by Evan Parks
The need for specialized mental health services within missions is growing. It can be responded to best by openly acknowledging the need and actively seeking out specialists who can carry out the work.
While I was assisting a large mission agency with its applicant screening, the personnel director shared with me why he thought the candidate selection process needed to be improved. He felt that too many unqualified people were going to the field. Regarding missionaries on the field, he stated,
About one-third of our missionaries are emotionally healthy and making a good impact on the field. About one-third are marginally healthy and not doing any specific damage on the field, but they are not really productive. The remaining one-third are very unstable emotionally and are doing more damage than doing good.
Having served on the field since 2001, I would confirm his observation. This presents both challenges and great opportunities for mental health professionals working in missions.
The first challenge to overcome within the mission community is the recognition of the need for specialized services such as psychological and psychiatric care. On the surface, it appears that the needs of missionaries are being taken more seriously. The term “member care” is often used in mission agencies and it gives the impression that the personal needs of members are being met or at least addressed. What confuses the matter is that almost every department that has interaction with field missionaries is called a “member care department,” even if that interaction is processing health insurance forms. Obviously, using the term “member care” more often does not increase the amount of actual member care provided, and it may be giving the wrong impression that specialized services addressing psychological issues are available when they, in fact, are not.
Within the broad framework of member care is the subcategory of "specialist care." Specialist care includes a variety of personal services such as medical care, career guidance, team-building, crisis intervention, and psychological counseling (O’Donnell 2002, 18). In theory, most missions and mission leaders would acknowledge the need for psychological services on the field, but there is a great reluctance to promote these services, educate members about the need for mental health services, and actively encourage people to get the help they need when they need it. In fact, within the mission community the term “mental health” is an upsetting one in and of itself. This term implies that some missionaries may, in fact, not be psychologically well, and this fact is hard for many to accept.
When presenting the work of the Budapest Care Center in supporting churches, we often see the confusion on peoples’ faces when they hear the details of our ministry. If it is an informal setting, at least one person will ask the question everyone is thinking: “I thought missionaries were above having emotional problems! You mean to tell us that there are missionaries who struggle in their marriage and personal lives like other people?” I explain that in any group of believers there will always be people who struggle with serious problems. What is true within the Church is also true within the mission community. Yet for missionaries, the context in which they live often brings out even more problems. The added dimension of cultural stress and lack of social support on the field makes the emergence of emotional and relational problems all the more likely.
If this type of confusion about the need for mental health services were confined only to the average church member, it would be much easier to address. Traveling to mission conferences, leading seminars, and meeting with mission leaders throughout Eurasia and Europe, I find there are many within this community who are surprised by the apparent need for psychological services. One mission leader said,
Until I heard you speak, I would have never put the words “mental health” and “missions” into the same sentence. I would have thought it wrong to do so. I did not know there was such a significant problem among Christian workers.
This type of response is hopefully becoming less common as efforts are being made to raise the issues related to member care by inter-agency groups such as Member Care Europe and the annual Mental Health and Missions Conference.
Clinical Challenges and Opportunities
Working as a clinical psychologist within the mission community is definitely a positive challenge. The majority of my work is focused on helping the “healthy” one-third of the missionaries. These workers are often exhausted, discouraged, and burned out from years of carrying a heavy load of ministry responsibilities. The heavy load comes in part from taking on extra responsibilities due to the ineffectiveness of teammates who are not productive. The exhaustion may result from weeks and months of lost sleep due to the stress of handling individual team members who are dysfunctional, impossible to satisfy, and often in personal crisis. Add to this the fact that an effective, productive missionary is often noticed by the mission and is then promoted to be an administrator for the field. Many such missionaries attempt to keep their ministry going, which they deeply enjoy, while working as a full-time administrator, a task for which they are often untrained or unskilled.
A common request from team leaders is for practical help in handling team members who have significant personal problems. The team leader has likely attended some type of training on debriefing, crisis counseling, or how to resolve conflicts. When faced with a problem member on the team, the leader follows all the steps he or she has learned in training, but finds that over time the problems remain, smoldering beneath the surface. Having seen this issue repeated time and again throughout the mission community, I began to educate individual workers, teams, and mission leaders about the basis of personal and mental health problems. Understanding how people operate and what it actually means to be dysfunctional lays the foundation for knowing how to respond, help, and bring about lasting change. This type of instruction provides an added dimension to the training a leader already has and therefore provides him or her additional tools for handling difficult people and situations.
Besides working with the healthy but discouraged segment of the mission community, there is also much effort spent addressing the needs of people who are struggling with significant mental health problems. Unfortunately, it is true that within the community of missions there is physical abuse, sexual abuse, eating disorders, panic attacks, homosexuality, prescription drug addiction, major depression, and psychosis (hearing voices, delusions, and eccentric behavior). Add to this the large number of marriages that are negatively impacted by extramarital affairs, pornography, compulsive shopping/spending, workaholism, chronic depression, and years of unresolved conflict. As missionaries struggle with these problems, it is generally a crisis that brings them to a point where they are willing to seek help. The crisis can come in the form of a confrontation by a team leader, their ministry collapsing, or their children becoming significantly dysfunctional as a result of years of family unrest. Intensive psychological help on the field can be provided to help turn some of these situations around. Seeing people have their relationship to God restored, their marriage renewed, and their family life healed is a great privilege of doing this type of work.
Despite increased awareness of personal, marriage, and family problems among missionaries, within sending agencies there is still a resistance to seeing this as an urgent and serious problem. A common retort among older missionaries within these agencies is, “You know those younger missionaries really do not know what it means to sacrifice. If they don’t have all their needs met, they think it’s a crisis.” This type of thinking does not generate helpful solutions to the reality of many hurting people who are leaving the field. The struggle of bringing mental health services into missions will undoubtedly go on for some time. There will be those who oppose it and deny the need for it, as well as those who see mental health services as a way to protect and preserve those who are effective and productive in ministry and not lose them to attrition. But regardless of this struggle, if we only see mental health services as a need within the mission community, then we will completely miss the tremendous opportunity mental health professionals have to reach a lost and hurting world.
Open Doors of Opportunity
Not long ago we were renewing our resident permit here in Hungary, and uncharacteristic to the nature of such official business, the immigration official looked up from her paperwork and said to me, “Tell me again what you do here.” I responded, “I help people with marriage and family problems and I help people who have been through traumatic experiences.” She looked at me and asked, “Can I please come and see you, too?” Not long after that event I was in a store trying on shoes and the salesman asked the same question, “Can I come with my girlfriend so we can get help? We don’t have anyone to help us.”
Through local Hungarian churches I offer the “Understanding People Seminar” as an outreach to the community. The theme of the first lecture is, “How do I know what is normal? How do I know what is right and wrong?” People are looking for help and they have no models to follow, no standard of what is right and what is wrong. One man asked me, “How can you help people with marriage problems? On what basis do you even know two people should stay married?” Only thirty percent of adults in Hungary are married; most just choose to live together and these relationships are much less stable than those who are married (Hungarian Central Statistical Office 2002, 9).
While attending the Understanding People Seminar, Hungarians who have gone through years of hardship and loss begin to find words to describe what they have experienced and felt. One man came to me at the end of a lecture and said,
Over the last twenty years I have hospitalized my wife eight times because of her depression. Until tonight I never understood why she was depressed and what she had gone through in her life. But now I finally understand. Can I please bring my wife to the next seminar?
While writing this article I received a phone call from a local pastor. In a panic, he said that one of the teenage girls from the church was missing. She ran out from her home wearing slippers and no coat, even though it was below freezing. He called back a few minutes later to say he had found her, but did not know what to do. She was talking nonsense (saying she was the chosen one of God), taking off her clothes to wash them so they would become holy, and was convinced that everyone in the church needed to be converted by her. The pastor was at a loss as to what to do next. The severity of this situation is similar to a call I received from another pastor not long ago. The pastor stated that his colleague had a nervous breakdown while teaching, now refused to work or to seek help, and was convinced that God was speaking to him in an audible voice. In 2007 alone, five pastors committed suicide here in Hungary. The need for mental health services among the Christian community is staggering. The shame, guilt, and hopelessness that people carry, in addition to the difficulties of everyday life, are tremendous.
The words of Jesus come to mind every time I teach and talk with people on the street: “When he saw the crowds, he had compassion on them, because they were harassed and helpless, like sheep without a shepherd. Then he said to his disciples, ‘The harvest is plentiful, but the workers are few’” (Matt. 9:36-37).
The need for specialized mental health services within missions is great and growing continually. It can be responded to best by openly acknowledging the need and actively seeking out specialists who can carry out the work. One veteran missionary of more than forty years of service once told me, “In my day, we never let the pastors of our supporting churches come to visit the field because we did not want them to see what kind of shape our missionaries were really in.” The word “dysfunctional” was probably not used back in the 1950s, but missionaries have struggled with personal, marriage, and family problems as long as missions have existed. It is only when we recognize the need that we can begin to seriously address it.
Hungarian Central Statistical Office. 2002. Women and Men in Hungary. Ministry of Employment and Labour, Budapest.
O’Donnell, Kelly. 2002. “Going Global: A Member Care Model for Best Practice.” In Doing Member Care Well. Ed. Kelly O’Donnell, 13-22. Pasadena, Calif.: William Carey Library.
Dr. Evan Parks moved to Budapest, Hungary, in 2001 and is serving the mission community and national pastors through the Budapest Care Center. He and his wife serve with SEND International.
EMQ, Vol. 46, No. 2, pp. 174-178. Copyright © 2010 Evangelism and Missions Information Service (EMIS). All rights reserved. Not to be reproduced or copied in any form without written permission from EMIS.