Travelling with a mental health condition

While travel is and should be a rewarding experience, it can also pose significant challenges to people with mental health conditions. Planning and executing a trip is stressful by anyone's standards, but it can be overwhelming if you suffer from mental illness. It is estimated that 1 in 4 adults will experience mental health problems at least once in their life, but just because you're going through a rough patch does not mean you should give up all the wonderful experiences travel can provide. Travel has been shown to have positive benefits to emotional and psychological well-being, so a successful trip may be just what you need to start feeling like yourself again.

So take a few moments to read this guide and learn how you can manage your mental situation while travelling. And regardless of how mentally healthy you consider yourself to be, all travellers should give the same consideration to their psychological well-being as they would to their physical health before leaving home.

Possible risks
Many factors may affect your mental health or well-being when travelling, including:


 * Disrupted routines – Many people with mental health conditions cope by following routines of varying strictness, but travel will necessarily disrupt these routines. You may have to adapt to a different pace of life and create a new routine to suit your surroundings, and this can be tough. The changed routine may cause you to neglect coping strategies you have devised for yourself, such as meditating or taking medication.
 * Jet lag – A sense of being out of step with the world around you because you have changed time zones. If your body clock is still on home time, this can throw your sleeping patterns and play havoc with your mood.
 * Isolation – Often when travelling, you will be separated from friends and family, and this can be especially acute for solo travellers. You may find it much more difficult to make connections or form friendships with the people around you due to language barriers or differing cultures. While travelling companions or locals may be sympathetic to your condition, the people you know you can rely on to look out for you and make sure you're safe and happy may well be hundreds or thousands of miles away.
 * Unfamiliar surroundings – Being in a very different setting to the places you're used to may cause anxiety or disorientation. A variety of factors may contribute to a sense of unfamiliarity, from the absence of "normal" foods, to a different climate or being surrounded by a foreign language. Such factors may result in homesickness or culture shock (see box).
 * Use of drugs or alcohol – While being on holiday can feel like an escape from real life, remember that mood-altering substances still have real effects wherever you are in the world.
 * Bereavement – Sometimes, the cause of your present difficulty is also your reason for travelling: funeral travel may be necessary, but it is often much more stressful than a long-anticipated holiday or well-planned business trip.

But all is not lost! Suffering or having suffered from mental health difficulties should not be a barrier to travel experiences. You just need to be able to plan and adapt accordingly, which this guide aims to allow you to do.

General preparation

 * The first step to prepare for your trip is simply to recognise to yourself that it may be challenging. This doesn't mean panicking or ruminating over 'what ifs', it means simply to acknowledge that things may not go according to plan and that you should be adequately prepared for such an eventuality; a mess-up doesn't have to become an unmanageable problem.
 * Many countries deny entry to travellers with serious mental health conditions. Consult your destination's diplomatic mission to confirm whether you are eligible to visit your destination.
 * When planning your journey, make sure it is well thought out, with realistic time allocated to making connections and developing contingency plans to cope with delays. It is also a good idea to learn your route, especially if you're going somewhere for the first time. When you're familiar with your own schedule and know where each leg of your journey will take you and how long it should take, you will naturally feel more in control. If you suffer from anxiety, be mindful of anything about the travelling process that may cause you to feel anxious, and think of ways around it. For example, if you are a nervous flyer, you may wish to read Wikivoyage's Advice for nervous flyers, or if practical you may consider alternative ways of reaching your destination without ever needing to get on a plane: by train, by boat, by car or by bus. If the thought of travelling underground on a packed subway train fills you with dread, investigate the other transport options in your destination city.
 * Think about the kind of trip that will work for you. Would you be happier on board a cruise ship, which will provide everything you need, or visiting a city, where you get to explore new sights? Would you rather roam from place to place, or stay in one spot? Do you want an urban adventure or a backpacking trip? Do you want to travel alone, with friends and family, or with other people? A tour group provides some safety and reduces your planning effort, but you will have to be able to keep up with their schedule. Travelling with friends and family can be delightful – or, in other cases, a difficult loved one can be the extra burden that destroys your spirit.
 * Research your destination well in advance of going there. Get to know the place you'll be staying, the culture and the language as much as possible. Learn about local traditions, and the religious and political situation you'll be encountering. And don't overlook the little things. Find out where the nearest supermarket is, whether there are any local holidays that may disrupt your arrival or departure, and where's a great place to eat if you're arriving at an unusual time of day. It's a good thing you're on Wikivoyage, eh?
 * Don't overschedule yourself. Don't aim for eight countries in seven days, or six wineries in four hours, or ten long business meetings in one day. Build your schedule so that you won't need a holiday to rest up from your trip.
 * Communicate your plans and needs in advance. Leave a copy of your itinerary with friends or family, and tell them when and how you will contact them during your trip.  If you are joining a tour group or other organised program, send some practical information about your condition to the operator in advance.  Most travel professionals have experience with common problems, such as anxiety and sleep disorders.  Tell them what you might need – perhaps extra sleep or avoiding crowded, claustrophobic areas? – and what to do and who to contact in case of a serious difficulty.
 * As for combating feelings of disorientation, the internet age allows you to 'visit' most parts of the world without ever setting foot there. Make use of resources such as Google Street View to, for instance, find out what the neighbourhood outside your hotel looks like, or even to visualise the route you might take from the station to your accommodation. Wikivoyage's airport articles explain the best ways to navigate the world's major airports. Anything that makes you feel less lost when you first arrive has to be worth doing.
 * Give a thought to how you're going to stay in touch with home, and how you can contact people if you experience problems. Does the place you're going have an internet connection? How much will a phone call home cost? Does your mobile network allow you to make calls in your destination country? If the worst comes to the worst and you need diplomatic assistance, where is your home country's nearest embassy, high commission or consulate in relation to your destination? Is there a nearby embassy of a third country which can offer diplomatic services to you on behalf of your native country?

Medical considerations
If you find the above information a lot to take in, take it in baby steps! Allow enough time before you leave home, so you can focus on your preparation one step at a time without feeling overwhelmed. You could write yourself a schedule for when you're going to buy travel tickets, when you're going to meet your doctor, etc. Have a check list to keep track of what you've already done and what is still left to do. Above all, focus on the immediate task.
 * Find out how to access medical facilities, including mental health services, while on your trip. Where are the nearest hospitals? What is the local emergency number? Whom can you turn to if you run into difficulties? Familiarise yourself with the psychiatric care system of your destination. You may wish to find and make contact with a reputable English-speaking mental health professional in your destination of choice before leaving home. In any case, you should take out travel insurance that specifically covers mental health issues and medical repatriation.
 * If you are receiving treatment, schedule a review with a medical practitioner (e.g. your psychiatrist, counsellor or general practitioner). Discuss your travel plans and listen to their advice; give notice to whether or not they think your plans are appropriate or advisable with your condition. Request adequate medication supplies to cover your trip. You could also ask them for an official letter written in the language of your travel destination, detailing any diagnoses, treatment plans or medication you take, as well as the name and address of your doctor at home. Such a letter will be of help if you need to access medical or psychiatric services while travelling.
 * If you have a potentially serious medical condition, regardless of whether it is related to your mental health situation, consider wearing a medical ID bracelet in addition to tucking an information card in your wallet. If you are feeling seriously unwell, the local medical staff will be grateful to know whether they should be checking for an overactive thyroid or for a problem with your medication schedule first.
 * If you take medication, a general rule of thumb is to have enough for the duration of your trip, plus an extra 1-2 weeks' worth in case of loss, theft or unforeseen delays. If you need travel vaccinations or prophylactic drugs such as antimalarials or antibiotics, check with your doctor whether these could interfere with your condition or existing psychiatric medication, and arrange alternative medicine if necessary. If you are changing time zones significantly, ask your healthcare provider whether your schedule should change. When travelling for a long period of time, you will need to research treatment and medication that you can access in your destination.
 * Check for special restrictions at your destination. Habit-forming drugs are frequent targets for country-by-country restrictions, and while most are okay at most destinations, the exceptions sometimes surprise people.  For example, amphetamines such as Ritalin and Adderall are commonly used in the United States, but possession of these common medications is illegal in Japan.  If you take medications for insomnia, anxiety, or attention difficulties, then it's best to check with your destination that your particular meds are okay.  If you find that there's a problem, then talk to your doctor early about alternatives. Some medications can be "paused" without doing too much harm and this may be an option for a vacation trip. Talk to your doctor whether that's an option in your case.

Get in
Going on a long journey can be stressful, but it doesn't need to be overwhelming, if you follow simple steps:


 * Contact your airline, train company, tour operator, etc., in advance of your trip to inform them of your needs, and find out whether they can make any adjustments to accommodate you.
 * Set off as ahead of time as possible so you have enough time to catch up to your schedule if you encounter any unexpected delays.
 * Be conscious of time zone changes and how this may affect your perception of where you are in the day and how long you have to make that flight connection or be at a certain place on time. If you need to take medication, it is important to maintain the schedule you would follow at home. Maintaining a regular pattern of meals and sleep at the correct times may help to keep you grounded while in transit. Adding scheduled reminders to your mobile device (e.g. "take medication now", "sleep now") will take the pressure off trying to match up different time zones in your head.
 * Drink plenty of water and avoid drinking alcohol while en route.
 * If you are nervous in large crowds or confined spaces like those you would expect to find in an airport, railway station or on board a plane, have a good supply of music or podcasts lined up on your mobile device and pack noise-cancelling headphones.

Transporting medication
Main article: Medication

Carry your medication in clearly-marked containers. If at all possible, keep the original packaging, including official labels from your pharmacy that show that this medication has been issued to you. A pile of pills tucked into the bottom of a suitcase looks much more suspicious than a recognisable bottle with a prescription label from your pharmacy. Consider adding your name, nationality and passport number to all containers.

For a short trip, carry all of your medications in your hand luggage. For a long trip, carry at least a week's supply in your hand luggage, in case your checked luggage goes missing in transit. You should have the appropriate prescription and/or doctor's letter to hand (e.g. in a zip pocket of your jacket) should you need to show it to security services or airport staff.

Sleep
Most mental health conditions cause sleep disturbances. Unfortunately, so can travelling. Try these things:
 * Think about when you're going to sleep. Schedules are important, and that includes both the time you hope to sleep, and the time before and after it.  Plan for some flexibility.  If you can't sleep at night, will you be able to take a nap during the day?  Jet lag can affect anyone, and there are some things, such as going outside during the daylight hours, that will help reduce the symptoms.
 * Think about how you're going to sleep. Do you need an eye mask, ear plugs, a white-noise-generating app for your smartphone?  Do you expect to take medications to help you fall asleep?
 * Think about where you're going to sleep. Will you have your own room, or be sharing a hostel with strangers?  A good mattress can make a big difference for some people.  If that's you, then specifically search for hotels that get good reviews for having high-quality mattresses.

Keep a routine
Even though your normal schedule may be impossible or impractical to maintain while on your trip, you should still maintain a regular routine, that you should make time to devise once you have arrived at your destination. Write it down if it will help you to remember, or schedule items into your phone's calendar and enable notifications. Having a regular and predictable pattern of meal times and a good sleep/wake cycle will help you feel in control. Allow yourself time to rest and stay hydrated and fed, even if you have a busy schedule of sightseeing, activities or work. Continue to take medication at the correct times, even if you feel your mental health has improved. If you practise any self-therapy techniques at home, for instance physical exercise, mindfulness, yoga or an emotions diary, continue doing them where possible during your trip, at roughly the same frequency as you would normally keep to. All of these combined will help to keep a sense of familiarity and continuity with your home life, even if the rest of your travel experiences are far out of your comfort zone.

Avoid unnecessary stressors
Take your time! Even if there are a million and one things on your bucket list, you shouldn't just rush around a destination without pausing to think or plan your next move. Make a list of the places you really want to visit or the sights you particularly want to see, and prioritise them. Be sensible with the amount of time you allocate for each activity, and take things slow. If you're on vacation, there's absolutely no point in making yourself more stressed than you would have been if you had just stayed at home.

Being surrounded by new sights, sounds and smells can be a sensory overload. If on occasion you find yourself overcome with too much new information to process, you can ground yourself by splitting up the experiences by sense. First, close your eyes and listen to the sounds around you. Then focus on the sense of touch, for example by feeling the temperature or the wind in your hair. Next, try to identify any smells that you can pick up, and probe your mouth for any lingering tastes. Finally open your eyes and take in the scene in front of you. Even this can be broken down into chunks, for instance by just looking at a particular building, or focusing on instances of a certain colour. When you take time to become familiar with your environment, step by step and at your own pace, you can bring yourself out of your mind and into the present moment, while feeling more connected and more at ease with your surroundings. If this kind of self-therapy appeals, you may wish to learn meditation.

Excessive alcohol or illicit drug consumption does have quantifiable effects on one's mood, and the effects are often amplified with people who suffer from mental health conditions or those taking legitimate medication. Of course travel can be about having fun and trying new experiences, but if you wouldn't down four vodka tonics on a night out at home, then don't do it while in a strange environment with a different climate and culture, and laws you may not be familiar with.

Keep busy
If homesickness or culture shock are an issue, the worst thing you can do is spend time ruminating alone. Prolonged inactivity and solitude can be especially damaging for sufferers of mood disorders such as depression, and once you start down that road of self-isolation, a low mood and the fog of inertia can engulf you with frightening speed.

So the thing to do is stay active: throw yourself into discovering the places around you, meet new people, seek new experiences, and say "yes" to opportunities. Not only will this distract you from what might be some quite unpleasant thoughts and feelings, it will also get the heart pumping, engage the brain and senses, and release serotonin, all of which will contribute to raising your mood. Sure, you can't be constantly on the go and do have to set aside time for relaxation, but when you have downtime, make sure you have plans for what comes next and, preferably, know when and how you will bring that downtime to an end.

Leave your accommodation every day, during the day, even if you really don't feel like it. Go outside, breathe a bit, take in the view, say "hello" to somebody. For a mentally healthy person, spending a day just chilling in your hotel room is no big deal, but for a person with anxiety or depression, that day can easily become a week, with the chilling replaced by catatonia.

The bottom line is, overindulging in rest can be just as bad as overstimulating yourself with activities, so find a balance that's right for you.

Know your triggers
You should hopefully know what kinds of situations or events give you discomfort, trigger unwelcome thoughts or feelings, or otherwise cause your symptoms to worsen in your everyday life at home. Therefore you ought to know what situations to avoid while travelling. Remember that since travel involves new environments and experiences, your body or mind may react in ways you didn't expect. Recognise your early warning signs, and nip the problem in the bud.

Connect
It is important to maintain contact with your friends and family back home, doubly so if you're travelling solo. Avoid impersonal means of contact such as email or texts; instead rely on telephone calls or video messaging services to allow you to actually talk to your loved ones. Such calls will alleviate loneliness, improve your mood as you share your travel experiences with others, and allow you to discuss plans and problems with people whose judgement you trust. You will also be providing reassurance to those you care about that you are coping during your travels.

It is always better to make arrangements to speak at a specific time, bearing in mind any time differences, and stick to that arrangement where possible. It can be comforting to know your loved one will be waiting for your call at a certain time, but conversely disheartening if you call home without prior arrangement and get no answer.

Living abroad
If you are contemplating long-term residence abroad – working abroad, studying abroad or retiring abroad – then some of the risks described above may eventually be reduced; you will have time to adjust, to find a new social circle, perhaps to learn a local language. However, all of them will apply when you first arrive and some may get more irritating over time.

There are also problems which only turn up for a long-term stay. If you are staying a few years you cannot expect to bring enough drugs for the whole trip, or to have follow-up visits with your doctor at home; you will need a local doctor and local pharmacy. In some places, local doctors or hospitals may not be up to the standards back home. A drug that is used back home may not be approved in the new country, or may be an expensive import. For many forms of therapy, therapists need very subtle language skills so a suitable therapist may be hard to find in an area where almost no-one is a native speaker of your language. Health insurance has its own complications.

For many people – with or without a history of psychiatric problems – it makes a lot of sense to take things slowly. Visit one or more potential destinations, preferably for at least a few weeks so you can get a real feel for the place, before you commit yourself for several months or years.

Many people with relatively mild mental afflictions will do just fine living abroad. There is an old joke that there are only three types of expatriate: missionaries, mercenaries and misfits. Most expat communities include people who would be misfits back home, and both expats and locals are often quite tolerant.

People with more serious illnesses, such as anyone who has ever had a psychotic episode, are traditionally extremely cautioned about moving abroad. The situation inherently involves some new and different stresses, including changes in the available support mechanisms, and if you do go over the edge in a strange place, that can be incredibly unpleasant and perhaps quite dangerous. That said, there are people living abroad quite happily with severe mental illnesses. Indeed, there are people who consider living abroad integral to their recovery from profound mental illness usually considered chronic in the current medical model. Exercise significant caution, and consider your own unique situation.

Stay safe
Societal and cultural attitudes towards mental health vary enormously between countries, and in many parts of the world ignorance, stigma and discrimination are very much part of the daily reality for sufferers of mental health conditions. In some countries, exhibiting strange behaviour or showing signs of psychological distress may be grounds for arrest, criminal charges or forced incarceration, while in others systematic discrimination against health sufferers is legal or commonplace. Elsewhere, symptoms of psychiatric disorders may be so poorly understood that they are perceived in terms of the supernatural, rather than being recognised as a medical problem.

In places where such attitudes are common, you may find even doctors and mental health professionals share the same prejudices. Mental health services may be limited or non-existent. In other cases, what 'help' there is may be seriously inadequate or outdated by the standards of home. For instance, local practice may favour forced institutionalisation, questionable treatment based on antiquated or unscientific beliefs, or dangerous or insanitary facilities.

It is therefore extremely important to research your destination country's relevant laws and culture, and assess whether there is an unreasonable risk to your safety or well-being should you enter that country.

When things go wrong
Even the best laid plans can go awry. No matter how much planning you do, or how many coping strategies you adopt, sometimes problems are unavoidable. C'est la vie.

The important thing is that you know how to get help when you need it. If you know your warning signs, and believe your mental health to be deteriorating, seek help and advice as soon as possible. People you may turn to include travelling companions, family or friends at home, or a local doctor or mental health professional. In extreme cases, you may have to be in touch with your country's embassy.

Although it may seem like good practice to shoulder your problems by yourself, and even embarrassing or shameful to call for help, it really isn't. Keeping problems to yourself and attempting to manage everything on your own is pretty much the worst thing you can do and almost guarantees that things will go from bad to worse. Your health and safety is your number one concern, and should take priority over all else.