Role of Occupational Health Nurses in Mental Health Management: Insights From Supporting Overseas Employees

Background: The mental health of expatriate employees is a growing concern. While occupational health nurses (OHNs) are well-positioned to coordinate multidisciplinary support, their specific role remains underexplored in international literature. Objective: This paper describes OHNs' role in coordinating multidisciplinary mental health support for expatriates. Based on 10 years of experience (2010-2020; N = 450) supporting Japanese engineers across eight international plant construction projects, we characterize this framework through three cases, exploring its feasibility and acceptability over effectiveness. Methods: We used a descriptive, retrospective design based on routine occupational health work within a Japanese multinational engineering firm. Cases were purposively selected from eight overseas projects in five regional clusters: North Africa (Algeria), Sub-Saharan Africa (South Africa), Southeast Asia (Malaysia), Central Asia and the former Russian bloc (Uzbekistan, Turkmenistan, and Tatarstan), the Caribbean (Trinidad and Tobago), and South America (Chile). Data sources included health records, structured emails, semi-structured manager interviews, and field notes. Outcomes were evaluated using three objective indicators (safe repatriation, absence of significant residual harm, and absence of acute crises), key-informant ratings, and OHN observation notes. Newsletter feedback underwent inductive thematic analysis following Braun and Clarke’s framework. The study complied with the Declaration of Helsinki and received ethics approval from Kaito Clinic; individual consent was waived due to the use of de-identified retrospective records. Results: Three illustrative cases are presented. Case 1 demonstrates the successful emergency aeromedical repatriation and return-to-work of an employee with acute psychiatric illness, aided by the OHN’s coordination and a pre-established referral pathway. Case 2 documents the reception of a multilingual monthly newsletter; 90 respondents (≈20% response rate) appreciated the culturally resonant content (55.6%), noted increased service awareness (44.4%), and felt connected to the home team (38.9%). Case 3 describes overseas site visits, rated favorably by 100% (22/22) of interviewed project managers. The three objective indicators were met across all cases, demonstrating practical feasibility and acceptability within this context rather than proven clinical effectiveness. Conclusions: Positioning OHNs as coordinators within a multidisciplinary mental health support team is a feasible and well-accepted approach for Japanese technical employees on overseas assignments. Site visits, multilingual communication, and established referral pathways are practically valuable. Given the retrospective, single-organization design, these findings do not prove clinical effectiveness or generalizability. Further prospective, multi-organizational studies with validated outcome measures are needed to evaluate effectiveness and transferability to other contexts.