Emigrating is stressful enough when you're well, but it gets more complicated if you have mental health problems to contend with.
Though Brexit may have made emigration feel like a reasonable and logical inevitability, it turns out that moving to a new country is – spoiler alert – quite hard. There's all the stuff you have to leave behind, like your family, a set of friends, most of your actual material belongings, and there are the terrifying things you're moving towards: finding a job and sourcing somewhere to live, trying to force people to hang out with you and navigating a hellish, bureaucratic nightmare-scape of paperwork, sometimes in a language you don't understand.
This is, pretty unsurprisingly, stressful. But what happens when, on top of this, you have mental health problems to contend with?
David Barnes, a British counsellor based in Berlin, says that dealing with mental health problems in a new country can be extremely challenging. "Understanding the health system in a new country and getting adequate health insurance can be challenging, to the extent that some people avoid trying to tackle the issue because of the jargon involved, or language challenges," he told me. "Obviously it can help if you have someone who's willing to translate for you, but that isn't always the case.
"Being in a new country with cultural differences can leave someone feeling extremely isolated too, particularly when they can't speak the language."
Cultural attitudes can also cause problems. Micaela, who emigrated from Canada to Japan 11 years ago, found it hard to overcome stigma in the country. "People who have never experienced mental illness assume it's a myth or an excuse," she told me. "Even though there's such a high suicide rate, Japan fails to recognise lots of mental health problems as a legitimate issue. It's stigmatised. If you're depressed, you're lazy. You're just not trying hard enough."
When Micaela, who was working as a TV and radio personality, told her boss she couldn't carry on working because of her depression, he told her, "we're all tired, but you don't see us complaining"; when she visited a mental health clinic, her doctor told her she should "go back home" and to "nap off" distressing panic attacks. "He just said, 'Why don't you just go home? I doubt your problems will follow you back to Canada.' I was so disappointed; I was seeing him as part of an attempt to get better, but his solution was just to turn round and go home.
"My Japanese boyfriend didn't like the idea of me taking meds either because there's such a stigma attached to it. He wasn't educated at all on the subject."
Livi, who was diagnosed with borderline personality disorder, anxiety and depression in the UK, found similar problems with stigma. She recently relocated from Cheshire to "the middle of nowhere" in Mayenne, France. Livi's move was more to do with necessity than choice, moving back in with her parents after "a series of suicide attempts". Because they'd relocated to France, so did she.
"I've really found that there's less understanding about the severity and reality of mental illness here, specifically when I've been dating," she told me. "People don't seem to realise that mental illness is a real illness and can be severe and life-changing."
And the language barrier was understandably challenging – unlike Micaela, who spoke Japanese, Livi's last-minute emigration meant she didn't speak the language. "Therapy was extremely difficult," she said. "I don't speak fluent French, so talking therapy was really hard to find. My psychiatrist just prescribed 'ergotherapy' for my anxiety, a course of walking in nature with other people every week. It just made my anxiety worse, though."
There are a number of ways to tackle the language barrier problem, though (bar, y'know, spending several years learning a language). Most major cities have directories of English-speaking therapists, and services like TalkSpace and Babylon have made digital therapy moderately accessible – at least to those who can afford it.
Babylon, which costs £39 per session, allows access to English-speaking therapists via a website or downloadable app. "Giving people access to digital therapy addresses several of the key barriers many face when trying to access treatment," said Rebecca Minton, therapy lead at the service. Patients can undertake consultations over the phone or online, removing the need for location-bound services.
Similarly, TalkSpace (at the slightly pricier $69 per week for unlimited messaging and four video or audio sessions per month), allows access to therapeutic services "regardless of time or location". TalkSpace allows users to start the therapy process via text-based messaging, and now offers video calling features, which it says allows people to have a "more intimate experience with their therapist", despite location. Many therapists offer similar services, so if you have a therapist pre-emigration it's worth asking them whether they'll consider seeing you via Skype or phone.
Technology can also provide slight respite from the strain of missing friends and family. Though Charlie, who emigrated to Australia from Ireland, described being away from loved ones as adding "a certain strain", he also said that instant messaging meant it was "easy to send someone a quick 'I'm okay' or ask for help".
Emigrating can also have its benefits. Livi said moving to France after a period of severe instability had felt like "a break from life", and Charlie described his experiences in Australia as "like seeing life in technicolour".
"Because of where I was from, I was so used to be a typical young man, not talking about anything and living in an insular and narrow-minded environment," he said. "When I moved, I got a whole new ecosystem where I actually had space for my mental health issues and accepted them. And it's a cliché to talk about the lifestyle, but being outside in the sun, taking the time to eat better, walking more... it chipped away at some of the hardness I'd developed when I was trying to repress my feelings."
Preparation is key: things like remembering to bring enough medication might seem like superficially simple advice, but being stranded without access to meds can be a powerfully isolating situation, as well as potentially dangerous.
It's also important to remember that emigrating may not be the all-powerful panacea for your problems that you might have hoped, especially if your mental illness is chronic. As I tweeted during a 2am breakdown the other day, moving to another country doesn't mean you no longer have mental health problems, it just means you have them in a new language.
"Lots of people emigrate to get away from their problems," said Barnes. "And sometimes it works. But our problems and personal issues follow us and still need to be dealt with."
More on mental health:
Language of Catastrophe: Why We Need to Stop Saying We're Mental
Female Hormones Can Make a Bloody Mess of Your Mental Health
Why Mental Health Disorders Emerge In Your Early Twenties