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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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HEALTH INSURANCE

EXPLAINED: Why do Swiss healthcare premiums vary so much per canton?

Switzerland’s health insurance scheme is not only expensive, but its structure is far from simple, especially when it comes to premiums.

EXPLAINED: Why do Swiss healthcare premiums vary so much per canton?

If you come from a country with a public (that is, government-sponsored) healthcare, as much of the European Union is, Switzerland’s system may leave you perplexed.

It is fundamentally different in that it is not tax-based or financed by employers, but rather by individuals themselves.

Everyone must have a basic health insurance coverage — KVG in German and LaMal in French and Italian — and purchase it from one of dozens of private carriers.

READ MORE: How is Swiss healthcare system different from the rest of Europe?

So far it doesn’t sound too complex, but the plot thickens.

The quality or the span of the basic healthcare is not in question — it includes coverage for illness, hospitalisation, medications, tests, maternity, physical therapy, preventive care, and many other treatments.

The problem is the cost, which has risen over the past 20 years at twice the rate of economic growth, resulting in health insurance premiums that are 90 percent higher today than in 2002.

This has become even clearer on Tuesday, when Health Minister Alain Berset announced that premiums will jump by 6.6 percent on average in 2023 — the sharpest hike in two decades.

While premiums will go up throughout Switzerland, residents of some cantons will have to pay more for healthcare than their counterparts in others.

The highest, above-national-average premiums will hit Neuchâtel (+9.5 percent), Appenzell Innerrhoden (9.3 percent), and Ticino (9.2 percent).

Residents of Zurich will see their premiums increase by 7 percent.

In Vaud and Valais, the rates will hover just below the national average, at 6.1 percent, and in Bern by 6.4 percent. Geneva and Basel, on the other hand, will see their premiums rise by a relatively ‘low’ 4.2 and 3.6 percent, respectively.

READ MORE: Which Swiss cantons will see the biggest increase in health insurance premiums?

Why doesn’t Switzerland have national health premiums — the same across all cantons?

The reason is the decentralised system of government, under which cantons wield a lot of power.

READ MORE: EXPLAINED: Why Switzerland’s cantons are so powerful

In terms of healthcare, responsibilities are divided between the federal and cantonal authorities.

The federal government regulates financing of the health system, ensures the quality of care, as well as safety of drugs and medical devices, and promotes research and training.

It also supervises dozens of private carriers to ensure that they comply with the federal KVG / LaMal law, which prohibits discrimination based on age or health status, withholding necessary treatments, and other provisions guaranteeing that every policyholder gets the same quality of care.

The Federal Office of Public Health (FOPH) is also responsible for approving premiums.

Cantons, on the other hand, are responsible for designing health care policies on their territories, licensing medical providers, coordinating hospital services, and setting healthcare premiums.

Why do the rates vary so significantly among cantons?

The reason is that cantons have different health infrastructure and levels of government funding.

Demographics and statistics also play a role: health premiums in cantons with younger and healthier population will be lower than in those with higher incidence of disease, and older, chronically ill people.

But the mere fact of living in a particular canton doesn’t necessarily mean premiums will be the same for everyone: cantons can also be divided into zones with different premiums.

The government “divides larger cantons, within which costs vary widely, into two or three premium regions”, according to FOPH. “It also determines the maximum permissible differences in premiums between regions”. 

For instance, communes in the cantons of Bern, Graubünden, Lucerne, St. Gallen and Zurich are assigned to three different premium regions. The cantons of Basel-Country, Fribourg, Schaffhausen, Ticino, Vaud and Valais each have two premium regions.

Does this mean you can only be treated in your own canton / region of residence?

It all depends on what kind of medical help you are seeking.

For instance, if, for whatever reason you want to consult a doctor or get an elective surgery in another canton, your health insurance will not totally cover the costs.

KVG / LaMal will only pay for treatment (both outpatient and in-hospital) in the canton where the patient lives.

However, this rule applies only to non-urgent situations; emergency cases are treated differently.

If you injure yourself skiing or require urgent surgery while visiting another canton and can’t be easily transferred to a hospital close to your home, then your insurance will cover all the the costs of medical treatment.

“In an emergency, you can go to any hospital in Switzerland”, FOPH said, adding that it must be an authorised public health facility, rather than a private clinic, which in principle is not covered by the basic insurance, but only by supplemental coverage.

READ MORE: Will my Swiss health insurance cover treatment in another canton?

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