Construction unions embrace mental health protections

In an industry defined by physical risk, construction workers in New York are beginning to acknowledge a new safety crisis – one of substance abuse and mental health struggles –  which labor leaders say have gone unaddressed for decades.

After years of pushing by unions and advocates, the city is now expanding mental health programs, peer-support networks and training requirements in an effort to respond to rising overdoses and suicides among construction workers.

Eric McIntire, founder of Labor Helping Labor -- a firm that specializes in peer-to-peer substance use disorder and mental health issues in the building trades, said the shift reflects a growing willingness within the industry to openly discuss the relationship between mental health and physical health.

“It’s been an issue for a very long time, but the culture is changing – what’s accepted to be talked about now is providing phenomenal support for our brothers and sisters,” McIntire said.

'You don't talk about feelings'

Construction workers have always had to deal with demanding schedules and uncertain employment. Projects end, crews disperse and workers must find the next job while managing the physical strain accumulated over the years.

“We wake up in the dark, we come home in the dark,” McIntire said. “The better we work, we work ourselves out of a job – with the hope of getting the next one.”

This instability, combined with chronic injuries and long hours, has contributed to mental health issues across the industry. In an attempt to numb the physical and mental strain, workers are increasingly looking to drugs, particularly opioid painkillers, labor advocates say.

According to the Department of Health and Mental Hygiene, construction workers account for more overdose deaths than any other occupational group in New York City. At least 269 construction workers died from overdoses in 2020 alone, mirroring national findings that show elevated rates of substance use within the industry.

Nationally, more than 5,000 construction workers die by suicide each year, a number which exceeds fatalities from workplace accidents. Conversations regarding the conditions which lead to overdoses and suicides have long remained stigmatized.

“We come from an industry where it was ‘walk it off, keep your mouth shut – you don’t talk about feelings. You just get the job done,’” McIntire said.

Ways to manage discomfort

For workers outside union jobs, however, access to formal support systems can remain limited. Elijah, a carpenter who restores historic buildings across New York City and asked that his last name and employer not be published, said the physical strain of construction work bleeds into their day-to-day lives. 

“The struggle of a long day of physical labor doesn’t end when you punch out,” he said. “The commute home, grocery shopping, even cooking dinner become harder tasks, but they still have to get done.”

Early start times and physically demanding schedules, he added, leave many workers chronically exhausted and struggling to recover between shifts. When soreness and fatigue accumulate over consecutive workdays, some workers turn to substances simply to cope.

“People end up relying on coffee, cigarettes, weed or alcohol just to manage the discomfort,” Elijah said.

Unlike unionized sites now incorporating mental health awareness into safety culture, Elijah said his small non-union company offers no formal mental health training or structured support programs.

“Support is informal,” he said. “It’s conversations with coworkers or management. I appreciate that it feels personal and not like someone checking a corporate box – but you have to actively seek it out.”

That difference can leave more vulnerable workers without assistance, he said, particularly those uncomfortable discussing personal struggles openly.

“Someone who doesn’t feel safe bringing it up would have no incentive,” Elijah said. “They’d just struggle quietly.”

Those gaps highlight the growing divide between union and non-union construction environments as unions expand peer counseling and recovery resources.

Unions, city working on issue

In recent years, unions have begun implementing assistance programs designed to connect workers with counseling, addiction services and peer support. McIntire mentioned it is a goal of many construction unions to place trained mental health peers directly on job sites, allowing workers to speak informally with colleagues who understand the strain of their job.

“[The] goal is to have a mental health peer on every job site – someone you can bounce something off of,” McIntire said. “Sometimes it’s something at home, sometimes it’s something on the job. People just need an outlet.”

This approach relies on relationships built through shared experiences rather than formal clinical settings, which can normalize these conversations and encourage workers to seek help earlier.

City officials have also begun addressing the issue.

In Oct. 2023, the Departments of Health and Buildings launched an initiative warning construction workers about overdose risks and distributing information about naloxone, a medication that can reverse opioid overdoses. Agency staff visited jobsites to discuss substance abuse, fentanyl risks and available support services.

Officials described construction sites as critical points of intervention, particularly as fentanyl has been found in 73 percent of overdose deaths citywide, according to a 2024 Department of Health study.

Furthermore, in Dec. 2025, City Council passed a bill, which became law on Jan. 3, expanding site safety training protocols to include mental health and wellness, suicide prevention and substance abuse education. Under the New York City Building Codes, workers were already required to carry SST cards certifying completion of safety courses previously focused on fall protection, ladder safety and fire prevention.

The new requirements add mental health coursework and expand access to naloxone training.

In 2019, construction companies around the country collaborated to institute Construction Suicide Prevention Week. The campaign gained momentum in New York City in 2023 when the Building Trades Employers’ Association and several unions began participating.

The BTEA also backed the legislation that passed the Council last year. The organization's president Elizabeth Crowley told The Chief in 2024 that contractors "know that, at times, their workers are going to need a helping hand.”

'Who doesn't need a little bit of help?'

McIntire said growing participation across unions and employers suggests the message is gaining traction throughout the trades.

The cultural shift, he added, may be as significant as any policy change.

“Now it’s becoming accepted to talk about what’s going on in your mind,” McIntire said. “A problem shared is a problem cut in half right off the bat.”

Labor leaders emphasize that mental health struggles are rarely isolated incidents, affecting crews, families and entire workplaces.

“It’s not more than one step away from somebody,” McIntire said. “If it’s not you, it’s the person right next to you.”

Elijah said he has noticed differences in how workers cope depending on workplace structure. While opioid use certainly exists, he said marijuana is more commonly used among workers trying to manage physical and mental strain without jeopardizing their ability to keep working.

“Weed doesn’t necessarily stop someone from doing their job,” he said. “That makes it easier for people to hide an unhealthy dependence.”

As construction activity continues across the city, unions say the challenge moving forward will be sustaining awareness while ensuring workers feel comfortable accessing support programs already in place – while extending those protections to workers outside union systems.

“Who doesn’t need a little bit of help in this crazy world?” McIntire said. “We’re out there now, the support’s there, and I want everybody to be able to take advantage of it.”