Expat mental health

Expat Mental Health - sunset in the Maldives

Every now and again I sit down knowing there’s a post I want to write and having literally no idea how it’s going to go. And this is one of those posts.

Today is World Mental Health Day and I’ve been waiting 364 days to write this. Last year I didn’t know it was World Mental Health Day until it was too late to be writing a post but I knew I wanted to write something. That it has caught me off-guard is another story. But it’s something I’ve been thinking about on and off for over a year. Because something we don’t talk about much is expat mental health.

Breaking the taboo

I feel like as a society we are making huge strides towards progress. High profile sufferers of mental health issues across the board and media coverage of them have helped enormously. That the likes of Robin Williams and Price Harry are not immune surely shows us that none of us are and that it could easily be any one of us tomorrow. Or already.

Is expat mental health the same?

I did a bit of research before sitting down to write this post. Anecdotally I know more people on expat assignments who are being treated for mental health issues than I do at home. And I know a fair few people at home too – so it’s not like it’s just something we talk about more now we’re away. In 2016 the UK committed to improving health care for people with mental health struggles after it was discovered that only 15% of people who need it currently get care.

But I haven’t been able to shake the feeling for a long time that expat mental health is somehow different. Expathealth.org told me that a report called The Mental Health Status of Expatriate Versus US Domestic Workers found that expats are more at risk of suffering from mental health issues and are also more likely to abuse substances.

I felt vindicated although I have no idea why – no-one has ever said to me that they think I’m wrong. But my gut was telling me the right thing – as people we are vulnerable. As expats we are even more so.

Expat mental health – is it normal?

As expats, we are as susceptible to mental health issues as the rest of the world. Triggers such as chronic health conditions, grief, financial problems, relationship issues, and physical or mental trauma are all just as likely to happen to us abroad as it is at home. Friends like my friends Laura and Polly have written beautifully about their experiences whilst on expat assignments and how it affected them.

And that’s the thing isn’t it? Issues like perinatal maternal health, postnatal depression, anxiety disorders, and depression don’t care where you live. They don’t discriminate.

The lightbulb moment

It all started to make sense. The joke about gin-swilling expat women. The fact that coming back after a long summer away is discussed at length – re-entry blues are a real thing when you’re not living in your home country. I think back to my first months in any new location and memories of the loneliness and the exhaustion comes flooding back. And I was one of the lucky ones because it never went any further than that.

But think about it

Moving is one of the single most stressful things you will ever do in your life.

The stress of moving doesn’t change whether you have a year or 2 weeks to prepare. Add to that international customs/imports/expats, decisions about suitcases, air-shipments and sea shipments, considerations about dual careers, housing choices and school selections all suddenly fill your mind. Amongst all that you have to have goodbye parties (usually multiple as not everyone can make one), close bills and bank accounts, arrange pet import/export details, co-ordinate the packers, put your house on the market…

It’s really no wonder that we all arrive in the new location looking bewildered and confused and, frankly, in some sort of state of burnout.

And that’s just the beginning

When we get to our new location a whole new set of challenges face us before we have even started! Visas, work permits, residency permits, and drivers licenses are just the start of the different types of paperwork that might need doing as soon as you arrive. New jobs need attention and international travel requires months of planning. Language barriers make even the simplest of transactions tricky and socioeconomic cultural differences baffle you at work and in day to day life. Your spouse or your children might be facing mental health battles of their own. Your new life brings with it new schedules that need adjusting to. There are new social expectations that you had no idea existed. You are completely disorientated – lost in a city you don’t yet know your way around so you show up late to, well, everything. The list goes on and continues to exhaust you.

As if that wasn’t enough

You have to do all this alone. Your family and friends – the support network that you relied upon at home aren’t even there to help. Video calling helps but time differences make it tricky and anyway they can’t help you when all you can see is a mosque and a building site and you’re late for the school pick up.

That support network might not even want to help you in those moments. We are so lucky that our friends and families understand and support our decision to live away. Not everyone has that. I’ve heard of everything from resentful comments to family feuds based on other people’s decisions to move abroad.

Is it harder to get help?

The truth is, I can’t personally comment on if it is or isn’t easier. Like everything in life I think it depends. Laura has had a great experience (once she got into to the right hospital). Others haven’t been so lucky.

It depends on the country and the culture – sometimes you find that mental health awareness isn’t as progressive as it can be in other countries. It depends on the location – is it possible to find someone who can help with your specific issue when you live in a country that doesn’t share your language or culture?

Do you even understand the healthcare system in this new world you’ve arrived in? If your employer is paying for your medical insurance you may be worried they’ll “find out” – the stigma still rears its ugly head even when you think we are moving forward.

Are you the sort of person who asks for help?

I hadn’t thought of this before but the Aetna study also concluded that expats tend to embrace risk and challenges. What if this means they are more likely to take risks with their own health? And if they’re the sort of people who have a mindset that they can do things on their own, does this mean they’re less likely to ask for help?

We don’t talk about it

I feel like it just isn’t something that is discussed as openly in expat circles as it is at home. For every friend who has confided that they have expat mental health issues, there is at least one more who I suspect might be but we aren’t close enough to talk about it.

Having hard days in life is normal and having them as expats is even more normal! But when they go on to be more than just hard days we need to take action! We need to look after ourselves and our fellow expats.

I’ve said it before and I’ll say it again

So in honour of World Mental Health Day I’m calling on all of you, but especially my fellow expats to go out and do something that changes this expat mental health taboo. Maybe you’ll message a friend out of the blue or take yourself to the spa for some you time. Maybe this post will prompt you to seek out help from a medical professional or to reach out to a friend who you think needs some help.

But what I’d really love, is if you would bring this post up in conversation next time you meet up with friends. Because it’s time to start normalising the conversation.

Pinnable image of calming Maldivian sunset
Emma Morrell
Emma Morrell

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  1. 11 October 2018 / 15:52

    Thanks for this post! I couldn’t agree more – this conversation is way overdue. Expats are some of the hardiest, determined, courageous and resilient people I know, and while that’s great for trailblazing, it can be really bad for self-awareness.
    I’ve run across far too many expats who are in a bad place, and maybe have been for a while. A lot of the time people around them knows they are struggling, and want to try to help, but the individuals themselves are often clueless. Sadder still is when a person becomes aware of having a hard time, but has no clue of how to get unstuck.
    The expat life is incredible in so many ways, but the risks and the costs are real. Take the initiative, ask how someone’s doing and be prepared to listen. I’m forever grateful to the seasoned expats that did that for me and mine.

    • 25 November 2018 / 09:47

      Such true true words. Thank you so much for reading and taking the time to comment.