The Foreign Service Journal, January-February 2016

30 JANUARY-FEBRUARY 2016 | THE FOREIGN SERVICE JOURNAL A DAY IN THE LIFE OF THE RMO/P These vignettes are all fictitious amalgams of real life situa- tions our RMO/Ps face every day. They require different kinds of skills. They represent complex issues that require complex decision-making involving multiple stakeholders. We work with many partners—our MHS team in Washington, D.C., our RMO and other MED colleagues, CLOs and post leadership— in an effort to find solutions that work best for everyone. Situation 1 A young couple presents to the health unit with their 28-month-old daughter. They report that she met her develop- mental milestones on time over her first 18 months, but now they have noticed she has stopped babbling, does not engage with other children and does not respond when her name is called. They wonder if she has a hearing problem. This is their second directed tour and returning to the United States would be extremely difficult financially. The RMO/P strongly suspects an autism spectrum disorder. What to do? Possible Response: The next step would most likely be a referral to a specialized center in the United States that has broad experience with pediatric developmental disorders. While obtaining the definitive diagnosis is critical, supporting and assisting these young parents as they navigate these trou- bled waters would also be a core element of the intervention. Situation 2 Post One contacts the RMO/P at 2 a.m.; there is an urgent call from a regional post several hundred miles away. The RSO has been called to see an entry-level FSO who has made some superficial cuts with a knife on her arm. The RMO/P speaks with the employee and finds out that a relationship breakup and alcohol both played a role in the event. When the RMO/P follows up the next day, the employee minimizes what happened and adamantly refuses an offer of medevac, insisting that she is “fine now.” There are no local mental health resources. What to do? Possible Response: Any RMO/P would have to man- age the uncertainty of a patient who may be at risk, with the ultimate goal of building a relationship with her. Although it might keep her safer, if we push too hard we could alienate the patient fromMED permanently. Post’s anxiety would also have to be managed, as their comfort with some degree of risk may be quite low. Ultimately it would be about negotiation and trust-building over time to, hopefully, allow the employee to engage in assessment and treatment. Situation 3 A couple presents to the health unit because they are “at the point of divorce.” The employee is highly idealistic, and rejects signs of wealth (an expensive car, family vacations) as “superfi- cial” and inconsistent with her deeply held concerns regarding wealth inequality in the world. The spouse is a foreign national who grew up in poverty. He sees these things as a symbol of success and wants to provide them to his children as he never wants them to suffer the same deprivations he experienced in his own childhood. What to do? Possible Response: The RMO/P would have to facili- tate couples therapy, either in the office or the community. Cultural conflicts in relationships are quite common in our Foreign Service population, and often amenable to treat- ment. The challenge is making it happen when RMO/Ps are frequently on the road, and local culturally sensitive providers are not always easy to find. Situation 4 In the RMO/P’s meeting with the front office during a regional visit to post, the DCM brings up a problem supervisor in the consular section. This supervisor is described as often angry with subordinates and colleagues, leading at least one junior officer in the section to seek a curtailment. The DCM has tried to confront the behavior, but the supervisor minimizes his impact and places the blame for the problem on his locally employed staff. The DCM requested the employee meet with the RMO/P during the current post visit, but he refused. Leadership reports there has been great anticipation of the RMO/P visit so that “something can finally be done” about this supervisor. What to do? Possible Response: The RMO/P sometimes has to set boundaries on appropriate expectations from post regard- ing the limits of what we can do. Many behavior problems are human resource issues, and have little to do with mental health diagnoses. However, all RMO/Ps are well-versed in group dynamics, difficult people and problem office behav- iors. Scenarios like this might lead to a brown bag lunch to discuss managing conflict in the workplace along with coach- ing and support of supervisors at all levels to address problem behaviors. —Dr. Stephen A. Young