Mental Health-Related Disabilities: Tips for Exchange Programs in Making Accommodations

— filed under: American, Non-US Citizen, Advising

Suggestions on confidential health history forms, disability-related accommodations and other advice on planning ahead and supporting international exchange participants with mental health related disabilities.

After an individual with a mental health-related disability is accepted into a program, international program staff can communicate to find out what types of services the individual has received at home and what the individual might require abroad. Accommodations preferences will vary from person to person, and what works well for one individual may not work well for another. Mental health-related disabilities include such conditions as depression, panic disorder, obsessive-compulsive disorder, schizophrenia, bipolar disorder, eating disorder, borderline personality disorder, seasonal affective disorder, etc.

In order to better advise program participants about their options, international program staff are encouraged to research ahead of time the resources available in the host country. The following resources and tips may be helpful, as well as other resources listed in our annotated Mental Health and International Education Bibliography.

Planning Ahead for Participants with Mental Health-Related Disabilities

Some international programs make it a policy to include a confidential health history and clearance form signed by a medical provider and/or an accommodation request form in the acceptance packet sent to each participant. These forms encourage the individual to talk with the medical provider about what is needed while on the program, and allows participants the option to disclose disability information and request accommodations they may require while abroad with the program staff.

For more information on disability disclosure, see Disability Disclosure and Education Abroad: Understanding the Issues. Organizations should make it clear that disability information is kept confidential and is requested for the purpose of arranging accommodations or services.

How are confidential medical forms gathered?

The same form should be given to ALL participants. It should be separate from and given after the application. Usually it is a requirement after selection when the participant is considered “conditionally accepted”. The form cannot be significantly more laborious for disabled participants to complete and should be connected to essential requirements of the overseas program.

One example of how a provider who offers programs in all parts of the world including very remote areas of Africa, Asia and Latin America might briefly explain essential requirements: "The type of program can vary – some include physically demanding components. All participants will be fully active in the culture. Many will live with a family for a protracted period of time in varying conditions of sanitation and proximity to Western-style health facilities and psychological services."

What message should the medical form be sending?

The form should explain that the information is needed so the program staff can:

Act safely and quickly in case of an emergency abroad,
Determine if can the individual can meet essential requirements or needs a different or deferred program,
Arrange for in-country supports as needed,
Inform participants about conditions abroad related to their medications, treatment or overall health.

What messages are participants looking for when reading the medical forms?

1) If I disclose a mental health disability could I still be cleared to go (e.g. do I trust there’s not a blanket bias)?

Example: On a clearance form to be filled out by medical provider or psychiatrist it shows three ways with stipulations that someone can be cleared:

      1)If in opinion of practitioner, the condition is under control
      2)Have a treatment plan in place for abroad (if currently being treated)
      3)Have been stable on medications for a reasonable period.

2) How will my information be assessed (e.g. what do you mean by stable)?

Example: Definition of Stable: You must be in a state where any changes in symptoms are not foreseen or expected.

Example: Assessment of individual’s ability to meet essential requirements of the program includes these indicators of stability: 1) Individual does not rely on counseling for daily functioning, 2) Stable on medications, 3) Length of time since inpatient or intensive outpatient treatment.

3) Who will be seeing the medical information and how will it be kept confidential?

Example: This information will be kept confidential and will be provided to our in country director and program staff as necessary in case of an emergency.

4) Will I have input on if I can meet the essential requirements of program?

Example: A staff member may contact individual participants to discuss program realities and to clarify expectations for our program staff and for the student.

5) Will it help me if I disclose to find out about in-country resources and support (e.g. is it beneficial)?

Example: The form shares information about mailing or getting medications abroad for the participant to consider and talks about how there may be fewer local resources to help individual manage potential triggers abroad. It may mention how pre-existing conditions can be intensified by living in different culture and the need to anticipate how new environment and stresses abroad will impact health.

Sample medical history and accommodation request forms can be found on study abroad providers websites, such as SIT Study Abroad and University of California System Education Abroad Programs health clearance forms and health history forms.

Additional tips for academic programs:

Focus not in mandating medical disclosure for the sake of disclosure, but to assisting the applicant to make a thorough and fair self-evaluation of whether she has, or can acquire, the qualities that the university or exchange program considers necessary for a successful overseas experience in a particular country.
Encourage disability disclosure by including welcoming and inclusive language in public presentations and program materials, such as brochures and handbooks, letting applicants know that reasonable accommodations are provided as needed to people with disabilities.

Linea Johnson, a student with bipolar disorder, traded the rain of Seattle for the rain of Dublin while studying English and Creative Writing in Ireland. Read her story Welcoming the Rain: Explorations in Ireland.

Can participants be required to disclose? It is in best interest of international exchange programs to make it clear to participants to answer fully and truthfully to all questions on medical history form, so it is clear its been requested and so the staff have better chance of knowing information in emergency. That said, the participant can still choose not to disclose as it is personal information and may not need to request accommodations.
If something happens abroad, can they be dismissed for not disclosing? Probably the reason would be more about a health crisis or behavioral issue that would warrant being sent home as an option regardless of disclosure. If disclosure of mental health disability came out overseas, but there were only minor or no issues to address, being sent home would not be necessary.
Relying on disclosure is not enough. Participants can decide not to disclose. Also, it can be difficult to predict which student will have a crisis, keeping in mind the first appearance of a mental health condition may be abroad. The age at which someone can be diagnosed with mental health condition matches the age range for majority of people going abroad (i.e. college-level study abroad).
Add information on mental health issues to pre-departure orientation materials provided to all participants, including information about how mental health-related disabilities are perceived in the host culture and support services available to all participants.
Individuals may have concerns about legal issues or cultural attitudes toward people with mental health-related labels. Organizations of and for people with mental health-related disabilities in the host country may be able to provide information on what to expect and cultural advice. Contact the international organizations listed below.
Avoid making assumptions about the ability of people with mental health-related disabilities to participate in international programs or the types of accommodations participants may need. Understanding the context will help in determining next steps; read the following tipsheet for better understanding Screening: Implications for Post Secondary Students with Disabilities in Education Abroad.

Contact the disabled student services office or officer to find out about reasonable accommodations for students with psychiatric disabilities. Other resources include the Association on Higher Education and Disabilities (AHEAD), Disability Rights Education and Defense Fund (DREDF) and the Center for Psychiatric Rehabilitation at Boston University, all listed below.
Ask the international students office at the host institution if they have experience accommodating students with mental health-related disabilities. They may have knowledge of resources for students who experience psychological issues while abroad.
Find out about on-campus counseling or similar services for international students at the host institution. Many campuses have a student health center or other medical services on campus, which can also be useful. It’s a good idea to research these resources as many students, both with and without documented disabilities, have a need for these services while adjusting to living in a new environment abroad.

Supporting Participants with Mental Health-Related Disabilities Prior to and During an International Program

Encourage all participants to ask for as many details as possible regarding the host location to increase understanding of how the location may be challenging.
Invite participants who disclose a mental health-related disability to talk about their disabilities during orientation if they choose; 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.

Read this MIUSA Blog "The Other Possibility: Successful Study Abroad with a Mental Health Condition".

Establish guidelines about who will have access to the participant’s disability-related information.
Find out 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. For additional information on such groups, you may wish to visit the website for the Center for Psychiatric Rehabilitation at Boston University, listed below.
Local crisis telephone hotlines may also be a good source of support for some program participants, and may provide information about other community resources.
Have counseling professionals train your international exchange leaders to learn how to identify people in distress and identify intervention strategies.
If the participant is not fluent in the language of the host country, it is important to find out if mental health services are available in the participant’s native language.
If the participant anticipates utilizing professional counseling or medical services abroad, they should find out if their insurance will cover such services. It is recommended that all group insurance offered by the program have mental health counseling, medications and pre-existing condition coverage. See more at Insurance Considerations for Exchange Participants with Disabilities.
If the participant uses medications, make sure that s/he brings a supply adequate for the entire stay. For more information, request our Medications and International Travel information sheet.
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 privacy or down time, and consulting with other students with similar disabilities who have studied abroad. Consider mobile phone applications that allow students to track how they are feeling.

Providing Reasonable Accommodations

Participants and program staff are encouraged to work together and think creatively to determine what types of reasonable accommodations will best meet each participant’s needs. Some participants with mental health-related disabilities will find that existing options for all participants, such as choosing single occupancy dormitory rooms or taking a reduced course load abroad, may satisfy any disability-related needs. Examples of other types of accommodations include:

Orienting the participant to the area where they will be living, working, studying or volunteering and discussing any accommodations that may need to be made.
Providing an accompanier/assistant to the participant. Some individuals may want a trusted and easily available person on the program who can provide assistance as needed. An accompanier/assistant could also be a person who serves as a notetaker, or a separate notetaker may be provided, if needed.
Allowing breaks when needed to manage stress, anxiety or restlessness (which may be caused by medications or other factors).
Providing flexibility in completing assignments and negotiating expectations ahead of time.
For academically oriented programs: providing a quiet area for study and permitting alternative testing arrangements, including extended testing time, individually administered exams or changes to the testing format.

Resources

Note: NCDE can provide individualized contacts for several countries upon request. The following are general contacts.

Association on Higher Education and Disabilities (AHEAD)
University of Massachusetts Boston
100 Morrissey Boulevard
Boston, MA 02125-3393
Tel: (617) 287-3880
Fax: (617) 287-3881
TTY: (617) 287-3882
E-mail: ahead@umb.edu

AHEAD is an organization committed to promoting the participation of people with disabilities in higher education.

Center for Psychiatric Rehabilitation
Boston University
940 Commonwealth Avenue West
Boston, MA 02215 USA
Tel: (617) 353-3549
Fax: (617) 353-7700
TTY: (617) 353-7701
Web: www.bu.edu/cpr/reasaccom/ (reasonable accommodation information)
www.bu.edu/cpr/reasaccom/educa-go-mencon.html (mental health resources)

The Center for Psychiatric Rehabilitation at Boston University offers an on-line list of reasonable accommodation options for individuals with mental health-related disabilities in employment and education. This is separated into sections for educators and employers, and for mental health consumers. While the website does not explicitly address study or work abroad issues and has a medical focus, it does contain helpful information.

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

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

Email: plehmann@t-online.de

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.

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

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

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.

National Alliance for the Mentally Ill (NAMI)
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201-3042
NAMI Helpline: (800) 950-NAMI (6264)
Tel: (703) 524-7600
Fax: (703) 524-9094
TTY: (703) 516-7227

National Alliance for the Mentally Ill (NAMI) is an organization for people with mental health-related disabilities and their families in the United States. NAMI focuses primarily on medical treatment options for people with mental health-related disabilities, and provides resources related to this, including a number of online tipsheets on mental health-related diagnoses and the use of medications to treat them. NAMI can also refer people to state and local chapters.

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

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.

World Association for Psychosocial Rehabilitation
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

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

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

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.