The Foreign Service Journal, January-February 2016

40 JANUARY-FEBRUARY 2016 | THE FOREIGN SERVICE JOURNAL physical health. The investigator does not need to know if I have had counseling or treatment for most mental health matters. In my opinion, mental health treatment is a medical issue and should be dealt with through MED channels and in the medical clearance process. It should not be part of a back- ground check. For serious behavioral issues, MED could make a determination to refer matters to DS. If this change were made, I would be much more willing to seek mental health care. a USAID’s Staff Care T he lack of mental health support is a big downside to the Foreign Service. A few years after joining, we realized that my husband suffered from an anxiety disorder. We were wrap- ping up one overseas tour and about to move to an even more isolated and poor country for my next tour. It felt lonely and dif- ficult to have to figure out his mental health needs in countries without adequate English-speaking care available. When I spoke with the visiting regional psychiatrist about my husband’s mental health needs and the possibility of getting him anti-anxiety medication, his response was that my husband shouldn’t have been medically cleared to come to post. This response was unhelpful: it did not provide me with the informa- tion I needed to help my husband, and it did not make me feel safe to get my husband the help he needed. Also, the regional psychiatrist only came to post once during my two-year tour, not an adequate number of annual visits. My husband was eventually able to get medication, thanks to the embassy medical officer. …In addition, we explored the option of talk therapy. …I was disappointed to learn that the Foreign Service Benefit Plan would not support Skype or phone therapy. Our saving grace has been the Staff Care services at USAID. Through Staff Care, my husband was able to receive Skype therapy, and we were able to receive Skype couple’s therapy— mental health challenges take a toll on spouses and families too! It has been an invaluable resource and the main type of mental health support we have received. After being in Washington for a while, I am bidding on overseas posts again, but I am nervous for my husband and his ongoing mental health challenges and worried about the impact on my family’s clearances that seeking mental health care for my husband could have. No matter what management says about the importance of mental health, if there are no real changes, then the Foreign Service will continue to be an ineffective and unsupportive mental health environment. Thank you for dedicating an issue to this topic. a Curtailment: One Size Fits All T he Foreign Service should offer more access to social work- ers and counselors for officers and their families overseas. At smaller and isolated posts there is little privacy and few people to talk to about your problems. Often it’s not the stresses of the job, but issues associated with living overseas, problems with a supervisor or disappointments during promotion and bidding season that wear on you. There is no one outside the embassy to talk to, and these are not the kind of issues for the community liaison officer. A visit by the regional psychiatrist every couple months for a day or two is completely insufficient. You also do not know who the regional psychiatrist’s client really is: you or the State Depart- ment? Does a psychiatrist see you as a patient who needs help or just a problem for the Foreign Service best remedied by removing you from post? Those of us overseas would benefit from counselors without having to resort to the regional psy- chiatrist. I would not seek assistance from post’s nurse or a regional psychiatrist for a mental health issue out of fear that any discus- sion of such a problem would immediately be relayed to the management officer and then to the front office. And then you can lose control over your job and career. A colleague who went through a difficult personal time at post raised this with a regional psychiatrist, was curtailed and sent back to D.C. against her wishes. No attempt was made to deal with the mental health issues at post or to comply with the officer’s desires to address the problem. Curtailment is the one- size-fits-all solution. a Unprepared for PTSD M y experience with mental health care at State was that they were completely unprepared to deal with someone with PTSD symptoms abroad. My regional psychiatrist in coor- dination with the embassy doctor took quick action to get me