Expat mental health

October 5

Expat life, depression, anxiety and more

Expats are at double the risk of mental health conditions compared to people who never move abroad. And over half of those who are unhappy living abroad say that not having a personal support network in the host country contributes to their unhappiness.

We have great hopes for our new expat life, but reality often lets us down. We realise that expat life is not the Instaperfect dream we expected and this can hurt. Expat life is an emotional rollercoaster. Many say it, many agree – you have ups and downs. It’s when the ups disappear and the downs dip further and stay down that we need to get support and help.

Nobody expects to experience mental health problems, and nobody can predict how you will cope with your new life, however resilient you think you may be.

Being properly and realistically prepared for your new life abroad makes it easier to manage your expectations and hopefully prevent some of negative experiences you may encounter.

Please scroll down for transcript

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Welcome aboard the Expatability Chat podcast, helping expat parents navigate the challenges of moving and living overseas. With Carole Hallett Mobbs, Expat Life Mentor and Consultant and founder of ExpatChild.com.

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Hi, welcome back to Expatability Chat. As we approach World Mental Health Day on the 10th of October I want to focus on an aspect of expat life that isn't always widely acknowledged. Expat mental health.

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If you've followed ExpatChild.com me for years, in which case, thank you so much! You'll know that I've always pointed out the realities of relocating overseas. The good stuff, as well as the not so good stuff. And for doing this, I actually get slated quite a lot, which is quite fun for me.

[00:00:56.340]
According to some. I shouldn't and I quote, "be negative about expat life, because it's all amazing and wonderful". Well, yeah, most of the time it is, but more often than you would believe, it is bloody hard work. I wrote an article on this topic, Expat Mental Health, a year ago, and some of the backlash was absolutely incredible. Apparently, there are some people who don't like me speaking about the potential negative aspects to expat life.

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They would prefer me to keep it all light and fluffy and pretend that each and every one of you has a super easy and fun time. And allegedly it is my place to maintain that expat bubble. According to some, everyone can make new and genuine friends as easily as breathing. Everyone has a ton of money to spend on what they like. Everyone has a nanny and a housekeeper who take on the day to day running of the home and the family. Everyone has resilient, academic kids who excel and love school.

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Seriously, do we really believe that? Please tell me you don't really believe that. All in all, some would prefer me to hide the reality of relocation from everyone. Well, that just simply is not going to happen. And if you are after all the fluffiness, then please go elsewhere because you're not going to get that from me. I'm going to tell you about expat life, warts and all.

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I'm not going to sugar-coat any of it. I prefer to be honest and open about everything. I'm not going to compromise my authenticity for anyone. So, yah boo sucks to anyone who wants to bury their heads in the sand.

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But that attitude, to me, does demonstrate a few things. It shows how closed minded some people are and it shows how the stigma of mental health problems still exists. It also shows how other people's assumptions and a refusal to recognise individuality and difference can affect others.

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I also think the people who complained that much may have problems themselves that they aren't quite ready to face just yet. But perhaps I'm thinking too much on it and maybe they are just dicks.

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I still reckon that by sharing the lows as well as the highs of expat life helps you make better choices, meaning that you end up having the wonderful expat life you so desire and deserve.

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Being properly and realistically prepared for your new life abroad makes it easier to manage your expectations and hopefully will prevent some of the negative experiences you may encounter.

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Now, how about this for a statistic? Expats are at double the risk of mental health conditions compared to people who never move abroad. Let that sink in for a minute; double the risk.

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How do these mental health problems manifest themselves? The main mental health problems experienced by expats are depression and anxiety. I've also known many people with eating disorders and those who have quite a heavy reliance on alcohol.

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Sometimes people moved with pre-existing conditions, either diagnosed or not, which the pressures of expat life then make worse. For example, bipolar disorder.

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I just want to clear up something, and that is the difference between things like the expat blues or the six month slump and more serious mental health conditions. It is extremely common for anyone who's moved abroad to experience a comedown or six month slump or the Expat Blues, a series of cutesy names I've given to periods of time where life kind of catches up with us.

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The comedown is when all the initial busyness of moving stops. You've unpacked your shipping container; The kids are in school; life is kind of normal, but you're in a strange land and you have a few moments of, "Oh, crap, is that it? Now what? And then you kind of just get up and carry on with your new life. The six month slump is pretty much the same kind of thing. And it's something that can actually be applied to now, as we hit six months of the covid lockdown's and all the palaver that this is causing. We hit a wall.

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And the expat blues often come about after traditional holidays such as Christmas and Thanksgiving. Holidays that are traditionally spent with friends and family. And also when we have visitors and they go home, there's a bit of a slump after those as well. And those times just emphasise how far away we are from friends and family and familiar ways. Oh, and I should mention culture shock, too, which can often be mistaken for a mental health problem and vice versa, but is different and you know all about culture shock.

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These are all natural processes in this alternative lifestyle we lead and we generally move past the dip. If you feel your dip in mood could be connected to one of those, the comedown the expat blues, the six month slump, be assured that that is a temporary feeling and incredibly normal just keep going. It's a temporary blip. Take one step at a time, one foot in front of the other, just keep going. And in about four to six weeks you'll be through it.

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Expat life really is an emotional roller coaster. Everybody says it, everybody agrees. You have ups and downs. It's when the ups disappear and the downs dip further and stay down that we need to recognise and get support and help.

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So who am I referring to when I'm talking about expat mental health? We tend to think of expats as people who move abroad because they want to explore new opportunities and experience new cultures.

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When we tell our friends and family we're moving abroad, we receive comments such as, "Oh my God, you're so brave. I could never do that". Expats naturally have a zest for life and a confidence and a self-sufficiency that drives us to embrace new ways of living. It's all about exploring the world and creating a new and hopefully better existence for ourselves. However, there are, if you like, different types of expats. I'm not talking about individuals at this point, I'm just sort of grouping everybody all together. I hate doing that. But for this it makes a lot of sense.

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Who expat mental health problems may affect also depends on the reasons or circumstances around the relocation. Different categories of expats each have separate outlooks that affect how they respond to their expat life situation. For example, one group of expats, those who move to escape conditions in their country of origin, usually do quite well on the mental health front. Fleeing danger and conflict, these people are often grateful for the peace and security of their new home country, particularly those escaping war, poverty or a violent society. In these cases, there's not an awful lot to miss about your home country, which in turn creates a positive outlook. They've taken steps to improve their life.

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Then we have the independently mobile expats; those who choose to move overseas as a lifestyle choice. They tend to view challenges as opportunities and are generally more independent and self-sufficient. And they're usually OK, too.

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And then we have the expats who I'm really focused on here, who move overseas on a global work assignment. They tend to see their challenges as difficulties and expect the company to support them. These expats tend to stay focused on their home culture. They refer to home as their original home country, not where they're living right now. It's just something I've noticed quite a lot. This is particularly valid if the company they work for is home based rather than their host country based.

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To drill down even further, it's actually the expat partner who is even more at risk of mental health problems.

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This is the partner who has given up their career and perhaps is now a stay at home parent and who doesn't have the distraction and focus of work to go to each day. The dependent partners of the employees on a work assignment.

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From sacrificing a career comes a loss of identity, a loss of self-worth, and quite often a loss of confidence. Sometimes resentment can build to breaking point. They often struggle to adapt to their new culture, circumstances and lifestyle and may not receive the support they need and want from their partner or the company.

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I should add right here that very few expats actually regret the decision to move overseas. It's just that some find it harder to settle than others. And most do admit to underestimating just how difficult settling into expat life would be.

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Most expats have a particular mindset, a particular personality, one that embraces challenges. They're often fairly extroverted, but that isn't a given, there are plenty of introverted expats, too. They're usually very positive thinking, looking forward and enjoying life in the moment at the same time.

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However, there is a consequence that can be quite damaging of this natural personality trait, and that can be a reluctance to prepare for negative experiences. That makes sense. We do look ahead and we do look at the very positives. After all, we're making a huge lifestyle choice here. We're making a huge change in our lives and we're doing it for all the right reasons. We're thinking ahead. We're thinking of the best thing for our kids, a better way of life.

[00:10:16.730]
And therefore, when something does go wrong, it's really hard for us to reach out. We're a little bit too independent a little bit, too self-sufficient. But it would be really good, if we can put a few self care and health related precautions in place before we move. And that's why I'm here. If I can tell you about this stuff now, before you move, you'll understand what may be in store and everything will be much better for you. That's my aim anyway.

[00:10:45.330]
Expats often leave their home country with dreams and expectations of a better life, only to find themselves lonely and isolated later on. They begin to doubt their choices. Everyday tasks are not straightforward. Try navigating the Japanese bus system for the first time, for example. Luckily, everybody's terribly kind, so it does help. Try wanting to buy baby formula on a Saturday afternoon in parts of Germany; yeah, they quite often close the shops on Saturday afternoons.

[00:11:13.540]
It's just little things like this that can make life - day to day life - seem really tough, especially if you're not quite in the mood at that point. It can all be a pain in the arse struggle. And homesickness is common. It's so easy to slip back into dreaming of where home and life was familiar.

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Adjusting to a new culture and not speaking the language is a real difficulty and this contributes to anxiety and a feeling of isolation, and even alienation. Feeling lost and inadequate.

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All you're trying to do is pay for your shopping and somebody barks instructions that you that you can't understand. Then the whole queue starts talking about you. All you wanted to do was pay for your groceries. Even if you do speak some words in the local language, it can be really frustrating. You make mistakes that may be unkindly pointed out to you. You may have an accent that people find funny. It's all really quite embarrassing and frustrating and can really, really hit your confidence.

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It takes skin like a rhino's to cope with that every day. Obviously, things will get better, but if your confidence gets knocked too low is actually harder to step back up again.

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We have great hopes for our new expat life, but often reality lets us down and we realise that expat life is not the InstaPerfect dream that we expected. And this can really hurt. And it may even negatively affect your entire time overseas. Basically, we're back to my personal bugbears again, assumptions and expectations.

[00:12:46.750]
Actually, I'm sorry, that really sounds far too flippant. I do know full well that full blown depression is a chemical / hormonal imbalance that has very little relationship with exterior influences. However, external and situational issues can tip the balance of these chemicals, and those damned hormones too, meaning that we are affected by external life stuff. It's a bit of a cause and effect issue. Life gets a bit shit. We don't see a way of getting out of it. The chemicals mess around and make life even more shit. It's a vicious circle.

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At times like these, we turn to our family and friends, our support system for help. But wait, there isn't one. You haven't found friends you feel close enough to talk to about this deep stuff with. Perhaps you don't fully trust them yet. Or perhaps they always seem so glossy and happy. Your support system of old friends, your family are on the other side of the world, several time zones away. And besides, you don't want to bother them with your woes right now.

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56 percent of expats who are unhappy living abroad say that not having a personal support network in the host country contributes to their unhappiness. We're back to a vicious circle again. We need people to talk to. We haven't got people to talk to, and our depression gets worse.

[00:14:07.130]
A major factor is that we feel that we cannot say anything to our friends and family back home when life gets tough. And expat life does get tough. You may post an irritable comment on social media when you're having a particularly hard day. And immediately somebody will say, "What are you complaining about? You're living the dream". And, "well, you chose to move away from your friends and family. You made your bed, now lie in it".

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No complaining, see? You're not allowed to complain if you're an expat. And yep the expat guilt piles on and we feel we can't even talk to those closest to us.

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If there are any friends and family of expats listening to this podcast, can I say just don't do this? Do you really think it's helpful? As my wise grandmother once said, "If you can't say something nice, don't say anything at all". What you're doing here is you are isolating your family member, your friend, by not being supportive. Isolation can lead to depression, and family issues can increase that pressure.

[00:15:06.970]
And of course, you're not only dealing with your own feelings and struggles right now. You're probably putting your children's needs and emotions first too. Younger children often adapt quite quickly to the changes in culture and circumstances, as their main concern is you basically. Their relationship with their parents and immediate family circle. As long as you are around, little kids don't really mind where they are.

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Older kids and teenagers, on the other hand, can really struggle to adjust and fit in with new groups of friends. And this in turn takes its toll on their mental health and, of course, that impacts you and the rest of the family.

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So what the hell is the answer here? Well, there isn't an easy answer, but let's start by talking about prevention and also recognition.

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It is sensible to take precautions if you're thinking about starting a new life abroad. Naturally, nobody expects to experience mental health problems and nobody can predict how you will cope with your new life, however resilient you think you may be. You cannot prevent the chemical imbalance of full blown clinical depression. You can, however, put in place precautions to prevent as much situational crap bothering you too much.

[00:16:17.650]
To start with make sure you are very well prepared for the realities of expat life. And that's me! That's me telling you all about this stuff. Yes, expat life is absolutely brilliant and it's a fantastic way to bring up your children. It is not an easy life. Take a good look through the many articles on ExpatChild.com. Make sure your expectations are realistic and you're not expecting all your troubles to simply evaporate in the sunshine of your new home country. Get in touch with me if you want to talk through anything.

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Intriguingly, many experts experience problems in countries that bear a close resemblance to their home country. It's actually the small differences that make day to day expat life tough. When you move to a very foreign culture, you're actually expecting more difficulties, more culture shock and may be surprised not to experience any at all.

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Prioritise keeping your energy up and keeping your well-being even. Self care as usual, eat well, exercise, get outside as much as possible and be proactive at finding your tribe or at least finding somebody to talk to.

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How can you get help if you're really stuck in the doldrums and are experiencing really tough times? The majority of people suffering from anxiety and depression do not seek help from professionals. Now, why is that? We're back to the stigma again and however much all the celebrities and famous people all over the world are opening up about their own mental health struggles, there is still a massive stigma attached to it all.

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The other difficulty is finding somebody in your host country to talk to, particularly if a language barrier exists. Finding a doctor that speaks your language and understands your lifestyle and any cultural differences makes successful help really difficult to find.

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Simply accessing available resources is nigh on impossible. For those who move to less developed countries finding adequate expat mental health services can be even more difficult. These countries are possibly still trying to get to grips with day to day health care priorities such as infant mortality rates and infectious diseases. Mental health interventions for lonely expats are not going to be a priority.

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Now a few companies provide services to help with mental health issues for their staff and for their staff members' partners. However, very few people would, in my experience, take them up on this offer, for confidentiality reasons. When you've socialised with a person who is your point of contact for this sensitive assistance, and you've seen them gossip about other people, would you really feel comfortable about asking them for such personal help? And of course, many people presume the call for help would impact their future employment when it's all kept in-house like that. Trust is generally very lacking in this kind of situation.

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People want to find help that is anonymous to the company, that may be anonymous to their friends. Even if the stigma of admitting to struggling with your mental health was finally removed, which is going to be a long, drawn out process, I believe, I still feel the lack of trust and true confidentiality will prevent employees and their partners from utilising this important benefit.

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Things are looking up, though. There's a huge number of specialised expat counselling services springing up around the world, as this need has become more obvious. Some practitioners offer Skype counselling too which will help massively if you can't find anyone to talk face to face to in your host country. And that also helps with the language difference. The difficulty would be is finding somebody within your time zone.

[00:20:05.330]
Expat health care companies are also stepping up their game, which may be a more palatable solution for people who don't want the details listed within their company. Your first port of call, though, if you are deep in the dip of depression and you know that something's not right, is to visit a doctor. You do need professional help.

[00:20:24.920]
Find out if there is any underlying cause and any medication you need. When I was struggling a few years ago, I eventually discovered, through a general first appointment blood test with a new doctor in a new country, that I was actually suffering from physical disorders rather than a mental health problem. I have a problem with my thyroid, and I also learned that I had finished and gone through a very early menopause. So that was a grim double whammy and a bit of a surprise. But my medication got sorted and life is so much better now.

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The doctor may be able to refer you to a counsellor or other therapist. Or try and find one yourself. The Internet does make this aspect of expat life so much easier these days. It's very helpful to seek a counsellor who understands expat life and the difficulties that this life can cause.

[00:21:14.480]
If it helps. Your problems are quite possibly related to self identity in the way you process your new life. CBT - Cognitive Behavioural Therapy is very helpful in this instance. CBT is a talking therapy that helps you manage your problems by changing the way that you think and behave. You'll have assistance in reframing your thoughts and beliefs, reframing challenges as opportunities. And this can be absolutely invaluable. And it works quite quickly, too.

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And as I say, online counselling via phone or Skype is a lifeline for expats who are struggling. Just having a person that you can talk with on the phone can be a backstop to prevent your mental health from worsening.

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But please do get medical advice first. You may need to keep taking the tablets!

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So to summarise, expat depression is more common for the accompanying partner or trailing spouse than it is for the working expat, for reasons that I've explained. And I'm going to go into more detail on these reasons in later episodes.

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Nobody expects to experience mental health problems and nobody can predict how you will cope with your new life.

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56 percent of those who are unhappy living abroad say that not having a personal support network in the host country contributes to their unhappiness.

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You are not alone.

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All social media only shows the best bits of expat life. The highlights, the happy days, the adventures, playing in the sea, drinking martinis by the pool. It's rare to read and see the difficulties many expats experience. My site has always aim to show the realities of living abroad. And in recent years, I've definitely seen others share more accurate and honest anecdotes of life overseas and the struggles many experience, which is actually brave and truly helpful to many. It really helps to know that you're not alone.

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Another tip for friends and family of expats. If you are friends with somebody living abroad and they go quiet on social media for a while or their posts seem different, please reach out. Call them message them; text them. You don't know what they're going through. And your message will demonstrate very clearly that they matter to you, that you are thinking of them. They may be struggling, unable to post the usual pretty pictures of their life, because, quite frankly, they may not be seeing the glamorous side of life right now.

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They may be struggling and feel unable to share it with anybody. Your message may make more of a difference than you could ever imagine.

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And also keep your options open to return home. Feeling like you're trapped in a new place is not pleasant. You always want to have the option of returning home if you can. It is not a failure if expat life doesn't work out for you. If you're missing your support system, if you are not coping with the homesickness and it's making you ill, then put a stop to it. Go home. Simply knowing that your options are open will help a lot.

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Moving to a new country is a challenge. Loss of identity. The struggles of daily life, homesickness and feelings of isolation can lead to expat depression. However, by putting in place sensible strategies to protect your mental health, you can bolster your defences and make your overseas move a healthy one.

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Get help. If you need more support with your mental health. Visit the doctor. Find a counsellor. Do it.

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Focus on the reasons you first moved overseas but don't ignore the option to go back. And most importantly, recognise that you may need help and act on it sooner rather than later.

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There is no straightforward, simple answer to expat mental health issues. Ultimately, we must all speak out in order to let others know that they're not alone. Let's stop keeping it a secret. Let's stop the stigma.

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Moving to a new country is a significant life challenge. You need to make considerable adjustments to your basic style of living.

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It's a good idea to have a mentor, somebody who's been there before, who's lived that life. A mentor can provide you with first hand insight into what it's like to live in a new country and provide you with some much needed survival advice.

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Remember the main reason cited by expats for what they see is the reason for mental health problems is the absence of the family and friends network that they relied on for support back home.

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I'm here for you. Let's chat. Please look after yourself.

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Thank you for listening to the Expatability Chat podcast. Please check out ExpatChild.com for more free information and resources and follow me on your favourite social media. Don't forget to join me next week for another episode. Until then, bye bye.

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