Whether you are currently being treated for mental health concerns or if you see them as something in your past, you should know that preparing for and participating in this new experience can bring about a return or increase in symptoms. Since it is always easier to prevent or respond to difficulties if they have been anticipated ahead of time, use this guide to prepare for mental health considerations and services abroad.

Before You Go | While You’re Abroad | When You Return | Questions | Useful Links

Before You Go

Although the state of one’s mental health is a personal matter and responsibility, we urge you to be open with your study abroad adviser about your pertinent health history, including mental health, and areas of potential vulnerability. Disclosing mental health information helps you plan with others so that the necessary support will be in place when you go abroad.

Determine if study abroad is a good fit

If you are currently involved with mental health services, discuss the advisability of participating in a study abroad program and issues related to cultural adjustment with your mental health practitioner. You may determine that based on your current symptoms, postponing or making adjustments to your plans is necessary.

Bring prescription medications abroad

If you are taking a prescription medication:

• Bring an adequate supply in the original container, and a prescription with your physician’s explanation of the condition, as well as the generic and brand names of the medication and dosage information.
• Check with the embassies of the countries you expect to visit to make sure your medications are not illegal there.
• Review potential side effects of your medications with your provider, as your body may react differently because of adjustment to new sleep habits, time zones, activities, and diet.
• Do not plan on sending medications abroad since it will require customs paperwork and may be delayed in delivery.
• Maintain your usual dosage and pattern of taking your medication while you’re abroad. Consult with your physician about any necessary adjustments to your dosage due to significant changes in time zones.

Research mental health services in your host country/sign up for Uwill telehealth services

Mental health support services vary worldwide, and you may not have access to mental health services in some countries. If you anticipate needing support services while abroad, do some research before you go. Determine if, what, and where those services are available in your host country. If not, you can participate in up to 8 free telehealth counseling sessions through the Counseling Center’s partnership with Uwill. To access telehealth counseling through Uwill, please create a profile using your K College email address at app.uwill.com. 

While You’re Abroad

Culture Shock

Culture shock is a normal developmental phase of adjustment to a new cultural environment. Culture shock occurs when one’s values and typical ways of viewing the world clash with the values and viewpoints of the new culture. Typical reactions to culture shock include feeling:

• Helpless
• Out of control
• Vulnerable
• Fearful
• Anxious
• Confused
• Sad

Keep in mind that any high stress situation can cause unusually strong emotional reactions and can interfere with effective functioning. Culture shock can also exacerbate previous symptoms or stir up deeper emotional issues. It is extremely important that you share your reactions with others and seek support immediately.

Establish new friendships with host country residents who can help explain the reasons behind some of the customs/behaviors you might find troubling. This will help you make healthy adjustments abroad. Working through culture shock can be a valuable growth experience – one that strengthens identity and intercultural competence.

Tips for adjusting to a new culture

• Take care of yourself physically, including getting regular and sufficient amounts of sleep and food, even if it is difficult re-establishing a consistent schedule because of jetlag.
• Give yourself permission to feel badly. Negative feelings are normal, and you should process these emotions, rather than just pushing them away and failing to address the issue.
• Don’t make any big life changes while abroad. It will take time to figure out how your new life experiences fit into your previous culture and life experience.

Determining if you need professional support

If you are currently working with a therapist/psychiatrist, discuss this before you go. Some signs to look for that may indicate the need for professional support include, but are not limited to:

• Heavy alcohol or drug use
• Not getting out of bed
• Staying in a room alone
• Changes in eating habits such as eating excessively or very little
• Avoiding friends
• Not attending classes or marked decrease in academic performance

Remember, you know yourself best and should seek out assistance when needed.

Dealing with a crisis situation

Anytime you are in a crisis situation abroad, or feel your health and/or safety is at risk:

As part of the on-site orientation, we expect that participants will be given information about locating local contact numbers for agencies and organizations that deal with crisis issues such as assault, rape, suicide, alcohol and drug abuse counseling, depression, etc. On Kalamazoo programs we ask our Resident Directors to include this in the materials students receive at orientation. If participants need help in one of these areas while abroad, we hope they will seek it out. In addition, the CIP urges participants to talk with the Resident Director or a staff member at the program. These are highly personal issues, and it is difficult to talk to anyone about them. The Kalamazoo Directors have experience in helping students through tough times.

In cases of crisis, the Counseling Center at K College is available to connect students to appropriate resources. Local contacts are another good option. If a study abroad participant is the victim of an assault and battery, sexual assault or rape, we encourage participants to inform the Resident Director and the local authorities in addition to seeking help and counseling from a crisis center or other professional.

Carry the contact information of your onsite director, CIP staff, K College Counseling Center, and insurance cards with you at all times so that you have access to these numbers.

When You Return

Sometimes people overlook the fact that similar adjustments are necessary when returning home. New ideas, friendships, and experiences gained overseas will change you, and you will return home with a variety of new perspectives. While you have probably made some progress in integrating these changes into your life while on studying abroad, you now have the new task of determining how to integrate these changes into your life at home.

Read more about reverse culture shock and re-entry strategies.

Frequently Asked Questions

1. I’m currently working with a counselor. What should I consider when discussing study abroad and my mental health needs?

It is extremely important to discuss your plans to go abroad with your treatment professional. Traveling abroad presents unique challenges that can heighten current symptoms. While it’s very exciting to think about studying abroad, moving to a different country means the loss of a support network, a routine, and a familiar environment. If you are taking any new medications, it is particularly important that you reach a stable condition for a period of time before leaving to go abroad. While it may be disappointing or difficult to make changes to your previously laid out plans, it is much easier to make changes to your study abroad plans while you are still in the U.S. rather than waiting until you are abroad. Postponing or adapting your study abroad plans may be what you need to do to best take care of yourself. All of these things are important to consider and discuss with a mental health professional when considering study abroad.

2. Can I work with a mental health professional in the U.S. while I’m abroad?

The Counseling Center at Kalamazoo College has partnered with Uwill telehealth services to allow K students access to up to 8 free video, phone, or message sessions with a licensed mental health professional while abroad. To access telehealth counseling through Uwill, please create a profile using your K College email address at app.uwill.com. Due to licensing laws and liability insurance in the U.S., which will not cover psychotherapy practiced across international lines, you are not able to continue working with any of the Counseling Center staff while abroad. You can also find a mental health professional in your host country if you prefer in-person counseling.

3. Will I have access to a local mental health professional while I’m abroad?

Students are encouraged to be vigilant about their mental and emotional health while abroad. Some study abroad sites have resources available for on-site counseling in English. Students are encouraged to contact CIP staff during the orientation process if they have specific concerns about availability. Resident Directors have information available upon request about local doctors, clinics, and programs available to Kalamazoo students.

4. I’m currently taking medication prescribed by a psychiatrist; can I keep taking this while I’m abroad? How do I get a refill?

If you are taking a prescription medication, talk with your prescribing physician well in advance about getting the supply you need for going abroad. You can also contact your insurance company to find out if your medication is available abroad. You will want to bring an adequate supply in the original container, and a prescription with your physician’s explanation of the condition and the generic and brand names of the medication and dosage information. Check with the embassies of the countries you expect to visit to make sure your medications are not illegal there. For more information visit Mobility International’s medications tipsheet.

5. Can I have my parents send me refills of my medication?

Do not plan on sending medications abroad since it will require customs paperwork and may be delayed in delivery.

6. If I disclose my mental health history to my study abroad adviser, program director or other administrator, will this jeopardize my ability to participate in a study abroad program?

Students with pre-existing mental health conditions will not be discriminated against in the application or approval process. Any information shared with the CIP, other university personnel or program staff will be used to assist you in making the best decision about your study abroad plans. We strongly encourage you to disclose your mental health history if you plan to study abroad, as this will only help to ensure that you have a safe and successful experience.

7. Will my health insurance cover mental health treatment while I am abroad?

All students participating in study abroad are required to have hospitalization and medical insurance that is valid outside the United States. This covers hospitalization and other related costs in a catastrophic event. Students should contact their insurance provider for details about what is covered outside of the United States. For students who need coverage while on study abroad, there is a plan available through Kalamazoo College. Many doctors and hospitals in the U.S. require only that you present a policy number at the time of service. This is not the case abroad: regardless of what insurance you have, students will be expected to pay all medical bills themselves at the time of service. However, this is generally much less expensive than in the U.S. U.S. insurance companies will not pay directly overseas. Students will have to get itemized statements and present them to the insurance company so that they can be reimbursed for medical expenses. Students should check with their health insurance companies for further information on the type of documentation required.

Other Resources

Kalamazoo College Counseling Center: Services include individual and small group interventions.

HTH Worldwide Health Insurance: HTH has mental health professionals available by phone 24/7, and will also refer students to local mental health professionals.

Additional Resources

• Concerns that Accompany Study Abroad at K
• Finding the Best Fit with Study Abroad Opportunities
• Disordered Eating and Study Abroad
• Mental Health and Study Abroad
• Adjusting to New Situations: The “W” Curve

Concerns that Accompany Study Abroad at K

1. Before Departure

• Getting into the program you want
• Writing the essays for the application
• Wondering how you will do away from home (family, friends) for so long
• Worrying that your language skills are not good enough
• Hoping that you get along with your host family
• Thinking about holidays and all other important family/friend activities you’ll miss
• Liking/disliking/not knowing other students on your program
• Worrying about family members who are sick/elderly

2. While on Study Abroad

• Feeling insecure about language
• Feeling uncomfortable with host family
• Not getting along with other K students
• Being lonely
• Experiencing academic difficulties (especially ADD and LD students)
• Partying too much
• Suffering a trauma (harassment, assault of any kind)
• Having mixed feelings about being an American
• Having sick/elderly family members get worse or pass
• Dating abroad

3. Return to K

• Realizing very few people understand what you’ve experienced
• Having more to say than people want to hear
• Taking classes and planning your SIP when part of you is still away psychologically
• Finding the pace at K to be unhealthy, dissatisfying
• Realizing there is much more to life than good grades and accomplishments
• Hating the consumerism of the U.S. culture

Finding the Best “Fit” Among Study Abroad Opportunities: An introduction to R. Michael Paige’s Intensity Factors

Selecting a study abroad program might be framed as three basis steps. The first step is to consider the essentials, such as language, minimum grade point average, program length, the number of students who can participate, financial aid, etc. Next, it is important to think about your goals for study abroad. Becoming a fluent speaker of the host country’s language, extensive travel in an intriguing region of the world, living in a major urban center, and sharing international experiences with friends and team-mates are very common goals, but there are literally hundreds more.

The third step is the more complex issue of fit: what is the best program for you given who you are at this point in your life? To think about fit students have to be pretty realistic about who they are and what kind of environment would be most beneficial for their development and growth. When identifying which programs might be a good fit for you, the following are questions for you might to consider:

• How do you respond to change?
• How do you cope when you have limited control over your situation?
• How important are comfort and familiarity to you?
• How different from the mainstream can you tolerate being?
• How much independence, privacy and time alone do you need to take care of yourself?

Answering questions like these sets the stage for students to be practical about the cultural differences between the home-culture and host culture and the discomfort (or culture shock) those differences are likely to generate.

Educator, Dr. R. Michael Page developed a list of contrasting cultural circumstances that have a significant psychological impact upon individuals in cross-cultural educational experiences. He names these circumstances “intensity factors” because they can heighten the psychological intensity of stress in the adjustment process (1).

Because there is no inoculation against culture shock, careful and honest consideration of the following intensity factors can be an important part of determining a program’s fit. These factors often help students anticipate potential adjustment challenges overseas. The ten intensity factors are as follows.

Ten Intensity Factors

1. Cultural differences: The degree of actual difference between home and host cultures and how negatively the student views those differences.
2. Ethnocentrism (the extent to which one’s own group is considered superior): The more ethnocentric a student is:
   1. the more difficulty he or she will have in accepting the other culture, and,
   2. conversely, the less accepting of difference the host culture is—the more ethnocentric the country as a whole is—the more difficult it will be to become engaged with people in that culture.
3. Language: The less language ability one has and the more essential language is to functioning well in the host culture, the more difficult it will be to function.
4. Power and Control: To the extent that students feel they have no power and control in intercultural situations, especially over their own circumstances, the intensity of the experience rises.
5. Cultural Immersion: Generally, the more completely the student is immersed in the culture, the higher the intensity.
6. Cultural Isolation: The level of intensity increases with the reduction of access to the student’s own cultural group. Students should consider the degree of isolation from their own cultural group when considering study abroad programs and sites. Cultural immersion is different from isolation.
7. Prior Intercultural Experience: If this is the first time the student has been out of his or her own culture, the intensity of the experience will be higher.
8. Expectations: If the student’s expectations are unrealistic—extremely positive and/or naïve — disappointment can be a serious factor. Conversely, extremely negative expectations can often create a self-fulfilling prophecy. A wise saying related to this aspect of intercultural preparations is that “Expectations are premature disappointments.” The antidote is keeping expectations reasonable and realistic.
9. Visibility and Invisibility: Being physically different from the host nationals and thus being very visible can make the experience more intense. Having to keep parts of one’s identity, such as being gay, hidden, can also increase the intensity.
10. Status: Feeling that one is not getting appropriate respect can raise the intensity. Conversely, receiving attention that does not seem warranted is equally distressing. Whatever the cause, receiving unwanted attention or scrutiny (good or bad) can intensify the experience significantly. (1)

Intensity Factors Index

The Intensity Factors Index is a tool students can use before application to study abroad or before overseas travel to identify potential adjustment challenges. It also offers practical steps for the preparation process to address the challenges.

Intensity Factors Index Rating

To complete the index, rate each of the following ten intensity factors on a scale of 1-10 (with 1 being least intense to 10 being most intense) by estimating the degree to which that factor might play a role in your overseas adjustment. Check the number you best think fits the culture you are going to or your own personal circumstances. If you are unsure of what the category means, go back to review the Intensity Factors description. When you are finished, total your score.

1. Cultural differences
2. Ethnocentrism
3. Language
4. Cultural immersion
5. Cultural isolation
6. Prior intercultural experience
7. Expectations
8. Visibility and invisibility
9. Status
10. Power and control

Additionally, feel free to discuss what you learn about the intensity factors with the staff of the CIP and the Counseling Center. These factors are often at the heart of many concerns as students make decisions about study abroad programs or begin to prepare for their international opportunities. At the same time, students’ abilities to respond constructively to the challenges the 10 factors present leads to the life-changing quality of study abroad.

Disordered Eating and Study Abroad

We’re writing this article because we have been involved in several difficult situations that involved students with disordered eating behaviors and study abroad in the last few years. It is important that you know that the CIP, Student Health Center and Counseling Center staff have serious concerns about sending students who have suffered from eating disorders, are at a very low body weight, or are currently engaging in disordered eating habits to other countries.

Our major concern is that K students going on study abroad have a safe experience and maintain their physical and emotional well-being. In order to do so, students need to be able to eat in a healthy way, even in an environment where the food may be very different and the control over what and when food is eaten may be in the hands of host parents or others. In our experience, the transition to another country and the pressures associated with food in another culture can be very difficult to manage for people who have struggled/are struggling with eating in this country. If you have had an eating disorder in the past, we would recommend that you contact the people with whom you worked
to talk about how to manage eating on study abroad and to anticipate possible issues that may arise. If you cannot make contact with those providers, please see someone in the Counseling Center to talk through concerns that you have and those we know have arisen for other students.

If you are currently engaging in disordered eating behaviors or are at a very low body weight (BMI <18), please contact the Student Health Center and the Counseling Center, so we can help you assess your current situation and make appropriate plans.

If you are the friend or parent of someone in this situation, please communicate your concerns directly. We have found that a statement of concern using “I language” is most effective. For instance, a friend may say “I really care about you and know that you came to K to go on study abroad, but I’m afraid that your weight is too low for you to be healthy enough to go.” A parent may say: “We are so eager for you to have the experience of study abroad, but we just can’t let you go unless we know you’ll be safe medically.” If these approaches do not seem to fit for you, please call or make an appointment at the Counseling Center to talk about your particular situation.

-The Counseling Center Staff

Mental Health and Study Abroad

We are writing this article at the request of the Center for International Programs to provide you with the clearest information and thinking we have about Study Abroad for students who have psychiatric disorders or psychological difficulties. Our three major concerns are that students maintain their treatment plans while abroad, inform important personnel of their disorders/concerns, and take
good care of their medication needs.

First, it is critical that students stay with their prescribed treatment plan to make study abroad a success. Our experience is that students who do not follow through (especially with medication) end up having a much more difficult experience, causing the host family and program directors serious worry,
and/or having to return to the U.S. before the end of the program. The best way to avoid these difficult outcomes is to follow the plan that you’ve made with your providers and to be in touch with them or with providers in the host country if you notice any concerning symptoms or have any very disruptive experiences.

Second, it is in the best interest of students who have been diagnosed with psychiatric disorders or who know they suffer from psychological difficulties to fill out the Health History form accurately and to let the program manager at K and the program director at the site know of their situation as early as possible. Some students are hesitant to provide this information. Over the years, we have found that clear communication makes a significant difference in students’ experiences because a safety network can be developed. That network seems to reassure both students and parents and puts all of us in the best possible position if there is a major problem.

Some students are not forthcoming about their history with mental health because they believe that Study Abroad will provide a respite from their problems. In our experience, that is not usually the case. There are so many challenges in living in a different country and some of those challenges create considerable stress. We have found that the challenges of a new environment can easily exacerbate
psychological concerns and psychiatric symptoms.

The third important concern is medication. It is very helpful to take all the medication that you’ll need with you, along with a letter from the prescribing provider indicating why you are taking the
medication. If for some reason that cannot happen, it is important that you make a connection with a prescribing provider early in your stay abroad. We have found that even medications with the same name may be slightly different because they are manufactured abroad. We also know that it is often difficult to get an appointment at the last minute and running out of medication can complicate life a
great deal.

Students often wonder about discussing their mental health situation with their host parents.Typically, a pretty matter of fact statement early on can be helpful (e.g., “I take medication because I have experienced depression. I don’t think you need to worry about me because the medication is effective and I’ve learned a lot about managing my difficulties. My parents are completely informed of my situation and are confident that I will be able to do well here. I also want you to know that you do not have to worry that I will hurt myself.”) One other note about home stays for those who take medication: it is extremely important to make sure that you keep your medication safe and out of the way of children or pets.

Finally for those on medication, it is very helpful to carry a list of your medications with the copy of your passport in case you need emergency medical help. Knowing the medication you’re taking can make a significant difference to the health professionals in emergency situations.

-The Counseling Center Staff

Adjusting to New Situations: The “W” Curve

When students are preparing for study abroad, we talk to them about the typical response to the experience of living in another culture. The response has been described as the W Curve – we start at a high point at the top of the W, typically head downward to a crisis point, and then gradually return to a more adaptive perspective. When we return home, we “do” the second half of the W – our excitement at being home gradually gives way to disenchantment, eventually to a crisis and, finally, to a sense of belonging. We find that this model can be applied to the adaptation to any new situation – like beginning college.

The first phase of the adjustment, which typically lasts several weeks, is the honeymoon phase during which everything about the new place or situation is exhilarating. We are enthusiastic as we discover new aspects of the culture/college and find all of what we are learning interesting and exciting.

The honeymoon phase gives way to the increasing participation phase and during this time, which typically also lasts about a month, we begin to feel more frustration, impatience and restlessness about the way things are done in the new environment. We are not as enthusiastic as we were and we begin to question the values we see in the new place and our own values.

The frustration culminates in the crisis phase, which typically occurs in the third month. At this point, we do not like the new environment – even feel hostile to it. The differences from home feel like too much to deal with and we become discouraged about our ability to adapt. Homesickness and loneliness are part of this phase. If we were offered the opportunity to go home, we would take it.

After this very tough time, most people begin to adapt to the new environment. The adaptation phase usually involves a sense of understanding the differences and seeing both the advantages and disadvantages. People report greater comfort with their surroundings and a sense of belonging in the new place.

When re-entry happens, the cycle repeats. First, most of us are very happy to be home and to see everyone we’ve missed and enjoy all the activities/foods/conveniences we did not have when we were away. We experience the honeymoon of re-entry.

After several weeks, however, we start increasing our participation at home and notice the things that we don’t like so well – things that we liked better about the host country/college. We begin to miss our experience away and to feel frustrated with some of the ways of home.

Again, a crisis typically occurs, when we would love to return to the host country/K. We miss everything about our other world and how we felt there. We would go back today if that were possible.

Finally, we begin to adapt to home. We see the differences, but know there is good in both places. We feel clearer that we belong where we are and can once again feel at home here.

This model seems to be useful because it gives us a frame for understanding our experience and our feelings about it – and for normalizing what can be very difficult times. Students report using the model on study abroad (particularly when the crisis hits) and reminding each other where they are on the “W Curve”. Thinking about the “W curve” is often reassuring because it reminds them that the
process of adaptation is a tough one and they are right where they need to be and that they will be okay.