“Passport, meds, wallet, phone…” My packing list looks the same as most people, but my medication is not as easily replaceable as the usual ibuprofen and imodium that most travelers carry. For years I have guarded them carefully in my carry-on, knowing that in some countries they’re not available at all.

While much progress has been made in the US to decrease the stigma of having a mental health diagnosis, many parts of the world aren’t there yet. This brings an extra layer of challenge to international travel for people like me. I was first diagnosed with bipolar disorder in 2000, and like many who struggle with mental health didn’t accept treatment immediately. After a difficult two years as a Peace Corps Volunteer in Morocco, I realized that I would not be able to travel and lead the life I wanted without support. Since starting treatment, I have traveled on five continents and am living the life I always wanted.

Travel can be a joyful and exciting experience, but it takes us out of our normal routine, which can be challenging or even dangerous for those of us with mental health conditions. I have traveled in over thirty countries, which means that I had to develop strategies for managing my mental health on the road and in the air. Here are eight tips that I have developed over decades of bipolar travel.

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Maintain the good habits you already have

My first piece of advice comes from Ellen Forney, author of Rock Steady: Brilliant Advice from my Bipolar Life. I take a copy of her book with me when I’m going on a particularly challenging trip. Her acronym “Smedmerts” stands for: Sleep, Meds, Eat, Doctor, Mindfulness, Exercise, Routine, Tools, Support System. It sums up everything we should do at home, which is exactly what we should try to do while traveling.

Of course, most of these are very challenging to keep up while on the road. The routine goes out the window and I have found that sleep is my biggest challenge. Still, our goal should be to continue all these as best we can, no matter where we are. In her book, Forney’s travel advice focuses on sleep, namely why we need to prioritize sleep while traveling and what to do if jet lag throws off your circadian rhythm.

Don’t try to do everything

Whether I’m planning a weekend getaway or a month long trip, I build breaks into my schedule. Also, if I’m tired after scuba diving or hiking, I let myself rest. Running myself ragged by trying to do everything just leads to disaster. When I asked if Forney had any other advice for travel, she brought up the issue of trying to keep up with other people.

“When we travel, we tend to put a lot of pressure on ourselves (and often get pressure from our travel mates) to get out and do as much as we can, go as many places as we can, dance and eat and swim as much as we can,” said Forney. “It can be frustrating to have to prioritize your health if all of your travel mates are going out to a party at midnight. That’s okay. It’s okay to stay in the hotel room in the evening, or sit for an hour on a bench, or read a book in your tent. Enjoy where you are feeling rested, well-fed, and balanced.”

I don’t have to do everything to enjoy the places I visit. Whether I’m traveling alone or in a group, I’ve learned that saying no to some experiences can make the trip even better.

Check that you can contact your doctor

One of the silver linings of the COVID-19 pandemic has been an increase in online medical services. I have been able to video chat with my psychiatrist in Seattle while in South America. Before you leave home, check with your doctor about options for contact while you are away.

If your doctor doesn’t have any way for you to contact them during a trip, find a counselor who does. Hopefully, your regular counselor can do video chat appointments and emergency appointments. If you must get a new counselor, find one who does all their appointments by phone or online. Try to have a few appointments with the new counselor before your trip, so that they can get to know you and see how you are at home.

When choosing a new counselor, Laura Robinson M.A., Professional Counseling Associate in Oregon, cautions to check that the counselor is licensed in the state you live in and is able to see you in the country or state you visit while on your trip. Even before your first appointment, tell the new counselor where you’re traveling and how you would be able to contact them while you’re on the road. If they aren’t a good fit, keep looking before you commit to the first appointment.

Happiful’s counseling resources include a link for finding an online counselor. Healthline has another great resource for finding online counselors. You can also ask your regular doctor or counselor if they have any recommendations.

If I’m going somewhere that doesn’t have any cell service or internet access, I use a journal or app to track thoughts and feelings to discuss with my doctor or counselor later.

If you take meds research if you can buy medications where you’re going

Though I guard my meds in my carry-on as if my life depends on it, I also plan for the possibility that I may need to buy meds while I’m away from home. If you’re traveling within the US, check with your pharmacy to see if they would be able to fill an emergency prescription in another state. If you’re traveling internationally, remember that every country is different in how they sell and control medications. For example, one of my medications, Lamotrigine, is available without a prescription in Turkiye and Mexico.

Unfortunately, it can also go the other way. I spent a full day in Hanoi going around to pharmacies and even tried a hospital only to find that Lamotrigine isn’t available at all in Vietnam.

In Peru, I was required to have a prescription from a Peruvian doctor. However, at a clinic that is popular with travelers in Cusco, a doctor was happy to write me a prescription after I produced my prescription from my doctor in Seattle.

Since it’s not always possible to call a pharmacy in the country you’re traveling to, check for resources online. The US Embassy websites in many countries include resources for travelers who need to buy medications. Also, check for Facebook groups of expats living in the country you’ll be visiting. They can be a wealth of practical information. Mobility International has a great list of how to find out if you can buy your medications in other countries. They also have tips for taking medications with you to other countries.

Be honest with travel companions

This can be hard in a society that still stigmatizes mental health. However, it is essential. I have been pleasantly surprised by many people’s reactions when I tell them that I have bipolar disorder. Real progress has been made in destigmatizing mental health and I expect that the trend will continue to improve.

If you are traveling with others, find a time to talk to them before you leave for the trip. This can be awkward the first time, so try creating an opportunity that’s not the two of you sitting down for a serious talk. You can compare a mental health diagnosis to diabetes or any other medical condition that requires constant awareness, daily maintenance, and for most, medication. Priory Group has a great list of tips for talking with somebody for the first time about having depression. These tips can be applied to conversations about a variety of diagnoses.

Ask for feedback from your travel companions

Travel companions can be helpful for this, but if you are traveling alone, choose a person back home with whom you can check in daily. Consistency is important. If they only see you once a week, it’s harder for them to give you useful feedback. With WhatsApp, Zoom, FaceTime and all the other new tech out there, it is easier than ever to make this possible. Be sure to check with places where you’ll be staying if they have Wi-Fi or other internet access.

If this is absolutely not possible, take a journal with you. This worked on my last Patagonia trip, when I was without electricity or cell service for over a week. I tracked my thoughts, feelings, and sleep patterns every day. Noticing our own unhealthy behaviors is difficult, which is why this is a last resort. It’s much better to have feedback from a person who has an outside perspective on what we are doing and saying.
Again, consistency is important and what we really need is a daily check to help us notice changes. Be open to feedback from others and make it clear to them that you will listen and not be offended.

That said, if there are specific phrases that you find upsetting, give them the words that you need to hear. Sometimes what I really need to hear is that I’m talking nonstop or too quickly. Sometimes I need somebody to ask me how much I’m sleeping and remind me how much I normally sleep when I’m home. Travel is more likely to trigger a manic episode than a depressive episode for me, so I make sure to ask for feedback around signs that may point to the beginning of a manic episode.

There are also a lot of great apps that help you track sleep, thoughts, and feelings. Very Well Mind has a great list of apps for specific diagnoses.

Have emergency plans

Just like going camping with a first-aid kit and knowing your embassy’s phone number in the country you’re visiting, you need to make specific emergency plans for your situation. This looks different for everybody, depending on your diagnosis. For me, this is identifying a safe place that I can go if I need help. I check to see if any nearby hospitals have a mental health clinic. Not all countries have systems for mental health, but most tourist destinations have clinics that will have somebody on staff who speaks English.

I also try to find contacts where I’m going, either through my network or through social media. This is especially important if you don’t speak the language of the country you’re visiting. Many expatriates love to show visitors around, so look for the expat community. These days, most of them have groups on Facebook but you can find them everywhere on social media. You don’t have to broadcast your diagnosis to a bunch of strangers but it’s good to know which cafés or parts of town are the main hangouts. Find out where you could go to easily meet up with somebody from your home country.

Besides emergency plans for during the trip, think about what you would do if you needed to cut the trip short and go home. If possible, buy plane tickets that are changeable or refundable. In a worst-case scenario, is there somebody from home who could go to you if you’re unable to travel? If you have a person who could do that for you, talk with them about that possibility before you leave.

The Copeland Wellness Center has some great resources for creating individualized plans. Their WRAP program also helps people develop their own personalized plan for recovery after a mental health episode or stressful event.

Bring something comforting

Not everybody wants to travel around with Ellen Forney’s book, even if I think that we all should. Books aren’t comforting for everyone but do bring something that you can hold or do that is comforting to you. What do you have or do at home when you’re having a bad day? Find a way to take that with you, even if it takes up a lot of space in your luggage. Knitting and coloring are calming for some people, as is sudoku. If it’s your childhood teddy bear, take it with you. It’ll be worth it.

If you need some ideas to help you choose what to take, check out StarWard’s article on comfort objects. I appreciate StarWard’s observation that “while being attached to an object like a soft toy or blanket can seem quite childish, it’s actually an important and healthy process for adults.” Whatever you decide to take, I recommend including it in the carry-on with your meds.

While I consider all these points for every trip I go on, I don’t let them take me down the catastrophizing wormhole. I focus on the places I’m excited about visiting and why I want to go there. Some trips I plan out every detail and others are more spontaneous. Either way, I still plan on having a fun and safe trip.