Mental health and living abroad: New data reveals the most common pitfalls

Studying or working abroad is a fantastic experience for many, offering new experiences and perspectives. However, it can also provide significant challenges, especially with regards to wellbeing and mental health.

Mental health and living abroad: New data reveals the most common pitfalls
Living in a new country can be exciting but also daunting. Photo: Getty Images

Many people experience significant challenges to their general wellbeing and mental health when moving to – and living in – another country. This can take many forms, such as:

  • Difficulty accessing medication, particularly medication prescribed in the previous country of residence.
  • Not being able to navigate the local health system to book an appointment.
  • Not being able to find the right ingredients for a vegan or vegetarian diet.

In partnership with AXA Global Healthcare, we take a look at some of the major issues facing international professionals, as well as what can be done to look after health and general wellbeing as an expat.

Difficulties faced

Having moved to Berlin from Saudi Arabia to study and work in HR, Hanan Asgar was excited about the opportunities Germany offered. As she says: “I wanted freedom, respect and equality for myself and my generation.”

However, the combination of being completely new in a foreign country, together with an unfortunate incident in her first few days in her new homeland – about which Hanan had no one to speak to – meant that Hanan began to feel isolated and anxious.

She tells us: “My anxiety grew and I actually ended up locking myself in my dorm room and questioning my choice of moving to Germany. But after some reflection, I realised that it was me who was missing out on the lectures I was avoiding. So I took the courage to step out again and face what was to come.”

Living and working abroad, far from home, can present a number of obstacles. Learn more about how AXA provides mental health and wellbeing healthcare as part of its global health plans 

Hanan subsequently underwent treatment for anxiety and depression with a therapist, and has now been living happily in Berlin for the past six years.

Hanan’s experience with initial culture shock and mental health challenges, while living and working abroad, is shared by many expats. A social listening study conducted by AXA* in 2021, across six popular nations or regions for those living abroad, discovered:

  • Anxiety was the most common difficulty faced by expats in France, the Scandinavian countries and the United Kingdom – 24%, 27% and 32% respectively.
  • Depression was the second most commonly experienced challenge.
  • Those in France were most likely to experience anxiety and depression regarding the consequences of Brexit.
  • Other issues that those in France, Scandinavia and the United Kingdom identified as obstacles associated with living abroad, included dealing with chronic illness (such as living with a condition like diabetes), safety concerns (for example, crime) and stress related to the workplace.  

Exercise can help deal with stress. Photo: Getty Images

Strategies that work 

Fortunately, the AXA study also shows that there are a number of strategies that work when dealing with health and general wellbeing issues. Their study found the following:

  • Building strong support networks and healthy relationships with friends and co-workers was seen as important by expats in all countries.
  • Building strong support networks, as well as spending time on entertainment and hobbies, were particularly important to those living in the United Kingdom
  • Exercise – outdoor, or in a gym – was particularly helpful to those in Scandinavia and France, while those in France reported that they had also had specific success with mindfulness practice and good nutrition.
  • The most effective and useful strategy that AXA discovered, however, was proactive and preventative healthcare, such as accessing a GP or qualified psychologist. 

Discover more ways to look after mind and body while living abroad with AXA and their Mind Health Service 

Seeking out the right health professionals for both body and mind can significantly reduce the levels of anxiety and depression experienced by those living abroad. Regular check-ups can prevent conditions becoming chronic, while discussing mental health and wellbeing can substantially reduce the pressure that many feel. Prevention, as the saying goes, is better than cure.

Hanan Asgar moved from Saudia Arabia to Berlin. Photo: Supplied

Ensuring you have the right healthcare

Finding the right health professionals abroad can be difficult due to language differences, cultural attitudes and varying levels of healthcare. As Hanan reports of her own experience: “I sought professional help and it was quite challenging to find a therapist who spoke English. It took months just for an initial appointment. In the meantime, I would go to an emergency psychological help centre or ask a friend to be around. It all worked out in the end, but it did take a mental toll on me”. 

This is why finding a health insurance provider that offers fast and effective links with health professionals is key. When looking for an insurance plan, consider what AXA has to offer, and the Mind Health Service1 they provide for their customers.

Included with all individual and small business coverage plans, the Mind Health Service provides up to six telephone-based sessions for those covered, in addition to their Virtual Doctor Service2. It’s easy and fast to connect to a qualified psychologist who speaks your language, wherever you are in the world, whenever you need it. There is no extra charge for this service for individual, family or SME customers, it has no impact on your excess and outpatient or policy allowances, and can also be used by anybody who is covered by your plan. 

Living abroad is, for many, the experience of a lifetime. The memories and friendships created can endure long after we’ve returned home. That’s why it’s so important to ensure that the care and support is there to ensure you can keep enjoying your new country.

Ensure that your time overseas is happy and healthy.  Access up to six telephone sessions with a qualified psychologist through AXA’s Mind Health Service, available at no extra charge as part of all individual coverage plans

*Social media listening, commissioned by AXA – Global Healthcare, conducted by Listen + Learn from 2018-21, across six regions: Canada, Dubai, France, Hong Kong, Scandinavia and UK

¹The Mind Health Service is provided by Teladoc Health
²The Virtual Doctor Service is provided by Teledoc Health

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.

Member comments

  1. disappointed of the use of the word “expats” that word is just creating a classist differentiation that shouldn’t exist, and using our privilege to create a gap doesn’t help, we all are migrants, that’s it.

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What foreigners need to know about old-age care in Germany

Whether you're thinking ahead to the future or wondering how to care for elderly relatives in Germany, here's what you need to know about the old-age care and the financial help that's available.

What foreigners need to know about old-age care in Germany

If you’re planning on living in Germany long-term, it’s a good idea to start thinking about how to provide for yourself in your old age – or for relatives who may live abroad and be unable to care for themselves.

Fortunately, Germany has quite a well-developed insurance system that offers support for people who require care at any point in their lives or for people with caring responsibilities.

Here’s a brief overview of the system and how much support you can get if you or a close relative requires care at home or in a nursing home. 

How does the nursing care system work in Germany?

As you may know, all employees in Germany pay compulsory care insurance, or Pflegeversicherung, throughout their working lives and as pensioners. 

People with children pay 3.05 percent of their salaries or pensions into the care insurance pot each month, while people without pay 3.4 percent. This is then matched by the employer – though the additional premium for those without children is paid exclusively by the employee. 

Freelancers can also choose to pay voluntary care insurance, though they generally have to bear both the employer and employee portions of this, so it can end up being much more expensive than it is for employees. 

Anyone who pays care insurance has access to financial support with social care in their old age – or, indeed, whenever they happen to need it. However, it’s worth noting that this financial aid is intended as additional support to cope with the high costs of care, rather than paying for all of it.

Instead, people usually have to rely on the support of relatives, their own savings or assets or private care insurance in order to cover the full costs of their care. 

READ ALSO: What you need to know about the complicated world of German insurance

A carer measures a patient's temperature

A carer measures a patient’s temperature in a care home. Photo: picture alliance/dpa/Getty Images | Halfpoint Images

Will my elderly relatives receive care if they come to live in Germany?

This is a complicated issue and one that it’s best to talk to immigration lawyers, migration advice services or social care advisors about. Since parents and grandparents aren’t considered part of the “core” family in Germany, bringing them into the country tends to be much more difficult than getting reunited with your spouse or your children.

That said, there are routes for bringing family members into the country if they’re facing hardship at home – for example, if they’re unable to take care of themselves due to illness or old age.

Once they’re in the country – or before they arrive – it’s best to seek advice from your private or statutory care insurance provider about what help you (or they) may be entitled to. You can also find a list of care advice agencies by searching the directory run by the Centre for Quality in Care (ZQP), a non-profit and non-governmental organisation that aims to improve long-term care in Germany. 

What support can I get as a carer?

There are numerous forms of financial and other support that you can access in Germany if you end up having to care for a relative. Firstly, there are free training courses available that can help you prepare for the challenges that come with looking after someone, as well as self-help groups that can help you handle the mental strain involved.

If you are a primary carer but find yourself unable to carry out your responsibilities for a certain amount of time – i.e. due to travel or sickness – your care insurance should cover up to six weeks of nursing care as a replacement. 

To reconcile your caring responsibilities with your work, you can also take a certain amount of time off and will be legally protected from losing your job. However, you won’t receive a salary during your time off.  

READ ALSO: Will Germany raise the pension age to tackle its worker shortage?

This includes:

  • Nursing time (‘Pflegezeit’): You can take up to six months of full-time or part-time leave to fulfil your nursing responsibilities, which has to be applied for at least ten days in advance.
  • Family care time (‘Familienpflegezeit’): If you need to care for a relative, you can cut your hours down to a minimum of 15 per week for at least two years. This type of care leave needs to be applied for at least eight weeks in advance. 
  • Short-term loss of working capacity (‘kurzfristige Arbeitsverhinderungen’): In an emergency, you can take up to 10 days’ leave in order to fulfil any caring responsibilities or organise medical care. Your employer won’t pay you for this time, but you can apply for reimbursements through your insurance. This is known as nursing support allowance, or Pflegeunterstützungsgeld.

You may be wondering how you can finance all this time off. Well, your relative’s care insurance should assist with this, since their care allowance can be used to support professional nursing care or care from family members – or a mixture of the two. 

Another important thing to note is that you can receive tax breaks for money spent as part of your caring role. The tax office assumes a lump sum for these outgoings, so you don’t even need to keep receipts or do time-consuming calculations in most cases. 

If you’re caring for someone with a nursing qualification and you spend at least 10 hours a week doing so, your care insurance should also pay your unemployment insurance and pension contributions during that time. 

What financial support is available for people who need care?

The amount of financial support you can get for care in Germany depends on the type of care you opt for and your medical requirements. Broadly speaking, the amount of care you require is categorised in levels, with level one representing only a minor need for care and level five representing the most extensive care requirements. 

At each level, you can either receive your money as a direct “care allowance” to support relatives who care for you or as “nursing benefits-in-kind”, which pays for a professional nursing or care service. You can also choose to combine the two if, for instance, your son or daughter works part-time and cares for you the rest of the time.

Elderly couple care consultation

An elderly couple take a care consultation online. Photo: picture alliance/dpa/compass private pflegeberatung GmbH | compass private pflegeberatung

Here’s how much you can receive at each level of care:

  • Care Level 1: People at this level aren’t considered in need of professional day-to-day care for things like eating, shopping, personal hygiene, etc., though they may have minor disabilities that affect their level of independence. That means they aren’t able to access care allowance or nursing allowance. However, like the other care levels, they are entitled to €125 in ‘care benefit’ per month and can still get financial support with other things, like adapting their living space or paying for a panic alarm.
  • Care Level 2: This level is entitled to either €316 per month care allowance or €724 nursing care benefits-in-kind, as well as support with adapting your living space, installing an emergency alarm, etc. 
  • Care Level 3: This level is entitled to either €545 per month care allowance or €1,363 nursing care benefits-in-kind, as well as additional support for exceptional costs like refitting your living space. 
  • Care Level 4: This level is entitled to €728 care allowance or €1,693 benefits-in-kind, as well as other financial support for refitting your living space, etc.
  • Care Level 5: This level is entitled to €901 care allowance or €2,095 benefits-in kind, as well as other financial support for refitting your living space, etc.

READ ALSO: How long do you have to work to receive a German pension?

How does it work if I want to combine professional nursing with a family carer?

Combining a few professional care services with care from close relatives is a popular choice in Germany. Mixing and matching the two mean that people in need of care have the comfort of being looked after by their loved ones most of the time, but professionals can step to assist where needed, i.e. during work commitments.

Take the example of someone who fits into care level 3 and therefore has a maximum entitlement to €1,363 nursing benefits-in-kind per month. This person may choose to spend 25 percent of this on a part-time nurse who assists at evening meal-times or in the mornings when they are getting dressed. With this part of the allowance accounted for, they still get 75 percent of their ordinary €545 care allowance, which would come to €408.75.  

In other words, whatever you don’t use from the nursing allowance is converted into your care allowance proportionally. 

Staying in a care home

People who don’t have relatives around to look after them or have more severe disabilities may prefer to go to a professional nursing home either on a full- or part-time basis.

Of course, with care homes costing an average of €3,200 per month in Germany – and sometimes even higher – this is by far the most expensive option. However, there is support available to help pay for it.

The first type of financial support would be through your nursing benefits-in-kind, which ranges from €724 to €2,095 per month, depending on your care level. Additionally, you can also get subsidies on top of your own contribution, which vary depending on the length of your stay in the care home.

Trainee at care home in Weimar, Thuringia.

A trainee carries out a shift at a care home in Weimar, Thuringia. Photo: picture alliance/dpa | Martin Schutt

From 1-12 months, you can expect a five percent subsidy on top of your own contribution – so €50 per month for every €1,000 you pay. This goes up to 25 percent in the second year (€250 for every €1,000), 45 percent in the third year (€450 for every €1,000) and and 70 percent from the fourth year on onwards (€700 for every €1,000).

In 2022, people paid around €991 on average out of their own pockets in order to stay in a care home, though this can vary greatly depending on what help you’re entitled to, the type of care home (and room) you pick and whether you’re a part- or full-time resident.

Another thing that’s important to note is that pensioners are often entitled to Wohngeld (additional housing benefit) and that the state will step in if your assets and pension aren’t enough to bear the costs. 

If you do have assets such as property, however, you may have to sell them before you can access help – and any transfer of assets to close relatives in the past ten years may have to be reversed.