Mental Health and Cruising

[kingsgirl]

New topic....

 

With so many recorded incidents of people jumping overboard, what do you think would happen if someone who was having a mental health crisis told the ship doctor? What do you think the course of action would be?

[CruisesOnMyMind]

New topic....

 

With so many recorded incidents of people jumping overboard, what do you think would happen if someone who was having a mental health crisis told the ship doctor? What do you think the course of action would be?

 

 

Why do I feel I need a lawyer:eek:

[jpr1908]

Interesting... as a mental health provider, I would be afraid that having the passenger disembark at the next port (not home) would be another trauma. And who would you release them "to" at a port? I would vote to have the person restrained and kept under close observation by a trained provider.

[CaveDiving]

Interesting... as a mental health provider, I would be afraid that having the passenger disembark at the next port (not home) would be another trauma. And who would you release them "to" at a port? I would vote to have the person restrained and kept under close observation by a trained provider.

 

Great idea...

 

...and on a ship of 1,000 to 3,000 passengers with one or two doctors, exactly who assumes the responsibility of restraining the person and exactly where do you obtain the trained provider to perform the close observation?

 

IMHO, not really practical.

 

Scott & Karen

[NoobCruise]

I would think it would have to be a case by case basis. There are varying degrees of mental health issues and not all would need "restraint". If the person is telling the doctor about it, they may be rational enough to come to an agreement together. In some cases, "releasing to family" just might be the worst thing to do. Every case is different. Every person is different and will respond to situations differently and should be handled differently.

[johneeo]

New topic....

 

With so many recorded incidents of people jumping overboard,

 

So many?

 

How many jumped last week, last month, last year?

 

I would bet that more people jumped off of buildings and other man made structures than off of cruise ships.

[Mar56]

I am not sure of the point of this poll. Unless the people responding to this poll have experience and/or training with mental health issues, the responses have as much value as if you asked what is the best way to remove an appendix? IMHO

[fungirl76]

As a mental health clinician I would state that if someone was trying to jump off the ship then they are most likely having suicidal ideations. At that point in time I would suggest the person be kept in the infimary and relatives contacted to meet passenger at the next port. If relatives can not be located then passenger should be transported via ambulance to the hospital when arriving at the next port. If this is not a US port then family members should be advised. The important thing here is that the passenger gets the needed mental health treatment. I don't think that many people jump ship, but if the statistics are increasing then perhaps cruise lines need to look at having a mental health clinician on board.

[Happy ks]

The unfortunate part of people jumping overboard is that they do it without telling anyone in advance. Once the deed is done all that can be done is search and hopefully rescue.

 

But if they admit it to a health practitioner onboard the ship in the medical center? I hope the ships' personnel take it seriously and keep watch on the patient. I think it would be best to get the individual off the ship ASAP.

 

I kind of don't understand your "so many" comment. I looked back through the news section, there have been 2 this year, one was a crew member that was rescued, the other person climbed onto a table on their balcony last Feb. and I didn't see that he was rescued. I don't know the numbers, but millions cruise each and every year, the odds of this happening are pretty slim. I think it's a newsworthy subject, but the media takes it too far when reporting an incident they will also report the numbers from past incidents as well, or over report, making the issue seem much larger than it is.

 

I'm don't including the Concordia, that was a totally different issue.

[dave_k63]

New topic....

 

With so many recorded incidents of people jumping overboard, what do you think would happen if someone who was having a mental health crisis told the ship doctor? What do you think the course of action would be?

What do you mean so many? I have only heard of a couple. Is it really a problem? I didn't know that.

[kingsgirl]

So many?

 

How many jumped last week, last month, last year?

 

I would bet that more people jumped off of buildings and other man made structures than off of cruise ships.

 

I meant as in that have been recorded. People going missing/jumping from cruise ships had, at one point, seemed a regular news story. It was only from my frame of reference that coverage of such events were more in recent years than perhaps in previous ones.

 

I was just curious to see what would happen if these people sought help before making this decision.

[kingsgirl]

What do you mean so many? I have only heard of a couple. Is it really a problem? I didn't know that.

 

I think lack of supportive mental health services is a problem, which overflows into lots of other areas of life (like cruising) so I was just curious as to how it would be handled.

[jpr1908]

So true...mental health services need to be enhanced everywhere! I wonder if cruise ships have trained, licensed therapists on board? I am one but would not be jeopardizing my license if not contracted to do so. Interesting question...

[CntPAcruiser]

On our last cruise (FOS 1/2012) one couple at our dinner table had an interesting story. The cabin next to theirs, also an inside cabin, had been unoccupied until the second night of the cruise, after which there was a lot of noise at times, such as screaming and yelling, and one or two security people were stationed in the hallway outside the door. After the next port, the noise and security people were gone. The couple later found out from the steward that a woman had tried to harm her husband and throw herself off their balcony, so they moved her to an inside cabin under security watch until they could get her (and presumably her husband) off the ship at the next port.

[spookwife]

New topic....

 

With so many recorded incidents of people jumping overboard, what do you think would happen if someone who was having a mental health crisis told the ship doctor? What do you think the course of action would be?

 

define "mental Health Crisis"

 

people can be bummed/depressed/not themselves and NOT be suicidal. and how can you expect a doctor who sees someone for the first time in decidedly NOT normal circumstances to make ANY sort of reliable diagnosis or form an opinion about whether or not they are a danger to themselves or another?!

[beachchick]

As a mental health clinician I would state that if someone was trying to jump off the ship then they are most likely having suicidal ideations. At that point in time I would suggest the person be kept in the infimary and relatives contacted to meet passenger at the next port. If relatives can not be located then passenger should be transported via ambulance to the hospital when arriving at the next port. If this is not a US port then family members should be advised. The important thing here is that the passenger gets the needed mental health treatment. I don't think that many people jump ship, but if the statistics are increasing then perhaps cruise lines need to look at having a mental health clinician on board.

 

For the tiny percentage of passengers who might have a mental health issue, this is not reasonable (IMO, of course). There's no mental health clinician who could possibly accurately assess someone's situation at a first meeting with absolutely no background on the person at all. Who would decide how to handle a passenger in distress? The liability issues here would be huge, especially if a passenger harmed himself or herself after talking to a doctor onboard. And who decides what constitutes behavior that should get a passenger locked up and then taken to a mental health facility? In a foreign country, it would be even more risky.

 

It is important for people to get needed mental health treatment, but it is not the purview of the cruise line to see that he/she gets it. Though I do agree that mental health issues are woefully underdiagnosed and undertreated in many countries. This is especially true in the US, where it is still deemed to be shameful, some sort of personal failing, and not considered part of overall health care. Kind of like how somehow we treat vision, hearing, and dental care as separate, as if those things aren't part of the body and don't affect all of it.

 

beachchick

[mp2010]

How do you define "crisis?" As someone trying to harm himself/herself or others? And, how often are people jumping off of ships???

 

I'm a mental health clinician, and I think that someone in danger of harming himself or others should be handled in the same way on the cruise as on land: ensure that the environment is safe from objects that could be used for harm until the person can be moved, and then transport to medical facility at next port for evaluation.

 

I don't think it would be worth it to have a full time mental health clinician on board a ship. You can't really do a whole lot with them without knowing background info. It is the job of the doctor on the ship to evaluate the severity of the situation and determine if further medical/psychiatric treatment is needed.

[calliopecruiser]

a mental health crisis

 

WAY too vague.......there are lots of different types of mental health crises, and in lots of different types of people (age, physical health status, and medication history all make a difference, as does previous history with mental health issues).

 

What a ships doctor might do or should do would depend on the specifics. One size never fits all.

[Gathina]

I voted "other"

 

As someone who works in that field for many years the right thing to do is always to minimize risk and increase safety.

 

You take action regarding what will keep the passenger safe immediately and that is going to differ from situation to situation. You can minimize someone's risk, but in the end if they want to take their life bad enough they will do it and sometimes you won't see a warning sign. I have been in multiple situations in my career that involved situations like this but was in a situation where it could be contained.

 

About 5 years myself and the team I was on at the hospital at that time worked with a male patient for many months..did very well in treatment and finally was discharged with what we thought was a positive prognosis. We had dotted every "i" and crossed every "t" clinical wise. That night he jumped out of the 9th floor of the Marriott. We had no clue. We never saw it coming and our unit was known for quality care so it was a shock. The staff ended up all in counseling for a few sessions.

 

Now regarding therapy on a ship..I don't think that's appropriate..many times therapy is a long term thing for more than a few weeks and not just a one shot deal unless it is some immediate crises then it's crisis intervention and not therapy. But I can say that years ago I dated a crew member for a long time and one time the ship was late coming in when I was coming to pick him up for the day. Reason: A female co-worker had ended up pregnant from another crew member and jumped overboard. Someone was brought in to meet with the staff and do a trauma debriefing. Don't know if the passengers ever knew about it or not.

[PCLMassachusetts]

So many?

 

How many jumped last week, last month, last year?

 

I would bet that more people jumped off of buildings and other man made structures than off of cruise ships.

 

I agree!

[calliopecruiser]

So......stats from the internet do look pretty comprehensive; it look like 15-20 people each year (staff and passengers) go overboard from a cruise ship. Some, of course, are stupid accidents and not suicides, and not all resulted in death. http://www.cruisejunkie.com/Overboard.html

[Mom2B&Z]

For the tiny percentage of passengers who might have a mental health issue, this is not reasonable (IMO, of course). There's no mental health clinician who could possibly accurately assess someone's situation at a first meeting with absolutely no background on the person at all. Who would decide how to handle a passenger in distress? The liability issues here would be huge, especially if a passenger harmed himself or herself after talking to a doctor onboard. And who decides what constitutes behavior that should get a passenger locked up and then taken to a mental health facility? In a foreign country, it would be even more risky.

 

beachchick

Actually, this is called "crisis intervention" and follows it's own set of assessment and intervention criteria. Other posters have already set out the criteria, which is essentially to determine imminent risk to self/others and actions that can be taken to reduce the risk until longer term treatment can begin. I too work in mental health, and I know out our clinic people can use the crisis services for months, mainly because there is such a back log to see our psychiatrists. Yes, people at risk of harming themselves or someone else are often released back into the community with support from their family/friends, and I can see how this could also happen on a cruise ship. It would be highly dependent on the situation as to whether the person would need to leave the ship.

This is different from someone who is imminently at risk of harming themself or someone else; in Ontario this person can be held against their will for a short period of treatment at certain institutions. In this case, I would imagine the ship doctor would somehow hold the person in a safe place until they could be transported to an appropriate hospital for psychiatric care.

I would hope that someone on the ship's medical staff has some mental health crisis and suicide training.

[jamessemaj]

How many people have no idea of what to do, wouldn't second guess the doctor on the ship, and think this is kind of a bummer of a question? That's my vote.