Int Marit Health

2012; 63, 2: 78–89

www.intmarhealth.pl
Copyright © 2012 Via Medica
ORIGINAL PAPER ISSN 1641–9251

The Mental Health of Seafarers

Robert T.B. Iversen

International Service Committee, Rotary Club of Melbourne South, Australia

ABSTRACT
Background: The objectives of this paper are to review published and unpublished infor-
mation on the mental health of seafarers in order to 1) provide a window on the current status
of seafarers’ mental health; 2) establish whether the mental health of seafarers in many
cases continues to be very poor; 3) describe two current projects to improve the mental health
of seafarers; and 4) suggest an industry-wide effort to improve the mental health of seafarers.
Materials and methods: A review of recent literature on the mental health of seafarers
was made, and published statistics covering the years 1960–2009 were obtained. In describ-
ing seafarers’ mental health the use of rates to cite trends in suicides by seafarers was not
employed. Statistics on seafarer deaths are given by two methods as percentages of deaths
by suicide by seafarers. One compares deaths by suicide to total deaths and the second
compares deaths by suicide to deaths due to illness. It is felt these methods are more readily
understood by non-scientists who may be in policy-making roles in business or government.
A detailed description covers two current projects to improve the mental health of seafarers.
Results: The causes of depression by seafarers are described. Statistics from 1960–2009 on the
deaths by seafarers compared to total deaths of 17,026 show 1,011 seafarers died as a result of
suicide (5.9%). Compared to deaths of 4,487 seafarers due to illness, 590 seafarers died as a result
of suicide (13.1%). These percentages would be higher if 50% of deaths due to seafarers disappear-
ing at sea were included. Based on industry data, in 2012 the daily expected costs to operate
a 3,000–4,000 TEU container ship are US$7,825, and US$10,944 for a 10,000 TEU container ship
— not including the cost of fuel oil. In 2011 a master who disappeared in waters off Australia may
have cost the ship owner US$50,000–US$100,000 due to the voyage being diverted and delayed.
Two projects to improve the mental health of seafarers, one by the Rotary Club of Melbourne South
and another by the International Committee on Seafarers’ Welfare, are described. It is estimated that
by the end of 2012 about 3,500–4,000 ships in 17 major Australian ports will have received booklets
and leaflets for masters and crew members on the sole topic of depression from the Rotary Club of
Melbourne South’s project The Mental Health of Seafarers.
Recommendation for further action: A suggestion is made for a shipping industry
project that could result in all merchant ships worldwide receiving mental health information
based on the material produced by both the Rotary Club of Melbourne South and the Interna-
tional Committee on Seafarers’ Welfare.
Conclusions: The data on suicides proves that the mental health of seafarers in many
cases continues to be very poor and often fatal. With deaths aboard merchant ships resulting
from depression leading to suicide being widely reported, the damage to the seafarers, their
families, and ship owners cannot be ignored. It strongly demonstrates the need for everybody
connected with the international maritime shipping industry to do something about it. The mental
health of seafarers and the economic health of the shipping industry will be improved as a result.
(Int Marit Health 2012; 63, 2: 78–89)
Key words: Seafarers mental health, economics of seafarer deaths

Robert T.B. Iversen, International Service Committee, Rotary Club of Melbourne South, e-mail: info@seafarersmentalhealth.org

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 Robert T.B. Iversen, The Mental Health of Seafarers

INTRODUCTION the economics of operating large containerships was

It is often said that seafaring is a dangerous occu- provided by Drewry Maritime Research, London. Infor-
pation. Nowhere has this been better expressed than mation on the mental health of seafarers, which result-
by the International Maritime Health Association when ed in a business plan for a project initiated by the Rota-
it says “It has been established that seafaring is one ry Club of Melbourne South, was obtained by the au-
of the most physically demanding professions in one thor from interviews and consultation with members of
of the most dangerous work environments: the sea.” the Melbourne Port Welfare Association and others in
[1]. Numerous studies and reports on the physical the international shipping industry. Other reports were
and mental health of seafarers, on their illnesses and obtained by searching the Internet for papers on the
causes of death, attest to this statement [2–16]. topics mental health of seafarers, depression among
Seafarers spend months, maybe years, away from seafarers, suicides among seafarers, stress and fatigue
home; they get lonely; they work many hours straight among seafarers, criminalization, and piracy.
through without enough sleep; they face stress and fa- Two tables describe the percentage of seafarer
tigue, lack of shore leave; they face short ship-turnaround deaths by suicide. Table 1 shows percentages of sea-
times, criminalization, harassment and bullying, and dan- farer deaths by suicide compared to all deaths. Table 2
gers from piracy. These can lead to anxiety and depres- also shows percentages of seafarer deaths by suicide
sion and in some cases to suicide. Depression and sui- but compared to non-traumatic deaths (i.e. deaths from
cide have devastating consequences, not only for seafar- illnesses such as cancer, heart attack, and stroke
ers’ families but also for shipmates and the companies and not from accidents). It is the opinion of the author
that employ them. The objectives of this paper are to re- that showing percentages compared to non-traumatic
view published and un-published information on the deaths is a realistic approach in presenting and analys-
mental health and welfare of seafarers in order to 1) pro- ing data. This method results in percentages of deaths
vide a window into the current status of the mental health by suicide being considerably higher than percentag-
of seafarers, 2) establish whether the mental health of es of suicide deaths compared to all deaths. Reporting
seafarers in many cases continues to be very poor and “rates” of seafarer deaths by suicide per population at
often fatal; 3) describe two current projects to improve risk is usually done, but may not be readily understood
the mental health of seafarers; and 4) suggest an indus- by non-researchers who are in policy-making situations.
try-wide effort to improve the mental health of seafarers.
CONCEPTUAL BASIS OF ANALYSIS
SEAFARERS’ RIGHTS TO MENTAL HEALTH CARE It is important to note this paper does not report data
Stevenson [17] states “Neither traditional maritime based on rates of seafarer suicides/100,000 seafarer
law or the ILO Maritime Labour Convention 2006 specif- years (“Suicide rates are calculated by dividing the num-
ically addresses mental health care, but court decisions ber of suicides among a group by the population of the
in the past fifty years make it very clear that a seafarers’ group and multiplying the result by 100,000. This pro-
right to free medical care includes a right to free mental duces the number of suicides per each unit of 100,000
health care. A greater obstacle to seafarers seeking for the group. The “crude” rates of suicide can be com-
mental health care is the stigma of receiving the care. pared directly to other crude rates” [19].), although many
Seafarers may fear being labelled as a person with studies cited used rates to study trends in suicides. This
a mental illness and all of its associated stereotypes… Seek- paper presents deaths by suicide as percentages of all
ing mental care can also have consequences for a sea- deaths by seafarers, without a comparison (except in
farers’ social acceptance and self-esteem”. two cases) with percentages of suicides among general
populations. Rates analysis is often used in reporting
MATERIALS AND METHODS seafarer deaths (see, for example [4]). A paper by Stack
Data and information on the illnesses and causes [18] titled “Occupation and Suicide” reports “It is not
of death of seafarers was taken from published reports, clear, for example, if persons in alleged “high-risk” occu-
usually those carried out by social scientists studying pations have high suicide risk because of occupational
the health and welfare of seafarers. Information on the stress associated with the occupation or because of the
causes of depression and suicide was also obtained demographic composition of the people in the occupa-
from the so-called “grey” literature on the health and tion. The results underscore the need for demographic
welfare of seafarers and anecdotal reports from indi- controls in the assessment of occupational risk of sui-
viduals closely aligned with seafarers and their needs cide.” Stack indicates such an analysis would require
(e.g. chaplains in seafarers’ centres). Information on the use of multivariate models. An attempt was made to

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 Int Marit Health 2012; 63, 2: 78–89

Table 1. Percentage of seafarer deaths by suicide compared with total deaths

Reference Date Nationality of Total deaths Suicides Suicides Missing at Seaa

of reference seafarers (%)
& years studied
Borsch et al. [2] 2012 Danish Fleet 356 39 11.0 –
1986–2009
Roberts et al. [4] 2010 UK Fleet 1,515 57 3.8 90
1976–2005
Roberts & Williams [47] 2007 UK Fleet 369 16 4.3 19
1986–2005
Roberts [48] 2006 Isle of Man Fleet 65 2 3.1 5
1988–2005
Szymanska et al. [10] 2006 Polish Fleet 324 33 10.2 –
1969–1999
Roberts & Marlow [12] 2006 UK RFAb 60 6 10.0 2
Fleet
1976–2005
Jaremin [11] 2005 Polish Fleet 324 34 10.5 32
1960–1999
Roberts & Marlow [25] 2005 UK Fleet 835 55 6.6 87
1976–2002
Roberts [49] 2003 UK Seafarers in 1,264 43 3.4 75
FOC c & UK Fleets
1976–1995
Li & Zhang [26] 2002 UK Fleet 5,389 348 6.5 –
1962–1998
Roberts [27] 2000 UK Fleet 324 10 3.1 20
1986–1995
Nielsen [50] 1999 Hong Kong Fleet 123 4 3.3 9
1986–1995
Nielsen & Roberts [28] 1999 World-wide 2,207 91 4.1 74
1990–1994 per yeard per yeare per year
Roberts [51] 1998 UK, Singapore 1,117 50 4.5 66
& Hong Kong
Fleets
1981–1995
Hansen & Jensen [14] 1998 Danish Female 39 7 18.0 –
Seafarers
1986–1993
Jaremin et al. [52] 1996 Polish Fleet 109 4 3.7 4
1985–1994
Hansen [15] 1996 Danish Fleet 106 12 11.3 –
1986–1993
Hansen & Pedersen [30] 1996 Danish Fleet 774 81 10.5 –
1986–1993
Brandt et al. [16] 1994 Danish Fleet 1,503 101 6.7 –
1970–1985
Larsson & Lindquist [53] 1992 Swedish Fleet 223 18 8.1 –
1984–1988
Totals 17,026 1,011 5.9
aNot bUnited
included in total deaths; Kingdom Royal Fleet Auxiliary; cflag of convenience; dincludes a few homicides and unexplained deaths;
eestimated on a world-wide basis

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 Robert T.B. Iversen, The Mental Health of Seafarers

Table 2. Percentage of seafarer deaths by suicide compared with deaths due to illness. References are only those listing
deaths due to illness

Reference Date of reference Nationality of seafarer Deaths due to illness Suicides Suicides (%)
Borsch et al. [2] 2012 Danish Fleet 142 39 27.5
1986–2009
Roberts & Williams [47] 2007 UK Fleet 166 16 9.6
1986–2005
Roberts & Marlow [12] 2006 UK RFA 30 6 20.0
Fleet
1976–2005
Roberts [48] 2006 Isle of Man Fleet 20 2 10.0
1988–2005
Jaremin [11] 2005 Polish Fleet 86 34 39.6
1960–1999
Roberts [49] 2003 UK Seafarers in FOC & UK Fleets 507 43 8.5
1976–1995
Li & Zhang [26] 2002 UK Fleet 2,640 348 13.2
1962–1998
Couper [54] 2000 World-wide 521 91 17.5
Fleets
Nielsen [50] 1999 Hong Kong 21 4 19.0
Fleet
1986–1995
Hansen & Jensen [14] 1998 Danish Female 29 7 24.1
Seafarers
1986–1993
Jaremin et al. [52] 1996 Polish Fleet 44 4 9.1
1985–1994
Hansen [15] 1996 Danish Fleet 53 12 22.6
1986–1993
Larsson & Lindquist [53] 1992 Swedish Fleet 314 18 5.7
1984–1988
Totals 4,487 590 13.1

describe a cohort of workers on shore with similar occu- used by UK shipping companies from 1970–2005. Rob-
pations to those of seafarers without success. It is possi- erts et al. [4] studying the United Kingdom fleet from
ble that such cohorts can be described, and the author 1976–2005, found there were 57 suicides among 1,515
urges other social scientists reporting on seafarers’ wel- total deaths (3.8%) and 90 seafarers who went missing
fare to develop such a data base. at sea (many social scientists studying the deaths of sea-
farers believe that about 50% of seafarers who disap-
REVIEW OF RECENT LITERATURE pear at sea are suicide victims). Wadsworth et al. [8]
Borsch et al. [2] studied deaths among Danish sea- reported that seafarer fatigue may be linked to longer-
farers from 1986–2009 and reported 36 suicides (11%) term individual ill-health and can only be addressed by
out of a total of 356 deaths. The rate of suicides dropped considering how multiple factors combine to contribute
from 14.4 in 1986–1993 to 7.8 in 2002–2009, which is to fatigue. Leszczyñ s ka et al. [20] said stress among sea-
attributed to preventative interventions relating to vessel farers is related to three factors (triangulation): percep-
safety, work environment, improved medical care on tion and feeling, direct consequences, and state of health.
board, and to technological and organizational changes Allen et al. [21] reported that fatigue has been notice-
in the Danish fleet. Roberts et al. [3] reported on 12 ably under-researched in the maritime domain compared
different shipping factors that caused fatalities in UK to other transport sectors. Smith et al. [22] recommend
merchant shipping, UK second register, and foreign flags the following for addressing seafarers’ fatigue: review

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 Int Marit Health 2012; 63, 2: 78–89

how working hours are recorded; fatigue management er et al. [29] studied stress and fatigue among Aus-
training and information campaigns; establish an indus- tralian seafarers and found the specific sources to
try standard measure of fatigue; and develop a multi- be hardships at sea, weather, broken rest, long hours,
factor auditing tool. Smith [23] says that “Fatigue is and industry change. Hansen and Jensen [14] found
strongly linked to mental health problems which are clear- female seafarers were adopting the risky lifestyle of
ly risk factors for more chronic disease and early death male seafarers, with a large number of suicides (7)
(e.g. suicide).” Allen et al. [21] say that seafarer fatigue is in comparison to total deaths (39), or 18.0%. Hans-
a serious health and safety issue and call for more “ro- en and Pedersen [30] studied Danish seafarers and
bust” regulations as current legislation on fatigue has found 81 suicides (10.5 %) of 774 deaths.
not had the desired effect. Smith et al. [24] say the po-
tential for fatigue at sea is high due to a range of factors, CAUSES OF POOR SEAFARER MENTAL HEALTH
many unique to the marine environment. Szymanska et The causes of mental illness among seafarers are
al. [10], studying suicides among Polish seamen from well known. The International Committee on Seafarers’
1969–1999, found that out of 324 total deaths there Welfare booklet “Guidelines for Mental Care onboard
were 33 suicides — 10.2% of seafarer deaths, which Merchant Ships” [6] cites stress, harassment and bul-
was significantly higher than the incidence of suicides lying, anxiety, fatigue, disruptive thinking and behav-
among the male Polish population over 20 years of age. iour, and addiction to alcohol and drugs. To these must
They noted that the possibilities of predicting and pre- be added loneliness, short ship-turnaround times, lack
venting suicides during periodic health examinations are of shore leave, separation from spouses and families,
limited. Salyga and Juozulynas [9], studying the associa- job retention, and long working hours. Piracy and crim-
tion between environment and psycho-emotional stress inalization of seafarers are also causes.
experienced by Lithuanian and Latvian seafarers, found
the following factors associated with psycho-emotional Loneliness
stress on ships: depression occurring more frequently There is no doubt that loneliness creates problems
at sea, disturbed working and resting regimens, and dis- for seafarers. Lefevere [32] quotes the 80-year-old
turbed regular sexual life. Jaremin [11], studying deaths Brazilian priest Fr. Mario Bilbi: “Loneliness is a seafar-
of Polish merchant seamen from 1960–1999, reported er’s heaviest cross, the Brazilian priest said, noting
34 suicides out of 324 deaths, or 10.5% of deaths. that many seafarers are away from home up to 10
Roberts & Marlow [25] studied traumatic work-related months. It’s the presence of God and the thought of
deaths in British merchant shipping from 1976–2002 their families that is awakened at sea, especially at
and found there was no reduction in the suicide rate night when you’re alone on the bridge. What you see
from 1976 to 1995 in comparison to that in most high- is darkness. What you hear is the talk of the waves.”
risk occupations in Britain, but a decline after 1995. Malakauskiene [31] (n.d.), citing Agterberg and
They recommended improvements in care for seafarers Passchier [33], and Sampson and Thomas [34], says
at risk of suicide. Li & Zhang [26] reported 348 cases of they “showed that the main psychological problems
suicide among 5,389 total deaths, or 6.5% of total deaths. were primarily caused by long periods away from
They noted that the number of suicides and homicides home, social isolation and its effects on seafarers,
has consistently fallen over the years and suggest this is the decreased number of seamen per ship, and in-
a result of improved working conditions on board UK creased automatization”.
ships. Roberts [27] compared mortality rates of seafar-
ers in the UK fleet and in Flag of Convenience registry Separation from spouses and families
ships and found the mortality rates were an estimated One of the first things that seafarers do when
3.2 times greater in foreign-flagged vessels and a great- visiting any of the five seafarer centres in the Austra-
er number of seafarers in FOC fleets took their own lives lian State of Victoria is to head for a bank of comput-
or disappeared at sea. In a classic book describing ‘Voy- er consoles they can use to communicate with their
ages of Abuse’, Couper et al. [13] list many instances of spouses and families at home. There is no charge to
seafarers being abused by dodgy ship owners and ship- use these computers and it is not unusual on any
ping lines, recruiting agencies, and bankrupt shipping evening to see banks of 5 to 20 computers (in the
companies. Neilsen and Roberts [28] studied fatalities five different centres) completely filled with seafar-
in the world’s merchant seafarers and concluded that it ers using Skype to see and talk with their families.
is likely that “…in excess of 100 seafaring deaths a year Many use centre facilities to wire money home to
are due to suicides in the world’s merchant fleets”. Park- families. A few ship owners allow some crew mem-

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 Robert T.B. Iversen, The Mental Health of Seafarers

bers to have their families on board. In mid-2009 at dent resulting from fatigue due to lack of sleep by
the Stella Maris Seafarers’ Centre in Melbourne I met a ship’s officer occurred in Australian waters on April
the second engineer from a ship with an all Filipino 3, 2010. The 225 metre long Chinese bulk carrier
crew. He had his wife and two children with him on Shen Neng 1, carrying 65,000 tons of coal and 950
the ship during the voyage. tons of heavy fuel oil, ran aground in a restricted zone
on the Great Barrier Reef as a result of the officer
Stress forgetting to plot a safe passage of the ship through
The International Committee on Seafarers’ Wel- the reef due to fatigue from lack of sleep. According
fare booklet “Guidelines for Mental Care Onboard to news reports the ship gouged a path three kilome-
Merchant Ships” has one chapter devoted to the tres long through the reef. An environmental disaster
problem of stress for seafarers [6]. It says” Typical was avoided because the weather was good and ex-
symptoms of stress are insomnia, loss of mental cept for leaking a small amount of fuel oil the ship was
concentration, anxiety, substance abuse, extreme an- refloated and taken to a safe anchorage prior to re-
ger and frustration, family conflict, and physical illness- turning to China for repairs. The Australian Transport
es such as heart disease, migraine headaches, stom- Safety Bureau has released a final report on this
ach problems, and back problems. Six key areas (or grounding, which says the accident was caused by
‘risk factors’) can be causes of work-related stress on fatigue of the officer responsible for plotting the ship’s
board. These are: the demands of the job; the level of path through the Great Barrier Reef [35].
control seafarers have over their work; the support re-
ceived from management and colleagues; relationships Lack of shore leave
at work; the seafarers’ role in the organization; and Von Dreele [36], in a paper delivered at a petroleum
change and how it is managed. When under severe industry conference, stated, “At SCI (Seaman’s Church
stress, a seafarer fails to take clear-cut decisions, fails Institute) we have 10 years of statistics of our ship visits
to re-evaluate and reassess priorities and lifestyles, and and services. Remarkably, shore leave levels have av-
ultimately tends to fall into unproductive distractions. eraged only between 20–25% per ship. There are
This can be described as a classic case of ‘burnout’. a number of factors beyond turn around times that
Chronic responsibility syndrome is a kind of burnout account for this low percentage: working, need for rest,
where people become mentally and physically exhaust- lack of a US visa, and depression. The implementation
ed from their workload. The symptom is often described of TWIC (Transportation Workers Identification Certifi-
as ‘there’s too much work to do, and no one else can cate) will restrict any crew members who currently walk
do it but me’. Typically it will occur in hard working, through a terminal to the gate for shore leave.”
hard driven people who become emotionally, psycho- In August 2010 I went aboard a large container-
logically, or physically exhausted.” Leszczyñ ska et al. ship in Melbourne to deliver booklets in English on de-
[20] report that stress is related to a triangulation of pression to the master (who also asked for our other
factors. They say, “Triangulation means collecting evi- booklets in Chinese and Russian, even though the crew
dence from three sources: Precursors-perception and was made up of Filipino seafarers, who are usually
feeling (moderating factors), direct consequences, and thought to have a good command of English). I was
state of health.” The possibilities of collecting data at told the crew had trouble getting shore leave in several
sea are analysed regarding these individual factors. U.S. ports for a variety of reasons, some relating to U.S.
Coast Guard security regulations, others relating to ship
Fatigue turn around times and the difficulty of simply getting to
Allen et al. [21], in a review of the recent litera- the dockyard gate from the berthing area.
ture on fatigue, say, “Fatigue has been noticeably
under-researched compared to other transport sec- Short ship-turnaround times
tors. While diversity in the seafaring population has Short ship-turnaround times are a problem. In
the potential to make global fatigue estimates mean- Melbourne turnaround times for container ships are
ingless, evidence of mis-recorded working hours not more than three days and in most cases less
shows how cultural and commercial pressures are than that. However, bulk cargo ships or combination
universally shared.” Smith et al. [24] say that “Fa- container/bulk cargo ships may be in port for some-
tigue is strongly linked to mental health problems what longer periods. A significant number of auto-
which are clearly risk factors for more chronic dis- mobile carriers call in Melbourne. Their cargos of
ease and early death (e.g. suicide). ”A classic acci- 5,000 or 6,000 automobiles can be discharged in

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 Int Marit Health 2012; 63, 2: 78–89

24 hours, after which they are able to leave. This in the investigation and prosecution of those inci-
can result in seafarers not getting a chance to go dents [37]. Many actions against masters and ship’s
ashore because their duties aboard ship does not officers have occurred as a result of oil pollution in-
leave enough time for even a half day ashore. cidents. According to Maris [39] “…recent cases have
shown a marked tendency for seafarers to be crimi-
Job security nally prosecuted for maritime accidents beyond their
Most non-rated seafarers are employed on nine- or control; criminally prosecuted for maritime accidents
ten-month contracts. As these contracts end the sea- where there has been some negligence, regardless
farers are said to be very concerned that their con- of the fact that such negligence is not considered
tracts will not be renewed, thus ending a chance to criminal in the maritime industry; detained indefi-
send money home as repatriation of wages. As a result nitely within the country bringing charges against
of the great financial crisis of 2008 the international them; held as ‘security’ or ‘material witnesses’ till the
shipping industry was severely affected with many ships ship owner or P&I club pays up; held in custody with-
unable to obtain charters, causing seafarers to worry out any access to legal assistance or without being
about job retention. Many ships were tied up and some formally convicted of a criminal office; and denied
anecdotal accounts said newly constructed container shore leave for arbitrary reasons”.
ships were being used as temporary storage warehous- A classic case of criminalization of ship’s officers
es for the surplus of empty containers that accumulat- is that of the tanker Hebei Spirit, while at anchor in
ed because of the lack of business. the Yellow Sea six miles off the resort island of Tae-
an, South Korea. On December 7, 2007 the Hebei
Cultural problems Spirit was struck by an uncontrolled crane barge
Von Dreele [38] also says, “Chaplains and ship that collided and punctured three oil tanks. This
visitors often confront the clash of cultures and na- caused a release of 12,547 kilolitres of oil, which
tionalities aboard ship. Certain nationalities should impacted nearby beaches ten days later. Master Jas-
never be put together on the same ship. Racism and prit Chawla and Chief Officer Syam Chetan were
abuse are prevalent on many open registry ships to- cleared of any wrongdoing at their first trial but were
day. To compound all of this, the seafarer has to deal kept in jail while the prosecutors appealed. A second
with the immense isolation aboard ship. He is gone trial found them guilty and sentenced them to three
for up to nine months and rarely has an opportunity years in prison and a fine of $22,530. They finally
to contact his family”. However, in fairness to ship returned home in India on June 11, 2009 after the
owners, crew members are now often allowed ac- case was dismissed and they had been in custody
cess to email facilities aboard many ships. This is for 18 months. Such criminalization can have seri-
particularly true of large oil tankers and of ships ous effects on seafarers’ mental health. Von Dreele
managed by reputable shipping lines. [38] reported that “… depression and addictive be-
haviour has surfaced among the crews…” and that
Abuse “a defendant in one case tried to commit suicide”
Couper et al. [13] describe a type of abuse that during a pollution incident near Philadelphia, U.S.A.
merits its own category. They say, “This is about sea- The Baltic and International Maritime Council has
farers employed within the sector of merchant ship- said criminalization could effect recruitment of sea-
ping which is regarded as substandard. By substan- farers by causing some individuals to forego seeking
dard we include ships defective in structure and a career at sea.
equipment, and those with low wages and poor work-
ing conditions. Very often they are the same vessels. Piracy
In this substandard sector of ship owning, seafarers The continued hijacking of ships off the coast of
are exploited and abused, and respectable shipping Somalia in the Indian Ocean and off the east coast
companies are exposed to unfair competition.” of Africa is becoming more and more of a problem
as the methods used by pirates become more so-
Criminalization phisticated. The 2009 hijacking of the Maersk Ala-
The term “criminalization of seafarers” is used bama and its successful release due to the heroic
to describe the treatment of maritime incidents as actions of its Master and the killing or capture of the
“true crimes”. It is also used as a blanket term to pirates by the U.S. Navy has highlighted the prob-
describe the denial of procedural and human rights lems of seafarers captured and held hostage by pi-

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 Robert T.B. Iversen, The Mental Health of Seafarers

rates. John Bainbridge of the International Transport cides would be higher. Percentages of deaths due to
Workers Federation called 2011 the ‘Year of the Pirate’ suicide are given in Tables 1 and 2.
with 450 hostages taken and 15 murdered. He report-
ed increased violence, abuse and threats to hostages,
and longer hostage periods (averaging more than 210 ECONOMIC COST OF POOR SEAFARER
days). The maritime newspaper Telegraph [40] report- MENTAL HEALTH
ed that “Naval forces have helped to secure a signifi- When a ship’s voyage is stopped or is diverted
cant reduction in the number of successful pirate at- because of a mentally ill seafarer or a seafarer disap-
tacks, a new report claims. The International Maritime pearing at sea, the dollar cost to the ship owner or
Bureau (IBS) statistics show that Somali pirates hijacked charterer can be very high. In 2012 the daily cost of
40% fewer ships in 2011 and that the total number of operating a 3,000–4,000 TEU container ship built in
attacks fell from 445 in 2010 to 439 in 2011 — ending 2000 is expected to be US$7,825 (information on
four consecutive years of increases.” the costs of operating container ships is provided
Cases of depression among seafarers subsequent- with the permission of Drewry Maritime Research,
ly released by pirates after a ransom has been paid London). This does not include the cost of fuel oil.
are common. The Seamen’s Church Institute in New This is based on the following categories of expens-
York City, aware that the trauma caused by being on es: manning, insurance, stores, spares, lubricating
a hijacked ship and/or taken hostage can affect the oil, repair and maintenance, and management of
mental health of seafarers, has completed a study administration. It includes a daily cost over five years
on post-piracy assessment and trauma [41]. Efforts of dry-docking at US$551,000. In 2012 the expect-
of flag states and ship owners to place armed guards ed daily cost of operating a 10,000 TEU container
aboard merchant ships have caused problems con- ship built in 2000 is US$10,944. This is based on
cerning the legal aspects of such action; however, the yearly cost of the same categories of expenses
recent press reports cite that armed guards have including dry-docking at US$750,000. The daily cost
been placed aboard some ships by ship owners. Brit- of fuel oil can be higher than all other daily costs of
ish Prime Minister David Cameron has said he is going operating container ships. Fuel oil costs can be as
to make changes in the regulations covering the use high as US$30,000 per day depending on the Sin-
of armed security guards [42]. gapore price of fuel oil. To this should be added the
cost of mortgage insurance and capital repayment
RESULTS (Prof. Alastair Couper, personal communication). He
notes that in the case of high value perishable car-
SUICIDE — A SERIOUS PROBLEM go, its loss could also be an added cost to the ship
The evidence that suicide among seafarers is a seri- owner.
ous problem is incontrovertible. Suicides among seafar- A recent case in Australia highlights how a ship
ers have been widely reported, as shown in Table 1. can lose several days and a large amount of money
Several cite seafarers that have disappeared without due to the disappearance of an officer. On Saturday
a trace and which are thought to be suicides. Roberts April 9, 2011 the Korean Master of the 180,176 dead
& Marlow [25] reported deaths of disappearing seafar- weight tonnage bulk carrier Ocean Caesar was re-
ers as follows: “…178 seafarers in this study were due to ported missing at 4:15 p.m. about 40 nautical miles
disappearances at sea or seafarers who were found northeast of Sandy Cape, Queensland. Aircraft of the
drowned. From examining official inquiry files, suicide Australian Maritime Safety Authority (AMSA) conduct-
was the most plausible cause in about half of these 178 ed a search throughout Saturday and Sunday, in-
cases.” Of these, 87 disappeared without trace, and most cluding using infra red sensing equipment at night.
were thought to be suicides. Disappearing seafarers are Unfortunately, the Master was not found. The Ocean
also discussed in Low [43]. Suicide by seafarers is much Caesar was forced to divert to a Queensland port
higher than suicides in general populations. In Austra- while AMSA, the Australian Transport Safety Bureau,
lia, for example, suicides were two per cent of the coun- and local authorities conducted an investigation over
try’s total deaths in 1998 [44] and 1.5% of all deaths in several days. The unexpected economic loss to the
2008 [45]. In the United Kingdom suicides in 2011 were shipping line of the bulker being diverted and then
1.2 % of all deaths [46]. If half the cases of disappearing spending days in port may have been as high as
seafarers at sea were included in the data, as suggest- US$50,000–US$100,000 plus costs to bring a new
ed by Roberts and Marlow [25], the percentage of sui- master to Australia for the ship.

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 Int Marit Health 2012; 63, 2: 78–89

TWO MENTAL HEALTH PROJECTS PROVIDING understanding depression, how someone with depres-
HELP FOR SEAFARERS sion can be helped, and on reducing stress. The small-
er leaflets for non-officer seafarers have the same in-
On board help from Rotary formation but in a shortened version. The Rotary Club’s
The Mental Health of Seafarers is an Australian website contains copies of booklets for masters and
project initiated by the Rotary Club of Melbourne the leaflet for non-officer seafarers on depression in
South (RCMS) with the cooperation of the Melbourne English, Chinese, Tagalog, and Russian, which can be
Port Welfare Association (MPWA); Beyondblue, the downloaded and printed at no cost. To obtain the book-
national depression initiative; the Stella Maris Sea- lets and leaflets go to www.seafarersmentalhealth.org
farers’ Centre in Melbourne and the Mission to Sea- and follow the prompts.
farers Victoria. The MPWA is a group of 15 promi- Shipping Australia Ltd., working with InchCape
nent organizations on the Melbourne waterfront that Shipping Services and their associated corps of ship’s
works to make the visits of seafarers pleasant and agents, has also undertaken distribution of the mate-
enjoyable. Beyondblue leads an Australia-wide advo- rial, so it is now being placed on board ships in 17
cacy on understanding depression and removing its Australian ports. By the end of 2012 it is estimated
stigma. The Stella Maris Seafarers’ Centre in Mel- the information on depression will have been placed
bourne and the Mission to Seafarers Victoria between on board 3,500–4,000 merchant ships. In 2010 and
them operate five centres where seafarers can rest, 2011 several depressed or troubled seafarers were
relax, wire money home, communicate with families given help after reading the booklets or leaflets. Be-
via the internet, purchase small personal items, and cause the project has been successful, the RCMS is
receive pastoral counselling if they are in distress. making efforts to make its work known internationally.
This project was the result of discussions between
the RCMS and members of the MPWA, after research On board help from the ICSW
by the RCMS showed that seafarers are more likely The London-based International Committee on
to have a mental illness than their counterparts on Seafarers Welfare (ICSW) has produced booklets ti-
shore [55]. Its purpose is to produce printed infor- tled Guidelines for the Mental Care of Seafarers’
mation on the single mental health issue of depres- onboard Merchant Ships [6]. The ICSW, aware of the
sion for distribution to masters and non-rated officer importance of the health of seafarers, has produced
on the more than 2,000 ships carrying 60,000 sea- the guidelines as part of its new mental health project,
farers that berth in Victorian ports each year [56], so which is funded by the International Transport Work-
that depressed crew members can be identified and ers Federation’s Seafarers’ Trust. The ICSW’s Seafar-
helped and the stigma associated with such an ill- ers’ Health Information Program is part of its Mental
ness can be reduced. In 2011 about 20,000 seafar- Care initiative. The guidelines are in a colourfully il-
ers visited the Mission to Seafarers and Stella Maris lustrated 12-page booklet with humorous cartoons
Seafarers’ Centre in Melbourne. The top three na- of seafaring life. It covers the following 12 topics: Risks
tionalities visiting the centres were Filipino, Chinese, for Seafarers, Stress, Harassment and Bullying, Anx-
and Indian seafarers. iety, Depression, Fatigue, Disruptive Thinking and Be-
Statistics gathered by the two seafarer centres in haviour, Addiction to Alcohol and Drugs, Mental Care
Melbourne show that 85% of seafarers visiting Mel- Onboard, Tips for the Successful Implementation of
bourne speak English, Chinese, Tagalog, or Russian. a Mental Care Campaign, and Where to Find Advice.
Eight-page booklets in colour for masters and small- The ICSW’s booklet notes that “Although psycho-
er 16-page leaflets for non-officer seafarers were print- logical problems are very common among seafarers,
ed in those languages. Each contains hotline tele- the mental health of seafarers has only comparative-
phone numbers that masters or ship’s officers can ly recently started to receive the attention it deserves.
call for help concerning a depressed seafarer. The True mental illness occurs independently of any phys-
hotlines are manned 24/7 by call centres at Lifeline ical ailment. Normally a difference in behaviour can
Australia and the Federal government’s Translation be seen, ranging from just slightly unusual to com-
and Interpreting Service (TIS). If a non-English speak- pletely abnormal. This can vary between mild anxi-
ing seafarer calls for help, a conference call with Life- ety attacks to depression, disruptive thinking, or ag-
line Australia, TIS (which provides an interpreter) and gressive behaviour. Even more tragically, it can lead
the seafarer is arranged. The booklets contain to suicide.” Booklets can be obtained by going to
a checklist to identify someone who is depressed, www.icsw.org.uk and clicking on the Online Shop.

86 www.intmarhealth.pl
 Robert T.B. Iversen, The Mental Health of Seafarers

DIFFERENCES BETWEEN THE TWO PROJECTS ed to identify the many causes of fatigue and stress
The basic difference between The Mental Health and for ship owners to reduce the factors causing
of Seafarers project and the ICSW’s project is that fatigue and stress in the seafarers that crew their
the Australian initiative covers only one topic: depres- ships.
sion, while the ICSW’s guidelines are a much broad-
er approach to seafarers’ mental health. It is hoped ECONOMIC COSTS
that the two projects described in this paper will be When the costs of operating ships are calculated
able to help bring about long needed improvements in terms of specific items like fuel oil, repairs, and
in the mental health of seafarers. dry-docking, losses due to mental illness cannot be
anticipated, but when they occur the economic cost
DISCUSSION to ship owners because a voyage is diverted or de-
layed because of a mentally ill seafarer or one who
DEPRESSION AND SUICIDE disappears at sea can be very high. The recent case
The reasons for seafarers becoming depressed, of a master disappearing at sea near Australia may
which in many cases result in suicide, are well known. have cost the ship owner as much as $50,000–
These include loneliness, separation from spouses –US$100,000 due to the voyage being diverted and
and families, stress, fatigue, lack of shore leave, job delayed. It does not take very long to have daily op-
security, cultural problems, abuse, criminalization, erating costs due to a voyage being diverted and
and piracy. The statistics of the percentage of seafar- delayed to mount up even higher. With the daily costs
er deaths by suicide prove that the mental health of in 2012 of running a 3,000–4,000 TEU container
seafarers continues to be very poor and are a call ship expected to be US$7,825 and a 10,000 TEU
for action to have them reduced. The compilation of container ship expected to be US$10,944 (not in-
20 published reports covering the years 1960–2009 cluding the costs of fuel oil, mortgage insurance and
showing that 1,011 seafarer deaths out of 17,026 capital repayment), efforts need to be made to less-
total seafarer deaths were by suicide – for a per- en costs due to poor seafarer mental health. Job sat-
centage of 5.9% of all deaths — is something that isfaction is important. Diederichsen [57] says that job
cannot be ignored. They ranged from a low of 3.1% satisfaction and bottom line costs go hand in hand.
to a high of 18.0%. A second compilation of 12 re- Besides the psychological aspects of job satisfaction,
ports of deaths due to illness from 1992–2007 he says there are other factors that contribute to
showed 590 seafarer deaths by suicide out of 4,573 a seafarer’s sense of wellbeing. These are acknowl-
deaths due to illness, or 13.1% of deaths. In these edgement and appreciation, social support, the pos-
12 studies the percentages ranged from a low of sibility to learn and develop, influence by having their
5.7% to a high of 27.5%. Both of these compilations contributions acknowledged, being aware their con-
would be even higher if the number of seafarers dis- tributions help a company succeed, and a good bal-
appearing at sea were included. Three studies, Bor- ance between work load, job complexity, and each
sch et al. [2], Roberts and Marlow [25], and Li and individual’s competence.
Zhang [26] reported some reduction in suicides.
Many social science researchers believe that at least PROJECTS TO IMPROVE SEAFARERS’
half of deaths due to disappearance at sea are due MENTAL HEALTH
to suicide. Whether suicides by seafarers are calcu- The projects by the Rotary Club of Melbourne
lated as percentages of total deaths or percentage South and the International Committee on Seafar-
of deaths by illness, the results can only be described ers’ Welfare, which provide written information on
as shocking. mental illness in general and on depression to mas-
Both methods of describing seafarer deaths by ters and seafarers, are the only two such projects
suicide as percentages should be readily understood that are known to Rotary. They could have more pos-
by ship owners or government officials who may not itive effects if such approaches resulted in all ships
have the technical knowledge of using rates to re- world-wide receiving information on depression and
port seafarers’ deaths. Comparing the percentage of the causes of poor mental health of seafarers.
seafarer deaths by suicide to deaths from natural The Mental Health of Seafarers project by the
illness is presented in the hope it may result in social Rotary Club of Melbourne South (RCMS) was start-
science researchers commenting on whether or not ed in 2009 in cooperation with the Melbourne Port
it is an appropriate method. More research is need- Welfare Association and ship’s agents to provide print-

www.intmarhealth.pl 87
 Int Marit Health 2012; 63, 2: 78–89

ed booklets and leaflets on the sole topic of depres- REFERENCES

sion for masters and crew members. By the end of 1. IMHA 2012. International Maritime Health Association.
Newsletter, January 2012: 14.
2012 it is estimated that this material will have been
2. Borsch DF et al. Surveillance of maritime deaths on board
distributed on 3,500–4,000 ships in 17 major Aus- Danish merchant ships, 1986–2009. Int Marit Health
tralian ports. The Rotary Club of Melbourne South is (in press).
undertaking efforts to make its approach to seafar- 3. Roberts SE et al. Shipping casualties and loss of life in
ers’ welfare known internationally. Details of a plan UK merchant shipping, UK second register and foreign
showing how the project developed and is being run flags used by UK shipping companies. Marine Policy 2012;
36: 703–712.
can be obtained by going to the project’s website at
4. Roberts SE et al. Suicides among seafarers in UK mer-
www.seafarersmentalhealth.org and following the chant shipping 1919–2005. Occupational Medicine 2010;
prompts. The project to improve the mental health of 60: 54–61.
seafarers by the International Committee on Seafar- 5. Iversen RTB 2011. The Mental Health of Seafarers:
ers’ Welfare is being successfully undertaken with A Brief Review. 11 th International Symposium on Maritime
Health, 6–10 September 2011, Odessa, Ukraine: 15 p.
the financial assistance of the International Trans-
6. ICSW. Guidelines for mental care onboard merchant
port Workers Federation. ships. International Committee on Seafarers’ Welfare,
Seafarers Health Information Program 2009: 12 p.
CONCLUSIONS (www.seafarershealth.org; e-mail: ship@icsw.org.uk).
The data on suicides proves that the mental health 7. Allen P. et al. The prevention and management of seafar-
of seafarers in many cases continues to be very poor ers’ fatigue. Int Marit Health 2007; 58: 81–92.
8. Wadsworh EJK et al. Fatigue and health in a seafaring
and often fatal. With deaths aboard merchant ships
population. Occupational Medicine 2008; 58: 198–
resulting from depression leading to suicide being –204.
widely reported, the damage to the seafarers, their 9. Salyga J, Juozulynas A. Association between environment
families, and ship owners cannot be ignored. This and psycho-emotional stress experienced at sea by
strongly demonstrates the need for everybody con- Lithuanian and Latvian seamen. Medicina (Kaunas)
2006; 42: 759–769.
nected with the international maritime shipping in-
10 . Szymanska K et al. Suicides among Polish seamen and
dustry to do something about it. The mental health fishermen during work. Int Marit Health 2006; 57: 36–45.
of seafarers and the economic health of the ship- 11. Jaremin B. Work-site casualties and environmental risk
ping industry will be improved as a result. assessment on Polish vessels in the years 1960–1999.
Int Marit Health 2005; 56: 17–27.
12. Roberts SE and Marlow PB. Work related mortality among
RECOMMENDATION FOR FURTHER ACTION
merchant seafarers employed in UK Royal Fleet Auxiliary
The following is offered towards reaching a goal shipping from 1976 to 2005. Int Marit Health 2006; 57:
of all ships worldwide receiving information specifi- 24–35.
cally on the mental health of seafarers. It is sug- 13. Couper AD et al. Voyages of Abuse — Seafarers, Human
gested that leading international organizations that Rights and International Shipping. Pluto Press, London
1999: 211 p.
are concerned with the welfare of seafarers, such
14. Hansen HL, Jensen J. Female seafarers adopt the high
as the International Maritime Health Association, the risk lifestyle of male seafarers. Occupational and Envi-
International Transport Workers Federation, the ronmental Medicine 1998; 55: 49–51.
Baltic and International Maritime Council, the In- 15. Hansen HL. Surveillance of deaths on board Danish mer-
ternational Chamber of Shipping and the Asian chant ships, 1986–1993; implications for prevention.
Occupational and Environmental Medicine 1996; 53:
Shipowners Forum, working with organizations like
269–275.
the philanthropic TK Foundation (whose website 16. Brandt LPA. et al. Mortality among Danish merchant sea-
says it has a “great affection for seafarers and men from 1970 to 1985. American Journal of Industrial
a passion for ships and the sea”), produce booklets Medicine 1994; 25: 867–876.
and leaflets modelled on those produced by the 17. Stevenson DB. Seafarers’ rights to mental health care.
The Sea. Issue 203, January/February, p. 6. Published by
Rotary Club of Melbourne South and the Interna-
The Mission to Seafarers 2010 (London).
tional Committee on Seafarers Welfare, in languag- 18. Stack S. Occupation and suicide. Social Science Quar-
es used by most seafarers, for distribution on board terly 2001; 82: 387–396.
all ships. 19. McIntosh JL. Year 2007. Official final statistics of sui-
cides in the USA. Prepared for the American Association
of Suicidology 2007; 5 p. (http://mypage.iu.edu/~jmcin-
ACKNOWLEDGEMENTS tos/SuicideStats.html).
I thank Dr. Stephen E. Roberts and Professors 20. Leszczyñska A. et al. Research and measures of stress.
Alastair Couper and Vsevolod Rozanov for their advice. Int Marit Health 2008; 59: 93–102.

88 www.intmarhealth.pl
 Robert T.B. Iversen, The Mental Health of Seafarers

2 1 . Allen P. et al. Seafarers’ fatigue: a review of the recent 3 8 . Von Dreele JD. Criminalization on the High Seas: Seafar-
literature. Int Marit Health 2008; 59: 167–177. ers Caught in the Middle — Great Risks and Indignities.
2 2 . Smith AP et al. A comparative approach to seafarers’ World Maritime Day Forum at the United Nations, No-
fatigue. Proceedings of the International Symposium on vember 15, 2006: 3 p.
Maritime Safety, Security and Environmental Protection, 3 9 . Maris B. Criminalization and Piracy are Damaging Sea-
Athens 2007: 15 p. farers Recruitment Warns InterManager. India Manning
2 3 . Smith A. Adequate crewing and seafarers’ fatigue: the in- & Training Conference, Mumbai. January 10, 2011.
ternational perspective. Centre for Occupational and Health 4 0 . Anonymous. Piracy down. Telegraph 2012; 45: 3. Pub-
Psychology, Cardiff University, Wales, UK 2007: 60 p. lished by Nautilus International Nautilus House, Mariners
24. Smith A et al. Seafarer fatigue: the Cardiff Research Pro- Park, Wallasey CH45 7PH, UK (www. nautilusint.org).
gramme. Centre for Occupational and Health Psychology, 41. Garfinikle MS. Post-piracy Care for Seafarers:Guidelines
Cardiff University, Wales, UK 2006: 87 p. (3.0). Published by the Seamen’s Church Institute, 241
2 5 . Roberts SE, Marlow PB. Traumatic work related mortality Water St., New York, NY 10038, USA 2011 (retrieveable
among seafarers employed in British merchant shipping, at http://seamenschurch.org/images/piracy-traumastudy/
1976–2002. Occupational and Environmental Medicine /piracystudyguidelines-printerfriendly-ver3.0.pdf).
2005; 62: 72–180. 4 2 . Anonymous. Flags seek controls on armed guards. Legal
2 6 . Li K, Zhang S. Maritime professional safety: prevention protection urged for guns onboard ships. Telegraph: 2011;
and legislation on personal injuries on board ships. Pro- 44: 6. Published by Nautilus International, Nautilus House,
ceedings of the International Association of Maritime Mariners Park, Wallasey CH45 7PH, UK.
Economists; 13–15 November 2002, Panama: 12 p. 43. Low A. Seafarers and passengers who disappear without
27. Roberts S. Occupational mortality among British merchant a trace from aboard ships. Int Marit Health 2006; 57: 219–229.
seafarers (1986–1995). Maritime Policy & Management 4 4 . Wesley Mission. 2000. Suicide in Australia, a dying shame:
2000; 27: 253–265. 26 p. (www.wesleymission.org.au/publications/r&d/suicide).
28. Nielsen D, Roberts S. Fatalities among the world’s merchant 4 5 . ABS 2008. Australian Bureau of Statistics. Measures of
seafarers (1990–1994). Marine Policy 1999; 23: 71–80. Australia’s progress — 2010: 48 p. (www.abs.gov.au).
2 9 . Parker AW et al. A survey of the health, stress and fatigue 4 6 . The Samaritans 2011. Upper Mill, Kingston Road, Ewell,
of Australian seafarers. Australian Maritime Safety Au- UK. Suicide Statistics Report, 2011: 30 p.
thority, Canberra 1997: 112 p. 47. Roberts SE, Williams JC. Update of mortality for workers
3 0 . Hansen HL, Pedersen G. Influence of occupational acci- in the UK merchant shipping and fishing sectors. Report
dents and deaths related to lifestyle on mortality among for the Maritime and Coastguard Agency and the Depart-
merchant seafarers. International Journal of Epidemiolo- ment for Transport. Research 2007; project 578: 85 p.
gy 1996; 25: 1237–1243. 48. Roberts SE. Surveillance of work related mortality among sea-
31. Malakauskiene R (no date). Health related quality of life farers employed on board Isle of Man registered merchant
among seamen-focus on Lithuanian seamen. Master’s ships from 1986 to 2005. Int Marit Health 2006; 57: 9–23.
thesis, Blekinge Institute of Technology, Kariskrona, 4 9 . Roberts SE. Word-related mortality among British sea-
Sweden: 114 p. farers employed in Flags of Convenience shipping, 1976–
3 2 . Lefevere P. Keeping seafarers’ faith afloat. National Cath- –1995. Int Marit Health 2003; 54: 7–25.
olic Reporter September 15, 2000. 5 0 . Nielsen D. Deaths at sea — a study of fatalities on board
3 3 . Agterberg, G, Passchier J. Stress among seamen. Psy- Hong Kong-registered merchant ships (1986–92). Safe-
chological Reports 1998; 83: 708–710 [(cited in ty Science 1999; 32: 121–141.
Malakauskiene (n.d.)]. 51. Roberts S. Occupational mortality among merchant seafar-
3 4 . Sampson H, Thomas H. Social isolation of seafarers: ers in the British, Singapore and Hong Kong fleets (1981–
causes, effects, and remedies. International Maritime –1995). Seafarers International Research Centre 1998: 50 p.
Health 2003; 54: 58-67 [cited in Malakauskiene (n.d.)]. 5 2 . Jaremin B. et al. Causes and circumstances of death of
3 5 . ATSB. Independent investigation into the grounding of Polish seafarers during sea voyages. Journal of Travel
the Chinese registered bulk carrier Shen Neng 1 at Dou- Medicine 1996; 3: 91–95.
glas Shoal, Queensland on 3 April 2010. Australian Trans- 53 . Larsson TJ, Lindquist C. Traumatic fatalities among Swedish
port Safety Bureau Investigation 2011 Number 274-MO- seafarers 1984–1998. Safety Science 1992; 15: 173–182.
2010-003 (final report) [to download the report go to the 5 4 . Couper A. 2000. Implications of maritime globalization
following address: http://www.atsb.gov.au/publications/ for the crews of merchant ships. Journal for Maritime
/investigation_reports/2010/mair/274-mo-2010-003.aspx]. Research 2000; 2: 1–8.
3 6 . Von Dreele JD. The Human Elements in Shipping: A Mar- 5 5 . Iversen RTB, 2009. A business plan for a project on “Men-
itime Chaplain’s Perspective. Proceedings of the Ameri- tal Health of Seafarers”: 16 p. (www.seafarersmental-
can Petroleum Institute Conference, San Diego, Califor- health.org; e-mail: info@seafarersmentalhealth.org).
nia, June 24, 2008. 5 p. 5 6 . Miriam O’Brien Consulting. Welfare services to seafar-
37. Kirby SM. The criminalization of seafarers involved in ers produced on behalf of the Melbourne Port Welfare
marine pollution incidents. Company of Master Mari- Association 2009: 31 p.
ners of Canada International Conference “Shipping and 57. Diederichsen S. Job satisfaction and bottom line go hand
Environmental Issues in 2011”. Halifax, Nova Scotia, in hand. Bulletin of the Baltic and International Maritime
June 7, 2011. Council 2012; 107: 48–51.

www.intmarhealth.pl 89