Culturally Informed Mental Health Care

EMQ » April – May 2026 » Volume 62 Issue 2

Summary: Mental health is a growing area of need. Christians have an opportunity to step into this space to bring holistic healing. However, we often engage in such ministries without taking the time to contextualize our understanding of mental health. This article explores some of the challenges when engaging in cross-cultural mental health work.  

By Sofia Locke

Mental health is becoming a major area of need in our world. WHO estimates that more than 1 billion people are living with a mental health condition.[i] They also estimate that 70% of the world’s population will experience a potentially traumatic event in their lifetime, with about 5.6% of these people developing post-traumatic stress disorder (PTSD).[ii] People living in countries in conflict, people in poverty, and people who have experienced devastation from natural disasters have an increased risk of developing a mental illness. WHO also notes that there are disparities in the availability of care for people living with a mental illness, with low-income countries having fewer resources to provide general health care (including mental health) to their population. This means that people with the greatest need are more likely not to have easy access to mental health care.

As the need for mental health services rises, many non-government organisations, including Christian aid and development agencies, are trying to build capacity to meet this need. As a psychologist with a heart for integral mission, I worked in such an organisation in a country in Central Asia that had experienced years of conflict. This organisation sought to bring the gospel holistically to this country through development work in education and health, including mental health. During my time doing cross-cultural mental health work, I began to realise that there was a disconnect between the help we were providing and the way mental health was understood and expressed in that country. I also felt that we were using foreign ideas of mental health and ways of treating mental health without critiquing their efficacy. In the long run, I wondered how this affected our gospel witness.

This article is an attempt to think critically about how we engage in mental health and well-being in integral mission. 

Caring For the Poor and Vulnerable

Christians have long had a mandate to look after the poor, vulnerable, and outcast. In Isaiah 58, God rebukes the Israelites as he sees through the hypocrisy of their fasting. He reiterates his desire for his people to “loose the chains of injustice…to set the oppressed free, and break every yoke.” In Micah 6, God reprimands his people for offering sacrifices yet not acting justly, loving mercy, and walking humbly with him. In Acts 6, the early church faced a discrepancy in how food was being distributed among the Hellenistic and Hebrew widows. While the passage focuses on how this situation was dealt with, it is clear that, from the conception of the church, looking after the vulnerable was part of what the church did. The solution to the discrepancy of food distribution wasn’t just to focus on either social welfare or gospel ministry; the church resolved the issue by doing both well.

The church today continues its mandate to look after the poor, vulnerable, and outcast. There has been much thought and intentionality in articulating why we should do this. One such effort comes from the Micah Network (now known as Micah Global). This is a network of evangelical churches and agencies committed to integral mission. In their foundational document, the Micah Declaration,[iii] they state that integral mission is a natural consequence of living a life transformed by Christ. The proclamation of the gospel brings about social consequences as people are called to love and repentance in all areas of life. Equally, work in social justice brings about evangelistic consequences as people witness the grace of Jesus through the work of his people, the church.

The mandate to look after the poor and vulnerable necessitates the question, “Who are the poor?”  Bryant Myers[iv] helps us move away from the one-dimensional view that poverty is merely a lack of financial resources, to understanding poverty in a more holistic, systemic way. This definition of poverty includes people who are socially isolated, who struggle psychologically, and who are unable to flourish in life. With this shift in thinking about poverty, from economics to holistic well-being, Christians are challenged to think about how they can serve the poor in domains beyond just the material.

With the rise of mental illness around the world, Christian development agencies are stepping into this area of need. They have set up trauma courses and counselling ministries in places where people are hurting. While these ministries seek to bring holistic healing to those we serve, especially in the areas of emotional and psychological health, we have not always looked critically at what we are doing. My experience has taught me that we need to ask more questions about our assumptions regarding mental health when we embark on such ministries.

Identifying the Problem

Understanding Mental Health in Context

Whenever I told people in Central Asia that I am a psychologist, they were intrigued. They would often ask me this question: “Look at my face, tell me what you see, what can you tell me about me?” Initially, I wondered if the words psychologist and psychic had been confused in this local language. However, I soon realised that the local understanding of mental health was very different from my understanding.

When I was in Central Asia, I was told that people “don’t have a good understanding of mental health.” What I came to understand was that people did have an understanding of mental health, but it just wasn’t the same as mine. I heard stories of people who had symptoms that I would consider mental health issues being taken to spiritual healers. What I understood as a mental health issue was seen as a spiritual issue requiring spiritual intervention. I also heard stories of people with depression, who had a more medical understanding of mental health, finally being able to see the only psychiatrist in the city. They were given medicine that made them so drowsy that they could not wake up from their stupor. Then, there were the stories from neighbours about horrific events they witnessed or experienced during the war. Contrary to the expectation that they would be suffering from symptoms of post-traumatic stress, they were functioning normally. These stories confirmed my growing suspicion that I had a different understanding of mental health than my local friends and colleagues. 

As I began to learn more about the culture in Central Asia, I began to question the efficacy of the “help” I was trying to bring. For example, how does therapy that relies on a level of self-autonomy and linear thinking apply to a collectivistic culture where most people haven’t had much formal education? I also saw discrepancies between psychological diagnostic criteria and the reality of living in a conflict zone. In Central Asia, many people were hypervigilant, which is an adaptive behaviour in their situation. However, one of the symptoms of post-traumatic stress disorder (PTSD) is hypervigilance. If we adhered strictly to the diagnostic criteria, we would be pathologizing an adaptive behaviour in Central Asia. 

Mental health does not look the same in all cultures and contexts. Human behaviour, and therefore human well-being, is shaped in part by the social context the person is in. Culture affects how people explain and interpret mental health symptoms, how they cope and seek help, express their emotional distress, and what sort of treatment is sought.[v] If we are helping people psychologically and emotionally in a cross-cultural setting, it is important that we first understand how people view these issues. Psychologists have studied the validity of Western paradigms in conceptualising mental illness across cultures and the efficacy of treatments that come from these paradigms with people from non-Western cultures.[vi] While it has been shown that diagnoses and treatment using Western knowledge have some efficacy, we often miss critical information if we do not take into consideration cultural differences in the conceptualisation and expression of mental illness.

To put this in a different way, we need to contextualise the way we approach mental health and well-being. Missionaries understand the need to contextualise the gospel. Understanding the worldview of the people we are sharing the gospel with and presenting the gospel in a meaningful way, are essential in communicating the gospel meaningfully. We need to do the same with mental health. Rather than imposing our understanding of mental health onto others, we need to understand mental health and well-being from their perspective. Then, we can treat those issues in ways that make sense to the people we are ministering to. To go into a culture without contextualising our understanding of mental health can only lead to ineffectiveness at best or, at worst, harm the people we seek to help. 

Underestimating Resilience in Trauma

When we define people only by their suffering and their struggles, we continue to impoverish them. This is because we silence their voice of resilience. The resilience I witnessed in the people of Central Asia stood in stark contrast to the stories of Central Asia that I read in the media. The media only talked about the negative impact of the war and the suffering of the people. While suffering was certainly part of the story, the stories of resilience were missing.  

As the field of development embraces a more holistic understanding of aid and development, aid in crises now includes psychological aid in addition to material aid. This is a step forward, as holistic help is delivered to people who have experienced traumatic events such as war and natural disasters. However, this has led to trauma becoming a dominant discourse in aid and development work. This has seeped into the Christian development world as we unquestioningly assume that people in crises have been traumatised and need our help. When we enter a situation with this framework, we are primed to see the negatives rather than the positives of the people we work with. While trauma is an area that needs to be addressed in such situations, only focussing on that devalues the inherent resilience that people have.

After hearing stories of the decades of war in Central Asia and the psychological need for a people who were traumatized, I was surprised to see how resilient people were even after facing significant adversity. People were going to work, children were going to school, people were throwing birthday parties, and dancing at wedding celebrations. Life hadn’t stopped because of the war. It continued despite the war. People were struggling with the realities of living in a country in conflict, such as bombings, insurgent attacks, and kidnappings, yet this wasn’t the whole story of people’s lives.

Resilience is a protective factor against mental illness. People have resilience and can recover from difficulties. When we approach people who have experienced traumatic events this way, we preserve their dignity and empower them. Recognising resilience helps people out of their psychological poverty as it disrupts the narrative that they are powerless and worthless. Rather than making people dependent on foreign experts, we need to help people recognize their abilities at a time when they may have lost their sense of belonging and self.

Overestimating Our Power to Help

While it is easy to see the deficits in those who are poor and vulnerable, it is sometimes harder to see our own deficits. Myers draws attention to the poverty of what he calls the “non-poor.”[vii]  Rather than thinking that only the poor are the impoverished ones, Myers shows that the “non-poor” are also impoverished as they often have an “inflated sense of identity.”[viii] They see their gifts and resources as a way to control those who have less. While we may not consciously strive to do this, the way in which we help could perpetuate this thinking.

There is a danger for Christian aid agencies to focus on the needs of the people and ignore, or downplay, the strengths and resilience of the people. Focussing on the need brings funding, it motivates people to give. Without a need, we find ourselves without a reason to be there. Ironically, our effort to help the poor can inadvertently keep them in a state of poverty to justify and support our efforts to help.

It is easy to do this with psychological need. Refugees coming out of horrific journeys to safety are presented as traumatised and needing help; women leaving domestic violence as needing practical and emotional help. While the need is there, keeping them in this state is not the goal. When we keep referring to the people we minister to as the “poor refugees” or the “victims of domestic violence,” we keep them in the role of victim and place ourselves in the role of rescuer. We assume that because we have more resources, we know what they need and can provide it for them. In our effort to bring healing, we impose our ideas of what healing looks like. When we do this, we rob them of their dignity to choose their own path of healing, which may not include our intervention.

The power difference between the vulnerable and those who are trying to help them makes it easy for both parties to fall into this trap. We need to find a way to help those who are emotionally and psychologically vulnerable that empowers them and protects their dignity.

Factors That Make Conversation Difficult

I have found that having an open conversation about this is difficult, as emotions are heightened, and theology is used to justify help that may not be appropriate. Yet, to be reflective practitioners, we need to ask if what we are doing is helpful or harmful.

When we see people hurting, we feel their pain. This is how empathy works. It is natural to want to do something to help when we see someone suffering. Emotions motivate us to act. However, when emotions are high, and the need is dire, it can be difficult to think dispassionately about the right course of action. This is especially so if that course of action is to refrain from doing something that might alleviate short-term suffering for a longer-term gain.

Sometimes, theological arguments can be used to justify action, even if the action is not culturally appropriate or sustainable in the long term. There is a sense of moral righteousness in these arguments that shuts down meaningful debate.

The expertise of people trying to help can also make it difficult to engage in meaningful conversation. Professionals in the field of mental health often have years of formal education. While this is valuable, this can also silence any conversation that is not considered “best practice.” This education difference creates a power imbalance that can make it difficult for people with less training to speak up. It makes them feel underqualified to enter into the conversation, and they defer to those whom they perceive as more qualified.

What We Need to Consider

The goal of psychological help is to bring about a person’s well-being. Myers noted that in a study that asked the poor to define what well-being is for them, having a sense of dignity and respect was high on the list.[ix]

 Our ministries in mental health should empower those we are helping. The poor and vulnerable are often left with a view of themselves that says that they have no value and nothing to contribute. This sense of worthlessness and helplessness is often seen in those who have been traumatised, abused, and neglected. When we enter this space with biased views of mental health or well-being and do not consult those we are helping, we push them deeper into helplessness.

Allowing people to articulate their suffering in a way that is meaningful to them preserves their dignity in their suffering. People in different cultures express distress and make meaning of it in different ways. We need to refrain from imposing our framework of suffering onto another culture. For example, we may impose a label like post-traumatic stress disorder (PTSD) on someone because they have been through what we perceive to be a traumatic experience. We interpret their actions through our cultural lens. In doing so, we have put our understanding of mental health onto someone’s suffering rather than allowing them to tell us what that suffering means to them.

Consulting with people to determine what recovery looks like for them is an important part of recovery for those with mental health issues. We start by understanding what is important to the people we are ministering to. We can listen to what their goals are and respect them, even if these contradict our assumptions of what well-being looks like. For example, people who are recovering from a traumatic event may not need counselling. This may be a very foreign concept to them. Instead, their greatest need may be a job so that they can provide for themselves and their families. Then, they will feel they can contribute to society and regain their sense of self-agency and dignity.

We also need to help people regain their dignity and identity in Christ. Psychological help isn’t the ultimate answer to suffering. As stated in the Micah Declaration, our works must point to eternal consequences. Work and word must go hand in hand. If we are working in a way that doesn’t make sense culturally in the psychological sphere, this may well affect our message and how people respond to us in the spiritual sphere.

Conclusion

With mental health issues on the rise, there is an opportunity for Christians to step into this space to bring about holistic healing. However, this needs to be done in humility. Mental health is not a one-size-fits-all concept. Every culture has its own expression of both distress and well-being. We need to be aware of our cultural biases and listen to the people we are ministering to so that we understand their picture of well-being. If we don’t, at best, our efforts may be ineffective; at worst, we strip people of their dignity and self-agency. We may end up doing more harm than good. Ultimately, our aim is to help people find their true sense of self in Christ.

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[i] World Health Organization. “Over a billion people living with mental health conditions – services require urgent scale-up”. 2 September 2025. https://www.who.int/news/item/02-09-2025-over-a-billion-people-living-with-mental-health-conditions-services-require-urgent-scale-up

[ii] World Health Organization. “Post-traumatic Stress Disorder”. 27 May 2024. https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder

[iii] Micah Network Declaration on Integral Mission. Effective 22 December 2025.  https://d1c2gz5q23tkk0.cloudfront.net/assets/uploads/3390139/asset/Micah_Network_Declaration_on_Integral_Mission.pdf

[iv] Bryant Myers, Walking with the Poor (Orbis Books, 2011).

[v] L.J. Kirmayer, L. Narasiah, M. Munoz, et al. “Common mental health problems in immigrants and refugees: General approach in primary care,” CMAJ, 183 no.21 (2011), 959–967.

[vi] D.Hinton and R. Lewis-Fernandez, “The cross-cultural validity of Posttraumatic Stress Disorder: Implications for DSM-5,” Depression and Anxiety, vol. 28 (2011), 783–801; K. Miller, P. Omidian, M. Kulkarni, et al. “The validity and clinical utility of Post-traumatic stress disorder in Afghanistan,” Transcultural Psychiatry, vol 46(2) (2009), 219-237.

[vii] Myers, Walking with the Poor,145.

[viii] Myers, Walking with the Poor, 178.

[ix] Myers, Walking with the Poor, 32.

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EMQ, Volume 62, Issue 2. Copyright © 2026 by Missio Nexus. All rights reserved. Not to be reproduced or copied in any form without written permission from Missio Nexus. Email: [email protected].