Mental Health-Related Disabilities: Considerations for Exchange Participants

1. Overview
2. Making Preparations to Participate in an Overseas Program
3. Planning Accommodations or Services Self-Assessment
4. Cultural and Educational Setting Differences
5. More Tips from Travelers with Mental Health-Related Disabilities
6. Resources

Overview

According to a recent survey of education abroad programs, students with mental health-related disabilities are increasingly choosing to participate in overseas opportunities, and, at some institutions, have higher representations in study abroad than on campus. If you, too, decide to study abroad, in most cases you will be earning credit toward your academic degree. Therefore, it is important to be able to access the same level of learning that you would receive at your home campus. In addition, you want to be involved in other aspects of the overseas studies program outside of the classroom. A successful study abroad experience often requires preparation, which includes planning so your mental health needs will be met while abroad.

When making preparations to participate in an overseas program, the following are suggested questions to ask your:

• U.S. disability service provider
• Vocational rehabilitation counselor
• Clinical specialists
• Education abroad professionals

While the disability-related staff and clinical specialists may be willing to research alternative accommodation and service possibilities for you overseas, you might find that you need to locate this information on your own or ask the education abroad advisors on your campus.  The education abroad staff is likely to have had students with mental health-related disabilities participate on their programs before and may be able to give you information and support that you cannot find elsewhere.

The following questions may not be relevant to all types of education abroad programs or all types of mental health-related disabilities. The answers to the questions listed below may be different for different programs as determined by such factors as:

• The binding relationship between the staff in the host country and staff in the United States
• The cultural value differences, educational systems and environment of the host country
• The host country’s and host university’s local infrastructure (available services, support groups).

In the Resource Section below is a list of mental health-related disability organizations that can connect you with peers who have traveled to or live in the country where you would like to study.  They may also be able to give you insight into:

• Cultural differences
• Available services/support groups
• Advice to help you prepare for what to expect overseas.

Please use these questions as suggested guides to help you plan for a successful experience overseas. The section begins with a self-assessment followed by questions grouped according to  topic. At the end, you can find more tips from travelers with mental health-related disabilities and a section on disclosure and asking for what you need in advance. Back to Top

Planning Accommodations or Services Self-Assessment

I use the following support system or self-care plan in situations that impact my disability condition: (e.g. “Sometimes what happens to me is this…. And what helps me at these times is this….”)

I use the following disability-related accommodations and services at school, at home, when traveling and in my community:

(TIP: For listings of possible accommodations or services see:Access Abroad Student Accommodation form or the Job Accommodation Network’s form.)

Can the same accommodations and support services I use in the United States work for me overseas? If not, what similar accommodations and services can be provided that still fulfill my needs?

What is the process to arrange for these accommodations and/or services?

• What files or documentation is needed by whom and by when?
• Who will pay for these if necessary?
• How will they be arranged (e.g. Do I speak directly with the faculty member who will be leading the study abroad program, etc.)?
•  When and how frequently will accommodations or services be available?
•  Who will be my contact person if I have questions about my accommodations or services overseas? Back to Top

For students who take medications:

How soon do I need to I consult with my clinical specialist about availability of medications abroad and the possibility of taking enough medication abroad with me to cover my entire time abroad?

If I can’t find the same medications, how much time will my doctor need to change my prescription and make sure that my condition is stable before traveling abroad?  (Note that education abroad advisors often can provide information about transporting and obtaining medications abroad.)

Are there any medications that I will need to take while abroad (e.g., anti-malarial medication) that could interfere with my current medication?  If so, what is the best way to manage this?

How do I adjust my medication regimen when crossing time zones?  (Some travelers start to adjust their schedules gradually while in transit, while others change to a new schedule after adjusting to the new time zone.  Your clinical specialist and experienced travelers with similar conditions can provide guidance on making the adjustments.)

For those who use daily medications, read our tipsheet Medications: Tips for Traveling Internationally. When selecting a study abroad program, you should check on the availability of your medications and of prescribing physicians at your planned location. Back to Top

Legal Issues

Will there be a contact person overseas for me to work with who is familiar with U.S. legislation regarding the provision of accommodations and services to people with disabilities and/or who has experience with my type of disability?

What is the policy for overseas staff regarding confidentiality about my disability?

• Will specific information regarding my disability be shared only on a “need-to-know” basis or when it’s strictly medically necessary?
• Who will be able to access my disability information and why?
• What privacy protections apply abroad?

 
What grievance-related systems can I make use of if I run into resistance regarding the provision of appropriate accommodations and services?

What are the laws or procedures in the host country regarding hospitalization for psychiatric disabilities? What are my rights in the host country?

 
What policies or contingency plans does my study abroad program have in place regarding emergency return to the United States?

 
If I am under 21, do my parents need to sign a mental health release for in-patient care, and/or my attending mental health care provider?

How do I write about how I want things to be handled if my condition were to become unstable while abroad? If I decide to write an advance directive, who will be responsible for seeing that it is properly carried out? (See more information about this under “Disclosure and Making Advance Arrangements” section below). 

If I encounter barriers after disclosure of my mental health-related condition to education abroad advisors regarding my acceptance into the program, what recourse do I have? (TIP: Read the free online publication “Rights and Responsibilities,” in particular the hypothetical case study on p. 68.)

What happens if I am taking medications that are still under strict patent in the United States or that are not legal overseas? Back to Top

Health and Medical Services

Are the same student health center and hospital services available in the host country as in the United States? If not, what kind of health services can I count on?  Is there a local crisis telephone hotline?

Will my insurance cover my medications, therapy or other related needs while overseas?

• If so, what is the payment/reimbursement process?
• If not, what alternative accommodations and services can be provided that still fulfill my needs? (e.g., Are there other free or low-cost counselors/support groups in the host community? Will I have access to my home clinical specialist?)
• Will my insurance pay for me to bring enough medication with me for the entire time I am abroad?
• If not, how will I obtain the medication that I need abroad? What is the payment/reimbursement process?

(Note: An example of a supplementary health/travel insurance plan for individuals that includes mental health coverage is iNEXT. Also many exchange organizations that provide group insurance may have negotiated no pre-existing condition and mental health exclusions.)

If I am not fluent in the language of the host country, are these services available in my native language?  If not, who can provide simultaneous translation should I be in need of medical care or be hospitalized?

Who will I ask to provide a translated psychiatrist/psychologist letter to inform “professional to professional” the seriousness of my condition? Back to Top

For students taking medication:

Are there pharmacies near where I will be living?

How do I find out what overseas equivalent of my medications are available? How can I get medication from home if the local medication isn’t effective or if my usual medication needs to be changed or is lost?

 
What if I feel my condition has improved overseas, and I stop taking medication that I’m typically on? What effects could this have?  Who will I consult for medical advice about discontinuing or decreasing my medication?

Cultural and Educational Setting Differences

How is the classroom setting and physical environment (e.g. noise level, crowded desks, etc.) in the host country different from my home university?

How are the instruction/assignments different from the U.S. educational system (e.g. class presentations are common, grades are dependent on one final exam, etc.)?

 
What are cultural attitudes toward people with mental health-related disabilities in the host country?

 
Are there general cultural differences that I should be aware of that may impact my condition? Back to Top

More Tips from Travelers with Mental Health-Related Disabilities

• Recognize that some of what you may experience overseas as part of the intercultural adjustment cycle (sometimes called “culture shock”) and that it is common to all study abroad participants and isn’t necessarily attributable to a mental health-related diagnosis (e.g. home sickness, anxiety about understanding/speaking a foreign language, loneliness, fear of being robbed or getting sick from the food, etc.)
• Learn the vocabulary associated with your condition before leaving the United States if you are going to a non-English speaking country. Bring a translated copy of needed medical records and release forms.
• Connect with international mental health-related groups to learn about what types of situations and attitudes exist in the host country and peer/support groups you can contact while there.
• If you are comfortable disclosing your condition to others, ask for a few minutes to talk about your condition during orientation; for some individuals, self-disclosure to others on a group program can reduce anxiety and creates opportunities for others to better understand their access needs.
  
• Another option is to find someone on the program whom you can trust to understand your condition and whom you can teach about the support needed if he/she sees changes in your health or behaviors.
• Be clear and direct with clinical specialists, friends and family at home, if staying in contact (receiving letters, emails, etc.) is important and necessary support for you while abroad.
• Plan in advance for contingencies, such as arranging to talk by phone with a familiar therapist in the United States, planning for more privacy or down time, and consulting with other students with similar disabilities who have studied abroad. 
  
• Consider pre-paying for sessions with your home therapist in case you need to call and have a session over the telephone while abroad.
  
• When searching for a program make sure the study abroad staff members are responsive and receptive to you in the planning process. This may indicate their reaction to your issues once you are overseas.
• Many of the problems that you could experience overseas will seem minor compared to the good experiences that you will have. However, if you feel that your health or safety is deteriorating, give yourself an outlet and permission to leave the program.
• Anyone can feel fear or trepidation before traveling abroad, but self-knowledge about what strategies work at home can also help once abroad. Plan ahead when you can. If you are staying with a family in the host country, you may want to communicate with them honestly about your needs before you arrive (if the program can provide this overseas contact information before your arrival). Back to Top

Disclosure and Making Advance Arrangements

Initially, you may want to share your history with specific individuals on a strict need-to-know basis, then decide as you develop relationships of trust if there are others with whom you want to share your history of a disability. Some students may decide not to disclose because discrimination and stigmatization of people with mental health-related histories is still prevalent, and could create stereotypical notions, extra “requirements,” or actions that are unwarranted. You also might feel you don’t need assistance.

Nonetheless, experienced travelers with mental health-related disabilities suggest setting up a support system in advance, even if you think you won’t need it. All individuals traveling to new countries and unfamiliar cultures experience some level of stress related to this transition. If your condition flares up with stress:

• Prepare to expect additional stress on a study abroad program at least initially.
• See proactive planning as a way to make the experience more successful.
• Bring your treatment with you whether it be medication, personal strategies, or a support network through remote telecommunications.

If you do decide to disclose to the education abroad advisors at your home university or to your overseas hosts, they may be able to provide you with information on how mental health emergencies are handled in the host country (and help to plan to evacuate you from the country if the conditions are not up to par). When disclosing, you might want to:

• Provide them with your plan for arrangements if your condition were to worsen overseas; some may choose a legal route with an advance directive, which is a document to clearly establish who you empower to make treatment decisions, if needed, in the case of declining health.
• Ensure that they keep this information in their confidential files. Ask what procedures they have in place for protecting confidential information.

While prior arrangements and even advance directives are not always respected, this 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.

In the event that you do not disclose to education abroad advisors at home or abroad, you may want to:

• Write down your plans of what should be arranged if something were to happen or leave an advance directive with a good friend or family member that will be in regular contact with you while abroad.
• Try to request accommodations or services that are needed 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.”
• Bring up with education abroad staff the discussion of emergency or contingency plans in event of a physical or emotional crisis without divulging your history.  After all, this is something all travelers need to think about ahead of time.

When deciding to disclose or not, remember that providing education abroad advisors with information about your mental health-related disabilities can help future study abroad program participants. Education abroad advisors who have firsthand experience working with students with known mental health-related disabilities become better informed about the diversity amongst their students and better able to assist students in planning for a successful experience abroad. This awareness can help to break down preconceived notions, and encourage more forethought in ensuring resources and support is available on education abroad programs for you and all students.

The national organization, NAFSA: Association of International Educators, has a committee focused on the health and safety of students on education abroad programs. This committee is also committed to developing resources to assist students with mental health-related disabilities, such as this best practices mental health handbook that would be useful to share with your international exchange staff so they are more educated on advising students on mental health issues. They strongly encourage you to plan ahead and self-disclose physical or mental health needs before departure for study abroad. This will enable your U.S. education abroad staff to work with you and their overseas colleagues to arrange appropriate accommodations abroad, whenever possible, and to inform you of any limitations in accommodations available at a particular education abroad destination. Back to Top

Resources

Disability Rights Education and Defense Fund (DREDF)
2212 Sixth Street
Berkeley, CA 94710
ADA Hotline: (800) 466-4232 (voice/TTY)
Tel/TTY: (510) 644-2555   Fax: (510) 841-8645
E-mail: dredf@dredf.org  Web: www.dredf.org

Disability Rights Education and Defense Fund (DREDF) works to advance the civil rights of individuals with disabilities. They can provide technical assistance and resources regarding accommodation for students with mental health-related disabilities.

European Network of (ex-)Users and Survivors of Psychiatry (ENUSP)
Peter Lehmann, Coordinator / Desk
Zabel-Krüger-Damm 183
D-13469 Berlin GERMANY
Tel: +49 30 85963706   Fax: +49 30 85963706
E-mail: desk@enusp.org  Web: www.enusp.org

ENUSP is a regional organization of people with mental health-related disabilities, with member organizations in many European countries. The website contains links to some of these organizations.

Mental Disability Rights International (MDRI)
1156 15th Street, Suite 1001
Washington, DC  20005
Tel: (202) 296-0800  Fax: (202) 728-3053
E-mail: mdri@mdri.org Web: www.mdri.org

Mental Disability Rights International (MDRI) enforces the rights of people with mental disabilities by working with human rights advocates in the Eastern European, the Middle East and South American regions. Depending on the country, MDRI may have contacts of peer or support groups and information on cultural views of mental health-related disabilities abroad.

MindFreedom International
PO Box 11284
Eugene, OR 97440-3484
Tel: (877) MADPRIDE (623-7743) or (541) 345-9106
Fax: (541) 345-3737
E-mail: office@MindFreedom.org  Web: www.MindFreedom.org

MindFreedom International is an international coalition of groups that advocate for human rights in psychiatry, and includes current and former mental health consumers. They can provide information on support and advocacy groups abroad in several countries.

The National Empowerment Center
599 Canal Street
Lawrence, MA 01840
Tel: (800) POWER2U (769-3728) or (978) 685-1518
TTY: (800) TTY-POWER (889-7693)
Fax: (978) 681-6426
E-mail: madpride@aol.com  Web: www.power2u.org

National Empowerment Center is an organization offering information and referral to people who have been diagnosed with mental illness. In addition to providing referral to local resources, they can assist with information on self-help techniques and advocacy information. They are also a resource for information on accommodating people with mental health-related disabilities in international exchange. Their information is available in English and Spanish.

Department of Mental Health and Behavioral Scienses. University of Athens.
Zografou Community Mental Health Center.
42 Davaki-Pindou St.
15773 Athens. Greece.
Tel:  +30 210 7481174 / 7718320
Fax: +30 210 7481174
Email: madianos@nurs.uoa.gr     Web: http://www.wapr.info/

The exclusive mission of the World Association for Psychosocial Rehabilitation (WAPR) is to improve the quality of life of individuals and families throughout the world affected by disabling mental illnesses. Currently WAPR has 86 chapters worldwide who are representatives of consumers, families and voluntary organizations.

World Federation for Mental Health

12940 Harbor Drive, Suite 101
Woodbridge, VA 22192
Tel: (703) 494-6515
Fax: (703) 494-6518
Email: info@wfmh.com
Web: http://www.wfmh.org/

World Federation for Mental Health, with members and contacts in 112 countries on six continents, has responded to the international mental health crisis through its role as a worldwide grassroots advocacy and public education organization.The Federation's organizational and individual membership includes mental health workers of all disciplines, consumers/users of mental health services, family members and concerned citizens.

World Network of Users and Survivors of Psychiatry (WNUSP)
Store Glasvej 49
5000 Odense C
Denmark
Tel: +45 66 19 45 11
E-mail: admin@wnusp.net     Web:  http://wnusp.rafus.dk/

WNUSP provides a global forum and voice of users and survivors of psychiatry, to promote their rights and interests. The organization includes people with mental health-related disabilities and professionals interested in furthering human rights in psychiatry. They have a list of related organizations and support groups worldwide.

Although efforts have been made to ensure accuracy, MIUSA/NCDE cannot be held liable for inaccuracy, misinterpretation or complaints arising from these listings.  Mention of an organization, company, service or resource should not be construed as an endorsement by MIUSA/NCDE. Please advise NCDE of any inaccuracies you may find.