**Background:** Mental health (MH) problems among seafarers are increasingly recognized, with Sampson et al. reporting that 37% of seafarers experienced short-term MH problems between 2011 and 2016. Despite this, seafarers are often viewed as recipients rather than active agents of MH strategies. The Maritime Labour Convention (MLC) 2006 addresses MH primarily through work-related risk assessments but falls short of promoting seafarer empowerment. Framed within the WHO's concept of empowerment—defined as a multidimensional process through which individuals gain better understanding and control over their lives—this study examines how seafarers' MH has not been a top priority among seafarers themselves and how ICT and formal education might empower them in health promotion.
**Methods:** The study used a two-phase mixed-methods design. Phase 1 (March–June 2021) involved in-depth interviews with 26 individuals from 8 countries (Brazil, China, India, Jamaica, Japan, Nigeria, Philippines, UK), including 14 seafarers, 2 spouses, 2 chaplains, 5 shipping/crewing company representatives, 1 maritime administration representative, and 2 maritime school representatives. Phase 2 (July–September 2021) was a survey of 1,412 seafarers, with 817 respondents included in the final analysis (those who answered all questions). The sample was predominantly Filipino (85.1%), male (96.7%), and officers (67%), with a mean age of 31 years (range 18–69). Interview data were thematically analyzed; survey data were analyzed using descriptive statistics in STATA SE version 12.
**Key Results:** The survey identified 11 forms of company-provided support. The five interventions perceived as most highly useful were those with direct family implications: facilitating timely crew changes (80.8%), provision of immediate family support (68.6%), increase in Wi-Fi data allowance (63.6%), updates on crew change and COVID-19 (59.5%), and overtime/extended service bonus pay (56.8%). Interventions relating directly to seafarers' own needs were rated lower: provision of sufficient PPE (63.7%), reduction of overtime hours (62.9%), outsourced professional counselling (61.3%), provision of MH self-support materials (54.9%), increase in food allowance (45.5%), and increase in recreational allowance (44.0%). Communicating with family was perceived as the most effective MH support (87.8%), though 15% of respondents had no internet access, and 27% of those with access were unsatisfied due to poor connectivity. Use of technology-based MH interventions was low: 83.6% had experienced internet access onboard, but only 6.8% had used MH mobile apps, 14.1% had used MH helplines, and approximately 30% had used outsourced tele-counselling. Non-technology-based interventions perceived as important included positive collegial atmosphere (73.9%), peer counselling and support (70.0%), practicing meditation (65.7%), and port chaplaincy (64.8%). Qualitative data revealed that seafarers provide informal peer counselling—e.g., a Nigerian Chief Engineer reported providing encouragement to colleagues, and a Filipino Second Officer noted contributing to helping others avoid negative mental effects of social isolation.
**Clinical Implications:** The study reveals a significant gap in seafarer empowerment: seafarers prioritize family-directed support over their own MH needs, reflecting a 'ship first' culture where operational safety and job security override individual health concerns. This suggests that MH interventions must be reframed to help seafarers recognize their own health as a priority. ICT holds promise—particularly improved internet connectivity, MH apps, and tele-counselling—but current utilization is low due to infrastructure gaps, cultural taboos around MH in masculine occupational cultures, and lack of awareness. The authors recommend developing formal, culture-sensitive, and gender-informed MH education and training for seafarers, noting that IMO member States have only recently begun discussing such training. Shipping companies should ensure free, reliable internet access and promote awareness of available digital MH resources. Future research should focus on developing and evaluating MH education programs that are specific to seafaring culture and sensitive to the multinational nature of the workforce.