Dealing with culture shock among international students
Alysia Cameron-Davies examines the mental health support available for students in crisis
For many students, studying abroad is a rite of passage. Beyond being an exciting adventure, it offers the opportunity to broaden horizons, learn a new language and gain invaluable life experiences, and ultimately opens doors to future possibilities.
Despite the benefits, students can face significant challenges when relocating to another country. Issues such as homesickness, culture shock, language barriers, financial difficulties, and feelings of isolation can significantly impact mental wellbeing. So, what support is available for students who find themselves struggling far from home? We spoke with representatives from the University of Valencia (UV) and experts in the insurance industry to explore the current support systems on offer.
Issues such as homesickness, culture shock, language barriers, financial difficulties, and feelings of isolation can significantly impact mental wellbeing
Study abroad surge
In today’s globalised world, studying abroad is increasingly popular. Despite a temporary decline due to the pandemic, universities across the world are once again welcoming streams of international students. Zsuzsanna Bodo, the Head of Travel Assistance at Iris Global, revealed that Iris Global insured over 120,000 international students last year.
She pointed to data from UNESCO showing that 6.4 million international students were studying abroad through global mobility programmes in 2021, a significant jump from the two million students recorded in 2000.
In 2023, Project Atlas identified the US, the UK, Canada, France, Australia, and Germany as the top des tinations for international students. As the front runner, the US welcomed over two million international students during the 2022/23 academic year – reflecting an 11.5% increase from the previous year, according to Open Doors.
In Spain, the Ministry of Universities reported that over 46,000 Spanish students ventured abroad through mobility programmes in the 2021/22 academic year, while 135,474 international students chose to enrol in Spanish universities during the same time. We spoke to the Vice- Rectorate for Internationalisation and Multilingualism at UV, who informed us that the university has welcomed 2,782 exchange students this academic year (2023/24). Additionally, there are 2,308 international students enrolled in undergraduate degree programmes and 2,300 international students completing postgraduate degrees.
Most common mental health conditions – culture shock a top concern
The Vice-Rectorate noted that in recent years they have observed a slight increase in mental health-related issues among foreign students. They indicated that the most frequently reported issues involve depression and anxiety, which may stem from factors such as culture shock, disruptions in routine, difficulty with adapting to new languages, unmet expectations, or the disappointment of finding that studying abroad does not resolve existing mental health concerns.
Bodo noted similar findings at Iris Global, outlining the most frequently reported issues as anxiety, sleep disorders, and stress. She explained that, for those studying abroad for the first time, “it’s very common to suffer cultural shock, difficulties to adapt to new situations and also stress related to new educational requirements at the destination university or organisation. Very often they have serious doubts about their professional future, as during their trip they might have their first work experience (internship). Depression is also a very common condition, and insecurity in an unknown environment. They often feel alone and find it difficult to face everyday situations without the support of their family or friends.”
Claudia Reichstein, Head of the Department of International Programmes at Dr-Walter, also identified culture shock and homesickness as primar y concerns. Additionally, she said, eating disorders are another common problem.
Greg Lawson, Head of Travel Insurance at Collinson, pointed out that although specific data on mental health needs among students may be limited, there is growing awareness of how neurodiverse traits and diagnosed conditions can impact students while travelling.
Bodo highlighted the problem of misdiagnosis, explaining that mental health issues can present as physical symptoms such as stomach aches, back pain, headaches, etc. As a result, she said, “the students overuse the medical services seeking care with inappropriate specialists instead of treating the mental issue”.
Providing adequate support
Students from diverse cultural backgrounds often have varying beliefs about mental health, and their approaches to addressing mental health issues can differ significantly. Some cultures are more open to discussing their concerns, while others might prefer to handle their problems privately or fear admitting their struggles because of the associated stigma.
They noted a growing need for policies that specifically address mental health issues, emphasising that obtaining mental health coverage before going abroad would greatly benefit students
In its Health and Wellness Guidelines for International Students, the government of the Canadian province of British Columbia explained that students unaccustomed to discussing mental health, or who view seeking help negatively, may delay assistance until their problems become acute. While respecting individual beliefs about mental health is fundamental, the guidelines advised universities to integrate mental wellbeing into international programmes by normalising discussions, promoting stress management techniques, and ensuring that students are aware of available support resources. Additionally, they recommended that universities encourage healthy habits and socialising, enhance staff capacity to confidently discuss and manage mental health issues, and proactively develop comprehensive plans to address mental health concerns.
The Vice-Rectorate echoed the importance of providing a solid support system. They identified the establishment of psychological counselling offices as an important measure for universities and noted that UV offers student counselling services and has a Health Office on each campus. Additionally, they said, implementing a mentor system can offer extended psychological support. Regarding health insurance, they noted a growing need for policies that specifically address mental health issues, emphasising that obtaining mental health coverage before going abroad would greatly benefit students.
Mental health coverage in insurance plans
The experts shared insights into the current mental health coverage and support included in student insurance plans. Bodo said Iris Global o ffers policies covering mental health conditions, such as anxiety, stress, and similar disorders that students might experience while studying abroad. “These products include an initial consultation with a psychologist and a limited number of therapy sessions depending on the medical condition of the patient. This service is supported by an experienced medical team that operates 24/7, 365 days a year,” she added.
Bodo stressed that having a multilingual team capable of providing assistance in any language is paramount to ensure all students have access to the ser vice. She explained that, for example, Spanish-speaking customers are offered online consultations with Spanish psychologists and specialised mental health professionals.
We offer a multilingual service, which is important especially for mental health support as it is easier for the students to communicate in their native language
“Students normally prefer to talk about their mental problems in their mother tongue. Language is very relevant in this case, as diagnosis and treatment depend very much on the correct understanding of the issue. Also, the common cultural background helps them to feel more confident and we think that therapy is much more effective in these cases,” she said. However, she noted that, if a student prefers a face-to-face appointment with a local consultant, they can also arrange this through their international network.
Reichstein stated that Dr-Walter’s policies also offer mental health coverage with benefits comparable to those provided by Iris Global. She reiterated the importance of having a multilingual team to offer assistance in students’ mother tongues. “We have an outpatient service for initial evaluations of acute situations, also online consultations. We offer a multilingual service, which is impor tant especially for mental health suppor t as it is easier for the students to communicate in their native language. It should be noted that each case must be considered individually. Sometimes inpatient treatment is needed, which includes in our insurance coverage.” Additionally: “In case the student may not continue the stay abroad, medically reasonable return transport is also covered,” she said.
Reichstein informed us that Dr- Walter’s international student plan includes the ‘My-Safety-App’, which allows insured students to access 24/7 assistance and telemedicine services in acute situations.
We strongly believe that there is no place for a general exclusion
covering anxiety, stress and depression, as if they are all uninsurable – but it is not a simple risk category to resolve either
Addressing policy limitations and exclusions, Lawson explained that most of Collinson’s UK policies require travellers to complete a medical screening service, where they must declare any existing medical or mental health conditions. However, he emphasised that anxiety, stress and depression should not be broadly excluded as uninsurable conditions. “We continue to work with the providers of such services to ensure that there are sufficient filters and questions of a sensitive nature to identify risk appropriately and avoid a one-size-fits-all approach. We strongly believe that there is no place for a general exclusion covering anxiety, stress and depression, as if they are all uninsurable – but it is not a simple risk category to resolve either,” he concluded.
Pre-departure preparation
Bodo and Reichstein underscored the importance of providing mental health guidance to students before they relocate, stressing the need for coordinated support from organisations, universities, and insurance companies to ensure students are fully prepared and informed.
Bodo noted that pre-departure advice helps students prepare for potential challenges and recognise early signs of possible issues they may face abroad. “Ideally this should be organised by the organisation, university or foundation that coordinates the scholarship, in collaboration with the insurance company and experienced psychologists,” she said.
Reichstein agreed that preparation is key and outlined the measures taken at Dr-Walter as part of its mental health coverage. “We take preventive care of our customers before they leave the country. We offer training sessions for participants and organisations, where we provide brochures on insurance cover and respond to individual cases and questions.”
She also addressed the subject of pre-existing mental health conditions. “We observe that information on insurance coverage and pre-existing conditions that need to be taken into account is becoming increasingly important for the sending organisations and schools,” she said. “We try to provide as much support as we can.”
Reichstein added that if pre-existing problems or vulnerabilities are identified before leaving the country, customers may be advised to postpone their move to avoid potential challenges and protect their mental health.
We take preventive care of our customers before they leave the country
Conclusion
While universities and insurance providers are increasingly offering effective mental health support for international students, the demand for comprehensive coverage continues to grow. As awareness of mental health issues expands, it is crucial for institutions and insurers to collaborate in evolving their policies and support systems to address the diverse and changing needs of students. This collaborative approach not only enhances the quality of support available but also significantly improves students’ overall experience and wellbeing during their time abroad.