Mental Health Considerations for International Exchange Participants

In This Tipsheet:

• What do I need to arrange related to my mental health abroad?

• What do I need to plan if I take medications?
• Should I disclose my mental health conditions?
• How can I plan for a crisis or emergency that may happen to me abroad?
• What can I expect when I go abroad and come home?
• What's some advice from travelers with mental health conditions?
• What can international exchange providers do?
  

What do I need to arrange related to my mental health abroad?

"I met with my counselor to talk about coping strategies if I felt unsteady. I met with my psychiatrist to make sure I knew what to do if things went wrong. I was ready and prepared for everything and I was elated at my opportunity to go."
- Linnea Johnson, Welcoming the Rain: Explorations in Ireland

1. Think about what support system or self-care plan you already use in situations that impact your mental health (e.g. “Sometimes what happens to me is this…. And what helps me at these times is this….”).
2. Think about what medications, counseling, or strategies for coping with fatigue, concentration or stress that will work for you overseas.
3. Ask your therapist or other specialists, your family, and exchange program staff to help with researching information overseas, from finding insurance coverage to English-speaking therapists in the destination.
4. Talk through options for support while abroad and know your options for communicating with people back home, especially when first settling in (e.g. Skype, cell phone access). 
5. Find out who your contact person is abroad if you have questions, are feeling overwhelmed, or want someone to monitor any changes in your behavior overseas. 

Learn other tips in our blog: Keep Calm and Study Abroad.

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What do I need to plan if I take medications?

The main issues that come up when using medications are: availability, legality, coverage of costs, back-up supply, time zone changes, and interaction with other medications. 

As a first step, find out if your health insurance will cover enough medications to cover your entire time abroad. Usually a letter explaining that you will be out of the country will allow for exceptions to allotment restrictions. However, you need to also find out about coverage for getting more abroad (because of limited amounts that can be prescribed for certain controlled substances or in case your supply is ruined or lost abroad). 

If you are bringing medications with you, then be aware of air travel requirements and customs restrictions. Some medications may be illegal to import into a country, and some may be in short supply, different dosage, or illegal to get once in the country. In these cases, you may want to try alternative medications far enough in advance of travel to see if they will work for you. 

More information can be found on our Medications and International Travel tipsheet.

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Should I disclose my mental health conditions?

You can choose to share your history with specific individuals on a strict need-to-know basis or if you want someone to be a source of support. Examples include exchange program staff or faculty, host families or roommates, and others. If you need academic or other accommodations (such as reduced course load or extended time on tests), then you need to disclose early enough to get these put into place before you travel.

If you choose not to disclose, you should still prepare to find support just in case you may need it.

Disclosing a Disability for an International Exchange Program helps to look more closely at this issue.

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How can I plan for a crisis or emergency that may happen to me abroad?

Research health and travel insurance plans that will cover you abroad. Plans often include trip cancellation protection, accident and sickness coverage, and emergency transportation to get appropriate care or to bring a family member to visit. Be aware of restrictions and exclusions, as mental health coverage and related issues could be affected by this small print. You may also need to pay upfront and be reimbursed on return home. Read more on the Insurance Coverage tipsheet.

Reputable exchange programs should have health, safety, security and risk management plans in place, including how to assist people with mental health conditions in countries that may not have strong legal protections. Ask questions such as:

• If I am having trouble adjusting and feeling overwhelmed once abroad, who do I talk to?
• What does the program do to help connect me socially with people once abroad?
• If I’m experiencing an emergency, what is the process for me to get help abroad?
• Does the program have enough staff to assist a student with an emergency? 
• What policies does the program have in place regarding return home either in an emergency or by choice?
  

If you have disclosed, then also ask:

• How do I share how I want things to be handled if my condition were to become unstable while abroad?  Do I need to sign any medical releases?
• Who will be able to access my mental health information and why? What privacy protections apply abroad?
• What are the laws or procedures in the host country regarding hospitalization for mental health reasons? What are my rights in the host country?
• Are there crisis lines or services available in my native language?  If not, who can provide simultaneous translation?
  

While prior arrangements and even advance directives are not always respected, having such a plan could be helpful in a country where there are few or no protections against involuntary commitment and few or no protections to ensure informed consent. Sometimes family, program staff, and therapists back home can be helpful even from afar, such as through remote communications and to assist with decisions if you are unable.

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What can I expect when I go abroad and come home?

Being away from usual stress at home can sometimes be a relief when abroad. Experiencing new adventures can be a useful distraction and a chance for you to gain confidence in your independence. You can also learn from challenges experienced abroad to gain useful perspectives even after returning home, such as more tolerance, flexibility, and appreciation. 

Nonetheless, you will also have times when you feel confused, uncomfortable, annoyed, and many of the same emotions that you manage in your daily life at home. Maintain some of the coping strategies (e.g. journaling, yoga) that help you at home even if it means taking some down time away from the many activities abroad.

“Since I’ve been back, I’ve been a little bit more open to people here and their ways of doing things and thinking. I feel more ready and able to speak up in different situations I probably wouldn’t have before.”
- Yanin, who has history of anxiety and depression and spent several months at a university in Australia

When you return home, you may notice changes in yourself and feel differently. You may be trying to make sense of all you experienced abroad, which could include seeing significant poverty for the first time or thinking differently about your home culture. Find people who are willing to listen or who can relate because they have been abroad too.

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What's some advice from travelers with mental health conditions?

"Recognize what is going on."

• Some of what you will experience overseas is just part of the intercultural adjustment cycle (sometimes called “culture shock”), and it is common to all study abroad participants.

• The low points are not necessarily attributable to a mental health diagnosis (e.g. home sickness, anxiety about understanding or speaking a foreign language, loneliness, fear of being robbed, etc.)
• You may also experience feeling very good on the high point of the cycle, which may make you feel that you no longer need medications if you use them. Keep taking your medication and consult with a doctor first.
• Many of the problems that you could experience overseas will seem minor compared to the good experiences that you will have. Give it time. However, if you feel that your health or safety is deteriorating, give yourself an outlet and permission to leave the program.

"Make connections and find support."

• International mental health-related groups have chapters in many countries (e.g. Befrienders Network, World Federation for Mental Health, World Network of Users and Survivors of Psychiatry) and can tell you about attitudes, laws, and support services that exist in their country.
  
• Find someone on the program whom you can trust to understand your condition, and teach that person how to support you if he/she sees changes in your health or behaviors.
  
  "I was in touch with my parents consistently while I was there through Skype. It was helpful mostly because I’m close to my mom and she knows me better than anyone else... she is my grounding force who gets me back centered and calm.” - Rosie, who has anxiety, did a summer dance program in France

• Before you go, discuss with your friends and family how you will stay in touch (Skype, email, etc.) and how often.
  
• Attend social settings where you can meet locals or other travelers, and consult with peers with similar mental health histories to avoid isolation, share strategies, and meet others who relate to what you are experiencing.
  
• In case you need to call and have a session over the telephone or Internet, pre-pay or make other arrangements with your home therapist. If time zone differences or costs are difficult, seek out local resources.
  
• When searching for an opportunity overseas, make sure the program staff or faculty are responsive and receptive to you in the planning process. This may indicate their reaction to your issues once you are overseas.
• Exchange or disability/counseling staff back home are a resource if you are having problems with getting what you need from local staff.
  

"Get what you need in place."

• Learn vocabulary in the local language that is associated with your condition or what you need (or don't need) from others. Bring, or be able to access, a copy of your medical records and release forms (translated if needed).
• Request any accommodations or services that you need well in advance. Some can even be done without revealing your condition. For example, you could just say, “Because I’m not a morning person, I need to arrange my schedule such that my courses don’t begin before 10 a.m.”
• If you are staying with a family or roommate in the host country, communicate with them honestly about your needs before you arrive.

• An open-ended flight ticket or cancellation protection insurance can help to provide flexibility if you do have to take time away from a program or return early.

Read other suggestions and about the international experiences of peers with mental health conditions on our Featured People webpage.

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What can international exchange providers do?

More international programs are becoming aware of the need to better prepare and support participants in managing mental health while abroad. Here's some steps these programs can take:

• Add information on managing mental health while abroad to pre-departure orientation information and in reminder e-mails to all participants during the program, including information about stress management, support services, and communication services (e.g. Skype) available once abroad.
• Encourage all participants to ask for details regarding the host location to increase understanding of how the location may be different from home, and if possible provide all participants with technical standards about each program.

• Identify and share about free or low-cost support groups in the host community. For example, organizations like Alcoholics Anonymous, Overeaters Anonymous, and other participant-led groups often have international chapters. Local crisis telephone hotlines may also be a good source of support for some program participants (depending on language differences), and may provide information about other community resources.
• Review medications and insurance information that is provided to participants and consider providing group travel insurance policies that cover mental health counseling, country-related medications information, pre-existing condition coverage, and easier ways to pay upfront for services abroad.
  
• Encourage participants to plan in advance for contingencies, such as arranging to talk by phone with a familiar therapist in the United States, planning for more social connections or more down time, and requesting academic accommodations.
  
• Check in with all participants abroad; consider mobile phone applications that allow students to track how they are feeling.
• Connect with the disability services, health center, or counseling services to build supportive relationships and cross-training of staff to better advise students.

• Avoid making assumptions about the ability of people with mental health conditions to participate in international programs or the types of support they may need. Read the following tip sheet for better understanding: Screening: Implications for Post Secondary Students with Disabilities in Education Abroad.

• Talk routinely with the faculty leaders, resident directors, host institutions, or other in-country staff about if they have clear way for participants to contact them if needed, experience recognizing signs of distress and where to refer students, and understanding of confidentiality and crisis procedures if needed. Refer to the annotated Mental Health and International Education Bibliography.
  

Mental Health refers to a broad range of conditions such as depression, anxiety, panic attacks, bipolar disorder, obsessive-compulsive disorder (or obsessions and compulsions), post traumatic stress, borderline personality disorder, schizophrenia, and disordered eating.

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