Going abroad to work is an excellent way for most people to get outside their comfort zone. For some, this is an exciting and rewarding thing to do; there is a potent little saying, to the effect that ‘a comfort zone is a nice place, but nothing grows there’. However, more multi-national employers the world over are increasingly recognising that being an expat, particularly a first-time expat in a strange country, can be stressful and disorientating. Of course, the majority of companies who ask staff to go and work abroad will provide insurance and medical health cover for those staff. But many of the problems that expats face lie outside the world of work and occur in the individual’s private life.
Getting children settled in foreign schools is a challenge, for example. The language itself and unfamiliar foods, coupled with the challenge of finding out how to cope with an unfamiliar culture, can generate stress – and this is quite apart from the difficulties that can arise if the expat or family members are need medical treatment. For all these reasons, a growing number of insurance companies are adding employee wellbeing policies to their portfolio of corporate and private offerings. Victoria Zolkiewka at William Russell, which specialises in international health and insurance policies, points out that expat wellbeing policies are a core part of the company’s brand and product portfolio. “We believe that a wellbeing policy is just as important as a health policy. It is unarguable that a focused, healthy executive is going to perform a lot better for their organisation than one that is stressed out. So that makes expat wellbeing the company’s concern, even if the stress is coming from factors external to the work environment,” she said. “What we find – and we have a great deal of experience to draw on in this area – is that moving abroad can be hugely stressful. People do it for a variety of reasons: for adventure, for financial gain, or to further their careers, but such a move can come at a high cost. What we are looking to do with our expat wellbeing policies is to make it easier for both the employer and the executive concerned.”
Expat mental health concerns
The statistics on what could be loosely termed expat mental health concerns, more than bear out the idea that being parachuted into a foreign culture and society can be disorientating. Proper research on the topic is thin on the ground, but a 2011 study entitled The Mental Health Status of Expatriate versus U.S. Domestic Workers led by Sean Truman, Director of Clinical Services at the Truman Group, showed that expats are two and a half times more likely to suffer from depression than ‘local’ workers. Truman and his colleagues conducted a two-group study based on questionnaires designed to compare the mental health status of an expatriate population to a domestic, US, non-expat population. Unsurprisingly, the study concluded that expat employees experienced a significantly higher range of risk for mental health and substance use disorders, than their US counterparts. They were two and a half times more likely than executives in the ‘local’ group to report suffering from periods of high anxiety and depression.
Several mental health counsellors told researchers from William Russell that their experiences with expats more than bore this out. Chris Neill, based in Spain, said that rates of depression, or the feeling that life is meaningless, could be up to 50 per cent higher among expats.
It is unarguable that a focused, healthy executive is going to perform a lot better for their organisation than one that is stressed out
Reports by expats of anxiety issues were also common, he said. “People with anxiety stop enjoying activities that used to give them pleasure. They don’t want to go out any more and they start ruminating on the past or worrying about the future.”
Zolkiewka points out that there are a number of areas outside of work that are often cited by expats as sources of deep concern. Worries over how the health systems work in the new country are high on the list of expat concerns, as are concerns over financial security, given that the expat is often a stranger in a land unknown to them and feels removed from all the usual support systems. This is precisely what expat wellbeing policies are – or should be – designed to address, she said. “Our wellbeing policies start with a basic package and there are a series of add-on options that the employer or individual expat can take to provide additional protection,” Zolkiewka said. The younger demographic, moving abroad for the adventure or experience, tends to take the basic package. “Where people are, say, into their thirties or older, and are moving abroad with their family, they are much more concerned with adding in options that will future-proof their lifestyle choices and security. So they go in for higher levels of cover. Life protection becomes very important, as does income protection. Counselling services for stress, anxiety and depression are also valued and are available as part of the insurance,” she added.
One of the innovations the firm has introduced is a policy for expats designed to deal with life changing illnesses such as cancer. The policy can cover new innovative techniques such as the DNA testing of potential cancer tumors. “Our full cancer cover starts from tumor DNA mapping and covers the patient through all the treatments, including reconstructive surgery, if required,” Zolkiewka said. She added that providing comprehensive health, financial and life cover can go a long way to removing potent sources of stress for expats.
Expat insurance specialist Aetna International recently produced its own white paper on expat mental health challenges and has designed expat wellbeing policies to provide cover across the areas highlighted in the paper. The paper cites the case of a US woman expat working in the Persian Gulf who took her own life in February last year. “Her fellow expats were shocked, in part because the woman had been ‘vivacious and full of life’, and in part because her death brought to mind their own struggles,” the paper notes. One of her colleagues, an expat from the UK noted on the company’s website: “It could have been me, just as it could have been one of many others I knew in the Gulf with untreated or improperly treated mental health issues.”
there is still a need for insurance companies offering wellbeing programmes to work harder at communicating just how important these programmes can be to individuals living abroad
Aetna International Medical Director Dr Mitesh Patel said that in the company’s experience, for many expats, working in an unfamiliar context far removed from friends and family can be a recipe for disaster. “We believe that it’s time to focus serious attention on the problem of expat mental health and to explore potential solutions,” he said. Aetna conducted its own study, in 2017, of 500 US expats to gauge what they found most disturbing about being away from home. The overwhelming conclusion that came out of the study was that expats missed their support networks, friends and family, the most. “Not having those support networks compounds stress and anxiety for expats abroad, so providing an all-embracing support network is one of the major things we try to build in to our expat wellbeing policies. This includes providing support to expats for whatever may crop up in their personal lives as well as work-related stresses,” Dr Patel said.
A preventative approach
Dr Patel also said that he is a firm believer in employers taking a more preventative approach to expat stress, depression and anxiety risks by introducing third party provider solutions such as employee assistance programmes. “At best these not only tackle mental health concerns when they arise, but also encourage broader employee wellness. This helps by addressing issues before they escalate,” he commented. Where expats are relocating under their own initiative, they would be best advised to consider preparing for the challenges they may face and seeking support before and during their move. “Increasing knowledge around mental health issues and the support available can change attitudes towards those with mental health, and the behaviour of those coping with issues,” he emphasised.
providing comprehensive health, financial and life cover can go a long way to removing potent sources of stress for expats
Aetna has an In Touch Care offering, which has been designed specifically to help in these instances. “We offer one-to-one support to vulnerable members and provide ongoing support, ensuring that wherever they are in the world they have quick and easy access to the help they need. Since this service launched for our Americas’ members, we have seen a decrease in mental health claims costs per member, suggesting that our support may have reduced the frequency of their visits to mental health treatment providers,” Dr Patel said. He explained that under Aetna employee assistance programmes, clients get telephonic support for workers for all manner of concerns, including life events like births and deaths. Under these schemes, employees get 24-hour access to counselors.
There is also a vHealth, or virtual healthcare service, which connects workers direct with specialists, either internationally, or back home. If you or a member of your family needs psychiatric counselling while working abroad, in, say, Japan, it is comforting to be able to talk to a psychiatrist that shares the same cultural values and knows where you are coming from on the issues that matter to you. Virtual counselling has some key benefits besides being in touch with a specialist from your own culture. Because it is virtual, there is no need to travel to the consultant’s offices and some clients may find it somewhat freeing not to be in the same locale as the counsellor. While this is still very much a niche optional offering, we may well be heading towards a near future where employers regularly provide this as a standard part of a wellness package for their employees, Patel suggested.
The In Touch Care programme Aetna provides uses predictive analysis to find, engage and help members with chronic conditions such as diabetes and chronic kidney disease. The programme then provides one-to-one nursing support which includes looking at the individual’s support network, which will often include the employer. Steve Nyce, Senior Economist and Director of the Research and Innovation Centre at Willis Towers Watson pointed out that US companies have tended to lead the way over the last two decades, in providing expat wellbeing policies for their staff serving abroad as well as for local staff. “The typical US company today offers nearly 15 different programmes to support the physical and emotional wellbeing of their employees,” he said. However, Nyce recommends that employers really look at the detail of what is on offer and put some time and effort into communicating the benefits of the programmes they choose to employees. Survey studies tend to show that fewer than one in three employees see their employer’s wellness programme as relevant to a healthy lifestyle and less than half think that these programmes meet their needs.
Clearly, there is still a need for insurance companies offering wellbeing programmes to work harder at communicating just how important these programmes can be to individuals living abroad. They can literally be the difference between life and death. ■