Several years ago, a short-term study abroad trip to Costa Rica ended in chaos and near-tragedy after poor planning and a series of missteps by officials at a small Wyoming college. A depressed student had not only been allowed to go along, but students and chaperones with no specialized training had been entrusted with her care. While in Central America, they not only failed to provide that care properly, but they also elected not to send her home -- even after she became suicidal.
An investigation found that Laramie County Community College made mistakes at every turn: from a lack of pre-trip screening to the absence of a plan to handle emergencies abroad. And no one on the trip was trained to help the at-risk student.
Unfortunately, we often hear similar news reports of students studying abroad. In so many cases, we learn that the students were enthusiastic and looking for an overseas adventure. However, the sudden and stressful shift to new environments and routines can cause underlying mental health issues to bubble to the surface.
As a father and medical doctor, I wince when I hear these stories. But as an executive with a company that helps organizations to manage health risks facing their international travelers, I think we can do something about the mental health plague facing students overseas.
Based on our own data -- consisting of hundreds of scholastic clients over a two-year period -- we found that students were 23 times more likely to need repatriation assistance on account of a mental health condition than their business traveler counterparts. That's a startling figure. And it's especially concerning given that the number of students studying abroad is increasing each year. For example, the number of international students coming to the U.S. has grown each of the last six years -- increasing by 5.7 percent in 2011-2012 alone. At the same time, the number of Americans studying overseas has more than doubled -- from 114,000 during the 1997-1998 school year to 274,000 in 2010-2011.
So what can we do to mitigate the ongoing collision of a new and culturally rewarding experience with the stress of a new environment?
First, we must understand that leaving home and going to college represents a major life transition which can exacerbate existing psychological difficulties or even trigger new ones. Furthermore, leaving family and peer support structures to enter an unfamiliar environment, with higher academic standards than what students might have been used to in the past, can deepen depression or heighten anxiety.
Second, we must be up-front about the fact that these stressors are only compounded once students begin studying abroad. The study abroad student may lack the emotional and cross-cultural coping skills to adapt or function in his or her chosen program. In some cases, the student could have a predisposition to mental illness and the stress of the "new" environment may actually trigger the problem.
Therefore, in this environment, the success of study abroad is predicated on a preemptive, transparent, and supportive environment established by the institution in the spirit of scholastic duty of care. To create this sort of framework, however, requires an effort from everyone involved.
The Student
Any student with an interest in a study abroad program, in the spirit of their "duty of loyalty," needs to be forthcoming and transparent with his or her school officials and parents regarding any mental health issue. The decision to participate in the study abroad program should be thoroughly discussed among everyone with a unanimous decision to participate.
Regimens of treatment should not be altered or discontinued prior to the study abroad and arrangements should be made to ensure continued access once in-country. Additionally, the student needs to be aware of the fact that challenging programs overseas can easily exacerbate psychological conditions.
Prior to travel, the student needs to confirm that his or her insurance provides mental health benefits abroad. The student needs to arrange a plan with his or her therapist in the event support is required overseas. Mental health resources may be extremely limited, if available at all. Even when services are available, the language barrier can easily preclude access.
The Institution
Just as the student has a duty of loyalty to disclose accurate information, the institution has a duty of care to provide campus resources abroad to protect all students.
Domestically, schools should provide access to educational support for students who intend to study abroad (like pre-departure orientation). Such education can be incorporated into a mandatory visit to student health facilities where pre-trip vaccinations are typically provided. To provide awareness, the student -- and parents or guardian -- should take an e-learning course that outlines various cultural issues and laws, as well as the signs and symptoms of common mental illnesses. Familiarity with such illnesses helps students identify at-risk behaviors in themselves and their peers. Embedded within this course could be an anonymous student self-exam to determine fitness to participate.
Study Abroad Site
Working with the students, in the spirit of bilateral transparency, home campus officials need to determine, in advance, the study abroad site that best serves the students' needs -- specifically, one with an infrastructure that has appropriate support.
If the study abroad program includes "outward bound" missions where students will be separated from the host country facilitators, the school should provide training to those leaders accompanying the students. Such training should include, but not be limited to, recognition of basic signs and symptoms of mental illness.
Ultimately, the majority of students should be able to participate -- and thrive -- in study abroad programs. Success, however, is predicated on a preemptive, transparent, supportive, and confidential environment. Prior to travel, the student should develop self-awareness, with or without the assistance of a professional. Simultaneously, the school must educate its local and distant faculty, as well as other students, to recognize and react appropriately to a mental health crisis.
Scholastic duty of care is a dynamic responsibility. The home institution must continue to provide ongoing education to the students, as well as to the accompanying faculty, in the recognition and management of mental illnesses. Adherence to such a strategy will certainly help to mitigate the risk of a failed study abroad experience. And maybe it will help prevent unnecessary deaths.
Robert Quigley, MD, D.Phil., is the Regional Medical Director, Americas Region, for International SOS, an international healthcare, medical assistance, and security services company.