International travel and expatriation can be stressful for everyone involved. This stress is intensified by a lack of familiar support systems, change in daily routine, language barriers, and culture shock. There are additional risks, however, for persons with psychiatric disorders. For expatriates and/or their family members with certain psychiatric conditions (see below), knowing how to assess suitability for long-term travel and to avoid potential risk factors that could trigger relapse are critical to the success of the move.
Readiness to Travel
Travelers (and/or family members) with psychiatric disorders should assess their suitability for long-term travel or expatriation, being especially aware of the following:
- Increased frequency of travel can lead to increased chance of relapse.
- Expatriation involves greater risk of relapse than short-term, infrequent travel.
Persons who may be at significant risk of relapse include:
- Persons who have experienced psychosis or bizarre behavior in the past
- Persons who have had conditions that involved danger to one’s self or to others
- Persons with long-term or debilitating disorders, such as with schizophrenia spectrum disorders, including schizophrenia (more likely to be seen in college student population or expatriate family members than employees)
- Conditions that usually or did require hospitalization
Travelers should discuss the following issues with the mental health care provider:
- The need for medical evacuation insurance. Ensure that the evacuation service does not exclude current or previous psychiatric diorders.
- Studies show that psychiatric emergencies are one of the leading causes of air evacuation, along with injury and cardiovascular disease.
- Availability of adequate mental health services, providers, and facilities at the destination
- Availability of reliable laboratory facilities to assess blood levels and potential side effects associated with some psychotropic medications
- Ability to legally carry needed medication to the destination without problems with customs or destination country laws. (Some medications may contain ingredients that are illegal in some countries.)
- Ability to carry sufficient quantity of medications for the entire trip
- Travelers should carry copies of all prescriptions and a letter from the prescribing health care provider stating the need for the medications.
- Ability to obtain medications in the destination, if needed for long-term travelers or expatriates
- Travelers should carry contact information for a friend, relative, or health care provider who is knowledgeable about the traveler's condition, in the event that their mental health deteriorates during travel.
- It may be wise to give Power of Attorney to this person, since mental health laws differ in each country, and some can detain and treat a person against their will.
Types of Preexisting Psychiatric Disorders
Bipolar Disorder, Type I
Persons with bipolar disorder, type I who have successfully maintained long-term treatment and mood stability are more likely to have success as expatriates as long as they are able to continue their treatment regimens in their new countries. This includes access to medications and adequate lab testing, as well as providers who can competently assess and address warning signs that a relapse may be imminent.
Long-term stability, compliance with treatment (including dietary restrictions and any medications), and insight into and acceptance of the problem are important components of success as an expatriate. These persons should be aware of potential stressors and should be able to perform stress-relief techniques as prescribed by a health care professional.
Alcohol and Drug Abuse
Alcohol and drug abuse disorders are characterized by relapses; thus, while long-term sobriety (on the order of years) is important, it is no guarantee of continued stability. These persons should acknowledge, without rationalization, how the disorder affects their work and social lives and should be able to identify personal triggers. It is important to be aware of early warning signs of impending relapse, establish a plan to avoid trigger situations, and establish a plan to respond to early warning signs.
Seeking Care Abroad
Travelers with preexisting psychiatric disorders should work with a health care provider and/or mental health care provider at home to locate and contact appropriate mental health professionals and facilities at destinations prior to travel. Depending on the situation, it may be necessary for home-based providers to maintain regular contact with in-country providers. Travelers must also know where and how to obtain medications and lab testing if necessary to treat ongoing conditions.