studies on mental health in the construction industry –
although researchers and companies are now paying more attention to this issue in recent
years. Thus, data about this problem was drawn from experiences in other industries and from
similar issues in the construction industry – i.e., addressing issues of Equity, Diversity and
Inclusion, understanding concepts relating to the ‘ideal worker’ and exploring management
literature relating to challenges changing the culture of companies. Because of the masculinity
aspect associated with the ‘ideal worker’ and the knowledge that the ‘macho’ culture
negatively impacts mental health in the industry, I branched my research out to understand
‘masculinity at work’ and how it can be linked to behaviors that aggravate psychological issues.
Focus was, then, placed on some other root causes of the mental health crisis in the industry as
well as general factors in mental disorders in the workplace. Understanding the culture in
construction was crucial and how having a highly male-dominated industry affected the issue
being analyzed.

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Why Should Construction Companies Care About Mental Health?

The construction industry is among the most stressful and mentally exhausting
industries with the majority of its workers experiencing stress every year (CIOB, n.d.a). In the
UK, male construction workers – which accounts for over 85% of the workforce in the UK (Burki,
2018; Clark, 2022) – are over three times more likely to commit suicide than the general
national average (CIOB, n.d.a; Burki, 2018; Chan et al., 2020). Poor mental health conditions of
employees can affect the financial and execution performance of construction companies.
Mental health-related issues cost more than 70bn GBP each year to the UK economy and 30-
40bn GBP to enterprises (Rees-Evans, 2020). In the United Kingdom alone, it is estimated that
the industry loses over 400,000 workdays per year from worker absences due to mental illness
(Burki, 2018; Chan et al., 2020). Studies show that people that are experiencing mental health
issues are more likely to abstain from work for longer periods of time than those with non-
mental health-related illnesses (Shaw, 2019). And costs to companies increase when
considering expenses associated with finding and onboarding new talent to replace those lost
due to psychological issues.

Workers’ mental health can not only pose a financial threat to contractors, but it can
also affect the general safety on site (Chan et al. 2020). Increased levels of stress caused by jobs
may trigger an increase in alertness at night, affecting one’s ability to sleep and contributing to
the development of sleep disorders (Han et al., 2012). Studies show how sleep deprivation
increases fatigue, which incidentally lowers individual’s ability to respond to situations,
increasing the risk of safety incidents by 9% (Powell & Copping, 2010). Thus, mental health
problems can indirectly pose a risk to the safety of construction sites as it directly affects
people’s quality of sleep (Powell & Copping, 2010; Chan et al., 2020).

Both safety and stressful work conditions can also impact attractiveness of the industry
to new talent, worsening the labor shortage seen today (CITB, 2021) since potential workers
choose not to join the industry because of the image they have of it (Nwaogu et al., 2020).
Although companies can target underrepresented groups in the industry to increase labor and
draw new talent, studies show that many show no interest in joining the workforce due to its

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typical work conditions and culture (Clarke & Gribling, 2008). A recent study (Nwaogu et al.
2020 pp. 401) argued that: “work stress, such as high job demand, low job control, little job
support, bullying, harassment and gender discrimination impacting on MH, are significant
causes for early exit and refusal to entry by female construction professionals.” Thus,
addressing some of these root causes that add to the mental health crisis could lead to an
increase in industry attraction to potential workers, helping reduce the impact of the shortage
of labor seen today.

It is important also to recognize that, although some employees are predisposed to

mental illnesses, the culture in the workplace plays a role in its worker’s mental health and how
mental health is viewed. The culture within the industry is deeply rooted into the fact that the
industry is mostly dominated by male workers, making it more likely for employees to behave
in ways that abide to gender-role norms (Courtenay, 2000). In fact, the belief in an ideal worker
links back to masculinity and aspects of it are often present in these male-dominated industries.
Berdahl et al. (2018) argues that many of the “unhealthy” behaviors of men in the workplace
are fruits of Masculinity Contest – a concept where different dimensions of the idea of
masculinity incentivize men to prioritize certain traits. Based on masculine norms and
definitions of masculinity in western cultures, Berdahl et al. (2018) developed four dimensions
that categorizes unhealthy male work behaviors: 1) Show No Weakness, 2) Strength and
Stamina, 3) Put Work First, and 4) Cut-throat competition. The hypermasculine culture and
ideology of an ideal worker leads male workers to engage in behaviors that can be harmful –
e.g., not prioritizing their physical and mental health (Courtenay, 2000 cited in Reid et al.,
2018). Reid et al. (2018) utilizes Berdahl’s Masculinity Contest framework to evaluate
masculinity in three distinct roles and sectors: firefighter, consultant, and executive, which
show parallels with the construction industry. Looking at relevant characteristics of different
jobs and how they are linked to Masculinity Contest helps put aspects of construction jobs into
perspective to understand the influence work cultures have on the behavior of employees –
i.e., it can help employers identify what emphasizes a culture where Masculinity Contest is
prevalent and what they can do to reduce and eliminate worker behaviors that aggravate
mental health problems. For instance, in the macho culture of the construction industry, men

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tend to avoid being emotional or admitting lack of confidence (Show No Weakness) (Rees-
Evans, 2020), which leads workers to internalize issues that may defy their masculinity, like
mental health struggles, and many also see putting work first as a fundamental or reasonable
behavior for a man who wants a successful career (Reid et al., 2018), often pressuring
employees to work long hours (Strength and Stamina) and overlook personal issues they may
be facing outside of work. Therefore, actions targeting this culture can be taken to improve the
mental health in the workplace.

Some of the actions include policy changes that affect the work culture (Reid et al.,
2018). For example, implementation of strict safety regulations changed how safety was
perceived in oil fields (Reid et al., 2018), showing that strict policy implementations, especially
from governments, may be effective in changing the mental health culture within the
construction industry. This is particularly relevant because many men tend not discuss or admit
their mental health because it would indicate vulnerability, which is often categorized as a
feminine trait (Potts et al., 1991; Reid et al., 2018) – changing the culture around this topic can
help eliminate this stigma. This behavior is also problematic since talking about mental health
helps with awareness and can help individuals seek help, thus reducing the risk of suicide
(Benham, 2014). By changing the culture of a male-dominated workforce, companies can
extend its benefits beyond the reduction of mental health cases. Transforming the culture into
one where health is prioritized and workers, both male and non-male, understand the
importance of caring for personal health can help employees engage in practices that prevent
health-issues and reduce the risk of suicide.

There are many strategies to improve the mental health of employees, reducing the risk
of developing of mental illnesses such as anxiety, stress, depression, and suicide (Nwaogu,
2020). Studies indicate that positive mental health of workers is positively related to their
productivity and performance, and that it reduces job turnover rates (Rajgopal, 2010).
Therefore, it is to the best interest of employers to create and implement plans that target the
mental health of workers.

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What Can Construction Companies Do to Improve Mental Health in the

Workplace?

Seeing the different reports released by regulatory bodies (Cattell et al., 2017; Rees-
Evans, 2020) and the continuous high rates of suicide (Chan et al., 2020), most companies do
not properly or effectively acknowledge mental health as a significant health problem that
needs to be addressed. Zero work-related mental health issues is a feasible goal, as is zero
accidents, but that can only be achieved if companies hold mental health paramount as they do
with physical safety. Although it important for companies to continue to promote mental
health awareness and provide mental health support services – more common practices for
employers are to provide a hotline, training and mental health first aiders (Gullestrup et al.,
2011; Balfour Beatty, n.d.a) – these are tertiary interventions, i.e., actions to treat the problem
instead of to prevent it, making them the least effective in addressing this crisis (LaMontagne et
al., 2007). Companies can benefit more if they focus on Primary- and Secondary-level actions,
which are interventions that “eliminate or reduce job stressors (eliminate or reduce risk factors
for job stress” and “alter the way that individuals perceive or respond to stressors”
(LaMontagne et al., 2007, pp. 223), respectively. That is, policies that eliminate or reduce work
stressors like long work hours, role and job support, and toxic masculinity culture.

Companies need to first recognize that the mental health of employees is just as
important for the business as their physical health and safety. Sandler et al. (2014) indicate that
programs to promote awareness of and prevent mental health are effective, as they provide
support services that can help those who are struggling with mental disorders. Awareness
promotion can help educate workers and can help reduce the stigma around mental disorders
(Coe et al., 2021). Just as the industry has put so much focus and emphasis on job site safety
(CIOB, n.d.b), it is important for companies to do the same in regard to mental health. Industry
leaders can make mental health a sector or department of its own within the company and
create positions that are specifically aimed at improving the mental health environment of
construction as well as supporting employees with the matter – similar to Safety Engineers and
Safety Managers seen in construction projects today. This would not only put more focus on

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the work to address the crisis seen today, but it would also show other employees that the
company takes mental health seriously and is working hard to improve conditions for all.

Secondly, employers must ensure that workers are taking advantage of these services.
Corporate-wide awareness of the services available is important, but companies can go a step
farther in engaging employees. Even with the knowledge of such programs, construction
personnel may not seek them out because they believe they do not have time to do so or
because of the stigma behind admitting they are struggling psychologically (Milner et al. 2018),
tapping into the issue of showing vulnerability and weakness – back to the idea masculinity
contest – in such a male-dominated industry (Reid et al., 2018). Therefore, companies should
pair the MH programs with incentives for workers to take advantage of such without feeling
guilt. Tactics that target motivation in the short-term, such as monetary or other tangible items
(Markham et al., 2002; Scott Jr. et al., 1988), are an effective way to get workers to start
enjoying the programs available. Knowing that programs geared towards well-being – physical
activities and mindfulness programs – can prevent mental health issues (National Health
Service, n.d.), schemes where employers award workers who are partaking in activities to
improve their overall wellbeing could be an effective way to get workers to take advantage and
engaged in these programs. Another possibility is perhaps allocating a certain time and day of
the week for employees to take care of their mental health.

Because the construction industry is notorious for having long working hours
(Construction Management, 2021; Clarke & Gribling, 2008) and long work hours have a
negative effect on one’s mental health and well-being (Sato et al., 2020), companies can make
use of different work arrangements with the intent of reducing fatigue and burnout from the
excessive time spent at work. An alternative is to provide employees with the flexibility to work
from home. Despite popular belief, work-from-home (WFH) arrangements have shown to
increase employee productivity (Bloom, 2014). Although some research shows no correlation
between WFH and job satisfaction – but does confirm a positive correlation between home
working and work-life balance (Bellmann & Hubler, 2021), others argue that employees did
report an increase in job satisfaction when given the option to work from home (Bloom, 2014).
And because studies indicates that job satisfaction can lead to better mental health and reduce

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the risk of depression and burnout (Nadinloyi et al. 2013; Faragher et al., 2005), providing
employees with the option to work from home a few times a week can be effective in
addressing the mental health crisis seen today while relishing the increase in worker
productivity. However, there are down sides to a WFH arrangement and companies should
carefully plan this new structure before rolling it out. It can be difficult to coordinate work in
large teams when each employee chooses their own schedule. Thus, requiring employees to
come to the office or site on specified weekdays a couple of times a week can help with team
management and coordination (Bloom, 2021). The other issue is that the nature of construction
work does not allow all personnel to have this WFH flexibility. Employees are required to be
present at construction sites for project execution in accordance with contractual schedules.
Therefore, when a WFH arrangement is not feasible, companies can consider shortening the
work week – without a pay cut. Although there is a lack of research on the benefits of a shorter
work week, some claim that it can improve morale, reduce absences, and even help with
recruitment (Ellerbeck, 2022). Dozens of companies in the United Kingdom are currently going
through a four-day week trial to evaluate whether it is beneficial to change the way work is
structured to gain a competitive advantage over peers and improve employees’ quality of life
(Kollewe, 2022; Ellerbeck, 2022). A downside to this is that it can be difficult for companies to
ensure employees are spending their extra day off to rest (Ashford & Kallis, 2013). And if they
are not, this initiative could be counterproductive. That’s why a combination of actions must be
taken to transition to this new work structure while creating a culture where employees
understand the importance of resting and the intentions behind such decisions.

In addition to, or regardless of, implementing shorter hours, it is crucial for companies
to develop realistic schedules when signing project contracts and to properly plan the work
before construction begins. Construction delays worldwide are often linked to contract
schedule durations that are too short and poor pre-construction planning (Assaf & Al-Hejji,
2006; Odeh & Battaineh, 2002; Sweis et al., 2008; Al-Kharashi & Skitmore, 2009). Planning also
plays a big role in the quality management of the product being built (Abdel-Razek, 1998) –
which is discussed later in the document. Nonetheless, both planning and appropriate
construction schedule can be easily managed and improved by companies and can affect the

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mental health of their employees. Involving employees in the decision-making process and
work planning can help create more realistic schedules and reduce stress as it allows workers to
plan in accordance with their own preferences and needs (LaMontagne et al., 2007). With
better planning and realistic schedules, projects are less likely to require longer hours and
reduces the chance of employee stress and burnout, which are considered to be notable causes
to the mental health crisis in the industry (Rees-Evans, 2020). Studies also indicate that there is
a problem in coordination between parties that delays the construction schedule (Assaf & Al-
Hejji, 2006; Sweis et al., 2008) – one of the potential areas for improvement is the hand-off
between phases of the construction process. Smoother hand-offs allow workers to fully move
on to new tasks, and to ‘enjoy uninterrupted family time during their “off” hours’ (Reid et al.,
2018, pp. 598). There is good indication that addressing long work hours can positively impact
the workers’ health or at least their attitude towards seeking professional help (Courtenay,
2000). However, changing working hours on its own may not be as effective since there is a
cultural stigma that bars men from seeking help (Milner et al., 2018), meaning workers may not
use their spare time to take care of their mental health. Therefore, additional measures to
complement the new work structure would be necessary.

With the intention of reducing unnecessary long work hours, contractors can also focus
on another prevalent issue seen in the industry today: quality management. It may not seem
clear how quality management in construction sites is related to mental health, but the two are
indirectly related. In 2018, after a series of quality issues that led to the closure of many
facilities and a defect-induced, lethal fire in the UK, CIOB (2018) reported quality control and
management as one of the major issues in the industry today and conducted research to
identify the major quality-related issues to be addressed. Improper training and education are
among the top causes of quality issues (CIOB, 2018; Dong, 2017). This lack of proper quality
training can negatively affect workers’ mental in two ways. First, poor or no quality training
leads to poor construction quality, which consequently requires rework, affecting the labor
productivity, which is one of the major factors affecting the construction schedule (Olanrewaju
& Lee, 2022; Odeh & Battaineh, 2002; Al-Kharashi & Skitmore, 2009) and increasing the need
for longer work hours to meet construction deadlines. Long work hours increase stress, which

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in turn affects employees’ mental health (Sato et al., 2020). Secondly, training, quality-related
or not, can improve role clarity – one of the stressors identified in the industry (Rees-Evans,
2020), which can lead to low job satisfaction (Hassan, 2013). And as previously discussed, job
satisfaction is one of the factors that can improve mental health in the workplace (Nadinloyi et
al. 2013; Faragher et al., 2005). Not to mention the effects that quality has on construction
companies’ financials and client relationships. CIOB (2018) reported that these quality mistakes
can cost the construction sector between 10bn and 25bn GPB every year, and that 99% of
customers reported quality problems to builders. Therefore, investing in the quality training can
not only help companies improve the mental health of employees in the workplace, but it can
also have great performance benefits to employers’ financials and client relations.

Finally, as mentioned in the previous section, changing the culture is an important goal
for addressing and improving the mental health status in the workplace. In the last two
decades, the construction industry has made significant improvements in the safety of work
due to the increased commitment of companies to a safer work environment (CIOB, n.d.b).
Molenaar et al. (2009) argue that the safety culture of a company is an important factor in their
safety performance, and that should not be any different for mental health. When changing the
safety culture, companies implemented different strategies, with some of the key actions being
the inclusion of safety as a main value of a company and getting the “buy-in” from everyone –
from top management to external parties, like clients, suppliers, and subcontractors (Choudhry
et al., 2007; Zou, 2011). To effectively address the mental health crisis, the same commitment
should be made for mental health improvement. And as one of the definers of the general
culture of the industry, addressing the highly male-dominated culture and its Masculinity
Contest must be at the forefront (Reid et al., 2018; Berdahl et al., 2018).

Although some of the ideas mentioned in this document to address the widespread
challenge of poor mental health in the sector already address some of the themes of the
Masculinity Contest in the industry – such as reducing work hours and “Put Work First” or
creating awareness and “Show No Weakness” (Berdahl et al., 2018), there are additional
measures that can be taken to move the culture of a company towards a more mental-health
positive one. Strategies targeting the change of beliefs, behaviors and attitudes of employees

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are the most effective and important in achieving such a cultural transformation (Zou, 2011).
Just as with safety, making mental health in the workplace a priority for the company can set
the tone for the environment employees work in. Many decades ago, safety was not a main
concern of construction companies and their collaborations mostly relied on the creation of
safety regulations on site (NOSHC, n.d.). Today, the contrast in culture can be seen as many
companies, especially large contractors, list physical health and safety as one of the company’s
top priorities and values (Multiplex, n.d.; Kiewit, n.d.; Balfour Beatty, n.d.b; Skanska, n.d.). Just
as it was done with safety years ago (Reid et al., 2018), changing the culture and how people
see the importance – and seriousness – of maintaining good psychological health can help
workers – especially men – see mental health as a crucial part of their job and performance and
not as a threat to their masculinity. And instead of relying on government policies, that change
starts with how companies position themselves on the matter and their commitment to act.

Another aspect of the culture that can be targeted is the support provided to employees
– one of the stressors that contribute to poor mental health (Nwaogu et al., 2020). Support
from top management would not only make workers feel comfortable to discuss issues and
express concerns, but it could also encourage a collaborative environment where personnel is
not afraid of facing their mistakes and learning from them and from others – as seen with
consultants (Reid et al., 2018). This can both help reduce the Masculinity Contest feeling of
“showing no weakness” and avoid a “cut-throat” atmosphere.

The list of actions that companies can take to address mental health in the workplace is
extensive: 1) make mental health improvement a company-wide initiative and core objective;
2) raise awareness of programs available and create incentives to increase engagement; 3)
reduce work hours or provide flexible work arrangements; 4) improve and provide role and
skill-development training programs; 5) build employee support and buy-in on any new
initiatives; and 6) change the culture around mental health in the workplace. However, with all
the programs and practices discussed thus far, being aware of obstacles that can challenge their
implementation can help companies fully consider each of these tactics and their impacts –
both positive and negative, and effectively roll out any plans created.

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Obstacles When Implementing MH Policies in Construction Companies

There are different types of challenges when addressing an issue at such a large scale as
an industry mental health crisis. There are general challenges of rolling out company-wide
policies and other strategic decisions, and there are barriers with the implementation of
individual actions. When developing company policies and strategies for mental health,
employers should understand general implementation barriers they may face. Although there
are not many studies on the implementation of plans to target mental health in construction
industries, similar challenges from other industries or initiatives – such as Equity, Diversity and
Inclusion (EDI) or sustainable construction – can be expected. For instance, Mohamad Bohari et
al. (2016) discussed the implementation of green construction initiatives in Malaysia. This is still
relevant for the UK since, like in Malaysia, awareness of the problem by executives and high
upfront costs of implementation would be some of the biggest challenges for buy-in of plans
(Mohamad Bohari et al., 2016). Cost of the solution was also a major barrier when companies
attempted implementing COVID-19 safety measures in jobsites (Ayat et al., 2021). Similar
challenges could be expected when addressing mental health.

Creating a culture that both eliminates Masculinity Contest and the stigma of struggling
with mental illnesses is also important. Gulliver et al. (2010) and Sagar-Ouriaghli et al. (2020)
discuss how one of the biggest hurdles with addressing mental health is that employees are
often fearful that mental health programs are not confidential and that providers might
disclose to others that they are struggling psychologically – with some believing that their
careers might be affected by that information (Kelly, 2019; Shaw, 2019). Given that, in general,
men fear mental health stigma more than women (Farina, 1981), it’s even more important to
look at this issue in a male-dominated culture. Providing services – such as hotlines and MH first
aiders – will not be effective if there is lack of awareness for such programs or if there is a
stigma that keeps workers from opening up and seeking help. Therefore, as briefly mentioned
in the previous section, internal marketing strategies and incentives to participate in these
programs can create awareness and ensure the effects of the culture transformation are
positive.

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Moreover, when considering changing the work structure or work hours, companies
should carefully plan this transition and understand the entire scope of the implementation.
Although flexible working arrangements have shown to have a positive effect on job
satisfaction (Wheatley, 2016; Aziz-Ur-Rehman & Siddiqui, 2020), working from home can
increase stress and worsen the expectations of employees towards the ideal worker ideology.
As boundaries between work and home fade, employees may suffer from worsening work-life
balance as they feel pressured or feel the need of being available around the clock, increasing
work hours and dedication of time to work (Davies & Frink, 2014; Holden & Sunindijo, 2018). It
is also important to recognize that not all workers may be pleased with the shortening of hours.
Many workers, particularly those with hourly wages, may depend on overtime pay and longer
work hours to make enough to be in good financial condition – financial struggles and insecurity
also aggravate mental health issues and increases the risk of suicide (Chan et al., 2020). Thus,
simply reducing work hours can positively affect some workers, but worsen the situation for
others. In these cases, it is better to rely on reducing other stressors, such as committing to
realistic schedules, which in itself may create other issues as not agreeing on faster
construction schedules may decrease the competitive advantage of companies when trying to
be awarded projects.

If less aggressive schedules are not feasible, an alternative stressor-tackling plan is

improving the quality of the work through better training programs to reduce quality issues,
improve skill qualification, and better role clarity and expectations – identified triggers for poor
and solutions for better psychological health of employees (Rees-Evans, 2020). However, many
companies today still resort to self-development training programs, which are not as effective
for skill-development (Detsimas et al., 2016). Companies can, then, develop role-specific
training programs for the onboarding process to better prepare employees for the workplace.
Although some recommend shadowing training (Jenkins, 2015), standardized programs would
better ensure there are no gaps in the training of employees as there may be by letting
employees get trained by others on the jobsite.

Although training and other mental health-focused initiatives are important, the way
mental health is seen needs to change. The conversation around mental health in the

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workplace has increased in the last few decades, but much still has to be done to address the
problem as the rates of work-related suicide and other psychological disorders is still well above
national average (Chan et al., 2020). When addressing an issue, education and training are key
drivers in ensuring company awareness and participation in company initiatives (Mohamad
Bohari et al., 2016; Amoah & Simpeh, 2021). It is also crucial to raise awareness of the problem
and inform all stakeholders about the impacts – both financial and performance – these would
result in. Once upper management understands the problem at hand, it can be easier to have
their buy-in and commitment to strategies, and it can also be easier to justify costs associated
with any proposed solutions – a major problem discussed earlier in this document.

It is also important to note that mental health in the workplace could become regulated
in the future, as it was done with physical safety and sustainability, forcing a culture change
around the topic. Examples are the creation of safety regulations of oil fields (Reid et al., 2018)
– which has parallels with construction in terms of the safety hazards of activities, and when
government regulations drove culture and priority changes of companies towards green
building (Mohamad Bohari et al., 2016). Lessons can be drawn from both cases by
acknowledging that stricter workplace mental health laws might be created in the future –
companies, then, will have to adjust to comply with those. Thus, by making their duty and
responsibility, industry leaders can initiate change for a better workplace environment and to
transform the industry culture before it becomes required by law. This can also be
competitively advantageous in case governments do impose regulations on work-life balance.
An example of this is how companies are having to adapt in Portugal after a new law prohibiting
employers from contacting personnel outside of work hours was implemented (McKeever,
2021).

Lastly, a culture change can help reduce the Masculinity Contest within the industry. It
can be difficult to change a culture and how men perceive mental health. Seeing executives
take such strong positions to address mental ill health can passively show support to workers
and indicate that showing vulnerability or “weakness” is not something that will affect their
careers, and that the company does hold mental health and wellbeing as a priority.

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All in all, a strong and thorough change management strategies and buy-in are
important prior to rolling out policies and initiatives. LaMontagne et al.’s (2007) systems
approach to intervene in job stress is a good way to understand the different types of actions
that can be taken by employees, and how these contribute to fixing the problem. Actions are
categorized by different levels of intervention – Primary, Secondary and Tertiary, and rated
from most effective to least effective in addressing job stress. Based on this approach, a
selection of interventions can be made by the employer to create an integrated plan that can
effectively workplace mental illness triggers and improve the overall mental health of
employees.

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Ways Forward

Key literature in this study shows how Masculinity Contest (Berdahl et al., 2018) and
operational flaws – such as lack of quality management training, role clarity, planning, and
support – are at the root of a “macho” culture that stigmatizes being vulnerable and schedules
that are centered around extremely long work hours. With a broader idea of the issue at hand
and the power and influence companies have to the mental health of employees, a plan can be
developed for action. As an industry leader, it is not only their responsibility to mold the way
work is structured and conducted, but it is also to their best interest to lead change and push
the construction industry to become a safe place to work – physically and mentally.

Based on the different challenges keeping construction companies from addressing

today’s mental health crisis and the different types of programs that can be implemented, a
Mental Health Initiative (MHI) framework can be used to guide employers to a positive mental
health work environment. The MHI framework is divided into different actions that collectively
provide the best outcome for the employees: Awareness & Stigma Elimination, Support,
Incentives, Policy Implementation, Buy-In, and Monitoring.

Awareness and Stigma Elimination

Spreading awareness about the importance of taking care of one’s mental health is the
first step of addressing this crisis for it can both educate employees on what mental
health issues look like and how it affects their life – personally and professionally, and it
can help eliminate the stigma of admitting struggle and seeking for help. When building
their mental health action plan, companies can start the culture change by taking
measures to target the self- and public stigmas that prevents workers from caring for
their psychological health. Providing mental health training to all employees – just as it
is done for construction safety – can be effective for this first step (Coe et al., 2021).
Evidence-based and an environment where workers are able to learn from others’
experiences and share their own is encouraged.

Public and structural stigma must also be addressed. Companies can help eliminate
those by showing employees that they take this issue seriously and are willing to create

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programs and policies to improve aspects of the workplace that are not mental health-
friendly – see Provide Support and Policy Implementation sections. However, as part of
the awareness creation, employers can create a marketing strategy plan to ensure
workers know about the services available to them and to entice them to make use of
these.

Provide Support

As lack of support is often listed as a stressor in the workplace (Nwaogu et al., 2020),
providing support to employees through programs and services to help them cope with
mental health illnesses – as well as indirect stressors like lack job role support – that
they may be experiencing is an essential element of this framework.

In terms of mental health support, companies can choose from secondary, and tertiary
intervening actions. A combination of the two – with non-support primary actions –
would be most effective as it tackles mental health from different angles.

Employers can provide workers with general therapy services and mindfulness-based
programs (King, 2019) to help them better respond to stressful situations. Because
individual therapy can be expensive, a good private health insurance that covers therapy
services is possibly the best alternative to such a support. Other services include
employee assistance programs (LaMontagne et al., 2007). Companies can train
managers “recognize signs of distress” (Coe et al., 2021). In addition to managers,
training any employee to become mental health first aiders can empower workers to
help anyone struggling psychologically. Both trainings can help proactively identify if
someone is experiencing mental health-related issues and provide adequate and
individual support to them – also motivating employees to speak up about these issues,
thus reducing self- and public stigma.

As it has been done with workplace Health & Safety and with Equity, Diversity, and
Inclusion (EDI), employers can create a specific department and positions dedicated to
mental health in the workplace. These professionals would be in charge of supporting
and monitoring the sites and offices on mental health, and help executives and

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leadership assess and create policies and programs for continuous improvement in the
area.

Other support programs include job trainings. These job trainings could be classified as a
non-support primary intervention as it reduces stress factors without directly addressing
mental health. Examples are Quality Management trainings, as previously discussed,
and other formative job-specific training programs – such as during newcomer
orientation or onboarding – that can help support and help employees prepare to
perform their job well. Training programs in construction today are often informal or
relies on self-development (Detsimas et al. 2016). Better and formal skill and role
development programs can indirectly improve the mental health of employees.

Incentives

No plan can be successful if employees do not participate. In addition to a good

marketing strategy, employers can provide incentive programs to engage workers in the
new services being implemented in the company. Changing the culture and work
structure will allow employees to have time to make use of these programs but
rewarding will attract and encourage them to do things that they normally would not do
with their free time – such as seeing a counselor or a therapist. Extrinsic rewards have
shown to be a great strategy for short term motivation (Markham et al., 2002), and
because the goal here is to get that engagement started, programs that can financially
reward participating employees would be a great tactic for employers. Examples of
these incentives are additional pension compensation, private health care assistance or
gift cards for meeting certain goals like seeing a therapist once a month or partaking in
mindfulness-based programs once a week. Or perhaps compensating employees for
their time at therapy – if the company provides a scheme that allows workers to see a
therapist once a week during work hours. Regardless of the program, monitoring and
tracking is important so that companies can ensure employees are using the time and
services as intended and not taking advantage of the incentive programs.

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Policy Implementation

Policy implementation is perhaps the most, or one of the most, important parts of this
framework. Creating new policies that affect work conditions is a primary intervention
tactic, which is most effective in reducing stress in the workplace (LaMontagne et al.,
2007). These are also important in shaping and changing the culture of at work as it
helps define the company’s values, priorities, and goals (Freeman & Funk, 2007).
Companies can implement policies that focus on reducing job demands – reallocating
resources, reducing work hours or stricter schedule agreement guidelines, policies
targeting the improvement of work-life balance, role support programs, role-specific
trainings, policies that can provide breaks or give control to employees, such as more
flexible work arrangements or rotation schedules to allow workers to “recharge” and go
see their families every few weeks – this is particularly important for construction
projects that require employee relocation, which can increase stress and other mental
health problems (Rees-Evans, 2020).

No matter what policy is developed and implemented, companies must understand the
impact it can have on other areas. For instance, encouraging workers to not overwork
and take time off to take care of their mental health may overload another employee
who is picking up the slack (Callan, 2007). Thus, if that’s the case, a combination of
policies may be necessary. Working on policies to reduce work hours may require a
parallel policy that seeks to increase the number of employees to evenly spread the
workload and mitigate the risk of overloading existing workers.

Buy-In

When developing a thorough plan – whether it is targeting mental health or any other
changes in the company, executive and management buy-in plays a crucial role in its
success. The participation of leaders enables them to set the tone for non-executive
employees. It is also important that, just like with Health & Safety, frequent
announcements and emphasis is put on the importance of mental health is done, by
leaders, company-wide to show workers that the company does prioritize the issue at

22
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hand – they walk the talk, which can influence how employees perceive mental health
in the workplace – and hopefully reduces the stigma and prejudice that is seen in highly
masculine and male-dominated cultures (Callan, 2007).

One strategy to improve buy-in for this plan is pairing professionals from the mental
health department with executives or other higher positions – or even creating an
executive position specific to improving the mental health of employees of the
company. This helps complement their mental health knowledge with the
understanding of the business and resources to “seek change” (Kirton et al., 2007).
However, their main task and focus should be related to improving mental health. Too
much focus on business management and goals could affect their ability and “drive” to
improve mental health in the workplace and instead take actions with the business in
mind and not the workers (Kirton & Greene, 2009).

Monitoring

Finally, the company must develop a system to monitor and evaluate the work that is
being done to reduce mental health issues in the workplace. The process of monitoring
is fundamental as it helps companies learn about and understand the severity of the
issue at a specific time, how effective the policies or initiatives implemented have been
in addressing the problem at hand, and what needs to be changed in the plan to allow
them to continue battling the mental health crisis and working on achieving the
company’s goals (Freeman & Funk, 2007).

Although there has not been enough research and studies focused on operational
practices to improve the mental health in the construction industry, literature review – both of
academic and practitioner documents – points to a mental health crisis that is affecting
construction workers all over the world. Information was drawn from these papers showing
how both a male-dominated culture as well as traditional industry practices can lead to and
aggravate psychological issues in employees. This study focused on some of the root causes of
stress and other psychological disorders in the construction workplace, its relationship to

23
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company performance, and actions that can be taken to address the issue and improve not only
the operations, but also make it an attractive and thriving place for construction talent. After
analyzing relevant literature and thoroughly looking at practices and obstacles, a framework
was developed and proposed to guide companies in the development of effective plans to
improve the mental health in the workplace and create an environment that helps both the
company and the employees to thrive.

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