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TRANSCRIPT
MIND OVER MATTER –
TACKLING MENTAL HEALTH ISSUES
Sandra Guiguet and Kunal Pathak
Gard
20 June 2019
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INTRODUCTIONMENTAL HEALTH OF SEAFARERS
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Are seafarers different from us?
ARE SEAFARERS DIFFERENT FROM US?
Does mental well being of seafarers matter?
Can they do something about it?
Can we do something about it?
TWO CONTRASTING SCHOOLS OF THOUGHT
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Yes, they are different as they
work and live in a very different
environment than us.
No, they are not different as we
would be affected as much as
they are, if we are subject to
similar work and life environment.
To be able to answer the questions we need to understand what is mental illness.
MENTAL ILLNESS / DISORDERS – TYPE & NUMBERSWORLD HEALTH ORGANISATION FACT SHEET (APR’18)
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DEPRESSION
BIPOLAR
AFFECTIVE
DISORDER
SCHIZOPHRENIA DEMENTIA AUTISM
1 2 3 4 5
Sadness, loss of
interest or pleasure,
feelings of guilt or low
self-worth, disturbed
sleep or appetite,
tiredness, and poor
concentration
300 million
Consists of both
manic and depressive
episodes separated by
periods of normal
mood
60 million
Distortions in thinking,
perception, emotions,
language, sense of
self and behaviour.
Common psychotic
experiences include
hallucinations
(hearing, seeing or
feeling things that are
not there) and
delusions
23 million
It affects memory,
thinking, orientation,
comprehension,
calculation, learning
capacity, language,
and judgement.
50 million
Impairment of skills
across multiple
developmental area
such as cognitive
functioning and
adaptive behaviour.
Lower intelligence
diminishes the
ability to adapt to
the daily demands
of life.
unknown nos.
DEPRESSION AND SUICIDESWORLD HEALTH ORGANISATION FACT SHEET
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Leading cause of disabilityworldwide
Major contributor to the overall
global burden of disease.
Nearly 800,000 people die due to
suicide/year
Many more who attempt suicide
Suicide is second leading cause of death
among 15-29 yr olds
79% of global suicides occur in low
and middle income countries
GARD FACTS
GARD FACT SHEETGARD DATA FROM 2010- 2019
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MENTAL DISORDER:
320 cases
Avg: 32 per yr
SUICIDES:
37cases
Avg: 4.6 per yr
DEATHS:
645 cases
Avg: 65 per yr
GARD FACT SHEETAGE DISTRIBUTION- 2009 - 2018
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CHALLENGES DEALING
WITH MENTAL ILLNESS
CHALLENGES DEALING WITH MENTAL ILLNESSWHAT ARE WE UP AGAINST?
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Social stigma Diagnosis and care Current measures
• Mentally ill cannot work.
• Mentally ill are aggressive
and perhaps alcoholics.
• Mental illness is a sign of
the weak.
• Mental illness, unlike
physical illness, is difficult to
diagnose.
• Limited to negligible care on
board.
• Individualization.
• Snap judgements on the cause,
such as Internet, nationalities,
food etc.
• Reliance on Psychometric tests.
SOCIAL STIGMA
CHALLENGES DEALING WITH MENTAL ILLNESSSOCIAL STIGMA
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Several cases of recovery:
• “With appropriate ongoing support and treatment, most people with mental illness recover well and are
able to lead fulfilling lives in the community”. (Source: Australian health services and support)
Anxiety disorders • the majority of people will improve over time.
Bipolar disorders • about 80 per cent of people will improve.
Schizophrenia • 60 % will improve and live independently with support.
• About 20 % of those diagnosed with schizophrenia will have an episode or two, a
nd then never experience symptoms again.
• For another 20%, symptoms are more persistent and greater support is needed.
Why don’t we talk about it and tackle it?
CHALLENGES DEALING WITH MENTAL ILLNESS
Both for office meetings and shipboard safety meetings
SOCIAL STIGMA
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AWARENESS = ACCEPTANCE
“Only 13% of Britons surveyed in 2013 agreed that a history of mental illness should bar someone
from public office, down from 21% five years earlier.” (Source: OECD, Economist)
Have it as an AGENDA ITEM during meetings.
DIAGNOSIS AND CARE
CHALLENGES DEALING WITH MENTAL ILLNESSDIAGNOSIS AND CARE.
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CONSEQUENCES
EMOTIONAL SYMPTOMS
Irritability Restlessness
Anxiety Helplessness
Self doubt Sluggish
Low mood
Feeling of worthlessness
PHYSICAL SYMPTOMS
Sweating Digestion issues
Short breathes Tremors/twitches
Muscle tension Migraines
Insomnia Fatigue
Pounding heart Palpitation
Decreased productivity Human errors Absenteeism
Conflict with co-workers Aggressive behaviour Unfinished tasks
Burnout Withdrawn Reduced interaction
Observable symptoms and consequences
CHALLENGES DEALING WITH MENTAL ILLNESSDIAGNOSIS AND CARE.
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How do I talk about my
depression…
Will they laugh at me…
• Allow crew to discuss matters that are bothering them.
- One to one sessions, when practical.
• If someone talks about mental issues or suicides, take them
seriously.
- Listen and encourage them to talk and show that you are taking their
concerns seriously.
- Tell or show the person that you care.
- Acknowledge their fears, despair or sadness.
- Ask if they are thinking of hurting themselves or taking their own life,
and if they have a plan.
- Stay with the person if they are at high risk of suicide.
- Have a system of helpline that the crew can connect to get counselling.
Question is, who should be doing all that?
CHALLENGES DEALING WITH MENTAL ILLNESSRANK DISTRIBUTION: 2010- 2019
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CHALLENGES DEALING WITH MENTAL ILLNESSDIAGNOSIS AND CARE.
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Psychiatrists and clinical
psychologists are scarce
Who is more vulnerable?
Seniors or juniors?
If master is in-charge then
who looks after him?
“Psychological first aid” aka “Cognitive Behavioural Therapy” (CBT) can be
taught rather quickly to laymen.
Mental
illness
intervention
“In Zimbabwe trained the grandmothers in
cognitive-behavioural therapy. In about 6 months
of introduction, only 13-14% of people seen by the
grandmothers still had symptoms of depression or
anxiety, compared with about half of those who
received the standard treatment, in which a nurse
talked to them and prescribed medication.” (Source- https://www.friendshipbenchzimbabwe.org/)
CHALLENGES DEALING WITH MENTAL ILLNESSDIAGNOSIS AND CARE.
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• ‘Friendship bench’ on board ships?
• Basic know how of “Cognitive Behavioural Therapy” (CBT)
Step 1 – Reach out and talk
Step 2 – Listen. Allow them to express emotions.
Step 3 – Offer encouraging words
Should we ask them to “calm down”?
CURRENT MEASURES
CHALLENGES DEALING WITH MENTAL ILLNESSCURRENT MEASURES- INDIVIDUALIZATION
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Individualization
will not work.
Stressors driven
from shore?
• Audits, inspections
• Commercial pressures
• Strong hierarchical
culture ashore
• No shore leave makes
isolation worse
• Seafarers will not be able
to manage this on their
own.
GARD FACT SHEETFREQUENCY ON VESSEL TYPE: 2010- 2019
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CHALLENGES DEALING WITH MENTAL ILLNESSCURRENT MEASURES- INDIVIDUALIZATION
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Individualization
will not work.
Stressors driven
from shore?
Our role as
managers/owners
• How often do we
acknowledge the high stress
environment that we are
instrumental in creating?
• Does SMS cover guidelines
on mental wellbeing?
• Do we provide psychological
crisis counselling at sea?
• Audits, inspections
• Commercial pressures
• Strong hierarchical
culture ashore
• No shore leave makes
isolation worse
• Seafarers will not be able
to manage this on their
own.
CHALLENGES DEALING WITH MENTAL ILLNESS
Correlation vs Causation. Are we mixing these two?
CURRENT MEASURES- THE INTERNET
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I have mental health
issues. I am suffering
from depression.
“It is because of ‘the internet’. Your home issues are
being transferred onboard and this makes you more
vulnerable to depression and feeling helpless.”
Shore managerCrew
Internet before wages!Can we live without internet at work and home?
CHALLENGES DEALING WITH MENTAL ILLNESS
• Wellness study carried out by International Chamber of Shipping (ICS) and the European Community
Shipowners’ Associations (ECSA).
CURRENT MEASURES- THE INTERNET
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The survey on the provision of internet access to
seafarers for personal use on board ships received
responses from 276 operators with 11,665 ships,
representing 14% of the world fleet.
CHALLENGES DEALING WITH MENTAL ILLNESSCURRENT MEASURES- PSYCHOMETRIC ANALYSIS
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• Use of personality tests and psychometric analysis as a
deterrent in the PEME.
- Personality tests are self-reporting.
- “These tests give no indication if the person has mental
health issues.”
- Repeatability and validity has not been proven.
CONCLUSION
CONCLUSION
• Raise awareness on the prevalence.• Remove the social stigma. Start from
the top. • Accept mental issues as a curable
illness. • Empower your people to;
- Identify. - Intervene. - Help.
• Include seafarers in policy making.
OUR THREE MAIN QUESTIONS.
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Does mental well being of
seafarers matter?
Can they do something
about it?
Can we do something
about it?
Does mental well being of seafarers
matter?
Can they do something about it?
Can we do something about it?
WWW.GARD.NOTHANK YOU
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