The Foreign Service Journal, January-February 2016

8 JANUARY-FEBRUARY 2016 | THE FOREIGN SERVICE JOURNAL LETTER FROM THE EDITOR Considering Mental Health BY SHAWN DORMAN O Shawn Dorman is the editor of The Foreign Service Journal. members via AFSAnet regarding their experiences with mental health care in the Foreign Service, and we asked for their recommendations. Based on that input, it is clear that there is much confusion—about what help is available, what mental health care needs to be reported and what might have an impact on a medical or security clear- ance, among other things. You’ll see themes emerge in “Mental Health Services Checkup,” where some 45 FS members weigh in. People want (1) a clearer understanding of what services are available and how those can affect clearances, both medical and security; (2) assurances of privacy; (3) confidence that they will not be penalized for seeking help; (4) a de-stigmatization of mental health care; and (5) relief from toxic bosses and unrealistic workloads. We sincerely thank all those who shared their personal journeys and per- spectives. In addition to input from the field, veteran MED mental health provider and former Director of Mental Health Ser- vices SamThielman presents a history of MED’s mental health program. In a Q&A format, Chantay White and Paulette Baldwin of State MED’s Employee Con- sultation Services staff explain how their office can help. f all the focus sections I have worked on during more than a decade with the FSJ , this may have been the most chal- lenging. Mental health is so personal, so sensitive, so private. And yet, if you are in the Foreign Service, it is also “of official concern,” as your employer must determine, each time it sends you out to a new post, whether you are healthy enough to go. There is a basic “dual agency” issue at play—that the employer is both responsible for providing care and for determining fitness for duty—which can complicate both the willingness of Foreign Service members to seek mental health care assistance when it might be needed, and the resulting impact of get- ting (or not getting) that help. The FSJ Editorial Board decided to shine a spotlight on mental health care for the Foreign Service in the hope that breathing air into a somewhat taboo subject and facilitating a conversation might lead to improvements and better understanding. In this issue, we hear frommedical professionals from the State Department and frommembers in the field, coping with an inherently stressful work-life reality involving regular moves across the world, dangerous environments and, often, tremendous workloads, all to serve and represent the United States. We requested input from Foreign Service Mental Health Services Director Ste- phen Young shows us the view from the side of the regional psychiatrist, and for- mer DS Agent Ronald Holloway bravely shares his journey frommental illness to health. We also take a heartbreaking walk down the Alzheimer’s path with a devoted Foreign Service spouse. As it happens, MED is—right now— undergoing a transformation. The Office of Medical Services is being “promoted” to the Bureau of Medical Services, with reorganization along the way. A Dec. 4 State Department Notice called the change “part of an extensive realign- ment of MED’s internal organizational structure that will be implemented over the next year to facilitate enhanced delivery of services and execution of core functions.” MED further clarified for the FSJ that the the bureau will have three direc- torates: Medical Program Operations, Clinical Programs and Mental Health Programs. Perhaps this is, indeed, the best time to share ideas frommembers on how to improve services. For additional fascinating content related to medical issues, I would also call your attention to two back issues of the Journal : the January 2008 focus on PTSD; and the September 2010 issue examining MED, both online at afsa.org/fsj. n We hope that breathing air into a somewhat taboo subject and facilitating a conversation might lead to improvements and better understanding.