Living in another country can be a rewarding, life-changing experience, but it is not without its difficulties. Many internationals underestimate how confronting life in a foreign country far away from close family members and their usual frame of reference can be, and the impact this can have on mental health. Unquestionably the pandemic added to this.
According to a survey in the Netherlands conducted by the International Community Advisory Panel (ICAP), 70% of respondents said the pandemic negatively impacted their mental health, and 17% were unsure where to find help.
Megan, an international who sought help, says, “locals benefit from deep roots with peers and established communities, while internationals spend their energy trying to find and cultivate a new community for themselves. It can be quite draining.”
ACCESS can help
“The easiest path for me to find mental healthcare that would properly address my needs as an international here, and in a language I am most comfortable in expressing myself, was through ACCESS.” Megan says.
ACCESS was established in 1986 to support the ‘mental well-being’ of the English-speaking international community. “Internationals suffer the same life challenges as nationals, but have to cope without a self-evident support network. This makes them resilient and resourceful,” says ACCESS Counselling Service Network (CSN) member Lysanne Sizoo, “but can also lead to feelings of loneliness and powerlessness.”
Today ACCESS has two counsellors on call every weekday (see sidebar) to provide a referral for anyone seeking help with their mental health. The CSN consists of licensed professionals with practices all over the Netherlands, offering a variety of expertise in different areas. In addition to English, a number of ACCESS counsellors speak other languages including Dutch, German, Spanish, French, Italian and Hebrew. All are personally familiar with the expatriate experience in one way or another.
In the last year or so, ACCESS has seen a significant jump in visits to their CSN-related webpages. From 2020 to the third quarter of 2021, the Counsellor on call page doubled in visits and the Meet the counsellors page rose by 25%.
Reaching out
Professional help with mental health issues may be covered by your health insurance. It is advisable to check with your insurance company before you seek help. A course of counselling may be covered by your medical insurance policy although eigenrisico (own risk) still applies–you may initially have to pay some of the amount yourself. You will need a referral letter from your huisarts (GP). “The GP is the primary healthcare provider with increasing responsibilities such as the possibility of a counsellor who is attached to the GP practice (praktijk ondersteuner),” says Sizoo.
Your huisarts will be able to recommend a professional, but you can also look for private help yourself. Persephone Proutuli, a therapist at Expats in Therapy, says, “ask your circle for recommendations, search online, call a few practices and ‘shop around,’ Focus on the therapist’s education. If the first contact doesn’t feel right, then it’s not the right person–trust your gut.”
Important
Anyone experiencing acute issues should always contact their huisarts first. Anyone experiencing extreme emotional distress to the point of harming themselves should contact the specialist suicide prevention line in the Netherlands by calling 113 or going to 113.nl/english
Help is here
ACCESS provides free referrals to professional mental healthcare support through the Counselling Service Network
Young people
If you have a child under the age of 18 with mental health problems, find information here
Expat blues
“Do not feel embarrassed about saying you are in a bad place,” says Rachel, an international who experienced stress and depression as a result of difficult life events. “Once you start to speak openly about needing help, most people are willing to help you. Reach out to organisations like ACCESS for confidential advice.”
“Talking with an impartial partner can lead to insights you couldn’t see for yourself through the fog,” adds Megan “I’ve wondered too many times whether my decision to move here was brave or crazy or stupid. But I never doubted that seeking professional help was the right thing to do.”
Lost in translation
Even for internationals who speak Dutch, feeling comfortable talking will often mean a professional who can communicate easily. “When it comes to emotional and mental issues,” Rachel says “it is easier for people to communicate in their native language– to articulate and express how you think and feel.”
“What was important was to find someone with whom I felt comfortable, had the right experience I was seeking, and who was able to communicate easily in English even though I had reasonable command of the Dutch language,” she adds.
While getting help with mental health issues has become less of a taboo, this–along with the pandemic–can also mean that help is less accessible. This is particularly an issue for internationally-focussed mental health professionals. But if someone really needs help and, because of availability, only a Dutch psychologist is available, everyone we spoke to agrees that they should start there rather than delay in getting help.
More acceptance
While mental health is increasingly being talked about openly, the pandemic has seen that “so many more people have been in need of support,” says Proutuli. “I see a lot more couples and a lot more men than before.” Sizoo adds, “expats who arrived in the Netherlands during the pandemic were not able to make the connections at work or socially that they would normally make. The natural adjustment has been disrupted.”
“There is nothing to be ashamed of,” says Bauke Bult, a Dutch psychologist who also works with English-speaking clients. “It is quite normal to seek help from a psychologist, and to tell friends about it.”
For anyone struggling but having difficulty finding a professional, there is help online for mental health issues. “In the past two years it has been a lifeline for many,” says Sizoo, “and as a result we have become more and more skilled in working online. Many of us who used to work only face-to-face now offer a combination of the two.”
Protouli agrees, but “the client has to take it as seriously as they would take in-person therapy. Therapy is not just about talking, it’s about being, experiencing.” CSN member Katarina Gaborova says that during the pandemic, “people became more comfortable with ‘e-health’”.
Finding support from the community, while not a replacement for professional help, can also benefit. “Being part of a group and a community that shares experiences and support can be very helpful,” says Gaborova.
Help for young people
“As difficult as it is for adults to navigate the system,” Helen cautions, “it can be hard for children and young people to find help. Almost all the parents of older children I spoke to told me that their children had been in a crisis situation during the pandemic.” According to one counsellor, mental healthcare for young people can be “patchy and not enough”.
Bult says concerns about school and the future, problems with family dynamics, and a lack of socialisation with peers during the pandemic have led to stress and an increase in depressive disorders in young people, and acknowledges that while the system is not perfect, things are improving. Gaborova points out that there might be more types of support for young people “via their GP, school or college, or the consultatiebureau (paediatric consultation office)”.
It works
“I would certainly encourage anyone to talk to a trusted person about their struggles,” says Rachel. The most important thing is to seek help. Everyone we spoke to agreed that there is no need to feel embarrassed. “I am still benefiting from my treatment,” says Helen. “Many people don’t have a safe space to express their emotions, doubts and fears and a good therapist can provide this.”
For Rachel, her therapy meant, “I was better equipped and had access to the necessary tools that allowed me to stay grounded and support others during the pandemic lockdowns.”
(Names have been changed to protect confidentiality)
About the author
Jacqueline Pemberton is a British-Australian freelance writer living in the Netherlands.
