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Expat Mental Health Struggles

by Emma Morrell

It goes without saying that mental health issues are not uniquely an expat problem. If a member of the British Royal Family, famous actors, musicians, and other high-profile personalities can experience them, so can anyone else.

Poor mental health does not discriminate—it affects people regardless of age, race, income, or geographical location. In fact, an article from The Guardian newspaper reported last year that as many as 970 million people worldwide are estimated to have a mental or substance use disorder.

In the same year, the World Health Organization (WHO) said: “Mental, neurological, and substance use disorders make up ten percent of the global burden of disease and 30% of non-fatal disease burden.” The WHO also estimates that around 264 million people are affected by depression alone and that someone loses their life to suicide around every 40 seconds. Plus, depression and anxiety cost the global economy a whopping USD 1 trillion per year. So worried was WHO by these findings that it put in place an action plan to improve mental health outcomes between 2013 and 2020.

But as with many situations, add the word “expat” to the conversation, and everything becomes infinitely more complicated. While there is a distinct lack of research on the topic, one study published in 2011 called The Mental Health Status of Expatriate Versus US Domestic Workers claimed that people living abroad are as much as 2.5 times more likely to suffer from mental health problems than their domestically-based counterparts. Furthermore, the insurance company Aetna International claimed in its 2017 Expatriate Mental Health Study that expat mental health problems are a growing issue, based on its latest claims data.

If expats are more prone to mental health problems, what could be the reason?

Challenges of Expat Life

Frankly, these findings are unlikely to cause shockwaves of disbelief in the expat community. Moving house is widely acknowledged as one of the most stressful life events that we will experience. Little surprise, then, that doing it in a new country is enormously stressful. International moves also have additional implications. For starters, discussions and decisions are needed on everything: shipping, flights, visas, housing, schooling, healthcare, and dual-career considerations. They also involve the angst of saying goodbye to loved ones and can include extra logistics that “normal” moves don’t have, such as securing visas, closing bills and bank accounts, and arranging pet import/export permits.

Most people arrive in their new host country already exhausted and in a state of burnout. And that is before they’ve even started the local logistics like going to medicals and sorting out residency-related paperwork. Often, there is poorly-understood bureaucracy to face as well as language barriers and various socioeconomic and cultural differences. Add to this that one or both parents is starting a brand-new job (another one of life’s most stressful events!), and it is little wonder that there is a huge mental strain on everyone involved.

Yet, despite its probable prominence, mental health struggles among expats remain one of the more “taboo” topics of conversation. The Aetna study speculates that there are a few main reasons for this, and one is that expats are often extremely self-sufficient—a character trait born out of necessity. Usually unable to rely on others, particularly at the beginning of a new assignment, expats become used to getting things done without asking for help. Asking for help becomes something they are simply not in the habit of doing.

There could be other contributing factors, including the fact that a new expat has very few people to confide in. Struggles with suicidal thoughts or obsessive-compulsive disorder are hardly ice-breaker topics at coffee mornings. New expats may find themselves equally isolated from friends and family at home, who are probably on a completely different time zone, and who may struggle to understand the complexities of expat life. Many people are also reluctant to seek help using their company medical insurance for fear that their employer will find out about their issues and (wrongly) develop concerns about their ability to cope in a potentially high-stress work environment. Although, in recent years, steps have been taken to ensure that mental health treatment is kept confidential, the stigma remains. Additionally, activities that are considered “normal” in many expat circles, including heavy drinking and partying, can actually mask more sinister underlying substance abuse or addiction problems.

So, what can you do?

10 Ways to Improve Your Mental Health.

There are many strategies that are proven to help improve a person’s mental health and overall well-being. Often, these are linked. For example, exercise and meditation can help with getting enough good-quality sleep. Please note that the list below is meant to help improve the overall general mental health of otherwise healthy people. It is not a substitute for professional help for people suffering from medical conditions.

Ways that you can support your mental health include:

  1. Exercise: It is a well-documented fact that there is a direct relationship between exercise and good mental health. A 2018 study published in The Lancet Psychiatry journal by Sammi R Chekroud et al. indicated that physical exercise was significantly and meaningfully associated with [reduced] self-reported mental health burden. Mentalhealth.org suggests aiming for 2.5 hours of moderate-intensity activity per week. This amounts to around 30 minutes of exercise a day, five times a week, which is in line with recommendations from the UK Department of Health.
  2. Get outside: On the website of UK mental health charity, Mind, it says that “spending time in nature has been found to help with mental health problems including anxiety and depression”. There could be several reasons for this, including exposure to natural light, being closer to nature, and getting fresh air. Furthermore, for people who are really struggling, the simple achievement of getting out of the house can have an enormous impact.
  3. Meditate: The much-studied art of meditation might only be gaining popularity in recent years, but it is far from a new phenomenon. Several articles published in the American Journal of Psychiatry suggest there are significant links between meditation and mental well-being. Not sure where to begin? Try one of the hugely successful meditation apps such as Headspace or Calm.
  4. Write: There have been many studies on the merits of regular journaling, and the consensus is that, unsurprisingly, getting your thoughts out of your head and onto paper has many therapeutic benefits.
  5. Have a morning routine: Incorporating a variety of techniques into a morning routine can also significantly help your overall well-being. These don’t have to be enormously time consuming—try a five-minute meditation combined with 10 minutes of journaling or yoga and/or some exercise, for example. Even a very simple routine that starts off with making your bed—as suggested by William McRaven, a US Navy Admiral, in his viral 2014 commencement speech to the University of Austin—can have positive knock-on effects throughout the day.
  6. Eat well: It stands to reason that what you put in your body can have a dramatic effect on it. Relationships with food can be complicated and closely linked to a person’s mental health. There are also some studies now linking gut health with mental health. Mind acknowledges that there is a lot of conflicting and confusing advice out there telling us what we should and shouldn’t eat. Hence, it suggests a simple but helpful guide for healthy eating on its website.
  7. Reduce or cut out alcohol consumption: While not applicable to all expats, those who do drink alcohol will know that it is not without its problems. Alcohol is a depressant and can be particularly harmful to someone experiencing a mental health episode. Abuse and addiction are an extreme that most people can avoid, but even more moderate consumption can have negative effects in the wrong circumstances. Reducing consumption, even for people in a good overall mental state, can have enormous benefits.
  8. Get enough sleep: There is an enormous number of studies on the link between sleep quality and mental health issues. In fact, The Effects of Improving Sleep on Mental Health (OASIS) study published in The Lancet in 2017 concluded that there is “strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems”.
  9. Find your people: Having a support network in place can have a critical effect on how anyone handles the challenges that life throws at them. But this is especially important (and tricky) for expats. Losing your networks from home can be hard, and it is daunting to form them again in a new community. Having people to talk to who also understand the complexities of expat life can be uniquely helpful.
  10. Talk: Opening up about your problems can provide an informal way of sharing them. Often, just getting them out in the open makes them seem smaller than they were in your head. Opening up can also make you feel less alone, especially when the other person admits they also feel the same way.

Getting Help

Of course, it can (and regularly does) happen, that a person does all of these things and still needs help. Or, their mental health issues become so overwhelming that even the simplest of tasks can be too much. Asking for help is the most courageous act someone can do in this situation. Reaching out to medical professionals and accepting the help that they can provide can be life-changing and life-saving for many people battling mental health disorders.

There are several places in Qatar that currently offer professional help for people suffering from mental health issues. Should you find yourself unable to find the help you need in-country, many individuals and practices operate online and over video calls. These agencies are often highly specialised in treating expats and have a unique understanding of the specific problems that expat life can present. Such organisations include:

Truman Group – Truman Group provides remote psychotherapy and mental health consultation to expatriates living around the world. It works with individuals, couples, families and children, and most of their providers have either lived overseas themselves or have extensive experience treating people who have lived and worked internationally.

The Expat Kids Club – The Expat Kids Club works to help young people around the world feel supported during big life transitions. Their “club” provides a sense of belonging to kids and is a safe-haven for those who might miss the stability of having a home base. They work with kids and teens of all ages, backgrounds, cultures, and families, particularly with those who struggle to overcome the difficulties associated with being a foreigner or having a mixed cultural identity.

Expat Nest – Expat Nest offers online counselling exclusively to expat adults, parents, and teens in several languages, including English, Greek, Spanish, Italian, Dutch, and Chinese. Expat Nest recognises that counselling at a younger age facilitates cure and can change lives for the better.

Breaking the taboo

There have been great strides made in the mental health community in recent years, with people from all walks of life opening up about their personal struggles with mental health. High-profile cases such as those of Prince Harry and the late Robin Williams serve to remind us that no one is immune to the harsh realities of mental health struggles. There is far more support available in the press and from health services globally. Yet, there remains much to be done, with many people feeling the stigma of suffering from mental health problems.

It is up to all of us to work together to break this taboo by keeping the conversation going.

And above all, remember: you are not alone.


Disclaimer: Doha Family has not verified the qualifications or licenses of the medical professionals listed in this article. As with all medical issues, all patients should take the time to research providers to ensure their legitimacy.