Seafarers’ mental

health and wellbeing

Helen Sampson and Neil Ellis, Seafarers International Research Centre,
School of Social Sciences, Cardiff University

www.iosh.com/seafarerswellbeing Research report

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Acknowledgement: IOSH would like to thank the peer reviewers of this report.
Contents
Abstract ....................................................................................................................................................... 1
Executive summary ..................................................................................................................................... 1
The research sought to address the following questions: .................................................................. 1
The following approaches to data collection were taken: .................................................................. 1
The research found that: ..................................................................................................................... 2
The report concludes that: .................................................................................................................. 3
General recommendations are made as follows: ............................................................................... 3
Specific recommendations are made as follows: ................................................................................ 3
Introduction ................................................................................................................................................ 5
Overview of existing evidence .................................................................................................................... 6
Seafarers’ mental health ..................................................................................................................... 6
The status of seafarers’ mental health................................................................................................ 6
Factors undermining seafarers’ mental health ................................................................................... 7
Suicide ................................................................................................................................................. 7
Repatriations and medical assistance ................................................................................................. 8
Method ....................................................................................................................................................... 8
Findings ..................................................................................................................................................... 10
The attitudes of key stakeholders to the issue of mental health among seafarers .......................... 10
Figure 1: Number of mental health cases by P&I club ...................................................................... 12
Figure 2: Number of suicide cases by P&I club.................................................................................. 12
The factors and features of life on cargo vessels that seafarers identify as supporting or
undermining good mental health and wellbeing .............................................................................. 15
Contextual features ........................................................................................................................... 16
Factors inducing happiness and unhappiness on board and at home .............................................. 16
Figure 3: Things that made seafarers happy/very happy on board ship ........................................... 18
Figure 4: Percentage of seafarers who had access to the following things on board ....................... 19
Loneliness at sea and at home .......................................................................................................... 19
Factors that had caused seafarers to feel ‘down’ ............................................................................. 19
Policies and practices that could be implemented by ship operators and/or welfare bodies to
provide better support for the mental health and wellbeing of seafarers ....................................... 22
Strategies employed by seafarers to combat loneliness ................................................................... 22
Figure 5: What seafarers did on board to make themselves feel better when they were lonely ..... 22
Strategies employed by seafarers to combat feelings of depression................................................ 23
Figure 6: Top three things that would make life on board better/happier for seafarers ................. 24
Discussion.................................................................................................................................................. 25
Conclusion ................................................................................................................................................. 26
General recommendations ............................................................................................................... 26
Recommendations for specific measures ......................................................................................... 27
References ................................................................................................................................................ 29
Appendix 1 – Respondent demographics – seafarers’ questionnaire ............................................... 32
Appendix 2 – Open responses to the seafarers’ survey question, ‘What activities make you happiest
at home?’ .......................................................................................................................................... 35
Appendix 3 – Open responses to the seafarers’ survey question, ‘What activities make you happiest
on board?’ ......................................................................................................................................... 37
Appendix 4 – Open responses to the seafarers’ survey question, ‘What things make you saddest at
home?’ .............................................................................................................................................. 39
Appendix 5 – Open responses to the seafarers’ survey question, ‘What things make you saddest on
board?’ .............................................................................................................................................. 40
Appendix 6 – Open responses to the seafarers’ survey question, ‘What do you do to make yourself
feel better AT HOME when you are lonely?’ ..................................................................................... 41
Appendix 7 – Open responses to the seafarers’ survey question, ‘If you feel down or depressed ON
BOARD what do you do to cheer yourself up?’ ................................................................................. 42
Appendix 8 – Open responses to the seafarers’ survey question, ‘If you feel down or depressed AT
HOME what do you do to cheer yourself up?’ .................................................................................. 43
Appendix 9 – Open responses to the seafarers’ survey question, ‘What do you think companies
could do to reduce depression and anxiety for seafarers while they are on board?’ ....................... 44
Appendix 10 – Survey of Seafarer Repatriation ................................................................................ 46
We would like to thank all participants who gave up their time to help us with this study.
Abstract
This research has sought to provide fresh insight into the issue of seafarers’ mental ill health. Existing
studies have been hampered by the difficulties associated with accessing sufficient information about
international seafarer populations and their mental health status to allow for comparisons to be made with
other workers and/or over time. This research adopted a different approach to the issue and sought to
clarify whether mental ill health among seafarers is considered to be a significant problem by key
stakeholders; what factors seafarers identify as supporting or undermining mental health and wellbeing
on board cargo ships; and what policies and practices could be implemented by ship operators in order to
provide better support for seafarers’ mental health and wellbeing. The research combined the use of
questionnaires, interviewer-administered questionnaires, semi-structured interviews and an analysis of
secondary data provided by insurance companies (known as P&I clubs). The study concluded that
seafarers’ mental health and wellbeing is of considerable concern to maritime charities, employer
associations and trade unions. It is, however, regarded as a less pressing problem by employers. The
research found that seafarers and some employers advocate proactive measures to improve the
shipboard communications infrastructure and available recreational facilities, seafarers’ employment
terms and conditions and physical health in support of better mental health and wellbeing on board.
These measures are likely to be more effective in improving happiness and mental health and wellbeing
on board than current reactive strategies (e.g. the provision of counselling to seafarers) and self-help
strategies targeted at seafarers.

Executive summary
In the context of growing concerns about mental health and wellbeing at work, this research set out to
explore mental health and wellbeing among seafarers working in the international cargo shipping industry.

The research sought to address the following questions:

1) In the context of changes to shipboard work and life in the 21st century, are mental health
problems among seafarers considered to be a significant problem by key stakeholders within the
international cargo shipping industry?

2) What factors and features of life on cargo vessels do seafarers identify as supporting and/or
undermining good mental health and wellbeing?

3) What policies and practices could be implemented by ship operators and/or welfare bodies to
provide better support for the mental health and wellbeing of seafarers?

The following approaches to data collection were taken:

1) A review of relevant literature was conducted.

2) A questionnaire was sent to a small, randomly generated, sample of HR managers working in ship
operating companies.

3) An interviewer-administered questionnaire was employed with a large sample of seafarers.

4) Interviews were conducted with employers, seafarers, maritime charities and stakeholder organisations.

5) Interviews were conducted with P&I clubs, which serve as insurers to ship operators, and requests
for data were also made to them.

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The research found that:

1) It is difficult to establish the extent of the problem of mental ill health (and suicide) among seafarers
relative to comparable populations.

2) There is evidence of an increase in recent-onset anxiety and depression among serving seafarers.

3) There is evidence that in some roles seafarers may be particularly prone to emotional exhaustion and
‘burnout’.

4) Significantly more seafarers report being happy or very happy at home than report being happy or very
happy on board.

5) Seafarers were significantly more likely to report being lonely at sea than at home.

6) Mental health and welfare is identified by maritime charities, P&I clubs and stakeholder organisations as
an important issue.

7) Employers do not recognise the importance of mental health and welfare on board to the same extent
as maritime charities and stakeholders.

8) Employer records and records obtained from P&I clubs do not provide evidence of an increasing
problem of repatriations as a result of mental ill health or of suicides among seafarers.

9) Isolation, loneliness, lack of shore leave, fear of criminalisation, fear of job loss and separation from
family all predispose seafarers to mental ill health.

10) Maritime stakeholders and charities are inclined to recommend proactive self-help guidance for
seafarers and reactive services in support of seafarers. They are less likely to recommend proactive
changes to seafarers’ terms and conditions of work and shipboard life.

11) Employers and seafarers recognise the significance for mental wellbeing of proactive changes to
conditions of shipboard life and work.

12) Some employers have adopted a wide-ranging approach to improving seafarers’ mental health and
wellbeing on board, which includes proactive changes to terms and conditions of employment as well as
improvements to quality of shipboard life. However, 55% of employer respondents stated that their
companies had not introduced any policies or practices aimed at addressing issues of seafarers’ mental
health in the last 10 years.

13) Most of the activities that seafarers identified as making them happy at home were not available to them
at sea (many involved interactions and activities with families and friends, for example).

14) Seafarers were able to identify a range of things that had the potential to make them happy on board.
However, in many cases they described how these were not available on their current vessel.

15) When they were experienced, family-related problems caused most seafarers to feel down/depressed
on board.

16) Various ship-specific factors caused seafarers to feel down such as too much work, being unable to
take shore leave and poor food.

17) Various crew-related factors caused seafarers to feel down such as having a ‘bossy captain’,
experiencing discrimination, being blamed for things and falling out with superiors and other colleagues.

18) Getting tired was identified by the majority of seafarers as an underlying cause of shipboard depression,
as was boredom.

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19) Seafarers reported a range of shipboard strategies that they used to combat depression, including
recreational activities and interactional activities.

20) Seafarers identified the provision of free internet access as the most significant contribution that could
be made by employers to the improvement of mental health and wellbeing on board. Alongside free
internet provision, they identified a range of areas where employers could take action in support of
mental wellbeing on board. These included terms and conditions of work, relationships on board,
physical health, accommodation and recreation.

The report concludes that:

Strategies to support good mental health need to be orientated towards proactive shipboard
improvements designed to stimulate positive social interaction (with those on board and those ashore)
and to improve opportunities for seafarers to relax, recharge and uplift their mood. Improvements in terms
and conditions in support of a good work-life balance for seafarers are also required.

General recommendations are made as follows:

1) Companies and stakeholders should take steps to address the significant difference found between the
happiness levels of seafarers when they are on board and when they are at home.

2) Companies and stakeholders should be aware of the evidence indicating that recent-onset
psychological disorders are increasing among serving seafarers.

3) Companies and stakeholders should recognise the importance of good mental health and wellbeing in
the cargo shipping industry.

4) Companies and stakeholders should reconfigure their efforts to support mental health and wellbeing on
board in order to proactively reduce the incidence of unhappiness and of recent-onset anxiety and
depression among seafarers.

Specific recommendations are made as follows:

1) Free and unlimited internet should be made available to all seafarers on board all cargo vessels.

2) In recognition of the differences between individuals, a varied menu of interactive recreational

activities should be available to seafarers on board.

a) As a minimum, one of the following activities should be facilitated on board: basketball, squash,
swimming.

b) In addition, a minimum of four of the following activities should be facilitated on board: table
tennis, darts, barbecues, karaoke, card and board games, bingo (with prizes).

3) In recognition of the differences between individuals, a varied menu of solitary recreational

activities should be available to seafarers on board.

c) As a minimum, a dedicated gymnasium with three different pieces of equipment should be

provided.

d) In addition, a minimum of two of the following should be provided: a sauna, a book and DVD
library, satellite TV within cabins, a library of interactive video games.

4) Comfortable mattresses and furnishings within cabins should be prioritised to facilitate rest and
sleep.

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5) Shore leave should be provided at every opportunity and for all ranks.

6) Varied, good-quality food should be provided on board and a feeding rate of at least US$11.00 per
person should be allocated to each vessel.

7) Self-help guidance on improving mental resilience should be provided to all seafarers.

8) Contracts should balance work and leave time for all ranks in a ratio not worse than 2:1 and with
an upper limit of a maximum of six months on board.

9) Anti-bullying and harassment policies should be introduced and enforced.

10) Officers should receive training in creating a positive atmosphere on board, including via the
provision of positive feedback on work, when appropriate, and respectful interactions with
subordinates.

11) Confidential counselling services should be made available to seafarers.

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Introduction

Work constitutes a major part of life for many people. In the UK, there were an estimated 32.48 million
people in work in the period August to October 2018 (Office for National Statistics
https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/bullet
ins/uklabourmarket/december2018 – accessed 9/4/19).
The UK Health and Safety Executive reports that, in the period 2017/2018, of the 30.7 million working
days lost due to work-related ill health and non-fatal workplace injuries (Labour Force Survey), 15.4
million were related to stress, depression or anxiety (http://www.hse.gov.uk/statistics/dayslost.htm –
accessed 9/4/19). This makes mental health a major cause of lost working time in the UK, resulting in a
significant cost to the economy.
However, this is not a UK-specific problem. In 2011, Wittchen et al1 published a systematic review of
mental disorders in the EU-27, Switzerland, Norway and Iceland. They concluded that approximately
38% of the EU population suffers from a mental disorder each year and were unable to uncover
substantial country variations (Wittchen et al 20111). In 2018, the World Health Organization estimated
that 300 million people suffered from depression, noting that ‘The burden of mental disorders continues to
grow with significant impacts on health and major social, human rights and economic consequences in all
countries of the world’ (https://www.who.int/news-room/fact-sheets/detail/mental-disorders – accessed
9/4/19).
Having been overlooked and considered taboo for many years, the importance of mental health and
wellbeing has been given greater prominence in the media in recent years. In the UK, this has been
spurred on by the efforts of major public figures (for example the Dukes and Duchesses of Cambridge
and Sussex via their ‘Heads Together’ initiative) who have engaged in campaigns to promote greater
social awareness of mental health issues in society and to simultaneously reduce the stigma that is
commonly associated with mental health challenges. Such media exposure combined with concerns
raised by governmental and non-governmental authorities at both the global and national level have led
to many industries examining the issue of work and mental health more closely. For example, the
Confederation of British Industry published research on the issue in 2018, highlighting ‘both the business
and moral case for making progress in this area’ (https://mhfaengland.org/mhfa-centre/news/cbi-front-of-
mind/ – accessed 9/4/19). In shipping, this concern has been shared by the UK Chamber of Shipping and
related stakeholders.
However, despite recently expressed concern for the mental health of seafarers, it is apparent that there
is conflicting evidence relating to the scale of the problem within the international cargo shipping sector
and conflicting views about the potential usefulness of a variety of approaches aimed at reducing the
prevalence of mental health problems on board. These oppositions are underpinned by a lack of
available evidence relating to the sector. Maritime Administrations are required to collect data on serious
incidents on board, which are usually defined as fatalities. In relation to physical or mental illness,
however, there are no such requirements and, in any case, most Maritime Administrations do not collect
population data, so it is impossible to construct fatality rates or indeed suicide rates. This makes it very
difficult to establish trends and to make comparisons over time or with other industries. As a result,
interested parties have relied on a very few sources of data, all of which carry with them particular
drawbacks in terms of providing a representative picture of the issues of interest, on a global scale.
In order to make a significant contribution to our understanding of the related issues, this study has taken
a fresh approach to the problem and has set out to address the following questions:
1) In the context of changes to shipboard work and life in the 21st century, are mental health problems
among seafarers considered to be a significant problem by key stakeholders within the international
cargo shipping industry?

2) What factors and features of life on cargo vessels do seafarers identify as supporting and/or
undermining good mental health and wellbeing?

3) What policies and practices could be implemented by ship operators and/or welfare bodies to provide
better support for the mental health and wellbeing of seafarers?

5
In this report we begin with an outline of the existing data and related literature. We outline the methods
utilised in this new research. We present the findings from the study and we complete the report with a
discussion, conclusion and set of recommendations.

Overview of existing evidence

There are three bodies of publicly available knowledge and evidence that are of particular relevance to
concerns about the mental health and wellbeing of seafarers. The first specifically addresses the issue of
seafarers’ mental health. The second relates to suicides at sea, and we review this literature here on the
basis that suicide in the context of shipboard work can normally be linked to a mental disorder. In doing
so, we distinguish between suicide as the ultimate indicator of a failure to cope with daily life and suicide
that can be understood as a rational act (in the face of a terminal prognosis, for example). When suicide
occurs on board it is highly unlikely that it is of the latter kind. Finally, we consider a relatively new body of
evidence relating to the repatriation of seafarers in combination with a longer standing (but small) body of
work concerning medical attendance in relation to seafarers.

Seafarers’ mental health

The literature on seafarers’ mental health has focussed on two related areas. Firstly, authors have sought
to present evidence relating to the question of how seafarers’ mental health problems compare with peer
groups ashore – their mental health status. Secondly, there has been an interest in discussion of the
factors that may contribute to poor mental health among seafarers on board.

The status of seafarers’ mental health

There is relatively little empirical work relating to seafarers’ mental health (Melbye and Carter 20172) and
how this compares with the general population. This is seen as being partly due to a historic lack of
interest in the topic (International Committee on Seafarers’ Welfare 20093), which may relate to the
transient nature of employment across the seafarer population (Beechinor 20174). However, it is also
likely to relate to the considerable challenges that are associated with assessing rates of mental ill health
within the seafarer population. There are several dimensions to this challenge. Firstly, seafarers are
largely recruited on temporary voyage-based contracts (Sampson et al 20185) which are only awarded on
successful completion of a medical examination. This tends to screen out unhealthy workers, leading to a
particularly strong ‘healthy worker effect’ (McMichael 19766, Oldenburg et al 20097) which cannot be
adequately compensated for with use of appropriate reference groups (Shah 20098). This makes it very
difficult to compare the mental health status of seafarers with other groups. Secondly, seafarers are a
remote and dispersed group of workers who are extremely difficult to access. Thirdly, and relatedly, it is
very difficult to obtain a random sample of international seafarers employed by different organisations.
The modest quantities of available evidence seem to indicate higher levels of psychiatric disorders
(Sampson et al 20179) and associated conditions such as alcoholism (Olkinuora 198410, Roberts 200511)
among seafarers than many other occupational groups. In a rare contemporary comparative study of the
health of active seafarers, Sampson et al (20179) found that short-term psychiatric disorders had
increased among seafarers in the period 2011–2016. In 2016, 37% of active seafarers were found to
have experienced a recent-onset deterioration of mental health. The study concluded that while this
figure did compare favourably with some studies of the general population, it compared unfavourably with
most. Furthermore, the authors considered the deterioration in seafarers’ mental health over a relatively
short period of time to be a cause for concern (Sampson et al 20179).
In early studies, consideration was given to the question of whether the seafaring occupation was behind
the development of psychiatric disorders or alternatively whether it was more likely that people with, or
susceptible to, psychiatric disorders would become seafarers (Brandt et al 199412). Some credence was
lent to the latter hypothesis by epidemiological work on Norwegian males from a variety of occupations
(Sundby and Nyhus 196313). More recently, however, studies (based on single nationality samples of

6
seafarers) have suggested that the occupation of being a seafarer presents a risk in relation to
psychiatric diagnosis (Hemmingsson et al 199714). Furthermore, there is evidence that some ranks of
seafarers (galley staff in particular) may suffer higher levels of emotional exhaustion and moderately
elevated levels of what is termed ‘burnout syndrome’ than employees in other occupations (Oldenburg et
al 201315).

Factors undermining seafarers’ mental health

There are many factors that may be considered to undermine seafarers’ mental health and wellbeing.
Some of these can be seen as factors that are generic across the occupation and others relate more to
some shipboard positions than others.
Generic predisposing factors that may be regarded as inherent to the seafaring profession overall include
isolation and loneliness (Melbye and Carter 20172, Jepsen et al 201516, Borovnik 201117, Oldenburg et al
20097), lack of shore leave (Borovnik 201117, Iverson 201218, Martek Marine 201719), bullying (Martek
Marine 201719, Iverson 201218), fear of criminalisation (Iverson 201218, Martek Marine 201719,
International Committee on Seafarers’ Welfare 20093), fear of job loss (Swift 201520, Jezewska et al
201321) and separation from family (Oldenburg et al 201315, Carotenuto et al 201222, Iverson 201218,
Jezewska and Iverson 201223, Borovnik 201117, Jepsen et al 201516, Jezewska et al 201321).

There is little consensus over which roles on board carry higher challenges for mental health. However,
there is agreement that risk exposure in terms of mental ill health does vary with rank and role on board
(Melbye and Carter 20172, Lefkowitz et al 2015a24, Carter 197625, Levy 197226, Carotenuto et al 201222,
Elo 198527). Officers are generally regarded as having more psychiatric problems than ratings (Melbye
and Carter 20172, Lefkowitz et al 2015a24, Carter 197625, Levy, 197226). However, both engineers and
engine crew have also been identified in the literature as more prone to mental health problems than
other seafarers (Carotenuto et al 201222, Elo 198527).
Other factors have also been linked to differences in mental health outcomes among seafarers. Shift
work (practised more frequently by some ranks than others on board) has been identified as a risk factor
by Jepsen et al (201516) and Filipinos have been identified as less likely to present with psychiatric
disorders on board (Bell and Jensen 200928, Grøn and Knudsen 201229) as a result of both pre-
employment medical screening and under-reporting (Grøn and Knudsen 201229).

Suicide

In extreme cases, poor mental health and the presence of depression may result in suicide among
seafarers (Szymanska et al 200630, Borch et al 201231). There is, however, relatively little robust evidence
relating to suicide rates among seafarers, making the contemporary situation across the international
fleet very difficult to gauge. This is partly due to the absence of contemporary population data, which are
necessary to construct rates, and partly due to the difficulties that are inherent in the process of
identifying suicide cases (Bedeian 198232). Nielsen describes the difficulties faced by all researchers very
clearly in discussing his study of deaths at sea on board Hong Kong-registered ships. He writes that:
[…] the third biggest cause of death is ‘individual persons missing at sea’. Classifying these
disappearances is a difficult task as the cause could be suicide, homicide, or an accident. In seven
of these cases there was no clear evidence to support a different characterisation, i.e. accident or
suicide. Four of the missing persons had been on-duty but they were catering personnel or engine
ratings with no direct necessity to work on deck. The other three missing persons were off-duty,
two of them being the master of the ship. For the eighth case no details were available in the case
file except for the fact that the seaman was missing. In the last case there was a confirmation that
the victim had actually been working on deck. However, as there were no witnesses to his
disappearance, the case was allocated to the ‘missing’ category. (Nielsen 1999:12933)

The robust data that do exist are largely based on national studies. Some studies are clear that suicide
rates are historically higher among seafarers than populations ashore (Szymanska et al 200630,

7
Wickstrom and Leivonniemi 198534, Roberts et al 201335, Roberts et al 201036, Brandt et al 199412) while
others suggest that contemporary rates of suicide among seafarers are more broadly comparable with
the general population (Roberts et al 201036). There are indications that seafarers are more at risk of
suicide in deep-sea trades (Roberts and Marlow 200537, Roberts and Williams 200738), that rates of
suicide among some national groups of seafarers are falling (Roberts and Marlow 200537 , Borch et al
201231), and that some departments (notably catering), nationalities (Roberts et al 201036) and ranks
(notably ratings) may have higher associated risks of suicide (Roberts and Marlow 200537, Szymanska et
al 200630, Wickstrom and Leivonniemi 198534, Brandt et al 199412, Roberts et al 201036). Very few
international studies of suicide have been attempted with reference to data from open registers (also
termed ‘flags of convenience’). This is largely due to access difficulties (Nielsen 200139). However, in
2019 a study of fatalities in the international fleet was published by the Seafarers International Research
Centre. It indicated that suicides were infrequently recorded as discrete events by Maritime
Administrations, making data analysis challenging and confident interpretation of data at the current time
pretty much impossible (Sampson and Ellis 201940). Over a period of 17 years the study identified 38
cases of suicide, which represented 3.7% of all fatalities. However, the authors noted that only four cases
of suicide had been recorded by any of the seven administrations in the period 2000–2006, and that three
of the administrations did not record a single suicide in the whole period. This was regarded as indicative
of considerable under-reporting/recording (Sampson and Ellis 201940).

Repatriations and medical assistance

The patchy nature of the available data on seafarers’ mental health and associated suicides has led to
some researchers studying data on repatriations and medical assistance to consider what they reveal
about psychological disorders among contemporary seafarers. Lefkowitz et al (2015b41) considered a
telemedicine database of 3,921 seafarers requiring medical assistance/advice, of which 61 cases
resulted in repatriation. They found that the incidence of psychiatric illness was relatively low among
seafarers for whom assistance was sought (0.6%) but that psychiatric cases were disproportionately
represented among repatriations (5%), emphasising the severe consequences of psychiatric illness on
board. Abaya et al (201542) considered repatriation rates among Filipino seafarers via an examination of
the records of local manning agents over a five-year period. Of 6,759 cases, just 1.8% related to
psychiatric disorders, which were most commonly identified as depression but also included cases of
anxiety, depression, schizophrenia and bipolar disorder. Much higher rates of anxiety, depression and
self-harm were identified in a study by Bell and Jensen in 200928, however. On examining the
international fleet medical records of crew employed by P&O Princess Cruises, they identified 8.3% of
repatriations to be due to psychiatric conditions.
While repatriation data have the potential to add valuable insights into severe cases of mental ill health, it
is likely that many seafarers who are aware of a deterioration in their mental health suffer in silence while
on board and may seek repatriation on alternative grounds that are less likely to jeopardise their future
work opportunities.

Method

Given the limitations faced by researchers attempting to examine the extent of seafarers’ mental ill
health, the rates of suicide among seafarers and the proportion of mental ill health cases found among
repatriated seafarers, this research set out to address the problem using a different approach. As such,
we were interested in answering the following questions:
1) Are mental health problems among seafarers considered to be a significant problem by key
stakeholders within the international cargo shipping industry?
2) What factors and features of life on cargo vessels do seafarers identify as supporting and/or
undermining good mental health and wellbeing?
3) What policies and practices could be implemented by ship operators and/or welfare bodies to
provide better support for the mental health and wellbeing of seafarers?

8
In order to assess the perceptions of stakeholders we undertook a review of ‘grey literature’ relating to
seafarers’ mental health, we interviewed a small number of stakeholders (10), we visited P&I clubs and
conducted semi-structured interviews with claims handlers and key personnel (15) and we analysed the
results from a questionnaire sent to HR managers in ship operating companies (43).
In order to gain an understanding of the factors which seafarers identify as supporting or undermining
their mental health on board, we carried out a total of 1,507 interviewer-administered questionnaires and
a small number of semi-structured interviews (5) with active seafarers. These seafarers were located in
seafarers’ centres or were found and interviewed on board while their ship was berthed in a port.
We analysed these combined data to allow us to make recommendations for good practice in support of
seafarers’ mental health and wellbeing.
All semi-structured interviews were conducted face to face* or using Skype.† They were recorded and
transcribed and were thematically coded utilising NVivo software.
The sample of companies included in the survey of HR managers was selected randomly using a
database of companies named Seaweb. Seaweb provides:
600+ data fields on 200,000+ ships of 100 GT and above […] on ships, owners, shipbuilders,
ship movements, fixtures, casualties, ports, companies, as well as maritime news and analysis.
(https://ihsmarkit.com/products/maritime-ship-tracker-ais-live-ship-data-seaweb.html – accessed
16/5/19)
After an initial trial, we ascertained that the database could provide us with the information we required
and would allow us to construct a random sample of international cargo ship operating companies. A list
of companies operating at least 10 in-service cargo vessels over 1,000 GT was randomly generated and
the top 173 for whom HR manager contact details could be established were contacted by email and
asked to complete a questionnaire. Repeated follow-up was used until no further responses could be
elicited. The follow-up was initially by email, then by telephone and finally by post including hard copy
questionnaires. Of 173 companies contacted, responses were finally elicited from 43. Given the quality of
the information that was extracted from the questionnaire, this was deemed a satisfactory result. The
questionnaire asked HR managers to provide factual information about cases of death and repatriation in
the last 10 years as well as data on the numbers of seafarers employed. It was more demanding than an
opinion survey and we were therefore satisfied with the response rate of 24.9%, which we feel was the
best result that could be achieved in the circumstances. As a result of feedback from some companies
who did not return a questionnaire, we felt that non-participating companies were more likely to lack the
information we required than to have a particular orientation to the issues concerned, i.e. we did not feel
that participation or non-participation indicated experience or lack of experience of the associated issues.
One company wrote to us, for example, explaining that:
We are indeed always very interested to contribute to your great research work and the subject
of Mental Health is definitely a very important topic, which as well have our attention, as we
currently run various programs to address this.
However, we are unable to answer your questionnaire in the current form, as we do not have
detailed data dating back to 2006. (Ship company based in Singapore)

In relation to our seafarers’ questionnaire we had to take a different approach. Databases like Seaweb
are not available for seafarers and as a result we were unable to generate a random sample for use with
our seafarers’ questionnaire. We therefore utilised an alternative strategy and visited both individual ships
in the company of port chaplains‡ and seafarers’ welfare centres in the UK, Germany and Philippines to
complete interviewer-administered questionnaires with a large sample of seafarers (1,507). Seafarers
from a variety of cargo ships call at the ports concerned and make use of the seafarers’ welfare centres.
Crews of mixed nationality predominate in the international fleet, although it may be more likely that
seafarers of some nationalities and ranks make more use of welfare centres than others.

*
All interviews with seafarers and most interviews with P&I clubs were face to face.
†
All stakeholder interviews were conducted using Skype.
‡
Port chaplains have permission to visit ships and our researcher was permitted to accompany them. The choice of vessels to be
visited was made by chaplains and not by researchers.

9
In constructing our sample of stakeholders, we selected five companies which included both ship owners
and ship managers and very large and very small organisations. We included major charities/welfare
organisations and ship owner associations in our remaining selection. These selections were made using
our locally held knowledge of the sector and with assistance from key informants in organisations such as
Intermanager, which is the international trade association for ship management companies.

Findings

The attitudes of key stakeholders to the issue of mental health among seafarers

A review of recently published grey literature uncovered a significant quantity of articles published on the
issue of seafarers’ mental health in 2017 and 2018 (Blake 2017a43, ITF 201744, Martek Marine 201719,
Maritime Repatriations Limited 201745, Blake 2017b46, The Shipowners’ Protection Ltd 201747, Nautilus
International Telegraph 201748, Linington 201849, Westbury 201850, Seatrade Maritime News 201751, UK
Chamber of Shipping 201752, Safety at Sea 201753). Many of these appeared to have been triggered by a
paper delivered in Singapore by a member of the UK P&I club in 2016 highlighting problems of suicide in
the sector and by the subsequent publication of a report by SIRC comparing the health of seafarers in
2011 and 2016 (Sampson et al 20179). The UK P&I club subsequently produced a series of short videos
available on the internet. In one, Neil Beckwith, a Senior Claims Executive, explains that when analysing
their own data on mental health cases and suicides they found that 50% of all the suicides they had
handled had occurred in the most recent three years, 2014–16 inclusive.
(https://www.ukpandi.com/knowledge-publications/tmtv/video/in-relation-to-seafarers-how-important-is-
mental-health-9/ – accessed 16/5/19).
In this research, we interviewed 11 of the 13 P&I clubs that constitute the International Group of P&I
clubs. We also asked them if they could provide us with data relating to claims relating to repatriations on
mental health grounds.

It was clear from the interviews that while the majority of P&I clubs were more sensitive to issues of
mental health at the current time than they had been in the past, they didn’t have a strong feeling that
medical repatriations in general, or medical repatriations on mental health grounds, were increasing in
relation to the claims that they dealt with. As one interviewee explained:
I mean we’re attuned to them because we read all the articles and we are you know it's a very live
issue at the moment so we do notice them when they come in but I wouldn’t say that we’re being
flooded with such claims. You know we've always had the psychosis cases you know true
psychosis and they're not on the increase, we've always, well you know at the other end of the
spectrum you’ve got what they always term in the Philippines as adjustment disorder where
somebody just claims he's got insomnia and can't sleep and …[…] he's lonely and he's feeling
negative or whatever. So those are really difficult cases because anyone can go on the internet
and look up the symptoms you know if they want to go home before Christmas, they can't sleep,
can't eat, having negative thoughts. (P&I club 2)

Another endorsed the view that seafarers’ increased awareness of the discussion of mental health within
the industry (and the increased acceptance of it) might in itself increase the occasions when mental
health is recognised as part of a claim. However, they too felt sceptical about having seen any increase in
numbers overall.
Okay so we've established we don’t know for sure. I think we probably see more than we used to, I
don’t know how many more, but […] I don’t know how much that is because people are more
willing to talk about it. So a crew member who may have come up with some excuse to be
repatriated, I say excuse but you know on a different grounds before might now be more open
about it. […] So I think there's more talking about it now I'm not sure that the problem has
increased. (P&I club 5)

There was also an uncertainty in relation to suicide cases and a clear awareness of the challenges
associated with trying to ascertain whether problems of suicide were increasing or decreasing. P&I clubs

10
were aware that while they might know the number of suicides they had been told of in a given year, they
could not construct suicide rates as they had no idea how many seafarers were employed by their clients
in any given year. One interviewee put it this way:
Those figures, we broke them up by year and there was one big spike a couple of years ago, but
it’s fairly meaningless because you don’t know the number of seafarers that you’re… you need
suicides per head or suicides per vessel, if you don’t have that information you can’t… That’s
always been our problem in loss prevention. (P&I club 10)

They were also aware of the challenges that arise due to reporting inconsistencies which might be a
result of inconclusive evidence of suicide, concern for family members or fear of reputational damage on
the part of companies who might prefer not to admit to suicides having taken place on board their
vessels. Interviewees explained how:
I think people are being a bit more canny and won’t actually tell us it’s a suicide in the first place.
(P&I club 3)
And:
So something where you can say maybe he went that far accidentally then we deliberately wouldn’t
record suicide because then the family wouldn't be able to get the money and he wouldn’t
potentially be able to be buried in hallowed ground. […] Give the benefit of the doubt. So on the
one hand you want to get more, generally more data about suicides and understand it more but
actually from the mother and the family, from the local community, from a financial point of view,
from all of these things it's actually better that it's not officially recorded as suicide. (P&I club 5)

In addition to providing us with interviews, P&I clubs provided us with data, where they could, and from
these we were able to ascertain the percentage of crew illness claims that related to mental health
(including suicide cases). The lowest percentage of illness claims relating to mental health issues was
found to be 0.9% and the highest proportion was found to be 3.6%. The average across the four P&I
clubs that provided us with data was 2%. This indicates that mental health claims make up a very small
proportion of overall repatriation cases on the grounds of illness. In relation to trends and patterns, the
data did not reveal any discernible increase or decrease in mental health repatriations as a percentage of
overall ill-health repatriation cases. This was also true in relation to an analysis of the raw numbers (see
Figures 1 and 2). It was not possible to consider rates of mental ill health from the P&I club data as there
were no data relating to numbers of seafarers employed by P&I club members (i.e. ship operators
covered by specific P&I clubs) in any given year or time period.

11
Figure 1: Number of mental health cases by P&I club

35

30

25
Number

20

15

10

0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Club 3 Club 5 Club 8 Club 9 Club 11

Figure 2: Number of suicide* cases by P&I club

12

10

8
Number

0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Club 3 Club 5 Club 9 Club 10 Club 11

It was apparent, therefore, that among P&I clubs there was a raised awareness of, and concern about,
mental health problems among seafarers. However, this was largely as a result of concerns raised by
others and did not seem to be driven by intra-organisational evidence of an increasing problem nor was it
seen in numeric/financial terms a significant problem.

*
For Club 10 suicides include both affirmed suicides and assumed.

12
Articles written in stakeholder publications tend to highlight the problem of seafarers’ mental ill health and
then propose causes and call for action. The UK Chamber of Shipping, for example, published a blog in
201752 that stated:
Suicide rates* among seafarers have more than tripled since 2014, according to figures from the
UK P&I Club […] Today the rate of suicide for international seafarers is triple that of shore
workers according to the International Maritime Organisation […] Due to machismo cultures, high
levels of prejudice, and poor mental health education, crew are not always likely to seek
counselling or professional support, and this often leads to serious consequences […]
Confidentiality is another factor that prevents seafarers from seeking help […]
(http://www.ukchamberofshipping.com/latest/breaking-taboo-seafarer-mental-health/ – accessed
17/5/10)

In considering what might be done to alleviate the problems, the UK Chamber of Shipping’s blog touches
on generic factors that produce a poor environment for mental health such as isolation and working away
from communities, small crews, long hours and communication barriers. These could all be addressed by
ship operators with a range of proactive measures such as improving ratios of working time to leave time,
improving connectivity, placing more seafarers on board and so forth. However, in relation to remedies it
references more reactive strategies to do with awareness raising, counselling and self-help guides.
The UK Chamber of Shipping’s emphasis on reactive, and self-help, strategies to address the problem of
mental ill health at sea has been echoed in the solutions that have generally been offered to the industry
by a range of concerned charitable, and other, stakeholders. While they are mainly reactive, these do
incorporate some proactive solutions at the level of advice to seafarers about their own behaviours on
board. Few stakeholders have made recommendations relating to necessary proactive changes on the
part of employers. Among the solutions offered are a free online service to provide specialist mental
health help to UK seafarers set up by the Seafarers Hospital Society in conjunction with the Big White
Wall (https://seahospital.org.uk/mental-health-and-wellbeing-2/ – accessed 31/5/19); free training
resources produced by KVH Videotel in association with the International Seafarers’ Welfare and
Assistance Network (ISWAN) which are designed to ‘help seafarers recognise signs of mental health
problems or when colleagues might be finding it difficult to cope’ and to underline ‘the importance of rest,
diet, team activities, and maintaining good relationships’ (https://www.ibj-online.com/seafarers-mental-
health-programme-offered-free/452, https://www.nautilusint.org/en/news-insight/news/Nautilus-helps-
launch-free-seafarer-wellbeing-resource/ – accessed 17/5/19); self-help guides of various kinds
(https://www.seafarerswelfare.org/assets/documents/ship/Psychological-Wellbeing-at-Sea-English.pdf)
and in a variety of formats; an app designed by the Sailors’ Society to encourage and support the
practice of psychologically healthy behaviours among seafarers on board
(https://play.google.com/store/apps/details?id=org.sailorssociety.was&hl=en_GB – accessed 17/5/19);
and guidelines on good practice to employers produced by the UK Chamber of Shipping, Nautilus
International and the Rail and Maritime Transport (RMT) union
(https://www.ukchamberofshipping.com/library/guidelines-shipping-companies-mental-health-awareness/
– accessed 17/5/19).

Stakeholder interviews that were conducted as part of this research also suggested that there is currently
a raised level of concern about mental health and seafarer suicides at sea. However, they indicated a
more open-minded approach to solutions than the grey literature has incorporated. Interviewees tended
to describe initiatives of both a reactive and proactive nature and emphasised the importance of
improving the context and circumstances of seafarers’ lives at sea while also ensuring that measures are
in place to assist seafarers faced with a deterioration in mental health while on board.
Examples of comments supporting a balance between reactive and proactive measures included the
following:
It’s obvious that prevention is much better than cure. (Stakeholder 5)
There’s space for both the proactive and reactive services. (Stakeholder 4)
So what we try to do in [company name] is give a holistic solution to this problem. (Employer 3)

*
NB this was meant as a proportion of mental health cases rather than as a rate per 100,000 seafarers.

13
 I think the biggest impact that we get is talking to people personally […] I can’t say enough about
the personal approach for people in understanding and working at making them feel as individuals
and making the connection there […] we’ve hired a set of independent personnel development
people […] who are there to guide people and help with the career and give the seafarer a contact
point when they’re on leave. (Employer 1)
A range of relevant issues that required attention in order to improve mental wellbeing were identified by
stakeholders including:

• reducing fatigue (including via the provision of improved mattresses)

• assisting families with comprehensive health insurance to reduce seafarer anxiety on board
• providing swimming pools and saunas
• providing gyms
• promoting the benefits of social interaction with barbeques, games etc.
• screening seafarers for mental health problems prior to employment
• psychologically assessing seafarers and attempting to produce a good fit among crew members
• evaluating and encouraging emotional intelligence among officers
• introducing the ‘Wellness at Sea’ app
• providing a range of activities and outlets for seafarers on board in recognition of the fact that
‘one size does not fit all’.

One employer explained how:

Every single wellbeing element we have on board brings something good to the crew. From a pool
that’s even a small size, it will bring euphoria to the people that […] immerse themselves in the
water, you know they feel euphoria, that’s proven medically. To the people who stay in the sauna
and feels their pores relax and feel a different mind-set [ …] we’ll educate cooks to have the
‘Mexican food night’ […] a pizza night […] so that people don’t get bored […] There’s no point
offering proactive or reactive mental wellbeing stuff when you exhaust the person to work on board
[…] you need to have your basic needs satisfied, and what’s a basic need? First of all I need to be
relaxed, first of all I need to have a good night’s sleep, and I don’t want to exceed my capacity
working on board […] (Employer 3)

This multifaceted approach was also reflected by some employers who responded to the HR
questionnaire. One described, for example, that their efforts to improve mental wellbeing included:
Well-maintained accommodation spaces, well organised and equipped training (gym) facilities,
good quality of food and water as well as health diet programs, low-cost communication facilities
(satellite internet phones - voice and emails) continuous on the job training and good performance
awarding schemes, shorter periods of employment contracts, recreation libraries (books/novels)
board games, quarterly organised health campaigns which are raising awareness to mental health
issues and educate shipboard personnel. (HR questionnaire respondent ‘free text’ open response)

However, not all companies had seen the need to introduce new initiatives aimed at improving seafarers’
mental health on board. Just under half of the HR manager respondents to our questionnaire (46.5%)
indicated that they did not personally believe that mental health problems were increasing and three
quarters of respondents (72.5%) stated that their own company had not specifically identified the mental
health of seafarers as an issue or area of priority in the last 10 years. Relatedly, 55% of questionnaire
respondents said that their company had not introduced any practices or policies relating to seafarers’
mental health in the last 10 years. The vast majority of companies that had not introduced any new
practices or policies relating to seafarers’ mental health (90.9%) had not identified mental health as an
issue of priority or concern in the last 10 years.
Reduced shore leave and moving to more mixed nationality crewing patterns have both been identified
as potential threats to seafarers’ mental health (Borovnik 201117, Iverson 201218, Martek Marine 201719).

14
Over half of the HR managers who responded to our questionnaire (55.6%) believed that shore leave had
reduced in the period 2006–2016 and just under 10% had either changed from single nationality to mixed
nationality crewing or added a nationality to their crew mix. Yet in this context, where we might expect
employers to compensate for such factors by providing better facilities on board, a small proportion
(3.9%) of HR manager respondents felt that the number of recreational facilities provided by their
companies to seafarers had actually declined on their vessels in the period. This was explained by
managers as relating to vessel size and commercial considerations. One manager wrote that:
Due to vessel size, recreational equipment have deteriorated. Owner looking into cost saving and
commercial pressure by charterer in place.
Another explained that:
As our vessels are very small we have no space for gyms or similar.
While a third was more blunt stating:
We provide limited gymnasium equipment. There is little room as these are cargo vessels.

Taken together, our data therefore indicate that while a number of charities, P&I clubs and journalists
have raised the issue of poor mental health among seafarers as a difficulty that requires urgent attention,
employers are less convinced that it is a problem that requires immediate or extensive action. This finding
is less surprising when the contradictory evidence in the public domain is taken into account and when
we consider shipping companies’ personal experiences of medical repatriations on mental health grounds
alongside their experiences of employee suicide at sea.
We asked HR managers to provide some specific and detailed information on numbers of seafarers
employed in 2006 and 2016, numbers of medical repatriations in the period, numbers of repatriations on
the grounds of mental ill health and numbers of suicides. The data indicated that repatriations on the
grounds of mental ill health had actually fallen as a proportion of all medical repatriations in our small
sample of companies (which collectively reported employing 30,034 seafarers in 2006 and 41,254
seafarers in 2016). Medical repatriations in 2006 totalled 619 and in 2016 they totalled 1,091. Of these,
31 (5%) were repatriations on the grounds of mental ill health in 2006 and 36 (3.3%) were repatriations
on the grounds of mental ill health in 2016 (this difference is not statistically significant, χ2 = 3.062, d.f.=1,
p=.080). When we considered repatriations on the grounds of mental ill health as a proportion of the
numbers of seafarers employed by our respondent organisations in 2006 and 2016, we found a stable
rate of 0.1% in both years. Analysis of the data relating to causes of repatriations on the grounds of
mental ill health indicated that most HR managers identified depression as the leading cause of
repatriation, followed by anxiety.

In terms of deaths on board, 70.7% of HR managers reported that at least one seafarer in their company
had been found dead on board in the period 2006–2016. Across all companies, a total of 109 seafarers
had been found dead on board in the 10-year period.* Thirteen of these deaths (11.9%) were deemed to
have been suicides. In one case a suicide note was left. In addition to the 109 seafarers who were found
dead on board, a further 18 seafarers were reported to have gone missing from their vessels in this
period. Seven of these missing seafarers (38.9%) were identified in the course of subsequent
investigations as suicides. The majority of HR respondents (72.1%) did not believe that suicides among
seafarers on board were becoming more common.

The factors and features of life on cargo vessels that seafarers identify as supporting or
undermining good mental health and wellbeing

Two approaches were taken in order to allow us to explore which features of shipboard life were
regarded as supportive to good mental health by seafarers and which were regarded as undermining the
potential for good mental health on board. We conducted an interviewer-administered questionnaire with
a very large sample of active seafarers (1,507 in total). In addition, we explored the issues in more detail

*
NB in this question we very clearly asked respondents not to include seafarers who had gone missing and we explained that we
would ask about missing seafarers separately.

15
with five seafarers who took part in a recorded interview. The characteristics of the seafarers who
responded to the questionnaire are detailed in Appendix 1.

Contextual features

We used the questionnaire to explore some relevant features of the context within which seafarers
served on board. We therefore asked seafarers whether or not their partners were allowed to sail with
them, how many days they worked each week and how frequently they were able to take shore leave.
These factors were included as they relate to isolation and levels of fatigue, which are both significant
elements identified in the literature as contributing to poor mental health among seafarers.
Many seafarers in the sample were single (33.8%). However, across the whole sample, 27.7% of
seafarers said that partners were allowed by their company to sail with them. Higher-ranked seafarers
and seafarers from Northern/Western Europe were much more likely to be allowed to sail with their
partners and this finding was statistically significant (Rank: χ2 = 105.046, d.f.=2, p=.000, Nationality: χ2 =
34.332, d.f.=5, p=.000). Given that the mean number of days worked per week was 6.646 (indicating very
low levels of time off) it is likely, however, that few partners would choose to accompany seafarers on
board as they would have little time available to spend together.* Almost half (48.3%) of the seafarers
responding to the question about shore leave indicated that they could sometimes enjoy shore leave but
that this was less often than once in every two weeks. For a substantial minority of seafarers the situation
with regard to shore leave was even worse and 7.2% stated that they were never able to take shore
leave.† Seafarers themselves were very aware of the ways in which the shipboard context could
negatively impact on their mental wellbeing. As one stated rhetorically:
Between pressure, workload, no days off and you are a gazillion miles away from home with
limited communication, what do you think is going to happen? (Seafarer 5)

Factors inducing happiness and unhappiness on board and at home

Prior to an exploration of the features of shipboard (and home) life that made seafarers happy or unhappy
we asked them to describe how happy they felt on average when they were at home and how happy they
felt on average when they were at sea. The vast majority of seafarers (70.5%) described themselves as
‘very happy’ on average while at home compared with only 10.5% of seafarers who described
themselves as very happy on board. When we combined the answers of ‘very happy’ and ‘happy’ we
found that 92.8% of seafarers considered themselves to be happy/very happy at home while only 66.9%
considered themselves to be happy/very happy on board. This difference was strongly significant (χ2 =
315.080, d.f.=1, p=.000).
In relation to the things that made seafarers feel happiest we categorised responses (which were open
and could be multiple).‡ We found that the majority of things that made seafarers happiest (1,920) could
be categorised as relating to being with family members. Involvement in activities such as sports, DIY,
hobbies, watching movies, being outdoors, driving cars/motorbikes, cooking, walking, being with pets etc.
was the second largest category of happiness-related activity with 530 seafarers identifying these kinds
of activities as making them happiest. The next largest category was related to friendships with 429
responses of a friend-related nature (e.g. partying, vacation, talking, going to bands with friends etc.). The
second last category of responses related to visiting places with 303 responses of this nature while the
final category of responses related to having a sense of freedom. One hundred and forty-nine responses
relating to the pleasure of having time for oneself were recorded.

It is worth noting that the vast majority of things that make seafarers happiest at home are simply
unavailable at sea. It is not surprising, therefore, that the things that seafarers identified as making them
happiest at sea were rather different to those that they identified as making them happy at home.

*
There are other reasons why seafarers’ wives may not accompany them on board, but lack of time together going ashore and
boredom on board are acknowledged problems for seafarers’ wives https://www.marineinsight.com/life-at-sea/seafarers-wife-the-
woman-behind-a-successful-life-at-sea/ (accessed 20/8/19).
†
(NB in Tilbury most seafarers were accessed while on board their vessels).
‡
Please see Appendix 2 for breakdown and categories.

16
At sea, we categorised the things that made seafarers happiest (which were again described to us in
open and potentially multiple responses) into six categories: social events, lone activities, job/work-
related issues, shore leave, things relating to relationships with the people on board and communication
with home (please see Appendix 3 for details of the categories). The largest group of responses related
to social events with 1,327 responses relating to social activities on board such as parties, team sports,
barbecues, karaoke, social drinking together and so forth. Things that seafarers generally did alone
accounted for a smaller proportion of the responses, with 490 indicating that going to the gym, reading,
listening to music and so forth made them happy on board. The next largest category of responses
incorporated activities relating to work, the context of work or the environment such as the general
lifestyle of a seafarer, the salary, travel, good weather and so forth. Four hundred and sixty-six responses
of this nature were categorised in this group. Shore leave was specifically mentioned 133 times and
relationships on board were mentioned 129 times. Specific reference was made to the ability to
communicate with the outside world as something that made seafarers happiest on board 100 times.
Twenty-five seafarers specifically stated that there was nothing that made them happy on board.
When asked what made them saddest at home, 783 responses from seafarers related to problems
arising in conjunction with family life or family members such as arguments, ill health, bereavement and
so forth (for full breakdown please see Appendix 4). Finance-related issues were mentioned 481 times,
employment issues (such as leaving to go back to the ship, having to do training during leave time and
worrying about availability of next contract) were mentioned 340 times, psychological issues such as
boredom were mentioned 71 times and missing the ship, colleagues or routines was mentioned 23 times.
One hundred and twenty seafarers expressly stated that there was nothing that made them sad at home.
There were three main categories of issue that seafarers identified as making them saddest on board.
The largest of these (incorporating 1,265 responses) related to vessel/crew-specific factors such as bad
relationships on board, fatigue, bullying and long tours. Family-related factors such as missing family
members, sickness at home etc. were mentioned 515 times and poor recreational access such as poor
food, poor internet access and so forth was specified 224 times (for a full breakdown please see
Appendix 5). Forty-two seafarers expressly stated that there was nothing that made them sad on board.
Having invited seafarers to respond openly to questions about what made them happiest and saddest at
home and at sea, we also asked them to indicate from a list of things that are sometimes available on
board, or that sometimes happen on board, what made them happy. After ‘leaving the ship’ the thing
identified by the most seafarers as making them happy was taking shore leave with colleagues (see
Figure 3). The vast majority of seafarers (98.7%) identified shore leave with colleagues as making them
happy and 98.6% stated that talking with colleagues made them happy. Texting family and friends and
skyping family and friends also made the vast majority of seafarers happy (98.4% and 97.3%
respectively) and watching films, working, eating meals and playing games with colleagues were all
identified by over 90% of seafarers as making them happy. More than 80% of seafarers identified
emailing friends and family, reading, swimming, watching satellite TV and working out in the gym as
making them happy. Finally, karaoke and drinking alcohol were identified as making respondents happy
when they were available on board by at least 75% of respondents.

17
Figure 3: Things that made seafarers happy/very happy on board ship

98.8% 98.7% 98.6% 98.4%

100.0% 97.3%
95.9% 95.8%
95.0%
95.0%
91.4%
88.9%
90.0%
Percentage

84.9%
85.0% 82.8% 82.0%
81.3%
79.0%
80.0%
75.2%
75.0%

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Unfortunately, many of the things that seafarers identified as making them happy on board were not
available to them on their current vessel (see Figure 4). Most notably, only 33.5% of seafarers had
satellite TV on board their current vessel, just 35.4% were sailing on a vessel with a swimming pool and
only 42.1% were allowed to drink alcohol on board. It was also evident that significant numbers of
seafarers did not even have access to email, tasty food, a gym or a DVD library. These can be regarded
as among the most basic facilities on board which are provided by the majority of ship operators but
which were not enjoyed by approximately one in six of our sample.

18
Figure 4: Percentage of seafarers who had access to the following things on board

85.5% 85.4% 84.8%

90.0%
77.7%
80.0% 70.8% 68.7%
68.4%
65.3%
70.0% 61.9%

60.0%
Percentage

50.0% 42.1%
35.4% 33.5%
40.0%
30.0%
20.0%
10.0%
0.0%
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Sp

Loneliness at sea and at home

The literature on seafarers’ mental health and wellbeing indicates that isolation and the experience of
loneliness is a long-established concern among those interested in seafarers’ welfare. Isolation is a facet
of shipboard life, but it is also considered to be a feature of shore-based life for some seafarers who have
spent long periods of time cut off from their communities and who return home as relative ‘strangers’
(Sampson 201354). As one seafarer who we interviewed for this study explained:
Three months on land is nothing. You can’t see your kids grow up, you can’t see anything. You are
just like an Uncle coming and going. (Seafarer 2)

Nevertheless, seafarers were much more likely to describe feeling always or very often lonely at sea than
they were to describe themselves at home. Just 4.2% of seafarers described themselves as either always
or often lonely at home compared with a much higher percentage of seafarers who described themselves
as always or very often lonely at sea (20.2%). This difference was highly statistically significant (χ2 =
179.152, d.f.=1, p=.000).

Factors that had caused seafarers to feel ‘down’

Factors that might make seafarers feel ‘down’ were grouped under several headings. We asked
seafarers about ‘ship-related’ factors that they had experienced in the past that had made them feel
‘down’, factors relating to other people on board (which they had experienced in the past) that had made
them feel ‘down’, health and wellbeing factors that they had previously experienced as making them feel
‘down’ and home-related factors that they had experienced in the past as having made them feel ‘down’.
In reporting these findings, we adopt two approaches. We will report on the proportions of seafarers who
said they had felt down because of the issues concerned without excluding those seafarers who had

19
never experienced the issues of concern. This will offer a sense of the scale of the problems identified.
We will then report the proportions of people who felt down because of an experience they had actually
had, which will indicate the severity of the different problems in terms of their emotional impact on
seafarers.
No more than 60.5% of seafarers indicated that any single ship-related issue had made them feel ‘down’
on board. The factor selected by most respondents as responsible for bringing their mood down was ‘bad
food’, which was identified by 60.5% of respondents. At interview one seafarer elaborated explaining that
good food could conversely cheer seafarers up. He told us:
Good food let’s start with that […] Good food really does do something. You start looking forward
to meals. (Seafarer 5)
Another endorsed his view saying:
The most important person on the vessel is the cook, you know if there’s good food most people
are happy. (Seafarer 1)

Too much work was only just behind bad food as a factor that made seafarers feel ‘down’. Just under
60% of seafarers (59.2%) stated that too much work had made them feel down in the past. This was
followed by being prevented from taking any shore leave, which was identified by 52.1% of seafarers as a
factor that they had experienced in the past as making them feel ‘down’. Explaining the positive elements
of shore leave, one seafarer described at interview how:
I went to the mall, down town […] that makes you happy. You see different people. Like I am
talking to you […] I went to the mall and I get connected with my wife and [ask] ‘what do you want
to buy’ and try to show her something [and ask] ‘ok is this good?’ […] you are as if you are with her
[…] Just to look around and what’s happening around, what’s new, how people are buying and
what they are buying. (Seafarer 2)
Seafarers also identified experiencing lots of port calls as causing them to feel ‘down’ (45.7%), working
alone as resulting in them feeling down (27.5%) and being the only person on board from their country as
having made them feel ‘down’ (18.8%). Almost half (43.8%) of the very small number of female
respondents to the questionnaire said that the experience of being the only woman on board a vessel
had made them feel ‘down' in the past.
A variety of issues relating to interaction with other seafarers on board were included in the
questionnaire. We asked seafarers to indicate which of these factors (if any) they had experienced in the
past as making them feel ‘down’. The most common response to this question was related to ‘being
blamed for things that were not my fault’. More than half of respondents said that this had made them feel
down (55.2%). One interviewee explained that:
You have lots of misunderstanding most times and you have to endure a whole lot because
sometimes you may want to explain yourself but then it is not possible. You have to accept blame
sometimes […] because you cannot really explain yourself to the person […] and the person gets
angry and is like ‘ok I am supposed to be your boss and I am higher in rank than you’ and you just
can’t do much except stay quiet. (Seafarer 3)

Being blamed for things that were not your fault was accompanied by a range of depressing factors that
appear to be associated with hierarchical relations on board, namely being shouted at (48.3%), a bossy
captain (45.1%), discrimination (43.1%) and falling out with superiors (39.9%). Echoing the thoughts of
many seafarers, one interviewee explained how critical the other people on board were to a seafarer’s
outlook, singling out the importance of the captain in particular. He said:
You have a watch for four hours, every twelve hours, the entire time you are on the ship. […] If that
person is insufferable that can make for a lot of really bad days […] If you have a bad captain, that
just makes a bad voyage. (Seafarer 5)

Bad relationships with superiors were identified by many seafarers as being responsible for making them
feel ‘down’, but relationships with colleagues more generally could also have this impact. Falling out with

20
colleagues was identified by 38% of respondents as having caused them to feel ‘down’ and being bullied
was identified by 31.3% of seafarers as making them feel ‘down’. These issues were followed by being
teased by colleagues (28.6%), not being able to make friends (19.6%), not being able to fit in (19.2%),
being physically assaulted (14.9%), sexual harassment (5.3%) and being sexually assaulted (4%).
Within the literature describing the root causes of ill mental health on board, health and wellbeing-related
factors feature quite prominently. We therefore asked seafarers about a variety of health and wellbeing-
related factors, namely getting tired, feeling unwell, getting bored, being afraid due to bad weather,
feeling trapped, being seasick and having too much time alone. Of these, getting tired was identified by
the most seafarers (61%) as a factor that had made them down/depressed. Feeling unwell was just
behind tiredness and was identified as a cause of feeling down by 60.6% of seafarers. These factors
were followed in descending order by getting bored (51.8%), being afraid due to bad weather (45.8%),
feeling trapped (41.9%), being seasick (41.7%) and having too much time alone (34.9%).
Family matters were key in relation to whether or not seafarers felt down. The majority of seafarers
(79.8%) said that missing their family had made them feel down, bad news from home was identified by
69.3% of seafarers as something that had made them feel down, financial difficulties were identified by
62.5% of seafarers as making them feel down, problems with a relationship were identified by 59% of
seafarers as a past cause of feeling down. These factors were followed in descending order by hearing
about a death (57.2%), the end of a relationship (47.2%) and moral dilemmas (33.8%).
When we excluded respondents who said they had not experienced the specified issues on board we
were able to gain a sense of which factors acted as the most powerful depressants if/when experienced
by seafarers.

Unsurprisingly, hearing about a death at home was the most likely trigger of depression noted by
seafarers. While 34.9% of seafarers had never had the experience of hearing about a death on board,
89.1% of those seafarers who had experienced hearing about a death on board stated that it made them
feel down. In general there were similar figures for the end of a relationship (not ever experienced by
39.9% of respondents but the cause of depression for 81% of those who had experienced it) and for
relationship problems more generally (not experienced by 23.8% of respondents but a cause of
depression for 78.1% of those who had experienced it). Missing family had been experienced by almost
all seafarers (only 2.9% said they had not experienced this and of those who had 82.25% said that it had
made them depressed).
In general, family-related problems were the most likely problems to result in depression among
seafarers on board if, and when, they were experienced. However, some issues relating to shipboard
relationships were also very important triggers of depression. The most significant of these appeared to
be the experience of being blamed for something that was not the seafarer in question’s fault. The
majority of seafarers had experienced being blamed for things that were not their fault (only 27.9% stated
that they had never experienced this) and of those who had experienced it 76.7% of respondents
reported that it made them feel down/depressed. When seafarers felt that they were subject to
discrimination on board (something that had not been experienced by 40.4% of respondents) they were
also quite likely to be negatively affected by this in terms of their mental wellbeing and 72.4% of those
who had experienced discrimination described it as making them feel down. Bullying and falling out with
colleagues also led to depression among seafarers and 61.5% of those who had experienced bullying
(50.9% of respondents had experienced being bullied) said it made them feel down/depressed. In terms
of falling out with colleagues this had been experienced by the majority of seafarers (63.6%) and 59.8%
of respondents who had experienced it stated that it had made them feel down/depressed. It was
surprising to see that seafarers were remarkably resilient when it came to some other serious forms of
misbehaviour and maltreatment on board at the hands of colleagues. Only 56.6.% of respondents who
were sexually harassed identified this as resulting in depression, 61.4% of those who were physically
assaulted stated that this had made them feel depressed and just 54.8% of the minority of seafarers
(11.8%) who had experienced sexual assault stated that this had caused them to feel down.
Of the ship-related issues that we identified as potentially depressing to seafarers’ mood, food was the
most significant factor with most seafarers describing experience of bad food on board (88% had
experienced bad food) and the majority (69.1%) reporting that bad food on board had led to them feeling
down/depressed. The vast majority of seafarers had experienced being unable to get ashore (94%), and
among these 55.5% stated that this made them feel down/depressed. Most seafarers (94.8%) had also
experienced being required to work alone, but a minority (29.1%) stated that this made them feel

21
down/depressed. Over half of our respondents (56%) stated that they had never experienced being the
only seafarer from their country on board a vessel but even among those who had, only 44.2% identified
this as having been a cause of being down/depressed. By contrast, it was very common for women to
have experienced being the only woman on board a vessel but less than half of our female respondents
(46.7%) stated that this made them feel down/depressed.

Policies and practices that could be implemented by ship operators and/or welfare
bodies to provide better support for the mental health and wellbeing of seafarers

When considering what could be done by ship operators and welfare bodies to provide more support for
seafarers’ mental health and wellbeing, it is helpful to begin with an analysis of the things that seafarers
themselves describe as useful in combatting loneliness and depression at home and ashore. In
administering our questionnaire, we asked seafarers what strategies they found useful in combatting
depression and loneliness at home and on board and they described a variety of activities and
interactions that they found helpful.

Strategies employed by seafarers to combat loneliness

The most commonly utilised strategy to combat loneliness on board (identified by 85.7% of respondents)
was reaching out to friends or family at home via the internet (see Figure 5).

Figure 5: What seafarers did on board to make themselves feel better when they were lonely

85.7%
90.0% 81.4% 79.0%

80.0%
70.0% 60.6%

60.0% 47.4% 46.7%

Percentage

43.5%
50.0% 38.3% 35.2%
40.0%
22.5%
30.0%
20.0%
10.0%
0.0%
s

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One seafarer explained that:

22
 I believe internet goes a long way in keeping you sane, trust me. […] not having this feeling that
you are totally excluded from the rest of the world. (Seafarer 3)

The importance of feeling connected to events and life ashore was stressed in a similar way by another
interviewee who said:
Nowadays, the internet you are connected to the world and what’s happening. Before you were
lost when you come [home] ‘oh that building came up, oh what fast cars’ […] but now everything’s
on the net and you don’t feel the change […] you’re in touch with what is happening in the world,
first of all, what’s happening with your family. You learn that somebody’s had marriage or
somebody has a bad day and you can give some suggestion or we can talk it out. (Seafarer 2)

Making use of the internet to combat loneliness was followed by the usually solitary activities of watching
a DVD (81.4%) or playing music (79%). Meeting up with colleagues was identified by 60.6% of seafarers
as a strategy they used to combat loneliness and this was followed in descending order by going to the
gym (47.4%), texting family or friends at home (46.7%), finding some work to do (43.5%), singing karaoke
(38.3%), emailing friends or family at home (35.2%) or playing cards (22.5%). In addition to the pre-
categorised responses we asked seafarers to respond to, we also offered them the opportunity to add
open responses to this question. These responses indicated that activities (such as video games,
swimming, smoking, board games and domestic tasks) were mentioned 235 times, strategies relating to
mental resilience such as reading the bible, looking at pictures or planning for the future were mentioned
35 times, communicating with family and friends (already covered in the fixed responses) were
mentioned a further 28 times, interacting with others on board was mentioned 24 times in free text
responses, and 10 seafarers specifically replied that they did not ever get lonely on board.
In relation to the strategies that seafarers used to combat loneliness when they were at home we invited
respondents to reply freely without pre-coding responses at all. Responses indicated that seafarers
employed a considerable variety of strategies in combatting loneliness at home. The majority of
responses could be considered to relate to activities that were pursued in order to allay loneliness. These
included sports activities and exercise, DIY, driving, fishing, spending time with pets, surfing the internet,
cooking on a barbecue, drinking beer and so forth (please see Appendix 6 for detailed breakdown).
Strategies linked to family and friends were described 813 times and visiting places was mentioned 223
times. Twelve seafarers specifically stated that they were never lonely at home.

Strategies employed by seafarers to combat feelings of depression

Seafarers reported a number of strategies that they employed to try to cheer themselves up when they
were down on board. The two most commonly employed individual strategies were to watch movies or
films and to chat with others on board. When we grouped the open responses given by seafarers to this
question, we found that the majority of seafarers (1,260) engaged in some kind of ‘activity’ if feeling down
on board. Many of these were activities that are generally solitary such as using the gym or playing video
games and not all of them are likely to be aligned with good health, for example eating, drinking and
smoking. However, for the most part they were found to be effective ways of fending off depression. The
second most common set of strategies related to interacting with others on board in some manner (490
responses were of this nature). As well as simply finding someone to chat with, seafarers reported
watching movies or singing with colleagues, generally socialising with others on board, having a drink
with others, playing games etc. The next most common set of strategies described by respondents
related to communicating with family and friends ashore. This approach was described in 373 responses.
Seafarers also described employing a variety of strategies that could build mental resilience (239
responses alluded to these). Among these responses, reading the bible or praying was the most common
strategy employed and it was mentioned 112 times (please see Appendix 7 for detailed breakdown).
When they were at home and feeling down seafarers were most likely to state that they would engage in
activity. Activities included watching TV/movies etc., listening to music, shopping, visiting places,
swimming, sleeping, reading and so forth. Nine hundred and eleven seafarers mentioned engaging in
some kind of activity at home should they need to cheer themselves up. Seafarers also described how
they would interact with friends and family when feeling down – playing, eating, visiting and talking with

23
them. Such strategies were mentioned 870 times. One hundred and twenty seafarers expressly stated
that they never felt down at home (please see Appendix 8 for detailed breakdown).
It is evident that seafarers have access to a far greater range of activities and potential interactions when
they are ashore. It is also clear that there is no ‘one size fits all’ strategy that individuals employ to
combat loneliness or depression. This suggests that ship operators need to consider the provision of a
range of recreational facilities for seafarers on board while also considering the provision of a good
communications infrastructure to allow seafarers to readily interact with friends and family ashore.
When seafarers were asked to name the top three things that they felt would make life on board happier
987 mentioned free internet access with 609 respondents stating that this was the number one thing that
would make life on board happier for seafarers. Permanent contracts and shorter contracts were also
mentioned a great deal by seafarers as topping the list of things that would make seafarers happier.
Three hundred and eighty-five seafarers put permanent contracts in their top three things to make
seafarers happier list, 372 mentioned shorter contracts, 260 felt that larger crews would be one of the top
three things to make seafarers happier and 229 described getting more sleep as something that would be
important in making seafarers happier. More shore leave was thought to be among the top three things
that would make seafarers happier by 188 seafarers.
When we grouped responses into the categories internet and communications, terms and conditions of
work, relationships on board, physical health, accommodation and recreation, we found that factors
relating to the provision of good internet and communications were most frequently mentioned by
seafarers as the single most significant thing that would make seafarers happier on board. However,
when the top three things that were mentioned were combined and categorised, we found that terms and
conditions of work were included by most seafarers as one of the top three things that would improve
seafarers’ happiness. This category was followed by the category ‘internet and communications’ and in
descending order we then identified relationships on board, physical health, accommodation and
recreation as the most significant factors (see Figure 6).

Figure 6: Top three things that would make life on board better/happier for seafarers

1800

1600

1400
1200
Number

1000
800

600

400

200
0
Internet and Term and Relationships on- Physical health Accommodation Recreation
communications conditions of board
work

Number 1 Number 2 Number 3

We also asked seafarers what companies could do to reduce depression and anxiety for seafarers while
on board. The most frequent responses came in the category of recreation. One thousand four hundred
and five responses mentioned some kind of recreational activity/provision, including internet (854),
recreation facilities generally (158), shore leave (117), gym (61), BBQ parties (56), games competitions
(38), welfare fund (31), karaoke (29), satellite TV/DVDs (21), pool/sauna (12), video games (8) and

24
books/magazines (4). The next most commonly mentioned kind of thing that companies could do in order
to reduce seafarers’ anxiety and depression on board was considered to be things relating to the
improvement of terms and conditions of employment. There were 1,270 responses to the question that
mentioned terms and conditions, including better pay, longer leave periods, less workload and paperwork
and bigger crews (see Appendix 9 for full details).
Despite the significant link made by seafarers between food quality and depression, it is surprising that
more seafarers did not think of mentioning cooks or victualling rates when asked what companies could
do to improve the mental wellbeing of seafarers on board. Our employer survey found that the victualling,
or feeding, rate on board had increased from an average US$8.869 in 2006 to US$10.0029 per seafarer
per day. This rate is rather meagre given that it covers three meals a day, provisions in some parts of the
world are very expensive and ships’ cooks always have additional personnel to feed in ports and when
pilots are on board.
Another area that was not highlighted as important by seafarers was the provision of counselling
services. Not only did negligible numbers of seafarers (nine) mention counselling as something that
companies could provide to reduce depression and anxiety for seafarers while on board, but very small
numbers had ever sought such support either at home (3%) or while on board (1.2%).*

Discussion

While a review of the relevant literature demonstrates that it is not possible to readily compare rates of ill
mental health among international seafarers with rates of ill mental health among comparable populations
ashore, and it is similarly difficult to compare rates over time, there are indications that global seafarers
are increasingly suffering from recent-onset anxiety and depression on board (Sampson et al 20179), and
that they are generally at a higher risk of experiencing a psychological disorder, suffering from ‘burnout’
or receiving a psychiatric diagnosis in their lifetime (Olkinuora 198410, Roberts 200511, Hemmingsson et
al 199714, Oldenburg et al 201315) than populations ashore. There is, however, no firm evidence that
these risks and conditions are resulting in increased proportions of seafarers being repatriated on the
grounds of ill mental health or in them being increasingly prone to suicide while on board.

The data we collected from both P&I clubs and employers suggest that no major changes in rates of
suicide or in poor mental health (which is serious enough to require repatriation) have been detected by
HR managers or by claims handlers/senior managers in P&I clubs. HR managers and P&I club personnel
were generally aware of the raised profile of mental health and wellbeing and paid attention to incidents
as they arose but were unable to conclude that the issue of poor mental health on board was getting
worse. The data that they provided to us supported these impressions and we could not discern any
upward or downward trends in the proportions of repatriations that were a result of mental ill health or in
the patterns of suicide.
Despite the lack of hard evidence relating to a worsening problem of serious ill mental health or suicide at
sea, it is nevertheless apparent that both P&I clubs and other industry stakeholders such as maritime
welfare charities, trade unions and employer associations are currently concerned about mental health
and welfare at sea. This seems to be a consequence of the effectiveness of key organisations and high-
profile individuals in raising awareness of mental ill health, and its consequences, across society as a
whole. In this context, the shipping industry can be understood to have more than its fair share of
difficulties with relatively high levels of suicide and serious mental health problems (Olkinuora 198410,
Roberts 200511) and indications of increasing shipboard recent-onset mental ill health disorders among
seafarers (Sampson et al 20179). While we do not have strong evidence in changing patterns of serious
mental ill health (requiring repatriation) and suicide at sea, it is not reasonable to conclude that mental
health issues are not a significant problem for the industry overall which has, perhaps, belatedly begun to
attend to them as a result of wider social concerns and related media coverage.
In response to concerns about poor mental health and wellbeing among seafarers, maritime welfare
charities have tended to propose and develop measures and guidance with an emphasis on reactive
measures that can be taken by employers to assist seafarers who are suffering in relation to their mental

*
NB we asked seafarers if they had ever contacted an organisation for emotional support or counselling on board providing them
with the examples of ISWAN, a chaplain or a trade union.

25
health on board and proactive measures that can be adopted by individual seafarers to increase their
resilience and ability to withstand poor shipboard conditions. While these inevitably make a positive
contribution to the protection of mental wellbeing on board, in neither case can they be seen as addressing
the underlying causes of the depression and anxiety that are most commonly experienced by seafarers on
board. These include separation from family and friends, isolation, work-related insecurities and difficulties,
poor shipboard relationships, fatigue and poor physical wellbeing. It is interesting to note that employers
(just under half of the employers who responded to our questionnaire) and the majority of seafarer
respondents who were included in the research identified a range of proactive measures that can and
should be taken by ship operators to improve the living and working conditions of seafarers on board in
order to improve mental health and wellbeing. It is also interesting to note that these measures include
factors relating to terms and conditions of work, shipboard interaction, facilities and communications
infrastructure and physical wellbeing.

Conclusion
In relation to very serious mental ill health and its manifestations (suicide and requirement for repatriation)
we find that there is no clear evidence of a worsening situation among seafarers in the contemporary
international cargo shipping fleet. However, there is some evidence that mental health problems are
generally higher among seafarers than non-seafarers and that recent-onset psychiatric disorders have
become more common on board cargo vessels in recent years. This indicates that it is appropriate for
industry stakeholders to be concerned about this issue and that such worries may be somewhat overdue.
The research indicates that in stakeholder guidance and in the provision of resources to support
seafarers’ mental health there is an emphasis on self-help strategies for seafarers (such as resilience
building) and on reactive measures that are recommended to employers (such as the provision of
counselling). Many employers do not see a need to invest resources in proactive measures to reduce the
shipboard pressures on seafarers’ mental health and wellbeing; however, a significant minority disagree
profoundly and have been very active in promoting a holistic approach to improving seafarers’ mental
health and welfare.
Although many seafarers seem to cope surprisingly well with challenging psycho-social issues on board
(indicating remarkable levels of resilience in the face of assault and bullying, for example) they are
significantly more likely to feel happy at home than at sea. The vast majority of seafarers identify a range
of areas where ship operators could provide resources that would support seafarers’ mental wellbeing on
board. These include factors that would create a better work-life balance for seafarers (e.g. shorter
periods of time on board), factors that would improve their ability to sustain good relationships with family
and friends ashore (e.g. the provision of free internet access), factors that would improve shipboard
relationships (e.g. bigger crews and more social activities) and factors that would provide seafarers with
better recreational opportunities to raise their mood (such as shore leave, barbecue parties and sports
facilities). The need for more reactive services for serving seafarers, such as counselling, hardly featured
in their responses.
To some extent the data indicate that current recommendations and initiatives targeted at improving
seafarers’ mental health and wellbeing on board need to be realigned. The research suggests that
notwithstanding a range of well-intentioned suggestions for seafarers and companies made by
stakeholders, there needs to be much more emphasis placed on proactive measures aimed at improving
the conditions of work and life on board for seafarers and less placed on reactive and self-help strategies
for employers and seafarers. While these (self-help and reactive) approaches may make a minor
contribution to seafarers’ mental wellbeing they are not identified by seafarers themselves as particularly
useful or desirable. Many employers also regard them as of limited use and promote a more holistic
approach to welfare in their organisations.

General recommendations

1) Companies and stakeholders should take steps to address the significant difference found
between the happiness levels of seafarers when they are on board and when they are at home.

26
2) Companies and stakeholders should be aware of the evidence indicating that recent-onset
psychological disorders are increasing among serving seafarers.

3) Companies and stakeholders should recognise the importance of good mental health and
wellbeing in the cargo shipping industry.

4) Companies and stakeholders should reconfigure their efforts to support mental health and
wellbeing on board in order to proactively reduce the incidence of unhappiness and of recent-onset
anxiety and depression among seafarers.

Recommendations for specific measures

1) Free and unlimited internet should be made available to all seafarers on board all cargo vessels.

2) In recognition of the differences between individuals, a varied menu of interactive recreational

activities should be available to seafarers on board.*

a) As a minimum, one of the following activities should be facilitated on board: basketball,

squash, swimming.

b) In addition, four of the following activities should be facilitated on board: table tennis, darts,
barbecues, karaoke, card and board games, bingo (with prizes).

3) In recognition of the differences between individuals, a varied menu of solitary recreational

activities should be available to seafarers on board.

a) As a minimum, a dedicated gymnasium with three different pieces of equipment should be

provided.

b) In addition, two of the following should be provided: a sauna, a book and DVD library, satellite
TV within cabins, a library of interactive video games.

4) Comfortable mattresses and furnishings within cabins should be prioritised to facilitate rest and
sleep.

5) Shore leave should be provided at every opportunity and for all ranks.

6) Varied, good-quality food should be provided on board and a feeding rate of at least US$11.00†
per person should be allocated to each vessel.

7) Self-help guidance on improving mental resilience should be provided to all seafarers.

8) Contracts should balance work and leave time for all ranks in a ratio not worse than 2:1 and with
an upper limit of a maximum of six months on board.

9) Anti-bullying and harassment policies should be introduced and enforced.

*
While it has been difficult to judge what this would constitute, it is nevertheless necessary to recommend specific levels of
provision to arrive at a minimum standard and a level playing field. Levels of provision have therefore been arrived at that are
considered to genuinely provide a range of facilities (already known to be available on cargo vessels) while not placing an undue
burden on ship operators. This explanatory note may be applied to all the quantified recommendations arrived at in the report.

†This figure is arrived at using known existing feeding rates as a guide.

27
10) Officers should receive training in creating a positive atmosphere on board, including via the
provision of positive feedback on work, when appropriate, and respectful interactions with
subordinates.

11) Confidential counselling services should be made available to seafarers.

28
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%20in%20the%20period%202000-2016.pdf (accessed 16/5/19)
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society.org/posts/we-need-to-talk-about-mental-health-in-seafaring (accessed 16/5/19)
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century, Manchester University Press (MUP), ISBN 978-0-7190-8868-1

31
Appendix 1 – Respondent demographics – seafarers’ questionnaire

Age

Descriptive Statistics

N Minimum Maximum Mean Std. Deviation

Age 1,507 18 72 35.36 10.383

Sex

Sex

Cumulative
Frequency Percent Valid Percent Percent

Valid Male 1,487 98.7% 98.7% 98.7%

Female 20 1.3% 1.3% 100.0%

Total 1,507 100.0% 100.0%

Nationality

Nationality

Valid Cumulative
Frequency Percent Percent Percent

Valid Western/ North 60 4.0% 4.0% 4.0%

Europe

Eastern Europe 174 11.5% 11.6% 15.5%

Asia 1,011 67.1% 67.1% 82.7%

Indian Sub-Continent 152 10.1% 10.1% 92.8%

USA/ Canada 75 5.0% 5.0% 97.7%

Other 34 2.3% 2.3% 100.0%

Total 1,506 99.9% 100.0%

Missing System 1 .1%

Total 1,507 100.0%

32
Rank

Rank (Senior, Junior, Rating)

Cumulative
Frequency Percent Valid Percent Percent

Valid Senior Officer 203 13.5% 13.5% 13.5%

Junior Officer 492 32.6% 32.8% 46.3%

Rating 803 53.3% 53.5% 99.8%

Other 3 .2% .2% 100.0%

Total 1,501 99.6% 100.0%

Missing System 6 .4%

Total 1,507 100.0%

Department

Department

Cumulative
Frequency Percent Valid Percent Percent

Valid Deck 731 48.5% 48.7% 48.7%

Engine 538 35.7% 35.8% 84.5%

Galley 157 10.4% 10.5% 95.0%

Unclassified 75 5.0% 5.0% 100.0%

Total 1,501 99.6% 100.0%

Missing System 6 .4%

Total 1,507 100.0%

33
Relationship status

Are you single or living with a spouse/partner?

Cumulative
Frequency Percent Valid Percent Percent

Valid Single 508 33.7% 33.8% 33.8%

Living with a spouse/ 994 66.0% 66.2% 100.0%

partner

Total 1,502 99.7% 100.0%

Missing System 5 .3%

Total 1,507 100.0%

34
Appendix 2 – Open responses to the seafarers’ survey question, ‘What activities make
you happiest at home?’

Being with the family 1,920

Generally 629
Children 245
Vacation/days out 213
Bonding/quality time 168
Spouse or partner 156
Gatherings/parties/special occasions 129
Meals together 91
Playing with my children 65
Beach 55
Taking care of children 45
Shopping 43
Relatives 25
Talking 18
Nieces and nephews 13
Good/healthy food 13
Grandchildren 11
Latest news and updates 1
Activities 530
Sports/exercise 151
DIY/home improvement 56
Hobbies 48
TV/video/movies 39
Outdoors/nature 38
Driving cars or bikes 33
Video games/computer/games 32
Cooking 30
Working on my business 28
Hunting/fishing 24
Gym 13
Walking the dog/pets 13
Surfing the internet 12
Reading books 9
Latest news 2
Games 1
Gardening 1

35
Being with friends 429
Generally 140
Socialising/partying/hanging out 135
Food and beer 45
Girlfriend 45
Vacation 27
Bonding/quality time 19
Roaming around 9
Talking 6
Music/bands 3
Visiting places 303
Vacation 96
Church 48
Beach 44
Restaurants/pubs/bars 30
Shopping malls 23
Movies/cinema 22
Outdoor/nature 21
Sporting events 17
Roaming around 1
Historic places 1
Having a sense of freedom 149
Own time/free time 44
Being home and not at sea 39
No restrictions 35
Good rest/sleep/relax 30
Having a phone signal 1

36
Appendix 3 – Open responses to the seafarers’ survey question, ‘What activities make
you happiest on board?’

Social events 1,327

Parties/social get togethers 386
Team games/sports 271
BBQ parties 174
Talking with other colleagues/friends on board 118
Karaoke/playing music together 115
Having a beer/drinking with others 72
Watching movies together 65
Good food 49
Spending time with friends 46
Socialising with other nationalities 20
Playing computer games 11
Loan activities 490
Films/movies/TV 136
Gym/exercise/swimming 111
Surfing the internet 68
Relax/rest/day off 63
Video games 37
Reading 27
Playing music 17
Listening to music 13
Fishing 9
Reading bible/praying 5
Just generally being on own 4
The job 466
Enjoy the work/job/lifestyle 151
Earning money for family/good salary 93
Job going well/being rewarded for work/compliments 59
Travelling/visiting new parts of world 56
Learning from others 37
Good cooperation on board/good skills of crew/teamwork 22
Not too busy/pressured 15
Good ship/good machinery 11
Good weather 8
On time salary 6
Safe working 5
Going home/signing off 3
Shore leave 133
The people on board 129
The people/camaraderie/good crew 108
Good captain/management 20
Bad people leaving the ship 1

37
Communication with home 100
Internet 69
Generally 28
Having a phone signal 3
Not happy on board/other 25

38
Appendix 4 – Open responses to the seafarers’ survey question, ‘What things make you
saddest at home?’

Family and home life 783

Arguments/problems – family 192
Health problems/sickness – family members 127
Arguments/problems – partner/relationship problems 107
Health problems sickness – general 73
Spouse/partner/relative working – busy while home 65
Health problems/sickness – children 55
Death in family/friends 41
Practical problems in home/community 26
Arguments/problems – friends 18
Political situation in country 17
Arguments/problems – general 16
Problems with family business 15
Problems with children e.g. in school 13
Health problems/sickness – own 12
Missing children growing up 5
Being home too long causing arguments 1
Financial issues 481
Having no money or running out 363
Financial demands/bills/debts 60
Not earning/no income/financial insecurities 48
Worries about money 10
Employment 340
Leaving to go back to the ship 172
The call to go back 46
When it’s close to going back – next contract 40
Having to do training courses/paperwork during leave 34
Time until next contract – leave too long 21
Worrying about next contract 20
Leave too short 7
Other 171
Not sad at home/always happy 120
Other 31
Bad weather 20
Psychological issues 71
Loneliness/boredom 67
No sense of purpose 4
Missing the ship 23
Missing the sea/lifestyle 16
Missing others on the ship 4
Lack of routine 3

39
Appendix 5 – Open responses to the seafarers’ survey question, ‘What things make you
saddest on board?’

Vessel-related factors 1,265

Trouble with others on board/bad relationships 176
Bad officers/problems with officers 158
Poor sleep/fatigue/lack of rest 121
Busy schedule/too much work/paperwork/lack of crew 115
Seasickness/illness 112
Loneliness/boredom 107
Issues relating to job/work/making mistakes 96
Discrimination/bullying/assault 93
Bad weather 93
Poor teamwork/cooperation 47
Vessel/ship-related problems 35
Hassle from ashore/office 25
Long tours/not relieved on time/extended contracts 24
When you sign on/join ship 23
Poor salary/no advance/late payment/no overtime 20
Nationality/cultural issues 16
Friends signing off 4
Family and home 515
Missing family/home 292
Poor communication facilities with home 78
Bad news/problems at home 65
Missing special occasions/children growing up 28
Being unable to do anything/help out 21
Illness/sickness at home 15
Death at home 12
Arguments with family/friends 4
Recreational issues 224
Bad food 83
No internet 65
Lack of shore leave 53
Poor recreational facilities 18
Not able to do things/hobbies 5
Not sad on board 42
Other 5

40
Appendix 6 – Open responses to the seafarers’ survey question, ‘What do you do to
make yourself feel better AT HOME when you are lonely?’

Activities 908
Sports/gym/exercise 183
Watch TV/movies/videos 138
Hobbies/DIY/work on house 138
Listen to music 95
Cook BBQ/eat/drink beer 82
Video games 52
Play music 42
Drive car/bike 28
Keep busy – general 27
Surf the internet 26
Sleep/rest 26
Read 21
Work on business 21
Time with pets 16
Hunting/fishing 13
Family and friends 813
Meet with friends/hang out/outings 178
Talk/play with children 103
Talk/call with friends 91
Meet up with family/get togethers 78
Talk/call with family 71
Beer/food with friends 57
Talk to spouse/partner 45
Sports with friends i.e. basketball 42
Outings with family 33
Outings with family – restaurants/beer 25
Visit family members 25
Outings with family – malls/shops 21
Outings with family – beach/park 14
Outings with family – movies/cinema 10
Vacation with friends 8
Vacation with family 7
Call/contact those on ship 5
Visit places 223
Shopping malls 41
Church/similar 39
Nature/outdoors 35
Beaches/swimming 27
Visit places 26
Vacation 22
Cinema/movies 20
Restaurants/bars 13
Mentally fix situation 21
Not lonely at home 12
Other 12

41
Appendix 7 – Open responses to the seafarers’ survey question, ‘If you feel down or
depressed ON BOARD what do you do to cheer yourself up?’

Activities 1260
Watch movies/films/TV 340
Listen to music 249
Gym/exercise 105
Sleep/rest 95
Read 85
Play music/sing 72
Video games 60
Keep busy (unspecified) 54
Find some work to do 51
Eat 32
Surf the internet 31
Drink/smoke 29
Sports 19
Household tasks 11
Shore leave 11
Hobbies 10
Walk on deck/look at nature 6
Interact with others on board 490
Speak/chat with others on board 340
Watch a movie/listen to music/sing with friends 56
Socialise with others on board 47
Have a beer/drink with others 19
Speak/chat with superiors 18
Play games with others 10
Communicate with family/friends 373
Speak to family 199
Speak to spouse 89
Speak to friends 68
Speak to kids 13
Post to/look at social media 4
Mental resilience strategies 239
Read the bible/pray 112
Mentally make better 67
Look at pictures/videos 26
Be alone 23
Plan for the future 11
I do not feel down/depressed 11
Other 11
Other (miscellaneous) 9
Ask the company to help/sign off early 2

42
Appendix 8 – Open responses to the seafarers’ survey question, ‘If you feel down or
depressed AT HOME what do you do to cheer yourself up?’

Activities 597
Watch TV/movies/videos 81
Listen to music 80
Gym/exercise 66
Hobbies/DIY/work on house 58
Sleep/rest 43
Sports 38
Cook BBQ/eat 33
Play music/sing 32
Drink/smoke 32
Drive car/bike 27
Video games 26
Read 23
Keep busy – general 22
Time with pets 12
Surf the internet 11
Hunting/fishing 7
Work on business 5
Post to or look at social media 1
Family 525
Talk to spouse 154
Talk to/call family 147
Talk/play with children 76
Meet up with family/get togethers/games 65
Outings with family 32
Outings with family – restaurants, eat out, beer 13
Outings with family – malls/shops 12
Visit family members 12
Outings with family – movies/cinema 7
Vacation with family 4
Outings with family – beach/park 3
Friends 345
Meet with friends/hang out/go out/socialise 161
Talk to/call with friends 127
Beer/food with friends 31
Vacation/outings with friends 14
Sports with friends i.e. basketball 7
Games/computer games with friends 5

43
Appendix 9 – Open responses to the seafarers’ survey question, ‘What do you think
companies could do to reduce depression and anxiety for seafarers while they are on
board?’

Recreation 1,405
Internet/communication facilities with families 854
Recreation equipment/facilities (generally) 158
Shore leave 117
Sports/gym 61
Parties/BBQ parties/social get togethers 56
Games/competitions 38
Provide a welfare fund/budget 31
Karaoke/music facilities 29
Provide TV/sat TV/movies 21
Beer/alcohol 16
Pool/sauna 12
Video games facilities 8
Books/magazines/newspapers 4
Term and conditions of work 1,270
Better salary/overtime/bonuses 270
Shorter contracts/longer leave 216
Less work/less paperwork 144
Bigger crews 124
Better leadership/good treatment by officers 73
Company shore side – friendly supportive management. 51
Permanent contracts/job security/company loyalty 49
Follow labour code MLC 49
Sign off on time/timely relief/quick repatriation 46
Support/benefits for families also 30
Health cards/insurance 28
Reduce frequency of port calls/less tight schedules/better routes 27
Better quality of officers 23
Practical ship improvements 21
Other training for crew 20
Company shore side – companies ask opinions of all seafarers 19
On time payment 16
Safe working practices/good safety equipment 12
Company shore side – good management of vessels 10
Enforce company polices 9
Better distribution of work 8
Company shore side – follow up/take seriously complaints 8
Social support/pensions 7
Company shore side/other 7
Better skilled crews 3

44
Physical/mental health 446
Quality/quantity of food 236
More rest/days off 132
Provide drinking water 17
Good cooks 15
Focus on mental health 14
Food for different nationalities 11
Better allowances/budget for food 9
Confidential reporting services 9
Provide counsellors for seafarers 3
Relationships on board 168
No bullying/discrimination 52
Encourage good relations/better interactions on board 42
Encourage social activity on board 37
Officers should listen to ratings 14
Officer training on crew management 11
Nationality/language on board 9
Better treatment of cadets 3
Accommodation 79
Better accommodation/cabins 79
Family members on board 24
Family members on board 24
Nothing 14
Other/miscellaneous 21

45
Appendix 10 – Survey of Seafarer Repatriations

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IOSH has not edited the text in any way, except for essential formatting requirements. The contents
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Suggested citation: Sampson, H., Ellis, N. (2019), Seafarer’s mental health and wellbeing. IOSH, 2019

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Institution of Occupational Safety and Health

Founded 1945
Incorporated by Royal Charter 2003
Registered charity in England and Wales No. 1096790
Registered charity in Scotland No. SC043254