Mental Health, Wellness, and Resilience for Transit System Workers (2024)
Chapter: 4 Findings and Conclusions
CHAPTER 4
Findings and Conclusions
Key Findings of This Research
The purpose of this research was to examine the mental health, wellness, and resilience of frontline transit workers and to develop a comprehensive set of resources and a toolkit to help transit agencies identify and mitigate workplace factors that cause negative impacts. This report uses a multipronged approach to understand the existing research and agency practices related to transit worker well-being and to gather feedback on the topic directly from frontline workers, agency management, and union leadership.
Previous Research
The research for this project began with a comprehensive literature review to develop familiarity with articles and studies that had been published on the well-being of transit workers, as well as studies from other fields and industries relevant to the research topic. The literature scan also captured the state of the practice at transit agencies by reviewing public-facing information about employee programs and benefits (such as EAPs). The scan yielded many findings that were verified in later rounds of direct engagement with frontline transit workers, transit agency management, and union management:
- Frontline transit workers experience a range of difficulties in the work environment.
- One serious issue that affects the mental health of train operators (as well as transit police and other emergency workers) is PUT incidents, which occur because of accidents, suicides, and homicides. Studies show that up to 30% of transit operators experience PTSD after PUT incidents and assaults.
- COVID-19 had a profound effect on transit agencies and workers, making it even more difficult for agencies to recruit and retain frontline workers, such as operators.
- Two empirical studies examined the effects of COVID-19 on transit workers’ mental health and well-being.
The body of literature highlighted the adverse work conditions that bus operators face, such as exposure to chemicals and fumes, extended periods of sitting and stressful postures, difficult traffic and weather conditions, assault (both verbal and physical), and the lack of restroom access. Rail operators and other frontline workers are exposed to violent crashes, suicide by train, and exposure to chemicals and fumes. These exposures impact workers’ health and well-being. From a mental health perspective, on-the-job occurrences can expose frontline workers to a range of potentially traumatic events, with one study finding a high prevalence of PTSD, major depressive disorder, and anxiety disorders among bus operators. These exposures also impact physical health, including chronic heart disease, occupational stress, and hypertension, among others. A lack of bathroom access can cause mental distress, affect operators’ cardiovascular system, and contribute to kidney and bladder problems.
Aside from the toll on human capital, adverse workplace events can also impact a transit agency’s bottom line. Assaults against transit operators resulted in lost work time, damaged employee morale and productivity, and increased worker compensation payments, medical expenses, lawsuits, and liability costs. In many other studies, authors have discussed secondary effects of the mental health and physical health impacts of transit workers’ adverse work conditions. These secondary effects include greater absenteeism, high labor turnover, and propensity for accidents. Although the literature review focused on public transit, numerous studies of other industries show that work-related mental health issues seriously impact productivity, absenteeism, and employers’ ROI.
The literature also identified ways to address adverse work conditions, such as improving the workplace environment by (1) building physical barriers between subway trains and platforms to reduce PUT incidents; (2) erecting enclosures between customers and bus operators; and (3) developing new or enforcing existing policies and protocols for policing and security, driver protection systems, voice communication and telemetry systems, and surveillance and observation systems.
Reconfiguring work hours can reduce fatigue and stress. Other initiatives, such as agency-provided programs that promote health, can reduce the impact of adverse environments. Common health and wellness promoting practices include health education, exercise, stress management, employee assistance, nutrition, smoking cessation, maintaining mental health, cardiovascular disease prevention, and disease management components. While 50% of agencies provide health and wellness programs, programs are less likely to be offered at smaller agencies. Barriers to using programming include work hours, fatigue, stigma, turnover, and leadership styles that may prevent workers from participating. There is limited information in the research about reducing barriers or increasing participation.
Interviews and Focus Groups
Focus groups and interviews were conducted with transit agency leadership, frontline transit workers and their managers, and Amalgamated Transit Union (ATU) leadership during two separate parts of the project. These conversations both verified well-known causes and factors impacting mental health and provided an opportunity to learn about lesser-known factors that were not as prevalent in the literature. Well-known factors discussed in focus groups and interviews included assaults and confrontations, PTSD, work schedules, extended periods of sitting/inactivity, lack of exercise, and lack of bathroom access.
- Assaults and confrontations. Verbal or physical altercations may arise during fare enforcement and general interaction with the public, including customers experiencing homelessness, customers with mental health issues, or customers with substance use issues.
- PTSD. Frontline workers may be victims of assault or witness assaults, which cause additional trauma on top of the potential for crashes, near misses, PUT incidents, attempted suicides, and deaths by suicide.
- Work schedules. The industry was experiencing a labor shortage prior to the pandemic, and continued shortages have made it difficult for employees to get time off (on top of common agency structures that rely on seniority for scheduling purposes). Frontline workers, unlike colleagues at other parts of their agency, did not have the option to work remotely during the pandemic; instead, they spent the health crisis on the front lines.
- Extended periods of sitting/inactivity. Operating a transit vehicle can also be a solitary and isolating job, since operators are typically on their own most of the time. For operators, the physical demands of driving require sitting for long periods of time with limited opportunities for exercise, movement, or a mental break from concentration on traffic, driving, and passengers.
- Lack of exercise. Although operators may choose how to spend their breaks, poor weather may make operators less likely to stretch or move around while on break. Stretching may also not be possible if routes are running late.
- Lack of bathroom access. This was mentioned by almost all interviewees. In general, operators can only access restrooms at the end of a run, and frontline workers without scheduled breaks may also face limited restroom access. In addition, many public restrooms were closed during the pandemic.
Lesser-known stressors uncovered during the interviews and focus groups included work–life balance, other internal stressors, and external stressors.
- Work–life balance. Transit is a 24/7 job, with work schedules that may be inconsistent. Varying work schedules complicate self-care and family care and may make it difficult to accommodate time-off requests due to labor shortages.
- Other internal stressors. Internal stressors related to interviewee jobs and agencies include the frequency and quality of communication; varying degrees of English proficiency among staff and the riding public; loneliness and isolation in the workplace; lack of support from managers in the field and after incidents; overall inadequate training to prepare workers for their jobs; an “us vs. them” mentality between unions, frontline workers, and management; and low morale among transit agency staff.
- External stressors. The provision of childcare and family care amid scheduling constraints is an additional source of stress, as is overall access to healthcare and childcare. Operators may also work in high cost-of-living areas and have long commutes because of a lack of affordable housing in their agencies’ service areas. Frontline workers lost friends, family, and colleagues in the pandemic and feared contracting COVID-19, especially since they could not work from home.
Survey
The goal of the survey was to better understand factors that affect the mental health and wellness of frontline transit workers and to gather frontline workers’ feedback on possible solutions to improve workplace mental health and resilience. The survey included questions about respondents’ health and well-being throughout the COVID-19 pandemic; their work environment; workplace stressors; their agencies’ preventive and health-promoting measures; personal characteristics; and strategies to address mental health and wellness. Out of the original 1,130 responses, 777 were considered valid for analysis.
The following list includes some key findings from the survey.
- Workplace stressors. Out of all respondents, 87.3% indicated that their agency was currently understaffed, 69.1% said they were exposed to people using alcohol or drugs while on the job, and 68.7% either were or saw someone else verbally or physically threatened. Operators were more likely to report having limited restroom access on the job.
- Anxiety and depression. Frontline transit workers are experiencing elevated anxiety, depression, and stress levels at work. Over one-third (35.8%) of survey respondents met the criteria for probable anxiety and 37% for probable depression.
- Existing program awareness and utilization. More than half of respondents (59.3%) reported that their agency offered mental health resources or programs to employees. Roughly one-third (31.3%) of frontline workers reported being unsure whether their agency offered mental health resources. Among respondents who reported having access to mental health resources at their agency, 20.6% reported utilizing the mental health resources available to them (which is 12.2% of the overall sample). An additional 11.9% of workers reported that they tried to utilize mental health resources at their agency but were unable to do so successfully.
- Satisfaction with resources. All respondents were asked to rate their level of satisfaction with mental health resources available at their agency. On a 0–10 scale, with 10 representing the
- Barriers to using mental health services. The most commonly cited reasons affecting the decision to not seek services through an employer were lack of time (35.9%), concerns about missed pay (33.2%), privacy concerns (32.6%), and being too tired/exhausted (31.5%).
- Preferences for mental health services. When asked about the preferred format of mental health services, most frontline workers (63.6%) reported a preference for participating in mental health services one-on-one with a mental health professional. Those who reported privacy concerns as a reason for not seeking services from their agency were significantly more likely to prefer one-on-one services with a mental health professional.
- Ideas for programs. Respondents indicated that the most helpful programs and policies would be those that reduce sources of stress in the workplace (54.7%), offer free mental health screenings and referrals (46.1%), and increase access to information about mental health resources (44.3%).
highest level of satisfaction, the average rating reported by frontline workers was a 4.50±3.0, which reflects moderate satisfaction.
Suggested Responses to Worker Mental Health, Well-Being, and Resiliency Needs
Various themes emerged about how transit agencies could respond to worker needs and address their mental health, well-being, and resiliency. The following are suggested actions agencies can consider taking to address the specific challenges faced by frontline transit workers.
- Improve the physical safety of the workplace. This can be done by building physical barriers between subway trains and platforms to reduce PUT incidents; erecting enclosures between customers and bus operators; and developing new or enforcing existing policies and protocols for safety, security, and driver protection systems. Many frontline workers noted that policies were in place at their transit agencies to help protect workers and set codes of conduct for passengers; however, they felt those policies were not enforced. Likewise, frontline workers desire support in the field from supervisors and transit police.
- Adjust benefits and policies to provide more support for frontline workers to attain and maintain good mental health and a better work–life balance. Workers repeatedly noted the difficulty of taking time off for their own well-being or for the care of family members. Varying work schedules, strict absentee policies, and seniority rules for selecting work schedules make it difficult for workers to exert autonomy over their lives and have a work–life balance that is typically expected in other industries. Frontline workers also felt their time off was not their own, since they were often required to be on call or available in case of emergencies or staff shortages. Likewise, transit timetables and ongoing operator shortages make it difficult to take breaks throughout the day. To provide a better balance of work and personal life, transit agency leadership, unions, and workers can collaborate to modify and improve scheduling practices for timetables and work schedules. Transit agencies can also revisit policies and practices to ensure that employee time off is protected and not interrupted by workplace emergencies.
- Improve and diversify communication and marketing efforts to grow employee awareness of available mental health and wellness resources. Since not all frontline workers have agency email addresses, marketing resources to them can be complicated. Frontline workers may also have working hours that do not lend themselves to lunch-and-learn sessions or other trainings and meetings that occur during first-shift working hours. The demands of their job and existing staffing shortages can complicate the attendance of information sessions. Agencies can take steps to diversify communication methods and the flow of information about available resources, such as ensuring that information sessions are offered across shifts, facilities, and departments or provided during regularly scheduled meetings that frontline workers are paid to attend during their working hours. These information sessions could include the
- Evaluate EAPs, UAPs, and other mental health programs to assess whether a program’s services align with employee needs and the extent to which programs are more successful. This may include a review of existing and future EAP service level agreements and the institution of a monitoring process for programs that focus on improving mental health.
- Address the privacy concerns that obstruct employees from using resources by providing a range of programming types. Survey results indicated that most frontline transit workers preferred mental health services that were delivered in a one-on-one format (not in a group format), led by a mental health professional (not a trained peer), delivered in person (not via telehealth), and accessed at an off-site location (not on-site at the workplace).
- Strengthen and enforce policies to protect frontline workers. Policies that outline clear and enforceable rules and procedures for handling inappropriate passenger behavior are needed to ensure operator safety. In addition, training on how to address passenger problems (e.g., communication and de-escalation; strategies for handling passengers with mental health or substance use issues) is also recommended.
- Provide more support in the field and ongoing support after incidents. Many frontline workers are on their own most of the time, which can be isolating and lonely. They are often left to handle situations and conflicts on their own, which can be especially stressful for newer employees. Additional and dedicated support through specialized staff trained in incident response, such as critical response teams, would help make frontline workers feel more supported and protected in their jobs. Ongoing support is also needed following incidents to ensure that frontline workers recover and are able to return to work without additional adverse impacts on their or others’ well-being.
- Provide peer support and mentoring to increase morale, build meaningful relationships among workers, and provide ongoing support systems. Frontline transit workers and transit agency managers engaged in this report noted the positive impacts on employee outcomes when a peer support or mentoring program was in place. These programs should be more widely adopted by transit agencies to increase employee engagement and workplace satisfaction.
- Strengthen community and create a culture where workers feel supported and support each other. As stated previously, frontline work can be isolating and lonely. Similar to mentoring and peer support systems, providing more opportunities for frontline workers to connect with one another regularly and build relationships with their peers can increase their overall connection to the workplace. Transit agencies can implement more social events and other opportunities for frontline workers to meet their peers and build relationships. Likewise, transit agencies can design social or volunteer-based opportunities for frontline workers to connect and engage with community members in a non-transit and non-work environment. This would help frontline workers understand the challenges faced by their community and be better equipped to engage community members when they interface with the public at work every day. These activities can create a strong community among frontline workers and can promote culture change that is centered around workers supporting each other and the communities they serve.
- Develop trainings that empower employees to navigate the adverse conditions they may face on the job. Include training on how to interact with riders experiencing homelessness, drug dependency, or mental health crises, potentially including de-escalation strategies.
staff member responsible for administering the EAP, and they could provide an opportunity for attendees to learn about the resources in-depth and ask questions, particularly around privacy. Since some frontline workers may not have agency email addresses, agencies could supplement their communication with text messaging to push information out. Sometimes taking a more old-fashioned approach to communication can help, such as flyers in common areas or posters in bathroom stalls. Supervisors and managers can also play a part in spreading the word by making direct reports aware of resources during recurring team meetings.
- Develop trainings to increase empathy and improve communication among frontline workers, managers, and agency leadership. Many frontline workers noted the disconnect between themselves and their managers. Managers not understanding what frontline work entails and using dismissive language made workers feel like their concerns were neither heard nor adequately addressed. Empathy training, communication training, and other activities (e.g., ride-alongs with operators) for managers, supervisors, and non-frontline staff would increase awareness of the challenges that frontline workers face as well as validate their feelings. Communication training could also benefit frontline workers by providing them with the tools to express their grievances and complaints in a productive way that can lead to collaborative solutions.
- Seek opportunities to improve trust between all parties, including between employees and their peers, between employees and managers, and between transit agency management and union leadership. Building trust can help reduce the negative stigma associated with seeking help to improve mental and emotional well-being. From the beginning, include frontline workers and unions in the identification and rectification of barriers to employee wellness.
Training for critical response teams to provide in-field, immediate support during times of crisis and continued support after incidents would also be helpful.
Overall, this research clarified that transit agencies—specifically transit agency leadership—must make a real and concerted effort to take the mental health and overall wellness of frontline workers more seriously. Leadership can play an important role by making a clear commitment and dedicating resources to address mental health, wellness, and resiliency at their agency. Ultimately, this means that more funding and staff resources are needed to address barriers and to develop, implement, and support programs aimed at improving mental health, wellness, and resiliency. This includes staff dedicated to implementing and monitoring holistic wellness programs.
Future Research
The findings from this research have uncovered knowledge gaps that could be explored in future research, as described in Table 4.1.
Table 4.1. Implications for future research.
| Research Gap | Description |
|---|---|
| Limited research on the mental health of transit workers | The literature review produced a limited amount of prior research about the mental health of transit workers, aside from two studies related to the COVID-19 pandemic. |
| Process/framework for evaluating EAP performance and user outcomes | Throughout the course of the project, no transit agencies with an established framework for evaluating EAP performance were identified. Future research may develop a methodology to better evaluate EAP performance and explore user outcomes associated with EAP use. |
| Guidebook for establishing peer-mentor programs | Some transit agencies had implemented peer-mentor programs, which participants generally found to be helpful. Transit agencies might benefit from a guidebook on best practices for peer-mentor programs that includes an implementation checklist for agencies to establish their own program. |
| Research Gap | Description |
|---|---|
| Service planner and scheduler training materials | Bus routes determine the areas where operators spend their layover time. Likewise, timetable design impacts whether and for how long an operator can rest and recover from the often stressful job of operating vehicles and managing passengers. Training materials could be developed to (1) help transit agency service planners understand how the physical environment impacts operator comfort and physical health and (2) provide tips for how to incorporate bathroom access and layover areas into the service planning process to improve operators’ job conditions. Training materials for schedulers could include information on the relationship between operator wellness and break time, as well as recommend standards for recovery and break time. |
| Strategies for reducing operator exposure to drug use on transit vehicles | Operators may be exposed not only to verbal and physical threats but also to passenger drug use while on the job. Future research could identify strategies to reduce operator exposure, including additional physical barriers as well as the development and consistent implementation of policies that establish a process for addressing drug use in transit vehicles. |
| Frontline transit preemployment tests | Interviewees explained that applicants and new hires might be unaware of what a frontline transit job entails, including both the nature of the work and the skills and abilities required to perform the job successfully. Developing a screening tool for frontline workers would benefit both potential candidates and the transit agencies hiring them by measuring a candidate’s propensity for the job, which could help candidates and agencies ensure a good fit on both sides. The FAA Air Traffic Skills Assessment Test, which evaluates the skills and attributes of air traffic controllers, may serve as an example. |
