This post is part of a series exploring data from a survey of over 800 Adult TCKs I conducted around 2019-2022. To learn more, please read this post.

MENTAL HEALTHCARE received by TCKS

A big part of the ‘why’ behind this survey was to see if the trends I’d seen anecdotally would hold across a wide sampling of TCKs. I knew many Adult TCKs struggling with their mental health, but how representative was this of the broader TCK community? I asked demographic questions to see if experiences of mental health, and mental health care, would differ by factors such as gender, age, and parent’s occupation. I was particularly interested to see if there were any differences between MKs (missionary TCKs) and other TCKs, as I’d seen specific hurdles to mental health care associated with the missionary world (finances, stigma, and over-spiritualising of mental health struggles).

In this post I am going to share overviews of a lot of data, but here are a few key findings:

there were few differences between demographics in terms of the percentage of TCKs who received care, and also whether they thought it was helpful
one key difference: men were a little less likely to access care, and much less likely to feel that care was accessible
younger people were more likely to feel that care was helpful
TCKs from non-profit backgrounds were less likely to access support from psychologists (as opposed to counsellors)
TCKs who did not access mental health care were still likely to report being impacted by mental health concerns

Now let’s dive into some details!

WHat types of mental health care did TCKs access?

In the survey I asked ATCKs if they had accessed various types of mental health support, any other mental health support, or none at all. First, we’re going to look at four specific types of mental health support:

Talking to a doctor (family doctor, GP, primary care physician) about your mental health
Sessions with a counsellor
Sessions with a psychologist
Taking medication for your mental health

I asked about other types of support as well, but these were the categories with the most responses. Below are charts for each that shows the general number of ATCKs who answered ‘yes’, both overall and broken down by various demographics.

Please note: while several non-binary ATCKs took the survey, the group was too small to provide reliable statistics, so only data on male and female ATCKs is provided.

Generally speaking, only 1 in 3 Adult TCKs had discussed their mental health with a doctor while half had had sessions with a counsellor. This shows a separation between mental health and physical health which I personally find interesting, as my doctor(s) have been extremely helpful in managing my mental health. To me, this warrants further research in the future as I am interested to know if there are cultural differences here — perceptions of whether mental health is connected to physical health and the ‘work’ of a doctor. That aside, it is certainly noteworthy that half of Adult TCKs had met with a counsellor.

TCKs from families who were abroad due to a parents work in business, foreign service, or the military were slightly less likely to have had sessions with a counsellor, and slightly more likely to have had sessions with a psychologist. Given that missionary and humanitarian families were less likely to have sessions with a psychologist, I wonder if this is at least in part due to financial pressures — whether families from these backgrounds are more likely to choose counsellors as they tend to charge less than a psychologist. Again, I think this warrants further research as I find this correlation interesting. There may be something important here for non-profit organisations, in ensuring employees have insurance that covers expert mental healthcare for their families, and that they feel safe to procure this.

Finally, 20% of Adult TCKs (1 in 5) had taken medication in support of their mental health. This is similar to rates in most Western countries. TCKs from foreign service and military families were slightly more likely to take medication (30%) and, and women were more likely to take medication than men. The rate also went up by age, which is to be expected. Though this brings up a question: will the lifetime rate for TCKs be higher than for other communities? 30% among TCKs over 35 is higher than what is seen in most communities.

what type of care did tcks find helpful?

The following two charts break down Adult TCK answers on whether there was mental health support/support groups available to them, and, if they accessed this support, whether they found it helpful. The biggest takeaway is that there was very little variation in the percentage of ATCKs who found support helpful if they accessed it — close to half. The biggest differences were in which groups felt that support was available to them.

Availability of Mental Health Support in general

38% of ATCKs said that mental health support was available to them.
Only 16% of male ATCKs felt that mental health support was available to them.
There was almost no variation by age, despite the survey asking about all-of-life experiences.
ATCKs from corporate backgrounds were less likely to say that mental health support was available to them (29%).

Helpfulness of mental health supports when accessed

While male TCKs were much less likely to say that mental health support was available to them, when they did access mental health support, they were equally likely to say that it was helpful (48% aross the board). This indicates that while mental health supports are equally helpful to men and women, men are less likely to feel that this support is available to them.

There was little difference in the rate of helpfulness for ATCKs over 25, yet 61% of those in the youngest age group (aged 18-25) who accessed mental health support said it was helpful. This group were not more likely to say support was available, but when they accessed support they found it much more helpful. This feels like very good news! I believe this indicates that the quality of mental health support being provided to young TCKs is improving over time. Ongoing research in this area may help provide additional answers.

Missionary ATCKs were slightly more likely to say that the mental health supports they accessed were helpful (52% vs 45% of other sectors combined), but in general there was little difference between different sectors on this.

A final word on this: less than half of Adult TCKs who accessed mental health supports found these supports helpful. We need to do better. The hopeful note is that the youngest ATCKs surveyed were much more positive about the helpfulness of the support they received! My belief is that as research and awareness into what TCKs need increases, the care and support they receive is improving. I hope that if the same questions are asked in 20 years time, we’ll see different numbers.

Availability of Support Groups

Only 7% of male ATCKs said support groups were available to them, compared to 33% of female ATCKs
The oldest ATCKs surveyed (over 50) were the least likely to say support groups were available (11%)
Only 18% of ATCKs from Foreign Service and Military families said support groups were available to them

Helpfulness of support groups when attended

While there were differences in availability, when ATCKs did attend support groups the rate at which they found them helpful was fairly constant — around 44%. There were a few outliers:

The youngest ATCKs (18-25) were more likely to find support groups helpful (58%), and the oldest ATCKs (over 50) were less likely to find them helpful (18%).
While few ATCKs from Foreign Service and Military families said support groups were available to them, when they did attend support groups 57% found this helpful.
55% of ATCKs from Education and Humanitarian families who attended support groups found them helpful.

When I look at this data, I think a few things. First, I want to see higher rates of ATCKs being helped when they reach out for support. Second, seeing that younger ATCKs are having better experiences with mental health supports is encouraging. There is hope that we are learning and growing in how we support TCKs! Third, support that is targeted to the needs of TCKs may be important — especially combined with data I will explore in my next post. Stay tuned for that!

What about tcks who did not receive mental health support?

When I looked at just the responses of Adult TCKs who reported that they received no mental health support throughout their life (either in childhood or adulthood), I found some sad results. Half said they were impacted by depression and anxiety in adulthood, and more than two thirds were impacted by unresolved grief as adults.

This indicates that there are a significant community of Adult TCKs who are struggling with their mental health and NOT receiving support to deal with this.

I wish I had far more detailed questions (and therefore answers) on this survey — I put together a simple survey to give me some guidance and received such a wealth of information I wish I’d asked more! This data is both validating — that what I’ve seen in the many interviews and conversations I’ve had with TCKs around the globe is representative of a wider pattern — and also saddening. I wish it wasn’t this way. Yet I am not without hope! There are many people doing wonderful work in this area, improving outcomes for TCKs. The results shown in younger ATCKs here is part of the reason for my hope that this work is already changing outcomes.

Want to help?

The question of how to prevent and protect against mental health issues among TCKs is an important one that needs urgent attention and future research. [See the research page for two important current studies on this subject that Adult TCKs can participate in now!] There are clues in other studies, however. We know TCKs have higher rates of Adverse Childhood Experiences than other populations, thanks to research by TCK Training, which research over the past 25 years links to negative outcomes in adulthood, including mental illness.

If you are an ATCK whose life has been shaped by struggles with mental illness, then please hear that you are not alone. You might be far more ‘normal’ than you realise and, there are many other ATCKs and professionals out there who understand your experiences and can help you. If you’d like to know more about where to access mental health support tailored to TCKs (including a list of crisis services available in various countries worldwide) please refer to this mental health resource list. If this post has brought up strong feelings or concerns and you need someone to talk to, please contact one of these crisis services. For those not in a crisis space, TCK Training has a number of resources for ATCKs you may find helpful, including workshops on Anxiety and Depression as an ATCK.

Finally, remember that is is GOOD that TCKs are accessing mental health care! This is one of the ways that we integrate the difficult parts of our stories and create lives that we enjoy. As I wrote in Misunderstood, 80% of Adult TCKs were glad to be TCKs, 90% were thankful, and 98% said they would not take back their TCK upbringing if they could. This is what I wish all TCKs were able to feel, and therapy is a wonderful tool to help us along that journey.

Mental Healthcare received by TCKs