Eutelmed is a company specialized in the psychosocial risks of international mobility, be it through individual assistance, emergency interventions, training, or advice to international organizations.

What are the psychological issues of international mobility?
The number of people moving abroad is rising each year. These people are essentially families that relocate abroad for increasingly long periods of time.

There is a lot at stake in this mobility for companies involved. Living abroad is a very rich experience, but it also presents many challenges on a psychological level.

Moving abroad implies changes in most aspects of life: family life, social life, professional life, and in one's surroundings. It requires leaving things behind and rebuilding elsewhere. The psychological changes that must be made to successfully adapt require substantial psychological resources, self-confidence, and confidence in one's abilities to resolve problems that may arise. When a person moves abroad in a family unit, good communication between family members (spouses and/or parents and children) is essential.

Moving abroad subjects individuals to an increasing amount of stress.

A study by the Department for French Nationals Abroad (Direction des Français à l'Etranger DFAE) published in 2010 clearly indicates the main sources of stress for expatriates. The initial sources of stress are the administrative tasks that must be completed, and the difficulties linked to new languages and social settings. These aspects are followed by the stress of being far away from loved ones and a lack of social and emotional support. These factors correlate with health services that are not as accessible (not adapted, far away, or inexistent) along with sanitary and security conditions which are at times difficult.

The biological and psychological stress mechanisms are well known. The repeated and prolonged secretion of hormones such as adrenaline, cortisol, and endorphins to help the person adapt to various new situations, which are at times difficult to manage, can offset the balance for the individual as well as for the family. Family members may feel overwhelmed as they try to manage their emotional and psychological capacities.

What do you mean by the "expatriate life cycle"?
Stress begins before a person leaves to live abroad. Once the decision is taken, the person begins to consider all that it implies for himself or herself and his or her family. Preparation for departure then follows. This "pre-departure" stage is accompanied by myriad questions and uncertainties concerning the children and the accompanying spouse who may have to leave his or her job. Tension and conflict can arise in this stage. It is therefore important to be attentive to each person's reaction to the project of moving, as well as to the losses that it will imply (friends, jobs, proximity of family members…) and to each person's capacity to deal with them or her reaction.

Once expatriates arrive in the new country, the expatriate life cycle follows a well-known pattern with stages. In most cases, people develop new bearings that are acceptable and satisfying, and which allow them to maintain a balance and flourish in the new country.

The culture shock stage is the most delicate stage psychologically. It begins around three months after settling in a new country. When expatriates first arrive, they are in the "honeymoon", actively settling in and euphoric about their new discoveries.. People feel euphoric as they discover a new place and get settled. Once this stage is over, Oberg* describes the "culture shock" stage. "The differences are harder to live with. Each person realises what his or her everyday life will be like and starts missing familiar things."

At this stage, people might feel exhausted, lose confidence in themselves, and begin having doubts about the project. Symptoms of anxiety may appear (sleeping problems, concentration problems, irritability). These manifestations can range from a mild psychological discomfort that will subside as the person adapts, to a more severe imbalance that can lead the person to question the project.

Finally returning to one's home country is a stage that remains sensitive in 70% of cases. In 1616, the French mathematician and philosopher René Descartes wrote, "When one spends too much time travelling, one must eventually become a stranger to one's own country".

Expatriation allows for different, new, extraordinary experiences. Coming back to a common, everyday life in one's country and company is far from easy. These experiences abroad are not always listened to, recognized nor appreciated by those one is reunited with, friends and loved ones, or by colleagues and managers.
Companies today are realizing that their employees struggle when they come back, and are now taking this into consideration by taking steps to accompany their employees when they return from an overseas mission.

Do people who live abroad suffer from different psychological problems than others?
People who live abroad do not have different psychological problems than the rest of the population, but the problems may be identified later due to specific risk factors. Being far away from those you care about, being isolated in a new country, and having difficulty finding appropriate help in one's native language often keep people from getting the psychological help that would be accessible to them in their native country.

We should also consider the role of mental representations. Expatriations based on professional grounds are construed as being performance-based and highly demanding. These perceptions apply not only to expats from major international companies and humanitarian organizations but also to students of prestigious universities who go abroad for an internship. Moving abroad in these contexts is generally perceived as a very costly investment in a new opportunity. With this idea in mind, admitting to having a problem is complicated as it would be tantamount to admitting to failure or weakness.

Take, for example, the manager who went to Russia for many months, was separated from his family, and was responsible for setting up an industrial platform in a very isolated area. After 6 months of dealing with a heavy work load, meeting tight deadlines, managing an intercultural team full of tensions while himself being remotely managed, he developed sleeping problems, became aggressive with his co-workers, and to "hang on", started taking sleeping pills and drinking alcohol without talking to anyone about it.

The most common problems we treat today are anxiety, depression, burn out, and addiction (alcohol, drug and prescription medication) but we also treat people for post-traumatic stress disorder due to serious situations (assaults, disasters, accidents, kidnappings, etc.).

Can a person be treated from a distance? How?
International regulations concerning telemedicine are a great step ahead in the care that we can provide for people who do not have available treatment in their native language where they are living.

This is what Eutelmed's remote treatment services are based upon and what allows us to care for people living abroad Each day, our multicultural psychologists and psychiatrists give video consults to expats in 16 different languages. All of our therapists have had experience living abroad, have been recruited through a very rigorous selection procedure, and have been specifically trained in remote therapy.

Is it possible to do psychological risk prevention for expatriates? If so, how?
It is particularly important for all of the various actors in prevention such as Human Resources, Security and Environment Management, corporate doctors, and general management to be educated and trained in the distinctive psychological characteristics of expatriation. Assessing and detecting an individual's existing or arising problems before departure, and also upon return will ensure the preservation of each individual's personal and professional balance.