Construction has always been a high-stakes industry. But while the industry has made enormous strides in keeping workers physically safe, the same can’t be said for mental well-being.
Behind the hard hats and steel-toe boots are people quietly battling addiction, trauma, chronic pain, depression and sometimes, despair. This article explores the transition from crisis response to culture change, presenting research-backed strategies, tools, and real-world examples of how companies are transforming their workplace cultures to foster mental health resilience.
A Crisis in Every Corner of Construction
When I first started this work in construction mental health, reactions ranged from polite skepticism to outright pushback. “Doc, we’re builders, not therapists,” one project executive said. Another cracked, “What’s next? Group hugs before drywall?”
It wasn’t cruelty. It was confusion. And to be honest, I understood it. People were worried we were going to ask them to do things they weren’t trained or prepared to do. What they didn’t know yet was that support doesn’t require a license and a bunch of letters after your name; it just requires leadership, humility and humanity.
And here’s the truth: The more honest we got, the more open people became.
After one training, a safety manager quietly told me, “I found my apprentice overdosed in the porta-potty last year. I didn’t know what to say to anyone.”
At another, a foreperson said, “I carried my friend’s casket after he died by suicide, then showed up to the jobsite two days later like nothing happened.” He paused. “There wasn’t a plan for anything else.”
That kind of silence? It’s not strong. It’s not tough. It’s dangerous.
The construction workforce is far more likely to die by suicide, overdose or the consequences of addiction than from a physical injury on the jobsite, and yet they are among the least likely to seek support for their mental health challenges. While traditional safety programs have made tremendous strides in reducing physical harm, we’re still lagging dangerously behind in addressing the invisible injuries.
One of the biggest misconceptions is that mental health issues are purely individual problems to be solved through personal counseling. But that’s not the whole story. Many of the struggles we see—substance misuse, burnout, hopelessness—are symptoms of deeper, systemic issues. Workplace-related psychosocial hazards like chronic stress, job insecurity, bullying, excessive pressure and lack of control are often the root causes of distress. Just sending someone to therapy, without addressing the environment they’re returning to, is like treating smoke and ignoring the fire.
In fact, this overreliance on an individual approach can unintentionally become a form of deflection—a way for organizations to avoid responsibility for the conditions they’ve helped create. True care means tackling both the person and the system. That means designing jobs and workplaces that support mental health, not sabotage it.
Getting Beyond Individual Level “Fixes”
Culture is often called “the air we breathe”—invisible yet shaping everything we do. Organizational culture is a collective pattern of behaviors, values and beliefs that guide how work gets done. And changing it? That takes intention, time and strategy.
I’ve been working on mental health in the construction industry since 2013. If you were to look me up, you’d likely see my clinical credentials and assume I spend most of my time providing therapy to workers. But what you might not know is that I also spent nearly a decade leading a university-based leadership development program. In that role, I helped people explore what leadership meant to them and how they could create meaningful change.
We didn’t just talk about theory; we studied how leaders around the world drive large-scale, cultural shifts in areas like mental health and suicide prevention. While my formal training is in individual-level change, my passion lies in pulling bigger levers—transforming systems, not just treating symptoms.
It’s time we apply what we know from the science of culture change to the construction industry’s mental health movement and build a practical roadmap for real, lasting change. Because sending someone to a counselor might help temporarily, but if we send them back into a toxic environment, we’re simply applying a Band-Aid to a broken foundation.
What Research Reveals
Culture is shaped by everything we do and say. Stanford experts Aaker and Huang emphasize that culture isn’t changed through slogans or messaging; it’s shaped by leaders’ everyday decisions like hiring and rewards, rituals, storytelling, and peer interactions. They advocate small, measurable experiments followed by strategic scaling to create lasting transformation (Aaker and Huang, 2023).
Leadership behavior is the primary signal of what matters. The Nous Group’s review of Australian hospital leaders shows that senior staff don’t just define culture; they are culture. Seven interrelated levers: modeling behavior, enabling two-way communication, focusing on psychosocial wellbeing, building accountability, removing structural barriers, supporting practical grounded networks, and measuring continuously were essential for real change (Nous Group, 2023).
Culture change is a long, strategic journey—not a checkbox exercise . The Leadership Research Institute emphasizes that effective culture change requires sustained planning, clear metrics, capacity building, and deliberate pacing. It isn’t a one-off initiative, but rather a building of momentum over time (LRI, n.d.).
People matter most and resistance is part of the process. Prosci’s research shows that people-focused change management—with empathy, stakeholder engagement, transparent communication, and change champions—is six times more likely to succeed. Organizations with strong change leadership report lower burnout (down 75%) and anxiety (down 25%) (Prosci, 2023; Prosci, 2024).
Structures must reinforce new behaviors. APMG highlights that culture change involves aligning strategy, leadership actions, and employee practices. Leaders must ‘do before they say,’ involve people in co-design, celebrate shifts in behavior, and maintain accountability, while recognizing that shortcuts rarely stick (APMG International, 2024).
These findings stress that workplace mental health culture change isn’t an “add-on” box to check; it requires embedding new behaviors into the fabric of everyday work. That means revisiting how jobs are performed, how meetings are run, how information is shared, and how leaders respond in crises.
By combining quantitative and qualitative data—mapped to behaviors we want to reinforce—leaders can make continuous improvements that stick.
According to the Oxford Review, successful culture change starts by aligning new behaviors with existing values and making those behaviors visible and consistent.
The Prosci model emphasizes that individual change is the building block of organizational transformation; leaders must support people through awareness, desire, knowledge, ability, and reinforcement.
Meanwhile, APMG International advises starting with a clear articulation of the “why,” and focusing efforts on the everyday levers that influence culture: policies, training, communication, and leadership modeling.
A recent Nous Group study commissioned by RACMA found that while most organizations say they value psychological safety, few have systems to support it. Workers need to see leaders “walking the talk”; creating environments where speaking up, asking for help and challenging unsafe norms are not just allowed but expected. The OCMSolution framework also reminds us that sustained communication, peer involvement, and resistance management are critical in high-risk environments like construction.
Conclusion
The construction industry is at a turning point. While hard hats and harnesses have saved countless lives, it’s time to recognize that protecting workers’ mental health is just as critical as physical safety. The stories and data make it clear: this is not a problem of weak individuals, but of systems that need to evolve.
Real change starts with leadership—leaders who are willing to listen, to act, and to challenge outdated norms. By moving beyond quick fixes and embedding mental health into the fabric of how work gets done, the industry can build a future where every worker is safe, seen, and supported—not just on the outside, but within. CD
Sally Spencer-Thomas, PysD, is a keynote speaker and impact entrepreneur. She also is the co-founder and president of United Suicide Survivors International.
