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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.

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READER QUESTIONS

Reader question: Is abortion illegal in Germany?

Reproductive rights are in the spotlight this week as the US debates possible landmark changes to abortion law. Here's what you need to know about abortion in Germany.

Reader question: Is abortion illegal in Germany?

A leaked document earlier this week claimed that the US Supreme Court is in favour of overturning a landmark 1973 ruling, called Roe v Wade, that made abortion legal in the USA.

The news has put a further spotlight on reproductive rights around the world. Readers of The Local have contacted us to find out about the laws on abortion in Germany. We spoke to campaigners for women’s reproductive rights to help explain what you need to know.

Is abortion illegal in Germany?

It may surprise many people to know that abortion remains technically illegal in Germany, but there are circumstances in which people can end a pregnancy without facing any legal consequences. 

The exceptions include: the abortion being performed within the first 12 weeks of pregnancy, and following mandatory counselling carried out at least three days before the procedure to terminate the pregnancy.

If there is a medical reason for an abortion, then it is not unlawful. This applies, for instance, if the pregnancy poses a danger to the life or physical and mental health of the woman. An abortion can also be carried out if tests identify that the foetus is disabled or seriously ill. Late abortions (after 12 weeks) are allowed if these special factors apply. 

Abortions are also legally possible if they are the result of a criminal act – for example if the pregnancy is the result of rape. 

The termination of a pregnancy is known as Abtreibung or Schwangerschaftsabbruch in German. Around 94,600 abortions were reported in Germany in 2021, according to official figures. 

The rate of abortions per 1,000 women in Germany stands at 6.8 – one of the lowest in Europe alongside Switzerland. The rate of abortions stands at 19 per 1,000 women in Sweden, 17 in the UK, 16 in France and 16 in the US.

People who choose to get an abortion in Germany generally have to cover the costs of the procedure themselves. 

According to the German Centre for Foreign Feminist Policy, which published information by Medical Students for Choice Berlin, abortion in Germany can cost between €200 and €650 depending on the methods involved. People can apply for financial help from their health insurance.

READ ALSO: Is abortion legal in Switzerland?

A pro-choice counter protester at the "March for Life" demo against abortion in Berlin in September 2020.

A pro-choice counter protester at the “March for Life” demo against abortion in Berlin in September 2020. Photo: picture alliance/dpa | Jörg Carstensen

Tell me more about abortion laws in Germany…

There has been a lot of discussion about abortion in Germany in recent years. Germany’s traffic light coalition – made up of the Social Democrats, Free Democrats and Greens – recently announced plans to scrap paragraph 219a – a controversial clause on advertising abortion that has remained largely unchanged since it was brought in by the Nazis in the 1930s.

It has meant that doctors in Germany have been unable to advertise that they carry out abortions, and detail what methods they use – and has even resulted in prosecutions, such as the high profile case of Kristina Hänel, a doctor from Giessen in western Germany.

Getting rid of this paragraph should pave the way for more accessible information on abortion in Germany.

READ ALSO: Do Germany’s planned changes on abortion go far enough?

But abortion in Germany is still regulated by paragraph 218 of the criminal code, which dates back to 1871. Although the law has been amended to allow for exceptions, pro-choice campaigners in Germany want to see abortion fully legalised. 

Dr Alicia Baier, chairwoman of campaign group Doctors for Choice, said the German coalition government’s plans to get rid of paragraph 219a were a step forward.

But she said much more action was needed – including removing abortion from the criminal code. 

“I think German abortion laws are behind the times,” Baier told The Local. “There are many European countries which regulate abortion outside the criminal law. But in Germany we still criminalise abortion, we still have the obligatory waiting period, and obligatory counselling.”

Baier said abortion didn’t belong in criminal law. “That’s not the place for abortion, it should be regulated in some other law. Like in France – they regulate it in the public health law.”

Although the coalition government has said it wants to set up a working group to look at options for regulating abortion “outside of the framework of the criminal code”, there doesn’t seem much political appetite for big change.

Earlier this year, Katrin Helling-Plahr, FDP parliamentary group spokesperson for legal policy, told The Local: “We Free Democrats are of the opinion that Paragraph 218, as the result of a long societal discussion, represents a successful compromise with regards to protecting the life of the foetus and the right to self-determination of the pregnant person.”

Campaigners at the pro-life 'March for Life' in Berlin in September 2021.

Campaigners at the pro-life ‘March for Life’ in Berlin in September 2021. Photo: picture alliance/dpa | Paul Zinken

Is it difficult for women in Germany to get an abortion in practical terms?

According to campaigners, it can be hard for people to find information on terminating pregnancy and doctors to carry it out depending on where they live.

“I think it really depends on the women themselves and where they are,” campaigner Annika Kreitlow, a research assistant with the Centre for Foreign Feminist Policy, told The Local. 

“I think in Berlin it’s okay – there are a lot of doctors in Berlin and a lot of progressive people move to Berlin. But if you live in the south of Germany, like in Bavaria for example, there are cities which don’t have any doctors who provide abortions at all.

“In the northern islands of Germany, people there also have to fly to the mainland to get an abortion – sometimes they have to travel 200 or 300km to get an abortion.”

Kreitlow also said people in Germany face additional barriers because of the mandatory counselling and three-day wait. 

“You have to be really consistent on finding a doctor who will do that before the 12th week. It depends on the region and also how much knowledge the person has on the situation,” she said. “If you’ve never come into contact with this and don’t know anyone who’s had an abortion, there’s a lot of fake information out there and fake websites.”

She said it’s more difficult for non-Germans.

“If you’re not a native German speaker and you come from somewhere else, it’s also very different to find the right information and distinguish what is real information and what is fake, who to trust and who to talk to,” Kreitlow said. “It’s a very difficult situation but a lot of circumstances make it even more difficult in Germany.”

How do the laws affect doctors?

Dr Baier said there was still a “big stigma” surrounding abortions in Germany – including in the medical profession. Although it is one of the most common gynaecological procedures, it is often hardly discussed at medical schools in Germany.

“In many universities – during six years of study – it’s not mentioned at all, or it’s mentioned in the context of medical law or medical ethics,” said Baier.

“It’s still very taboo in medicine. We wish it was acknowledged as part of medicine because it’s a medical procedure. In Germany, only doctors are allowed to perform them. If we don’t do it, people are left alone and that could cause a lot of health risks.”

Baier said the barriers for women in Germany looking to get an abortion, or for information on it, need to be urgently worked on.

“In some regions of Germany it’s catastrophic and people are treated very badly,” she said. “We have a modern health system but it doesn’t correspond to that at all in this area.”

 

Is there a large pro-life movement in Germany?

There’s a sizeable number of campaigners who are against abortion in Germany.

Pro-life events such as Marsch für das Leben (March for Life) take place every year in Berlin. In 2021 around 4,500 people attended the march, demonstrating against abortion and euthanasia laws. Counter-demonstrators from the pro-choice movement also march on the days of these events. 

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