Can people with mental health problems go on mission overseas?
My friend Philip (pseudonym) is a young married man with a good education, doing well in his profession, and active in church service. To look at him you may never guess that for many years he has suffered with a significant anxiety disorder, Obsessive Compulsive Disorder (OCD). He has seen numerous psychiatrists and therapists, takes anti-depressants and at times has cried himself to sleep due to his mental torment. And now, he is sensing a call to serving God overseas.
Is he really a suitable candidate? Will he cope? Will he be of any use to God or others? How long will he last? These are some of the questions we may ask on hearing Philip's story, and indeed some of the many questions he is asking of himself. Mission workers can be exposed to many stressful and traumatic situations, including cross cultural transitions, state conflict, team difficulties, complex language study, loneliness, and suffering of local people. Is this really the right environment for someone with mental health difficulties?
One in every four British adults experiences at least one diagnosable mental health problem in any one year 
One in every four British adults experiences at least one diagnosable mental health problem in any one year (The Office for National Statistics Psychiatric Morbidity report, 2001). Mental illness is no respecter of gender, socioeconomic background, race or religion. So it should come as no surprise that those we worship alongside on a Sunday and serve alongside in our ministries, may well be included in that 'one in four'. Indeed, one of those 'one in four' may be you or me.
Over recent years, the Evangelical Church has begun slowly moving away from the often well-intended but sadly misguided and damaging opinion that truly godly people do not suffer with anxiety, depression or delusional disorders. We are starting to appreciate that experiencing such symptoms and engaging with pharmaceutical or psychological therapies are not signs of weak faith.
The tide has been turning too in the health sector. There is now a firm understanding in UK mental health services that an episode of mental illness need not define an individual's life nor discount them from making a meaningful contribution to society. As Pope Francis (2013) beautifully describes,
"Recovery means sustaining hope, inclusion, finding strengths, building resilience ... does not deny illness... is about making a life despite limitations."
Beth Moore from Living Proof Ministries puts it another way. She encourages us to foster an environment where we do not define ourselves or our brothers and sisters by what God has delivered us from, but instead celebrate what He is delivering us to (Hillsong Colour Conference, 2012).
Changing the question
It is tempting to view mental illness from a 'them and us' perspective. But like the psalmist and my friend Philip, who of us hasn't at some point cried out to God a prayer such as this?:
"Turn to me and be gracious to me, for I am lonely and afflicted. Relieve the troubles of my heart; and free me from my anguish." (Psalm 25: 16-17)
The truth is we each find ourselves on a spectrum of mental wellbeing and vulnerability, with many variables throughout our lifespan that can be biological, psychological, social (Zubin and Spring, 1977), and spiritual in nature. Our place on the spectrum can so easily shift under life's stresses, no matter the strength of our faith.
Moving from 'them and us' to 'we' in our terminology closes the distance when asking the question 'Does mental illness exclude people from overseas mission?'. It invites us to pay closer attention than we otherwise may dare to - to those 'innermost parts' of our human experience, of which Psalm 139 reminds us God knows all about and is present in.
We often remind ourselves that 'mission' is not restricted to individuals who make the sacrifice to serve God in a foreign land, and that 'ministry' is not exclusive to salaried clergy. Rather we each have a role in the Kingdom of God. A role determined by God, not health status. We know that in God there is no ranking system of superior locations or ways to serve Him in the Great Commission. As The founder of the Vineyard Movement, John Wimber put it, "Everybody gets to play"!
So, our question shifts from talking about the appropriateness of going on overseas mission if there is a particular mental health concern. It becomes a conversation about timing, preparedness, self-awareness and willingness to take practical measures in managing our mental health, however the Lord is calling us to serve Him, wherever we find ourselves on the spectrum.
Moving forward
If a consensus is reached that there has been a good period of stability and management, and there is sufficient self-awareness and proactivity within a candidate, it will be important to devise a mental wellbeing plan in moving forward. This will be of a very practical nature to enable the individual to stay on the field and be adequately supported. In seeking resolution to mental and emotion difficulties, we often yearn for a spiritual breakthrough, sometimes forgetting we are mind and body as well as spirit and soul.
In 1 Kings 19 we read of a traumatised Elijah, exhausted, discouraged and wanting to die. God provides Elijah with what he needs to regain his energy and focus, and it comes in the form of food and sleep. This may not seem particularly spiritual in comparison to the miracles Elijah performed in God's power! However, God knows exactly what we need, and often the most spiritual thing to do in looking after our health is of a simple and practical nature. Pausing and taking time to become more aware of how we're feeling emotionally and physically is not a sign of weakness, but gives us the opportunity to reflect and make any changes we need to before health issues get out of control. In Luke 5:16, we see that amidst his popularity and growing ministry, "Jesus often withdrew to lonely places and prayed". He knew when to escape despite the overwhelming need presented, and take time to be still and be with His Father. There are many useful mental wellbeing tools and guidelines we can borrow from the psychology and psychiatry sectors as we seek to build on this aspect of our member care, and I would recommend finding a Christian mental health professional who can share some ideas.
Philip's future in world mission
So, back to my friend Philip. His calling overseas is recognised by his leaders and church family, and now he and his wife are in the process of exploring the specifics of where they might go and with whom. His OCD is something he manages on a daily basis, and he has become familiar with potential relapse triggers such as high stress, sustained loud noise and tiredness. For Philip, knowing that stress is a major contribution to his mental health difficulties prompts him to proactively manage his exposure to it. As we chat about potential options for his overseas work, he tells me,
"I know that if I worked in a war-torn area, I would be a lot more vulnerable to having a relapse than if I worked in a more developed, stable country. Having a relapse won't be great for anyone, not me, not the people I want to serve. Yet I do not believe my mental health history should rule me out completely from serving overseas."
Philip is realistic about the sort of stressors that are involved in uprooting and working in a different culture, and it is so encouraging to observe the process Philip and his wife are undertaking. I am humbled by Philip's attitude and faithfulness to the Lord. I am reminded of the response of Shadrach, Meshach and Abednego to King Nebuchadnezzar in Daniel 3:17-18:
"If we are thrown into the blazing furnace, the God we serve is able to deliver us from it... But even if he does not, we will not serve your gods or worship the image of gold you have set up".
Whilst we pray for and believe in the miracles of healing, the determination to stay firm in service despite the suffering, is a beautiful act of worship. I have confidence that Philip will be a great blessing to the people he serves with his skills and knowledge. Like diamonds, which become more beautiful with each cut, I suspect that in his ministry, because of and in spite of his difficulties, Philip has something uniquely special to offer.
"Is the Lord going to use you in a great way? Quite probably. Is he going to prepare you as you expect? Probably not. And if you're not careful, you will look at the trials, the tests, the sudden interruptions, the disappointments, the sadness, the lost jobs, the failed opportunities, the broken moments, and you will think, He's through with me. He's finished with me. When in fact He is equipping you." (Charles Swindoll)
