I sat in a cafe opposite a tenth-grade girl. Her father worked for a large multinational company, and their family had lived all over the world. She attended one of the best internatioanal schools in the country. We were sitting together because her parents were worried, and the only person she would agree to talk to was me. She explained her side of the story - but she wouldn't look me in the eye.

Her parents found out she was self harming. Cutting.
She told them it wasn't a big deal. That it helped her deal with stress.
Her parents did not find this comforting.
Especially because a girl in her grade, a girl they knew well, had died through self harm only a few months earlier.
They tried to explain their concerns but the daughter just rolled her eyes. They didn't get it. 

I didn't agree with all the logic she presented, but I listened. I asked questions. 
I heard the stress and pain she was burying, and the quick solution self harm seemed to offer her.

It wasn't a new story to me - other TCKs had told it before.

Mental health challenges are common among expat kids. Naming this does not mean we need to panic – and there is good news. Before we discuss the good news, let’s look at the stats. According to TCK Training’s 2024 survey of 1,643 TCKs, 86% of expat kids experienced symptoms of at least one mental health concern during their lifetime. Among Gen Z expat kids, 88% experienced symptoms during childhood (before age 18).

Self-harm is defined as intentionally causing harm to oneself, whether or not there is suicidal intent. A large portion of self-harm falls under non-suicidal self-injury (NSSI), which includes behaviours such as cutting or burning. A 2019 study spanning 41 countries found that around 22% of children and adolescents globally had engaged in self-harm, with onset most commonly around age 13. Cutting was the most frequent method (Lim et al., 2019).

When we compare this to what expat kids report, we see:

• 22% of children globally self-harmed before age 18.
• 19% of expat kids overall self-harmed before age 18.
• 30% of Gen Z expat kids self-harmed before age 18.

While these are different studies with different parameters, the message is clear: an international lifestyle does not provide immunity from self-harm or other mental health challenges.

These numbers are sobering, but they are not the end of the story. There are things we can do now to lower the risk of self-harm in our expat kids. TCK Training’s research consistently shows that Positive Childhood Experiences (PCEs) are strongly associated with lower rates of self-harm among expat kids.

• Expat kids with 5-7 PCEs were 55% less likely to self-harm in childhood than those with 0-4.
• Only 11% of expat kids with all 7 PCEs self-harmed during childhood.
• Gen Z expat kids with all 7 PCEs were 78% less likely to self-harm than those with 0-2 PCEs.

PCEs have a huge impact, but they are not magic nor are they overly complicated. They are just indicators of emotionally safe homes, supportive friendships, and connected communities.

From a TCK’s point of view, the seven PCEs are:

1. I receive emotional support at home (my feelings are heard and accepted).
2. My family stands by me in difficult times.
3. An adult in my home makes me feel safe and protected.
4. There are two non-parent adults in my life who take a genuine interest in me.
5. I enjoy participating in community traditions.
6. I feel supported by friends.
7. I feel a sense of belonging during my teen years.

Each one of these matters. They aren’t difficult, but they require intentionality – especially when global mobility and cross-cultural living is involved. (Learn more about PCEs with this free course on How to Implement PCEs.)

How adults respond to a struggling child matters, both before and after a child discloses. The way we talk about emotions, stress, and struggle teaches children whether we are ‘safe’ people with whom to share their inner struggles. Many young people ‘test’ potential helpers by sharing smaller concerns first. If those are brushed off, the larger problems stay hidden. 

Most TCKs I’ve worked with who self-harmed fell into the non-suicidal self-injury (NSSI) category. They knew it wasn’t exactly healthy, but believed it was the least harmful way they knew to cope. That means our first response should not be panic or control, but curiosity. (That’s one of the four Safe Space Responses – access a free course on them here.) Trying to stop behavior without understanding why it developed rarely leads to lasting change.

Non-judgmental listening allows us to uncover the emotions underneath and opens the door to healthier coping strategies. Next we connect the young person and their family with professional support, a crucial tool for long-term wellbeing. 

That’s what I did in that cafe. I listened. I asked questions. I helped her understand what she was running from, and created an emotionally safe space where she could safely feel the stress she was hiding from.

Together, we created a plan for how to move forward, and we shared it with her parents.

For anyone who regularly spends time with expat kids – whether teachers, mentors, family friends, pastors, and even parents themselves – training matters. You don’t need to become a therapist, but you do need tools.

I highly recommend both Youth Mental Health First Aid for TCKs and Suicide Intervention for TCKs.

To go deeper, there is Groundwork for anyone who interacts with TCKs regularly, which includes both the YMHFA and Suicide Intervention certifications, and TCK Crisis Care Training. 

Because kids don’t need us to be perfect. They need us to be prepared when they are ready to reach out. 

Note: If your family or a family you care about is in crisis, don’t wait. You are not alone, and support is available. Finding a licensed therapist your child feels comfortable with is critical for long-term wellbeing.  Here is a great list of TCK-informed therapists you can refer to for assistance. The Season of Crisis Toolbox is also a great starting point for working out how to support your family as a whole while navigating difficult seasons together.

See a version of this post specific to Missionary Kids here