The pandemic changed the game for the way in which everyone looks at their own mental health due to lockdowns cutting people off from their friends, family and local support networks.
But what about those who travel abroad for work and are cut off from their support networks?
The good news is international private medical insurance (IPMI) providers have raised their game when it comes to meeting the unique needs of these workers.
Employee assistance programmes (EAPs) are now offered as standard and providers and are also upping their investment in technology to further support these needs.
But providing these services is not without its challenges as they need to be tailored to the unique circumstances of the worker as well as their families and aligned to the cultural sensitivities of the location of their placement.
And while the pandemic and lockdowns have ensured everyone now looks at mental health in a different way, it is clear there is more providers can do to support workers and their families on assignments in far flung locations.
EAPs now commonplace
“Most IPMI providers offer added value services and EAPs which offer support to employees that can be accessed wherever they are in the world,” David Clare, head of healthcare and protection at Sutton Winson, tells Health & Protection.
And Clare adds Covid changed the game in how these services are rolled out.
“The main trend the last few years is due to Covid – prior to Covid a lot of these services were optional or paid for,” Clare continues.
“However due to the circumstances and the fact it was harder for people to move around and access mental health treatment, insurers made these EAP services available to all members.
“Since then it has become commonplace for IPMI insurers to offer EAPs as standard.”
Stronger focus on mental wellbeing
Kevin Melton, head of IPMI at IMG Global, agrees, adding that since the onset of the Covid-19 pandemic, IPMI products have definitely had a stronger focus on mental wellbeing.
“There has been an increased emphasis on the inclusion of EAP services within products, and virtual counselling services are more commonly offered to help mitigate challenges customers may face given their location and the local culture they are in,” Melton explains.
“There is always room for providers to grow in their understanding of and empathy towards their vulnerable customers to ensure they are meeting the mental health demands of today’s customers and that the best possible outcome is achieved for each customer.
“It’s not only about products meeting this demand—providing excellent service is just as important. Providers can ensure they’re meeting the needs of globally mobile citizens by employing expert staff who have experience working in multiple time zones, languages, and currencies, or who are expatriates themselves.”
Digital services now expected
Technology is also a key means of fostering connections those needs and Anthony Cabrelli, managing director at Bupa Global, notes customers now expect digital services from their healthcare providers, along with more personalised experiences throughout their care journey.
“More people are using these services than ever before – our Global Virtual Care service has seen a 29.5% increase in usage year on year and a 49% average monthly increase from 2023 to 2024,” Cabrelli continues.
“These services open up access to mental health care across borders, making care more convenient, affordable, and equitable.
“That’s why we’re investing in Bupa Blua, a comprehensive digital health service offering virtual appointments, health programmes, and wellbeing information in one app.
“This service promotes preventive care and early intervention, providing convenient access to medical services and guiding customers to appropriate care pathways.”
Cultural considerations
But the rollout of these services can be complicated by cultural considerations at play as Adam Harding, divisional director International at Howden Employee Benefits and Wellbeing, points out.
“While insurers have improved mental health access, proactive usage remains a challenge, as it does in the UK,” Harding says.
“Many mental health benefits rely on individuals taking the initiative to seek support, which may be less likely in cultures where mental health is stigmatised.
“Technologies such as wearable devices that detect mood changes and AI-driven mental health tools are expected to play an increasing role. Integrating these tools with insurance platforms could streamline access to support, creating a more seamless route to access mental health resources.”
Risk of depression
These services can play a critical role as it is not just the mental health of expats themselves that can affect the success of an assignment as Dr Colin Preece, clinical head of mental health, Teladoc Health UK, notes.
“Adapting to a new culture can cause acculturative stress due to language barriers, differing social norms, and potential discrimination,” Preece explains.
“Expat workers experience shifts in family dynamics, including changes in caregiving roles that may lead to guilt and stress.
“Children typically adapt quickly to new cultures, while parents might feel isolated, resulting in potential intergenerational conflicts.
“Expat workers also face professional pressure from high expectations, demanding roles, and financial instability. Those on specific work visas experience additional stress regarding job security and immigration status, exacerbating mental health issues.”
Getting it right at point of relocation
Kieran Brown, managing director, UK at SIP Medical Family Office, adds getting it right for expats at the start of the assignment is critical.
“Overall, one could argue the needs or a migrant or expat worker are not too much different to a local, with one notable exception and this is the point of relocation or the start of the new assignment which inevitably impacts the employee, family and friends,” Brown tells Health & Protection.
“In this case there is not too much health insurers can do except to support through education and awareness.
“However, employers and health providers do offer many services to help ensure the transition of a new assignment is successful.
“Where a new assignment is not successful, it is extremely likely that the employee or a family member or both will be impacted by poor mental health.
“As much as employers and health providers can help with risk assessments and pre-employment screenings, there must be a responsibility on the employee and their families to prepare and embrace what will be a significant change in their personal and professional lives.”
Personal experience
Cabrelli reveals he has personal experience of the upheavals moving abroad can have on daily routines and lifestyle.
“Living abroad can significantly impact an expat’s health, especially when distanced from friends and family,” Cabrelli tells Health & Protection.
“The absence of a familiar support network often leads to increased feelings of isolation and loneliness, exacerbating mental health issues like anxiety and depression.
“Without the immediate comfort of loved ones, expats may struggle with stress management and emotional resilience.
“Adapting to a new environment, including cultural differences and language barriers, can further strain an expat’s mental and physical health.
“The lack of social connections can also affect their ability to access local healthcare services, as they might be less aware of available resources or hesitant to seek help due to language and cultural barriers.”
Alex Weir, independent health and protection expert at Drewberry, also reflects on his own family’s experience.
“My own father spent a long time working in places such as Bahrain and commonly commented on the cultural differences,” Weir says.
“It was also difficult to adapt to new ways of socialising to create that new support network. Providers now providing helplines where you can seek advice and have a chat about how you are feeling as well as clinical services can be invaluable in venting frustration.
“People need support and to feel secure – being away from what you know can have such a big impact on this.”
Clear marketing needed
And the role of providers is key in signposting expats to support on offer, Melton says.
“IPMI providers need to ensure that their customer-facing staff members recognise and understand the increased vulnerability of customers who are distanced from their friends and family while abroad,” Melton continues.
“This can be accomplished through clear marketing collateral that highlights country-specific cultural differences and local mental wellness provisions.
“Virtual counselling services with a specialist from the customer’s home country can also help better address the needs of the individual while abroad.
“It is also important for providers to realise that the customer’s spouse or children can experience feelings of isolation if they are abroad as well.
“Providers should ensure that policy wording and benefits related to mental wellbeing are available and accessible to all relevant family members, as opposed to only being accessible via the insured’s company’s intranet, for example.”
Room for growth
Ultimately, while the pandemic has driven crucial improvements supporting the mental health of expats and their families, more can be done, according to Peter Lurie, founder and director at Proactive Medical and Life.
“There’s still room for growth,” Lurie says.
“Maternity benefits, which is one area we work closely with and which can positively impact mental health, play a significant role by easing financial stress for families planning childbirth abroad, allowing them to focus on mental and emotional wellbeing during a critical time.
“That is one area that can be enhanced further.
“I am not certain how postnatal depression is covered, but I am sure it is very much part of the current cover as part of the ongoing service.
“Perhaps more can be researched into this with international health insurance plans, to give further peace of mind to clients who want to make sure that they never feel they are vulnerable at the most important times of their lives.”