While travel is and should be a rewarding experience, it can also pose significant challenges to people with mental health conditions. Planning and executing a trip is stressful by anyone's standards, but it can be overwhelming if you suffer from mental illness. It is estimated that 1 in 4 adults will experience mental health problems at least once in their life, but just because you're going through a rough patch does not mean you should give up all the wonderful experiences travel can provide. Travel has been shown to have positive benefits to emotional and psychological well-being, so a successful trip may be just what you need to start feeling like yourself again.
So take a few moments to read this guide and learn how you can manage your mental situation while travelling. And regardless of how mentally healthy you consider yourself to be, all travellers should give the same consideration to their psychological well-being as they would to their physical health before leaving home.
Culture shock
Culture shock is a temporary psychological stress caused by overwhelming exposure to a new culture. Everyone can experience culture shock, but mental health sufferers are especially vulnerable. In some cases, culture shock is unavoidable, but learning to recognise it in yourself is the first step to overcoming it. Contributing factors include:
Symptoms of culture shock can include:
There are many factors which may affect your mental health or well-being when travelling, including:
But all is not lost! Suffering or having suffered from mental health difficulties should not be a barrier to travel experiences. You just need to be able to plan and adapt accordingly, which this guide aims to allow you to do.
Going on a long journey can be stressful, but it doesn't need to be overwhelming, if you follow simple steps:
Main article: Medication
Carry your medication in clearly-marked containers. If at all possible, keep the original packaging, including official labels from your pharmacy that show that this medication has been issued to you. A pile of pills tucked into the bottom of a suitcase looks much more suspicious than a recognisable bottle with a prescription label from your pharmacy. Consider adding your name, nationality and passport number to all containers.
For a short trip, carry all of your medications in your hand luggage. For a long trip, carry at least a week's supply in your hand luggage, in case your checked luggage goes missing in transit. You should have the appropriate prescription and/or doctor's letter to hand (e.g. in a zip pocket of your jacket) should you need to show it to security services or airport staff.
Most mental health conditions cause sleep disturbances. Unfortunately, so can travelling. Try these things:
Even though your normal schedule may be impossible or impractical to maintain while on your trip, you should still maintain a regular routine, that you should make time to devise once you have arrived at your destination. Write it down if it will help you to remember, or schedule items into your phone's calendar and enable notifications. Having a regular and predictable pattern of meal times and a good sleep/wake cycle will help you feel in control. Allow yourself time to rest and stay hydrated and fed, even if you have a busy schedule of sightseeing, activities or work. Continue to take medication at the correct times, even if you feel your mental health has improved. If you practise any self-therapy techniques at home, for instance physical exercise, mindfulness, yoga or an emotions diary, continue doing them where possible during your trip, at roughly the same frequency as you would normally keep to. All of these combined will help to keep a sense of familiarity and continuity with your home life, even if the rest of your travel experiences are far out of your comfort zone.
Take your time! Even if there are a million and one things on your bucket list, you shouldn't just rush around a destination without pausing to think or plan your next move. Make a list of the places you really want to visit or the sights you particularly want to see, and prioritise them. Be sensible with the amount of time you allocate for each activity, and take things slow. If you're on vacation, there's absolutely no point in making yourself more stressed than you would have been if you had just stayed at home.
Being surrounded by new sights, sounds and smells can be a sensory overload. If on occasion you find yourself overcome with too much new information to process, you can ground yourself by splitting up the experiences by sense. First, close your eyes and listen to the sounds around you. Then focus on the sense of touch, for example by feeling the temperature or the wind in your hair. Next, try to identify any smells that you can pick up, and probe your mouth for any lingering tastes. Finally open your eyes and take in the scene in front of you. Even this can be broken down into chunks, for instance by just looking at a particular building, or focusing on instances of a certain colour. When you take time to become familiar with your environment, step by step and at your own pace, you can bring yourself out of your mind and into the present moment, while feeling more connected and more at ease with your surroundings. If this kind of self-therapy appeals, you may wish to learn meditation.
Excessive alcohol or illicit drug consumption does have quantifiable effects on one's mood, and the effects are often amplified with people who suffer from mental health conditions or those taking legitimate medication. Of course travel can be about having fun and trying new experiences, but if you wouldn't down four vodka tonics on a night out at home, then don't do it while in a strange environment with a different climate and culture, and laws you may not be familiar with.
If homesickness or culture shock are an issue, the worst thing you can do is spend time ruminating alone. Prolonged inactivity and solitude can be especially damaging for sufferers of mood disorders such as depression, and once you start down that road of self-isolation, a low mood and the fog of inertia can engulf you with frightening speed.
So the thing to do is stay active: throw yourself into discovering the places around you, meet new people, seek new experiences, and say "yes" to opportunities. Not only will this distract you from what might be some quite unpleasant thoughts and feelings, it will also get the heart pumping, engage the brain and senses, and release serotonin, all of which will contribute to raising your mood. Sure, you can't be constantly on the go and do have to set aside time for relaxation, but when you have downtime, make sure you have plans for what comes next and, preferably, know when and how you will bring that downtime to an end.
Leave your accommodation every day, during the day, even if you really don't feel like it. Go outside, breathe a bit, take in the view, say "hello" to somebody. For a mentally healthy person, spending a day just chilling in your hotel room is no big deal, but for a person with anxiety or depression, that day can easily become a week, with the chilling replaced by catatonia.
The bottom line is, overindulging in rest can be just as bad as overstimulating yourself with activities, so find a balance that's right for you.
You should hopefully know what kinds of situations or events give you discomfort, trigger unwelcome thoughts or feelings, or otherwise cause your symptoms to worsen in your everyday life at home. Therefore you ought to know what situations to avoid while travelling. Remember that since travel involves new environments and experiences, your body or mind may react in ways you didn't expect. Recognise your early warning signs, and nip the problem in the bud.
It is important to maintain contact with your friends and family back home, doubly so if you're travelling solo. Avoid impersonal means of contact such as email or texts; instead rely on telephone calls or video messaging services to allow you to actually talk to your loved ones. Such calls will alleviate loneliness, improve your mood as you share your travel experiences with others, and allow you to discuss plans and problems with people whose judgement you trust. You will also be providing reassurance to those you care about that you are coping during your travels.
It is always better to make arrangements to speak at a specific time, bearing in mind any time differences, and stick to that arrangement where possible. It can be comforting to know your loved one will be waiting for your call at a certain time, but conversely disheartening if you call home without prior arrangement and get no answer.
If you are contemplating long-term residence abroad – working abroad, studying abroad or retiring abroad – then some of the risks described above may eventually be reduced; you will have time to adjust, to find a new social circle, perhaps to learn a local language. However, all of them will apply when you first arrive and some may get more irritating over time.
There are also problems which only turn up for a long-term stay. If you are staying a few years you cannot expect to bring enough drugs for the whole trip, or to have follow-up visits with your doctor at home; you will need a local doctor and local pharmacy. In some places, local doctors or hospitals may not be up to the standards back home. A drug that is used back home may not be approved in the new country, or may be an expensive import. For many forms of therapy, therapists need very subtle language skills so a suitable therapist may be hard to find in an area where almost no-one is a native speaker of your language. Health insurance has its own complications.
For many people – with or without a history of psychiatric problems – it makes a lot of sense to take things slowly. Visit one or more potential destinations, preferably for at least a few weeks so you can get a real feel for the place, before you commit yourself for several months or years.
Many people with relatively mild mental afflictions will do just fine living abroad. There is an old joke that there are only three types of expatriate: missionaries, mercenaries and misfits. Most expat communities include people who would be misfits back home, and both expats and locals are often quite tolerant.
People with more serious illnesses, such as anyone who has ever had a psychotic episode, are traditionally extremely cautioned about moving abroad. The situation inherently involves some new and different stresses, including changes in the available support mechanisms, and if you do go over the edge in a strange place, that can be incredibly unpleasant and perhaps quite dangerous. That said, there are people living abroad quite happily with severe mental illnesses. Indeed, there are people who consider living abroad integral to their recovery from profound mental illness usually considered chronic in the current medical model. Exercise significant caution, and consider your own unique situation.
Societal and cultural attitudes towards mental health vary enormously between countries, and in many parts of the world ignorance, stigma and discrimination are very much part of the daily reality for sufferers of mental health conditions. In some countries, exhibiting strange behaviour or showing signs of psychological distress may be grounds for arrest, criminal charges or forced incarceration, while in others systematic discrimination against health sufferers is legal or commonplace. Elsewhere, symptoms of psychiatric disorders may be so poorly understood that they are perceived in terms of the supernatural, rather than being recognised as a medical problem.
In places where such attitudes are common, you may find even doctors and mental health professionals share the same prejudices. Mental health services may be limited or non-existent. In other cases, what 'help' there is may be seriously inadequate or outdated by the standards of home. For instance, local practice may favour forced institutionalisation, questionable treatment based on antiquated or unscientific beliefs, or dangerous or insanitary facilities.
It is therefore extremely important to research your destination country's relevant laws and culture, and assess whether there is an unreasonable risk to your safety or well-being should you enter that country.
<big>Are you in crisis? </big>
<big>Most countries have a confidential telephone hotline for people in emotional distress. Whether they're called Befrienders, Samaritans, or something else, the concept is the same: you talk, they listen. Wikipedia has a list of hotlines by country for you to consult. Please don't suffer alone.</big>
Even the best laid plans can go awry. No matter how much planning you do, or how many coping strategies you adopt, sometimes problems are unavoidable. C'est la vie.
The important thing is that you know how to get help when you need it. If you know your warning signs, and believe your mental health to be deteriorating, seek help and advice as soon as possible. People you may turn to include travelling companions, family or friends at home, or a local doctor or mental health professional. In extreme cases, you may have to be in touch with your country's embassy.
Although it may seem like good practice to shoulder your problems by yourself, and even embarrassing or shameful to call for help, it really isn't. Keeping problems to yourself and attempting to manage everything on your own is pretty much the worst thing you can do and almost guarantees that things will go from bad to worse. Your health and safety is your number one concern, and should take priority over all else.