Travel and Psychosis

Psychosis occurs when a person loses contact with reality and cannot distinguish between what is and what is not real. It is a serious medical condition that affects how you think, function, and behave. You can suddenly experience a psychotic episode while travelling without a prior history of mental illness. In addition to managing stress, recognizing the warning signs of psychosis and knowing where to get help abroad are key to a safe trip.

What is acute situational psychosis?

Acute situational psychosis occurs suddenly and can be triggered by your circumstances. Your physical and mental condition, surroundings, or medication regimen may trigger a psychotic episode.

Signs of psychosis include:

Disrupted thinking patterns (difficulty concentrating, disconnected thoughts)
Delusions (unusual ideas and beliefs)
Hallucinations (hearing voices, seeing images)
Disorganized behaviour (difficulty completing daily tasks)
Extreme mood changes (exhilaration, depression)
Thoughts of death and suicide

Adventure travellers are at greater risk of developing acute situational psychosis. Exposure to a physically and mentally demanding environment without proper sleep, irregular food and fluid intake, including substance misuse, can cause the mind to react to the body’s stress resulting in psychosis.

Tourists on religious or historical trips can also suddenly exhibit symptoms of psychosis. In this case, travellers become ‘intoxicated’ and overwhelmed by their surroundings. This can cause travellers to become detached from reality and can lead to delusional thoughts and behaviours.

What is schizophrenia?

Schizophrenia is an illness that disrupts the brain’s functioning. It affects how you feel, think, behave, and relate to others, including lack of motivation in daily life and reduced social interactions.

Travel does not cause schizophrenia, but it can trigger a psychotic episode. Unfamiliar environments, a disrupted daily routine, language barriers, difficulty understanding social mores, and using psychoactive substances such as alcohol or cannabis can threaten the mental and physical well-being of a traveller with schizophrenia.

The illness usually develops during the late teens to mid/late 20s, a time when many young people travel abroad. Emotional outbursts, the inability to complete tasks, and disorganized thoughts can put you at risk. Abandonment by travel companions is common due to not understanding or tolerating their friend’s erratic behaviour.

How can I manage my psychotic disorder while travelling?

Due to the unexpected nature of acute situational psychosis, it is important to know your physical and mental limits, get adequate sleep, eat healthy foods, and stay hydrated. Refrain from using caffeine or psychoactive substances like alcohol or cannabis.

Travellers who are actively managing and controlling schizophrenia can travel safely. Consult your mental health professional before a trip to ensure that it is an appropriate activity for you.

Plan ahead: Choose a low stress destination, consider time zone changes, take direct flights or routes, and recognize stress factors and warning signs that could lead to a psychotic episode. Travel with a trusted friend, family member of professional travel companion. Stay in touch with your doctor back home or find a qualified mental health practitioner to ensure continuation of care during your trip.

Know before you go

Experiencing a psychotic episode in a foreign country can be extremely frightening and disorienting – being in an unfamiliar environment without supportive networks, language barriers, and not understanding social mores can make it even more distressing.

Travellers experiencing an episode may be at risk of engaging in behaviour that puts themselves or others at risk. Psychotic episodes vary from person to person and may change over time. Treatment for psychosis during travel includes taking anti-psychotic medication to stabilize symptoms, hospitalization, and possible evacuation.

When travelling with a mental health condition, it's important to know and prepare for factors that can influence your ability to access healthcare abroad.

Cultural perceptions of mental health

Social and cultural acceptance of mental health in your destination country determines the type of psychiatric care you will receive. Forced admission (where voluntary consent is not the norm), substandard psychiatric facilities (unhygienic living conditions), questionable treatment (isolated confinement, lack of appropriate medicines), and difficulty finding mental healthcare professionals that speak your language should be taken into account when planning your trip.

In some countries, disturbing the peace, uttering threats, or exhibiting strange behaviour can lead to arrest, criminal charges, imprisonment, or forced admission to a hospital or mental health facility.

Travel health insurance coverage

Standard travel health insurance plans do not cover mental health conditions. As a result, you may be responsible for the full cost of medical expenses if you require psychiatric care abroad. Look for travel health insurance plans that cover psychiatric care – an independent broker can help.

Get coverage from a company that specializes in emergency evacuation and repatriation. This service generally covers patients who have managed their illness and are being hospitalized abroad. Check the fine print for restrictions and exclusions. Last-minute evacuation insurance is extremely expensive (starting in the tens of thousands of dollars) and may be refused on the basis of the patient’s mental health condition.

Travelling with medication

If you are travelling with any medication, be aware that your destination may place restrictions on the amount or type of medication you can import. Substances that are legal or available over-the-counter in one country may be illegal or require a prescription for importation in others. The importation of medication that contains controlled substances – drugs that are classified as having a high potential for abuse or addition such as narcotic and psychotropic medication – is highly regulated around the world.

Country-specific regulations regarding the import of controlled substances can vary widely. In most cases, travellers are permitted to bring a 30-day maximum supply of medication containing controlled substances, but some countries place stricter regulations or require specific documentation.

You can learn more about travelling with medication here:

Helping a family member or friend

If you are accompanying a traveller with a mental illness, it's important that you don't forget about your own health. Know how to recognize signs of psychological stress and avoid being isolated. You may want to hire a professional companion traveller to help during all or parts of the trip.

If you suspect someone is at risk of self-harm or suicide, remove self-harming objects such as knives, toxic chemicals, alcohol, and other psychoactive substances from reach and seek help from a mental health professional that speaks your language. Contact the person's embassy or consulate for emergency assistance. Note that suicide attempt survivors may require legal assistance in countries where suicide is illegal.

Travel and mental health checklist

Before you leave

Consult your healthcare practitioner to discuss if the type of travel you are planning is right for you. Get advice on how to stay healthy and cope with the effects of travel stress and jet lag. Ask if you can stay in touch with your health professional during your trip.
Find a reputable mental health professional at your destination who speaks your language. You may want to contact them prior to your trip to ensure continuity of care.
Familiarize yourself with the psychiatric healthcare system of your destination country. Know what steps you need to take in case of an emergency.
Book the most direct route possible to your destination; avoid layovers and long hours in transit.
Travel with a trusted friend, family member, or professional travel companion. If you are travelling alone, set up regular check-in times to reach a family member or friend.
Register with your embassy or consulate in case you need their assistance during an emergency abroad.
Make sure to pack enough medication for the duration of your trip. Check whether your medication is regulated or restricted at your destination.

During your trip

Give yourself plenty of time to arrive and go through security checks. Note that airports, train stations, bus depots generally have medical facilities that can support you as needed.
Establish a routine that sets the tone for your trip. Familiarize yourself with your surroundings and if you can, integrate some activities that you are used to doing back home or bring you a sense of comfort.
Bring a calming item (a book, listening to music on your iPod), memento, or journal that provides comfort during stressful situations.
Know your mental and physical limits. Regularly re-assess your original plans and change them to minimize stress levels.
Know when to stop a challenging situation from escalating. Find non-confrontational solutions.
Practice relaxing breathing exercises and integrate physical activity like walking and stretching to relieve stress. Get the appropriate amount of sleep, eat a healthy diet, and stay hydrated.

When you return

Book an extra day or two off after you return to mentally and physically recover from your trip. This will help you adjust from jet lag and help you get back into your daily routine.
Follow up with your healthcare practitioner if you needed emergency care abroad or to address any concerns you may have related to post-travel readjustment.