Expats' Mental-Health Claims Rise

Employees on international assignments or who relocate on their own are experiencing more bouts with depression or anxiety, according to new research.

By Carol Patton

According to a new white paper by Aetna International, there's a sharp rise in mental health issues, specifically depression and anxiety, among expatriates around the world. Between 2014 and 2016, there was an average 28 percent increase in the insurance provider's mental health claims in Europe, Southeast Asia, the Americas, and the Middle East and Africa, says the paper's author, Dr. Mitesh Patel, medical director at Aetna International in London.

"I was surprised by the increase in claims," says Dr. Patel. "But at the same time, it's actually a positive thing . . . . Mental conditions are not such a stigma anymore and becoming similar to chronic conditions like high blood pressure. People are stepping forward and have more access to help."

The Aetna white paper reveals some startling facts, including: Europe had the biggest claims increase (33 percent) compared to the Middle East and Africa (28 percent); the Americas (26 percent) and Southeast Asia (19 percent). Patel's research also found that only 6 percent of expats were concerned about mental health before moving to their new assignment. Once they get there, the top five pressure points for international assignees are challenges of a new job (62.8 percent); inability to take part in activities available at home (44.6 percent); loss of a support network (42.8 percent); language and other cultural difficulties (40.7 percent) and worker's spouse not able to find work (37.9 percent)

Many expats (without trailing dependents) also "felt they had trained themselves to be lonely, a key attribute people needed in order to survive in new surroundings," says Patel. Likewise, mental-health services are disproportionately distributed across the globe.

HR professionals can do more to minimize some of the distress related to overseas assignments. Even something simple like giving expats a free gym membership or a list of local activity groups that match their interests can help, he says. HR could also offer a one-month, in-country trial to help determine how expats will perform. To ease transitions, he adds that Aetna created a program called In Touch Care, where counselors reach out to expats with mental health issues or claims (or vice versa), offering therapy as needed.

"Mental health affects absolutely everyone," says Patel. "HR can support employees to reduce the risk of them being affected by those five pressure points."

And many are affected. Roughly 300 million people in the world suffer from depression and anxiety, the most common global disabilities, says Betsy Schwartz, vice president of public education and strategic initiatives at the Washington-based National Council for Behavioral Health.

Surprisingly, she says, depression and anxiety are fairly common problems, regardless of whether employees are expats. She says this presents an ideal opportunity for HR to introduce innovative mental health programs or solutions. One program that Schwartz oversees at NCBH is Mental Health First Aid, a mental health-literacy program now offered in 24 countries.

"It teaches people how to recognize signs and symptoms of mental health and addiction problems," she says, adding that employees also learn how to approach coworkers who may be experiencing such problems, engage them in conversation and direct them to appropriate resources.

She says HR needs to normalize "the entire realm of mental health problems," partly by explaining that depression or anxiety is a common side effect of working abroad and identify accessible resources. Likewise, consider mental health in the same way physical health is perceived. Promote it as part of an individual's overall well-being and ensure that mental health and addiction services are part of a comprehensive and larger healthcare benefit.

But HR professionals must first move past their own fears of dealing with employees with mental health conditions. Schwartz says that the workplace presents an excellent opportunity to deal with these issues and, unlike some chronic health conditions, many mental health problems can be effectively treated.

"Realize that the workplace really is an opportunity to help employees," she says. "Some of the isolation they may be feeling by being away from their family and friends can be (minimized) by social contact and the sense of meaning they get from their work."

Other HR approaches include enhanced employee assistance programs, says Theresa Nguyen, vice president of policy and programs at Mental Health America in Alexandria, Va.

She says HR professionals in each country can develop a list of local services. Identify local therapists who speak English, for example. But if service gaps exist, offer telehealth services that enable employees to engage in counseling sessions back home via phone or Skype. Before employees move abroad, HR needs to inform them of available mental health benefits in addition to online communities or social networks for expats, she says. 

Meanwhile, it may be time for HR to re-evaluate its global mental-heath services to ensure adequate coverage is being provided, adds Nguyen, who says that physical health can't be separated from mental health.

She believes that Aetna's whitepaper draws much needed attention to mental health problems that frequently arise during transitional stages in life.

"People feel so much anxiety and depression that they're actually reaching out for help, which is really encouraging," says Nguyen. "[Offering additional] resources can help reduce that period of time when someone is struggling to adjust to a new environment."

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Jun 29, 2017
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