Would you be shocked to discover that 90% of field workers will suffer from depression, anxiety, burnout or some other mental health disorder at some stage during their service?¹ 

Some of the stressors unique to mission work include moving overseas, cultural differences, language barriers, physical isolation, worries about finances and support, education for children, changes in diet and lifestyle, different climates and geography, politics and bureaucracy, and the burden of expectation that comes with being a ‘cross-cultural worker’. And then add to that the general ministry stress of working with other Christians with different styles of leadership, theology and of course the big one… sin.

Sending a candidate to the field ill-prepared mentally, emotionally and spiritually is like throwing a non-swimmer into the pool for his first swimming lesson.

It’s clear that any call to cross-cultural service is a call to suffer for the Lord. Paul found this out in Acts 9:15-16 “For I will show him how much he must suffer for the sake of my name.” Suffering may come through external factors, but it may also come by way of internal issues: expectations may have been unrealistic, struggles with sin are amplified, emotional and spiritual struggles may surface… So depression and anxiety are not uncommon on the mission field.

The long term activation of the stress response system… can disrupt almost all your body’s processes, increasing the risk of anxiety, depression, high blood pressure, concentration and sleep problems.²

It’s no surprise then that, according to a 2018 study,³ almost 10% of workers leave the field due to mental health challenges. This highlights just how important the support from sending agencies is. So how can a mission organisation care for its members and equip a cross-cultural worker to deal with the loss, unmet expectations, and all sorts of personal struggles they might face?

First of all, extensive spiritual and emotional screening along with training in things such as communication, culture shock, conflict management and team development are critical before a candidate even sets foot on the field. Sending a candidate to the field ill-prepared mentally, emotionally and spiritually is like throwing a non-swimmer into the pool for his first swimming lesson. They may dog paddle for a while but they will never learn to be an Olympic swimmer without a coach and proper training.⁴ 

Once there, regular on-screen and in-person visits from member care personnel are vital. Member carers are responsible for encouraging workers to build resilience and practise good self care. Resilience (perhaps summarised best as being able to bounce back from adversity) is the ability to recognise symptoms of stress and know the steps to take to restore wellbeing, before a plunge into depression happens.⁵ It is therefore critical for field workers to not only know Jesus, but also to know themselves.

Galina Hitching of OMF International says, “whether we pretend we’re fine, pretend we’re holy, or pretend we don’t need help, the life of pretence sets us up for failure and separates us from ourselves, from God and from others. Whether we face mental health issues or not, we must learn to stop pretending. Our only hope to deal with the challenges of life is to learn to come to the Father and rely on him in our lack.”⁶ 

Jennifer Grocott, ECM cross-cultural worker in Romania, had to confront her declining mental health whilst on the field: 

I think one of the biggest things was just being real about my struggles; not to think, ‘oh, just suck it up’, ‘keep going’, or ‘it’ll pass’… unhelpful things like that. Being honest with myself, first of all, but also being honest with my spouse and then with my mission agency, and my church.

Jennifer says having a broad network of support and different people to help in all the different areas of her life was foundational. She utilised people including her husband, prayer partner, field leader, mentor and professional counsellor:

The fact that all of these people were believers and all of them were able to keep pointing me back to Jesus; keep pointing me back to the gospel; keep pointing me back to God’s love, God’s grace, God’s forgiveness. It really was God’s faithfulness and His restorative power that helped me come out the other end.

It really was God’s faithfulness and His restorative power that helped me come out the other end.

Workers may often find themselves in situations on the field where they don’t receive much encouragement from the church they minister in. But God has placed field workers within the global body of Christ. It is therefore the responsibility of the sending church(es), mission agency, and supporters to perform the functions of the body instead. Just like we do with those we live around, we must be praying regularly for cross-cultural workers overseas, checking in and caring for them in practical ways all through the year. Developing and maintaining relationships with them that help them stay fixed on the Lord Jesus are invaluable on the field, and technologies like Zoom, WhatsApp and Facetime make it easier than ever. This framework allows God to work in and through the people who are closest.

It’s critical that member care provides a safety net for workers so that when issues arise they can be dealt with. Galine Hitching continues:

When a [worker] on the field faces depression or other mental health struggles, it doesn’t mean they are unfit for ministry. It does mean we need to cover them in prayer, support them, and at times give them space from their duties as a [field worker]. Rather than being surprised when a [field worker] faces mental health challenges, we should expect they will experience some level of struggle in this area and be prepared to support them when they do.⁷ 

Just because a field worker battles with mental health, that does not mean they cannot serve overseas. However, it may sometimes be necessary to bring someone off the field, even if only for a time. Whether it’s depression, anxiety, PTSD or burnout, compromised mental health impairs your ability to function in a healthy way. Living with mental health issues is difficult enough in familiar circumstances, but when you’re in a foreign country and find it even harder to take care of yourself, that difficulty compounds for both the sufferer and everyone else on the mission team. It can often be a hard call for a mission organisation to make, but to take a worker off the field when it is clear they are not coping is vital for their sake and for the sake of the gospel. Member care can then support healing and work through what’s best next, whether returning to the field or staying at home.

Our only hope to deal with the challenges of life is to learn to come to the Father and rely on him in our lack.

Field workers are human. They need a saviour as much as the people they are trying to reach. There are ups and downs for everyone, and those in ministry are not immune. The call to mission is a call to suffer for Jesus’ sake, and sometimes that suffering can be too much. However, with God’s help, with lifelong learning and re-equipping, and with the support of the body of Christ, a worker can stay the course. 

Who shall separate us from the love of Christ? Shall trouble or hardship or persecution or famine or danger or nakedness or sword? As it is written…’For your sake we face death all day long; we are considered as sheep to be slaughtered’. No, in all these things we are more than conquerors through him who loved us. Romans 8:35-37

1.  Henry, J, “Missionaries and Mental Health”, College Park Church Resources, 2020

2. Mayo Clinic, “Chronic Stress Puts Your Health at Risk” July 08, 2021

3 Sears, Andrea, “The Missions Experience”, Weebly, 2022

4 Walls, W, “Managing Stress and Burnout on the Mission Field”, Missio Dei, 2015

5 Button, R, “Why don’t we talk about missionaries and mental health?”, Thinking Mission Practice, Wordpress, 2017

6 Hitching, G. “How do we face the stigma of mental health in missions?” OMF, 2019

7 Ibid.

Sam Boog is communications and media trained and has a particular passion for the gospel needs of Europe. She lives in western NSW with her husband and four daughters.

Please Pray

• For the ECM office and good screening processes to be in place for ECM missionaries for their sake and the team in Europe.
• For the mental health of all ECM missionaries…for the Lord’s protection and strengthening in this area of their lives.
• Please pray for ECM missionaries to practise good self care and maintain a deep relationship with the Lord while on the field.

This article appears in ECM News Summer 23/24.