The Foreign Service Journal, January 2008

disorders. The best results occur when both PTSD and the other problems are treated together rather than one after the other. About half (40 to 60 percent) of people who develop PTSD get better at some time. But about one out of three people who develop PTSD will always have some symptoms. Getting help can make you feel more in control of your emotions and result in fewer symptoms. Since there are many types of treatment for PTSD, you and your doc- tor will discuss the best approach for you. You may have to try a number of treatments before you find one that works for you. If you do not like your therapist or feel that he or she is not helping you, it might be useful to talk with another professional. How Can Family Members Help? PTSD can adversely affect even a tight-knit family’s dynamics. The survivor may act differently and get angry easily. He or she may not want to do things you used to enjoy together. You may feel scared and frustrated about the changes you see in your loved one. You also may feel angry about what’s happening to your family, or wonder if things will ever go back to the way they were. These feel- ings and worries are common. You may feel helpless, but there are many things you can do: F O C U S 32 F O R E I G N S E R V I C E J O U R N A L / J A N U A R Y 2 0 0 8 The Office of Medical Services oversees primary care and mental health services overseas and occupational health services both overseas and in the States. In the States, MED does not provide primary care or mental health services, with the exception of Employee Consultation Services, which is the State Department’s Employee Assistance Program. In December 2003, when Iraq was still under the Coalition Provisional Authority, MED sent representatives to assess the medical effects of that environment on Foreign Service workers. Shortly thereafter, MED began providing, in association with the Foreign Service Insti- tute’s Transition Center, a High Stress Assignment Out- brief Program which was made mandatory for employees returning from Iraq and Afghanistan. This is held at the Foreign Service Institute (FSI course code MQ 950) and is done in a group format. The course is mandatory precise- ly to remove any fear that it would stigmatize attendees with a “mental health” label. Furthermore, anyone who prefers to have an individual- ized outbrief, whether for the convenience of scheduling or to bring up more personal matters in a private setting, can do that instead (FSI course code MQ 951). These courses are also available on a voluntary basis to any employee returning from any unaccompanied tour. So as not to stigmatize those who served, no one is forced to undergo a personal mental health screening. Instead, at the outbrief they are empowered to self-screen by means of these four steps: 1. They are given information about the more common mental health problems seen in people who serve at high- stress posts, such as normal and self-limited stress reac- tions, Acute Stress Disorder, Post-Traumatic Stress Disorder, alcohol or other substance abuse, depression and other mood disorders, and marital problems. This infor- mation is based on self-reports from peers who attended previous outbriefs in recent years and the anonymous sur- vey that MED and the Family Liaison Office conducted in 2007, to which 877 employees responded. 2. They are then advised about signs and symptoms that may indicate sufficient concern to warrant a profes- sional consultation. 3. Clarification is offered about the confidentiality of medical histories and the fact that seeking help for mental health issues in itself is never cause for an automatic change in medical or security clearances. An opaque boundary between MED and both HR and DS is well estab- lished, and an individual’s medical history is never revealed to either. However, employee medical clearances can affect assignments as their purpose is to make sure that any needed medical care is available at the post of assignment. 4. They are advised how to contact mental health pro- fessionals and to contact HR/ER for processing claims for workmen’s compensation. They are also informed that Employee Consultation Services, (202) 663-1815, offers a biweekly support group in Washington for returnees from unaccompanied tours. Even before deployment, these topics are introduced by MED staff to all attendees at the mandatory pre-deploy- ment courses offered by DS. Furthermore, in Iraq we have the only mental health provider in the Department of State who is designated to provide services to the mission of one single country, with back-up support provided by our psy- chiatrist in Amman. MED is currently developing a Deployment Stress Management Program and hopes to hire two to three more mental health specialists who will provide evaluation, sup- port and, possibly, initial treatment for employees suffering from PTSD or other mental health problems upon return- ing from unaccompanied tours. The Role of the Office of Medical Services