When you think about living and working abroad, what do you picture? I’m betting you imagine lots of adventure and learning. And you probably do know that there’ll be some culture shock at first. But if you’ve never been through an international relocation, you may not realize the serious, long-term mental health challenges that expats face. Sometimes the hardest part of a relocation comes after the culture shock wears off.

Now don’t get me wrong: I believe that living and working abroad is an enormously positive experience. But expats have to be mentally healthy enough to reap the benefits of their time overseas, and it can take its toll on anyone. And that takes some serious planning, intention and self-care — by both expats themselves and their employers.

What causes Expat Mental Health Issues?

It’s clear that many expats don’t anticipate just how much moving abroad will shake them to the core. According to a survey of Aetna members, just 6 percent were concerned about mental health issues before they moved overseas. At the same time, though, Aetna found that mental health claims were on the rise around the globe and that 56 percent of expats self-reported signs of anxiety and depression. And since the number of people going on global assignments is expected to increase 50 percent by 2020, that means that expat mental health will be a growing issue.

Why are expats so vulnerable to mental health challenges? Experts cite a number of reasons. And many of those reasons match up with my own experiences back when I was an expat working in Mexico.

· Expats are often isolated. “Part of the reason expats are more susceptible to mental health issues is the absence of the family and friends network they relied on for support back home,” says Dr. Mitesh Patel, medical director of Aetna International. Facebooking and Skyping with your loved ones back home can only go so far. You need regular face-to-face contact with people who care about you. But expats often have trouble building a new support network after they relocate internationally. That’s especially true if they aren’t fluent in the local language.

That was definitely the case for me when I was working in Mexico. I lived alone in a small town where there was only one other American. Even though I had studied Spanish in school, I still couldn’t communicate well. I struggled to connect with others, and I was deeply depressed.

· Pre-existing mental conditions can get worse. Mental health disorders affect one in four people. So it stands to reason that about a quarter of all expats are already dealing with an issue that affects their mental health even before they move overseas. The stress of an international relocation can make these conditions worse.

· International moves can strain families. Some expats relocate overseas with their families. The upside of this is a built-in support system. But the downside is that an international move with family members creates its own set of issues. For example, the spouse of an expat employee might become depressed when they have trouble finding work or adjusting to suddenly not working, or even completely halting their career path. That puts strain on the relationship and increases the expat’s own chances of depression.

· It’s just hard. Adjusting to a new language and culture is a lot of work. And that wears you down. Life activities that used to be simple are now a major challenge. In Mexico, I had to get used to standing in line three or four hours just to pay my electric bill. (How I missed online auto-pay!) I learned that the most common way to call out of country was using a calling card. But when I needed one, I had trouble explaining what I wanted to the store clerk. Daily stresses like these add up, especially when you aren’t anticipating quite so many of them!

· The experience doesn’t match what you imagined. The difficulties of navigating life in another culture can be especially painful if you’ve been imagining that your international relocation would mean adventure and an escape from your usual routines. After the initial excitement wears off, your unrealistic expectations collide head on with reality: You still have daily routines. But now they’re harder. Ouch. On top of that, you may feel self-conscious about reaching out for help because everyone is telling you how lucky you are to have this cool international job.

· Physical health affects mental health. Another source of stress is how your body responds to life in a new country. In Mexico, I had bouts with dengue fever and mild typhoid fever. When you’re drained physically, it’s easy to become mentally drained as well.

· Seeking help is more difficult. I don’t want to downplay how much of a challenge it is to get good mental health care even in the U.S. You have to find a provider that’s the right fit for you and then hope that they’re covered by your insurance or that you can otherwise afford them. Now imagine trying to do the same thing in a country that has fewer mental health care providers overall — or few to no providers who speak your language. Also consider that many of us feel intimidated or insecure around healthcare providers even when we’re at home. That’s true for me, even though I’m typically loud and outgoing in other circumstances. Using my second language to try to explain to a doctor what was going on with me made me even more hesitant to speak up.

How Companies Can Help Expat Employees

Although my time in Mexico transformed my life for the better, I also have to admit that I barely survived it, and to be honest, I went home 9 months earlier than expected. And the bar for a successful relocation has to be a lot higher than “I survived”! So what can we do to address the hidden crisis of expat mental health?

If your company sends employees on overseas assignments, this issue absolutely has to be a priority for you. A Relocate Global editorial by Dr. Patel, the medical director of Aetna International, sums up why:

If an employee is experiencing high levels of stress at work, they are unlikely to be able to perform at their best each day and will struggle to stay committed to the company’s success. This affects productivity and ultimately – particularly if the international assignment fails – the bottom line.

In his Relocate Global editorial and in an interview with Expat Network, Dr. Patel has numerous recommendations to help employers protect their expats’ mental health:

· Companies should have employee assistance programs that address mental health. Such programs should help employees and their families tackle issues as soon as they arise as well as pre-emptively encourage overall wellness.

· It’s especially useful if your employee assistance program gives expats phone or virtual access to counselors.

· Employers can also screen employees before sending them on international assignments.

· Before sending employees abroad for the long term, give them a shorter trial period to experience what their new life would be like.

· Promote or pay for language training to help expats and their families more quickly adjust to a new country and make new friends.

To that list, we’d add the following suggestions:

· Be sure to support expat employees’ families as well with services like counseling and job placement assistance.

· Beyond language training, expats need plenty of instruction on how their new culture works.

· Take as much stress out of the moving process as you can. When employees don’t have to spend all their energy on logistics, they have more energy to mentally prepare for their move and for excelling in their new role overseas.

How Expats Can Stay Mentally Healthy

Expats can also take many steps before, during and after their international moves to ensure good mental health while they are overseas.

First, Dr. Patel says, be aware of the mental health challenges that an international relocation can bring. Start seeking support before you leave and figuring out where you can find support after your move.

Read up on expat depression and learn to recognize the signs. A great starting point is the series on expat depression on the blog The Expat Partner’s Survival Guide. Blogger Clara Wiggins collected stories from expats about how living abroad affected their mental health. She noticed common themes in their experiences with expat depression, including:

· Lacking energy or feeling apathetic.
· Isolating yourself socially.
· Feeling negativity toward your partner or your new country.
· Experiencing tearfulness or anxiety.
· Losing interest in things you usually enjoy.
· Sleeping too much or too little.
· Eating too much or too little.
· Neglecting physical and mental self-care.
· Abusing alcohol.

Give your expectations a reality check. Read other expats’ accounts of living in the country where you’re moving. And, if possible, meet up with them to talk in person. This should help you get the total picture of both the good things and the difficult things about your new home.

Make a plan for staying in touch with home. With social media, it’s easy to take for granted that we know what’s going on in our loved ones’ lives. But Facebook likes and comments don’t tell the whole story, and they won’t give you the emotional support you need as an expat. If you’re not already familiar with technology that enables video calls, educate yourself on how to use it before you move. Commit to a regular schedule of communication with the people back home who are most important to you. Your first months in a new country are a chaotic time, and you don’t want to let your key relationships fall off your radar.

Hopefully, your company is providing language lessons. But if it doesn’t, pay for language training yourself. You won’t regret this investment. It’s super-helpful to start your language training well before you move. And if you’re moving with your family, enroll them, too. This is one of the most important things you can do to make your relocation easier. When you’re fluent in the local language, it’s easier to connect with others. And if you take lessons from a native speaker, they can also become a guide to your new culture.
Take care of yourself. Paying attention to your overall wellbeing supports positive mental health. A few ideas:

· If you don’t already exercise, start adding more physical activity to your life before you move. This will help you manage stress and anxiety. If you do regularly exercise, think about how you can still find time for your workouts amid the busyness of your move.
· Get enough sleep. Even before you move, get in the habit of turning off your devices earlier to help your mind relax. If your racing mind keeps you from sleeping, keep a notepad by your bed so that you can write down your worries and get them out of your head.
· Ease your way into the local diet. You don’t have to eat like a native as soon as you arrive!

Find ways to pursue your hobbies and interests in your new country. Doing things you love is good for your mental health, and it’s also an effective way to make like-minded new friends.

If you do become depressed or have other mental health challenges, remember that your experiences are normal. Reading Wiggins’ blog and other blogs by expats will quickly help you realize that others have been in your situation. I have myself, and I can tell you there’s a way through.

Fluency Corp: Language and Cultural Support for Expats

My own experiences as an expat inspired me to found Fluency Corp. We understand the needs of employees working abroad, and we tailor our training to help them thrive at work while building a satisfying life and nurturing support network in a new country. Customized language lessons give expats the vocabulary they need to excel at their jobs, to navigate life outside work and to make connections with others. And because our experienced instructors are native speakers, they can also offer valuable guidance that helps expats and their families adjust to their new culture. For a free consultation, contact us at getfluent@fluencycorp.com or (800) 401-3159.