Exploring the expat employee mental health crisis

by | Sep 10, 2021

How employers and brokers specialising in group benefit solutions can help expat employees navigate the COVID-19 mental health crisis

COVID-19 has been a catalyst for employees all over the world to re-evaluate their priorities. Experts are calling this period of career change “the great resignation”, with employers fast realising that physical and mental wellbeing is a top priority for their top talent. As Gallup Workplace summarises it, “People want a good job and a life well-lived.”

Record-high employee stress levels – particularly for expats

Employee stress levels are at their highest ever. According to the Gallup State of the Global Workplace 2021 Report1, employees’ daily stress reached a record high last year, increasing from 38% in 2019 to 43% in 2020. Not only that, but sadness among employees increased by 4 points globally in 2020.

The negative impact of the pandemic on employees has been especially apparent for expat employees and fly-in fly-out (FIFO) workers who have faced unprecedented challenges, including longer work rosters, strict quarantine conditions, limited social activities, and lengthy travel bans.

A study2 by the Centre For Transformative Work Design, Curtin University and the University of Western Australia, entitled FIFO Worker Mental Health and Wellbeing: The impact of COVID-19, looked into the experiences of FIFO (fly-in fly-out) workers during the pandemic. It found that:

  • 41% reported experiencing psychological distress (depression and anxiety) in 2020 – as opposed to only 33% in 2018
  • 50% of workers felt more lonely than usual
  • 53% said that the pandemic had negative impacts on their family and other relationships
  • 65% experienced limited opportunities to socialise or be around people

Expat and FIFO workers are at a high-risk for mental health issues

As an international health and life insurance provider for individuals, families and corporates all over the world, The Unisure Group has a large base of expat and FIFO members. When it comes to advising our clients on employee wellbeing interventions and solutions, we rely on the expertise of our Unisure Consultant Psychologist Clare Rudd.

Clare has practised as a psychologist for 30 years. She joined The Unisure Group two years ago and the focus of her work has been around proactivity on mental health issues. She’s an expat herself, currently based in the Democratic Republic of Congo, and says that she has noticed a spike in mental health issues amongst her expat and FIFO patients (both individually, and in corporate settings).

“COVID-19 changed everything,” Clare explains. “It threw structured work rosters out of the window, and suddenly expats found themselves stuck in their work compounds for months on end, without being able to fly back and visit their families. This wasn’t at all what they signed up for.”

As was the case for the respondents participating in the Centre For Transformative Work Design study, the typical FIFO worker profile is male and 25 – 44 years old. Clare explains that this demographic mirrors the global profile of people most at risk of mental health problems, which means that before one takes into consideration the impact of a FIFO lifestyle, there may already be mental health risk factors at play.

“We’re often dealing with a ‘tough guy’ culture,” says Clare, “where asking for help is seen as a weakness, and where talking about one’s problems and feelings isn’t commonplace. On top of this, when employees aren’t with their families, they say that they might as well work more, which really throws their work/life balance out of kilter.”

When is it time to seek help?

There’s no doubt that expat and FIFO careers can be incredibly exciting, offering numerous advantages such as exposure to new languages and cultures, learning tolerance, and dealing with prejudice and bias, but they can also bring with them significant challenges, particularly when it comes to what experts call the “golden handcuffs” (lucrative salary packages that seem to outweigh the sacrifices).

“This way of life is certainly not for everyone. The key is to give yourself time to settle into a new routine and a new culture, but also to recognise if it’s not working for you or your family. It’s important not to ignore the warning signs of mental health issues, as they typically get worse over time, not better,” Clare cautions.

Mental health issues include a wide range of conditions. The differences between normal expected behaviour and a mental health problem can be subtle, which is why it’s always wise to discuss any concerns with your medical practitioner or a mental health professional. It is also important to recognise that signs and symptoms may manifest physically, emotionally or behaviourally. Here are some of the common signs and symptoms to look out for:



  • Sudden or unexplained exhaustion or fatigue
  • Frequent or unexplained aches and pains for example headaches, back ache, stomach problems, heart palpitations
  • Changes in eating and sleeping habits (eating or sleeping too much or too little)
  • Loss of libido (low sex drive)


  • Extreme mood changes or swings creating problems with relationships
  • Pervasive sadness or melancholy
  • Excessive worries and fears
  • Feeling hopeless and helpless
  • Isolation and withdrawal (avoiding friends and social activities)
  • Suicidal thoughts


  • Problems performing routine daily tasks
  • Difficulty with executive functions (planning, problem solving, attentional control, memory problems etc.)
  • Anger management issues
  • Excessive use of substances (drugs, alcohol or medication)

Clare’s advice if you recognise some of these signs in yourself or a loved one:

  • Don’t ignore the signs and try to ‘push through it’. If you don’t address the signs, it can cause considerable harm to your life. Prolonged symptoms can have serious medical effects like high blood pressure, heart disease, and diabetes. Emotions like sadness, anger or irritability can harm relationships and contribute to mental health problems such as anxiety, depression or alcohol and substance abuse.
  • Evaluate your options. Discuss your work concerns with a work colleague who you trust and your family concerns with a loved one. Weigh up the pros and cons of your situation and evaluate what is most important to you and what decision will give you the best quality of life.

What can clients, employers and HR professionals do to help expat and FIFO workers?

The Centre For Transformative Work Design study asked participants what helpful practices their employer was doing that was supporting them positively during COVID-19.

Many participants described the following practices:

  • Clear communication and transparency from companies
  • Regularly checking in on workers’ mental health
  • Providing support
  • Flexibility with workload and work hours
  • Make accommodations for work-life balance as needed
  • Facilitate social connections
    • With home
    • On site
  • Making mental and physical health a priority consideration for workload and fatigue
  • Providing options for mental health support
  • Innovative strategies for keeping people connected
  • Taking care of high-risk employees

On top of these suggestions, Clare also emphasises the importance of education and awareness, particularly in the form of an onboarding process when an employee arrives in a new country.

“Giving people information at the beginning of their stay can have a very positive effect,” she says. “It’s important for companies to be transparent about the challenges that people are going to face, and also give some helpful suggestions on how to mitigate them. That, and offering support – in the form of company support and wider support circles so that people can talk to each other and offer advice.”

At the end of the day, there are personality types that are better suited to the expat/FIFO lifestyle than others, but human beings are adaptable, and we can learn to adapt to new circumstances if we want to. The key, however, is to keep a healthy work/life balance and prioritise one’s physical and mental wellbeing to be able to live and perform at one’s best.