A crew member approaches you as master and says he is severely depressed and considering harming himself. Describe your immediate management and the MLC requirements relevant to mental health support at sea.

A. MENTAL HEALTH CRISIS — MASTER'S MANAGEMENT AND MLC OBLIGATIONS: IMMEDIATE SAFETY: (1) TAKE THE DISCLOSURE SERIOUSLY: any statement about self-harm must be treated as genuine — never dismiss it; (2) LISTEN without judgement — do not leave the person alone; (3) REMOVE ACCESS TO MEANS: quietly ensure the crew member does not have access to harmful items (medications, sharp instruments, heights) — this is discreet safeguarding, not confinement; (4) DESIGNATE A TRUSTED PERSON: assign a crew member to remain with the individual; (5) Seek radio medical advice IMMEDIATELY — this is a psychiatric emergency requiring professional guidance. MLC 2006 MENTAL HEALTH REQUIREMENTS: Standard A4.1 and Standard A5.1.3 require that: (a) Medical care includes mental health care; (b) Seafarers have access to advice and support; (c) STCW 2010 Manila Amendments include fatigue and mental fitness awareness in Basic Safety Training. MASTER's OBLIGATIONS: (a) Arrange MEDEVAC if the crew member is assessed as at high risk — a suicidal ideation with plan is a psychiatric emergency equal in urgency to a medical emergency; (b) Company notification: DPA and P&I Club; (c) Document appropriately — sensitivity required (medical confidentiality); (d) Ensure the crew member receives appropriate care at the next port. POST-INCIDENT: debriefing for crew who witnessed the incident; company follow-up on crew welfare.

B. Lock the crew member in their cabin for their own safety and continue the voyage. Mental health conditions are not covered by MLC medical provisions — they are a personal matter.

C. Mental health episodes at sea do not require MEDEVAC. Confine the crew member to their cabin under watch and continue to the next port — psychiatric support is only available ashore.

D. Tell the crew member that seasickness and homesickness are common and that feelings will pass. Depression is a normal part of long sea passages and does not require medical intervention.

A. INTERNATIONAL MEDICAL GUIDE FOR SHIPS (IMGS) — MANAGEMENT USE: THE IMGS (3rd Edition, WHO/IMO publication): the authoritative reference for managing medical cases at sea. It is required under MLC 2006 Standard A4.1 and SOLAS Chapter III. STRUCTURE OF IMGS: (1) SYMPTOM-BASED approach — start from the patient's presenting complaint (chest pain, abdominal pain, breathing difficulty, altered consciousness), not from a diagnosis; (2) Assessment tools — vital signs guidance, AVPU scale, pain scoring; (3) Treatment protocols — appropriate to medications available in the ship's medical chest; (4) Evacuation criteria — specific signs that indicate when MEDEVAC must be requested; (5) Medication information — dosing, contraindications, side effects; (6) Specialist chapters — dental, eye, mental health. PROCESS: (1) Start with the patient's MAIN SYMPTOM — locate the corresponding chapter; (2) Follow the clinical assessment guide to narrow the differential; (3) Apply the treatment protocol; (4) Check the EVACUATION CRITERION — is this patient in the evacuate category? (5) Contact radio medical advice — provide: patient demographics, symptoms duration and onset, vital signs, current treatment. RADIO MEDICAL ADVICE: available 24/7 — in UK SAR area contact MRCC Falmouth, who connect to NHS Pathfinder or the relevant service. Document all medical consultations in the Medical Log.

B. The IMGS is only for use by ships' doctors. Officers without a medical qualification should not attempt diagnosis or treatment — radio for immediate evacuation instead.

C. The IMGS provides fixed protocols with no decision points. Follow the protocol for the suspected condition from beginning to end regardless of patient response.

D. The IMGS is an outdated publication replaced by the Ship Captain's Medical Guide (SCMG). Modern vessels are required to carry the SCMG, not the IMGS.

A. RADIO MEDICAL ADVICE — PROCESS AND INFORMATION REQUIREMENTS: CONTACT POINT: Telemedical Assistance Service (TMAS) — in UK SAR area, contact MRCC Falmouth (VHF Ch 16 / DSC Ch 70, or MF DSC). MRCC connects to the NHS emergency medical consultation service. Internationally — CIRM (Italy), Euro-TMAS (Germany), Falck (Denmark) also cover international waters. HOW TO CONTACT: transmit "PAN PAN MEDICO" on Ch 16 or via MF DSC. Provide: (1) Vessel name, position, course, speed; (2) Flag state; (3) Distance from nearest coast or port; (4) ETA nearest port; (5) PATIENT MIST REPORT: Mechanism/onset (chest pain started 20 minutes ago at rest), Injury/Illness (crushing chest pain, radiating left arm, sweating, pallor, score 8/10), Signs (BP 160/95, HR 105, RR 18, O2 Sats if monitor available), Treatment (aspirin 300mg given); (6) Available medications on board; (7) Crew medical training level. WHAT THE MEDICAL ADVISER WILL PRESCRIBE: likely: aspirin (if not already given), GTN spray if available, oxygen, ECG if available, rest and monitoring. EVACUATION DECISION: if symptoms are consistent with MI, TMAS will likely recommend MEDEVAC to nearest hospital with cardiac catheterisation capability. DOCUMENT: time contacted, medical adviser name, instructions given, patient observations throughout.

B. Transmit a Mayday on Ch 16 requesting immediate evacuation. A suspected heart attack is a life-threatening emergency requiring Mayday, not PAN PAN.

C. Treat the patient from the IMGS protocol for chest pain and do not contact radio medical advice unless the patient deteriorates. Medical advisers should only be contacted as a last resort.

D. Radio medical advice is only available in coastal waters within 200 miles. On the open ocean, radio medical advice is not available and the master must rely entirely on the IMGS.