Mental health in construction

Introduction
This article is intended to constitute an ‘Introduction to mental health’, which is a subject on its own, in an endeavour to create awareness of the problem and challenges, and conscientise construction stakeholders.
United Kingdom (UK) construction statistics courtesy of The Holistic Health Care Group (2020) indicate that:

Male site workers are three times more likely to commit suicide than the average male in the UK;
Suicide kills more construction workers than falls every year;
Depression and anxiety have overtaken musculoskeletal disorders among construction workers in terms of H&S issues;
The construction industry accounted for 13.2% of in-work suicides between 2011 – 2015, despite only accounting for 7% of the total UK workforce;
23% of construction workers are considering leaving the industry in the next 12 months due to poor mental health, and
454 construction workers committed suicide in 2014.
Prior reference to mental health is courtesy of, among others, a Chartered Institute of Building (CIOB) UK study (Campbell, 2006), which included construction industry professionals, the majority of whom were construction managers. 68.2% had suffered from stress, anxiety, or depression as a direct result of working in the construction industry. However, only 6% of those who had experienced occupational stress had taken time off as a result thereof. 

Health versus well-being

Health is “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (World Health Organisation, 2013). However, well-being “Includes the presence of positive emotions and moods (e.g., contentment, happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with life, fulfilment, and positive functioning.” (Centers for Disease Control & Prevention, 2018). It includes physical well-being, economic well-being, social well-being, development and activity, emotional well-being, psychological well-being, life satisfaction, domain specific satisfaction, and engaging activities and work.
The health component of health and safety (H&S) is multi-faceted, as although the Occupational Health and Safety Act (OHSA) and several regulations are concerned with occupational health (OH), there is the issue of primary health (PH). Furthermore, many OH and PH issues are inter-related. Stress, for example, which is experienced in construction, is an OH and a PH issue.

The experience of stress

Stress is a major issue in construction, and, among others, has a major impact on mental health.
During the first ever ‘OH in construction’ study conducted in South Africa (& Africa) during 1996, Smallwood and Ehrlich (1997) investigated, among others, the experience and causes of stress. According to respondents from two ‘construction management’ sample strata, contracts management, site management, and all categories of production workers experienced stress, the degree of stress rising commensurately with the degree of occupation responsibility in the organisation.
Participants were required to indicate the extent to which 27 causes within six categories contributed to the experience of stress, namely physical environment, organisational, individual, time variables, and off-the-job. Those that contributed to more of a major, as opposed to a minor extent, include project schedule, job complexity, incompetent staff, overburdening, crisis management, inadequate staff, inappropriate communication channels, temperature, and lack of training.
The respondents to the CIOB UK study (Campbell, 2006) identified the contribution of the causes of stress thereto as follows: lack of feedback (56.8%); poor communication (55.7%); inadequate staffing (55.0%); too much work (64.1%); ambitious deadlines (59.7%); pressure (59.9%), and conflicting demands (52.2%).
A more recent South African study conducted among construction H&S agents (CHSAs) investigated, among others, the extent to which 30 OH aspects were identified on projects (Smallwood & Deacon, 2020). Table 1 below presents 6 / 30 aspects, which impact directly on mental health. The ‘response’ column indicates the percentage of CHSAs who identified the aspects on projects, and the ‘percentage of projects’ column indicates the percentage of their projects on which they were identified.  

People in Construction Study

An exploratory study conducted among delegates attending the Conseil International du Bâtiment (CIB) W099 (Safety, Health and Well-being in Construction) and TG59 (People in Construction) Conference in Salvador, Brazil, August 2018 included participants representing ten countries, both developed and developing, and the continents, Africa, Asia, Australasia, Europe, and South America. Academics constituted 75.0% of respondents, and researchers 10% (Smallwood & Emuze, 2021).
90.5% of respondents responded ‘yes’ to the question ‘Does your country face ‘people in construction’ (PiC) issues?’ 90.5% responded to ‘If ‘Yes’, please record the top five PiC ’issues’. 95.2% responded to ‘Please indicate the top five ‘PiC’ research priorities in your country’, and 95.2% responded to ‘Please indicate any ‘PiC’ research gaps in your country’. 53 Issues were identified relative to the three questions - 33 relative to the top five, 29 relative to research priorities, and 28 relative to research gaps. 
The top five (seven due to joint rankings) ‘PiC’ issues are: workforce well-being (1=); H&S (1=); mental health (3=); workforce engagement (3=); under-skilled workforce (3=); productivity (3=), and employment practices (3=).
The top five (six due to joint rankings) research priorities are: mental health (1); workforce engagement (2=); H&S (2=); workforce well-being (4); productivity (5=), and motivation & leadership (5=).
The top five (seven due to joint rankings) research gaps are: mental health (1); workforce engagement (2=); workforce well-being (2=); human rights (4); management failures (5=); women in construction (5=), and technology / new technology (5=).
Overall, the top five issues based on the mean of the percentage responses to the top five issues, research priorities, and research gaps, are mental health, workforce well-being, workforce engagement, H&S, and productivity.

Conclusions

Mental health is ‘the’ construction H&S issue, and straddles OH and PH, which are inter-related.
The effects of mental ill-health are wide ranging, and ultimately impact on the sustainability of the industry, due to, among others, the need to attract young people and other potential participants to the industry.
To address mental health effectively will require the South African construction industry to cure itself of ‘safetyitis’, which entails among others, the use of the word ‘safety’ as opposed to H&S, and affording OH and PH issues at least equal attention afforded to, and resources allocated to ‘safety’.

Recommendations

The level of awareness and knowledge with respect to mental health should be raised through among others, articles such as this. Continuing professional development (CPD) should be promoted and championed by built environment employer and employee associations, professional associations, and statutory councils.
Industry H&S programmes, competitions, and star grading programmes should place the requisite emphasis on mental health, and on OH and PH in general. PH Promotion programmes should be comprehensive, and include an employee assistance programme. Mental health guidelines and practice notes should be evolved for all built environment stakeholders.
The OHSA and the Construction Regulations should include mental health requirements, or ‘Mental Health Regulations’ should be gazetted.
Mental health should be addressed by all built environment tertiary education programmes, and construction skills training.

References
Campbell, F. 2006. Occupational Stress in the Construction Industry. Ascot: Chartered Institute of Building (CIOB).

Centers for Disease Control & Prevention. 2018. Well-Being Concepts. [online]. Atlanta: Centers for Disease Control & Prevention. Available from: https://www.cdc.gov/hrqol/wellbeing.htm [Accessed 1 August 2018]

Smallwood, J. and Deacon, C. 2020. Occupational Health (OH) Practices in South African Construction. MATEC Web of Conferences, 312, 03003 (2020), https://doi.org/10.1051/matecconf/202031203003

Smallwood, J.J. and Ehrlich, R.1997. Occupational health in construction. In: Proceedings of the 1st South African Construction Health and Safety Conference ‘Health and Safety in Construction: Current and Future Challenges’ , Cape Town, 7 - 10 October 1997, 171-187.

Smallwood, J. and Emuze, F. 2021. People in Construction: Research Issues. In: Proceedings of The Economic Forum ‘Creating Sustainable Built Infrastructure’ , Johannesburg, 15 - 16 July 2021, 3-20.

The Holistic Healthcare Group. 2020. Mental Health in the Construction Industry. [online]. Clare Park: The Holistic Healthcare Group. Available from: https://theholistichealthcaregroup.com/2020/02/mental-health-in-the-construction-industry/ [Accessed 20 October 2020] 

World Health Organisation (WHO). 2013. Measurement of and target-setting for well-being: an initiative by the WHO Regional Office for Europe. Copenhagen, Denmark: WHO.