Dr. Sean Truman grew up in Nairobi, Kenya, where his father worked for the United Nations. He attended the International School of Kenya in Nairobi, where his mother was a teacher. He knows what it means to be an expatriate.

He also knows the stress a family can go through living overseas, which is why, a few years ago, he formed The Truman Group, a mental health practice that specifically serves expats. He and his fellow therapists use Skype to treat expatriate employees across the globe struggling with varied mental health/emotional issues that could cause an otherwise perfect-fit assignment to crumble, potentially costing employers hundreds of thousands if dollars.

Take a company with 200 employees working as expatriates. The cost of sending one person and a family over is around $1 million. The failure rate of an assignment is around 6% on average, with 67% of those failures coming from family adjustment issues. Even if the expat does not "wash out," if the employee is in any way impaired because of family issues, the cost is around $20,640 per employee.

This is according to research by the Levinson Institute, which develops technology-based tools to assist HR/benefits professionals in relocating families abroad.


Specialized EAPs offer help

Enter an employee assistance program specifically for expatriates and families. The average cost of preparing a family and following up is around $2,750 per employee, with 65% effectiveness. The return on investment is around $13.68 for every dollar invested in making the transition a smooth one.

"Think about what it's like to be overseas; [expats] don't just go somewhere and stay there for 10 years - it's two to three years and then a move," Truman says. "Think about the ways that affects [their ability] to make significant relationships that will sustain over time. If you've never been seen as an outsider, it's a weird experience. Multiple stresses on individuals and families and all of that will increase the probability that people have problems."

An expat-focused EAP can help head off these problems, offering services ranging from support groups for spouses, predeparture screenings and cross-cultural training to connecting the employee with a therapist who specializes in expat issues.


Dupont the exception

At Chestnut Global Partners, the care model includes outreach to employees going abroad before an assignment begins to catch problems before they arise and even aid companies in selecting expatriates based on "emotional maturity" on the front end.

However, as David Sharar, managing director at CGP, acknowledges, "companies don't select [expats] to go abroad based on [emotional stability] ... They do it based on technical skill."

An exception is Dupont, which sends numerous people abroad each year. Paul Heck, the firm's global manager of employee assistance and work-life services, works with seven regional EAPs to help screen employees once they have been chosen to go abroad.

Employees and family members go through a medical evaluation and then a cross-cultural adaptability assessment. The employee and the family then sits down with a staff member to go through the assessment and if no red flags are raised, then the employee is cleared for departure.


Extra work 'worth it'

"We don't want to put anyone through inquisition, but if someone does raise concern we'll have more in-depth discussion with them and their family. At the end of the day, [our goal is to] make sure people don't feel alone," Heck says.

The extra work pre-assignment is worth it, emphasizes Dr. Dale Masi, an expert on EAPs and president of Masi Research Consultants, Inc.

"[Employers] need more knowledge to really give this some thought and try to access people who've had some deeper experience with this and understanding of it," he says. "It's worth their time to do this because frankly the cost is so high when they have to bring a family back. And no doubt about it, families are sent back."



Expats more likely to be depressed, abuse drugs, alcohol

A study conducted jointly by Chestnut Global Partners and the Truman Group reveals that expatriates face a higher overall risk for mental health problems and substance abuse disorders. Specifically, 50% of expatriates in the study were at high risk for problems like anxiety and depression, a rate 2.5 times their U.S.-based counterparts.

"Studies estimate that American expatriates have rates of assignment failure as high as 40%, which often results from stress caused by cultural differences and demanding workloads," says study co-author Dave Sharar, Ph.D., managing director of Chestnut Global Partners, the international employee assistance arm of Chestnut Health Systems. "As the number of expatriates is expected to increase, our findings underscore the need to design programs and provide services that mitigate the challenges of living and working abroad."

Indeed, according to the 2012 Global Relocation Trends Survey report from Brookfield GRS, there was a 64% increase in expat assignments in 2011 following a downturn the previous year due to economic pressures. Sixty-three percent of those surveyed, meanwhile, expect this upward trend to continue in 2012, signaling a return to pre-recession activity levels. Research for the report was compiled from 123 companies around the world; combined, these firms manage a worldwide employee population of 6.9 million.

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