What actually makes missionary feel stressed

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www.missionsinterlink.org.au
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What Actually Makes Missionaries feel Stressed?

• Marjory F. Foyle
• MD, BS, FRCPsych, DPM, DRCOG
• 
  2009

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Stress as Reported by missionaries

• The following table shows the questionnaire
• response to the types of stress most commonly
• experienced by missionaries to those latest
• mentioned.

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Two Things Important

• What Are They Actually Complaining of?
• Are any of the stresses more likely to result in
  development of psychological
• symptoms?
• For those who dont like statistics,
• significant merely means it is important!

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Occupational Stress

• Significantly related to
• Development of depression overseas
• If present at the initial selection interview,
• more likely to develop psychological symptoms
  overseas.

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Usual causes in order of importance

• National working conditions
• Unspecified
• Technical problems
• Inadequate job description
• Overload
• Professional isolation

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Suggestions for reducing occupational stress

• Study the problem. Reduce or else increase time
  off, support.
• Improve job descriptions. People must know what
  they are taking on.
• Discuss carefully if occupational stress present
  at initial selection interview. Train in coping
  strategies.

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Suggestions for reducing occupational stress

• a. Throughout service conduct personal
• audit and professional upgrading.

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Mission Leaders should do certain things

• a. Avoid making unrealistically high demands on
  workers.
• b. Ensure all workers have some rewarding tasks.
  Mix difficult jobs with smaller tasks that can
  be accomplished.

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Suggestions for reducing occupational stress

• c. Train workers in time management and
• relaxation techniques.
• d. Modify jobs that are too stressful. e.g We
• should not do things like acting as finance
• officer for a national church.

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2. Childrens education

• Significantly related to the development of
• psychological symptoms overseas.
• Small numbers but much anxiety!

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Suggestions for stress reduction

• Discussion during the candidates period.
• Discourage parents from rigidity on the
• type of education they will seek.
• Consult child.

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Suggestions for stress reductionEducational
options

• Home schooling by computer (loneliness)
• Boarding school (separation) - go to see this
• during post arrival orientation course
• Local school (cultural problems)
• Discuss all these options

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3. Parent-Related Stress

• Significantly related to developing
• psychological symptoms overseas in two
• situations

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Parent-Related Stress

• Liable to cause problems during overseas service
  especially if
• 1. Reported during Initial interview
• 2.Continued during overseas service
• A new finding in missionary literature.

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Usual causes on order of importance

• Cultural factors
• Bereavement
• Health
• Opposition
• Poor relationship between missionary and parents.

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Suggestions

• Serious discussions where cultural factors are
  involved.
• Discuss parental problems with candidates at
  initial selection interviews. Arrangements for
  compassionate leave if necessary to be settled
  before departure.
• Help to arrange parental visits to their children
  overseas.
• Support personnel re frequent distressed phone
  calls/emails.

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4. Home country stress

• Numbers were small, significantly related to the
• development of both depression and other
• psychological symptoms during overseas
• service.
• Usual causes in order of importance
• Family illness
• Relations with home church
• Unspecified
• Poor Communications

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Suggestions

• Relations with home church are important
• Who is in charge?
• Sort this out in the home country and not over
  the dying body of the missionary!

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5. Singleness stress

• Significantly related to being conditionally
• selected, not to any particular overseas stressor
  
• Possibly related to the reason for singleness.
• Usual causes of stress
• Loneliness
• Cultural problems
• General problems
• Unspecified

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Suggestions

• Singleness should be discussed during training at
  home suggest coping strategies organise singles
  seminars overseas.
• Sexuality of great importance due to the
  promiscuous sexual backgrounds of many
  candidates.
• Discuss homosexuality if legally allowed to do
  so.
• Advice needed on problems and successes of
  cross-cultural marriages.

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6. Marital stress

• Significantly related to the development of
• psychologically symptoms overseas.
• Usual causes in order of importance
• Poor relationship
• Too much/too little contact
• Role problems

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Suggestions

• Serious marital problems should be adequate
  reason for refusing or delaying candidate
  acceptance.
• Sexuality, child-related problems, and frequent
  separation of husband, wife and children should
  be discussed during training.
• Current problems of children must be discussed
  during selection.
• Arrange marital seminars overseas, provide
  regular support.

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7. Acculturation stress

• Significantly related to development of
• depression and psychological symptoms
• overseas.
• Usual causes in order of importance
• Non-specific, just difficult
• Foreignness
• Female role
• Poor support in early stages of settling in.

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Suggestions

• Discuss male and female roles before departure
• Support while adjusting

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8. Poor support from sending agency

• Significantly related to development of
• psychological symptoms overseas.
• Usual causes in order of importance
• Poor support from home council/church
• Financial inadequacy

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9. Expatriate and National Leadership

• Problems significantly related to the
• development of
• psychological symptoms overseas.

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Local expatriate leader

• Those conditionally selected more likely
• to have problems with expatriate leader
• than with the national one.

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• Common causes
• Incompetent
• Domineering
• Insensitive
• Poor communicator

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Local national leader- common causes

• Unspecified
• Finance
• Differing expectations

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Try To Understand!

• Expatriate leaders
• Often take on the job in addition to a full work
  load.
• Feel inadequately trained.
• Often poor office help.

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Try to Understand!

• National leaders
• Often lack information on
• expatriate background
• Hence not very supportive.

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Suggestions

• Administration should make adequate provision for
  overseas needs.
• e.g. Physical care, Mental healthcare,
• mentoring, housing, educational needs
• language learning,
• support services locally and at home.

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Suggestions

• All administrative arrangements should
• be regularly audited and revised.
• Local expatriate leader needs better
• training and support.

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Suggestions

• National leaders need help in -
• a. Handling expatriates
• b. Relationships with sending country
• leaders.

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Suggestions

• Personnel should be informed in
• advance
• of all administrative arrangements,
• and given clear instructions what to do
• in emergency.

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10.Failure of Post-Arrival Orientation

• Provoked the most comment of all questions
• Causes of complaint
• Poor content
• Not available
• Domestic problems

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Suggestions

• 1.Find expatriate and national mentors.
• 2. Repeated requests for this.
• Vital Advice
• Organise post arrival orientation courses.

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11. Re Entry stress

• On furlough, (temporary re-entry)
• Major Complaints -
• Loss of role, deputation work, general re-
  settlement
• All significantly related to the development of
  psychological symptoms.
• Especially if had been originally
• conditionally selected.

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Suggestions

• Re-entry care begins at selection, with
• decisions about property etc.
• Re-entry seminars should be conducted
• overseas 3-6/12 before leaving.

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Suggestions

• Re-entry care must include physical and
• psychological debriefing, and ongoing support.
• Major furlough problem of deputation and fund
  raising appears insoluble until the financial
  structure of Missions changes.

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2. Permanent re-entry

• Housing and childrens education were
• significantly related to the development of
  psychological symptoms.
• Grief at loss of overseas role was significantly
  related to being conditionally selected.

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Major problems

• Housing
• Childrens education

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Suggestions

• Personal and seminar debriefing should
• be arranged.
• Physical and psychological debriefing
• should be available.

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Suggestions

• Someone in the office should be
• available for ongoing help.
• On-going help can be given through a
• Home Partners association.

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12. Final Comments

• Spirituality
  
• a. Personnel satisfied with their spiritual
• development but found church difficult
• because of language and differing
• worship patterns.
• b. Spiritual development seminars and teaching
  very helpful throughout service.

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12. Final Comments

• The importance of Physical care
• Depression overseas was
• significantly related to physical health
• problems.

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An important principle-

• Suitable physical and mental health care must
• be available to all overseas personnel.
• Personnel must have clear instruction about
• handling physical and mental health problems.
• They should understand what they can and cannot
• treat themselves or with the help of local
  doctors.
• This will reduce the need for repatriation.

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Membercare is currently working worldwide to
achieve this.

• Brief summary of membercare findings-
• Flow of care must be continuous, starting at
  selection and ending after re-entry, until the
  person wishes to discontinue.
• Care must be peoplecentered and include
  children. Compatible with Code of best Practice
  or other approved national occupational care.

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Brief summary of membercare findings-

• Must be done by properly qualified people,
• Missionaries also can help each other and
• benefit by simple training during orientation.
• Regular supportive seminars during service.

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Brief summary of membercare findings-

• Facilities for complicated or long standing
• physical and mental health care should be
• available.
• If not possible instruction about repatriation
• must be available.

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Brief summary of membercare findings-

• Major stressors should be researched and
• reduced if possible.
• Crisis care teams should be set up for
• personnel support where required.

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A word of warning

• My talk has all been about negatives.
• Some firm positives
• Missionaries are doing very well. In my surveys,
• the numbers with severe stress are
• comparatively small, and generally comments
• have been strongly positive.

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It is right that we care for people, God has
commanded us to do so.

• But
• Side by side with good care we need to teach
• endurance, faith in God , and the ability to
• stand alone with him if necessary.
• If we do not teach this, and only teach people to
  
• depend on counselors or outside help, we shall
• be creating monsters, not a healthy work force.

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