Labor Commissioner Val Hoyle noticed something disturbing as she regularly signed certificates for those graduating from state-sponsored apprenticeship programs.

Some, most often men, had died before they could start their new trade.

“I asked my staff why these people died,” Hoyle said, “and it was suicide, and these are young men that were my son’s age.”

Construction workers across the U.S. have some of the highest rates of suicide among any industry, according to the Centers for Disease Control and Prevention.

An initiative spearheaded by the Oregon Bureau of Labor & Industries to add suicide prevention programs into apprenticeship training aims to address the issue.

The high number of suicides in construction can be attributed to the physical toll the work takes, which can lead to a dependence on alcohol, pain killers or opiates. Other factors are the financial instability caused by seasonal work and the male-dominated industry being averse to conversations about mental health, well-being and individual suffering, according to the CDC.

“It’s like, you show up; you suck it up; you get it done. Don’t be weak,” Hoyle said of the culture in construction.

“I wanted to do something about changing culture, and to see what we can do to prevent suicide within our apprenticeship programs. Because that’s where you change the culture, it’s in your education.”

Task force forms

In 2019, nearly 70 companies, trade organizations and public health nonprofits in Oregon teamed up with the bureau to form the Construction Industry Suicide Prevention Taskforce.

The task force’s goal was to train construction workers to notice signs that their colleagues might be suffering. They needed to make it easier to talk about struggles with substances and mental health, to remove the stigma around talking about them, and to make sure people knew there was help.

In 2021, the focus became on a prevention program called Question, Persuade, Refer or QPR training,

According to Dwight Holton, CEO at the Portland-based suicide prevention organization Lines for Life, “It’s the CPR of mental health.”

The “question” part of the method involves training people to ask their colleagues tough questions about whether they are considering suicide.

The next step, “persuade,” is about asking the person if they’d be open to help and seeing it through with them.

The last step, “refer,” is to get them to the professionals by either physically taking them or arranging for a meeting.

Research from Missouri, where suicide is the 10th leading cause of death, showed that across age groups and demographics, the training had short- and long-term benefits in raising awareness of suicide and resources for help.

The Gatekeepers

Oregon provides apprenticeship programs for 160 trades and professions — from carpentry to ironworking to pipe fitting. More than 10,000 apprentices are training in Oregon now, according to the Bureau of Labor & Industries, and more than 200 new apprentices start every month.

Holton, Hoyle and the task force hope this year to get the QPR training out to leaders of the apprenticeships, 80% of which are in the construction industry.

Part of the strategy is to train some staff at the bureau in the approach.

Training the trainers makes them “QPR Gatekeepers.” The gatekeepers provide 90 minutes of training during an apprenticeship in suicide awareness and prevention.

Lisa Ransom is director of apprenticeships and training at the bureau. Ransom and Lines for Life coordinated the first training of about 40 apprenticeship program leaders in the Question, Persuade, Refer method on Feb. 3.

“Apprenticeships are in a mental health crisis,” she said. “Eventually, I want to offer this training to every last apprenticeship program,” she said.

She plans to have at least 50% of apprenticeship program leaders trained as gatekeepers by June, and to have trained her staff to administer the coursework, too.

She said a program leader recently called her seeking help.

“She was asking for resources because she had an apprentice who requested to drop out because he was dealing with substance abuse,” Ransom said. “They wanted him to be successful, to not quit, and I was able to lean on our partnership to provide resources.”

Sara Brady, director of apprenticeships at the Northwest College of Construction in Portland, was at that first training. She said everyone is on board with the importance of the Question, Persuade, Refer method.

“Everyone is just trying to figure out how to implement it,” she said.

She was unsure if apprentices would be required to go through the course as part of their certification or that it would be incorporated instead into student orientation.

One procedure she learned about at the training to implement at Northwest College of Construction right away is distributing stickers with mental health and suicide hotline numbers so apprentices can stick them to their hard hats.

“They know there are issues and they don’t want to be part of the problem,” Brady said of the students.

Ransom said more people are considering the mental health resources available, and the culture around talking about mental health, when they decide to enter the trades.

“Mental health is part of the whole consideration of the occupation you chose now,” she said. “People are more self aware about putting mental well-being in the same package as considering their benefits package.”