Mental Health and Education Abroad

November 25, 2013

 

According to the National Survey of College Counseling 2012,1 88% of US university counseling center directors report a recent trend toward greater numbers of students with severe psychological problems on their campuses. At the same time, the numbers of students participating in US education abroad programs continues to grow. The number of U.S. students who studied abroad for academic credit increased by three percent in 2011/12, the most recent year for which data is available.2

It is, therefore, very important that education abroad professionals consider how we can best respond to and support students with mental health considerations. Additionally, we need to be aware that first incidences of several significant mental health diagnoses often occur in the college/young adult ages. This means that a student may be faced with a mental health diagnosis for the first time in his/her life while studying abroad.

In order to assist education abroad professionals in responding to student mental health needs, the NAFSA EA KC Health and Safety Subcommittee provides the following recommendations.

1. Develop Partnerships

Identify and work collaboratively with key campus colleagues. Student health and wellness are core values in higher education and education abroad. Ask yourself:

  • Who are your key partners in this endeavor on campus or at your institution? Consider the Counseling Center, Student Affairs, the Wellness Management Office, the Student Health Center and other colleagues dedicated to student health and wellness.
  • How can you best collaborate to share information and expertise?

Highlight the campus partnerships throughout your processes to help students understand that all the campus teams are working together.

2. Receive Training

Have partners come to your office to train your staff about how to talk about mental health diagnoses and conditions. Involve key colleagues in discussions about mental health challenges students may face when abroad and after returning from study abroad. Hold regular meetings with key campus partners to remind them of the resources available to students planning to study abroad and cross-train. Consider and build knowledge on questions including the following:

  • How do you encourage students to think about what might be different when they study abroad, and how they can best prepare themselves?
  • What health information do you communicate during orientation to all students so that you reach students who have not disclosed?
  • How will you help students to understand that being in a completely new location without the usual support systems will be different than what they are used to?
  • What needs to be done to make sure that the necessary services/resources are in place for students overseas? This includes a range of services including, but not limited to, help from medical professionals, counselors, availability and legality of medications.
  • How will you support the student and make it clear that the student is not a "failure" if he/she does need to ultimately return home?

3. Collect and Review Student Health Information Forms

Work with other professionals on your campus, including your campus attorneys and risk management office, to develop a health and wellness review process that encourages student to disclose medical conditions for which they might need treatment while abroad. Consider:

  • Do your students complete a self-disclosure medical form for your programs? Or do they submit required medical clearance forms completed by a health care professional? Do you require both self-disclosure and an examination by a medical professional?
  • Are questions about both physical and mental health included in the review process?
  • What resources does the student utilize to remain healthy and well here in the US? What services/resources will the student need to stay healthy and well abroad?
  • Do you talk with students about consulting with any medical professionals who are currently treating them regarding their plans to manage conditions and medication while abroad?

A few institutions reported that they have successfully worked with their Student Health Centers to develop an on-line medical history review process that allows all study abroad applicants to disclose medical histories that will be reviewed by a medical professional in the Student Health Center. Another institution has developed a process by which their Student Health Center "clears" students to study abroad based on a required physical examination and student self-disclosure of health conditions.

4. Send a list of students planning to study abroad to the Counseling Center

Although they won't be able to provide detailed health information to you due to privacy regulations, this can provide an excellent opportunity for counselors to discuss strategies for managing a mental health diagnosis abroad as well as the timing of the student's study abroad participation with any student they are working with that appears on your list.

With or without a formal review of health student records, colleagues in Student Affairs, Student Health, Wellness, etc. also can be encouraged to work with students that visit their office to discuss strategies for maintaining health and wellness while studying abroad. One institution reports their Counseling Center asks all students if they plan to study abroad as a matter of practice in order to assure early discussions on specific considerations.

5. Develop consistent process across your team

Train education abroad advisors to respond to students who disclose pre-existing conditions in a consistent manner. Evaluate and update your processes over time.

Northwestern University provided the following good practice model:

Part One

  • Step one: express gratitude for the student's trust and explain that staff will assist the student in developing a management plan for successful participation in his/her program.
  • Step two: explain that our health insurance plan includes pre-departure medical management planning services as well as funds for outpatient counseling.
  • Step three: encourage students to discuss their travel plans with their personal physician and then contact the insurance provider and copy the designated person in the education abroad office to explain the student's current condition, treatment plan, and prescription medication so that the education abroad staff member and insurance company can begin to review on-site resources and options.

Part Two

  • Have education abroad advisors send a template email that summarizes the above information that the advisor sends as a follow-up after the disclosure (the disclosure normally occurs during an in-person advising session).

These basic steps can be modified depending on what is in place at your university or institution. Other universities have had success assisting students who self-disclose mental health conditions either during one on one appointments with education abroad advisors or with students who self-disclose conditions on health information forms by providing education abroad staff members with standard responses and follow up questions. Designating one person in the education abroad office to follow up with each student who discloses a past or present mental health problem to help the student set up a personal contingency plans for managing the student's mental health diagnosis abroad has worked well on other campuses.

6. Work with Health Insurance Providers

If you have a university-endorsed health insurance policy, learn the "ins and outs" of the specific information and services that they can provide to students. If your university doesn't have an endorsed health insurance plan, encourage students to consult their current health insurance provider to obtain this information.

If applicable, invite your insurance provider to your fair and/or orientation to promote pre-departure health management planning. Co-present with your Counseling Center staff to educate students about resources available when students are willing to develop a management plan by working with the education abroad office and insurance provider prior to departure for study abroad. Explain insurance policy benefits that cover mental health needs and how students can make appointments or obtain prescription renewals while abroad.

7. Consult Resources

NAFSA Education Abroad Knowledge Community (EA KC) Health and Safety Subcommittee

If you have additional questions on health, safety and security issues, feel free to contact members of the EA KC Health and Safety Subcommittee. Find someone in your region or at a similar institution/organization.

Acknowledgements

Many thanks to the following EA KC Health and Safety Subcommittee members for their contributions to this resource:

  • Barbara Lindeman, Director, Study Abroad & Assistant Director, International Center International Center, University of Missouri, Columbia;
  • Arlene P. Snyder, Director of Health, Safety and Security, The College of Global Studies, Arcadia University;
  • Julie Friend, Past-Chair, EA KC Health and Safety Subcommittee & Associate Director for International Safety and Security, Northwestern University; and
  • Stacey Tsantir, Chair, NAFSA EA KC Health and Safety Subcommittee & Director of International Health, Safety and Compliance Global Programs and Strategy Alliance, University of Minnesota.

  • 1 Gallagher, R.P. , (2012). National Survey of College Counseling. The International Association of Counseling Services, Inc.
  • 2 IIE Open Doors 2013. Retrieved from http://www.iie.org/Research-and-Publications/Open-Doors.