SHARE
COPY LINK
PRESENTED BY AXA

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.

Log in here to leave a comment.
Become a Member to leave a comment.
For members

HEALTH

One year since Spain’s euthanasia law was passed, what has changed?

A year since Spain's euthanasia law was passed, there have been over 150 assisted deaths in the country but still many objectors from within the medical sphere. Here's what the data reveals about Spain's approach to this highly divisive practice.

One year since Spain's euthanasia law was passed, what has changed?

Spain’s historic euthanasia law was passed a year ago on June 25th, 2021.

Since that day at least 171 people have ended their lives through the assisted dying procedure, although the statistics to date are both regional and provisional. That number could, in reality, be higher.

The figure is based on figures from Spanish newspaper El Mundo, although it must be said that it doesn’t include the regions of Asturias and La Rioja, where the data is not yet available.

Before the landmark legislation, assisting somebody who wanted to die was punishable by up to ten years in prison, and the law, which made Spain the fourth country in Europe to allow people to end their own life, following the Netherlands, Belgium and Luxembourg, was as controversial as it was groundbreaking.

Pedro Sánchez’s PSOE-led coalition government had to rely on the congressional support of minor left-wing parties to pass the bill, and although it was celebrated by right-to-die campaigners in Spanish society -described as creating a “a more humane and fair society,” by Health Minister Carolina Darias – it outraged many conservative and religious groups.

 
The law

Although widely known as Spain’s euthanasia law, in reality the legislation prescribes two forms of dying: euthanasia and assisted suicide.

Euthanasia is the procedure of prematurely ending a life to relieve suffering or pain – via lethal injection administered by a doctor, for example.

Assisted suicide, however, is undertaken by the person themselves with help.

Both euthanasia and assisted suicide can be carried out on consenting patients suffering from chronic and debilitating conditions, incurable illness, or conditions that cause immense suffering.

You must be an adult Spanish national or have legal residency in Spain, and be “fully aware and conscious” when you make the request, which must submitted twice in writing, two weeks apart.

But that doesn’t mean that applying, or having your application accepted, is easy.

The Local had delved into the realities of Spain’s historic euthanasia legislation one year on.

Regional variations

Although there are still no officially collected and aggregated statistics on a national level, and even some slight variation on the figures within Spanish media outlets, using provisional regional data it is possible to gage how the law has been implemented in its first year.

Nationally speaking, it seems at least 336 Spaniards requested euthanasia procedures in the first year of legal euthanasia, of which 171 were performed, 18 applications rejected, and 43 still pending decisions. 

But data from the first year of euthanasia procedures paints an interesting regional picture. Euthanasia and assisted dying have so far been, it seems, concentrated in certain regions of Spain.

Catalonia, for example, has performed 60 in the first year alone, while Andalusia, with one million more inhabitants than Catalonia, just 11.

In Andalusia, just 19 applications were made, of which 11 were accepted, six rejected and two still pending. In Catalonia that figure was 137.

After Catalonia, Basque Country had the second most euthanasia procedures, with 25 of 75 applications accepted. Third was Madrid, with 19, and fourth the Valencian Community, where 13 procedures have already been completed out of 23 applications made. 

On the Balearic Islands, eight were carried out of the 17 applications, whereas in the Canary Islands seven applications were made with four still awaiting a decision.

In Castilla-La Mancha eight applied, with four approved. But in Galicia, it seems the Galician government have a lower threshold for accepting euthanasia applications: of the 19 applications it received this year, just four were accepted. 

Similarly, in Castile y Leon, just two of the seven applications were accepted, and it is believed that the process became so drawn out that some patients even died before receiving a verdict.

In Murcia, on the other hand, four of the five total applications have already been carried out. In Cantabria, 12 procedures were requested, five completed, two rejected, and one still pending decision, 

Across the rest of Spain’s autonomous communities, none have completed more than five procedures.

How quickly is euthanasia approved in Spain?

Judging from the raw numbers, it seems that Catalonia and the Basque Country are the most willing to grant euthanasia procedures, but are also the fastest bureaucratically speaking: it takes patients, on average, 41 days from application to procedure in the two northern regions.

In Andalusia and Madrid, however, the process is much slower. In Andalusia, for example, the regional government took five months to even implement the law, and it is believed that they have kept applications waiting as long as three months due to a convoluted bureaucratic process that passes the application between different doctors with no streamlined system, which leads to a lag in processing.

Other regions, however, have already set up systems to deal with the applications.

In Catalonia, Navarre, the Basque Country and the Canary Islands, applications are dealt with by specially created teams made up of at least one doctor and a nurse who have studied and specialise in the implementation of the law. 

Medical objections

While the issue of euthanasia has long been politically and religiously controversial, the law has also divided doctors. In just the six regions alone where data is available, it is believed 4,500 doctors have objected to the procedures, either refusing to carry it out or withdrawing from the process altogether. 

Madrid has had the most objections from doctors, with almost 3,000 in the first year alone, while in Andalusia over 500 have objected.

Interestingly, even in a region with very few applications such as Castille y León, where only seven patients requested the procedure, over 400 doctors have ruled themselves out of the euthanasia process. That is more than Catalonia (167) where the most applications and procedures were recorded.

However many believe, the figures, admittedly provisional and very patchy at a national level, for now, could be hiding greater numbers of doctors who are uncomfortable with Spain’s new euthanasia law. 

The president of the Ethics Commission of the Andalusian Council of Medical Associations, Dr. Ángel Hernández Gil, said that “there are a very large number of doctors who are conscientious objectors” but are not recorded in the official statistics “because they are only registering as conscientious objectors when the request arrives. In the event that the application does not arrive, people will not register,” he explained in the Spanish press this week.

Speaking as a representative of the medical profession in Spain’s most populous region, Hernández Gil suggested so many doctors are against euthanasia because they believe “is not within the purpose of medicine.”

“Our position has nothing to do with any kind of political ideology, religious principle or moral principles,” he added.

“We understand that euthanasia is not a medical act.”

SHOW COMMENTS