Expat mental health: taking a preventative approach

As employee mental health rises up business agendas, Aetna International’s Dr Mitesh Patel advises firms on how to fulfil their duty of care to overseas workers, international assignees and relocatees.

Relocate Editorial

3 July 2017

Expatriate mental-health issues are on the rise, impacting both the well-being of relocating employees and the commercial success of the companies they work for.The prospect of moving abroad to work, whether on assignment or independently, can certainly seem like an adventure: a new city, new people, the chance to experience an unfamiliar culture, and even a different way of working.However, being separated from the vital support of family and friends can make the whole experience overwhelming, leaving expatriates more susceptible to mental-health conditions such as anxiety and depression.Unfortunately, safeguarding their mental health is often the furthest thing from employees’ minds as they prepare for a new life abroad. In 2016, a survey of 5,000 members of Aetna International, the health benefits and services provider, revealed that just 6 per cent of expats worried about mental-health issues before relocating.As a result, the vast majority are inadequately prepared for the challenges of expatriate life and its potential impact on their well-being.Yet mental ill health is a growing issue for expatriates across the globe. If left unchecked, it can result in individuals returning home and the failure of the assignment or relocation.A review of Aetna International member data from 2014–2016 shows a rise in mental-health-related claims around the world. Europe experienced the greatest increase (33 per cent), followed by the Middle East and Africa (28 per cent), the Americas (26 per cent) and Southeast Asia (19 per cent).Depression emerged as the most common condition, with a 50 per cent increase in prevalence, followed by anxiety (28 per cent increase). Women between the ages of 30 and 49 were the most likely to seek treatment.These findings are troubling. What they show is that mental ill health is a very real and growing issue – one that businesses with employees working abroad simply cannot afford to ignore.

Increased risk for expatriates

One of the main reasons why expats are vulnerable to mental-health problems is their separation from family and friends whilst overseas. Loved ones provide valuable support in times of crisis, and often expats don’t realise how much they depend on them until they are no longer there.Our clinical experts have found that the absence of networks of family and friends compounds the stress and anxiety suffered by expatriates on foreign soil.Also, expats often struggle with adjusting to a new language or culture. Being an expert in your field is not a guarantee of assignment success. The interpersonal skills needed at home become even more important when joining a new place of work – especially if you don’t speak the local language or understand the cultural nuances.Feeling like an outsider can have a negative impact on expats’ mental health.Expats don’t always relocate alone – which can create its own issues. For example, relationships can come under strain if a couple moves abroad for one partner’s assignment and the other has difficulty finding work in the right field. If the non-working partner has trouble making friends or finding a sense of purpose, this can make matters worse, increasing the risk of depression for both parties.

Cost for international businesses

It is encouraging to see that corporate attitudes are shifting and businesses are becoming more attuned to the issue of employee mental health.Given that mental-health resources are disproportionately allocated around the world and overseas deployments can contribute to mental-health issues, it makes sense for multinational firms to take extra responsibility for their workers’ well-being. Doing so is not only good for the employees, but also benefits the business.Recent research has drawn a direct correlation between stress and workplace disengagement. 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.

Pre-emptive action is key

In order to make a real difference, employers should be thinking ahead. The key is to take pre-emptive action so that they are not only tackling problems as they arise but also encouraging broader employee wellness, to reduce the risk of these issues arising in the first place.Even before their assignees have left for foreign shores, businesses can take steps to help them prepare. Screening employees for their suitability for an overseas assignment, and enabling individuals to experience their new life during a short trial period, are sensible approaches.Offering to pay for, or encouraging them to enrol in, language classes is another of the ways in which employers can assist. Learning the language of the country they are moving to makes life easier for expats. They can interact with their co-workers, make friends much more readily, and integrate into the local culture.Providing individuals with the skills they need to manage their own mental health can also pay off in the long run. Training them in preventative and coping behavioural health techniques not only makes expat life more manageable, but also improves knowledge and attitudes towards mental health.

Importance of in-country support

A growing number of businesses provide employee assistance programmes (EAP), to help staff who have made a move. These offer telephone support to workers facing all manner of concerns, from work-related stress and substance abuse to major life events like births and deaths.They can also assist by finding solutions to more mundane, everyday stresses. Employees typically have 24-hour access to counsellors who can, if needed, make referrals to local professionals.One of the key advantages of this is that full confidentiality is maintained; employers never learn which workers have used the service or what concerns they shared, so individuals can open up about the issues they are facing without fear of stigma and judgment in the workplace.Virtual health, or vHealth, services are increasingly popular. They enable businesses to offer their employees remote access to a wide range of health services, including counselling and behavioural coaching.vHealth can connect people with specialists in their home country or abroad. This can help facilitate a continuity of care in circumstances where individuals are already receiving treatment back home and want to keep it up while abroad.Also, it is a great way for employees to have someone to talk to who understands their culture, speaks the same language, and is available at the time that is most convenient for them.

Working together

The good news is that companies are not alone when it comes to tackling the issue of mental health and equipping their employees for work and life abroad.Medical benefits providers and service partners can help by giving both businesses and their employees the vital assistance they need, covering the critical stages both before and after a move. They can act as an important support network for individuals relocating for work, helping them make the most of new opportunities while providing all-important peace of mind for their employer and protecting the employer’s investment.