Guidance

Foreign travel advice for people with mental health needs

Advice for British nationals with mental health needs to prepare for travelling and living abroad, and how the FCO can help.

Overview

This guide provides advice for British nationals with mental health needs, and their families and carers, to prepare for travelling and living abroad, including how the Foreign & Commonwealth Office (FCO) can help. It explains some of the differences between English law and practice and that of other countries.

To produce this guide, we have gathered feedback from a range of people with mental health needs and organisations that specialise in mental health support. This information on mental health abroad is also available in pdf format. The information complements our fuller advice in Support for British nationals abroad: a guide, which sets out further details of who we can help.

When offering you support, we will ensure that our help is accessible and equal to everyone, no matter what your sex, race, age, sexuality, disability, religion or belief.

Factors affecting mental health during travel

Your mental and physical health prior to, and during, a trip determine how well you will cope with travel stress. Lack of familiar support systems, disrupted daily routines, language barriers, culture shock and unexpected situations can intensify stress levels rather than alleviate them. Consider the following:

  • tiredness or lack of sleep
  • major life events occurring prior to travel such as a birth, death, wedding, divorce, moving or serious illness
  • difficult home or professional life; experiencing recent emotional exhaustion or financial strain
  • being lonely; prone to depression and anxiety
  • having pre-existing psychiatric, behavioural, neurological disorders; memory or cognitive deficits.
  • dependence on, or misuse of, psychoactive substances
  • using medications that have psychiatric or neurological side effects (some anti-retrovirals and anti-malarials)
  • stopping medications while travelling and the side effects of this withdrawal
  • infections (particularly urinary tract infections in people over 60 years of age) are an example of the physical health issues that can radically affect behaviour and mental health
  • type and duration of travel; adventure, business, leisure, emergency aid work, missions
  • travel destination; travelling to politically unstable or war-torn areas, returning to a place where psychological trauma occurred
  • there are clear links between mental and physical health, which makes looking after yourself whilst travelling and while abroad so important

Planning before you go

Follow this checklist to prepare for travel abroad:

Have you checked the foreign travel advice?

Check our foreign travel advice and Travel Aware information. Monitor news reports of any problems in the area you are visiting. Follow FCO Travel on Twitter and Facebook for regular travel advice updates from the FCO.

Does your insurance cover your mental health condition?

Before you travel, get comprehensive travel insurance – which includes any pre-existing medical conditions you have, and ensure it covers all activities you intend to undertake. If you do not take out proper insurance, you will normally have to pay the costs of any emergency yourself, including expensive medical bills. Choosing to go to a country against our travel advice may seriously restrict any help we can provide and may also mean that your travel insurance is not valid. More guidance on insurance

Anyone travelling within the European Economic Area or Switzerland should also get a free European Health Insurance Card (EHIC). You can apply online, by phone on 0300 3301350 or at Post Offices.

At least six weeks before you travel, check with your doctor what vaccinations and other health precautions you may need to take for your trip. Take any prescribed medicine with you and keep it to hand, as well as a copy of the prescription. Be aware that some medications (including prescription medications) may be illegal in the country you are visiting. Speak to your prescribing doctor for advice. More guidance on medication.

Is your passport valid and in good condition?

Make sure your passport is valid and in good condition and that you have any necessary visas. Fill in the emergency contact details in your passport.

Have you left copies of your passport and insurance documents with family or friends or someone else you trust?

Leave copies of your passport, insurance policy (plus the insurer’s 24-hour emergency number), ticket details, your itinerary and contact details with your family and friends or someone else you trust.

Have you got enough funds for your trip?

Take enough money for the duration of your trip and some backup funds, such as appropriate travellers’ cheques, prepaid cash cards or credit cards. Before you leave, find out how you can replace your travellers’ cheques and credit cards if you lose them, and keep a separate note of their numbers.

Have you researched your destination?

Before you go, get a good guidebook and get to know your destination. Find out about local laws and customs, and follow them. Be aware of your personal security and take sensible precautions to protect yourself.

What mental health services are available in the country you are travelling to?

Before you go research what mental health facilities are available in your destination. Facilities and resources available to those experiencing mental health issues, as well as the understanding of these issues, vary greatly in different countries. Remember that we cannot get you better treatment in a hospital than the treatment that is given to local people because we cannot interfere in another country’s processes (just as we would not accept such interference in the UK).

Who would help you if your mental health deteriorated abroad and how would you contact them?

If you want us to we can contact friends and family in the UK or in the country you are visiting. We would usually need your permission and their details to do so. So keep details of friends, family and/or carers with you when you travel and fill in the details at the back of your passport. It is a good idea to carry a ‘travelling letter’, which gives a brief description of your mental health needs, diagnosis and, if appropriate, details of any difficulties that could occur and what assistance you might then need. This may be part of any Wellness Recovery Plan or Advance Directive you already have in place.

Have you considered giving someone Power of Attorney?

If you want to, you can give someone the power of attorney to look after your financial affairs in the UK while you’re away. You could also consider if you want to give someone the power to make decisions about your welfare or health care in case a situation arises where you are unable or incapable to make decisions for yourself.

What kind of help the Foreign and Commonwealth Office can provide

Whenever possible, we will seek your permission before taking any action on your behalf. We can:

  • listen to you and help you look at your options
  • help you contact friends, family and/or carers if you want to
  • visit you in hospital or prison and, where possible, prioritise the visit
  • raise any concerns about your treatment or welfare with the responsible authority (such as a prison or hospital)
  • help medical staff overseas contact medical staff in the UK who may be able to provide advice on your medical history
  • give information about local medication suppliers
  • be available, as appropriate, to offer you assistance if you choose to remain overseas
  • offer information to help you make an informed decision about returning to the UK, if you plan to do so
  • liaise with your travel representative or travel insurance company, if you want us to

We cannot:

  • give you medical advice
  • buy or supply medication
  • withhold or remove a passport
  • stop you from travelling abroad
  • require you to return to the UK
  • pay for you to return to the UK
  • pay for food, accommodation or medical bills
  • get you better treatment in hospital or prison than is given to local people

While you are abroad

Promote and maintain your mental health when travelling

There are a range of resources available online to help you understand how travel can impact your mental health. You may wish to discuss this with your GP or community mental health team. For more information, including detailed tips on preparing for travel with mental health needs, visit International Association for Medical Assistance to Travellers.

Keep a note of contact details

Keep a note of the local British Embassy, High Commission or Consulate phone number and find out how to get in touch with the local emergency services.

Stay in touch with family, friends and/or carers

Stay in regular touch with your family and friends in the UK, especially if you are travelling alone or in a remote area, or if you are aware of a crisis in the region in which you are travelling. Although you may feel perfectly safe, people at home may worry if they don’t hear from you and could report you missing. If you take your mobile phone abroad, make sure you have international roaming (the facility to use your phone on a foreign network), and an adaptor so you can recharge your battery.

General advice

In addition you should:

  • follow health advice. You should, for example, drink plenty of safe drinking water, use sunscreen, and take care what you eat and where you eat it

  • protect your passport. A passport is a valuable document. You are responsible for taking all reasonable steps to protect it

If something happens to you abroad

British nationals take millions of trips overseas every year, most of which are trouble free. But if you do get into difficulty with your mental health you can approach the nearest British Embassy, High Commission or Consulate to find out how our consular staff can help you.

Your holiday representative, local guide, hotel or local police should also have information about your nearest FCO office. To enable you to make quick contact with people who might be able to help in an emergency it is a good idea to take an overseas activated mobile phone with you.

If you need help in a country where there is no British diplomatic or consular office, you can receive help from the diplomatic or consular office of another member of the European Union. There are also informal arrangements with some Commonwealth countries, including New Zealand and Australia, to help British nationals in some countries.

Mental health support at your destination

Facilities and resources available to those experiencing mental health issues, as well as the understanding of these issues, vary greatly in different countries.

Where appropriate, we will do our best to help you find support and advice wherever you are. If you need medication, we can provide information on prescribing and dispensing doctors or chemists. We are unable to provide and pay for specialist mental health help, advice or medical supplies. If you want, we can contact your family and friends in the UK.

If you would like to speak to charities or NGOs for emotional assistance or advice there are a number of UK online services you can access overseas

Mental health hospitalisation

Mental health law differs in each country and therefore local law will govern the area to which you have travelled. Detention under local mental health law may not be transferable to another country. In Northern Ireland this law is the Mental Health NI Order (1986) and in Scotland this is the New Mental Health Act (2004) In England, the Mental Health Act 1983 (as amended 2007) is the law under which someone can be admitted, detained and treated in hospital against their will. It does not apply to all people with a mental health condition and there are specific criteria which need to be met if it is going to be used.

What this means for you

If you need hospital treatment overseas for a mental health issue and receive treatment in the UK, we will try to help overseas and UK medical staff to contact each other. Our aim is for relevant information to be shared between those treating you, so you can receive appropriate care in-country and ongoing support if you return to the UK. Having travel insurance can be very helpful in providing payment for medical treatment. However, there are occasions where it becomes invalid – for instance, if a pre-existing condition is not declared or if the policy does not cover mental health needs. In these cases, you or your family must pay for any treatment.

If you have been detained under the Mental Health Act in the UK and you abscond overseas, the authorities in some countries will try to contact the UK hospital. They may also arrange for you to return to the UK hospital, often at your own expense. The UK hospital may report you missing to local police.

If you are detained under the mental health law of another country, the hospital may try to arrange for a UK Community Mental Health team or psychiatric hospital to assess you or provide follow up on your return. Unfortunately, in some countries you may be detained in a prison facility and then deported.

What this means for family, friends and/or carers

Individuals often nominate the person they wish to be their next of kin, whereas “Nearest Relative” status is a specific legal term within the English Mental Health Act 1983. The Nearest Relative is given certain powers and rights under the Act, which are only applicable in England and Wales. These rights and powers are therefore not transferable to other countries.

We cannot overrule consent unless a person is deemed to lack capacity. This might mean that we cannot share specific information with you about a person’s hospitalisation.

In some countries, it is common practice for family to be expected to consent to medical treatment or hospital admission – even when detention under local mental health law is being considered. We cannot provide this consent on behalf of family or friends, nor can we request a hospital admission or discharge for the person we are assisting.

Data protection and mental health hospitalisation

Being hospitalised for mental health reasons does not take away an individual’s right to make decisions about their personal information. We cannot automatically disclose personal information about a hospitalised person, even if a family member or friend holds a specific status within the local mental health legislation.

Mental capacity

Mental capacity is the ability to make decisions. Mental health and mental capacity are two different things. A person with a mental health diagnosis does not automatically lack capacity, and a person who lacks capacity does not automatically have a mental illness. For example, a person with a diagnosis of Bipolar Affective Disorder (manic depression) does not usually lack capacity. However, if they were to become acutely unwell, they may temporarily lack capacity to make some decisions. They will not lack capacity permanently. While English legislation does not apply outside the UK, the FCO uses it as a framework for assisting British nationals overseas.

Consular staff in British Embassies, High Commissions and Consulates overseas are not trained to undertake complex capacity assessments. However, there may be times when there are concerns about capacity. These concerns will be discussed by FCO staff using the above English legislation as a framework.

What this means for you

We will respect the decisions you take and assume that you have the capacity to make decisions unless proven otherwise.

We will give you as much information as we can or direct you to people who can help so you can make an informed decision.

If we have concerns about your capacity, we will discuss this using the previous four points before making any decisions about how to assist you.

What this means for family, friends and/or carers

If an individual has the capacity to make decisions, we will respect those decisions. This means, for example, that if the person refuses to allow us to contact family or friends, we can ask again, but we cannot ordinarily overrule the decision when the person has capacity.

Data protection and mental capacity

Even if a family member or friend holds the position of Power of Attorney, that person does not necessarily have rights to the sensitive personal information of the person represented, unless it is a Health and Welfare Lasting Power of Attorney. Where a registered Enduring or Lasting Power of Attorney is in place, we may only share information with the designated person in the best interests of the individual we are assisting.

Data protection

The Data Protection Act (1998) establishes a framework of rights and duties which are designed to safeguard personal data. All organisations collecting and using personal information are legally required to comply with the principles of the Act.

The threshold for sharing sensitive or confidential information (such as your ethnic background or health issues) is higher than that for other sorts of information. In most cases, consent should be obtained prior to sensitive information being shared. However, there will be occasions where information may be shared without the individual giving consent. For instance, advising an airline that a passenger with a serious communicable disease (like typhoid) is intending to travel, as this could potentially harm other passengers.

What this means for you

We will respect your personal information and store it securely. Wherever possible, we will seek your permission in order to assist you appropriately. Please be aware that in certain circumstances we are obliged to inform other authorities, such as where it is necessary for the prevention and detection of crime or immediate risk to life.

What this means for family, friends and/or carers

We understand that family and friends may be worried about a loved one. However, if the individual declines permission for us to make contact or discuss their situation we must respect their decision. We can however, listen to and record your concerns and talk in general terms about the types of assistance we may provide in similar circumstances.

Returning to the UK

If you would like us to we can try to assist you in making plans for your return. This could involve contact with family or friends, social services, NHS teams and/or charities and NGOs.

If you are a British national returning to the UK after living abroad, or if you are a British national but have never lived in the UK, you may not be automatically entitled to state benefits, a state retirement pension, free NHS hospital treatment or assistance with higher education fees. To be eligible for any of these, a British national must meet certain residence requirements and/or make the appropriate National Insurance contributions. British nationality or past/present payment of UK taxes and National Insurance contributions are not taken into consideration when establishing residence.

See information on benefits and services, employment, tax and education, and you can get free, independent advice from the Citizens Advice Bureau.

If you have served in the British or Commonwealth Forces, the Royal British Legion (RBL) or the Soldiers, Sailors, Airmen and Families Association (SSAFA) may be able to help you.

Staying overseas

It is your decision whether you stay overseas or return to the UK. This can depend on local conditions, cost of living and availability of help. You could consider:

  • looking for support or services from recognised charities, voluntary groups, welfare organisations or religious groups
  • if you have served in the British or Commonwealth Forces, the Royal British Legion (RBL) or the Soldiers, Sailors, Airmen and Families Association (SSAFA) may be able to help you

Although we will respect your decision to stay overseas as far as possible, the local authorities may insist or require you to leave the country. This may be the case if a British national has been detained, hospitalised under mental health legislation, cannot support themselves, or has overstayed their visa.

What to do if you are worried about someone else

In the UK who is planning to travel overseas

  • If you can, speak to the person you are concerned about and look at this leaflet together.

  • Talk to any professionals involved in that person’s care and explain your concerns. Consider whether that person has the mental capacity to travel.

  • Contact charities and NGOs for advice.

Who is missing and believed to be overseas

If you are in the UK and worried about a British national who you think is missing abroad, we can tell you how to make a missing persons report with your local police so that Interpol enquiries can begin.

It is important that you include any details of the person’s mental health needs and any other reasons they may be vulnerable.

Although we cannot carry out physical searches on your behalf, we can give you information about appropriate local authorities. We can also give you contact details for any relevant local charitable and voluntary organisations specialising in tracing missing people. Where appropriate, we can give you information about the federation or association of local private detective agencies.

If you want, consular staff in the UK can meet family representatives, maintain contact with you and tell you about any new developments which we find out about.

We can put you in touch with The Lucie Blackman Trust who may be able to offer further advice and help.

We have a leaflet called Missing persons abroad which you may find helpful.

Who is known to be overseas and you are worried

When we are told about an incident involving a British national abroad we will try to contact the person’s family as soon as possible.

You can tell consular staff in London what your concerns are. This can include the reasons for your concern, details of that person’s diagnosis, professionals involved in the UK and any risks that you are aware of.

However, we cannot normally pass on information to relatives if the person involved asks us not to – for example, if they have been hospitalised but do not want their family to know about this.

Insurance

Make sure your insurance is up-to-date, valid for the entire trip and covers everyone who is travelling. When looking for travel insurance, ask as many questions as possible to ensure that the policy you buy will be right for you. Check what is covered, for example:

  • medical and repatriation expenses
  • cancellation of the trip or any delays you may experience

You should also look carefully at exemptions to the policy, including any relating to alcohol and drugs or pre-existing medical conditions. When you declare a medical condition you will generally have to undergo some sort of medical screening.

Please be aware that some insurance companies will exclude cover for a mental health condition – it is likely to be worth shopping around. Always check the small print.

When looking for an insurance supplier, you should bear in mind any rights you may have under the Equality Act and any corresponding obligations of the insurer. If you feel that you have been discriminated against within the meaning of this Act then you should raise this with the insurer.

This can mean calling a medical helpline to give details of your condition, or asking your doctor to complete a questionnaire or declaration of fitness to travel. Alternatively, you might simply be required to sign a declaration stating that you are not travelling against doctor’s orders, do not have a terminal prognosis, have not received in-patient treatment in the last six months, and are not awaiting treatment or travelling in order to obtain it.

Medication

If you take medication, you should ensure that you take enough with you to see you through the holiday and allow for possible delays. Always keep clearly labelled medication and any medical documents in your hand luggage or in a place you can get to them easily.

It may be essential to have a letter from your doctor stating your need for the medication just in case you lose your medicine, need to get more and particularly if you are going to a country with strict drug controls. You should always be ready to show this letter to customs officers.

Because of increased security at airports, it is vital that you check with your airline provider what documentation you should take with you to prove the need to carry medication and in what receptacles the medicines should be carried.

The medication you take may contain ingredients which are illegal in some countries. Check with your prescribing doctor and the nearest Embassy or High Commission of the country you are visiting to find out more about any restrictions.

Legislative background

Mental Capacity Act (2005)

The 5 core principles of the Mental Capacity Act (2005) (England and Wales) are that:

  • people aged 16 and over have the right to make their own decisions and must be assumed to have capacity unless it is established otherwise
  • individuals must be given all appropriate help before anyone concludes that they cannot make their own decisions
  • people with the capacity to make a decision retain the right to make what might be seen as an eccentric or unwise decision
  • any decision made on behalf of someone who is deemed to lack capacity must be in their best interest
  • any action taken on someone’s behalf should be the least restrictive of their basic rights and liberties

A person is deemed to lack capacity if they are unable to do one of the following:

  • understand the information relevant to the decision
  • retain the information for long enough to be able to make a decision
  • use or weigh up the information as part of the process of making the decision
  • communicate the decision by any possible method, such as talking, using sign language and squeezing someone’s hand

Data Protection Act (1998)

Some of the key principles of the Data Protection Act (1998) are:

  • data should be kept securely
  • data should only be used for the purposes for which it was originally obtained
  • it should not be retained for longer than is necessary
  • it should not be transferred to countries which do not have adequate data protection laws
  • any decision made on behalf of someone who is deemed to lack capacity must be in their best interest
  • any action taken on someone’s behalf should be the least restrictive of their basic rights and liberties

These principles are designed to ensure that there are certain safeguards in place which protect individuals’ privacy. Wherever possible, individuals should be able to exercise choice on whether their information is to be shared.

Sources of information and support

Internationally available online support services

There are a variety of e-communities, counselling services and peer support groups that you can access abroad. They can also be helpful if talking on the phone or face to face feels too challenging.

Useful contact information in the UK

Charities providing fact sheets on all issues to do with mental health, including diagnosis, treatment, stigma, law, travel insurance.

Mind
For better mental health
MindInfoLine: 0300 123 3393

Rethink
Working together to help everyone affected by severe mental illness recover a better quality of life
Rethink Advice and Information Service: 0300 5000 927 (Mon–Fri 10am–2pm)

SANE
Meeting the challenge of mental illness
SaneLine: 0845 767 8000

Mental Health Foundation
The UK charity for everyone’s mental health

Other relevant organisations in the UK

Office of the Public Guardian
The Office of the Public Guardian supports and promotes decision making for those who lack capacity or would like to plan for their future, within the framework of the Mental Capacity Act 2005.

Age UK
Age UK has a vision of a world in which older people flourish and aims to improve later life for everyone through information and advice, campaigns, products, training and research.
Tel: 0800 169 6565

Time to Change Campaign
Let’s end mental health discrimination.

Royal British Legion
Caring and campaigning for the serving and ex-service community.
Telephone helpline open to everyone 8am–8pm, 7 days a week: 0808 802 8080 (free from UK landlines and main mobile networks)
Overseas: +44 (0)20 3376 8080 (full rate)

The Soldiers, Sailors, Airmen and Families Association (SSAFA)
One day’s service, a lifetime of support for Armed Forces personnel and their families
Forcesline free phone numbers (open Mon to Fri 10.30am–7.30pm UK time)
UK: 0800 731 4880
Germany: 0800 1827 395
Cyprus: 800 91065
Falklands # 6111
Rest of the world + 44 (0)207 463 9292

Useful contact information: international organisations

World Fellowship for Schizophrenia and Allied Disorders (WFSAD)
WFSAD is the only global grassroots organisation dedicated to lightening the burden of schizophrenia and other serious mental illnesses for sufferers and their families. WFSAD has now merged with the World Federation for Mental Health
Tel +1 416 961 2855

Befrienders Worldwide with the Samaritans
Befrienders centres work to reduce suicide worldwide with 31,000 volunteers in 40 countries. The website gives details of local helplines around the world, as well as further information on depression and suicide intervention.

Published 22 March 2013
Last updated 10 October 2016 + show all updates
  1. Information and links updated.
  2. An additional leaflet linked to, and a new checklist attached.
  3. First published.