The Foreign Service Journal, January-February 2016

THE FOREIGN SERVICE JOURNAL | JANUARY-FEBRUARY 2016 45 v I would like to hear that State will implement addi- tional support for FS families focused on ease of access to appropriate mental health care from English-speaking providers and more general emotional/therapeutic sup- port for couples, singles and families overwhelmed by the transitions—perhaps incorporating online counseling (such as Skype). v The Foreign Service should adhere to the same stan- dards of privacy and professionalism as other U.S. mental health care providers and, given the number of officers exposed to trauma, should train managers to respond more appropriately. v I would really like to see the department take sub- stantial measures to assist with mental health care. At FSI, we had a presentation about “resilience,” which now seems to be a buzzword; but it takes more than holding medita- tion sessions to provide a healthy working environment. Mental health is one reason why I might be seeking to separate from the Foreign Service, and it seems like mak- ing substantial steps in this area would help retention. v The Foreign Service Benefit Plan should support Skype or phone therapy. The regional psychiatrists should visit embassies more often and be empathetic about people’s mental health needs rather than threatening to revoke medical clearances. They should also follow up with people who do require medication and be more available as a resource for them. v Regarding PTSD, I have four recommendations: (1) Use a more extensive screening checklist for PTSD as part of the regular physical exam, and do not allow it to be waived; (2) If the screen shows potential PTSD, MED should reach out to the individual at six and 12 months post-assignment; (3) Update regulations for mental health evacuations, allowing for reimbursement. (People are hospitalized only if they threaten to harm themselves or others, which is not normally the case. Treatment needs to be reimbursed and followed up for a year as with a regular medevac); (4) Inform FS members clearly on the current policy, in particular the difference between medevac and medical curtailment: Medical curtailments do not allow for reimbursement of medical care. v I’d like to hear that MED is hiring more psychologists and giving them adequate support, training and resources. And I’d like to hear that we’re dealing with how our man- agement styles can contribute to our stress and hold us back. v Out briefings and support for issues like PTSD, anxi- ety and depression should be addressed not just at FSI, but also at post. It would help to reduce the number of people who reach a point of crisis like I did. v Before seeking assistance from the State Depart- ment for a mental health issue, I would want to see State’s policy on the following in writing: (1) Are discussions with the regional psychiatrist confidential, and what are the psychiatrist’s obligations to the patient and to the depart- ment? (2) What, if any, parts of the session must a regional psychiatrist share with post’s Front Office? (3) What mental health issues will result in a curtailment from post? What types of mental illness are relevant to a security background check? (5) Does ECS not serve family mem- bers? v Top-level managers need to do a better job of man- aging the managers. And they need to do a better job of assuring real RMO/P coverage—not just fly-ins every few months. They should also ensure patient privacy is respected. Having the RMO/P out brief with the ambas- sador and DCM present does not inspire trust. The depart- ment should find ways to provide therapy services to patients overseas—studies have shown apps and online therapy can be just as useful as face-to-face therapy. Finally, mental health needs to stop being a joke (“That guy needs some happy pills” or “He’s going to be wack- evac’d”). In an organization where our job is not just a life- style, but almost our entire life (e.g., your employer owns your phone, your house), our employers have an extra responsibility to ensure that we actually do have a balance between our work and our life. —Compiled by Shawn Dorman Note: Each recommendation is from a different individual among those who shared their views with the FSJ .