Even before the pandemic, there were signs that stress and anxiety were growing problems in the UK construction sector. While many large firms have made great progress to identify and support their employees, only a meagre patchwork of services are being offered or used by the almost two million self-employed workers in the sector, with sometimes devastating consequences. This briefing, by Stephen Bevan, Head of HR Research Development at the Institute for Employment Studies, looks at the issues.

The rate of suicide in construction is more than three times the national average for men, with more than two construction workers taking their own life every working day. For men working in skilled trades, the highest risk is amongst those in building finishing trades who have more than double the suicide risk of the male national average.

Whilst an increasing proportion of employed workers in construction have access to mental health services, a large proportion of self-employed construction workers have access to no such support and, as a result, remain an especially vulnerable group. For those who do have access to some support, this may well be inconsistent and sporadic as it likely varies from job to job. More generally, very little is known about their support needs nor about the best way to reach those whose needs may be greatest.

There are many factors contributing to this challenge. For example, hours on UK construction sites can often be excessively long, the process of competitive tendering for winning projects can create an unstable work environment reliant on subcontracting, and (as we have seen during the COVID-19 pandemic) long and unpredictable supply chains, shortages of materials, late payment and a transient and fragmented workforce. All of this is often managed through bonus and payment schemes that encourage intensive work practices to incentivise project completion. For many in the construction workforce, not being able to look much beyond the next job or project, the potential for employment uncertainty to negatively influence their health is clear.

One significant challenge is that, even when support and resources are available to workers, many appear reluctant to access them. Several studies have found that men in male-dominated workplaces are more likely to have negative attitudes toward so-called ‘help-seeking’ and more likely to view asking for help for emotional problems as a sign of weakness or failure. This led IES and our colleagues at Mates in Mind to seek and win generous funding from B&CE Insurance via their Occupational Health Research Award to conduct research on this important topic. The final report of the study, published this week, included a rapid review of previous research evidence, a survey of over 300 self-employed construction workers across a range of trades in the UK and a small number of follow-up interviews.

Using data and insights from our rapid review of previous research and the collective experiences of IES and Mates in Mind, in conducting research on these topics, we produced an online questionnaire which embedded the General Anxiety Disorder Assessment (GAD7) scale. The survey also collected data on the causes of stress and anxiety, where respondents went for help and support, other health issues they had experienced and their preferences for mental health information, support, education, and other resources (and their likelihood of using them).

Overall, we found that almost a third of our respondents had ‘severe’ anxiety on the GAD7 measure and a further third had moderate anxiety. The survey also illustrated the multiple barriers respondents faced in speaking about and seeking support for their wellbeing. For example, we found that:

• The most trusted and frequently accessed sources of support are family and friends, with significantly less trust being placed in formal and expert sources of advice, guidance or treatment.
• A significant minority appear to be routinely engaging in unhealthy behaviours which are, at least, in part attributable to poor mental health (e.g. alcohol consumption, non-prescription drug use and consideration of self-harm).
• Stigma and self-stigma relating to mental illness is strong in this group, as is the notion that improving resilience and coping is preferable to treatment or support.
• GPs are not favoured as a source of support by this population. This could be a reflection of the challenges being experienced in primary care as a result of COVID-19 and other factors, or it could be that this cohort of predominantly male construction workers are reluctant to talk to medical professionals about issues about which they are sensitive or even ashamed.

Those with the most severe anxiety seem to have more extreme experiences and most acute physical and psychological symptoms, yet are clearly more distant from (and reluctant to access) most of the formal sources of support beyond close family and friends. This is, perhaps, the most complex conundrum that providers of wellbeing support to this hard-to-reach population of construction workers need to overcome. As one of our interviewees told us:

“I’ve always thought that, even though this job is hard, you had to show that you can cope with the pressure and never admit that you’re struggling a bit. You don’t want people to think you’re a bit ‘flaky’ or that you can’t be relied on. So you keep quiet and soldier on, don’t you?”

The project has highlighted five areas where we feel that support and access to it may be improved and where Mates in Mind’s efforts to extend its impact could be delivered. These include:

• Building networks of peer support to help construction workers with lived experience of mental illness to connect with each other;
• Working with large construction firms to improve the way they use their supply chains to ensure smaller companies and sole traders can access mental health support and EAPs;
• Building the Mates in Mind bursary fund to enable more construction workers to access pro bono professional mental health support;
• Exploring ways of improving support for the financial wellbeing of the self-employed so that they can prevent the mental health consequences of debt or late payment from being so severe; and
• Seeking to build better partnerships with trade suppliers to enlist their help to raise awareness of the support available to self-employed construction workers.

There are various ways in which employees can raise their concerns about the stress they may be under. These could include the following:

• Create an environment where employees are encouraged to talk, both formally and informally, to their manager or another person in their management chain.
• Remind employees that they can speak to trade union representatives, health and safety representatives, or human resources personnel.
• Encourage employees to talk to someone in the organisation or seek advice from occupational health advisors or their GP if they are concerned about their health.
• Introduce mentoring and other forms of co-worker support.
• Provide employee assistance, such as counselling services.

While there are no ‘easy fixes’ to the mental health challenges faced by this group of workers, this research is contributing to our knowledge about how to make the support they need more accessible.