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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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HEALTH

How to get prescription medicines in Denmark

Are prescription drugs covered by Danish national healthcare? It's complicated.

How to get prescription medicines in Denmark

How prescriptions work in Denmark

You’ve seen your doctor and been given a prescription. Now what? 

Once your doctor inputs the details of your prescription into the Danish health system, your data is available to any pharmacy in the country with a quick scan of your yellow health card. 

All pharmacies in Denmark charge the same price for each medication, so there’s no need to shop around or commit to a single ‘home’ pharmacy — you can just swing into whichever is most convenient for you that day. 

There are also online pharmacies that can fill your prescriptions and deliver them by courier or mail, or arrange for pickup at a pharmacy or another location. Remember to only purchase from websites with the green EU logo, according to the Danish Medicines Agency. 

READ ALSO: What happens if you lose your Danish yellow health insurance card? 

Do you have to pay for prescription medicines in Denmark? 

Mostly, yes — as a rule, prescription medicines aren’t covered by the national healthcare system until you reach certain spending thresholds for the year. At that time, discounts will be applied to your future prescription medicine purchases based on how much you’ve already spent. 

The scheme is called ‘reimbursement,’ which can be slightly misleading — the discounts are applied at the pharmacy, so you don’t have to pay up front and wait for the Danish Medicine Agency to cut you a check. 

Your progress toward the reimbursement thresholds is tracked automatically by the Central Reimbursement Register (abbreviated CTR in Danish), which sums up purchases of reimbursable medications associated with your yellow card. Your current CTR total is given on your receipt from the pharmacy after you purchase a medication, and you can also track your spending on reimbursable medications here

Reimbursable prescription medications purchased in other EU/EEA countries can count toward your CTR. If you’ve bought prescriptions abroad, fill out this form to be reimbursed based on the price of the medicine in Denmark. 

READ MORE: Why does it take so long in Denmark to see a psychologist or therapist? 

What are the reimbursement thresholds for 2022 for adult patients? 

If you’re over 18, you’ll have to pay out of pocket for your first 1,020 kroner of prescription medications. 

Once you’ve spent 1,020 kroner, you’ll receive a 50 percent reimbursement on future reimbursable purchases, and your copay will be 50 percent. That increases to a 75 percent reimbursement after your CTR total hits 1,705 kroner (with a copay of 25 percent) and an 85 percent reimbursement (and copay of 15 percent) for CTR totals above 3,700. 

Remember, your CTR total is calculated by the price of the medications before the reimbursement is applied. (Even though you’ve only paid 50 percent of the cost of medications after you hit the first reimbursement threshold, the full price of the medication is added to your CTR total.)

After your CTR total reaches 20,091 kroner, you’ll receive 100 percent reimbursement on future medications.

Taken together, that means the most you can pay out of pocket for prescription medications in Denmark in 2022 is 4,320 kroner.

The Danish Medicines Agency provides a chart of the thresholds and an example patient’s yearly spending history and reimbursements here. 

READ ALSO: Are you eligible for Danish national healthcare while your residence permit is processing? 

What about reimbursements for children’s medications? 

For patients under 18, all applicable prescriptions have a minimum 60 percent reimbursement rate. That gets bumped up to 75 percent after a CTR total of 1,705 kroner, 85 percent after 3,700 kroner, and 100 percent after 24,628 kroner. 

Just like for adults, the maximum out-of-pocket costs for a child’s prescriptions in a year is 4,320 kroner. 

What if I know I’ll need more than 20,000 kroner of medications? 

If you have chronic conditions or a major health challenge and can tell at the beginning of the year that you’ll hit the CTR maximum, you can apply for an installment plan. 

Pick the pharmacy most convenient for you and request an installment plan — you’ll be able to pay the maximum yearly copay of 4,320 kroner in 12 monthly installments of 360 kroner. 

Generic versus name-brand drugs and reimbursement 

Different drugs with the same active ingredients are called synonymous — generally, if your doctor prescribes a name-brand drug and there’s a less expensive synonymous drug, your pharmacist will give you the option to choose. 

If you stick with the more expensive name-brand drug, you’re responsible for the cost difference and only the price of the generic drug will be added to your CTR total. 

There are sometimes good reasons for choosing a more expensive synonymous drug — if, for instance, you’re allergic to some of the added ingredients in the generic form, your doctor can apply for increased reimbursement on your behalf. 

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