A common concern in preparing to live, or even travel, abroad, is health. For many, this concern is dominated by questions surrounding physical health. What vaccinations will I need? Can I drink the tap water? Is my insurance cover sufficient? How much mozzie repellent can I use before I get DEET poisoning? Can I work or volunteer in a low-income country with a disability?
All of them. Probably not. Probably yes. If you have to ask you should probably stop. And yes. Most, if not all, international aid and development agencies are actively working to diversify their workforce with respect to gender, ethnicity, nationality (though we all know a certain org that pays local nationals less than international staff), and ability. However, despite significant developments in engaging persons with a disability in the sector, mental illness is often overlooked.
The World Health Organisation estimates 100 million people in the western Pacific suffer from a mental disorder. Mental illness affects 1 in 5 Australians. Look around your office, the café, the train, the lecture hall. Are there more than five people? Perhaps, it is not so much overlooked as it is never seen. If a candidate does not disclose they have a mental illness there is no reason for a potential employer to consider them differently to any other applicant. So why would a candidate disclose a mental illness?
It will shock no one to hear that there is great stigma around mental illness. Although agencies work for improved services and support for persons with a mental illness in the countries in which they work, a candidate applying to work in a low income country with a mental disorder may face discrimination from HR processes that assess a person’s suitability for working in challenging, remote locations. Even when HR policies prevent discrimination on the basis of mental illness, there is little incentive for candidates to disclose a mental illness when it is so easy to hide.
The result is persons with a mental illness are not provided with the treatment or support they will need when working abroad. This support is no more expensive than that offered to persons with a physical disability or illness. Unfortunately, the services that persons in Australia struggling with mental illness such as depression can turn to here at home are not available internationally. The advice given by the government via Smart Traveller is to call the Consular Emergency Hotline (+61 2 6261 3305) and request a transfer to a mental health hotline.
Insurance for mental illness can be rare and, where insurers do cover claims related to mental illness, expensive. A 2015 study by CHOICE revealed just 2 of 35 travel insurers they reviewed covered mental illness. The review found that a traveller “can be denied a mental illness claim if you had a different type of mental illness when you took out the policy and didn’t disclose it.” Basically, if a person suffering from addiction didn’t disclose it at the time of application, the insurer would not pay a claim for an unrelated mental illness, such as depression or an eating disorder, if this condition presented for the first time while travelling or living abroad. Imagine being denied a claim for a broken arm because you had not disclosed your diabetes when you applied for insurance!
In 2014 a CHOICE investigation into insurance cover revealed significant discrimination against persons with a mental illness, identifying such disorders as “mostly a no-go zone for travel insurers”. The investigation revealed that what insurers cover and what they will pay can be two very different things in the category of mental health, making living abroad with a mental illness a risk for many Australians.
Many arguments could be made to justify this discrimination. The incidence of comorbidity in mental illness relative to physical disability may make it difficult for insurers to define pre-existing medical conditions. Aid and development agencies shy away from placing people with a mental illness in a location that may increase stress and exacerbate symptoms or lead to a relapse. However, consider that the 2015 CHOICE study revealed that a prior, undisclosed visit to a therapist for stress or mild anxiety may be enough to be denied coverage or an insurance claim. If disclosed, this one trip could result in increased premiums. Additionally, the risk of relapse is higher for persons placed in a challenging situation without adequate support than those who disclose an illness and are provided with support.
Though there is little evidence to suggest that persons disclosing a mental illness are actively discriminated against in applying for positions within the aid and development sector, there is little incentive for a person to disclose a former or existing mental health condition, especially when such a condition, unlike a physical disability, can be easy to withhold from a potential employer. When given the option to disclose a mental condition, a sufferer inevitably speculates about the consequences for their potential employment. Will I be allowed to work in a hospital in a remote area if I am taking medication for depression? Will they think I can’t work on a project combating malnutrition if I am suffering from anorexia nervosa? This is a competitive industry, why wouldn’t they choose someone without a mental health condition over me?
The consequence of such speculation is that persons suffering from mental illness often opt not to disclose their condition. This World Mental Health Day we take the opportunity to shine a light on the stigma of mental illness within an industry that prides itself on championing inclusion and diversity. Whether you are looking to travel abroad, work abroad for a short time, or relocate for a long-term assignment, consider your mental health as a priority. Just as you think of your vaccine schedule and antimalarials, or whether your insurer covers lost luggage, consider how you are covered for mental health conditions and what support is available while abroad.
Palms Australia does not discriminate against Australians with a mental illness who want to undertake an assignment abroad. Counselling is available to all participants prior to departure, during an assignment, and upon return to Australia. We advise that candidates with a mental health condition research travel insurance coverage options to ensure they will be covered for their time abroad. All participants are advised to consider a policy that covers mental health conditions that arise for the first time while overseas.
If you are in Australia and need someone to talk to call:
Lifeline: 13 11 14
Kids Helpline: 1800 551 800
MensLine Australia: 1300 789 978
Suicide Call Back Service: 1300 659 467
Beyond Blue: 1300 22 46 36
Headspace: 1800 650 890
QLife: 1800 184 527