Mental Health at Sea: A Storm is Brewing

According to the latest statistics, over 25 percent of people will experience a mental health problem at some point in their lives and for those working offshore, this figure is significantly and potentially dangerously higher. What’s more, the problem’s growing.

So, what’s causing the rise of mental health problems within our industry and why are seafarers more likely to suffer from these issues than those working on land? Most importantly, what can be done to solve the problem and establish a happier, healthier and safer workforce on the 51,000+ merchant ships that sail our seas?

The big debate: mental health issues - a growing problem, or just less taboo?
June 12 to June 18 this year marks Men’s Mental Health Week: one of many calendar dates throughout the year aimed at raising awareness of mental health issues. According to a report commissioned by the anti-stigma program Time to Change and published by the charities behind the campaign, Mind and Rethink Mental Illness, results show public attitudes towards mental illness are moving in the right direction. It would seem that the stigma that once surrounded mental illness is slowly being chipped away and those suffering are more likely than ever before to speak out about their problems and seek help.

Taking this into account, it’s easy to see why the question of whether mental health issues are in fact on the rise, or are simply better recorded splits opinion. Either way, one things for sure, there are a staggering number of people working on ships that are experiencing intense emotions of anxiety, hopelessness, negativity and helplessness for extended periods of time and what’s more, the figure appears to be growing.

Why are mental health issues more common for off-shore workers?
Although psychological issues are very common amongst seafarers, the mental health of those working offshore has only recently started to receive the attention it deserves. So, why are seafarers more likely to suffer from mental health issues than those working on land?

Lack of communication with the outside world
Away from home between six months to a year, unable to see family and often with limited access to the internet to use communication platforms such as Skype or WhatsApp to keep in contact with loved ones: times can be very tough on a vessel and feelings of loneliness and isolation can soon start to creep in.

In this day and age, it’s hard to believe that internet access is not readily available across the globe, but Seafarers’ Trust recently reported that as many as 77 percent of seafarers have their internet access strictly limited, or have no access to internet whilst offshore at all.

Could lack of communication with the ‘outside world’ be to blame for the large numbers of seafarers suffering with mental health concerns?

Physical demands: tiredness kills!
It’s often said that seafaring is a physically demanding occupation. Nowhere has this been better expressed than by the International Maritime Health Association when it says, “It has been established that seafaring is one of the most physically demanding professions in one of the most dangerous work environments: the sea.”

The fact that there is global evidence of misreported working hours on vessels, shows how cultural and commercial pressures are universally shared. Many seafarers blame the demands of split shift patterns for the high levels of fatigue they experience offshore, but whatever the cause one thing’s for sure, fatigue is strongly linked to mental health problems and is considered one of the greatest contributing factors to mental illness.

Social isolation compounded by quick turnaround times in port
It’s been said that an increase in social isolation, compounded by quick turnaround times in port, can make a seafarer’s life very similar to that of a jailed inmate: the ship becoming a floating prison. As a result, and very sadly, depression, psychotic breakdown, and even suicide are relatively common, documented real-life consequences that result from social isolation of vulnerable crew.

The rise of multinational crews: making it difficult to form a strong bond
The majority of shipping companies employ multinational crew, which introduces its own set of problems such as the language barrier and group formation leading to cultural isolation. Reduced common language and shared culture means that it’s becoming more difficult for crews to communicate with each other in a meaningful way.

The happiness and mental welfare of a crew often depends on how well they get on and work together and if there are language barriers and a lack of shared cultural references, it can be very difficult for crews to form a strong bond. Sadly, as a result there’s less familiarity working together and it’s less likely that crew feel that they ‘know’ their colleagues.

Reduced crew numbers lead to increased physical and psychological stress
The reducing number of crew members onboard ships is generally seen as the main reason for increased levels in physical and psychological stress offshore: a major contributor to mental health problems. More than ever before, crew are become mentally and physically exhausted from their workload.

Work related stress offshore can soon escalate, with common contributing factors, including; the demands of the job; the level of control seafarers have over their work; the support received from management and colleagues; relationships at work; the seafarers’ role in the organisation; and change and how it is managed, all playing their part.

Drug and alcohol abuse: influencing behaviour and emotions AND a serious safety hazard
Over the last few years we have seen an alarming increase in the number of accidents at sea in which drugs have been a causative factor. In some areas of the world and on certain types of vessel drug abuse is becoming a serious safety hazard.

Alcohol and drugs influence behaviour and emotions and are therefore a major contributor to mental health problems. People under their influence react differently, cannot focus and concentrate and are not able to perform complex tasks adequately, which also poses serious safety risks on vessels.

What about when seafarers aren’t working? Some people might argue that that the use of drugs whilst on leave is no business of the shipowner, operator or employer, but this argument does not stand. Why? Well, it’s been proven that the majority of drugs have long term effects which continue long after the drugs were taken. It may also only be a matter of time before the seafarer develops a taste for the drugs and decide to take them when working too.

Bullying and harassment: experienced by almost 50% of seafarers!
Bullying and harassment at sea can have serious consequences for the physical and emotional health of a ship’s crew, such as decreased motivation, increased absenteeism and a fall in productivity. What’s more, bullying and harassment can also have negative effects for the companies themselves, resulting in a deterioration of working conditions with huge organisational, economic and potential legal consequences too. Given the serious consequences of bullying and harassment, it’s shocking that according to research carried out by Nautilus International, almost 50% of seafarers have personally experienced bullying, harassment or discrimination at sea: this is a common problem.

Harassment and bullying can take a wide variety of forms, ranging from verbal aggression, ill-treatment, cyber-bullying or sexual discrimination through to various forms of physical aggression resulting in serious injuries.

Aggression may take the form of body language, intimidation, contempt or disdain. While the physical effect of harassment and bullying is fairly easy to identify on account of the obvious external signs, the same cannot be said of the emotional effects of harassment and bullying which are often denied or distorted. Enhancing the problem, there’s evidence to show that a large number of seafarers who’ve experienced bullying or harassment, don’t feel able to make a complaint, for fear that it wouldn’t be taken seriously.

Criminalization
The ‘criminalization of seafarers’ is used as a blanket term to describe the treatment of seafarers in the investigation and prosecution of maritime incidents.

Arguably the most well-known case of criminalization of ship’s officers is the case of the tanker Hebei Spirit. Whilst at anchor in the Yellow Sea, the vessel was struck by an uncontrolled crane barge that collided and punctured three oil tanks. This caused a release of 12,547 kilolitres of oil, which hit nearby beaches ten days later. Master Jasprit Chawla and Chief Officer Syam Chetan were cleared of any wrongdoing at their first trial, but were kept in jail while the prosecutors appealed. A second trial found them guilty and sentenced them to three years in prison and a fine of $22,530. They finally returned to their homes in India after the case was dismissed and they had been in custody for 18 months.

With many cases like this occurring, seafarers often describe that they ‘live in fear’ of being held responsible for an incident at sea and harbour feelings of anxiety in relation to the investigation and prosecution process that may ensue. This growing problem is a well-known contributing factor to the mental health issues in seafarers.

The cost of poor mental health
In a worst-case scenario, crew suffering with serious mental health issues resort to suicide. Unfortunately, crew ‘going missing’ from a vessel is common and seafarers that decide to take their own lives at sea are often never found.

A particular case in Australia highlights how a ship can lose several days and a large amount of money due to the disappearance of an officer in the case of suicide. The Korean Master of a 180,176 dead weight tonnage bulk carrier Ocean Caesar was reported missing at 4:15 p.m. about 40 nautical miles northeast of Sandy Cape, Queensland. Aircraft of the Australian Maritime Safety Authority (AMSA) conducted a search throughout Saturday and Sunday, including using infra-red sensing equipment at night. Unfortunately, the Master was not found. The vessel was forced to divert to a Queensland port while AMSA, the Australian Transport Safety Bureau, and local authorities conducted an investigation over several days.

The unexpected economic loss to the shipping line of the bulker being diverted and then spending days in port may have been as high as $100,000, plus costs to bring a new master to Australia for the ship.

Solving the problem
According to a recent crew welfare survey by Nautilus International and maritime technology company Martek Marine, mental health was a key topic of concern for those that participated.

‘We need to focus on mental health and wellbeing onboard. I have seen more over the recent years: seafarers not being able to talk to anyone onboard if they have problems from home or work-related problems. If this is not caught early it can lead to other things in the future,’ said one seafarer.

‘More in-depth training is required for a variety of health problems especially regarding mental health of seafarers onboard and to spot the signs,’ said another.

An increasing number of support services and guidance resources are now available
Progress is being made, slowly, but we do seem to be heading in the right direction. Many ports now have ship-visiting teams and seafarers' centres that provide transport and help crew when they reach port. Charities and foundations such as Mission to Seafarers and the Seafarers Hospital Society provide excellent support and resources aimed at seafarers’ mental health too.

Further support services such as Big White Wall offer anonymous digital support to help people experiencing common mental health problems, such as depression and anxiety: helping them to manage their own mental health whilst at sea.

Excellent targeted publications and guidance documents are also starting to emerge. In 2016, the publication titled ‘Managing Traumatic Stress – Guidance for Maritime Organisations’ was published. The guidance is authored by Professor Neil Greenberg, Professor of Defence Mental Health at King’s College London and aims to provide top-level guidance to senior management to help improve the mental health of seafarers: offering education and evidence-based approaches specifically designed for the maritime industry.

What’s lacking?
Getting guidance from a healthcare professional as early as possible is key to tacking mental illness according to the Mental Health Foundation. “If you are concerned that you are developing a mental health problem you should seek the advice and support of your GP as a matter of priority,” they advise.

That’s all very well, but not all seafarers have the luxury of a company doctor. In fact, the vast majority of ships don’t. So, what are the rules regarding access to professional healthcare offshore? Well, shipowners are obliged under MLC 2006, to ensure that they provide, ‘access to prompt and adequate medical care whilst working on board.’ Seafarers should also be provided, ‘with medical care as comparable as possible to that which is generally available to workers ashore.’

That said, the average merchant vessel is staffed by less than 25 people, meaning it’s not mandatory to have a doctor on the vessel and this being the case, the vast majority of ships don’t benefit from having access to a medical professional offshore.
What needs to be done?

We must provide all seafarers with access to clinical professionals when they’re offshore: to diagnose mental health problems early and to allow on-going clinical engagement to track, advise and assess the condition of those suffering with mental health issues.
A new telemedicine solution called iVital could provide the answer, it gives seafarers access to top level healthcare at a small cost (under $10 per day), meaning it’s an accessible way to safeguard the mental wellbeing of those at sea. A complete solution, it offers the necessary hardware, software and specialist clinical service, which provides access to an entire team of medical experts who specialise in the health of seafarers.

Telemedicine: a quick diagnosis & ongoing professional, specialist care
Foolproof, the medically certified hardware and software can be used by anyone. Wireless sensors are attached to the patient and vital signs data can be transmitted to the clinician onshore. The clinician then uses the data, combined with the persons medical history and one-to-one video consultation with them, to make a quick and accurate diagnosis. Following diagnosis, scheduled follow-up appointments ensure continuation of professional, specialist care whilst the patient effectively manages the condition, or works towards recovery.

The impact on the mental health of those working at sea is huge, benefits include; increased patient engagement which enables the effective monitoring of mental health concerns whilst offshore; better patient care quality which is achieved through access to mental health clinical experts that specialise in seafarer health; quicker and more convenient clinical access which allows crew to have regular, scheduled as well as emergency mental health consultations; a reduction in lost time through mental illness thanks to early diagnosis and regular consultations to ensure the mental health of the patient does not deteriorate; & improved crew retention due to proper and thorough professional care delivered early and consistently which dramatically decreases the chances of the condition deteriorating and the crew member leaving employment.

What’s more, the solution dramatically reduces unnecessary patient evacuations and ship diversions due to mental health concerns. In fact, feedback from the International Maritime Health Association (IMHA) on telemedicine, outlines huge financial benefits to its use.

According to their study of 23,299 commercial ships with 420,000 crew members, one in five ships are forced to divert due to crew illness each year and the average cost per ship diversion is $180,000. In addition, their feedback suggests that it is possible to obtain a 20 percent saving to the industry from the deployment of telemedicine. If the prediction of the IMHA is correct, then this will equate to an industry saving of $168 million per year.