Supporting essential workers at sea during the COVID-19 pandemic - barriers to accessing mental health support among seafarers in Canada.

BACKGROUND: The COVID-19 pandemic exacerbated mental health challenges among seafarers around the globe, who faced increased isolation, extended contracts, and limitations in accessing essential landbased services. Although some mental health support have been provided to seafarers internationally, concerns remain regarding its accessibility, quality, and relevance. MATERIAL AND METHODS: The study explored the mental health support use, unmet needs, and barriers to accessing healthcare through a cross-sectional online survey among seafarers who had worked in or transited through Canadian waters during the COVID-19 pandemic. RESULTS: While the study targeted seafarers of all nationalities, the final sample was predominantly composed of Canadian residents. In the 12 months before the survey, 64.0% of respondents accessed some mental health support, with 29.4% accessing counselling or therapy or help for personal problems and 12.4% using medication. Ships and ports emerged as critical points of care. Unmet needs remained among 18.0% of those accessing support, particularly in counselling for personal issues. Among those who did not access support, 22.6% reported unmet needs. Prominent barriers that prevented seafarers from accessing help, even when they thought they might need it, included self-management preference, uncertainty about where to seek help, difficulty leaving the vessel, and limited internet access. Experiences of harassment, fears of employer retaliation, and perceived risk of medical certification denial further deterred help-seeking intentions. CONCLUSIONS: These findings and recent Canadian advancements in policy and service delivery underscore the need for improved connectivity, anti-harassment measures, periodic training, and accessible care models to ensure timely and stigma-free mental health support for seafarers. Furthermore, lessons learned from the COVID-19 context highlight the importance of pandemic preparedness, emphasizing flexible service delivery models and strengthened cooperation among maritime stakeholders.