September is National Suicide Prevention Awareness Month and, according to experts, perhaps no field should embrace the call more than construction. According to Centers for Disease Control and Prevention, with 53.2 suicides per 100 thousand workers, construction has among the greatest suicide rate of any industry—a rate that experts say is over four times higher than the national average and five times higher than all other forms of construction-related deaths combined.

Meanwhile, it’s worth noting by door and window companies that among the six major occupational groups with the highest suicide rates are those working in installation, maintenance and repair. The issue is worst among male workers, experts say, as according to Kirk Bol, a vital statistician at Colorado Center for Health and Environmental Data, males are less likely to be diagnosed and treated for mental health problems.

While no impact can be more than the loss of human lives, there are also severe ramifications for the industry, suggests Fatbardhe Maloku, a digital public relations specialist representing Workwear Guru, a site that provides apparel reviews and comparison articles. Workwear Guru commissioned a report, examining why suicide rates are abundantly high among those working in construction industries, including what companies can do to help preserve the mental health and wellbeing of employees.

“The employers with a worker that commits suicide bear a financial debt, covering production disturbance costs, human capital costs, medical costs, administrative costs, and other costs,” Maloku says. Officials for the Centre for Mental Health say 91 million days are lost each year to mental health issues, Maloku points out.

In their research, experts Sally Spencer-Thomas, an international mental health and suicide prevention speaker and author, and Amanda McGough, Ph.D., a licensed psychologist at BASE Cognitive Behavioral, found that among the prevalent factors leading to suicides within the construction industry are high-pressure work environments, work at remote locations, “tough guy” mentalities and industry-wide opioid dependencies. Approximately 26% of overdose and opioid-related deaths came from the construction industry, the report says. A study conducted by Midwest Economic Policy Institute finds that, as a large number of workers take opioid-based painkillers for work-related injuries, a high injury rate places them at risk of dependency and overdose, leaving 15% of workers battling abuse.

According to CDC, other contributing factors within the industry contributing to suicide include low skilled labor, lower education, relatively low socioeconomic status, poor supervision and colleague support, low job control and job insecurity.

“The construction industry knows it has a problem,” Workwear Guru’s report states. “Working in the building and construction trades has become the U.S.’s deadliest occupation. But it isn’t cranes or ladders nor bad backs or broken bones that get construction workers to sign off. They are more likely to die by their own hands rather than be killed in an on-the-job accident.”

So far as what companies can do to help employees, researchers suggest measures that aim to break the taboo associated with expression of depression and suicidal thoughts.

“The culture must create the conditions that foster openness to speak out and up and must equip and empower all employees with the personal skills they need to feel comfortable speaking up or seeking assistance,” says Greg Sizemore, vice president of health, safety, environment and workforce development at Associated Builders and Contractors. One crucial step, Sizemore and other experts suggest, includes establishing Employee Assistance Programs (EAP) to help employees connect with mental health and substance abuse programs. As construction companies value and discuss workplace physical safety, they should follow “the same tenacious attitude in addressing mental health,” Sizemore says.

“The goal of any workplace suicide prevention program should be to increase mental wellness and resiliency and reduce toxic job strain and under-addressed mental health concerns through a focus on upstream, midstream, and downstream approach,” Spencer-Thomas says.

One way for employers to help includes steering employees to prevention resources, such as the National Suicide Prevention Lifeline,  Construction Working Minds, or suicide prevention resources at The Center for Construction Research and Training.

Those who are unsure of how to help can call the National Suicide Prevention Lifeline at 800-273-8255, or by sending the message “TALK” to the Crisis Text Line at 741-741, to get professional advice and next steps.