MacLachlan et al.23 reviewed the 192 publications in the journal International Maritime Health from 2000 to 2010 to establish the coverage of the journal and the scope of research in maritime health. Six broad thematic categories were identified: healthcare access, delivery and integration; telehealth; non-communicable diseases and physical health problems; communicable diseases; psychological functioning and health; and safety-related issues. Within these themes, psychological functioning and health, and telehealth, had the fewest publications.

However psychological functioning incorporates many health problems long recognised in the industry, including suicide, depression, anxiety, alcohol or drug dependence, to name a few. Psychological health also relates very strongly to many life-style associated health problems found in the other thematic categories; such as cardiovascular disease, diabetes and sexually transmitted disease. Finally, MacLachlan et al. noted a trend for more papers on telehealth, stress, fatigue and other psychological issues.

 The increasing awareness of mental health problems at sea is encouraging and there have recently been some very practical initiatives in this area. On ships and in docks leaflets are increasingly becoming available in an attempt to give access to mental health information and address the strong stigma around mental health in many cultures. For instance the ’Mental Care – you are part of it!’ leaflet provides a very good and easily to understand information leaflet that covers monotony, stress, anxiety, depression, harassment and bullying, fatigue, psychosis, drugs and alcohol, and job satisfaction. Importantly it highlights that ’Having a useful job as a member of a mutually supportive team can be one of the best protections against mental health problems’; and it continues, ’Sensitivity to the mental problems of your fellow crew members remains at the heart of good management and efficient ship operations’24. These messages resonate strongly with the thrust of this chapter- that organisational aspects of work and personal health, welfare and performance are intrinsically braided, not just in through, but at each layer of activity in the ship and the maritime industry.    

 Complementary to the ICSW work is an Australian initiative partnering Melbourne Port Welfare Association, Beyond Blue (the national depression initiative), The Rotary Club, Stella Maris Seafarers’ Centre, and the Mission to Seafarers Victoria25, on a project which has also produced an accessible leaflet on ’The Mental Health of Seafarers’, which focuses on depression (including a nine point check list to help people to identify the core symptoms of depression), but also mentions aspects of anxiety and stress, including some explanation of treatment options. The leaflet states that ’The purpose of this booklet is to provide Masters and other ship’s officers with basic information about the mental illness of depression so seafarers who are depressed may be identified and helped.’ The leaflet may also be useful to seafarer ratings, if provided in accessible formats. This is important as having your ‘boss’ identity your mental health problems may be felt by some to simply add to your problems, and is also potentially open to abuse. Some may be concerned that such a label could constitute reason for a company to terminate their employment. This project is however very well motivated and has been based on a concern to address the very serious problems of depression and suicide at sea26. It is also one of the few projects that recognises the problem of workplace bullying.