Travelling with a mental health condition

• The first step to prepare for your trip is simply to recognise to yourself that it may be challenging. This doesn't mean panicking or ruminating over 'what ifs', it means simply to acknowledge that things may not go according to plan and that you should be adequately prepared for such an eventuality; a mess-up doesn't have to become an unmanageable problem.
• Many countries deny entry to travellers with serious mental health conditions. Consult your destination's diplomatic mission to confirm whether you are eligible to visit your destination.
• When planning your journey, make sure it is well thought out, with realistic time allocated to making connections and developing contingency plans to cope with delays. It is also a good idea to learn your route, especially if you're going somewhere for the first time. When you're familiar with your own schedule and know where each leg of your journey will take you and how long it should take, you will naturally feel more in control. If you suffer from anxiety, be mindful of anything about the travelling process that may cause you to feel anxious, and think of ways around it. For example, if you are a nervous flyer, you may wish to read Wikivoyage's Advice for nervous flyers, or if practical you may consider alternative ways of reaching your destination without ever needing to get on a plane: by train, by boat, by car or by bus. If the thought of travelling underground on a packed subway train fills you with dread, investigate the other transport options in your destination city.
• Think about the kind of trip that will work for you. Would you be happier on board a cruise ship, which will provide everything you need, or visiting a city, where you get to explore new sights? Would you rather roam from place to place, or stay in one spot? Do you want an urban adventure or a backpacking trip? Do you want to travel alone, with friends and family, or with other people? A tour group provides some safety and reduces your planning effort, but you will have to be able to keep up with their schedule. Travelling with friends and family can be delightful – or, in other cases, a difficult loved one can be the extra burden that destroys your spirit.
• Research your destination well in advance of going there. Get to know the place you'll be staying, the culture and the language as much as possible. Learn about local traditions, and the religious and political situation you'll be encountering. And don't overlook the little things. Find out where the nearest supermarket is, whether there are any local holidays that may disrupt your arrival or departure, and where's a great place to eat if you're arriving at an unusual time of day. It's a good thing you're on Wikivoyage, eh?
• Don't overschedule yourself. Don't aim for eight countries in seven days, or six wineries in four hours, or ten long business meetings in one day. Build your schedule so that you won't need a holiday to rest up from your trip.
• Communicate your plans and needs in advance. Leave a copy of your itinerary with friends or family, and tell them when and how you will contact them during your trip. If you are joining a tour group or other organised program, send some practical information about your condition to the operator in advance. Most travel professionals have experience with common problems, such as anxiety and sleep disorders. Tell them what you might need – perhaps extra sleep or avoiding crowded, claustrophobic areas? – and what to do and who to contact in case of a serious difficulty.
• As for combating feelings of disorientation, the internet age allows you to 'visit' most parts of the world without ever setting foot there. Make use of resources such as Google Street View to, for instance, find out what the neighbourhood outside your hotel looks like, or even to visualise the route you might take from the station to your accommodation. Wikivoyage's airport articles explain the best ways to navigate the world's major airports. Anything that makes you feel less lost when you first arrive has to be worth doing.
• Give a thought to how you're going to stay in touch with home, and how you can contact people if you experience problems. Does the place you're going have an internet connection? How much will a phone call home cost? Does your mobile network allow you to make calls in your destination country? If the worst comes to the worst and you need diplomatic assistance, where is your home country's nearest embassy, high commission or consulate in relation to your destination? Is there a nearby embassy of a third country which can offer diplomatic services to you on behalf of your native country?

• Find out how to access medical facilities, including mental health services, while on your trip. Where are the nearest hospitals? What is the local emergency number? Whom can you turn to if you run into difficulties? Familiarise yourself with the psychiatric care system of your destination. You may wish to find and make contact with a reputable English-speaking mental health professional in your destination of choice before leaving home. In any case, you should take out travel insurance that specifically covers mental health issues and medical repatriation.
• If you are receiving treatment, schedule a review with a medical practitioner (e.g. your psychiatrist, counsellor or general practitioner). Discuss your travel plans and listen to their advice; give notice to whether or not they think your plans are appropriate or advisable with your condition. Request adequate medication supplies to cover your trip. You could also ask them for an official letter written in the language of your travel destination, detailing any diagnoses, treatment plans or medication you take, as well as the name and address of your doctor at home. Such a letter will be of help if you need to access medical or psychiatric services while travelling.
• If you have a potentially serious medical condition, regardless of whether it is related to your mental health situation, consider wearing a medical ID bracelet in addition to tucking an information card in your wallet. If you are feeling seriously unwell, the local medical staff will be grateful to know whether they should be checking for an overactive thyroid or for a problem with your medication schedule first.
• If you take medication, a general rule of thumb is to have enough for the duration of your trip, plus an extra 1-2 weeks' worth in case of loss, theft or unforeseen delays. If you need travel vaccinations or prophylactic drugs such as antimalarials or antibiotics, check with your doctor whether these could interfere with your condition or existing psychiatric medication, and arrange alternative medicine if necessary. If you are changing time zones significantly, ask your healthcare provider whether your schedule should change. When travelling for a long period of time, you will need to research treatment and medication that you can access in your destination.
• Check for special restrictions at your destination. Habit-forming drugs are frequent targets for country-by-country restrictions, and while most are okay at most destinations, the exceptions sometimes surprise people. For example, amphetamines such as Ritalin and Adderall are commonly used in the United States, but possession of these common medications is illegal in Japan. If you take medications for insomnia, anxiety, or attention difficulties, then it's best to check with your destination that your particular meds are okay. If you find that there's a problem, then talk to your doctor early about alternatives.

If you find the above information a lot to take in, take it in baby steps! Allow enough time before you leave home, so you can focus on your preparation one step at a time without feeling overwhelmed. You could write yourself a schedule for when you're going to buy travel tickets, when you're going to meet your doctor, etc. Have a check list to keep track of what you've already done and what is still left to do. Above all, focus on the immediate task.

Main article: Medication

Carry your medication in clearly-marked containers. If at all possible, keep the original packaging, including official labels from your pharmacy that show that this medication has been issued to you. A pile of pills tucked into the bottom of a suitcase looks much more suspicious than a recognisable bottle with a prescription label from your pharmacy. Consider adding your name, nationality and passport number to all containers.

For a short trip, carry all of your medications in your hand luggage. For a long trip, carry at least a week's supply in your hand luggage, in case your checked luggage goes missing in transit. You should have the appropriate prescription and/or doctor's letter to hand (e.g. in a zip pocket of your jacket) should you need to show it to security services or airport staff.

Even though your normal schedule may be impossible or impractical to maintain while on your trip, you should still maintain a regular routine, that you should make time to devise once you have arrived at your destination. Write it down if it will help you to remember, or schedule items into your phone's calendar and enable notifications. Having a regular and predictable pattern of meal times and a good sleep/wake cycle will help you feel in control. Allow yourself time to rest and stay hydrated and fed, even if you have a busy schedule of sightseeing, activities or work. Continue to take medication at the correct times, even if you feel your mental health has improved. If you practise any self-therapy techniques at home, for instance physical exercise, mindfulness, yoga or an emotions diary, continue doing them where possible during your trip, at roughly the same frequency as you would normally keep to. All of these combined will help to keep a sense of familiarity and continuity with your home life, even if the rest of your travel experiences are far out of your comfort zone.

Take your time! Even if there are a million and one things on your bucket list, you shouldn't just rush around a destination without pausing to think or plan your next move. Make a list of the places you really want to visit or the sights you particularly want to see, and prioritise them. Be sensible with the amount of time you allocate for each activity, and take things slow. If you're on vacation, there's absolutely no point in making yourself more stressed than you would have been if you had just stayed at home.

Being surrounded by new sights, sounds and smells can be a sensory overload. If on occasion you find yourself overcome with too much new information to process, you can ground yourself by splitting up the experiences by sense. First, close your eyes and listen to the sounds around you. Then focus on the sense of touch, for example by feeling the temperature or the wind in your hair. Next, try to identify any smells that you can pick up, and probe your mouth for any lingering tastes. Finally open your eyes and take in the scene in front of you. Even this can be broken down into chunks, for instance by just looking at a particular building, or focusing on instances of a certain colour. When you take time to become familiar with your environment, step by step and at your own pace, you can bring yourself out of your mind and into the present moment, while feeling more connected and more at ease with your surroundings. If this kind of self-therapy appeals, you may wish to learn meditation.

Excessive alcohol or illicit drug consumption does have quantifiable effects on one's mood, and the effects are often amplified with people who suffer from mental health conditions or those taking legitimate medication. Of course travel can be about having fun and trying new experiences, but if you wouldn't down four vodka tonics on a night out at home, then don't do it while in a strange environment with a different climate and culture, and laws you may not be familiar with.

If homesickness or culture shock are an issue, the worst thing you can do is spend time ruminating alone. Prolonged inactivity and solitude can be especially damaging for sufferers of mood disorders such as depression, and once you start down that road of self-isolation, a low mood and the fog of inertia can engulf you with frightening speed.

So the thing to do is stay active: throw yourself into discovering the places around you, meet new people, seek new experiences, and say "yes" to opportunities. Not only will this distract you from what might be some quite unpleasant thoughts and feelings, it will also get the heart pumping, engage the brain and senses, and release serotonin, all of which will contribute to raising your mood. Sure, you can't be constantly on the go and do have to set aside time for relaxation, but when you have downtime, make sure you have plans for what comes next and, preferably, know when and how you will bring that downtime to an end.

Leave your accommodation every day, during the day, even if you really don't feel like it. Go outside, breathe a bit, take in the view, say "hello" to somebody. For a mentally healthy person, spending a day just chilling in your hotel room is no big deal, but for a person with anxiety or depression, that day can easily become a week, with the chilling replaced by catatonia.

The bottom line is, overindulging in rest can be just as bad as overstimulating yourself with activities, so find a balance that's right for you.

You should hopefully know what kinds of situations or events give you discomfort, trigger unwelcome thoughts or feelings, or otherwise cause your symptoms to worsen in your everyday life at home. Therefore you ought to know what situations to avoid while travelling. Remember that since travel involves new environments and experiences, your body or mind may react in ways you didn't expect. Recognise your early warning signs, and nip the problem in the bud.