One of the most exhilarating experiences a college student can embark on is the opportunity to study abroad for a semester — complete with romantic thoughts of immersing oneself in a new and unknown culture, and plenty of “I’ll tell my children about this someday” memories intertwined throughout.

This writer enjoys a romantic thought here and there, but when it comes to studying abroad, college students should face the sobering reality: Your mental health and its potential struggles will be boarding that plane with you, going through customs and traveling across the world.

And for students who have a history of mental health issues, recognizing the potential barriers that may arise while studying abroad — and prioritizing proper prevention and response — is crucial.

Looking at how both students and their higher education institutions can prepare for mental health issues while studying abroad is the focus of this installment of Risk & Insurance’s Mental Health in Higher Education series.

When addressing a student’s mental health (and all that it entails) before a semester abroad, colleges and universities must provide substantial resources and adequate preparation before takeoff.

Delving Into the Issues

The array of mental health issues that can arise in higher education is daunting, but especially so when a student is living in a foreign country.

“What gets very difficult with mental health issues is the broad spectrum of what those issues could be,” said Joan Rupar, area senior vice president in Gallagher’s higher education practice.

One major concern is students who have already been experiencing bouts of mental health issues, including anxiety and depression. While students can receive the necessary accommodations for their mental health diagnoses in the United States, that may not be the case in the countries they are traveling to.

“Acceptance isn’t the same in every country, even in regions of a country,” Rupar noted. “With that, the [potential] issues are almost unlimited, because they are all situational and geographically oriented.”

Hillary Pettegrew, senior risk management counsel for United Educators (UE), echoed these sentiments: “Depending on the location, there may be little to no access to mental health counselors or providers.”

Pettegrew also noted a significant risk is posed for students who are prescribed an antidepressant or any medication meant to address mental health. This risk coincides with the mental health stigmas observed in other countries and how they could impact access to care.

“It may not occur to students that if they’re on a prescription medication, they may need to bring a sufficient supply that will last the entirety of their trip,” Pettegrew said.

“Sometimes, students aren’t aware that some prescription medications may be restricted or banned in a program location, so they might be unable to bring medications into the country or obtain refills.”

The Impact of Culture Shock

Defined as “a sense of confusion and uncertainty, sometimes with feelings of anxiety, that may affect people exposed to an alien culture or environment,” culture shock can be especially difficult to prepare for.

According to Tristan Tafolla, director of international risk management for Columbia University, “culture shock can manifest in different ways for different people.” The most often reported feelings that students endure when experiencing culture shock are anxiety and depression.

What makes culture shock such a prominent risk for universities and their students is the possibility that its introduction may exacerbate a preexisting mental health problem.

“Culture shock may be something relatively minor,” Tafolla said. “But it may also be the impetus for an issue that [a student] never experienced before.”

Rupar noted that the severity of culture shock impact can be determined by the location of the study abroad program. Based on what she refers to as “the validity of the information [a student] has received [about the trip location],” students can make an informed decision as to whether a particular country and program is the right fit for them.

How Universities Can Step Up

Universities that offer international study abroad semester programs are aware of the slew of mental health risks. So, what are these institutions doing to ensure students are readily prepared?

For starters, higher ed institutions must construct an arsenal of mental health resources for their students to peruse prior to departure. These resources can include information about whether a particular location is right for the student and the various mental health services that may be available within their chosen program.

Pettegrew cited several universities that provide students with information dedicated specifically to mental health challenges while studying abroad.

Such resources (including these examples from the University of Wisconsin and Arizona State University) will include specifics about how students should prepare for their semester abroad and how culture shock could affect their current mental health conditions.

“Institutions that have study abroad programs [without] a specific page devoted to addressing mental health would be well advised to consider having one,” Pettegrew said.

Additionally, universities can equip their study abroad programs with mental health services to assist their students. Pettegrew said that this remains relevant even for U.S. students who are familiar with readily available mental health resources.

“We know that U.S. institutions increasingly see higher demand on their home campuses, ” she said. “It stands to reason that [universities] may have more students studying abroad who will have additional [mental health issues], so anything a school can do to help them and ease that path is a good thing.”

For Rupar, incorporating a preventative approach to the risks students face while studying abroad is key.

“The best-laid plans are those which were made ahead of a crisis with thoughtful consideration around the risk appetite of the institution,” she said.

A well-thought-out plan can also assist a higher ed institution when deciding on coverage options.

“[Insurance] coverages can overlay with the institution’s desire [in terms of] how they want to support mental health considerations,” Rupar said.

Coming from a higher ed institution perspective, Tafolla provided several tangible methods that universities can implement to aid with potential student mental health setbacks.

“One of the first things a university can do pertains to pre-departure orientations that can prepare and warn students about the mental health issues that may arise while they’re abroad,” he said.

Joan Rupar, area senior vice president, higher education practice, Gallagher

Additionally, universities can put “the right protocols and resources in place when a student needs to talk to someone,” per Tafolla. This is now especially important because, according to Tafolla, telehealth no longer seems to be a viable option for a student experiencing mental health issues overseas.

“[University counseling services] were able to include telehealth mental health visits during COVID,” he said. “But it’s my understanding that those special permissions have now expired.”

To combat this, Tafolla said that many universities, including Columbia, “work with their travel services provider to leverage the relationships they have.”

For example, Columbia’s provider, International SOS provides up to five sessions per traveler/trip with a certified mental health professional via phone, video, or in person depending upon the location.”

And, of course, higher ed institutions should take a close, detailed look at their travel medical policies and possible mental health or pre-existing conditions exclusions. Tafolla also urged universities to look at any policy exclusions that relate to alcohol, drug use and self-harm.

Another area that may trigger mental health challenges for students is their return to the United States after their semester abroad.

“I’d recommend re-entry support,” Tafolla said. “This is a newer focus for universities.”

He continued, “[Columbia’s] undergraduate global engagement office offers re-entry reflection sessions for students, which provide information on some of the feelings that they may be experiencing as part of culture shock and the opportunity to reflect on those feelings.”

While new, support options for students’ return have proven to be beneficial.

“It’s a continuity of care,” Tafolla said.

How Students Can Step Up

While universities can provide the utmost quality of services and resources, students must play a critical role in maintaining their own mental health while abroad. An important component is honesty.

“The first thing students need to be willing to do is voluntarily disclose their mental health condition to the institution,” Pettegrew said. “As early as possible.”

Additionally, students should research potential locations in terms of their approaches and stigmas around mental health, as well as which resources, if any, are present there.

For students who are taking medication for mental health conditions, both Pettegrew and Rupar emphasized the importance of sorting through the logistics.

“It’s critical [for students] to research what the status of medications are in foreign countries, so that if they misplace or run out of medication, they know if they’d be able to refill the prescription,” Pettegrew said.

“Some of these [medications] can be hot commodities, so theft is a real risk,” Rupar noted. “If that should happen, students should understand how they could get replacements and what they may need to do that.”

Ultimately, it comes down to personal responsibility.

“A surprising amount of serious mental health issues can present and do present abroad,” Tafolla said.

And when it comes to overall mental wellbeing, especially while in a foreign country, “students need to know that they are also responsible.” &