Does Mental Health Stigma Keep Missionaries Off the Field?

He was a faithful missionary. He led people to faith, planted churches, endured significant suffering and remained deeply committed to his calling. Yet in a letter to one of the churches he served, he wrote,

“For we do not want you to be unaware, brothers, of the affliction we experienced in Asia. For we were so utterly burdened beyond our strength that we despaired of life itself.” (2 Corinthians 1:8)

That missionary? The Apostle Paul.

Whenever I read those words, I’m struck by Paul’s honesty. He wasn’t giving us a diagnosis of his despair, but he was remarkably transparent about the depth of what he was experiencing. He didn’t minimize his suffering, hide behind spiritual language or pretend that faithfulness somehow made him immune to being overwhelmed.

Yet I see an unspoken assumption persisting in parts of the church today: If someone struggles with a mental health condition, or is perceived as having one, they may be seen as unfit for missionary service.

Last year, I wrote the article Can You Be a Missionary and Take Antidepressants? It grew out of my family’s experience with mental health challenges in the field. What I didn’t expect was the response. The unusually high engagement with that article suggests it resonated with something significant in the mission community. Missionaries and prospective missionaries are grappling with questions about mental health, treatment, calling and what honesty about those struggles might cost them.

That raises a difficult question for mission leaders: Is stigma around mental health influencing who we send and who we keep on the field?

Mental health absolutely should be taken seriously when assessing and caring for missionaries. But legitimate concern should lead us toward careful discernment, not automatic disqualification. Let’s take a closer look at this through three crucial questions.

1. Is a mental health diagnosis a legitimate concern when assessing candidates for missionary service?

Let’s be clear: mental health is certainly a legitimate concern when assessing candidates for missionary service. Cross-cultural ministry brings real pressures. These can include isolation, relational challenges, cultural stress and the everyday difficulty of adjusting to life in another country. A mental health diagnosis should be taken seriously, just as we would any other health condition.

The key, though, is discernment.

While I was in the field, I took medication for high blood pressure. During our pre-field process, I researched whether I could access that medication at our destination. It was an important factor for me, my doctor, my organization, and my church to consider. But it didn’t automatically disqualify me from serving.

Unfortunately, we don’t always approach mental health in the same way. Stigma and misunderstanding around conditions such as depression can move us from asking whether someone is ready to serve toward assuming that they shouldn’t serve at all.

I knew people who received treatment for mental health conditions and served faithfully for years. I also knew people without a formal diagnosis who eventually had to leave the field because they needed help they couldn’t get in-country.

Church leaders should use discernment when assessing readiness. But a diagnosis by itself should not result in disqualification.

Some helpful questions might include:

• Are candidates both spiritually and emotionally mature?
• Do they demonstrate stability and self-awareness?
• Are they receiving appropriate treatment?
• Can they access necessary medication and care where they will serve?
• Do they demonstrate resilience and healthy coping patterns?
• Will they have a healthy support system both on the field and at home?

Mental health concerns should inform prayerful discernment. They shouldn’t replace discernment with preconceptions or biases.

2. Is mental health stigma keeping qualified missionaries off the field—and silencing those already there?

Mental health matters not only during missionary assessment, but throughout a missionary’s time on the field. Yet missionaries may not always feel safe being vulnerable in the way Paul was with the Corinthians. They should.

I once spoke with a missionary who was reluctant to tell his church and sending organization that he was struggling, fearing they would pull him from the field.

That kind of fear matters. Stigma, even when unintended, can create an environment in which missionaries hide their struggles because they fear what will happen if they are honest. The result can be that missionaries suffer quietly rather than asking for help.

Sending churches should pursue both careful assessment and open communication. Missionaries will sometimes need additional help. Cross-cultural adjustment itself can involve significant stress and can make someone appear as though they aren’t doing well. And sometimes they genuinely aren’t doing well.

A missionary may need additional treatment. They may need greater stability for a season, stronger support systems, or even a different country, ministry or team assignment. But struggle should not automatically be viewed as evidence that someone is unfit for missionary service.

We need to learn to distinguish between “not yet” and “never.”

The goal isn’t to find missionaries without emotional vulnerabilities. Such missionaries don’t exist. The goal is to discern whether someone can serve faithfully, healthily, and sustainably with the right support.

That also means assessment shouldn’t be viewed as a one-time hurdle someone clears before going overseas. It is part of the church’s ongoing responsibility to know, care for and wisely shepherd the people it sends.

3. Are we pulling missionaries off the field too quickly?

This raises another difficult question: When should we pull a missionary from the field?

There isn’t a simple answer.

Certainly, if the missionary or others are unsafe, it’s time to bring them home and provide the care they need. Returning may also be necessary when someone can no longer function healthily in daily life, relationships or ministry, or when the treatment they need isn’t available where they are serving.

The goal should never be to keep someone on the field at all costs.

Before assuming that returning home is necessary, mission leaders should ask another question: Have we adequately discerned whether returning home is actually the best form of care?

Part of that requires churches to examine their own assumptions.

Distance already makes it difficult to understand what a missionary is experiencing. Often, churches are trying to understand life on the field through newsletters, emails and occasional conversations. Mental health stigma can make that even more complicated.

If we assume emotionally healthy missionaries shouldn’t struggle deeply, we can begin interpreting vulnerability as instability and struggle as evidence that someone is no longer fit to serve.

A missionary describing loneliness, frustration, anxiety or cultural confusion may sound alarming from thousands of miles away. Those struggles deserve attention. But they may also be part of cross-cultural adjustment. Struggle by itself is not always a sign that something has gone wrong. Sometimes it is simply part of learning to live and serve well in a new culture.

Churches should also consider available resources.

Mission organizations and field leaders often have valuable insight into the challenges their workers face. While a mission organization should never replace the local church's authority and responsibility, it can provide important perspective and care.

Professional help may also be available on or near the field. Thailand, for example, has ministries specifically designed to provide mental health care for missionaries and other cross-cultural workers. Resources like these can allow missionaries to receive professional care from people who understand cross-cultural life without automatically requiring them to return to their passport country.

Before making the decision to bring someone home, church leaders should consider:

• Are the worker and their family safe, and how well are they functioning?
• Is this normal cross-cultural adjustment or something more serious?
• What does the missionary believe they need, and what are the people closest to them observing?
• What professional, organizational, or field-based care options are available?
• Could our assumptions about mental health be influencing how we interpret what we’re hearing?
• Would remaining in the field with additional support improve their health, or do they need care they cannot receive without returning home?

For some missionaries, the wisest decision would be to remain in place but get additional support. For others, it may mean stepping away for a season or returning permanently.

The goal is not to keep someone in place at all costs, but neither should stigma make that decision for us. The goal is to shepherd missionaries wisely based on what they actually need.

Conclusion

I’m still struck by the vulnerability in Paul’s words. They raise such important questions.

• Does the modern church create space for missionaries to share their suffering honestly?
• Does stigma make missionaries feel those struggles are better left unspoken?
• Have we developed expectations of missionaries that leave too little room for the weakness, suffering and vulnerability we see throughout Scripture?
• Do the people we send feel safe telling us when they’re struggling?

Ultimately, that comes down to the culture we create in our churches and ministries. Can missionaries say, “I’m struggling,” without immediately wondering what might happen to them or to the ministry they have dedicated their lives to?

Those fears aren’t trivial.

• Bringing a missionary home can affect their calling and vocation.
• It can separate them from a community they have spent years building.
• It can disrupt finances and housing.
• It can uproot children from the only or primary home they know.
• It can change nearly every part of a family’s life.

Churches shouldn’t make decisions with such significant consequences lightly, nor should stigma make those decisions unilaterally. Instead, churches should cultivate a culture where honesty is first met with love, compassion and a listening ear.

That doesn’t mean removing accountability, ignoring serious concerns or avoiding difficult decisions. It means shepherding missionaries well enough to carefully discern the kind of care they actually need.

The last thing we want is for missionaries to suffer in silence until a manageable struggle becomes a crisis.

Healthy missionary care should make it easier to ask for help early. In fact, when missionaries fear that honesty could cost them their ministry, we may unintentionally encourage them to wait until their struggles become much more serious before asking for help.

That requires churches to know their missionaries beyond newsletters, support checks, and occasional conversations. Sending carries an ongoing responsibility to know, love, shepherd and care for those who go.

So, let’s close where we began.

Are we creating a sending culture in which missionaries believe they must appear healthy to remain called—or one in which they can be honest with us about when they need help?

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