Living abroad is an excellent way to discover new cultures. It can also bring its share of psychological challenges, such as cultural adaptation, isolation and estrangement from loved ones. These difficulties can have an impact on expatriates’ mental health. Health insurance policies often restrict access to psychological health professionals. Psychological care is frequently postponed or subject to special conditions. It is often excluded or restricted, and the regulation of psychologists varies from country to country. It’s important to anticipate these issues and understand your international health insurance contract, so that you can benefit from appropriate support.
The psychological challenges of expatriation
Living abroad means adapting to a new language, foreign lifestyles and an unfamiliar environment. These changes can lead to stress, anxiety and even depression. The absence of a local social network and the lack of cultural references are often the main causes of increased loneliness. These challenges need to be identified if they are to be properly addressed.
Psychiatrists, psychologists and psychotherapists: what are the differences?
When it comes to mental health, it’s important to distinguish between psychiatrists, psychologists and psychotherapists. This is all the more true for expatriates, whose access to such care varies from country to country. Some professionals specialize in working with expatriates. They integrate the specificities of expatriation into their therapeutic approach. Intercultural clinical psychology takes into account the cultural dimensions and hybrid identity of expatriates. It offers them personalized support tailored to their specific needs.
Psychiatrists: doctors specializing in mental health
Psychiatrists are doctors who have specialised in psychiatry after completing their medical studies. They are qualified to make medical diagnoses, prescribe complementary tests (blood tests, medical imaging, hormone analyses) and prescribe drugs such as antidepressants, anxiolytics or neuroleptics.
The profession of psychiatrist is generally highly regulated internationally, ensuring official recognition of diplomas and qualifications in most countries.
Psychologists: recognition varies from country to country
In France, the profession of psychologist is strictly regulated by law n°85-772 of July 25, 1985. To hold this title, it is imperative to have obtained a Master 2 in psychology from a recognized university, in accordance with decree no. 90-255 of March 22, 1990.
Since 2002, psychologists have been registered in the ADELI file. In 2022, this file was replaced by the RPPS (Registre Partagé des Professionnels de Santé), guaranteeing their qualification and official recognition in the French healthcare system.
However, this recognition is relatively recent and evolving. In other countries, training and practice requirements can vary considerably. It is therefore essential for expatriates to carefully check local qualifications, titles and regulations before consulting a psychologist.
If the professionals are domiciled in France/Outre-mer and work within a structure that is itself headquartered in France/Outre-mer, then they can officiate since consultations are not carried out from the local territory, but depend on the structure.
Psychotherapists: regulated but variable training
The title of psychotherapist is even more recent: it was regulated in France in 2010 by the decree of June 8, 2010. To obtain this title, you need to undergo specific training in clinical psychology at a state-approved establishment, including a minimum of 400 hours of theoretical courses and 5 months of internship.
It’s important to point out that a psychiatrist or psychologist can be a psychotherapist, but the reverse is not always true. This plays an important role in the way insurers pay for treatment.
Internationally, regulation of the title of psychotherapist varies widely. Some countries do not regulate this profession, which exposes it to the risk of charlatanism. For member states of the European Union, the European Economic Area and Switzerland, circular no. DGOS/RH2/2012/431 of December 24, 2012 can be a point of reference for verifying recognition of qualifications.
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Health insurance reimbursement rules for expatriates
Mental health is often neglected in many healthcare systems around the world. Psychiatrists are often among the lowest-paid specialists. In addition, psychological care structures are often under-funded. This can be a difficult situation for expatriates seeking mental health support.
Supporting local healthcare systems
In many countries, mental health services are underfunded. This limits access to quality care. Expatriates often find themselves in systems where mental health resources are limited, making access to care more difficult.
Coverage by the Caisse des Français de l’Étranger (CFE)
CFE offers expatriates health cover similar to that provided by French Social Security. For consultations with psychiatrists, the Caisse des Français de l’Etranger reimburses 70% on the basis of a tariff of €46.70, i.e. a reimbursement of €32.69 per consultation.
For psychologist consultations, reimbursement depends on the “Mon soutien psy” scheme. Under this scheme, on referral from a doctor, you can benefit from sessions with an approved psychologist, reimbursed at 60% of the rate of €50 per session. It is important to check whether this scheme applies to expatriates, and whether there are any psychologists working abroad under contract.
Private insurance reimbursements
Private health insurance plans for expatriates vary considerably in their coverage of mental health care. There are generally two scenarios:
- Mental health care is a special category
Some expatriate insurance plans offer special packages that include mental health care. For example, AXA – Global Healthcare offers flexible medical cover for expatriates, potentially including mental health services. Similarly, MGEN and April International offer international health and provident plans tailored to residents abroad. - No specific heading for psychological care
In this case, insurance policies reimburse psychiatrists’ consultations in the same way as those of other specialists, generally with no ceiling or waiting period. However, consultations with psychologists may not be covered if they do not appear on the list of health professionals recognized by the contract.
Psychiatric hospitalizations
Health insurance contracts generally subject psychiatric hospitalization to specific conditions. These may include reimbursement ceilings in terms of amount or number of days, as well as specific waiting periods, often of 12 months. It is therefore essential to read the general conditions of your contract carefully to understand the terms and conditions of coverage.
Santexpat.fr x Feel Better Company: a partnership for the mental well-being of expatriates
At Santexpat.fr, we’re proud of our partnership with Feel Better Company, the first mental health web application dedicated to French expatriates. This collaboration gives us the opportunity to offer our customers privileged access to individual therapy services. These services address the specific challenges of expatriation, such as malaise, anxiety, relationship difficulties, burn-out, trauma, emotional dependency, addictions and eating disorders.
We combine our expertise in international health insurance with the specialized services of Feel Better Company. This enables us to offer comprehensive, personalized support for the mental well-being of our policyholders around the world.
The importance of consulting in your mother tongue
Expressing oneself in one’s native language makes it easier to express emotions and memories. Teleconsultation enables expatriates to consult French-speaking psychologists. This is particularly useful in countries where such professionals are rare.
Psychological care on expatriation: what you need to know
Living abroad means you need to be well informed about access to psychological care. You also need to be aware of local regulations governing mental health professionals. Psychiatrists are generally recognized as medical specialists, but the status of psychologists varies from country to country.
Health insurance policies for expatriates that cover consultations with psychologists are rare. Where they do exist, they often impose long waiting periods. What’s more, you must declare any current or recent psychological treatment when taking out insurance.
To ensure proper psychological follow-up, check the practitioner’s diplomas and registration with an order or official register. Also check the reimbursement conditions in your insurance contract. Good preparation will help you avoid unpleasant surprises and ensure that you receive the support you need to cope with the difficulties of expatriation.
