Many expats experience some form of mental health issue during their time abroad. Homesickness and a degree of culture shock are normal and can be addressed with relative ease, but what happens if you have a serious mental health condition? Could this be adversely affected by disruption to your normal routines, or by jetlag and a new time zone? How can you best access treatment and support? Will your condition have an impact upon your job? Mental illness is a major cause of repatriation for expats and travellers. In this article, we’ll look at how to deal with serious mental health conditions abroad.
The effect of stress on existing conditions
It is important to recognise that the stress of a move abroad might exacerbate an existing condition. In order to prepare for this possibility, it is highly recommended that you do as much research as possible before you depart. Check out local mental health services, including specialised care units and hospitals. Find out about procedures for hospitalisation. For example, what documentation will you need? Do you need to be registered with the public health system before you can be admitted? If you are travelling in Europe and are an EU citizen, you may want to ensure that you carry an EHIC card (or a GHIC, if you are British), which will grant you access to emergency care. In most developed countries, emergency care is free or low-cost, but you don’t want to reach the point of actual emergency if it can be avoided. Also, check your private health insurance to see whether it covers mental health care while you are abroad – some policies do not.
Make sure that you have enough medication to cover your initial period abroad, while you sort out registration with your local GP or medical centre and find out the location and provision of your local pharmacy. This is particularly important if you are travelling to a remote area where psychiatric care, or even a local pharmacy, is far away from your home.
You should also check in advance whether your medication is legal, as laws are not standardised between countries. Some nations, for instance, restrict opioids or ADHD medication. If you need regular blood tests (for instance, with regard to medications such as lithium), check that these are available in your new location.
Check, too, that your particular medication is available in your destination country. Even if it is not illegal, it may still not be readily available. If your medication is likely to be on a prescription-only basis, make sure that your new GP is appraised. Take your meds with you in your hand luggage, not in your check-in bags. You might also want to consider taking a ‘travelling letter’ with you – this should contain details of your doctor and of your diagnosis, plus a list of your prescribed medication. Make sure you carry a repeat prescription with you. The letter might also need to detail your symptoms and any behavioural issues.
If your medication is time-sensitive (if, for example, you normally take it at a particular time each day), make sure you allow for this if you are travelling between time zones, particularly long-haul. It is easy to get disoriented, particularly if there are long delays. Lack of sleep can have an adverse effect on your mental health, too, so make sure you plan your trip out as thoroughly as possible. You may want to travel with a companion. Ensure that you take something calming with you, such as a book or a game, avoid mood altering substances, and leave plenty of time to go through any stressful parts of the journey, such as security checks.
Check that any medications that may be necessary for your new locale are not contraindicated with respect to certain mental health conditions or psychiatric medications. For instance, some anti-malarial drugs are contraindicated with respect to certain conditions, such as depression, psychosis and schizophrenia, which they can exacerbate. Make sure that you check with your GP before you travel as to whether any particular medication is contraindicated, and, if necessary, get a letter from them to give to your new medical centre or pharmacy. Vaccines are not contraindicated for mental health conditions.
For guidance relating to taking your medications abroad, British expats can visit the NHS website.
Power of attorney
Consider giving a relative power of attorney. This is a major undertaking in terms of relinquishing your personal responsibility, but it may be worth discussing if you have a condition that significantly affects your awareness or your judgement. Powers of attorney can relate either to healthcare or to financial matters, and the same person does not have to handle both. You can ask two different people to take on these responsibilities.
You should also research attitudes and policies towards serious mental health conditions in your host country. Is forced confinement without your consent a possibility? Could your behaviour render you liable for arrest? Are local treatment options good, or are they poor? In some developing countries, mental health facilities may be rudimentary at best. In addition, you may find it difficult to find a medical professional who speaks your language.
If you are working abroad, make sure you consult the HR department of your company to determine the level of mental health support they are able to offer. This may depend on whether your employer is local or a large international organisation, as levels of mental health stigmatisation vary across different nations. In general, developed countries stigmatise mental illness less than developing ones.
Keep an eye on your own mental health and learn to recognise the signs that it is deteriorating, especially if you have been recently diagnosed. If your family is with you, then they may also be aware of your symptoms. In the case of a recent, serious diagnosis, you may want to delay travelling, if possible, until you have a better idea of what your condition involves and what stress factors might be in play.