Mental Health

Depression is not only one of the most common mental health conditions but also one of the main causes of disability across the world. The WHO have estimated that approximately 264 million people are affected by this condition with research showing that women are more affected by this than men.

The impact of depression on an individual's ability to function can be severe, and as a result, it is a leading cause of disability worldwide. In fact, the WHO estimates that depression is the leading cause of disability globally, accounting for nearly 7% of all disability-adjusted life years (DALYs).

The condition is described as someone who is experiencing extreme sadness, loss of interests or pleasures, feelings of guilt, have a low self-worth, disturbed appetite or sleep, tiredness and poor concentration, for most of the day, nearly every day for a period of at least two weeks.

These physiological effects can also come with physical complaints with no apparent physical cause. It can be recurrent or long-lasting and can severely impact someone’s ability to function at work or cope with daily life.
 

The National Institute of Mental Health (NIMH) states that anxiety involves a prolonged period of feeling worried or fear. With a person that is suffering from anxiety, the anxiety does not just go away and may get worse over time.

There are various types of anxiety conditions, including Generalised Anxiety Disorder (GAD), panic disorder, Post-Traumatic Stress Disorder (PTSD) and various phobia-related disorders.

Anxiety and stress are often confused, with stress being a response to an immediate threat, while anxiety is a prolonged experience without a clear trigger. However, stress can often lead to anxiety, making it crucial for seafarers to address and manage any negative stress they may encounter.

People who suffer from GAD exhibit extreme anxiety or worry on most days for a minimum period of a least six months. The signs and symptoms of GAD may include, but are not limited to, the following:

• Feel unsettled and fidgety.
• Easily worn out and tired.
• Difficulty concentrating.
• Easily irritated or bad-tempered.
• High blood pressure.
• Constantly worrying and feeling overwhelmed.
• Either sleeping too little or too much with unrestful sleep.

WHO’s statistics have stated that this condition affects approximately 45 million people worldwide. The condition consists of both depressive and manic events. These may be separated by periods of stable moods or move straight from a depressive event to a manic event or vice versa. When a person is experiencing these manic events, the behaviour consists of irritable or elevated mood, rapid speech, over-activity, inflated self-esteem, and a decreased need for sleep. When a person is experiencing a depressive event, they will exhibit the same signs and symptoms of depression.
 

Psychosis refers to a significant alteration in a person's perception of thoughts, mood, and behaviour. It is not a mental health condition but a collection of symptoms.

Stress is a common factor associated with psychosis, which can be triggered by physical, environmental, emotional, or chronic stress. Other factors that can cause psychosis include alcohol and drug abuse, traumatic events, acute life events, reactions to prescription medication, or physical conditions such as brain tumours.

Psychosis can cause distortions in thinking, perception, emotions, language, sense of self, and behaviour, including hallucinations, delusions, and disorganised speech or behaviour. Negative symptoms, such as limited speech, emotional apathy, and difficulty experiencing pleasure or cognitive skills, can be equally debilitating.

Short-term treatment may be necessary for individuals who experience isolated psychosis events in their lifetime.

Schizophrenia is a mental health condition where a person experiences prolonged periods of psychosis, requiring long-term treatment. Approximately 24 million people are affected by schizophrenia, and medical advancements have improved recovery rates.

With treatment, 33% of people with schizophrenia can fully recover, and 50% can improve their functioning with minimal relapses.
 

The following are some strategies to help seafarers while at sea:

• Monthly mental health briefings or monthly mental health drills:

These sessions equip the crew to acquire the required knowledge and coping strategies to manage stress, enhance their well-being, and effectively recognise and handle mental health challenges. The sessions also serve as a platform for seeking guidance from mental health professionals, breaking down stigmas related to mental health, and encouraging early intervention and treatment. Emphasis on self-care and stress management practices, along with providing information about available resources and services, further bolsters the crew's mental health and well-being.

• Talk Time:

Designating a specific time and place where the crew can come together to talk and listen to one another about stress and fatigue, ensuring that the crew feels safe and supported during these conversations. Encouraging active listening, empathetic responses, and non-judgmental attitudes can help to create a culture of openness and understanding.

• Apprenticeship style training:

Where possible, try practical arrangements such as assigning less complicated tasks to less experienced individuals; slowly introducing them to harder tasks or pairing them with more experienced seafarers especially for trainees such as cadets and junior ratings. 

• Breathing exercises:

These can help calm the body during a mental health-related reaction, which often triggers the 'fight or flight' response, leaving the individual feeling hyper-aroused or hyperventilating. Controlled breathing can slow down the respiration rate, ensuring sufficient oxygen in the bloodstream and reduced levels of carbon dioxide. These exercises are easy to perform and can be done anywhere, providing anxiety relief for seafarers.

• Muscle relaxation exercises:

One of the first indicators of stress is muscle tension. With the individual learning and practicing muscle relaxation techniques such as progressive muscle relaxation, autogenic training, visualisation, yoga, and mindful relaxation, they can pick up the early warning signs of growing tension and work successfully to ease them. These exercises are best used on a break or before bed and can be difficult to perform at workstations.

• Sport facilities:

Engaging in sports, such as basketball, can effectively alleviate stress by triggering the release of endorphins in the body. These hormones, produced by the brain, have pain-relieving and stress-reducing properties. It is advisable to allocate time for group sports activities in the ship's schedule.

• Recreational activities:

Participating in group activities such as table tennis, darts, barbecues, karaoke, card and board games, and bingo (with prizes) can foster a sense of value, belonging, and attachment. These activities have been known to alleviate stress, anxiety, and depression among seafarers. Moreover, they can help seafarers cultivate confidence, build friendships, and enhance team communication.

• Mindful Moments:

Going outside for fresh air on deck and take time to appreciate the environment. The steps to follow can be seen in our poster - REACT! Mental Health 02
 

Companies should prioritise mental health promotion in the same manner as health, welfare, and safety. This can be achieved by establishing a culture that supports mental well-being, regularly communicating it to employees and demonstrating it through role models. They must also conduct risk assessments and management in the workplace, particularly on aspects that could affect mental well-being negatively. Although some factors that contribute to seafarers' mental health issues are beyond the company's control, they can still focus on mitigating the potential impact or likelihood of these risks through intermediate steps.

Companies could consider making changes that can improve a seafarer’s mental wellbeing such as:

• Consultations with crew members.

• Training for seafarers in identifying and recognising stressful situations.
• Interviews with seafarers regarding post-sick leave when they return to work.
• Looking into staff suggestion surveys.
• Place senior officers on Mental Health Awareness and Wellbeing training courses.

In terms of the workplace conditions the following should be examined but not limited to the following:

• Length of contract.
• Shift patterns/hours of rest.
• Frequency of port calls.
• Availability of shore leave.
• Crew accommodation.
• Recreational facilities.
• On-board food and catering.
• Communication facilities – this includes internet access.
• Quality of shipboard management.
• “Macho” culture, or where a culture accepts harassment and bullying.
• Crew composition, such as nationalities, ages and genders.

There have been reports stating that seafarers at times can feel isolated on board and sometimes retreat to their bunks, which reduces social interaction. However, this is not always a cause for concern, but there should be measures in place to encourage interactions. This can include the following:

• Provision of communal recreational facilities.
• Organisation of activities that promote interaction amongst crew members.
• Facilitation of pastoral visits to ships from providers of port welfare services.
• Creating mental health organisational policies and procedures.
• Provide information on where the seafarers may be able to receive support whether this is from internal/external counselling services or a telephone advice line like the Sailors’ Society.

The future generation seafarers may not be accustomed to a work environment that lacks internet connectivity, and while some companies may be unable to consistently provide the necessary bandwidth, it is important to consider that a lack of internet access could hinder their ability to attract and retain the next generation of workers.

Finally, it is important to note that diet can impact both mental and physical health. To improve the wellbeing of their crews, Companies may consider implementing food programs that aim to improve and diversify their diets. Some studies have shown that these programs can yield significant results and are well-received by seafarers. Companies can also tailor onboard meal plans and provisioning to accommodate the cultural and religious backgrounds of their crew members, promoting inclusivity and individual wellbeing.
 

It is essential that the Master and senior officers are aware of the psychological impact of stress and mental health issues and should be made aware of the short and long-term consequences of stress.

The Master and senior officers should also:

• Establish prevention and minimisation programs.
• Be able to identify crew suffering from issues.
• Put in place essential support if required – including Masters, officers and senior crew members being trained in mental health first aid.

Additionally, the following behaviours, should be identified as a sign of poor mental health: 

• Withdrawing and isolating themselves in their cabins.
• Acting out of character.
• Appearing distressed.
• Irritable and agitated.
• Unable to manage their workload.
• Prone to conflicts and aggressive behaviour.
• Trouble concentrating and seem confused.
• Arriving late for shifts.
• Change in appetite.

In case of a mental health emergency concerning any crew member, it is essential to adhere to the DR EFG protocol which is outlined in our REACT! Mental Health 03 poster. Additionally, if any of the situations mentioned below occur, it is imperative to contact the designated telemedicine provider without delay:

• There is an immediate danger of harm to an individual or others.
• The individual is contemplating suicide.
• The situation exceeds the expertise of the Master or senior officers.
• The individual has engaged in self-harm, such as bleeding, overdosing, or considering self-injury or harm to others.
• The individual has sustained a self-inflicted injury.