Covid & Expat Mental Health AsiaPac

Since 2017, with the suicide of a expatriate lady due to depression in the Emirates, I noticed a health insurers writing about Mental health disorders. Well Being-Depression became a trendy topic through 2018-2019, probably due to increasing psychotherapy costs incurred by the insurer and the business opportunity costs of ‘failed expatriate assignment” for companies and HR departments. All had a vested interest in sorting out the problem quickly. Corporate Expatriates are 2.5 times more likely to have depression and anxiety than a local. With Covid19 pandemic in 2020, Work From Home WFH, loss of income, separation from family members (sometimes with Covid19 treated relatives) and confinement: not a week without reports and advice on mental health monitoring advice.

As I write, Google APAC report on searches in 2020, reveals all countries in aggregate had +40% searches including “mental health tips”.

What can cause mental illness in expats? #5 MAIN REASONS

According to a Aetna insurance study on thousands of expatriates clients over 2014-2016, for more than 40% of interviewees, the 5 top reasons for mental health disorder being 150% higher compared to their compatriotes at home are:

1- challenges of the new job (63%)

2- no replacement for home country activity (45%)

3- loss of family, friend and home support (40%+)

4- Language and cultural difficulties (40%+)

5- Spouse not finding a job & home tensions (40%-)

The top five pressure points


One of the costliest elements of expat management is expatriate failure. We look at the usual causes and what HR can do to reduce the chance of expats not completing their assignment.

What employers and HR can do to avoid failed expatriate assignment


  • Consistent feelings of being sad or down (or the absence of positive feelings) for most of the day, nearly every day, lasting at least a couple of weeks
  • Feelings of hopelessness or worthlessness
  • Sleep issues
  • Changes in energy levels
  • Unexplained changes in appetite
  • Unintentional weight loss or gain
  • Loss of interest or inability to take pleasure in things previously enjoyed
  • Unexplained physical ailments
  • Difficulty concentrating or making decisions

Source: American Psychiatric Association12


There are three barriers:

 –the language, the culture and the mental state – to overcome. Many people give up seeking help at the start, believing it is not available for foreigners or they won’t receive the treatment that would suit them

Language for psychology

Obviously a Swedish expatriate seeking help with complicated mental phenomenon vocabulary to a Malaysian therapist is not efficient at best, dangerous at worse if you are prescribed long-term medicines.

Culture of mental disorder

  • In developing countries, you may discover the lack, I may say the absence, of specialists like neurologists or rehabilitation specialists (physical and mental) when it comes to mental or brain disorders. Between Neurosurgeons and Psychologists, there is a no-man’s land.
  • In some cultures, whether you are crazy and dangerous, therefore your residency should be interned in a psychiatric hospital or an asylum. Or you should seek advice as an outpatient psychotherapist occasionally when your behaviour causes nuisance to your neighborhood.
  • In the corporate world, mental disorder is associated with mismanagement of your own stress and anxiety. At worse, it is considered by your superiors as a weakness and a serious handicap for higher assignments.

The mental state

Depending on how long you had the symptoms and how resilient you are about mental strength.  Your resilience can be -natural mental adaptability or through your personal experience/practice of ‘battling your monkey mind’ as the buddhist monks call it.


Once admitted and declared, which is a giant step towards getting back onto your health

  • Seek a connection. Attending a language class or joining an activity group is a great way of learning to love something about a new country as well as making friends locally
  • Set some boundaries. Don’t compromise on quality time with your family or doing other things that are important to you. Those are your last daily safety net abroad
  • Remember to sleep and exercise. Physical activity Physical activity and sleep have both been linked to mental wellbeing
  • Ask for advice. Join online communities and ask for advice well before you go, and find out about what issues you’re likely to encounter in your chosen destination.  Expat ForumExpat ExchangeThe Expat Partner’s Survival Guide and Mumsnet   are all great sources of information
  • Treat your mind like your body. Find out what help is available locally in case you ever have need of it and time is not readily available. Help can be sourced through the International Therapist Directory
  • Don’t spend your life online. Keep up with friends and family at home as much as possible, but also try going out and making new friends locally
  • Recognise expat depression. Being able to act on negative feelings is an essential part of the expat’s toolkit. If you feel depressed and suspect that you may be suffering any mental health issue, seek help at the earliest opportunity
  • Manage your expectations. If you’ve experienced mental health issues in the past, make sure you have support in place before you go.
Everyday habits for better mental health


If you are suffering with expat mental health issues such as stress and anxiety while living/working overseas you may feel that it’s difficult to find the right help and support.

Depending on your country of expatriation, you may have trouble finding appropriate, quality help in small towns and cities, which, combined with their smaller size can make coping with loneliness harder. He also says that many people simply don’t know that there is support available in their host country.

With three barriers – the language, the culture and the mental state – to overcome; many people give up seeking help at the start, believing it is not available for foreigners or they won’t receive the treatment that would suit them.

But the truth is that many countries have mental health services available. Many major towns and cities offer counselling and mental health support, and treatment at these centres is often covered by insurance.


Nobody wants to admit they need to consult a psychotherapist, especially if you are the Can-do pilar manager, the ‘superman’ sent from abroad to ‘save the country’.

the intersection of depression and anxiety

To find out if you might be depressed, take this simple 10-question assessment:

To find out if you might have anxiety, take this simple seven-question assessment:

B- Mindfulness-based stress/anxiety/depression reduction

It is typically a professional practitioner for one-to-one support. Your practitioner will create a six-week mindfulness plan and help you learn how to put it into practice. The coaching plan comprises one session per week and will be designed to:

• Fit in with your schedule

• Help you develop emotional and mental resilience

• Help you develop your concentration and focus skills

• Help you improve your sense of well-being

• Guide you through breathwork

• Teach you coping mechanisms to manage your stress and live in the present

Note a new type of chatbots apps like Wysa can help you along

C- Therapeutic Counselling

You generally will speak with a clinical therapist who will help you determine the best route for therapy, whether you’d like to work with a counselor in person or on the phone. The support lasts for up to five weeks to help you move forward through your situation. If you want to continue with treatment, the therapist will try to find you a local provider. When you contact us, you will initially speak to a clinician for a 15 – 45 – minute conversation. The clinician can then help determine the next best steps for you and find the right health care provider for your needs.

Note the

D- Psychotherapist

Depending on the country therapists are available on a permanent basis or not.

Culture and language are very important. But also the fit and confidentiality of the practitioner in a small country/city may be a block to your expectations. With the widespread use of video conferencing and WFH, neighboring countries like Thailand, Singapore, Hong Kong or even your home country can offer solutions increasingly suitable to avoid a repatriation and a failed assignment.

INTERNATIONAL DIRECTORIES or consult your health insurer assistance service as part of what you pay for is their ability is to connect you to the best possible specialist so you recover health quickly.

The Anxious achiever podcast, by Morra Aarons-Mele Harvard HBR series

The WFH burnout syndrome

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