The long-standing stigma around mental health care has faded from many American churches, but has the shift made its way to the ends of the earth?
When you’re an overseas missionary, a season of deep depression, panic attacks, or chronic anxiety can seem to put your ministry in jeopardy, keeping you from the work you are being called and paid to do.
Yet missions workers are extra susceptible to such conditions. They experience culture shock. They witness trauma and fear persecution. And they often live in places where access to mental health professions is difficult to impossible.
For years, supporters have been trying to open up more conversations about mental health and to get workers on the field the help they need, but missionaries still fear the repercussions of coming forward with their struggles or their family members’.
Just over half of missionaries say they have an issue they worry could jeopardize their work in the field, according to a survey conducted this year by Global Trellis, an organization that supports cross-cultural workers. Emotional and mental health struggles were among their top concerns.
The ministry asked nearly 400 missionaries, many of whom had spent 20-plus years in the field, “How do we keep senders from putting missionaries on the pedestal, and keep missionaries from feeling like they have to stay on the pedestal?”
“We help people have language to talk about things. So, normalizing rest, normalizing growth, and just normalizing change,” said Amy Young, the founder of Global Trellis and a former missionary to China.
Other research has shown that missionaries’ stress levels are double to triple those of the average American, reaching levels that can lead to major health issues.
Sending organizations have seen missionaries leaving the field in crisis. From their view, improving mental health care is a way to better support those sent out to fulfill the Great Commission and to ensure their work is sustainable.
Some agencies are advising missionaries to include a budget for mental health care when they’re fundraising. They are also hiring and deploying more trained counselors who can be available—online and in person—to help work through the specific complications that come with missionary life.
“There used to be a strong belief that if you are really right with the Lord, you shouldn’t need counseling; you have the Holy Spirit,” said Penny Phillips, who served with Wycliffe Bible Translators. “There was some degree of shame associated with seeing a counselor, and that has changed.”
Over decades as a missionary counselor with Wycliffe, based at its Orlando headquarters, she saw missionaries grow more open to seeking counseling. Phillips and fellow professional counselors were available to travel to remote locations to minister to missionaries in many different countries.
“We were willing to see missionaries from any missionary organization,” said Phillips. Wycliffe’s goal, she said, was to serve all missionaries before, during, and after their time on the field. The main idea is for counseling to always be an open option to people serving all over the world.
While Phillips experienced and recognized the convenience of virtual counseling sessions, she still placed a high value on traveling to visit families in person. It is “easier to develop a trust relationship in a face-to-face situation,” she said.
John Leverington, also a longtime Wycliffe staff counselor, echoed Young in the importance of releasing missionaries from the pedestal on which they have stood for so many years.
“Those expectations are impossible to live up to and can lead to isolation, presenting a false self of competence while emotionally questioning one’s own faith, and, at some point, coming to a crisis that can’t be resolved on your own without support.”
With the particular dynamics of missionary work, mental health has proven to be a tough issue to navigate. In some cases, even when provided with mental health support, missionaries would rather suffer in silence than risk their sending organization declaring them unfit for their role.
“When missionaries are expected to go straight to their employers with health concerns, and when the help received is coming primarily from the ones in charge, a culture of distrust, fear, and secrecy can ensue,” Catherine Allison, who previously served in Malawi, wrote last year for The Gospel Coalition.
“Even when set with the best intentions, the structures to protect missionaries might inadvertently cause harm when mental illness comes knocking, especially if missionaries fear the potential loss of their careers, homes, and ministry dreams.”
In the Global Trellis survey, respondents described a range of self-reported mental health struggles and clinical issues: anxiety, depression and loneliness, PTSD from exposure to violence, and even suicidal ideation. One missions worker saw health issues as “the main way the Enemy attacks” families on the field.
Some said pastoral counseling and member care helped but wasn’t enough. One said they are transparent with their organization so they can get the care they need, but they couldn’t be as open with supporters. Another said being open about her mental health has been a connecting point with supporters.
“This fear that a missionary would be removed from the field due to emotional health can exacerbate the disconnect between many missionaries and the ones who send them,” the Global Trellis report read. “This can lead to hiding how their emotional health is really going.”
Sending organizations are trying to anticipate the potential for mental health needs and better incorporate trusting and supportive relationships throughout their ministries, so that missionaries and their families feel less isolated and leaders can be better positioned to help along the way.
The Southern Baptist Convention’s International Mission Board (IMB), with 3,590 overseas personnel, takes a team approach. Its five-member care teams—one in the US and four abroad—include around 80 employees, a combination of clinically trained professionals and pastoral care staff. They serve as relational connections and support partners for those on mission fields.
“We focus on supporting individuals, families—and we care for people, not only regarding what might be typically associated with counseling or psychological needs. Our focus is more holistic in terms of what people need spiritually, emotionally, and relationally, to be well and to be able to thrive in their places of assignment,” said Chris Martin, IMB’s director of member care.
As the agency continues to improve the ways that they serve their missionaries, Martin says he appreciates the cohesion among the different pieces of member care.
“Ideally, we would have routine contact with our personnel. Not only through our member care consultants but through team leaders and other leadership in our organization—and also team members who see and know enough about what’s going on with one another to be mutually caring and supportive,” he said.
As a past missionary himself, Martin understands the high stress of overseas living as well as the fact that no matter where someone is, life is not perfect. With that in mind, he talked about the idea that one of the most important goals for IMB member care is to promote well-being within each individual and between their teams across the globe.
Connie Dunn went through her own mental health struggles when serving as a missionary with Antioch Missions International. She brings that perspective and understanding into her work as a kids advocate for Antioch’s missionaries.
Antioch assigns its adult missionaries a pastoral overseer who is not necessarily licensed in counseling but is committed to encouraging and caring for each person. Additionally, it also encourages all their missionaries to include a budget for professional mental health care as they raise support for their time on the field.
Dunn’s job is to check in with families and children to make sure that they are receiving the mental health care that they need.
“It’s not just a kid counselor, but it’s also a kid counselor that understands the hardships that third culture kids and missionary kids face,” she said.
When parents see their kids suffering or in crisis, it’s difficult and can be hard to get them help. But the mission field context adds another layer of difficulty. Young at Global Trellis noted:
The missionary may wonder, “If it gets bad enough, are we going to have to leave the field? Could we lose our home and community? How will this affect our other kids’ schooling, education, and friends? How will this impact our children’s relationship with God? How will it impact our livelihood?”
Phillips at Wycliffe also expressed a need for more counselors for young people. She herself had spent 17 years as a teacher to missionary kids before deciding to become a licensed mental health counselor specifically for kids on the mission field.
Phillips said it’s important to be able to intervene early when kids are facing trauma, anxiety, and depression so they can learn tools for navigating mental health challenges before entering adulthood.
IMB recently implemented a program for kids and teenagers on the field called TCK (third-culture kid) focused member care. IMB’s goal is to be available both to the kids as well as to their families for advice and consultation.
As missions groups seek to bring the good news of Christ to the nations, they are also learning how best to care for the people they have sent out.
Counseling, said Phillips, “is for courageous people—who have the courage to come and ask for help—and for [people who] are willing to say, ‘I don’t have it all together.’ None of us do.”
