10.4 Psychological Health: Psychosocial Hazards, Stress, Fatigue, Violence and Substance Misuse

Why psychological health is a safety issue

Mental health problems affect workers directly and also cause accidents:

• a fatigued crane operator misjudges a radius
• a stressed supervisor skips a permit check
• a worker under financial pressure accepts an unsafe shortcut to finish faster

OSHA 1994 recognises this. Section 4(c) lists among the Act's objects promoting "an occupational environment for persons at work which is adapted to their physiological and psychological needs". DOSH's 2024 guideline bases psychosocial risk assessment on the section 18B duty to assess risks to anyone affected by the undertaking; breaching section 18B carries a fine of up to RM500,000, two years' imprisonment, or both (section 19). The CDM 2024 First Schedule asks duty holders to:

• reduce monotonous work and work at a predetermined rate (principle 4)
• develop a prevention policy covering work organisation, working conditions and social relationships (principle 7)

DOSH has published two guidance documents:

• Guidelines for the Prevention of Stress and Violence at the Workplace (2001)
• Guidelines on Psychosocial Risk Assessment and Management at the Workplace 2024, which introduce the PRisMA approach

Key concepts from DOSH's 2024 guideline

• Psychosocial risk: following ISO 45003:2021, the combination of the likelihood of exposure to work-related psychosocial hazards and the severity of the injury or ill health they can cause.
• Psychosocial hazards (DOSH's examples):

• The job demand-control-support model (Karasek and Theorell, 1990): strain is highest when job demands are high, job control is low, and social support is low. Stress can be reduced by increasing workers' control over their work and the support they get from supervisors and colleagues, as well as by reducing excessive demands.

Effects

DOSH's 2024 guideline lists the effects of psychosocial risk:

• on employees: increased stress, burnout, anxiety, depression and reduced job satisfaction, plus physical problems such as cardiovascular disease
• on organisations: lower productivity, absenteeism and presenteeism, higher turnover and reputational damage

The PRisMA process (DOSH 2024)

Roles under the 2024 guideline:

• The employer shall conduct risk assessment as the Act requires, and should appoint a Psychosocial Trained Person (PTP) to help carry out PRisMA.
• The PTP must keep information confidential and act with integrity.
• Employees must cooperate with PRisMA activities and report psychosocial issues.

The guideline favours a proactive approach (employee surveys, job design reviews, risk mapping, policy reviews) over reacting after problems appear.

Fatigue and working hours

Fatigue impairs judgement and reaction time like alcohol does. On construction sites it comes from:

• long shifts and overtime, including back-to-back day and night pours
• seven-day working and long commutes
• heat and dehydration
• poor sleep in crowded accommodation
• night work disrupting the body clock

Controls:

• Plan programmes and pours to avoid excessive hours. Set maximum shift lengths and minimum rest periods in the site rules.
• Rotate crews on long pours, and schedule the most safety-critical tasks (crane lifts, confined space entries) for when workers are fresh.
• Provide rest areas and water (CDM Second Schedule) and manage heat (Section 10.1).
• Brief supervisors to spot fatigue and stand people down without penalty.
• Check that workers' accommodation meets the Employees' Minimum Standards of Housing, Accommodations and Amenities Act 1990 (Act 446).

Workplace violence, bullying and harassment

DOSH's 2001 guideline treats violence, including threats and abuse, as a workplace hazard. The 2024 guideline lists bullying, harassment and discrimination under organisational culture. Malaysian law also provides remedies for sexual harassment through the Anti-Sexual Harassment Act 2022 (Act 840), which set up a tribunal, and the complaint procedures in employment law.

On site:

• set a clear policy and site rules against violence, bullying and harassment, explained at induction in workers' languages
• provide confidential reporting routes, including routes outside the worker's own subcontractor
• act on complaints, protect complainants from retaliation (OSHA section 27 protects employees who raise safety complaints), and investigate fairly
• prepare security staff and supervisors to defuse conflict, for example at gates and pay days

Alcohol and drugs

Impairment from alcohol or drugs, including some prescribed medicines, endangers everyone on a construction site. Under section 24 of OSHA every employee must take reasonable care of themselves and others. Good practice includes:

• a written alcohol and drug policy in the site rules, with clear consequences and support routes
• fitness-for-duty checks by supervisors at the start of shifts and before safety-critical tasks
• testing programmes only where lawful and fair, with confidentiality
• support rather than only punishment for workers who seek help, with referral to counselling or treatment services

Supporting workers' mental health

1. Talk about it. Include mental health in toolbox talks and inductions, and make it normal to say "I'm not OK".
2. Train supervisors to recognise warning signs (withdrawal, irritability, absence, mistakes, talk of hopelessness) and to respond with concern, not discipline.
3. Provide help. Display contacts for counselling and crisis support, such as the national mental health helplines, in workers' languages. Some employers fund an employee assistance programme.
4. Remove root causes. Realistic programmes, pay on time, fair treatment of subcontractors' workers, decent accommodation, and clear roles.
5. Respond to crises. If a worker talks of suicide or self-harm, stay with them, take it seriously, and get urgent help (999 or hospital emergency services).

Scenario: the night-pour supervisor

A site engineer has supervised three consecutive night pours after working day shifts. During the third pour he signs the permit to load without inspecting the deck, and later snaps at a worker who raises a concern. The SSS:

1. Stops the pour until the falsework is inspected properly by a fresh, competent person.
2. Raises fatigue with the project manager as a workload and work organisation issue. Crew and supervisor rotas are revised to set a minimum rest period between shifts.
3. Suggests the company include this project in a PRisMA assessment led by a trained PTP, using the LEO26 survey, and review workload and support measures.
4. Makes sure the worker who raised the concern is thanked, not blamed, reinforcing open reporting.