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Mental health: what are the warning signs international residents should look out for?

Even today, mental health issues are too often subject to stigma and taboos. If you’re living or working abroad, you can face huge challenges and not know where to turn for help or support.

Mental health: what are the warning signs international residents should look out for?
Photo: Getty Images

The Covid-19 pandemic has shone a light on some issues of stress, loneliness and depression. But it should not need a global crisis to increase awareness of and create more open discussion about such a serious issue.

The Local has partnered with AXA – Global Healthcare to examine how and why people living international lives should pay special attention to their mental health.

Moving abroad to work? Find out more about AXA – Global Healthcare’s international health insurance options

Trouble adjusting? You’re not alone

Following a career overseas as an international worker can be exciting and challenging in equal measure. Multinational workforces are now the norm in most global major cities and businesses increasingly view diversity as one of their biggest strengths.

Yet many people struggle to adapt as they face up to dealing with culture shock, new ways of working, a different language, and being distant from friends and family. If this sounds familiar, you’re far from alone.

One in five employees surveyed in AXA’s 2020 World of Work research¹ experienced mind health difficulties while working away from home. Half said that the biggest impact on their mental health came at the start of their time in a new location.

Mental health challenges faced when working away from home can have a number of consequences, such as work performance issues, increased risk of illness and organizational difficulties. In some cases, this can lead to assignments ending early and missed experiences. 

Working away from home always comes with its own series of challenges, without mental health difficulties compounding the situation. This is why it’s so important not only to monitor how you’re doing, but also be able to have meaningful conversations with your manager if you’re struggling.

This is not always possible. Around two thirds (64 percent) of employees surveyed agreed that their employer could do more to support their mental health and 50 percent said that their employer only offers support in response to a crisis¹. In taking a new position overseas, it’s worthwhile asking what support a potential employer can offer you.

With AXA’s Mind Health service, you can speak to a psychologist from wherever you are in the world².

Know the warning signs

While everybody responds to stress and difficulties differently, there are common signs that you may be struggling. If you experience a number of the following over the space of a few weeks, it’s worth contacting a health professional to talk.

Reflect, reevaluate, recharge

It could be worth monitoring your mood and observing whether there is a discernible dip, or an increase in negative feelings.

There are a number of free apps and online tools, including AXA’s Low Mood and Anxiety Quizzes, that can allow you to track your daily mood over the space of weeks or months. They can also allow you to identify triggers for sudden dips in mood, or anxiety.

If the results of your mood tracking raises concerns about your mental health, your insurer will often have support services to help you rest, recharge and heal. 

AXA, a global leader in health insurance, has multiple levels of cover to suit you at different stages of your life, giving you access to local healthcare professionals and facilities. If you struggle with the local language, and/or prefer to speak to a doctor from where you are, their Virtual Doctor service can do everything from consultations, to prescriptions and referrals to specialists if you need further treatment³. 

Mental health is as important as our physical health, and it deserves the same attention. If you’re in an environment that may lead to increased stress and mental health challenges, it’s worth considering how you can take the best care of yourself and make the most of your opportunities abroad.

Understand the range of insurance options that can help you take care of your health with AXA

1. Research conducted in April 2020 by Savanta. A total of 543 HR decision makers (108 in North America, 105 in the UK, 51 in France, 54 in Germany, 111 in China, 55 in Hong Kong and 59 in Singapore) and 568 non-native assignees (107 in North America, 113 in the UK, 57 in France, 57 in Germany, 116 in China, 60 in Hong Kong and 65 in Singapore) were surveyed.

2. The service provides you with up to 6 sessions with a psychologist, per mind health concern, per policy year.

3.  Appointments are subject to availability. You do not need to pay or claim for a consultation but you will be charged for the cost of the initial phone call when using the call back service. Telephone appointments are available 24/7/365 and call-backs are typically within 24 hours. Video appointments are available between 08.00 and 00.00 UK time, Monday to Friday. Video appointments in German are available between 08:00-20:00 CET, Monday to Friday. Prescriptions are available if medically necessary and are subject to your location.

This article was produced by The Local Creative Studio and presented by AXA.

AXA Global Healthcare (EU) Limited. Registered in Ireland number 630468. Registered Office: Wolfe Tone House, Wolfe Tone Street, Dublin 1. AXA Global Healthcare (EU) Limited is regulated by the Central Bank of Ireland.

AXA Global Healthcare (UK) Limited. Registered in England (No. 03039521). Registered Office: 20 Gracechurch Street, London, EC3V 0BG, United Kingdom. AXA Global Healthcare (UK) Limited is authorised and regulated in the UK by the Financial Conduct Authority.

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HEALTH

Reader question: Am I liable for ambulance costs in Austria?

The government passes on the costs for ambulances, but the compulsory health insurance might cover the payments - in some very specific cases.

Reader question: Am I liable for ambulance costs in Austria?

Austria has a health system with compulsory health insurance for its citizens, similar to many of its neighbouring countries. Everyone is insured, either by their employer, themselves, or, in some cases, by the state.

However, the insurance models can get complicated and the “who pays for what” question can result in some costly responses. In the case of an emergency, when an ambulance is called, the professional rescue is made by the government ambulances and rescue service.

The costs are then paid for by the health insurance fund, with 75 per cent of Austrians covered by the Österreichische Gesundheitskasse (ÖGK).

Can the health insurance companies refuse? 

The health insurance companies refuse to cover the costs for four main reasons, according to the City of Vienna: when the person is not insured at the time of the rescue operation, when there is no “medical emergency”, in cases of alcohol or drug abuse, and in case the person is found dead when the emergency services arrive.

READ ALSO: Who to call and what to say in an emergency in Austria

The exceptions are not without controversy, and patient lawyer Sigrid Pilz criticises the “lack of love in the procedure”, according to statements she has given in Austrian media.

There is also very little clarity on what qualifies as a “medical emergency”, and the health insurer says that it will cover costs when the insured person is “unable to talk and cannot use public transport due to their physical or mental condition, even with an accompanying person”.

“Only medical reasons count”, according to the ÖGK website.

Air rescue in Austria

Another significant exception to the insurance coverage concerns air rescue. The ÖGK says that it will cover the costs of domestic transport by aircraft if the patient is in danger of death, and the urgency calls for air transport. Additionally, the medical necessity must be proven by a doctor and recognised by the ÖGK.

The insurance company highlights that this does not include “accidents in the practice of sport and tourism on the mountain” – a not so rare occurrence in the Alpine country.

On its website, ÖGK reiterates that it “recommends taking appropriate precautions. Otherwise, an emergency can quickly become a big financial problem”.

The “appropriate precautions”, according to expert lawyers, would include hiring private insurance.

How much does it cost to call an ambulance?

The fees for emergency rescue are set by the municipal council in Austria. In Vienna, there is a lump payment of €709 for any use of the public rescue service – even if both assistance and transport have been deemed unnecessary.

There is also a €30 fee for each kilometre driven if the assistance is needed outside the city limits.

READ ALSO: EXPLAINED: How freelancers in Austria can pay four times less in social insurance

The fee is valid from the moment an ambulance leaves its station. In practical terms, this means that if somebody faints on the street and a third person calls the ambulance in concern, emergency service will come. Even if the patient wakes up well and does not require assistance, they will receive a €709 bill.

There are several cases of people who called an ambulance after foot injuries, or due to high fever, for example, and as they were not considered “severe enough”, received the payment request.

It is worth mentioning that there are also ways to waive or reduce the fee, including in cases of low income or after direct negotiation with the insurance company.

It is not difficult to find examples, especially among immigrant groups and Austrian media.

In one case, shared on social media, Irina B. was a student in Vienna when she got sick with a high fever and dry cough – before the coronavirus pandemic. She decided to call the emergency ambulance and received a quick checkup at home and the recommendation to “drink a lot of tea”.

“On the day after, I went to my doctor, and he gave me treatment recommendations. I almost forgot about this story, but four months later I received a letter asking me to pay around € 700”, she wrote.

READ ALSO: EXPLAINED: What are Austria’s new rules around sick leave for employees?

She decided to go to the main insurance office with her doctor’s sick note. The ÖGK representative told her to call the general health line 1450 in cases such as hers in the future and waived the payment.

“He said it was my first penalty, and I also suppose the certificate from my doctor really helped”, Irina said.

What should you do to avoid the high ambulance costs?

The best way to avoid ambulance costs is to call the Austrian health line at 1450. The health workers are trained to give advice on the phone.

They can quickly assess whether you need an ambulance or not – they can also call for you immediately.

The health line can also give medical advice if there is no emergency and call a doctor to your house if necessary.

READ ALSO: EXPLAINED: What is Austria’s ‘tick vaccine’ and should you take it?

Whenever travelling, even inside Austria, primarily if you practise winter sports, it is worth considering private insurance with air rescue coverage.

Costs for helicopter rescues could add up to thousands of euros. The compulsory insurers will not cover in most cases.

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