Mental health in construction is a critical and urgent issue, especially for Carolinas merit shop contractors. This article is designed for executives, HR leaders, and safety professionals in North and South Carolina who are responsible for workforce well-being and business performance. The construction industry faces a unique convergence of mental health challenges—including high suicide rates, labor shortages, and significant business impacts—that demand immediate attention from leadership.
The urgency of this topic is underscored by the construction industry’s ranking as the second-highest in suicide rates among major industries, as well as the ongoing skilled labor shortage that threatens project delivery and profitability. For contractors in the Carolinas, addressing mental health is not just a wellness initiative—it is a core business risk that directly affects safety, retention, and the bottom line.
The construction industry faces unique mental health challenges due to factors such as job insecurity, chronic physical pain, social isolation, and limited access to resources. These issues can lead to increased rates of anxiety, depression, substance use, and suicide among workers. The cyclical and seasonal nature of construction work, combined with physically demanding labor and long hours, creates an environment where mental health concerns are both prevalent and often unaddressed.
This article explains why mental health is a critical issue in the construction industry, highlights the high suicide rates and untreated psychological distress among workers, and provides actionable strategies for leaders to support mental health and reduce stigma. Readers will find data-driven insights, definitions of key concepts, and practical steps to foster a supportive culture and improve workforce outcomes.
For CEOs, HR leaders, and safety directors across North and South Carolina, mental health represents a quantifiable workforce risk amid unprecedented market pressures. Regional construction unemployment hovers near record lows under 3%, while multi-year backlogs in commercial, industrial, and infrastructure work—fueled by data center booms and highway expansions—strain available crews.
Unplanned absences, presenteeism, and preventable incidents tied to untreated mental health conditions translate directly to schedule risk, rework costs, and liquidated damages on complex projects. Stressful work environments and high-hazard conditions contribute to anxiety, burnout, and other mental health challenges, making psychological safety as critical as physical safety for retention. National surveys position mental health issues among the top voluntary quit factors.
Investors, insurers, and large owners increasingly evaluate contractor safety cultures—including how companies address mental health—as part of prequalification. Organizations must intentionally create a supportive culture that fosters mental health awareness, trust, and open communication to improve worker well-being and achieve higher retention rates and better business results. The data supports this: 93% of construction industry leaders agree that addressing mental health at work is a sound business practice.
Mental health awareness is critical in the construction industry, which currently faces a silent crisis of high suicide rates and untreated psychological distress. CDC analyses from 2021-2023 confirm construction and extraction occupations rank among the top three for suicide rates, with rates of 56 per 100,000 for males aged 25-44, several times the U.S. working population average of 17-20 per 100,000.
Bureau of Labor Statistics data show construction experiences both high physical injury rates (3.0 cases per 100 workers versus 2.7 all-industry) and chronic stressors, including 55+ hour workweeks. Many construction workers report experiencing stress, anxiety, and fatigue, which can lead to burnout and increased safety risks on job sites. Notably, among many survey respondents, 64% of U.S. construction workers reported experiencing anxiety or depression in the past year, a significant increase from previous years.
The financial impact compounds these concerns. BLS and industry estimates indicate that the fully loaded cost of replacing a skilled craft professional is 30-50% of annual pay—$15,000-$30,000 per worker at median salaries of $60,000, with higher percentages for foremen and superintendents. Unwanted turnover rates in construction run 15-22% annually, according to AGC reports, meaning even modest mental health-driven reductions could save mid-sized Carolinas firms $500,000+ annually.
While 70-80% of large and mid-sized firms offer EAPs, utilization in construction lags at 2-5% annually, compared with 7-10% economy-wide. A significant percentage of construction workers lack access to appropriate resources to manage mental health challenges, signaling access and stigma problems rather than a lack of need.
Commercial construction’s traditional “toughness” culture—especially among older male craft workers dominant in Carolinas merit shops—historically suppressed discussions of stress, anxiety, or depression. Norms like “leave problems at home” and “get it done no matter what” have discouraged open dialogue on jobsites.
Fear of being labeled as weak, unreliable, or unsafe keeps workers from using EAPs, particularly on merit-shop projects where performance is highly valued. Long commutes averaging 45-60 minutes, rotating shifts, out-of-town fast-tracks, and heavy overtime isolate workers from family and community support networks. Fostering a sense of connection and trust within the workforce is essential to counteract this isolation and support mental health.
Chronic physical pain from physically taxing labor frequently leads to addiction to opioids or alcohol to cope, which is strongly linked to higher suicide risks. CPWR data indicate that construction accounts for 17% of overdose deaths.
Carolinas contractors can plug into existing national frameworks rather than building programs from scratch. The Construction Industry Alliance for Suicide Prevention (CIASP) offers construction-tailored tools, including free toolbox talk templates, supervisor conversation guides, company pledge kits, and awareness campaigns emphasizing peer support.
The AGC Mental Health & Suicide Prevention Task Force has compiled a wealth of tools and resources related to mental health, substance abuse, and suicide prevention, which can be utilized by organizations in the construction industry, similar in spirit to ABC Carolinas’ Safety & Management Education programs. These resources help normalize discussions and connect workers to support without clinical overreach, and can enhance managers’ confidence and effectiveness in addressing mental health issues through targeted training and support.
NIOSH’s Total Worker Health framework treats safety, health, work organization, and well-being as a single integrated system, aligning closely with ABC’s Safety Training Evaluation Process (STEP). It encourages contractors to align scheduling, overtime practices, safety rules, and benefits design with both physical and psychological safety. Leading firms using these frameworks report normalized stress and suicide-prevention conversations, with results tracked through claims data and turnover metrics.
Psychological safety means workers feel able to speak up about hazards, mistakes, and personal struggles without fear of ridicule or retaliation. ABC National’s Safety Performance Report shows high-engagement programs built on trust achieve Total Recordable Incident Rates under 1.0 versus industry averages over 2.0—a 50-70% improvement.
Workers struggling with untreated anxiety, depression, or stress are more likely to lose focus, impairing judgment and decision-making on site, which directly increases the risk of accidents. Cognitive impairment from poor mental health leads to decreased concentration, slower reaction times, and reduced situational awareness on high-risk job sites.
Crews who can raise concerns about fatigue or distraction prevent incidents linked to inattention and shortcuts. For Carolinas merit shop contractors, building psychological safety reinforces core values of personal responsibility and high performance. Even a 10% incident drop through mental health support yields $100,000+ in workers’ comp savings for a mid-sized portfolio.
Mental health support must compete for dollars with equipment, technology, and wages. Peer-reviewed research on Employee Assistance Programs shows returns of $3-$10 saved for every dollar spent through reduced absenteeism, presenteeism, healthcare costs, and turnover.
Because construction work is safety-critical, the economic impact of a mentally distracted worker amplifies ROI compared to office-based industries. Connecting this to Carolinas skilled craft turnover costs—lost productivity, schedule delays, overtime for remaining crews—the potential savings from retaining even a small number of high-value employees are substantial.
Some insurers view robust mental health programming as a positive factor in contractor risk profiles, influencing EMR trends and bid competitiveness. Executives should treat these investments as multi-year risk-reduction strategies, tracked with specific KPIs, rather than as one-time HR expenses.
Providing, promoting, and encouraging the use of Employee Assistance Programs is essential for supporting mental health in the workplace. An EAP serves as the most direct pathway from job-site concern to professional care—but only if workers know it exists and trust it.
Use this checklist to assess and improve your EAP:
Audit how EAP information is delivered: Is it buried in onboarding packets, or reinforced in toolbox talks and supervisor conversations? Include specific, job-site-friendly contact instructions clarifying confidentiality protections. Meet with providers to share industry context—shift patterns, travel issues, common stressors—so counselors connect with construction workers realistically.
Frontline supervisors, foremen, and superintendents bridge the gap between company policy and daily crew experience. Training construction managers to support mental health can significantly increase their comfort discussing these issues with employees, fostering a more supportive work environment.
Supervisors should be trained to notice the following warning signs:
Training programs that teach construction professionals how to recognize and respond to signs of suicide are essential for creating a supportive work environment where employees feel comfortable addressing mental health concerns. The goal isn’t to turn supervisors into counselors—it’s to teach them to start non-judgmental conversations, listen, and connect workers with appropriate professional help.
Include role-play scenarios with construction-specific examples. Incorporate expectations for mental health conversations into supervisor job descriptions and performance reviews, signaling that supporting crew well-being is a core leadership responsibility.
Crew members often confide in trusted coworkers rather than managers, making structured peer support a powerful complement to formal benefits. Mental health ambassadors—trained volunteers across trades and demographics—know how to listen, provide information, and encourage help-seeking while respecting privacy.
The most efficient path embeds mental health into safety systems you already run well. Add brief mental health and stress management topics to regular toolbox talks, safety stand-downs, and pre-task planning, using simple language and construction-relevant examples.
Organizations that foster a supportive work environment can help reduce stigma around mental health, making it easier for workers to seek help when needed. Effective strategies include destigmatizing help-seeking and addressing industry-specific stressors like long hours and job insecurity. Measure culture change through anonymous pulse surveys, including questions about psychological safety and comfort, as well as about raising concerns.
Mental Health Awareness Month, starting May 1, 2026, offers Carolinas merit shop contractors an opportunity to launch a year-round strategy, not a campaign that fades by June.
Active and continuous leadership engagement is essential in breaking down barriers in addressing mental health and worker well-being. Schedule check-ins for June, September, and year-end to maintain momentum. ABC Carolinas can help members turn May activities into sustainable programs.
ABC Carolinas is committed to helping member companies tackle mental health and suicide risk in the construction industry as part of an integrated workforce and safety strategy, and expanding membership in ABC Carolinas strengthens access to these resources. We offer education sessions and webinars on mental health and suicide prevention designed for executives, HR leaders, and safety professionals.
We connect members to national ABC mental health programming, including toolkits, insights from the Safety Performance Report on psychological safety, and curated resources from the Construction Industry Alliance for Suicide Prevention. ABC Carolinas hosts member peer groups and executive roundtables where leaders confidentially discuss workforce well-being challenges and share policy ideas, with support from the association’s chapter leadership and organizational structure.
Our workforce development and safety training increasingly incorporates Total Worker Health principles, integrating mental health, substance misuse awareness, and resilience topics into existing safety curricula. Contact the ABC Carolinas staff or visit our online member resources to access templates, sample policies, and upcoming training details.
Mental health strategy links directly to the long-term labor shortage defining 2026 for merit shop contractors and to ABC Carolinas’ broader workforce development agenda. Workers dealing with mental health challenges are more likely to call in sick or leave the industry altogether, contributing to labor shortages. Preventing burnout, supporting mid-career workers, and retaining experienced foremen are essential—not just recruiting entry-level talent.
For deeper tactical detail on crisis intervention, see our Effective Construction Suicide Prevention Strategies post and our broader guide to construction suicide prevention strategies. Leaders interested in their own resilience can explore How ABC Peer Groups Empower Construction Executives to Lead with Confidence. View these interconnected resources as a unified playbook for stabilizing your construction workforce.
| Category | Action Item |
|---|---|
| EAP Review | Review current EAP contract and utilization data |
| Communication | Map how and when EAP is communicated to field staff |
| Training | Schedule or update supervisor mental health training |
| Peer Support | Identify potential peer ambassadors on key projects |
| Toolbox Talks | Integrate at least one mental health topic monthly |
| Investigations | Update incident templates to consider fatigue and stress |
| Policy | Add mental health language to safety policies and orientation |
| Leadership | Assign executive sponsor for mental health initiatives |
| Measurement | Set goals: EAP utilization increase, survey score improvements |
| ABC Engagement | Attend training, join peer group or roundtable |
| Notably, 77% of Presidents, CEOs, and Owners in the construction industry recognize addressing mental health at work as a priority, promoting awareness and reducing stigma. Additionally, 94% of survey respondents recognize the importance of sharing mental health resources with workers to raise awareness, reduce stigma, and encourage help-seeking behavior. |
Pick 3-5 concrete actions for this quarter rather than attempting to build a perfect program all at once. Progress and consistency matter more than perfection.
While everyday work-related stress is part of demanding project work, mental health encompasses broader conditions—including depression, anxiety, substance use disorders, and trauma-related issues—that can impair judgment, safety, and reliability. Effective programs address both healthy stress management (sleep, workload, recovery) and access to professional mental health care when symptoms become persistent or severe. Focusing only on resilience without pathways to clinical support can unintentionally signal that workers must “handle it alone,” increasing risk.
General contractors and construction managers influence job-site culture, expectations, and communication norms that shape how comfortable all workers feel about raising concerns. Include mental health language in site orientation, model supportive leadership, and encourage subcontractors to share their own EAP information. Discuss mental health expectations in preconstruction meetings, reinforcing that psychological safety is part of the overall project safety program, and consider engaging in ABC Carolinas safety and workforce development committees.
Many foundational steps—changing orientation language, encouraging open conversation, training supervisors—are low-cost and can be phased in, especially when combined with robust retirement and savings solutions for construction employees that support long-term well-being. Pooled or regional EAP offerings, association-based training and events through ABC Carolinas, and telehealth services provide smaller firms with access to high-quality support without building internal clinical teams. Even preventing the loss of one experienced foreman or avoiding a few lost-time incidents yearly offsets modest program costs, especially when paired with customized insurance solutions for contractors.
Track quantitative and qualitative indicators: EAP utilization rates, anonymous survey responses on psychological safety, turnover data for key roles, and incident rate trends, and consider tying these reviews to events like the ABC Carolinas Safety & Health Summit. Capture feedback from supervisors and peer ambassadors about their conversations while protecting individual privacy. Review data at least annually, adjusting training and communication as needed, and share positive trends with employees to reinforce commitment.
Have a clear, written crisis response protocol that supervisors and ambassadors are trained on, including internal contacts and emergency services in each jurisdiction, and stay informed through ABC Carolinas construction health and safety events. The 988 Suicide and Crisis Lifeline connects callers with a crisis counselor, and the Crisis Text Line offers text-based support, complemented by ABC Carolinas health and safety initiatives and events. In any situation suggesting immediate danger, prioritize rapid access to emergency medical professionals rather than trying to manage the situation alone. EAP providers and local mental health agencies can help design appropriate crisis procedures and follow-up processes.
