Yellow September : A Month for Mental Health

Yellow September is an opportunity to highlight and heighten mental health awareness. That’s why every year September 10 is marked as World Suicide Day.

However, the entire month is a reminder that mental health concerns everyone, including those living abroad. Whether it’s missing good times with friends or craving nothing but family recipes, living abroad can be an adjustment.

Not to mention the added stress that can come with learning a new language and culture.

Homesickness is one of the most common forms of emotional distress that people living away from home face. Students or those working overseas may feel lonely or withdrawn from their new community.

They may also have physical symptoms such as lack of appetite or even trouble sleeping.

People experience homesickness in waves, however, and many get over the culture shock and find ways to feel more integrated into their new society, or to keep pieces of home with them. 

Missing home in a foreign land is completely normal | Photo by Ümit Bulut on Unsplash

But expatriates also contend with other serious mental health issues, such as depression and anxiety. It might be tempting to brush these issues aside as a little homesickness that will blow over.

However, it is believed by some professionals that people living overseas have a high risk of developing mental health issues.

The reasons for this may vary, ranging from difficulty fitting in, adjusting to new social norms or expectations, or the tasks associated with forging new relationships.

Additionally, complicating matters is that it can be difficult to distinguish a bad mood or a funk from a mental health concern. This makes it hard for individuals to know when to seek help.

Moreover, how does one go about accessing mental health services and resources in a country like Japan? 

Jump To :

Mental health risk among expatriates

Mental health issues of students

Language barrier and mental health

Isolation and mental health

Seeking help


Mental health risk among expatriates

Figuring out life in a foreign country might be challenging | Photo by Steven Lewis on Unsplash

According to a 2018 study published in the International Journal of Health & Productivity, expatriates can have a higher risk of mental health problems compared to their counterparts living at home.

The subjects in the study “had higher overall risk for mental health problems, including risk for internalizing problems, externalizing problems, and substance use disorders.”

These findings are largely consistent with the notion that living as an expatriate involves very significant stress and high demand for adjustment.

While these demands can be (and frequently are) exciting, engaging and interesting, they can also converge to the point where they become impairing and precipitate significant mental health or psychosocial problems.” 

The authors of the study further wrote: “We hypothesized that expatriates would be particularly prone to internalizing problems.

This position is consistent with the notion that moves, cultural dislocation, stress and high demand for adjustment and adaptation can lead to problems, and in particular anxiety disorders and depression.”

Mental health issues of students 

Academic pressure, financial challenges, and more could add up to one’s mental stress | Photo by Centre for Ageing Better on Unsplash

There are also mental health worries for students in foreign countries. Several studies have been conducted on the mental health of international students in Japan.

Research in 2019 analyzed 55 previous studies of factors influencing the well-being of migrants in Japan. The research participants ranged from junior high school students to university students to workers.

The analysis identified language difficulties and lack of social support among impediments to mental well-being. 

In 2002, an article titled Psychological barriers for international students in Japan, cited previous studies in the United States and Canada showing that international students may even face mental health issues before entering the new country.

In addition, mental health problems in students can be difficult to recognize as students may tend to repress their issues. Problems can surround financial challenges, getting used to a new culture and adapting to a different climate.  

The academic pressure is equally hard for any students | Photo by Kenny Eliason on Unsplash

However, it’s not just international students who have mental health problems. A 2000 UNICEF report concluded that school-aged children in Japan lagged behind their peers in other developed nations in terms of mental well-being.

A newspaper article on the study said: “Among the factors examined to rank mental health were the ratio of children who said they were satisfied with their lives as well as suicide rates.

Japan topped the ranking for physical health, but only ranked 27th for academic and social skills and 37th, or second from the worst, for mental well-being.

Children aged 15 were asked to rank their satisfaction with life on a scale of 0 to 10. In Japan, close to 40 percent of the respondents gave responses of 5 or lower, while the figure was about 10 percent for the Netherlands.”

This again reinforces the idea that mental health is everyone’s concern. 

Language barrier and mental health 

Explaining your emotion in a different language could be tricky | Photo by Joshua Hoehne on Unsplash

In the analysis of 55 studies mentioned previously, the issue most commonly stated as having a negative effect on the mental health of migrants was trouble communicating in Japanese. 

These studies reported that language barriers created stress in managing daily life or trouble describing symptoms in a medical environment. 

Indeed, many foreigners, from long-term residents to tourists, have experienced the language barrier at one point or the other. To some extent, this is to be expected.

Japan is the only country where Japanese is spoken and Japan was shut off from the rest of the world for a long time.

There might be ways to get over language, general communication differences and culture shock, but these matters can still amplify feelings of displacement. For this reason alone, seeking mental health support is an option. 

Isolation and Mental Health

On top of other issues, building a relationship is also a hard challenge to face | Photo by Sasha Freemind on Unsplash

Many people who move to Japan do it alone. They live alone, without family, and navigate social or business situations with limited or no support.

Their feelings of being alone can also be compounded by seeing images on social media of friends and family members back home socializing. This can be particularly pronounced at holiday times or periods of special celebrations.

Among the Japanese, isolation is also a growing social issue, with the appointment of a so-called minister of loneliness making world headlines in 2021.

Just this year, a government survey showed that 40% of people felt lonely, at least sometimes. 

Foreigners in Japan are not separate from the environment in which they live. Their mental health can take a hit under these circumstances. During the pandemic,too, many foreigners felt even more isolated. 

With the language barrier, lack of social networks and support, and general isolation, it may be necessary for foreigners to seek out mental health resources. 

Seeking Help

Talking out your feelings to a certified professional might help your mental health. | Photo by Alvin Mahmudov on Unsplash

As mentioned earlier, it can be hard to know when a feeling of sadness isn’t just temporary. It might be better, however, to err on the side of caution and seek help whenever in doubt about your mental well-being.

If you appear to be spending a significant portion of time simply managing or coping in your daily life, then it might be time to seek assistance.

Fortunately, several resources are available in Japan. This A Guide to Getting Mental Health Support in Japanarticle has a substantial list of services in Japan, as well as online resources.

It also covers topics such as the cost of mental health services, and differences between private and public mental health care in Japan. 

While there are psychiatry, psychology and psychosomatic clinics in Japan, and mental health support is provided by many wards and cities, research suggests that rates of access are not high.

A 2020 study concluded that “foreign nationals who reside in Japan are less likely to contact appropriate services for mental illness, especially young people at relatively high risk of mental illness. Furthermore, lack of medical interpreters may impede the mental health conditions of foreign nationals.” 

Counseling services like Tokyo English Life Line offer text chat, telephone or in-person support, so people don’t have to go out of their way to get to the service. TELL offers support in Portuguese, Spanish, Cantonese and Japanese as well. 

Tokyo Mental Health is another service offering online support in English. There is also a growing number of non Japan specific apps and online platforms helping people manage mental health issues. 

For some people, becoming part of a community with a shared interest or background, or making deliberate efforts to regularly reconnect with friends and family can also go a long way. 


All in all, mental health and wellness is not a taboo thing to talk about. | Photo by Emma Simpson on Unsplash

Whether it’s homesickness or more serious issues like depression, expatriates contend with mental health issues.

The adjustments that come with living in a new country are significant and can lead to people living overseas being at a high risk of developing mental health problems. Everything is new and exciting at first, but after a while may become overwhelming and just too different.

Yellow September, or Mental Health Awareness Month, brings these issues under the spotlight. In addition, students at all levels in the education system as well as working members of society can be affected.

In Japan, where loneliness and isolation are national concerns, the language barrier and cultural differences can lead to even more isolation among the international community. 

However, services are available to assist anyone in need with mental health concerns. 


How can I get mental support if I’m not comfortable talking to someone?

Counseling services like TELL and Tokyo Mental Health offer online or telephone consultations. Apps like Betterhelp and Talkspace have various modes of therapy and can be used by people in various countries. 

How can I maintain mental well-being while living in Japan?

The same things might not work for everyone. However, some general tips include maintaining contact with loved ones, actively attempting to make connections in your new country, and paying the usual necessary attention to diet, exercise and sleep.

Perhaps a regular phone call to friends or a weekly Japanese class can help ease some of the culture shock and lead to smoother integration. 

How can I get mental health support in Japan in languages other than English? 

Language can be a significant barrier to accessing mental health services. As mentioned above, TELL provides support in Portuguese, Spanish, Cantonese and Japanese.

Tokyo Counseling Services offers support in German, Korean and Chinese (in addition to English and Japanese). 

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