The Foreign Service Journal, January-February 2016

THE FOREIGN SERVICE JOURNAL | JANUARY-FEBRUARY 2016 29 to possess in some countries even with a valid prescription. Community education is critical, since many employees are understand- ably anxious about making individual appointments for the first time. Brown bag lunches, CLO presentations and com- munity talks at schools all give employees the chance to meet and engage with an RMO/P in a more comfortable setting. Assisting post leadership can take many forms, and it’s an area that is always chal- lenging—patient confidentiality is para- mount. Our RMO/Ps must be especially mindful of privacy concerns in small mis- sions where “everyone knows everything.” Mental health issues can come into play in both the medical clearance and security clearance pro- cesses. Employees know this, and fear of howmental health care might affect these processes is one of the largest barriers to our ability to provide care. The reality is that seeing a mental health provider rarely affects either one. Mental Health Care and Clearances On the medical clearance side, mental health issues are treated just like other medical conditions. The medical records of employ- ees who report a history of mental health treatment at the time of a medical clearance update are routinely reviewed, as they would be when report- ing any medical problem or treatment. If there is a signifi- cant new diagnosis, medical evacuation or serious safety event, then, yes, the medical clearance may be revised, primarily to make sure that needed care is available at post. However, the vast majority of employee medical clearances are unaffected. And, most importantly, seeking routine mental health care or making an office visit to an RMO/P—even though, like all doctor visits, it will be documented in the health unit record—is con- sidered good health care that is encouraged whenever necessary and, as such, rarely affects the employee’s medical clearance. For security clearances, here is how the process works. When information regarding a mental health issue comes to the Bureau of Diplomatic Security through their security clearance investiga- tive process, they refer the case to a specialized office within MED staffed by two psychologists who work only in this area (they do not provide care, have access to records, etc.). They review all cases referred by DS. (Note: Mental health treatment arising from marital, family or grief; service in a war zone; or being the victim of sexual assault, need not be reported at all.) Roughly 50 percent of the mental health related cases referred by DS are assessed as so low risk that they are cleared at this phase without any further review. In the remainder of cases, the psychologists may review records, interview the employee or performpsycho- logical testing. However, no evaluation of any individual is performed without informed consent, and nomedical information is released to these MED psychologists from the health units, Medi- cal Clearances Office or private providers without a signed release. These psychologists do not work for DS—they are MED employ- ees—and DS has no access to any MED records during the process. In any given year, approximately 95 percent of all cases referred to the specializedMED psychologists are returned to DS with the Community education is critical, sincemany employees are understandably anxious about making individual appointments for the first time. State Department psychiatrists at their annual meeting in 2014. COURTESYOFSTEPHENYOUNG