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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.

Published: 1 June 2021 11:00 CEST
Updated: 4 September 2023 15:17 CEST
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

How to find available therapists in Germany

It’s no secret that mental health care can be particularly tricky to access in Germany. Here are some helpful tips for anyone who is struggling to book an appointment for therapy.

Published: 23 April 2024 12:55 CEST
How to find available therapists in Germany

The process to find psychotherapy in Germany’s urban centres is arduous – licensed therapists often have impossibly long wait times, and private practices don’t accept public health insurance.

A major reason that public insurance funded mental health care is hard to find in Germany comes down to regulations. Specifically the ‘coverage plan’ (Bedarfsplanung) that basically limits the number of licences available for publicly insured therapists in a region.

Germany’s maddening bureaucracy probably won’t be fixed any time soon. So residents in need of therapy will need to find a way through the system as it is.

So here are a few helpful tips for finding therapists, as well as how publicly insured patients can have private practice therapy costs reimbursed.

Look for therapists enrolled at academies

You’ll probably have a better chance getting an appointment with therapists who are currently in training, because not everyone knows that this option exists.

You can search for “Akademie für Psychotherapie”, to find one in your location. The Berliner Akademie für Psychotherapie, is one in the capital city, for example.

If you arrange an appointment this way, you can expect to be connected with a grad student therapist in training who needs to complete their supervised practice hours. In this case, you would see your therapist as usual, and they will be going through your session with an experienced therapist afterward.

The main advantages to seeking a therapist in training is that it may be cheaper and you can probably more readily find an appointment. A potential disadvantage is that the therapist you’ll be seeing is less experienced. 

But according to a Stockholm University study, student therapists who receive regular feedback from supervisors may be just as effective as licensed therapists at treating patients.

How to get reimbursed for going to a private practice

As mentioned above, therapists covered by public health insurance are few and far between, especially in many urban centres, and therefore regularly come with long wait times. But for those willing to do battle with the bureaucracy, there is an option to have your costs reimbursed for seeing a private practice therapist.

Specifically, public insurance providers are obligated to provide full reimbursement of costs in the event of a “supply emergency”. 

Waiting times of more than three months are considered unreasonable. So generally, patients can claim a supply emergency if they have contacted several therapists, and none of them offered available appointments within that time frame.

But you’ll want to make sure that your process is properly documented so that you won’t be stuck with the out-of-pocket costs.

First, you’ll need to document your need for psychotherapy. To get this, make an appointment for a psychotherapeutic consultation with a practice in your area, and be sure to collect a written recommendation for treatment (a PTV 11 form). 

If you don’t know where to start with this, look to the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung) for a database of therapists. You can also call 116 117 or use the 116 117 App.

After you’ve got your PTV 11 certificate, you’ll need to document your futile search for a licensed therapist. To do this, contact at least three to five therapists that have public health insurance approval. Keep a list of the names of therapists you contacted, as well as dates and times of contact and how long the waiting list for treatment is. 

Additionally, you should try to arrange treatment through the aforementioned Association of Statutory Health Insurance Physicians, and receive confirmation if it’s not possible. So you’ll need to call 116 117, or use the 116 117 App again. But this time go through the process to have them try to find you placement with a therapist. This should take a maximum of four weeks, but rarely happens.

Finally, if you have documented all of the above and have still not found a readily available therapist, then you can seek out a private practice. You’ll need to enroll as a self-paying patient initially, but then you can submit an application for an outpatient reimbursement (Kostenerstattungsverfahren) along with the previously collected certificates and proof of your search. Private practice therapists are usually familiar with this process, and may be able to help you with the application as well.

READ ALSO: What are the main reasons internationals in Germany turn to therapy?

Free phone consultations for students

Students in Berlin can also take advantage of a free 50-minute conversation with a therapist through StudierendenWERK.

For students elsewhere, it’s worth checking what kind of mental health support services your school offers. Many German universities offer mental health support to some extent, and if school counsellors can’t provide the care that you need, they may be able to offer helpful information about where such services are available in your area.

READ ALSO: Here’s how you can get mental health help in English in Germany

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