The Foreign Service Journal, January 2009

J A N U A R Y 2 0 0 9 / F O R E I G N S E R V I C E J O U R N A L 47 again. He did. I called the same nurse. She confirmed that my internist had sent a fax in August and again in Septem- ber, but repeated that they needed a report from my psy- chiatrist. I reminded her that she’d agreed to accept a letter from my internist instead. Memory triggered, she agreed to move my file to the next step in the clearance process. In the meantime, the assignment process was humming along. In October, I was given an appointment with a psychiatrist in MED. I assumed that we would review my therapist’s and internist’s evaluations and the list of posts on which I’d bid, and then I’d be cleared. In- stead, the psychiatrist gave me an hour to tell the history of and reasons for my depression; my eating and drinking habits; whether I worry about money (just days after the stock market plummeted 700 points!) or that I’ve left the stove on when I’m out of the house; the history of my mental health treatment; and my family structure, my exercise routine, and every- thing except my favorite color. At the end of the hour, she picked up my list of bids, now down to just two viable over- seas posts, and told me I would not be cleared for one of them. This one post for which she said I couldn’t be cleared was literally the only place in the world (except Iraq and Afghanistan) where my spouse and I shared a decent chance of being assigned together, in challenging jobs at our grades. Not even Washington meets these criteria. The place is two short flights away from my mother. It’s sunny and warm, which always helps my mood. And the job would be full of interesting new challenges. The post for which the psychi- atrist said I could be cleared is in a cold, dark city a continent and an ocean away from my mother, and offers no jobs for my spouse. I would also have no chance of a promotion out of this assignment and my time-in-class would expire at the end of the tour. MED apparently makes its clearance decisions solely on the basis of the availability of American-trained mental health practitioners, even in cases such as mine where my therapist and I are confident that I no longer need therapy. Thinking MED would consider potential for satisfaction and happiness when they look at post-specific criteria, I made this point to the psychiatrist, giving her all the reasons why the unsuitable post was, in fact, suitable and vice versa. She agreed to take my case to the committee, assuming that my former therapist could respond to the question sheet that I was given for my internist. The therapist did so, and also offered to be available to me by phone and e-mail. I was then cleared for the more challenging and ge- ographically desirable job. Disincentives to Seek Treatment My own story has a happy ending. But the system still has many flaws: • Mental health issues are still treated differently than physical health issues, even in cases where the problem(s) can be addressed with medication. • The Web site on clearances for people with post-spe- cific clearances doesn’t mention that there’s a specific form for people with mental health issues. • MED’s records aren’t complete, and people are some- times forced to run back to their doctors for forms and let- ters that have already been submitted. • The purpose of the appointment with a department psychiatrist isn’t made clear. • MED focuses too much on the availability of treatment and not enough on whether the employee actually needs treatment. • MED is reluctant to communicate by e-mail, which can be a problem for people who are in different time zones, in open cubicles or shared spaces, or away from their phones during business hours. These may all be minor problems, but when combined with the larger problems of security clearances and Class 2 medical clearances, they act as incentives for people to hide their mental health treatment from DS or MED — or, worse, to let their problems go untreated. State still treats mental health issues differently than physical health issues, even in cases where the problem(s) can be addressed with medication.