Integrating mental health supports throughout the international student journey

In recent years, educators have become increasingly aware that many international students face mental health challenges that are both similar to those of domestic students and also unique. Unlike domestic students, international students face the additional pressures of leaving their country without friends and family for support, adjusting to a new culture, and pursuing degrees and other credentials in a language that may be new to them. The prospect of encountering racism may be another worry for some international students, as reports of racial discrimination have increased during the pandemic.

More broadly, the era of COVID has of course made all students’ lives more stressful. In 2020, more than half (56%) of nearly 17,000 students in 21 countries responding to a Chegg survey said their mental health has suffered in the pandemic. While some students will seek out help for their mental health issues, many – and particularly international students – will suffer in silence. This is a key concern for educators everywhere. The need to create appropriate supports for international students – supports that will actually be accessed by them – is a common topic now at international education conferences and among staff at institutions all over the world.

Stigma of mental illness still weighs heavy

A guide prepared by the Government of British Columbia (Canada) – and focused on students from China, Taiwan, Japan, Hong Kong, and South Korea – notes that attitudes towards mental health are quite different in East Asian countries than in the West and that this contributes to students from this region being reluctant to seek out support when they need it. The guide notes,

"The level of mental health literacy – the knowledge, beliefs, and abilities that enable the recognition, management, and prevention of mental health challenges – is generally lower in East Asian countries than in Canada. Those with more traditional East Asian beliefs may attribute mental illness to an imbalance of the body’s energy flow (yin yang), personality traits, or, in some cases, punishment from God. Such beliefs, along with the value placed on emotional self-control and conformity, contribute to high levels of mental health stigma. Many East Asians see mental illness as reflecting on a person’s family and could bring the family shame.”

The guide points out that East Asian students might describe and/or manifest emotional distress in physical terms, such as feeling physically ill or explaining that they are losing weight or unable to sleep. While physical symptoms often do accompany mental distress, it’s also possible that it is more comfortable for some international students to prefer to focus only on feeling physically ill given that they perceive less stigma to be attached to bodily rather than mental symptoms.

A 2018 paper published in the journal Educational Research: Theory & Practice points out as well that students are often simply unaware of counselling services or other important supports; “Previous research has indicated that often international students are unaware of the available mental health services provided on campus, thus leading to an underutilisation of counselling centres. This lack of knowledge may occur if similar counselling services are not available to these students in their native countries.”

Mental health supports throughout the study journey

The British Columbia government guide recommends that educators take a proactive, holistic approach to ensuring students have mental health supports when they need it. That means incorporating discussions about mental health – and mental health services – into the pre-arrival period, during orientation, and regularly during students’ time at the school/university. Students need a solid understanding of who they can turn to if they are having problems, that such counselling is confidential, and that seeking out help will not affect their academic record or be shared with anyone they know.

Because East Asian societies are so much more focused on family connections and a collectivist culture than those in the West, the guide notes the importance of fostering all kinds of connections for international students – connections with other international students, other students from their own country, domestic students, staff and faculty, and spiritual leaders in cases where that is appropriate. Providing students with many ways of engaging on campus – from sports to music to other activities – reduces the chance that they will suffer from mental health crises.

From an organisational perspective, staff throughout the institution should be aware of an overall, official plan and set of procedures to follow if they suspect that an international student is struggling with mental health. The BC guide says this plan might include guidance on what to be looking for, when and to whom to escalate the issue to, when and how to approach parents, and how to activate the list of supports and resources in your district and community.” They stress that “having a plan in place can help you address issues before a crisis occurs.”

The power of peers

Two international students, one studying at Concordia University in Canada and the other at Johns Hopkins University in the US, penned a helpful article in The Conversation that is addressed directly to other international students. Ezgi and Qiyang (who go only by their first names in the article) preface their thoughts by acknowledging how difficult it can be for international students to overcome fears of being stigmatised as a result of seeking help for mental illness. They go on to list a host of ideas for students who are feeling this way, many centred on connection, including:

• Reaching out to a peer support/networking group (e.g., at Concordia there is a Canadian Asian society focused on building skills for successful careers);
• Joining student groups working to raise awareness about systemic racism and how to counter it;
• Seeking out culturally relevant support services on campus.

Ezgi and Qiyang also have advice for institutions: if you don’t have culturally relevant services, then you are likely preventing some international students from getting the help they need when in crisis. In terms of best practices, the students provide the example of Tufts University, where the counselling and mental health team has a “culturally sensitive generalist clinician who is bilingual in English and Mandarin.” This clinician is highly trained in helping students to navigate “life transitions, cultural adaptation, and racial dilemmas.”

Make information easy to find

Given that feeling overwhelmed is often a precursor to deteriorating mental health, one way of reducing the chance international students will enter a crisis is to make all the information they need to succeed in their new home easy to find. Conduct a staff brainstorming session where participants imagine the daily life of an international student and what decisions they need to make – from accommodation to immigration to food and transport and more – what gaps in knowledge they may have, and what could help them navigate their day in the least stressful way possible. The fewer obstacles an international student has to overcome, the more likely they will avoid serious challenges in maintaining their mental health.

For more on best practices in providing mental health supports to international students, particularly during COVID, you can listen to our podcast episode on the topic, in which Brittany Goodman, ICEF’s business development manager for the Americas, discusses the topic with Clark Hortsing, vice president of Strategic Partnerships at guard.me; Christina Furtado, mental health counselor with guard.me, Jenny Frankel, the marketing director at International Student Insurance, and Yasemin Wigglesworth, the executive officer of AEGIS UK – the Association for the Education and Guardianship of International Students.

For additional background, please see:

• “Survey finds majority of students struggling with mental health during COVID”
• “Promoting mental health on campus”
• “Global survey highlights increasing importance of student supports during pandemic”