Introduction 

•  Have in place direct access to a service(s) that provides clinically certified psychologists, counsellors etc. For suggestions see Professional Care Provision. If a peer feels a seafarer needs professional support, they should have a clear process to be able to signpost them towards help.
• Appropriately trained professional help should be made available for peers to access if needed, particularly post critical incident*. (*Note definition of critical incident should be defined by the company.)
• Have clear and documented employment policies within the onboard Safety Management System - particularly in respect of drug and alcohol use, medical rehabilitation (physical and mental) and temporary relief from duties that may be available for life crises e.g. death or serious illness of a spouse / close relative;
• Have documented and effective processes for data protection; all methods of contact and record storage for a peer to peer programme should be kept confidential and secure. Medical confidentiality guidelines and data protection legislation should continue to apply;
• Have company-wide awareness of mental health challenges at sea;
• Promote health and wellbeing onboardas well as positive lifestyle choices/ behaviours, to reduce the risk of illness and injury.

The programme will also need:

1. A defined proces of how it will work, including:
   • Peer and programme coordinator roles and responsibilities;
   • Structured training of peer support volunteers;
   • How to raise concerns and who to contact;
   • Process for responding to a critical incident;
   • Communications and engagement plan to launch, grow and maintain active participation;
   • Evaluation and feedback system;
   • Governance structure, including process for maintaining and refreshing knowledge and capability.
2. Reinforcement of confidentiality including:
   • Clear confidentiality guidelines within the Safety Management System to mitigate the risk of the seafarer fearing loss of Certificate of Competence if they ask for help;
   • A confidentiality agreement signed by peers – maintaining strict confidentiality is essential for the effectiveness of the programme, which will rely heavily on the establishment of trust between all participants;
   • A clear process for seafarers to give consent for information and data to be shared with relevant parties when referral to a medical professional is required, or where there may be doubt around ongoing validity of ‘fit for duty’ medical certification;
   • A process (notwithstanding points 1 – 3 above) for peers to seek urgent medical specialist advice without consent if there is a concern that the seafarer may present an imminent risk to voyage safety and/or could pose a risk of harm to themselves.
3. Written indemnity for peers
4. A variety of simple methods for the seafarer to access the service i.e. web-based, telephone, or email
5. A clear policy on how time taken for training, or work related to peer to peer activities, will be managed. The time commitment and prioritisation of activities should be agreed with the ship manager, as well as how time spent working as a peer will be compensated.

Developing peer training

Spotting issues quickly is known to be key to the high success rates of peer to peer support. All peers should receive training (appropriate to their role) to ensure that issues are handled appropriately, objectively and sensitively, so that seafarers can be referred for professional advice, or signposted to other services, if needed.

All training should be provided by appropriately qualified and experienced professionals. Structured education of peers can be undertaken by the company but must include medical professionals and may include psychologists.  Medical professionals involved should have specialist training in mental health, knowledge of shipping and awareness of the unique challenges that affect the seafaring industry. Some face-to-face education is desirable. On-line computer-based training and apps may be useful additions.

The following elements should form part of the education syllabus for all peer support volunteers:

1. Practicalities of the programme
   • Aims of the programme;
   • Code of practice and ethics;
   • Importance of confidentiality;
   • Function and scope of the role, limits of expectations, responsibilities and liabilities;
   • Governance and organisation support arrangements;
2. Self-awareness; how you react, respond and cope and how that affects others;
3. Ranges of ‘normal’ behaviour and reactions;
4. Work-related and other life stressors;
5. Coping strategies; how to boost your ability to manage difficult life events/ situations;
6. The importance of getting support early - before mental ill-health or psychological issues present a risk to a job or someone’s safety;
7. General awareness of signs of dependence
   • potential side effects and early signs of drug and alcohol misuse, including prescription or ‘over the counter’ medication;
   • familiarity with health professionals and organisations offering support to signpost to;
8. When to raise concerns about a seafarer with them directly, as well as when to report concerns to others without a seafarer’s consent;
9. How to manage concerns raised by others, including how to verify a report (also limiting potential abuse of the system);
10. How to help de-stigmatise mental ill-health;
11. Clear onward referral pathways and where to signpost for further help (e.g. self-help information, health professionals, seafarers’ representative organisations, medical emergency organisations and other support associations/ charities);
12. Support for ‘difficult’ cases and how peers can look after themselves, including access to debriefing and counselling if required;
13. Critical incident support
    • what should be classed as a critical incident;
    • process for immediate and longer-term access to help;
    • process for formal debriefing and support for all staff involved, including consultation with peers;
14. How to support a seafarer returning to work after illness, or during a significant life event, including how to engage occupational health support;

Governance of the programme

The following elements should be considered when selecting peers for the programme:

1. Numbers - aim  to train enough peers to support the number of seafarers identified by the company i.e. senior officers only, all officers, or the full vessel complement including ratings;
2. Resilience - how well will peers be able to cope in a challenging situation, do they have good listening skills, are they approachable, trustworthy and non-judgemental?
3. Representation -  peers volunteering should reflect all areas of the seafarers’ community with a diversity of characteristics, e.g. age, vessel type, rank, experience, gender, background.
4. Availability – consider the time and capacity of the peer/s to undertake anticipated peer-related activities (i.e. training, engagement and support conversations etc.)

A peer to peer programme should have an appropriate governance structure which addresses the following: 

1. The manager of shipping operations within the company must demonstrate and document commitment to the programme and to the overall aim of providing support for seafarers by promoting Just Culture principles and fair treatment. The success of a programme will depend on support at the highest Executive and Board level;
2. Managerial governance of the programme should be applied;
3. There should be managerial and clinical focal points;
4. The clinical focal point should be responsible for all clinical aspects, including training of all parties, competence of medical experts and oversight of peer case handling;
5. The managerial focal point will be responsible for reporting back to senior leadership about the programme. The report should refer to all aspects of the programme including, whether enough resource has been allocated and whether any changes are required. The managerial lead will be responsible for all other aspects of the programme including the programme infrastructure, clear KPIs to demonstrate effectiveness and uptake of the programme, as well as provision of staff resources such as a programme coordinator and accessibility of peers and medical experts;  
6. The programme coordinator will be responsible for the practical elements of the programme such as ensuring and tracking peer training, facilitating contact between seafarer and appropriate peer, tracking workload and availability of peers, maintaining records, providing input to KPI reporting and monitoring feedback;
7. If a seafarer representative body is engaged within a peer to peer support programme, the governance structure should include this representative body;
8. All governance arrangements should be documented and included within the company safety management system.

This information for ship managers has been based on onlines sources which are included in the references below