Feature: Piracy trauma checks

Feature: Piracy trauma checks

There can be few more traumatic events than being attacked by armed men and held hostage, facing the threat of torture and even murder. Some of the tales told by those who have survived being held hostage by Somali pirates have revealed the extent of their ordeal, but whether such experiences invariably result in lasting psychological damage remains the subject of debate. In the often macho, male-dominated world of seafaring, being able to cope with even such gruelling experiences has come to be expected. In the early days of hijackings it was not unknown for crews to be expected to return to work immediately on release. In one case, the crew of a ship that had been freed on payment of a ransom sailed it from Somalia to Singapore.

This image of stoical seafarers was developed at a time when the hijackers treated their captives reasonably well and violence towards them was rare; yet, for reasons that remain unclear, this attitude changed and some captors became brutal, inflicting torture and killing hostages.

The possibility that seafarers who have been through such experiences may suffer from trauma has been officially acknowledged. Masters, for example, were advised in a 2009 International Maritime Organization (IMO) safety circular to hold crew debriefings immediately after attacks or on the release of the ship “in order to reduce the risk from trauma”, while the use of professional counsellors was also recommended to “assist the crew in managing their experience”.

The IMO advice has been accompanied by a number of industry initiatives that include good-practice guides for shipping companies and manning agents produced by the Maritime Piracy Humanitarian Response (MPHRP) Programme, the industry alliance involving trade unions, seafarer welfare organisations and industry groups, including BIMCO Seafarers and their families can also avail themselves of a range of “trauma management” services that include telephone hotlines and “mobile care units” complete with psychiatrists and counsellors.
Evidence gathered by MPHRP suggests the majority of seafarers, after receiving support, from, among others, their employers, families and welfare bodies, are able to recover quickly and return to work, albeit some may prefer to avoid going through high-risk areas, but new research argues that this may not be telling the full story.

Initial results from the research, published last month with a second peer-reviewed report due out early next year, suggest some seafarers may be reticent about any psychological effects for fear of losing their jobs and because of the stigma attached to mental health problems.
The research was commissioned in 2009 by the Seamen’s Church Institute (SCI) of New York and New Jersey which, while acknowledging some companies had adopted “psychologically-informed” policies, believed the industry needed to adopt an organised and “macro-level” approach to caring for seafarers affected by piracy.

The first problem for the researchers from the Mount Sinai School of Medicine in New York was that they had little to go on in the way of previous scientific studies into seafarers’ lives and work. Without this they had no baseline for normal stress levels among seafarers and had to create their own through a series of interviews.

Another problem was the stigma attached to mental illness meant few seafarers were prepared to admit they were suffering any symptoms. As one interviewee told them: “The thing men do…is to be brave.”

Fear of losing their jobs if they admitted to any medical problems was a further discouragement. The study says the fear of being “blacklisted by the industry” if their medical records were made available without their permission also deterred them from seeking care after a piracy incident.

The Mount Sinai team had begun their work by interviewing crews on ships calling at Port Newark but, as word spread about the project, the researchers found seafarers contacting them and asking to take part. This latter group, although numerically much smaller, had had, proportionately, more direct contact with piracy and, the researchers believe, felt a need to talk and were helped by doing so.

Almost all interviewees said they had not received adequate “mental preparation” for transiting “known zones of piracy”, while less than a third felt they had received adequate “post-event” care, with those from the “western hemisphere” generally receiving more care than their counterparts from the eastern hemisphere. (The vast majority of interviewees came from The Philippines.)

Among those seafarers who had been held captive or had witnessed attempts to hijack, most endorsed experiencing some “clinically significant” symptoms that included sleep disturbance, concern about returning to work and increased use of alcohol.

It acknowledges that the incidence of Somali piracy has declined this year, but warns the “psychological impact on seafarers remains – and is likely to increase – as piracy continues and episodes of captivity become better known among the seafaring community”.

On the question, however, of whether seafarers who have been exposed to pirate attacks or been held hostage might be suffering from post-traumatic stress disorder (PTSD) the report adopts a cautious approach.

Noting differences in criteria for diagnosing PTSD, it warns that if seafarers are assessed only for the condition, other “clinically important” symptoms such as “major depression” may go untreated. It suggests, instead of emphasising illness, “resiliency factors” in individual seafarers should be bolstered to improve recovery and “possibly thwart development of other symptoms”.

The SCI report does make a number of recommendations on the provision of post-incident care for both seafarers and their immediate families and, in particular, the adoption of strict confidentiality agreements to cover the results of medical examinations.

It adds there needs to be global collaboration between industry groups such as MPHRP, seafarer welfare bodies and the international mental health community in developing a set of assessments that first-responders can use in the wake of a piracy incident.

“Maritime stakeholders,” the report concludes, “have moral and ethical obligations to promote an environment where disclosures about mental and physical health concerns facilitate diagnosis, treatment and rehabilitation rather than dismissal from employment”.

As it noted earlier, a seafarer who is open about symptoms and receives treatment is a safer employee than one who remains silent.

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