LDS missionaries and mental health: The challenges are rising and so is the church’s response

Editor’s note • This article discusses suicide. If you or people you know are at risk of self-harm, call or text the 988 Suicide and Crisis Lifeline, or chat at 988Lifeline.org.

It was an ordinary day in an Armenian city three years ago when Latter-day Saint missionary Jaxon Washburn suddenly felt overcome by a kind of existential dread and a terrifying thought:

“I don’t want to be here anymore.”

And by here, he meant alive.

Washburn had experienced the normal stresses and tensions that come with the rigors of missionary life in The Church of Jesus Christ of Latter-day Saints — learning a language, getting along with “companions” (assigned partners) with whom he had profound differences and debates, teaching the theology to total strangers — but only once before had he had this overwhelming death wish. It frightened him so severely he called the volunteer therapist assigned to his case, who recommended he meet with his mission president a few hours away.

Within a week, Washburn was back in the United States, having served less than nine months of a two-year assignment.

Dealing with multiple cases like Washburn’s — and lots of other mental health traumas — is the new reality for Latter-day Saint mission presidents and their wives.

And it has upped the ante of expectations placed on these leaders, all of whom are volunteers, with many drawn from the business world, where they excelled in sales, finance, management and organizational behavior.

Mission presidents are wholly responsible for the safety, welfare, success and spiritual growth of their young charges, and thus are in a profound position to teach and transform their ranks with words of wisdom. Indeed, these shepherds can have a lifelong imprint on the missionaries in their assigned flock.

Beyond doling out spiritual advice and keeping companion conflicts to a minimum, these Latter-day Saint leaders must identify and address an array of modern mental health needs.

For much of the faith’s history, any young enlistees in “God’s army” who couldn’t get out of bed to go proselytizing were labeled lazy. Those who feared approaching unfamiliar people on the street, on buses or in their homes were viewed as cowards. Those who went to extremes in their obedience were praised as leaders. And those who came home early were treated as failures.

Like the rest of society, though, the Utah-based faith now grapples with the fact that some of these conditions are symptoms of mental illness — everything from depression and anxiety to the religiously obsessive behavior known as scrupulosity.

These afflictions have risen dramatically among millennials — which includes today’s college students and the military — and the COVID-19 pandemic only made them worse.

Such trends have similarly plagued the church’s volunteer force of more than 50,000 evangelizers between ages 18 and 25 across the world.

Whether they are reporting their issues more openly than previous generations or experiencing a higher degree of mental health issues, surprisingly high numbers of missionaries, by some estimates, serving in the 400-plus missions have noted mental health diagnoses or medications on their applications to serve.

Those serving from the U.S. and Europe, insiders say, tend to report their mental health needs more than missionaries coming from other countries. The latter may be hesitant to put a name on what they are feeling due to cultural considerations, but the numbers are rising across the board.

Thus, the church has adapted its strategies for ministering.

Rather than assessing missionary mental health based on a particular diagnosis, the church’s approach is all about growth — intellectual, social, physical, emotional and spiritual, says Nathan Gibbons, a Family Services adviser to the missionary department.

“We not going to say, ‘Well, that’s diagnosed as depression with suicide ideation. So you’re going home,’” Gibbons says in an interview. “We want to focus more on what’s going to best contribute to this person’s growth.”

The main goal, he says, is to keep missionaries “safe, functional and growing.”

These days, mission presidents have plenty of help doing that.

Every mission has an assigned mental health professional, who is on call for any emergency or ongoing support. Sometimes that therapist develops a closer, more compassionate relationship with missionaries than their religious leader.

Mission presidents can draw on the advice of their “mission health council,” a multidisciplinary team composed of experts in various areas who can assemble other resources.

Even so, a mission’s structured days, its exacting expectations, the pressure of perfectionism and removal of all distractions, can strip some young proselytizers of the coping mechanisms they developed in high school — listening to music, taking a walk, sleeping all day, solitary hiking.

None of those avenues is available to them anymore, Gibbons acknowledges. “The mission itself can be a stressful environment.”

Growth requires “stress and accommodation,” the Family Services adviser says. “Growth doesn’t occur in a vacuum, you know, without some difficulty. And if the goal is to help these young people with some life skills, with maturity, we recognize there is going to be difficulty that comes from it.”

Cora Longhurst

Philadelphia Mission, May 2022-September 2022

Since I was 16, I have been in therapy and dealt with multiple mental health challenges on and off throughout the past four years, including depression, anxiety, attention-deficit/hyperactivity disorder, insomnia and anorexia. When I submitted my [mission] papers, I was open and honest about all of these issues, but thought I had everything under control and would be able to handle any problems with ease should issues arise in the field. Unfortunately, almost as soon as I arrived in Pennsylvania, I began to feel quite depressed and while I tried to suppress what I was feeling, after about 3½ months, I was no longer able to ignore my mental health. By this time, I had also stopped eating, was constantly anxious, and getting a good night’s sleep was rare. It didn’t help that the female leaders constantly commented on sisters’ weight. I finally asked for help one P-Day [preparation day so missionaries can attend to personal chores] and was emergency-transferred home on a health release by the end of that week.

Since then, it has felt like God has disappeared from my life. I feel like I’ve tried everything: temple service, church attendance, service, personal study, spending time in nature, etc., anything I could in order to feel that love and connection again, but nothing has worked. I am not giving up, but it is incredibly discouraging and often leaves me feeling like I have failed God in some way.

‘It’s a brain disease’

Mental health “is not a personality flaw; it’s a brain disease,” says Christena Huntsman Durham, vice president of the Huntsman Mental Health Foundation. “My sister died of a drug overdose. She was not a bad person, she had a bad disease.”

When a person has diabetes, “no one says that’s the work of Satan,” she says. “Until we look at these conditions like we look at heart disease — with love and empathy — there will still be stigma.”

Durham is passionate about ending the stigma associated with mental illness.

Last October, the foundation launched a 10-year ad campaign to “free the world from the stigma that leads to increased rates of mental illness, substance use and suicide.”

The shame “keeps people from seeking the treatment they need, leading to increased rates of suicide and substance use disorders,” the foundation says in its release. “Stigma has led to an underfunded mental health system, and often those with the most severe needs fall through the cracks.”

She and Dr. Mark Rapaport, CEO of the Huntsman Medical Health Institute in Salt Lake City, met last month with Latter-day Saint apostles, women’s leaders and other general authorities to spell out the mental health needs of today’s young members.

“The complexity of the world our children live in now includes both the benefits but also the tremendous challenges of social media for kids,” Rapaport says. In pre-internet days, “you would be bullied at school by people you see all the time. Now it’s 24/7 and frequently by people you don’t know.”

TikTok and Instagram offer a fantasy world that “seems to be perfect,” the psychiatrist says. “That creates a real challenge for many kids, whose lives are far from perfect.”

Then came the pandemic, which “exposed children and adults to social isolation,” he says. “They saw people get sick and die. Their sense of the world being a safe place and feeling in control over their lives was really damaged.”

That was compounded with the fact that young people coming of age during COVID-19 missed out on a lot of “normal, psychological-social development with youth groups, school activities and other high school opportunities,” Rapaport says, “and they haven’t had the same maturing experiences. You had kids who were ninth graders but acting like seventh graders.”

When these young people go on missions at 18 or 19, he says, they are “like strangers in a strange land.”

The nationally renowned innovator on mental health praised the church for its willingness to address these concerns.

He pointed to the success of SafeUT, a suicide prevention app and a “system of intervention” that is staffed round the clock to help anyone who is feeling bullied, desperate or hopeless.

Last year, Safe UT counted “a million conversations,” Rapaport says. “It saved a life a day.”

With its vast resources and global network, the church could replicate this program worldwide, he told them. “Family Services has the network, and the foundation would share the technology and design of the program.”

The Latter-day Saint leaders’ response to Rapaport’s presentation was “gratifying and wonderful,” he says. “It was clear that the leadership of the church and women’s groups were very concerned about their young people and very open to listening and learning.”

Michael Skaggs

Las Vegas, March 2018-June 2018

Church headquarters service mission, July 2018-February 2020

I went out having attention-deficit disorder and Asperger’s, which created a red flag with the church about my ability to serve full time. Due to this, they sent me on a two-transfer mission to Vegas, four hours away from my home. I had zero Missionary Training Center experience and was basically sent out blind. I struggled a lot. I cried a lot during my studies because I felt like a failure.

At the end of the two transfers, I was told that they didn’t believe that I could continue in a normal proselytizing mission, but there was a unique mission I could go to — the only full-time nonteaching mission — in the Salt Lake City Headquarters Mission. I wasn’t too fond of the idea. We had a mission president, had to have curfew, be with our companion 24/7, serving in the Family History Library, Church History Library and Joseph Smith Memorial Building.

I felt out of place and had bouts of depression, but it was never officially diagnosed. I continually wanted to go home. I would cry every day and sleep during lunch and dinner. I didn’t have a filter and so I said a lot of stupid things and got in arguments with other elders.

I went to [the church’s] Family Services and saw a counselor, and then got put on two medications to stabilize my mood and help with anxiety. Thankfully, my mission president wanted to give me the opportunity to change and do better. He had a huge love for me and cared about me. I was able to complete the full two years. I was extremely grateful for him. It never affected my faith, but it did make me realize that missions aren’t for everyone and, it’s OK to not go on a mission due to mental health.

The service option

Every missionary is on a “growth curve,” says Gibbons, the Family Services social worker, and “the steepness of the growth curve is different for everyone.”

Those who are “growing and functional will continue in their assignment,” he says. “But if the growth curve flattens where they begin to drop, then we work — hopefully in tandem with leaders and parents — to try to help them transition to a service mission.”

Gibbons is emphatic on this point: “It’s not a return home; it’s a transfer to a service mission.”

Young applicants can’t just choose the service option rather than a teaching mission at the outset, he says, “but they can opt for it if teaching becomes too burdensome.”

An “intervention” may be “the best way to describe the first step,” he says. Staying on the mission could include some counseling and maybe even medicine, if that’s possible and desired.

If, after a time, that’s still not working, then the volunteers can transfer to a service mission.

“There’s a whole process that the mission presidents are trained on, about how to have that conversation both with the missionary and the parents,” Gibbons says. “The mission health council meets regularly to make sure everybody’s counseling together to focus on the missionary’s growth and what might be best.”

Any decision about a service mission transfer “isn’t just coming from one person,” he says. “It’s the whole team.”

The hope is that all people who desire to serve — no matter their challenges — will be offered a way to do that.

The church has done “an excellent job with mission presidents, giving them resources to help with these issues,” says Richard Ferre, a Salt Lake City psychiatrist who has worked with many Latter-day Saint missionaries. “More and more area medical advisers are becoming much more conversant with mental health issues, and the church has psychiatrists on call in every part of the world.”

The mission health councils, Ferre says, have proved a “dramatic success in helping presidents learn and grow.”

For missionaries who transferred to a service mission, whether serving in a temple or working in the community, he says, “their recovery is resolved much more rapidly than if they come home with no structured opportunity for continued service.”

This combination of preaching and serving means offering a balm in the here and now, Ferre says, as well as joy in the hereafter.

Jaxon Washburn did not transition to a service mission but returned home to Arizona to heal himself.

Those months in Armenia, he says today, were still some of the best days of his life, transforming his future and his faith forever.

Editor’s note • This story is available to Salt Lake Tribune subscribers only. Thank you for supporting local journalism. Also, Christena Huntsman Durham is a sister of Paul Huntsman, chair of the nonprofit Salt Lake Tribune’s board of directors.