Expatriate Mental Health Challenges

Now that most of the world has opened up post-COVID-19 lockdowns and quarantines, opportunities are reemerging for individuals, and their families, to participate in overseas assignments. An expatriate is an individual who lives and/or works outside of his/her own home country temporarily (Andreason, 2003). These assignments are often filled with opportunities for advancement while providing expanded cultural knowledge and experience.

There seems to be a paucity of research on the expatriate experience. Many employees, their families, and employers do not have the information to proactively prepare for the experience and manage mental health concerns, whether overt or covert. Therefore, many issues and concerns will likely go unnoticed until they reach a tipping point while the expatriate is overseas.

Research has identified several areas of concern about the expatriate experience (Sterle et al., 2018). Studies show that expatriates are at higher risk for mental health and substance use concerns and issues consistent with domestic workers, including depression, sleeping difficulties, anxiety, and poor ability to focus (Truman et al., 2011). Another study showed that expatriates tended to experience a high prevalence of affective and adjustment disorders related to occupational anxiety, home country anxiety, acculturation concerns, and physical ill-heath (Foyle et al., 1998).

1. For expatriates, lower levels of successful adjustment (e.g., a poorly perceived adjustment in everyday life, difficult interactions with host country nationals, and problematic adjustment to new job tasks, environment, and roles) were related to higher levels of psychological distress.
2. A higher degree of socioemotional support, having someone to talk to and receive comfort from about homesickness or loneliness, relates to a higher degree of successful adjustment to their work and the residents of the visiting country.
3. Mismatched assistance and availability to help those who need it with personal and medical care, transportation, and meal preparation led to increases in poor adjustment and additional stress.

An expatriate package could cost a company between $300,000 and $1,000,000 and is “probably the single largest expenditure most companies make on any one individual except for the CEO” (Black & Gregersen, 1999). Up to 20 percent of expatriates return early due to displeasure or difficulties adjusting to their overseas assignment. Noting these areas of contention and the cost and consequence of an adverse overseas experience, companies, and individuals must understand the following eight expatriate challenges before examining the steps to increase the likelihood of expatriate success and satisfaction.

1. Acclimating to a New Language and Culture

Many will first experience a honeymoon phase where everything is new and exciting, fueled by the novelty of the situation. A dissonant phase often follows, where the expatriate feels displaced, unmotivated, and possibly angry about choices that led up to their work situation. Finally, the stabilization phase can occur when the individual recognizes that time, perseverance, and understanding of the various facets of the overseas assignment can be beneficial and assistive in maximizing the experience of the new language and cultural differences.

2. Facing Unrealistic and Unmet Expectations

Most see an expatriate experience as an adventure to be had alone or with family. They often have trouble seeing the inherent challenges and frustrations outlined previously. Too great of a focus in any one direction, all good or all bad, creates a distorted experience that magnifies the acculturation process challenges.

3. Feelings of Isolation and Homesickness

Isolation and homesickness are common to expatriates, as making new friends can be difficult and impact social engagement. First-time expatriates may compare being overseas to idealized memories of home, leading to frustration, anger, anxiety, or depression.

4. Having an Overfull and Overwhelming Agenda

This is the “free buffet” scenario. The person arrives in a new location with countless new opportunities that drive them and their family to try and experience it quickly. Their plate is too full to take it all in. The expatriate becomes pulled in many directions, including work, family, cultural outings and experiences, novel stressors, and countless inherent compounding pressures.

5. Lack of Awareness of Mental Health Concerns

Organizations often fail to assess the mental health history or current issues of those embarking on working overseas. Physicals are always conducted, but there is little or no emphasis on mental health. Novel experiences can exacerbate or be a source that originates mental health concerns.

While overseas, individuals may feel even more isolated and afraid to speak up about mental health issues out of fear of losing their job or the benefits of their overseas assignment. This lack of awareness is not only exhibited by the company but by the individual as well.

6. Known Preexisting Mental Health Issues

Failure to identify preexisting conditions and their influence on acclimation difficulties can put the expatriate and accompanying family members under greater stress from expectations, homesickness, isolation, and overwhelmed feelings. Being mindful of mental health history, its severity, and maladaptive management strategies can significantly attenuate factors that increase the probability of assignment failure.

7. Making Long-Distance Relationships Work

Expatriates who go unaccompanied may initially feel that time away is a positive, but many ultimately feel fragmented from family members. Expatriates often develop communication guidelines about frequency, expectations, visits, workload, and other aspects that may impede their relationships.

8. Inadequate Personal Support

Many expatriates feel removed from their companies and families, which adds to the abovementioned challenges. Clear support services are critical but uncommon. Leaving employees to their own devices fosters a sense of dismissal or emotional distance between the individual and others, the company included.

Noting the challenges and issues related to expatriate assignments, should all companies discontinue these, and should overseas workforces be created in each international locale to avoid these problems? Absolutely not. Expatriate assignments are highly sought after, and many companies, employees, and their families reap great benefits. Noting the effort and expense that goes into them and the associated challenges, procedures should be undertaken by those companies seeking to maximize their return on expatriate assignments.

What Can Companies Do?

Moving to a new country can be an emotionally challenging experience for an expatriate and their family. To help prepare, employers should consider conducting a psychological evaluation before departure. This evaluation can assess an individual’s mental health, identify potential problems, and provide coping strategies to help them adjust to their new environment.

Conducting a psychological evaluation can help employers understand potential issues their employees and their families may face upon moving to a new country. These issues could include anxiety, depression, or difficulty adapting to a new culture or language. A psychological evaluation can also help identify existing mental health issues the move may exacerbate.

In addition to identifying and addressing potential psychological issues, a psychological evaluation can provide useful information on supporting an employee and their family best. Support could include advice on maintaining strong relationships with family members or coping strategies to help them adjust to their new environment.

Ultimately, a psychological evaluation before an expatriate assignment can help employers ensure that employees and their families are well-equipped to handle the challenges of the move and that they are more likely to thrive in a new location.

An intake interview is an essential part of preparing for an expatriate assignment. This interview can assess an individual’s mental health and identify any potential risks that may arise due to the move. It should also examine a person's history, including mental health concerns, alcohol or substance abuse, educational or occupational stability, and how they plan to maintain contact with those back in the originating country. An objective mental health assessment provides a framework to determine areas needing additional expatriate training or preparedness.

An overseas mentorship program can attenuate isolation, disconnection, and interpersonal challenges. This is best if done with a peer and not a supervisor. The employee knows the supervisor/supervisee's power differential, which can add to reluctance to report problems or fears. A peer-mentor relationship strengthens comradery and fosters a sense of relatedness that lessens the abovementioned eight challenges. Lastly, a peer mentorship program can be low-cost to the company with a high return.

A confidential Employee Assistance Program (EAP) can support the employee, or family members, to access mental health help when needed. It is best if this program is populated with individuals from the employee’s originating culture. This helps to avoid the stress of having to acclimate to foreign conversational words and phrases. An EAP can conduct meetings via various secure teletherapy platforms.

Lastly, employers should provide an overseas mental health training workshop, even for those with past expatriate experience who may be going to a new location. This workshop can address the issues listed above and provide an opportunity to normalize the experience with colleagues and answer common questions and concerns. This workshop is best done in a live setting. The expatriate assignment will be “in-person,” and so should the training.

The expatriate experience can be filled with excitement and potential for advancement, complications, and challenges. Companies approach this process in many ways, but the challenges discussed in this post permeate them, as acclimation is challenging for everyone to varying degrees. Utilizing cost-effective and helpful policies and procedures can significantly increase the likelihood of expatriate success.

In my experience providing these services for over a decade, I have seen the benefits for companies, employees, and their families.