Towards an Evidence-Based Critical Incidents and Suicides Response Program in Australian Construction

Abstract

Fatal and non-fatal accidents and suicides at work pose a substantial threat to workers’ physical and psychological safety, particularly within the construction industry. Managing these incidents is an essential component of workplace health and safety (WHS). Additionally, a formal program to support workers and provide feedback to improve the existing WHS management system is increasingly important. However, knowledge of the factors contributing to an effective critical incident (CI) or postvention response is limited by the lack of published evidence-based interventions, especially for occupations and industries that are exposed to higher rates of fatal and non-fatal injuries due to accidents and suicides. In addition, broader concerns surrounding the effectiveness of conventional critical incident programs highlight the need to develop innovative and evidence-based critical intervention and postvention responses addressing acute stress symptoms arising from exposure. This research outlines the development of the MATES Respond Training Program, a component of the WHO-endorsed MATES in Construction program, which is a charity charged with the task of improving mental health and suicide prevention in the construction industry in Australia and New Zealand. Development of the MATES Respond Training Program was informed by the following three key sources: a rapid literature review, interviews with 11 workers trained in peer support suicide prevention interventions, and an analysis of site notes on 193 critical incident and postvention construction site attendances by MATES in Construction field officers, case managers and social workers. Insights and recommendations obtained from these sources, along with the resulting program, are discussed in this paper.

1. Introduction

Exposure to fatal and non-fatal accidents and suicides poses a substantial threat to organisations and employees, particularly within construction, where the likelihood of such incidents is greater [1]. Milner et al. (2013) confirm that labourers are at a higher-than-average risk of suicide, but beyond that, many occupational groups have been found to be particularly vulnerable. When accidents and suicides occur within the workplace domain, there are consequences for many people in the workplace [2]. The literature commonly refers to critical incidents as including a range of serious and significant events that (a) occur suddenly or unexpectedly, (b) are beyond the scope of workers’ usual everyday experiences, and (c) have the potential to overwhelm the usually effective coping resources of workers who are directly or indirectly exposed to the event, potentially resulting in significant psychological distress [3,4]. It outlines that these incidents may arise because of many causes, including accidents, injuries, illnesses, and criminal acts against people and/or property, and also because of deaths by suicide and non-fatal suicide attempts [2].

Although fatal accidents and suicides occur infrequently relative to other stressors, acute stressors arising from exposure are prevalent in workplaces throughout the world. Global estimates indicate that 2.78 million work-related fatalities occur each year, with approximately 380,000 of these attributed to workplace accidents. An additional 373 million serious non-fatal workplace accidents, each requiring at least four days of working time lost, are estimated to occur annually [5,6]. In the decade preceding 2023, more than 1850 traumatic injury fatalities occurred in Australia, and approximately 1 in 12 workers (i.e., 1,140,000) made a serious workers’ compensation claim, requiring at least one week of working time lost [7]. Work-related injuries and illnesses have profound economic and human costs. Estimates suggest that the absence of work-related injuries would increase Australia’s economy by AUD 28.6 billion and create an additional 185,000 full-time equivalent jobs [7]. According to the U.S. Bureau of Labor Statistics [8], 2962 work-related fatalities occurring in the United States between 2011 and 2021 were attributed to death by suicide.

In Australia, a meta-analysis of suicide by occupation identified a higher risk of suicide among men with low-level manual skills compared with those in high-skilled non-manual positions [2]. This evidence suggests that workers in industries employing a higher proportion of younger male workers, such as construction, are likely to have greater exposure to workplace incidents involving fatalities and serious injuries related to accidents and suicide than occupations with a more diverse labour profile. The key contribution of this research is detailing the approach taken by MATES in Construction (an industry-led, non-profit organisation focusing on suicide education and prevention within the construction industry) in developing the “MATES Respond Training Program”. This program is a dual approach to the modulation of Critical Incident Stress Management (CISM) with theoretical underpinnings of psychological first aid tailored to the construction industry.

2. Literature Review

2.1. Impact of Fatal and Non-Fatal Accidents and Suicides

Both direct and indirect (or vicarious) exposure to fatal and non-fatal accidents and suicides are acute stressors that rapidly overwhelm an individual’s capacity to cope and have the potential to seriously harm their mental health. These incidents often elicit intense emotional reactions that can be functional when they provide sufficient energy and focus to support an individual’s immediate response to the event [4]. However, extreme and prolonged stress reactions induced by exposure to fatal and non-fatal accidents and suicides can produce significant harm in the form of many acute traumatic stress symptoms, such as intrusion, avoidance, hyperarousal, hypervigilance, and insomnia [9,10]. Recovery, which is individual to each person, may be compromised by the cumulative effects of acute traumatic stress symptoms, exposure to subsequent incidents, and experiencing chronic stressors [4]. Long-term mental health impacts include the development of post-traumatic stress disorder, anxiety, and depression [4].

Exposure to acute work-related stressors, such as fatal and non-fatal accidents and suicides, can also initiate a spiral of poor mental health. According to the Conservation of Resources theory [11], individuals are motivated to obtain and retain valued resources; stress arises because of circumstances resulting in actual or threatened resource loss, or when individuals are prevented from proactively investing resources to cope with future stressors [12]. In relation to traumatic fatal and non-fatal accidents and suicides, the actual or threatened loss is perceived to be sudden, severe, and rapid [13]. Conservation of Resources (COR) theory suggests resource loss has a cumulative effect, referred to as a “loss spiral”, in which an initial loss of resources makes an individual more vulnerable to further resource losses [14]. As such, the adverse effects of exposure to fatal and non-fatal accidents and suicides may be more profound for workers already experiencing stress. Additionally, a worker experiencing threatened or actual resource loss due to exposure to fatal and non-fatal accidents and suicides may be more vulnerable to future acute and chronic work-related stressors, compromising their ability to recover and exacerbating their distress.

Evidence indicates that multiple factors during and after an incident, including trauma severity, lack of social support, and additional chronic stress, have a stronger impact on the development of mental health injuries than pre-incident factors (personal psychiatric history, childhood abuse, and family psychiatric history) [15]. Research shows that social support and active problem-focused coping methods reduce the severity of post-traumatic stress (PTS) and the likelihood of Post-Traumatic Stress Disorder (PTSD) from occurring, while long-term, emotion-focused, and avoidant coping strategies increase PTS and PTSD [4,16]. Withdrawal, avoidance, and denial are all common responses to exposure to fatal and non-fatal accidents and suicides, which can exacerbate rather than improve outcomes. This reality is likely to be more of an issue for suicide-related incidents, which are highly stigmatised topics.

2.2. Organisational Response to Fatal and Non-Fatal Accidents and Suicides

Within an organisational context, losses occur in waves by eroding workers’ overall perceptions of the supportiveness of the organisations’ leadership and culture and making them more vulnerable to chronic work-related stressors in the future. A comprehensive organisational approach for dealing with exposure to fatal and non-fatal accidents and suicides is required, starting with implementing policies, procedures, and psychologically safe leadership teams and cultures that focus on prevention [17]. However, beyond the efforts for prevention, it is important that organisations consider effective responses when exposure to fatal and non-fatal accidents and suicides does arise. While the occurrence of these incidents is somewhat unpredictable, they do occur, and developing effective and timely postvention responses is necessary, particularly for those sectors with a greater risk of exposure to fatal and non-fatal accidents and suicides. In Australia, employers have a regulatory duty to disrupt this cycle as much as possible by mitigating psychosocial hazards in the workplace. There are several interventions an organisation might implement to protect workers from the psychological effects of exposure to fatal and non-fatal accidents and suicides. Many organisations choose to outsource the management of these incidents, opting instead for a third-party response service, such as an employee assistance program (EAP) [18]. EAPs can provide a response service as part of a multicomponent intervention that aims to facilitate proper communication with employees to support professional concerns, personal issues, and counselling [19,20].

Another outsourced intervention is Critical Incident Stress Management (CISM) programs. In contrast to EAPs, CISM programs are offered by practitioners familiar with this model and focus on providing peer-to-peer support to mitigate the effects of exposure to traumatic events [21]. CISM programs offer several components, all focused on providing interventions over the entire temporal span of a CI [22]. However, there is limited evidence of the effectiveness of CISM programs [23]. Thus, it is important to research CISM programs, their development, and their effectiveness. Psychological first aid offers a different clinical response to that of CISM programs. Psychological first aid focuses on individuals within groups impacted by the effects of exposure to incidents [24]. The evolution of responses to trauma has developed further than modulated approaches that incorporate debriefing. Psychological first aid acknowledges individual responses to trauma and grief and does not require group debriefing, particularly where this debriefing may cause psychological harm [25].

2.3. Research Gaps and Aims

Despite the significant human, organisational, and economic impacts associated with work-related response services, evidence on effective organisational responses and interventions is unclear and inconsistent [23,26]. Organisational responses to exposure to fatal and non-fatal accidents and suicides are vital for breaking the cycle of poor worker mental health [27], particularly for industries at greatest risk of exposure to these events, such as construction [23]. Furthermore, as mental health and suicide are highly stigmatised, there is a particularly large gap in the evidence guiding appropriate organisational responses to suicide-related events.

This article seeks to address these important research gaps by providing an analysis of the development of the “MATES Respond Training Program”, which is a dual approach to the modulation of CISM with theoretical underpinnings of psychological first aid tailored to the construction industry and is embedded within the MATES in Construction (hereafter, MATES) program. Established in 2007, MATES is an industry-led, non-profit organisation focusing on suicide education and prevention within the construction industry. MATES offers an integrated industry intervention program that raises awareness of suicide as a preventable problem, builds stronger and more resilient workers, connects workers to the most suitable available help, and supports and partners with researchers to inform industry on best practices [28]. It was created in response to a report on suicide in the Queensland commercial construction industry, which identified higher rates of suicide for males in the industry compared with average rates of male suicide in Australia and 2.38 times higher rates of youth suicide within the industry [29]. The MATES Program Logic includes various short-term, medium-term, and long-term outcomes, including a reduction in psychological distress and suicide in the construction industry in 5–10 years [30].

The development of the MATES Respond Program involved three components. The first component, a rapid review of published peer-reviewed literature on responses to exposure to work-related fatal and non-fatal accidents and suicides, aimed to identify practices across various industries [23]. The second component involved qualitative interviews with key industry members of the construction industry undertaken to explore their experiences with responding to exposure to fatal and non-fatal accidents and suicides and how these experiences could influence future training within the industry [31]. The final component drew on data from 193 formal site notes from MATES staff attending workplace called-in construction workgroups from 2018 to 2023. Each of these three data sources yielded recommendations for developing the MATES Respond Program. In this article, we provide an overview of the MATES context, followed by the key findings from the three data sources (Components 1, 2, and 3) and an outline of the MATES Respond Training Program. Finally, we conclude this article with an overall discussion, avenues for future research, limitations, and conclusions. An overview of the methodology used to develop the MATES Respond Training Program is presented in Figure 1.

2.4. MATES in the Construction Context

The MATES Suicide Prevention Program is internationally recognised, with the World Health Organisation (WHO) acknowledging it as the best practice in workplace suicide prevention in 2021 [32]. From its inception, MATES has provided support to sites and workgroups impacted by fatal and non-fatal workplace accidents or suicides. Practice insight is imparted to WHS professionals and mental health advocates in the industry in relation to key learnings regarding safe and industry-specific practices when responding to a traumatic workplace event. MATES Respond formalises this practice and instils the importance of community development and industry-based capacity to respond to the industry’s challenges.

3. Development of the MATES Respond Training Program: Component 1 and Component 2—Rapid Review and Semi-Structured Interviews

3.1. Component 1: Rapid Review

In 2021, MATES commissioned a rapid review seeking to synthesise critical elements of pre-, during-, and post-incident responses to CIs and suicides in workplace settings. The approach taken for the review is detailed in the publication Effective Elements for Workplace Responses to Critical Incidents and Suicide: A Rapid Review by Pearce et al. (2021) [23]. While six databases were searched, only five studies that met the eligibility criteria were identified, underscoring the limited research on critical incident interventions. Drawing on Haddon’s Matrix as a conceptual framework to capture the elements of interventions across time and function [33], the review provided an overview of exposure to fatal and non-fatal accidents and suicides in various industries and workplace contexts, such as railways, factories, police, and the military. Recurring themes identified across interventions were worker resilience, organisational preparedness, worker support, incident evaluation, organisational response, intra- and extra-organisational facilitation of worker recovery, support for staff in management and leadership roles, and facilitation of return to work.

One notable outcome of the review was a recommendation for active post-event monitoring. Although the WHO advises against using psychological debriefing for those recently exposed to traumatic events to reduce the risk of post-traumatic stress, anxiety, or depressive symptoms [10], the rapid review endorsed a non-specific approach to post-event monitoring with the use of a risk matrix to identify those requiring more intensive support while emphasising its priority [23].

3.2. Component 2: Semi-Structured Interviews

The purpose of the semi-structured interviews was to identify the key elements of the responses to CIs and suicides within a construction setting and understand how these events are experienced by those involved to inform the development of the MATES Respond Training Program. Semi-structured interviews were determined to be the best opportunity to gather sensitive information in a manner that allowed the interviewee the freedom to guide the conversation within their limits of comfort and the framework provided by the interviewer [34].

Some of the findings are published in Maple et al. (2020) [31]. Ethical approval was granted before conducting this research (as described in Maple et al. 2020). Participants were recruited for the interviews via purposive sampling, in which information about the research and invitations to participate were distributed to relevant workplaces facilitated by MATES. Participants were eligible to participate if they were aged 18 years or older, spoke English, had experienced work-related trauma, and had completed MATES suicide prevention and intervention training. Interviews were conducted via telephone or video conferencing and lasted from 30 to 90 min.

Eleven participants who met the recruitment criteria were interviewed. While this number is considered low in some research contexts, it was appropriate for the purpose of the study [35]. Furthermore, Guest et al. (2006) and Townsend (2013) outline the process of reaching saturation in interviews and make the point that when the breadth of the research problem is narrow, and the sample is heterogenous, saturation is likely to be reached very early [36,37]. Both of those factors were the case in our data collection process. Each of the 11 participants had experienced CIs; 7 of these participants had experience with suicide as a CI. Participants represented a variety of job roles, including construction worker, workplace health and safety manager, general foreman, training manager, and project manager.

The interview process began with consistently broad questions relating to work history and the participant’s role. Data collection focussed on questions examining interviewees’ experiences, and while questions were introduced in a similar order, variation occurred if participants spontaneously mentioned relevant issues. The research team engaged in analytical conversations during the analysis process to identify preliminary themes or concepts and discuss relationships among themes. This process formed a version of convergent interviewing; a technique advocated by Jepsen and Rodwell (2008) to improve internal, external, and construct validity of qualitative data collection techniques [38,39]. Interviews were audio recorded and professionally transcribed before content was analysed using NVivo. A two-step coding procedure based on the “inductive analysis” technique was used to analyse the interview data. Consistent with this coding technique, interview transcripts were read and re-read before assigning keywords (categories) to passages of text to facilitate sorting and the identification of higher-order themes. Members of the research team first independently assigned keywords to passages in a sample of data, which were then sorted into overarching themes. Then, independent coding systems and a process of creating, deleting, merging, and dividing resulted in agreement-defined themes.

Noting that there is no standard definition of a CI, the participants were provided with a broad definition of a CI and asked to recall a time they were involved in what they consider a CI response. Further questions relating to the CI response asked the participants to recall whether they or their workmates received support, what type of support was offered, who provided the support, what aspects of the support were helpful, and what aspects could be improved. The participants were also asked to reflect on the impact of the incident on themselves personally, and their workplaces more broadly, and to reflect on whether their workmates coped well or struggled in the aftermath of the response. The interview questions focused on the participants’ experiences of the events, as well as the short-term and long-term responses to the events. The codes and themes drawn from the data followed the temporal sequence of phases depicted in Haddon’s Matrix [23]. The results and discussion of these themes included an overview of the CI and suicide experience, pre-CI factors, factors during the CI, post-CI factors, and overarching principles guiding an organisation’s response to CIs.

Component 2: Findings

Some participants reported being involved in CIs recently, while other CIs had occurred over a decade earlier. The participants unanimously recalled CIs involving serious human-related consequences, such as those resulting in fatalities or permanent disability, but acknowledged that CIs can inflict serious non-human consequences, such as damage to equipment and facilities. Examples of CIs discussed included accident-related deaths (e.g., due to falls and malfunctioning machinery) and sudden deaths relating to pre-existing health issues. Seven of the participants discussed suicide as a specific critical incident they had experienced. Although the participants were not prompted to recall a specific traumatic or significant event, the participants generally referenced events that significantly impacted themselves or their worksites, for which they were required to provide direct care and support to others. From the interview data, we were able to establish clear themes, which are presented, along with relevant quotes, in Table 1, Table 2, Table 3, Table 4, Table 5 and Table 6.

Table 1. Individual factors in the pre-critical incident timeline.

Timeline	Themes	Example Quote
Pre-critical incident factors	Impulsivity/risky behaviour	“You can think back on it from any which angle you want, and the guy wasn’t following the rules, did something stupid and that was an accident, but we all handled it as best we could.” (MIC11)
	Personal stressors	“When a guy loses the job and then things starts falling apart and then that’s, and this is what actually what happened with me, it was when I wasn’t working that I was close to suicide because I’d had a lot of things fall apart in my life … So, I would fall on these really hard times because I used to live it up. I used to go out and drink and all that kind of stuff, spend all my money and then all of a sudden, I’d lose my job on a day’s notice and I’m in a really bad position.” (MIC4)
		“… people who might suicide in construction, I think they already have a pre-existing condition not being able to deal with stress or high levels of stress or whatever that is. A common cause that I’ve seen in suicidal or people who go downhill, have been substance abuse, whether that’s party drugs and/or alcohol. Now, that is not the sole reason, but that’s been a very major contributor, and the four people been close to me who have suicided, the party drugs and alcohol have been heavily involved.” (MIC3)

Table 1. Individual factors in the pre-critical incident timeline.

Timeline	Themes	Example Quote
Pre-critical incident factors	Impulsivity/risky behaviour	“You can think back on it from any which angle you want, and the guy wasn’t following the rules, did something stupid and that was an accident, but we all handled it as best we could.” (MIC11)
	Personal stressors	“When a guy loses the job and then things starts falling apart and then that’s, and this is what actually what happened with me, it was when I wasn’t working that I was close to suicide because I’d had a lot of things fall apart in my life … So, I would fall on these really hard times because I used to live it up. I used to go out and drink and all that kind of stuff, spend all my money and then all of a sudden, I’d lose my job on a day’s notice and I’m in a really bad position.” (MIC4)
		“… people who might suicide in construction, I think they already have a pre-existing condition not being able to deal with stress or high levels of stress or whatever that is. A common cause that I’ve seen in suicidal or people who go downhill, have been substance abuse, whether that’s party drugs and/or alcohol. Now, that is not the sole reason, but that’s been a very major contributor, and the four people been close to me who have suicided, the party drugs and alcohol have been heavily involved.” (MIC3)

• Factors Prior to the CI

Much of the narrative regarding pre-event factors focused on individual worker characteristics, behaviours, and circumstances, which we labelled “impulsivity/risky behaviour”. For instance, human factors considered to precipitate a CI included impulsivity from young men, attention-seeking from colleagues and social media, and limited opportunity to reflect on a worker’s increasingly erratic behaviour. There were additional human-related factors recollected in the lead-up to a CI, including issues surrounding individual workers, such as relationship breakdowns, financial stress, mental health history, substance abuse, fatigue, and work–life balance, which we labelled “personal stressors”.

While there was a focus on the individual worker, there was also recognition of the influence of the context in shaping behaviours and the subsequent need for workplaces to assess the risk on site continually, reinforce the need to respect the level of risk involved, and consider the role of cultural norms in influencing risk behaviour. Additionally, the need to conduct training and rehearsals to develop processes and skills to respond effectively when CIs occur without warning was highlighted (Theme 2, “preparedness for CI response”). Importantly, although training to be prepared for future CIs matters, equally as important, according to our data, is the theme that the organisation must make sure that “training and policies for safe machine use” was a priority.

Table 2. Team and organisational cultural factors in the pre-critical incident timeline.

Timeline	Themes	Example Quote
Pre-critical incident factors	Training and policies for safe machine use	“…critical incidents is an area where you can never probably plan enough… you may only use it once every few years, but when you do kick in the more you plan for it the more you understand it, the better the outcome.” (MIC1)
		“… no matter how messed up or how ugly it is, you know if you can massage the heart and if you can put breath in the body you can sustain life… the ambos said oh, mate we’ll take over from here… and with all their gear and stuff, and they had a look at the wounds and mate they put a sheet on him within, I wouldn’t have thought more than 10 s, 15 s… I was indirectly involved, I suppose, in an incident that resulted in a very serious injury to a guy. He got backed over by a piece of machinery. We weren’t all trained in how to deal with it. There was no incident investigation. He just got struck by a piece of machinery, but now, we ask a lot more questions of people and therefore, we know a lot more about our fellow workers and co-workers. A lot of that’s good, but I think a lot of that we have to be very gentle with it.” (MIC5)
		“Technical training in the construction industry is very, very good where you train to look at all the technical aspects of how something works or how it’s stopped working or risk management processes, but when it comes to human element, there should be some training structure in human element.” (MIC5)
	Preparedness for CI response	“… it’s one thing to have like a crisis centre set up at a corporate level, but at the remote level beyond head office it’s almost a separate team and response that could, certainly from my business we do need improvement.” (MIC1)
		“I’ve done a lot of safety in my life. I’m qualified in ICAMs and investigations and incident causation, but I’m not really trained in what to do afterwards… look, they might mention it. It might be something that’s mentioned, it’s briefly discussed, but really it all focuses on why the incident happened and what was the events leading up to it?” (MIC4)

Table 2. Team and organisational cultural factors in the pre-critical incident timeline.

Timeline	Themes	Example Quote
Pre-critical incident factors	Training and policies for safe machine use	“…critical incidents is an area where you can never probably plan enough… you may only use it once every few years, but when you do kick in the more you plan for it the more you understand it, the better the outcome.” (MIC1)
		“… no matter how messed up or how ugly it is, you know if you can massage the heart and if you can put breath in the body you can sustain life… the ambos said oh, mate we’ll take over from here… and with all their gear and stuff, and they had a look at the wounds and mate they put a sheet on him within, I wouldn’t have thought more than 10 s, 15 s… I was indirectly involved, I suppose, in an incident that resulted in a very serious injury to a guy. He got backed over by a piece of machinery. We weren’t all trained in how to deal with it. There was no incident investigation. He just got struck by a piece of machinery, but now, we ask a lot more questions of people and therefore, we know a lot more about our fellow workers and co-workers. A lot of that’s good, but I think a lot of that we have to be very gentle with it.” (MIC5)
		“Technical training in the construction industry is very, very good where you train to look at all the technical aspects of how something works or how it’s stopped working or risk management processes, but when it comes to human element, there should be some training structure in human element.” (MIC5)
	Preparedness for CI response	“… it’s one thing to have like a crisis centre set up at a corporate level, but at the remote level beyond head office it’s almost a separate team and response that could, certainly from my business we do need improvement.” (MIC1)
		“I’ve done a lot of safety in my life. I’m qualified in ICAMs and investigations and incident causation, but I’m not really trained in what to do afterwards… look, they might mention it. It might be something that’s mentioned, it’s briefly discussed, but really it all focuses on why the incident happened and what was the events leading up to it?” (MIC4)

• Factors During the CI

The way participants reported experiencing the event and its immediate aftermath, and the roles they themselves undertook during the event, demonstrate the ways in which immediate responses can influence the long-term impacts of the event for the workers and their workplaces. Many of the participants indicated they held critical response roles in relation to the CIs they described. Some participants were present on site when the CI occurred, while others arrived within a few hours of the event. Those who were off site were generally made aware of the event via a phone call and then were required to travel to the site and navigate the emergency response. Participants could recall these events clearly because of the heightened physiological response to the situation that propelled them into action. The initial critical response required when attending an incident, including ensuring policy and procedures are followed, made it difficult to pause and process what psychological trauma was occurring. In this way, the emergent theme of “narrow focus (autopilot)” became clear as the participants discussed how they managed the intersection between the practical and emotional needs of themselves and others by focusing on the critical practical needs of the situation and shutting down emotional needs. When recalling an event, one participant described feeling both “numb” and “hypervigilant” when explaining their experience of heightened physical arousal.

Table 3. Individual factors in the critical incident timeline.

Timeline	Themes	Example Quote
Factors during the event	Narrow focus (auto-pilot)	“It’s really challenging… but… you go into autopilot… and literally you’re breaking down, unfortunately, it probably starts off a bit unemotional… where you’re actually just going in very direct conversations with people: do this, I need that sorted, get the lawyers here, notify the unions, notify the regulators, and you go into autopilot mode of response… That, I find, takes probably an hour to get initial responses up and running, in which case your brain then flicks into standing back away from everything and stepping away from the direct mode into bringing the emotional capacity now of how is everybody doing, and the welfare is now forefront of my mind.” (MIC1)
	Role conflict	“I can see as clearly as I’m looking at you now, workers running, just running and screaming, you better get up there… you know. I see this avalanche of people running away and in that time you’re sort of like thinking oh well that’s not going to be real pretty by the time you get up there but how bad can it be? Well it was fairly ordinary. But after that, you know you’ll be concentrating on your job and you know there was stuff that was happening around me at that particular time, which was like, I should never have put myself in that situation. The load wasn’t secured still, it was whipping around like a snake’s tongue, and there’s like 8 or 10 tonnes laying over your head while you’re trying to drag this body out to actually perform CPR.” (MIC12)
	Provide referrals	“In terms of how I reacted, it was personally get the workforce together, announce what has occurred in as plain language and directly as possible, here’s the support available to you, but go home and be with your loved ones essentially.” (MIC1)
		“He did say, ‘hey, look we have counsellors available, these are their numbers’, kind of thing.” (MIC4)

Table 3. Individual factors in the critical incident timeline.

Timeline	Themes	Example Quote
Factors during the event	Narrow focus (auto-pilot)	“It’s really challenging… but… you go into autopilot… and literally you’re breaking down, unfortunately, it probably starts off a bit unemotional… where you’re actually just going in very direct conversations with people: do this, I need that sorted, get the lawyers here, notify the unions, notify the regulators, and you go into autopilot mode of response… That, I find, takes probably an hour to get initial responses up and running, in which case your brain then flicks into standing back away from everything and stepping away from the direct mode into bringing the emotional capacity now of how is everybody doing, and the welfare is now forefront of my mind.” (MIC1)
	Role conflict	“I can see as clearly as I’m looking at you now, workers running, just running and screaming, you better get up there… you know. I see this avalanche of people running away and in that time you’re sort of like thinking oh well that’s not going to be real pretty by the time you get up there but how bad can it be? Well it was fairly ordinary. But after that, you know you’ll be concentrating on your job and you know there was stuff that was happening around me at that particular time, which was like, I should never have put myself in that situation. The load wasn’t secured still, it was whipping around like a snake’s tongue, and there’s like 8 or 10 tonnes laying over your head while you’re trying to drag this body out to actually perform CPR.” (MIC12)
	Provide referrals	“In terms of how I reacted, it was personally get the workforce together, announce what has occurred in as plain language and directly as possible, here’s the support available to you, but go home and be with your loved ones essentially.” (MIC1)
		“He did say, ‘hey, look we have counsellors available, these are their numbers’, kind of thing.” (MIC4)

“Role conflict” became a theme where the tension between practical and emotional needs was revealed as the participants spoke about how they managed the competing needs of securing a site, engaging with the investigative response, and supporting as many people as possible. The participants spoke about the tension between the practicalities of the immediate response and the emotional needs of workers in contexts that are often chaotic, suggesting that responding to the moment of crisis needs to be instinctive but must also consider the physical and psychological safety of all workers, including managers and first responders when securing the site. Related to this tension between practicalities and emotional needs, the participants spoke of the need to be wary of dealing with the immediate needs at the time, not assessing what caused the event, nor what will be needed to prevent the event from occurring again in the future.

The participants noted that all people on site were affected, although there were varying degrees to which individuals were impacted; thus, the support provided must be individually based and driven by the needs of employees. Furthermore, it was recognised that it is unlikely that any response during the event will sufficiently deal with all workers’ needs, and additional onsite and off-site support is likely needed, including our third theme, “providing referrals”. One complication associated with this need for individualised support is that it relies on understanding the workers themselves, which is challenging because of the aspects of construction work. For instance, a clear tension in the interviews was the casualisation of the workforce, with managers not knowing their workers to the same depth as they may have in the past. Also, many workers operating across multiple sites or on rosters results in a network of connected people. Thus, when an event occurs on one site, it is likely to have an impact on workers across multiple sites, requiring a response across several sites.

When considering themes related to the team or organisational culture, some participants discussed the disconnect they experienced between what they had been taught in response training and the reality of the event. This “uncertainty (training–reality gaps)” means that given that the seriousness of the events experienced by the participants could be graphic, confronting, and leave lasting images, the need for training to provide realistic preparation for responses was raised as vitally important. A related point is the gap between the reality of the event and the fundamental assumption most workers hold, being the expectation of going to work and returning home safely, which can impact workers’ sense of reality when experiencing the event.

Table 4. Team and organisational cultural factors during the critical incident timeline.

Timeline	Themes	Example Quote
Factors during the event	Emotional demands	“I guess a lot of people ring me going, ‘are you all right?’ but I’d say once again, I wasn’t worried about me, I put me in the background and I was just worried about the individuals that were there and made sure everyone else was okay and did the whole site thing and meeting and do that. I haven’t really dealt with it in that sense.” (MIC9)
		“You wouldn’t go on the cusp of how it’s happened at that point in time because it’s only just happened. You’re more looking at the welfare of the individuals that are on the job at the time, making sure they’re okay.” (MIC9)
	Uncertainty (training-reality gaps)	“The guy was a mate of mine and I was the first aider, so I was actually there trying to save his life, which was quite impossible, but I didn’t know that at the time … it goes back to your foundations of training that you learn… and then you know when the ambos got there and with all their gear and stuff, and they had a look at the wounds and mate they put a sheet on him within, I wouldn’t have thought more than 10 s, 15 s.” (MIC12)

Table 4. Team and organisational cultural factors during the critical incident timeline.

Timeline	Themes	Example Quote
Factors during the event	Emotional demands	“I guess a lot of people ring me going, ‘are you all right?’ but I’d say once again, I wasn’t worried about me, I put me in the background and I was just worried about the individuals that were there and made sure everyone else was okay and did the whole site thing and meeting and do that. I haven’t really dealt with it in that sense.” (MIC9)
		“You wouldn’t go on the cusp of how it’s happened at that point in time because it’s only just happened. You’re more looking at the welfare of the individuals that are on the job at the time, making sure they’re okay.” (MIC9)
	Uncertainty (training-reality gaps)	“The guy was a mate of mine and I was the first aider, so I was actually there trying to save his life, which was quite impossible, but I didn’t know that at the time … it goes back to your foundations of training that you learn… and then you know when the ambos got there and with all their gear and stuff, and they had a look at the wounds and mate they put a sheet on him within, I wouldn’t have thought more than 10 s, 15 s.” (MIC12)

• Factors Following the CI

A clear theme that emerged from the data is the potential for events to have long-lasting impacts on workers, meaning that ongoing trauma is a serious concern, thus highlighting the need for support options that focus on the potential long-term impacts of a CI experience. Several participants suggested that post-event support appeared to be time-limited or insufficiently prioritised in comparison with the need to return to “business as usual”.

These quotes illustrate that support options may appear time-limited, particularly when there is a perceived pressure to return to business as usual. Although the participants expressed an understanding amongst workers of the financial imperative to return to work, the sense that the job was more important than the lives lost, or the injuries endured, impacted workers’ ongoing experiences of the event. Related to this point is when there is a perception of greater value placed on learning from the incident to prevent further damage to machinery and equipment rather than emphasising the human-related impacts of the event. Although uncommon, when it occurred, the participants noted that being reminded that people were more valuable than equipment allowed for a more supportive environment for discussing the incident.

Table 5. Individual factors in the post-critical incident timeline.

Timeline	Themes	Example Quote
Factors following the critical incident	Emotional surge	“I felt shitty for a while. I felt really bad for the guy’s family, I felt really bad for some of his close workmates so yes, there was a definite effect for a period of time, yes.” (MIC10)
		“This dread sort of like hits you and all this what else could you have done hits you, you know, you’re talking about all the things you should be doing, could’ve done, and it floods you. It’s really fucking overwhelming.” (MIC12)
	Continuation of heightened emotional response	“… the whole philosophy that Mates in Construction… use [is] looking out for your mates and that kind of thing but when you [are] busy that tends to fall away and no one on a construction site’s primary role is as the site psychologist… (but) this particular incident was that it brought back memories and things for other people of… other trauma that they’ve had in their life” (MIC10)
		“It was probably that night when I was down there in the room on my own, stepping back feeling really drained, because it obviously ends up being a big day, really emotionally drained… I probably… it hit home firstly there. Secondly probably two to three weeks later, when a lot of the operational elements are done, the emotion floods through and it’s almost you’re starting to really process what has occurred, in an emotive way, the adrenaline is wearing off, and you’re now actually thinking about everything you’ve had to deal with, what you’ve seen, what you’ve done.” (MIC1)
	Empowering individual support decision	“Training and resources that provide multiple opportunities for engagement—peer to peer support, team support, EAP and MIC all working together to acknowledge the needs of people.” (MIC3)
		“It’s a tough one ‘cause from my experience it’s really hard, I’m trying to have some engaging and deep conversations with men on the jobsite and there are a lot of walls. So, if someone isn’t processing something like that very well, to give them the space to talk and open up.” (MIC4)
		“I remember [NAME] taking me home, taking me back to his place and we had a couple of beers. We didn’t talk about the incident, didn’t talk about it. He was just with me, he just stayed with me and he phoned my wife and let [NAME] know that [NAME] has been involved in a very nasty incident, he’s okay but you know he’s the guy that was trying to preserve life, so you know he’s going to be a bit upset or agitated or whatever happens during that time. But I never was, I was more, you just keep flicking over in your head what else could you have done, what else, what else, what else?” (MIC12)
	Preoccupation with assigning responsibility	“… You just keep flicking over in your head what else could you have done, what else, what else, what else?” (MIC12)
		“… then we got a bit of blame for moving him onto a roster and FIFO at his request. One of his mates said, ‘If he stayed up here, I could have looked after him’. So, yeah, you sometimes second guess or doubt yourself, did we do the right thing or not.” (MIC3)
		“By the time I got down those conversations had been had, but it was all with our management team and our supervisory staff where again we facilitated a similar discussion just… with our team… Because obviously they’re going through some trauma themselves, because they feel they’ve contributed one way or another indirectly.” (MIC1)

Table 5. Individual factors in the post-critical incident timeline.

Timeline	Themes	Example Quote
Factors following the critical incident	Emotional surge	“I felt shitty for a while. I felt really bad for the guy’s family, I felt really bad for some of his close workmates so yes, there was a definite effect for a period of time, yes.” (MIC10)
		“This dread sort of like hits you and all this what else could you have done hits you, you know, you’re talking about all the things you should be doing, could’ve done, and it floods you. It’s really fucking overwhelming.” (MIC12)
	Continuation of heightened emotional response	“… the whole philosophy that Mates in Construction… use [is] looking out for your mates and that kind of thing but when you [are] busy that tends to fall away and no one on a construction site’s primary role is as the site psychologist… (but) this particular incident was that it brought back memories and things for other people of… other trauma that they’ve had in their life” (MIC10)
		“It was probably that night when I was down there in the room on my own, stepping back feeling really drained, because it obviously ends up being a big day, really emotionally drained… I probably… it hit home firstly there. Secondly probably two to three weeks later, when a lot of the operational elements are done, the emotion floods through and it’s almost you’re starting to really process what has occurred, in an emotive way, the adrenaline is wearing off, and you’re now actually thinking about everything you’ve had to deal with, what you’ve seen, what you’ve done.” (MIC1)
	Empowering individual support decision	“Training and resources that provide multiple opportunities for engagement—peer to peer support, team support, EAP and MIC all working together to acknowledge the needs of people.” (MIC3)
		“It’s a tough one ‘cause from my experience it’s really hard, I’m trying to have some engaging and deep conversations with men on the jobsite and there are a lot of walls. So, if someone isn’t processing something like that very well, to give them the space to talk and open up.” (MIC4)
		“I remember [NAME] taking me home, taking me back to his place and we had a couple of beers. We didn’t talk about the incident, didn’t talk about it. He was just with me, he just stayed with me and he phoned my wife and let [NAME] know that [NAME] has been involved in a very nasty incident, he’s okay but you know he’s the guy that was trying to preserve life, so you know he’s going to be a bit upset or agitated or whatever happens during that time. But I never was, I was more, you just keep flicking over in your head what else could you have done, what else, what else, what else?” (MIC12)
	Preoccupation with assigning responsibility	“… You just keep flicking over in your head what else could you have done, what else, what else, what else?” (MIC12)
		“… then we got a bit of blame for moving him onto a roster and FIFO at his request. One of his mates said, ‘If he stayed up here, I could have looked after him’. So, yeah, you sometimes second guess or doubt yourself, did we do the right thing or not.” (MIC3)
		“By the time I got down those conversations had been had, but it was all with our management team and our supervisory staff where again we facilitated a similar discussion just… with our team… Because obviously they’re going through some trauma themselves, because they feel they’ve contributed one way or another indirectly.” (MIC1)

Similarly, the participants spoke about how the emotional impact or significance of an event can be undermined by information-gathering activities perceived to be focused on assigning blame for the incident. The participants reported that discussions about what had occurred and who or what was to blame often happened after an event. The insinuation of blame and questioning from others produced a sense of exhaustion, failure, and self-doubt at the individual level and a corrosive culture of a “preoccupation with assigning responsibility” at a team and/or organizational level.

The design of jobs, roster, and organisational culture can also limit access to support options for employees exposed to CIs. For example, access to appropriate support at times they are available was important in an industry that works beyond the general 9 to 5 workday. The participants suggested that to allow people the capacity to recover, they need to be able to access services within usual work hours, even when this means taking time out from their onsite work. These points illustrate ways in which the work environment influences workers’ ongoing experiences of the event itself and their capacities to recover and access ongoing support.

Table 6. Team and organisational cultural factors in the post-critical incident timeline.

Timeline	Themes	Example Quote
Factors following the critical incident	Close knowledge gaps (training)	“I would love to see MATES in the future working in that, like having another safety net or a support for those people who have lost their job and just checking in with them and helping them cause I think that’s a real, it’s a red zone. It’s a real slippery area where lives, if they fall into that and then drugs and alcohol or whatever, and a fight with the missus and it can really take off from there.” (MIC4)
		“I actually got the defibrillator out after this event and actually showed all the staff how to use it because it was a bit of a complicated process with somebody talking in a, I think it was probably in America or maybe a similar accent to your own, so that actual, in relation to this specific critical incident the equipment used, i.e., the defibrillator, the application of the defibrillator definitely could have been more widely understood throughout the site.” (MIC10)
		“Anybody in a managerial role, because we deal with humans all the time, one of the things that we should understand is the basic elements of human behaviour, whether that be understanding body language or understanding how we present ourselves or how we should approach people. There could be training in that area.” (MIC5)
	Time limited support	“ … it was like, ‘well, you guys, you know, we still need to pull this thing tomorrow so we’re got to get moving boys kind of thing’. So, it was definitely more so the, like well what I felt was that the job was more important than these lives.” (MIC4)
		Interviewer: “So do you think there were people there that may have needed that extra support but didn’t really get it or put their hand up?” MIC10: “Yes, I’d say there probably were, yes.”
	Return to work pressures	“… the focus was, okay, yes, this bad thing happened but, I always hate when someone says but because it really just means that they’re kind of saying, let’s get back to work.” (MIC4)
		“We had the union come out and it might have been like we got together in the smoko shed and it might have been like a 5 or 10 min talk and then basically, cause it wasn’t in my direct area, it wasn’t in our direct crew, it was like, ‘well, you guys, you know, we still need to pull this thing tomorrow so we’re got to get moving boys kind of thing’. So, it was definitely more so the, like well what I felt was that the job was more important than these lives.” (MIC4)
	Preoccupation with assigning responsibility	“Some people don’t want to be followed up, like I know some people were just like, yes, it’s happened, done, okay, let’s move on and scratching the scab for them was maybe quite painful and maybe not really wanting to go back over it. I for one didn’t want to continually go back over it, I got sick of answering questions about it from management whereas some people would have talked about it every day of the week… So, every different level of management wanted to hear the full story, wanted to know how you felt, blah blah, yes.” (MIC10)
		“Nowadays, every time there’s a near miss or there’s an incident, there’s a need to understand what happened and you can’t really understand what happened unless you start asking questions and sometimes, I even find that asking questions can be traumatic to people. The whole thing surrounding incidents and, as I said, they don’t have to be serious incidents, it’s depending on the situation, near miss or minor incident, is becoming a very, very delicate subject.” (MIC4)
	Barriers to seeking help (stigma, work hours)	“Going back some years ago, people were more linear, I suppose. They either said, ‘Yes, I want some help’ or ‘No’ they didn’t and if they didn’t want help, are probably okay. If they wanted help, they wanted help. But nowadays, I think, there’s a lot more forces at play in the every day of people now. It’s a lot more complicated.” (MIC5)
	Support may be time-limited and not sufficient for the ongoing trauma experienced by workers	“I had a number of people associated with the business reach out to me personally going, how you doing?… There was initial on the day and the next day, really quick, hey, I understand what you’re dealing with, let me know if I can help in any way… But within two weeks that pretty much disappeared, and it was more, what’s happening with the investigation, what can we learn from it, that was more where the questions turned to.” (MIC1)
		“I didn’t use the EAP support and I’m not, I think the people who used it were a little bit, I’m not sure about was that good or not. I don’t believe that there was too much follow-up so I think the support that was offered and the support was provided varied in its effectiveness.” (MIC10)
	Perceived pressure to return to work	“You didn’t really have time to dwell on anything. It’s an issue. It happened. Close it out. Move on. So, you don’t have time to dwell on critical incidents, if you want to call them that.” (MIC3)
	Culture affects recovery and people seeking help	“If [support] was there and it was during worktime because you’ve just gone through a fatality or something, I reckon people would have more interest in it because I guess in—I’ll say using my own brain, but I’ve just gone to a traumatic event that’s a part of my job, I then am going to now take time off out of my time, I’m not going to get paid, so I never did it. I just went there and did what I had to do as what I was employed to do. Now I’m going to suffer the consequences. I’m going to lose out on something I had nothing to do with. Whereas if you turn that around and go we’ll pay you and you find them and we’ll pay you to go there and it’s half day on a Friday.” (MIC9)
		“… to take time out, or expect someone to make a proactive appointment with their GP (General Practitioner), was not always part of the culture.” (MIC6)
		“I think for any high stress level job it should be mandatory to go see whether they pay for a psychologist twice a year or a psychiatrist or whatever you need to see or just a counsellor, that should be mandatory because at the end of the day, if you don’t want to do something, and it has proved back that if you don’t want to do it you’ll find any excuse under the sun not to do it.” (MIC9)
	Ongoing support varies on an individual basis	“Maybe the theoretical answer goes back to which box everybody sits in psychologically and how they’re wired and how they deal with stress. I think that the people who were closely involved in this, well the guy that was most closely involved in the incident, the first guy that did CPR, the first responder, our project safety officer, he seemed to deal with it the best and didn’t want any EAP assistance and we have a quick chat about it but he was an older guy and he just moved on with what he needed to do. Whereas other guys that were in the second responder or helped out a little bit later on category, they were the guys that had other issues that doubled up in their lived about their parents and whatever else came out in the slightly longer term. I think if your personal life, home life, wife, kids, partners, dog, if everything is going well in your life, it’s quite, it’s easier to process and event like this and from personal experience if all that other stuff’s, even in the absence of a critical incident like this, if the other stuff in your life, if you’ve got a couple issues going on the background, then it’s much harder to focus and an incident like this probably does make you think its all doom and gloom possible.” (MIC10)
	Focus on people over equipment	“[the Managing Director passed on this message]: ‘We can get another truck, we can’t get another you. Don’t dwell on it. We’ll look after you.’ That’s about all it took, but those sort of situations are rare.” (MIC9)

Table 6. Team and organisational cultural factors in the post-critical incident timeline.

Timeline	Themes	Example Quote
Factors following the critical incident	Close knowledge gaps (training)	“I would love to see MATES in the future working in that, like having another safety net or a support for those people who have lost their job and just checking in with them and helping them cause I think that’s a real, it’s a red zone. It’s a real slippery area where lives, if they fall into that and then drugs and alcohol or whatever, and a fight with the missus and it can really take off from there.” (MIC4)
		“I actually got the defibrillator out after this event and actually showed all the staff how to use it because it was a bit of a complicated process with somebody talking in a, I think it was probably in America or maybe a similar accent to your own, so that actual, in relation to this specific critical incident the equipment used, i.e., the defibrillator, the application of the defibrillator definitely could have been more widely understood throughout the site.” (MIC10)
		“Anybody in a managerial role, because we deal with humans all the time, one of the things that we should understand is the basic elements of human behaviour, whether that be understanding body language or understanding how we present ourselves or how we should approach people. There could be training in that area.” (MIC5)
	Time limited support	“ … it was like, ‘well, you guys, you know, we still need to pull this thing tomorrow so we’re got to get moving boys kind of thing’. So, it was definitely more so the, like well what I felt was that the job was more important than these lives.” (MIC4)
		Interviewer: “So do you think there were people there that may have needed that extra support but didn’t really get it or put their hand up?” MIC10: “Yes, I’d say there probably were, yes.”
	Return to work pressures	“… the focus was, okay, yes, this bad thing happened but, I always hate when someone says but because it really just means that they’re kind of saying, let’s get back to work.” (MIC4)
		“We had the union come out and it might have been like we got together in the smoko shed and it might have been like a 5 or 10 min talk and then basically, cause it wasn’t in my direct area, it wasn’t in our direct crew, it was like, ‘well, you guys, you know, we still need to pull this thing tomorrow so we’re got to get moving boys kind of thing’. So, it was definitely more so the, like well what I felt was that the job was more important than these lives.” (MIC4)
	Preoccupation with assigning responsibility	“Some people don’t want to be followed up, like I know some people were just like, yes, it’s happened, done, okay, let’s move on and scratching the scab for them was maybe quite painful and maybe not really wanting to go back over it. I for one didn’t want to continually go back over it, I got sick of answering questions about it from management whereas some people would have talked about it every day of the week… So, every different level of management wanted to hear the full story, wanted to know how you felt, blah blah, yes.” (MIC10)
		“Nowadays, every time there’s a near miss or there’s an incident, there’s a need to understand what happened and you can’t really understand what happened unless you start asking questions and sometimes, I even find that asking questions can be traumatic to people. The whole thing surrounding incidents and, as I said, they don’t have to be serious incidents, it’s depending on the situation, near miss or minor incident, is becoming a very, very delicate subject.” (MIC4)
	Barriers to seeking help (stigma, work hours)	“Going back some years ago, people were more linear, I suppose. They either said, ‘Yes, I want some help’ or ‘No’ they didn’t and if they didn’t want help, are probably okay. If they wanted help, they wanted help. But nowadays, I think, there’s a lot more forces at play in the every day of people now. It’s a lot more complicated.” (MIC5)
	Support may be time-limited and not sufficient for the ongoing trauma experienced by workers	“I had a number of people associated with the business reach out to me personally going, how you doing?… There was initial on the day and the next day, really quick, hey, I understand what you’re dealing with, let me know if I can help in any way… But within two weeks that pretty much disappeared, and it was more, what’s happening with the investigation, what can we learn from it, that was more where the questions turned to.” (MIC1)
		“I didn’t use the EAP support and I’m not, I think the people who used it were a little bit, I’m not sure about was that good or not. I don’t believe that there was too much follow-up so I think the support that was offered and the support was provided varied in its effectiveness.” (MIC10)
	Perceived pressure to return to work	“You didn’t really have time to dwell on anything. It’s an issue. It happened. Close it out. Move on. So, you don’t have time to dwell on critical incidents, if you want to call them that.” (MIC3)
	Culture affects recovery and people seeking help	“If [support] was there and it was during worktime because you’ve just gone through a fatality or something, I reckon people would have more interest in it because I guess in—I’ll say using my own brain, but I’ve just gone to a traumatic event that’s a part of my job, I then am going to now take time off out of my time, I’m not going to get paid, so I never did it. I just went there and did what I had to do as what I was employed to do. Now I’m going to suffer the consequences. I’m going to lose out on something I had nothing to do with. Whereas if you turn that around and go we’ll pay you and you find them and we’ll pay you to go there and it’s half day on a Friday.” (MIC9)
		“… to take time out, or expect someone to make a proactive appointment with their GP (General Practitioner), was not always part of the culture.” (MIC6)
		“I think for any high stress level job it should be mandatory to go see whether they pay for a psychologist twice a year or a psychiatrist or whatever you need to see or just a counsellor, that should be mandatory because at the end of the day, if you don’t want to do something, and it has proved back that if you don’t want to do it you’ll find any excuse under the sun not to do it.” (MIC9)
	Ongoing support varies on an individual basis	“Maybe the theoretical answer goes back to which box everybody sits in psychologically and how they’re wired and how they deal with stress. I think that the people who were closely involved in this, well the guy that was most closely involved in the incident, the first guy that did CPR, the first responder, our project safety officer, he seemed to deal with it the best and didn’t want any EAP assistance and we have a quick chat about it but he was an older guy and he just moved on with what he needed to do. Whereas other guys that were in the second responder or helped out a little bit later on category, they were the guys that had other issues that doubled up in their lived about their parents and whatever else came out in the slightly longer term. I think if your personal life, home life, wife, kids, partners, dog, if everything is going well in your life, it’s quite, it’s easier to process and event like this and from personal experience if all that other stuff’s, even in the absence of a critical incident like this, if the other stuff in your life, if you’ve got a couple issues going on the background, then it’s much harder to focus and an incident like this probably does make you think its all doom and gloom possible.” (MIC10)
	Focus on people over equipment	“[the Managing Director passed on this message]: ‘We can get another truck, we can’t get another you. Don’t dwell on it. We’ll look after you.’ That’s about all it took, but those sort of situations are rare.” (MIC9)

Support options should recognise that living through and responding to events will have different meanings and varying levels of significance for workers depending on their own history of mental health and trauma, current personal circumstances, and existing support networks, and while services, such as EAPs, were viewed as being person-centred, they were not uniformly suitable for all people. The participants noted that individuals should not be required to access a particular form of support; rather, individuals need to be given space to talk and open up. Peer-based support that is simultaneously directive and supportive, driven by the individuals themselves, allows the incident and its impact to be acknowledged while also allowing individuals to express their needs in a safe environment.

• Suicide-Specific Data

As reported earlier, although all the participants had experienced CIs, a smaller proportion of the participants had specifically experienced a suicide-related CI. Six of the participants discussed either their own suicide attempts or the bereavement of a worker they had known who died by suicide. It was significantly more difficult to elicit information regarding suicide-related pre-event factors, the event itself, or post-event factors. The difficulty discussing the topic of suicide in the interviews is reflected in the broader construction work environment, where the topics of mental health and suicide are often regarded as taboo. Suicide is not viewed as a “one-off” situation unrelated to work but is viewed as being inherently related to construction work-specific challenges, with the link between suicide, financial strain, and employment uncertainty expressed by the participants. While there are some obvious risk factors that precede a death by suicide, many are unexpected and “left-of-field”. The participants, for instance, noted that training and support for suicide responses needed nuance as, for some deaths by suicide, there were no obvious early indicators to observe. There was a sense that many of those who died by suicide appeared strong and resilient on the outside, so it was difficult to know what was going on internally. All workers, irrespective of their organisational levels, may be vulnerable. The participants noted that suicidal thoughts and behaviours impacted the workplace and, importantly, the safety and morale of the workplace. The participants noted that a lot of the workplace training was focused on physical safety, while little was focused on psychological safety or mental health. The participants spoke about the dual responsibilities of training people and supporting the workplace, along with the challenges of learning to engage with others to be able to provide support within construction. The participants also noted the need for appropriate, integrated, and ongoing support, for example, in the form of a peer-support network, which would provide a safety net, capturing those who really need it.

Additionally, the participants spoke about the need for continual invitations to speak about all aspects of life and that for some, dwelling on trauma or the negative aspects of the workplace was not always conducive to connecting with others, while also being a time when communication about difficult events can occur. Mental health challenges related to exposure to CIs and chronic conditions are challenging to deal with in the context of construction work. Symptoms such as manic and risky behaviours and insomnia make it difficult to complete work tasks. Compounding this issue is that prescription medications offered as a treatment for some symptoms have side effects that impact a worker’s capacity to work; for example, medications that may cause drowsiness cannot be used when operating machinery.

3.3. Summary of Interview and Rapid Review Insights: Transition to Component 3

The interviewees shared insights on various topics, including pre-, during-, and post-event reactions, desired interventions, and the importance of integrated support. The respondents stressed the significance of responders’ familiarity with the construction industry and lived experiences with mental health and CIs. The need for a horizontal support system facilitating peer-to-peer assistance was recognised, enabling workers to support each other after a critical incident. The participants also acknowledged sector-specific challenges, such as the transient nature of work sites, which sometimes hindered the delivery of post-event support.

There were four key recommendations drawn from the rapid review and qualitative research. The first recommendation highlighted the need to bridge the gap between preparedness for and response to CIs. This recommendation is particularly applicable to the construction industry, where the transient nature of worksites and the diverse work environments necessitate a pre-site assessment to identify workers at higher risk. The second recommendation catered to the male-dominant nature of the construction workforce, emphasising an enhanced post-suicide support system because of the lower likelihood of men seeking help. Other recommendations included brief interventions focused on problem-solving and referral and global awareness of supportive connections.

4. Development of the MATES Respond Training Program: Component 3—Content Analysis of Site Notes

The site notes from MATES field officers, case managers, and social workers (hereafter MATES Support Team) detailing their responses to fatal and non-fatal injuries (referred to as critical incidents [CIs] by MATES) or suicides (referred to as postventions by MATES) in the construction industry were analysed to inform the Respond Program. The site notes, recorded in real time during 193 CIs and postventions occurring between 2018 and 2023, were collated and deidentified for analysis. Consisting of 212 typed pages in total, the notes recorded key information about who was involved in the response (i.e., person providing the response, the position of the organisational representative requesting a critical incident response, and the number of people on the worksite to whom the response was provided); brief information about the incident itself; the date, time, location, and duration of the response; an outline of the response provided to groups of workers or individual workers; and whether further action was needed or planned. Some of the site notes also included email communications, primarily relating to planning the response. For this component of the program development, a content analysis was performed, where multiple members of the research team reviewed the documents and themes were drawn through an iterative process. Once the themes were discussed and agreed upon, MATES began to develop the first iteration of the Respond Program.

4.1. Findings

According to the site notes, CIs and postvention responses involve a series of key activities occurring across three broad stages including the following: planning the response, during the response, and post-response. Summaries of the activities are detailed in

Table 7. Learning from site notes: responses to 193 cases.

Stage	Actions
Planning the response	Details about the incident itself: The MATES Support Team needs to know details about the event itself, including date, time, location, workers directly involved, and whether a critical incident or postvention response is required, depending on the nature of the event.	Date, time, and location of response: Information about the date, time, and location is necessary to coordinate responses adequately. In some cases, a coordinated response is required across multiple locations, as workers directly involved in the incident may be part of teams that work across multiple locations. In other cases, it is also necessary to coordinate multiple responses when workers are temporally or geographically dispersed (e.g., when one shift begins in the early morning and another in the afternoon).		Workers involved in the response: The MATES Support Team needs to know which workers were involved in the incident and how many workers will require support. Contextual information is needed to understand site dynamics, complex relationships, and whether varying levels or types of support will need to be provided. For example, many responses combine a public address involving all available workers on site, with a more private session involving a smaller number of workers who worked more closely with those directly involved in the incident.
During the response	Public address to a group of workers: Critical incident and postvention responses often involve a public address delivered to groups of workers; the size of these groups depends on the size of the worksite and varies for postventions. These public addresses usually involve all available workers on site, irrespective of how close they were to the individuals directly involved in the incident, and are convened in a public location on the worksite. An address usually takes the form of a toolbox talk at pre-start or during lunch.	Remaining onsite for one-on-one conversations: As already mentioned, the MATES Support Team generally remains onsite to greet workers and provide an onsite presence for anyone who wishes to have a private conversation about the incident or seek further advice and support.	Distribution of MATES contact details: While onsite, the MATES Support Team also distribute items containing MATES contact details, such as flyers, pens, magnets, posters, and stickers. In addition to distributing these directly to workers, they are left in public areas for workers to access at a later date.	Additional support: There is commonly a need to offer information and support to individuals or small groups who were closer to the worker involved in the CI. This will expand to ad hoc, one-on-one support and time for more private discussion. Additionally, information about training and support programs and resources are provided along with referrals when requested.
Post-response	Follow-up actions: The MATES Support Team plan follow-up actions, including returning to the site at a later date to check-in with how workers are doing, following up on appointments that were made, and attending future planned fundraising events and anniversaries. In some cases, the deceased person worked across multiple worksites, and additional site visits are arranged as part of the response. While most site notes suggested a typical pattern of addressing all available staff in a public setting prior to engaging with a smaller group of staff in a more private setting, the complexities of relationships among different groups of workgroups or logistical difficulties meant deviations from the usual planned protocol were needed.	Documentation and reporting: The MATES Support Team documents the details of the incident and their response in a report. This report includes information about the incident, the response, and any required follow-up actions.	Debriefing: The site notes indicated that the MATES Support Team providing the response often engaged in their own debriefing session with colleagues, site contacts, and professionals affiliated with the response to discuss how things went.

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4.1.1. Stage 1: Planning the Response

The MATES Support Team are usually advised of the need for a critical incident response via a phone call or email from a key site contact. The key contact is often a health and safety representative or business owner. During this initial contact, whether a critical incident or postvention response is required is communicated: 94 of the site notes were related to postvention responses, while the remaining 99 were related to CIs primarily involving the death of a work colleague due to accident or illness. In many cases, a brief overview of the event requiring a critical incident or postvention response and relevant contextual information is provided, enabling the MATES Support Team to begin organising the response. During this initial period of contact, the MATES Support Team and the key contact person onsite communicate multiple times via telephone or email to organise the logistics of the response. The time between the initial contact and conducting the critical incident or postvention response is quite short: usually, contact is made the day prior to conducting the response. Responses are usually scheduled to coincide with a pre-start meeting when workers arrive on site to start their shifts (e.g., approximately 6:00 a.m.) or during workers’ lunch breaks (approximately 12 p.m.).

Once the MATES Support Team arrives onsite, the initial step is to participate in a briefing and inspection of the site. This step is usually conducted in collaboration with an individual or small group of site contacts. This initial briefing allows the MATES Support Team to attain more details about the event necessitating the critical incident or postvention response and to better understand the impact of the incident on workers (e.g., page 195, date: 7 June 2022). This step is also an opportunity for the MATES Support Team to obtain any other contextual or logistical information relating to the response, such as what format the response will take, the location, and the people who will be involved.

4.1.2. Stage 2: During the Response

Although every incident requiring a response, and the actual response itself, varies, the site notes suggested responses follow a semi-structured process. As noted in Stage 1, there was usually an initial contact that occured via telephone or email to arrange the response, followed by an initial debrief that occured once the MATES Support Team was onsite. After the onsite debrief, the response would often include a clear, plain-language explanation of the incident followed by a moment of silence to commemorate the deceased. A standard delivery would also include offering information about “normal” emotional responses that employees might feel, for example, sadness, confusion, anger, fear, or even a lack of immediate emotion. The responders would also reiterate the importance of seeing support and engaging in adaptive coping mechanisms while avoiding maladaptive coping mechanisms, such as self-medication. Finally, the site notes demonstrated that responders would provide information to employees about where they could go for further support if required.

While the MATES Support Team would let the workers know that they would remain on site for a period for anyone who felt they needed some additional information or support, the site notes suggested that the information and support required and provided during this public address varied for critical incident and postvention responses. There is, however, a ten-point structured protocol that is typically followed for responses, which includes the following:

• Emphasising our sympathy for losing their workmate.
• Emotions and feelings, and normalising these.
• Looking out for changes in co-workers and approaching them.
• The ripple effect—may bring back one’s own feelings.
• Taking breaks if needed—with the project manager and union delegate’s permission.
• Here on—home, normality of actions, normal lifestyle things.
• Keeping in touch with mates/family/friends.
• Particular mention of holiday periods and possible ramifications.
• Emphasising strategies for comfort—MATES 1300#, EAP, GP, each other and others.
• Emphasising MATES commitment—reaffirmed the use of 1300# (also mentioned in emergency/life-threatening situations—to call 000).

Workers on site often request additional practical or emotional support beyond what is typically offered to all workers onsite in a standard critical incident or postvention response. Table 7 presents the additional support that is often requested or provided, as indicated in the site notes.

4.1.3. Stage 3: Post-Response

The analysis of the site notes indicated that after the site visit concludes, additional activities are undertaken by the MATES Support Team. Although every incident and response detailed in the site notes varies, the site notes indicated that critical incident and postvention responses follow a semi-structured process. This semi-structured approach provides valuable guidance about the key elements that need to be included in a response, including who should be involved, the required resources and information (and who should provide them), the tasks that need to be accomplished, challenges likely to arise, and the skills and abilities required of a responder. The semi-structured approach that is usually followed is also beneficial because, while it provides an essential framework for conducting a response, it also offers responders some flexibility to tailor their responses to meet the unique needs and contextual factors that vary across responses. Finally, the site notes indicated the types of skills and abilities required to respond effectively, including empathy, active listening skills, help-offering behaviours, public speaking, flexibility, emotional intelligence, self-care, and knowledge of support services. The capacity to collaborate with others is also necessary, given that responses often involve a high degree of collaboration with other stakeholders, including site managers, safety officers, and professional support services (e.g., page 185, date: 19 August 2021).

5. Overview of the MATES in Construction Respond Training Program

The “MATES in Construction Respond” critical incident training model operationalises practical guidance for human, equipment, physical, and socio-economic factors across the pre-event, event, and post-event phases of critical incidents [31]. The model is a comprehensive framework tailored to the construction industry, informed by recommended interventions drawn from the existing literature and research on worker experiences, the practice insight of MATES key personnel responding and supporting workgroups over fifteen years, and the analysis of 193 site notes based of interventions after an incident on a construction site (Studies 1, 2, and 3). It also serves as the foundation for the development of the MATES Respond Training Program, which addresses various interventions, including closing the loop between responding to a critical event and preparing workers for potential future incidents through reflective practice. The training is designed to improve and understand responses to traumatic events from an individual and organisational context [31,40].

The program modality for MATES respond training compartmentalises this reflective practice into three key components for participants wanting to lead and provide critical incident and postvention responses in their work environments as follows: connecting with the event, understanding the event, and assisting workers and the site. This terminology is reframed from Maple et al. 2020, who recommend pre-event, event, and post-event activities that unpack the human, equipment, physical, and socio-economic factors segmented as the format for training activities across these three sections [31].

Each key component of the training program is underpinned by two constant factors. The first factor is that whilst trained in the program and knowing the psychosocial factors impacting self and teams post-event, best practice infers the need for constant appraisal of self, peers, and post-event for collective impact on individual and team psychosocial wellbeing [41]. This point of reflection requires the guidance and support of the broader MATES team through case managers, social workers, and field officers. When MATES Respond Volunteers are in doubt about elements of the program, irrespective of the MATES Respond Training Program, contacting the MATES team as a default is critical to the principles of individual and collective safety and care and the principles of community development [30]. This safety and care is bolstered by the program logic of no wrong door, 24-h support, case management support, and the multifaceted network that is the broader MATES Connector and Applied Suicide Intervention Skills Training (ASIST) volunteer network [30].

The second factor is the availability and encouragement to debrief individually and practically with a clinician post-coordination of a response to maintain effective reflective practice, safe procedural post-incident support, and enhance individual learnings from the coordinated response [42]. This debriefing is not suggested to re-traumatise the individual conducting the response but rather to link into the overarching reflective practice of the program’s intent and to mitigate potential impacts of providing a response that could cause ongoing mental ill health and develop practice insight into what worked well in the coordination and what can be learnt from responding [43]. This debriefing is at the Respond Volunteer’s autonomous direction and is not mandatory; however, it is encouraged [43]. Both these elements of the program are at no cost to the Respond Volunteer with funded sessions with a clinician for debriefing built into the psychosocial safety of the MATES Respond Program. These two factors are critical to the industry-owned and guided response to suicide prevention and workplace mental health that is the overall MATES program [28]. These two factors maintain safe, congruent, consistent, and clear responses to traumatic events that do no harm in the construction industry and build experience and learnings into future responses [31].

Training to become a MATES Responder is designed as a four-hour program. The training is facilitated by members of the MATES multidisciplinary team who have experience in delivering postvention or critical incident responses. The facilitators include mental health social workers and caseworkers alongside field officers with trades-based backgrounds in carpentry, plumbing, electrical work, bricklaying, and steel fixing. The training is free of charge and available to any member of the construction industry who has completed existing Connector or ASIST training [28]. MATES’s use of ASIST in the broader program modality also reinforces the three-pronged approach to interventions in connecting, understanding, and assisting familiarised through existing contact with the MATES program [30].

5.1. Connecting with the Event

Connecting with the event, as the first component of the MATES Respond Training Program, leverages the individual’s self-awareness and preparedness for responding to a critical incident or suicide. This awareness is required to understand both their own wellbeing and potential connection to previous traumatic incidents and personal experiences that may impact judgement such as their relationship to the person injured or who passed [44]. Initial psychological safety within the group setting is established by facilitators asking participants to share their own experiences of postvention support or critical incident support with the group [45]. With facilitation mirroring safe language, lived experience sensitivities, and respectful confidentiality for those who are not present in the group, trauma-informed practice establishes psychological safety and group norms [45]. Respectful sharing and modelling of behaviours alleviate anxiety and or stress from potential unknowns of the group and the content of the training program [46].

In pairs, one facilitator works through the content of the program whilst the second facilitator is available to members of the group who may experience distress because of the content of the training [47]. The modelling of prompted reflective practice as an ongoing point of permission and analysis of known interpersonal and site-based stressors is critical to effective support and prevention of traumatic stress or complicated grief for the Respond Volunteers [48]. Preparedness for the role is enhanced by identifying and facilitating interpersonal and site-based boundaries for a postvention or critical incident response through facilitated group collaboration [23]. Identifying known boundaries in relation to emotional and physical capacity to respond to an event, including colleague support and referral, creates self-actualisation and awareness of individual variances, comfort levels, and safety in taking on the task of a site-based response to an incident [49]. This activity gives permission and acknowledgement that there are site-based variables that might exclude the Respond Volunteer from being able to organise a response to an event because of psychological safety [50].

Reflective practice, as a dominant theme throughout the Respond Training Program, is also used to elicit empathetic and appropriate responses to grief and distress in a workgroup [51]. Using the explanation and practical application of empathy as a tool for creating connection, understanding and interpersonal strength are modelled through facilitated discussion. Cognitive bias towards resolution and repair in the height of crisis attached to a critical incident or suicide is reframed towards listening, unconditional positive regard, care, and fellowship [52]. Video examples of construction workers addressing a group post-incident, using positive, nuanced language, and embodying empathetic responses are also used to assist with normalising and modelling effective communication and compassionate responses that “do no harm” [53,54]. The reiteration of guidance from MATES personnel, either through a field officer or a representative from MATES through the twenty-four-hour helpline, when a Respond Volunteer is undertaking the process of self-reflection and preparing to undertake a response, is also affirmed with participants to strengthen safe practice and preparedness [31]. Overall, this first component of the training compartmentalises activities that underscore the human, equipment, physical, and socio-economic factors that impact an individual’s readiness or preparedness to undertake a CI or postvention support plan prior to the incident [31].

5.2. Understanding the Event

Understanding the event is the next section of the MATES Respond Program as it progresses from the volunteers’ perceptions of their own connection to the event [23,31]. In determining capacity and appropriateness both from an organisational and personal standpoint, the next learning outcome of the program is the actual planned site response post-event. Video segments addressing a workgroup are used to support and assist participants to familiarise themselves and become comfortable with formulating and undertaking a response [53,54]. Specific resources that affirm common emotional or psychosocial responses for members of the workgroup as well as explaining and actioning the case management model of MATES are used to assist this process [55,56]. This process includes the Respond Volunteer using these resources for the workgroup they address [55]. Specific emotional recall and normalisation of grief and trauma responses are facilitated with participants as a formal process already part of the MATES postvention policy, as evidenced in the 193 analysed site notes.

The normalisation of emotions in a workgroup is important for a male-dominated industry where emotional vulnerability and or distress is not considered part of the accepted workplace culture [57,58,59]. Modelling emotional recognition and facilitated discussions asking participants, through reflective practice, about common responses to trauma creates a common language and recall for distress, as well as reframes misconceptions and cultural norms attached to emotional vulnerability and masculinity [60,61]. This normalisation and, in turn, the permission for a workgroup to grieve on their own terms, in their own way, is a critical component of the MATES process of conducting a postvention as per the analysed 193 site notes.

The theoretical underpinnings of grief and loss through the dual process model of grief and modelling common restorative and loss-oriented behaviours, similarly, give a narrative and explanation of a workgroup’s likely responses [62,63]. Working through facilitation with participants, the often gendered, however, divergence and broad responses of bereavement evidenced through the dual process model are explained in detail [62]. This model assists with understanding what common responses at a site level are likely to involve in practice and look like with peers experiencing distress and grief [64]. These responses can range from emotional distress and pain to restorative fundraising for bereaved family members or loved ones [56,62,63,65].

For CIs and postvention responses, the construction work environment can create unique circumstances and factors that drive strong emotional reactions of blame, regret, shame, and responsibility [66]. Modelling through facilitation alongside videos of construction workers using reframing and brief cognitive behavioural therapy is used in the training to demonstrate the redirection of these feelings and emotions. This redirection is towards a model of loss-oriented or restorative grief and away from blame and shame [62].

The workshopping of examples assists participants in alleviating anxiety and confusion for complex questions regarding grief and loss when responding to a workgroup with a myriad of emotional responses attached to the work environment [23,67]. Physically preparing the worksite for a postvention or critical incident response with supportive resources such as scripts, policies, processes, and the use of EAPs and clinical support is facilitated to enhance preparedness for the Respond Volunteer and enhance the experiences of a workgroup impacted by traumatic events [31,66]. This learning, structure, and guidance under pressure, by having a stepped-out process of responding, is a critical component of the existing practice that is a part of the MATES program. Pairing into small groups, participants read through and engage with the resources provided in the training, such as scripts and policies, to simulate a self-guided response to a critical incident or postvention with a workgroup. This act of repetition and practice assists in breaking down known barriers to responding to an incident attached to unpreparedness, anxiety, stress, and unknown practical steps in a time of heightened site-based adrenaline and distress [60,67].

5.3. Assisting Workers and the Site

Assisting workers and the site, as the final component of the training, starts from the premise that Respond Volunteers are already onsite Connectors or ASIST Volunteers. These Connectors and ASIST Volunteers are already trained and experienced in interventions to link workers to support when peers are experiencing distress [28]. This integrated model of support is heightened through the process of undertaking a response based on the literature confirming the heightened emotional state and likelihood of distress for a workgroup experiencing a traumatic event [23]. Facilitators work through timelines of linking members into support post-incident, with recommended intervals for addressing workplace health and safety committees, pre-starts, and site inductions, all opportunities for reflective practice to use connector skills of guided peer support [30]. These skills are stressed as being heightened and attuned when a workgroup collectively experiences a traumatic event [31].

The explanation of the differences between a typical response to a traumatic incident and complicated grief is workshopped with participants highlighting sleep, flashbacks, intrusive thoughts, and ongoing rumination as key invitations from individuals in the workgroup who may need broader ongoing support [68]. Clinical supports and referral pathways are established to assist with the movement through the grief process and the Respond Volunteer’s suite of known supports to assist in their site-based roles [69]. Vicarious trauma and complex grief warrant significant focus in this section of training because of the occupational rates of suicide in the construction industry and the occupational health and safety record of a high-risk industry [70]. Presentation, identification, and prevalence of repeated traumatic events are workshopped with the group. This aspect is enhanced via examples of seeking and receiving support, providing positive outcomes for workers alongside the prevalence and likelihood of psychosocial workplace injury [71].

To prevent ongoing mental ill health or psychological injury, self-care workbooks that stress the individuality of routine, physical, emotional, mental, and spiritual health are workshopped, with participants identifying and prioritizing where they need to invest more time and care in improving their social and emotional wellbeing based on their own individual needs and circumstances [72]. These workbooks are provided to participants for regular review, reflection, and updating as their own perceptions and experiences of stress and site-based activities ebb and flow [72]. Clinical support through the MATES case management referral pathway is articulated as a highly recommended activity for self-care and wellness after having undertaken a response [55]. This reflective practice is critical for understanding key learnings and enhancements for the Respond Volunteer undertaking future interventions and can also include active feedback to MATES in Construction for improvement and evolution of the MATES Respond Program [23,31]. Overall, the program compartmentalises activities that underscore the human, equipment, physical, and socio-economic factors that impact an individual’s readiness or preparedness to undertake a CI or postvention support plan prior to the incident [31].

6. Overall Discussion

The development of the MATES Respond Training Program presented in this article describes an effective program, drawing on the principles of psychological first aid, which limits psychosocial hazards in the workplace, improving employee mental health. This program should be taken into consideration at the organisational level by businesses concerned with the mental health of their employees and at an industry level by practitioners concerned with the mental health of the workforce within a certain sector. Resources developed in consultation with MATES Respond Volunteers are provided to assist mental health advocates on site develop formal policies and procedures that adhere to best practice timelines for grief responses, sites-based activities, and use of Connector networks and EAP providers.

While it is well established that suicide is a problem for the construction industry in Australia, it is a problem that extends both beyond Australia and beyond the construction industry. Thus, for organisations in construction and beyond, the Respond Program can be used to inform the procurement of critical incident training providers, should the company choose to outsource the handling of CIs and suicides. Where this is undertaken internally, the training provides a framework, clarity, and a sense of support for the individual formulating a response on behalf of the worksite or company. For industry practitioners, this program serves as a framework for the development of a CISM program guided by principles within psychological first aid that is designed to provide support based on the unique characteristics of a given industry, providing a more customised approach tied into the existing MATES network. For workplace health and safety professionals within the construction industry, the MATES Respond Training Program is already common practice. However, utilisation of the framework could result in important steps forward within other male-dominated blue-collar industries, such as mining and agriculture, and beyond into male-dominated white-collar industries, such as finance and information technology.

In summary, the development of the MATES Respond Program was an iterative process that began with a rapid review of the relevant literature, which was published by Pearce et al. (2021) [23]. Interviews were conducted with individuals involved in critical incidents, and themes were identified. Some of these qualitative data were published in Maple et al. (2020) and expanded here [31]. Together, these findings were combined with an internal review from MATES in Construction of almost 200 site notes from critical incidents leading to the development of the training program, which develops the skills necessary for individuals to provide support at the workplace level. The training program identifies pre-event, event, and post-event actions and is deliberate and intentional in the feedback process, with an aim to improve and develop further iterations of the training program continually. This process is presented in Figure 2.

7. Future Research and Limitations

This article described the activities undertaken to develop the MATES Respond Training Program. The essential next steps for future research are to evaluate the program’s effectiveness in training Respond Volunteers to deliver postvention responses successfully, as well as examine the overall impact of these postvention responses for workers exposed to CIs. The latter could assess exposed workers’ outcomes specifically linked to the acute stressors associated with the critical incident (e.g., post-traumatic stress symptoms) as well as their overall perceptions of chronic work-related stressors and the supportiveness of the organisational culture and leadership, which are viewed more positively when workers see that their organisations take appropriate actions to prioritise workers physical and psychological safety. Longitudinal impacts of exposure to traumatic events and peer suicide with the potential mitigation of complex grief could also be evidenced in an industry with high-risk exposure to both suicide and workplace injury. The use of debriefing in order to inform response learnings, analyse individual impacts of grief and trauma, and use critical reflection to understand motivation and responses, whilst commonplace in mental health and social work settings, lacks literature on congruent practice for multidisciplinary professionals who do not have formal clinical experience. Establishing workplace health and safety standards, procedures, or guidelines for what peer, individual, and organisational debriefing should entail after a traumatic incident that is also congruent and responsive to members of the construction industry with diverse experiences and trade backgrounds requires investment and attention. The MATES accreditation program currently does not include onsite Connectors and ASIST Volunteers receiving MATES Respond training. The inclusion of MATES Respond as a component of MATES accreditation requires additional evidence of its impact on site-based psychosocial safety. The training is offered to individuals who have already become MATES Connectors and ASIST Volunteers. This program aims to provide onsite support and guidance in the event of an incident until further help can arrive. It focuses on the following three key elements: connecting with the event, understanding the event, and assisting workers onsite.

This article is not without limitations. Given that the goal of this article is to analyse the development of the MATES Respond Training Program, we must be modest in our claims and not suggest that our findings are generalisable to other CISM programs. We must understand that while this program is proving to be successful at this time in this context, similar programs developed in other industries or, indeed, the construction sector in other countries might require a very context-specific approach to developing such a program.

8. Conclusions

The MATES Respond Training Program serves as an example of a CISM program influenced by psychological first aid, tailored to the construction industry. Initial reports suggest its success in increasing worker confidence and reducing anxiety and stress when dealing with CIs. However, other industries may lack the information necessary to replicate this intervention. Critical incidents occur across all industries, emphasising the need for the adoption of the most developed and up-to-date interventions. The literature and evidence, workers’ narratives of experiences, and practice insight from fifteen years of a multidisciplinary team have shaped the MATES Respond Program. In formulating a framework for critical incident and postvention responses, the MATES Respond Training Program imparts the principles of empowerment, capacity building, and resilience into the Australian and New Zealand construction industry.