Episode 5: Build a Caring Culture | Cal Byers Shares Strategies to Approach Employee Substance Abuse with Care

This podcast is sponsored by Dynapac.

Listen to the audio-only version of this podcast on our Suicide Prevention page, and take a moment to sign the Suicide in Construction Awareness Proclamation while you’re there.

Sandy: Welcome to part two of the AsphaltPro magazine podcast miniseries for mental health wellness and suicide prevention. I’m magazine editor Sandy Lender, your host for this miniseries. In this three-part podcast, we’ll explore ideas for incorporating a mental health wellness component into your safety program. 

Sandy: AsphaltPro is honored to expand the conversation around this important topic and to bring Holmes Murphy’s Cal Byers to the podcast for that purpose. Cal Byers has over 30 years of safety, risk management, and insurance experience. He has expertise in a host of emotional intelligence programs such as mental health, suicide prevention, employee well-being, safety culture development, and transformation, wellness program design, implementation and evaluation, Employee Assistance programs, and more. He is the vice president of workforce risk and worker wellbeing at Holmes Murphy and Associates. Let’s get started on our interview.

Sandy: So, let’s begin part two of this three-part podcast talking about how we create a caring culture where we help workers avoid opioid dependency or get away from opioid dependency without taking on financial risk and liability. One of the topics that comes up in the mental health wellness conversation is that of employer responsibility and liability. 

Get Cal’s white paper, Building a Caring Culture: Addressing Mental Health in the Workplace.

Sandy: I’d like to have you walk us through some fact and fiction to hopefully set employers’ minds at ease. We’re wanting to reframe some discussions in work environments. It seems a common theme for HR and management to work alongside employees who are struggling with a mental health issue, and that’s kind of what I’m looking for here. I want to talk about how we reframe some of these discussions and what different employees are allowed to do when reframing these conversations.

Cal: This is what I love, this idea of reframing. I’ve been involved in this topic for many years, as you know, before there was data. So I’m going back post 9/11 but pre-Hurricane Katrina. It was after Hurricane Katrina where I was reframing the idea around workplace mental health and including suicide prevention. I called it the next frontier in safety because there was no standard, there was really no basis for doing it because there really wasn’t data. But we recognized the challenges in industries that were predominantly male-oriented. So construction, mining, extraction, agriculture, forestry, commercial fishing, to name a few. 

Cal: The data we had was from veterans and first responders. And so, I postulated based on my past work in public entities working with police, fire, and emergency medical services post 9/11. They had employee assistance programs, they had chaplains, some had peer support. Construction had none. So when we asked contractors post 9/11 how are their people, we got answers like “we’re fine, we’re tough, we’re construction, don’t baby us.” So I started working on this idea of critical incident response to address the emotional needs of employees in the aftermath of a traumatic injury. And that critical incident response took about seven to 10 years to get to a tipping point because it’s not what we’d always done. [There’s this mentality of] “We gotta get back to work, we don’t want to have workers dwell and think about what has happened, we want them to focus on getting the job done. That would be the best therapy.” And in time, we learned that the better outcomes were teaching people how to take care of themselves after a traumatic experience. So that was positive.

Cal: The second part was that no one wanted responsibility. HR was hearing from legal counsel, “This is a slippery slope, don’t talk about mental health, don’t talk about these tough issues, do drug testing.” But when someone doesn’t pass a drug test, it’s their responsibility. So we would have clear and concise policies. The downside was everyone thought someone else was taking care of the rehabilitation. We kicked a lot of good people to the curb. So when we talked about this idea of caring cultures, it was to have this be the next frontier in safety. There was no standard, but we were going to teach people how to prevent injuries, how to focus on getting people back to work, and reducing stigma, shining light, offering people more support by talking about this. 

Cal: I would say that reframing [this] as the next frontier of safety worked until about 2014 when I went to work for a contractor. And then I reframed it yet again. We were reading a book that I had introduced to the contractor, it was called “Safety 24/7”. It had nothing to do with mental health, it talked about a company’s journey toward exceptional safety performance. And we reframed “Safety 24/7” [to mean], “It’s not enough to get people home safe at the end of a workshift. If we really were going to be effective, we had to focus on getting people back to work safe from home.” So reframing has always been a part of this. That’s what’s powerful, and that became a tipping point much like safety as the next frontier. 

Cal: I would say we learned some things during the pandemic. We were able to educate employers and leaders. Before the pandemic, our industry struggled with mental health, substance misuse, even suicide risk. And the powerful part is, it took the pandemic for us to really address substance misuse. You wrote one of those early articles that both Dr. Sally Spencer-Thomas and I wrote in AsphaltPro back in like 2017. It took us until 2020 before editors would really let us write about substance misuse. So the education now is reframing that addiction isn’t only people making bad lifestyle choices. In part one, we talked about three leading gateways to new persistent opioid use, and if we don’t address those three initial causes, we’re going to have more people with addiction. And so one thing we’re seeing companies do today is put Narcan or a drug called Naloxone on job sites, and many leaders are like, “I can’t believe we’ve gotten to this point, how did it get so bad?” But when you think about the totality of the opioid crisis, in the most recent reporting year, [there were roughly] 48,000 suicides and 108,000 overdose deaths. So this need for reframing is really important. And what I would say is Narcan alone is not enough, just like previously drug testing alone wasn’t enough. 

Cal: We truly need to teach people, we need to share resources for those individuals with a substance use disorder that they can find AA meetings and share literature, normalize the conversation, offer things called recovery first aid training, not waiting for people to put their hand up and come and seek help, but to make it available to everyone. That would destigmatize it. 

Cal: Another thing that I think is really important is teaching people not to wait until someone hits rock bottom. If we wait for people to hit rock bottom, we’re destroying human capital in the process. They’re breaking all their relationships, they’re damaging the potential for salvaging a marriage or keeping shared custody with children, they lose their job, they lose their insurance, the spiral continues. They might lose their home. Those items are called human recovery capital, and you need certain capital to be able to recover from substance use disorder. And if we wait for people to hit rock bottom, they’ve lost everything. And then people who feel helpless often feel hopeless, and when people are concerned that they’re a burden on others, they think about taking their life. 

Cal: So this idea of reframing, there’s a lot that we need to relearn, just like we had to learn on suicide prevention. If you talk about suicide, if you ask someone directly, “Are you considering suicide?” it does not put the idea in their head. Research has shown that. And I want everyone who’s listening to really realize, I learned years ago that there was research that showed a 9-minute scenario from the time someone thinks about an ideation of suicide to when they would make an intentional act. We have 10 minutes for each other to be part of this solution, to stay connected, to offer that person hope, help, and a chance at recovery. It is very powerful in reaching out to that person.

Sandy: When a worker is going through something, even if it’s not obvious yet but you have a suspicion, how can we give leaders the permission to ask a worker what they’re struggling with? How can we give leaders permission to reach out to a worker, an employee, or a colleague?

Cal: Sandy, I believe in leaders at every level. So I think that’s what’s really important, this idea of shared leadership in this regard. You might be talking about formal leaders, not informal leaders. So the formal leaders need to understand, like, this is our responsibility and it is an opportunity to build a tighter relationship with the workforce. The workers today are seeing signs of stress in their families; 65 to 80% of American families are feeling more pressure today than before the pandemic. Stress, anxiety, ideas of burnout, substance misuse increased, obviously grief during the pandemic, more families have increased responsibility for caregiving. Building a caring culture becomes a safety net. It keeps people from slipping through the cracks. So everyone [needs to think], “I have a role to play in worker safety, health, and wellness.”

Cal: Well-being is the intersection between physical and mental health. And if we focus on well-being, I’m going to be there for my employees, we’re going to talk about a caring culture, we’re going to share resources. And the workers will respond if the leader leads. I’ve always believed in the three Vs of leaders: being visible, vocal, and vulnerable. Leaders who are visible and vocal will have an easier time being vulnerable. Vulnerability is sharing our struggles, too. [For example], I use mental health services, I’ve used the employee assistance program and it helped us, or I wish I had used it but I didn’t know about it. 

Cal: When those three Vs are present, employees feel psychologically safe and feel more comfortable that the company authentically cares about them. They’re more likely to have a fourth V emerge, and that is vertical—up and down the organization chart. People start sharing because they know it’s okay to not be okay. The leader that is visible, vocal, and vulnerable is modeling the right type of behavior. And where that psychological safety occurs, other people are going to follow that modeling. People fundamentally seek connection, they want support, and we need to make three aspects of help very pronounced. It’s offering help, it’s accepting help, and it’s seeking help. Those three are different and we need to teach people how to accept help when someone offers. Number two, we need to teach people how to offer help. So that’s using things like wallet cards to teach people 988, the crisis text line, the warning signs of suicide, do role playing, role modeling to teach people how to share that information with their families and their coworkers. Those are some of the examples people can use.

Sandy: So let me ask about the fitness for duty examination. I want to ask when this is allowed, and when this is not allowed. Does the employer have the right to say “I think you’re under the influence of a narcotic and that could put our entire company at risk”? And is there a point at which the employer would be liable for the employee causing an accident while under the influence of an opioid or should that even factor in? Should the employer just be able to walk up to his employee and say, “I believe that you have a substance use disorder. I’m worried about you”?

Cal: As a risk management and safety professional, there’s established protocols. Many companies now are doing drug testing as a standard of business. For 20 consecutive years, Quest Diagnostics, which is a national testing laboratory, has shown positive drug test results have increased. So you are going to be liable as a business for the actions or inactions of your employees, that’s the reality. So being proactive, you want to have pre-placement drug testing, you want to have protocols in place to teach supervisors reasonable suspicion, have post-incident, even return to work, for people who have tested positive who go and get recovery or rehabilitation or just work with a substance abuse professional. 

Cal: It’s hard to say that there’s one pathway [because] there unfortunately are different rules. Marijuana has become legal in more jurisdictions, that should be a separate podcast by itself. That alone, without a legal counsel, wouldn’t even be an appropriate topic. It’d be too hard to keep current on all the state laws. What I said earlier in podcast one, drug testing alone is not enough because there are different gateways to different medications. One thing employers should be aware of is every year the Bureau of Labor Statistics, which is part of OSHA, has an annual census of fatal occupational injuries, and nine years in a row, there’s been an increase in job site-related fatalities due to ingestion of substances. In the most recent reporting period, that was 8% of all job site fatalities. 

Cal: So this is a workplace issue. You cannot bury your head in the sand. It would be hard to confront an employee directly when you have other methods. So it would be hard for me to give one answer, Sandy. A majority of medium and large-sized companies do have comprehensive drug testing programs. The testing results will give you an opportunity. Doing that recovery first aid training is a way for people to seek help. There are programs being built into employee benefits that are helping people find a pathway. The National Safety Council says 19% of construction workers have a substance use disorder. There’s data from Gallup that shows between 25 and 40% of individuals go home from work to a person with addiction. Alcohol-related deaths increased by 25% in the year immediately after the pandemic. So people are increasingly aware that doing nothing isn’t going to solve the problem. 

Cal: So, [let’s talk about] recovery first aid. I was taught that by a gentleman named Hamilton Bon and Rich Jones. They’re with a company called U-Turn Health. I serve on their Advisory Board in an uncompensated role. It was a radical reframing. Instead of saying “Hey, we’ve got the EAP here today, they’re in Jane’s office. If you want to talk to them, go see Jane.” No one does. [With recovery first aid], you offer every employee the opportunity to learn about substance use disorder, substance misuse, treatment options, recovery capital. More people are likely to seek help in that situation than any other way I’ve seen. 

Sandy: It’s been a pleasure talking with Cal today. I hope everyone listening in has picked up something they can use in their companies to expand the conversation around mental health wellness and reducing opioid use in their workforce. I want to encourage you to follow Cal on LinkedIn. You can find the Holmes Murphy and Associates Insurance Brokerage online at www.holmesmurphy.com. If you or a colleague needs immediate help, the Suicide and Crisis Lifeline has licensed counselors standing by at all times to speak with you. Please call or text 988. Thank you for tuning in, and thank you for your willingness to share this podcast and conversation with others.