The Foreign Service Journal, September 2010

22 F O R E I G N S E R V I C E J O U R N A L / S E P T E M B E R 2 0 1 0 “For those who really need contin- ued counseling, monitoring and treatment, why would you want to seek assignments where you could come to harm because of the un- availability of needed treatment? Who would be hurt the most: the department, MED or the individ- ual?” asks Yun. But the perception that serious mental health problems are on the rise among Foreign Service members serving overseas continues to strain officers’ relationships with MED, notwithstanding Yun’s insistence that the numbers don’t support it. Several Foreign Service officers who asked not to be identified said that because the diagnosis of a men- tal health problem can result in the department restricting or taking away security and medical clearances, some who desperately need treatment don’t seek it. Those who do, and then have their clearances pulled, feel like they are being punished for doing the right thing. One Senior Foreign Service officer who responded to AFSA’s inquiry recalled the department’s harsh response after he revealed that he had once sought marital coun- seling (a subject about which inquiries by the Bureau of Diplomatic Security were subsequently barred). The counseling had been effective and the officer didn’t men- tion the sessions until three years after they occurred, when he checked a box on his annual five-year security up- date. “A juggernaut from State/MED immediately kicked in, wanting to know why we had sought counseling, who the counselor was, what her diagnoses were, where she was located, her contact info, requiring us to sign a waiver allowing her to discuss our full range of martial issues with State/MED,” he recalls. “We actually received threats from State/MED that our clearances would be pulled until we ‘cooperated.’ We acted like responsible adults and were treated like criminals for seeking counseling.” By contrast, the same officer recalls working with a col- league overseas who was exhibiting such bizarre behavior that he began to document it. But because the colleague avoided treatment, she kept her job, he says. “She refused to meet with the regional psychiatrist. The regional psychi- atrist said he could not force her to meet with himnor force her to accept treatment; nor would he remove her from post without the ability to meet with and diagnose her. So we continued to have to tolerate her bizarre behavior.” MED and DS Some employees, aware that the Bureau of Diplomatic Security re- ceives information about diagnoses from MED, believe that DS pulls patients’ security clearances, even when department doctors don’t think that step is necessary. “State/MED continues to use admissions of mental health treat- ment as a way to punish individuals who voluntarily seek out assistance for mild mental health conditions, but has no ability to police individuals in need of serious care,” says one officer. “I’m a fairly senior man- ager, and I tell employees who I think would benefit from mental health counseling to seek it out —but never to tell the State Department a word about it as long as State/MED and Diplomatic Security continue to treat in- dividuals who seek care for mental health conditions as criminals.” In addition, several respondents to AFSA’s inquiry said they’d found the process for evaluating and treating men- tal health issues — ranging from attention deficit disorder to depression to Post-Traumatic Stress Disorder — con- fusing and sometimes unhelpful. One FSO commented that she had retained her Class 1 medical clearance despite a history of alcoholism. She was pleased with the decision, arguing that she was able to set up Alcoholics Anonymous meetings even in a post that hadn’t previously had them. But she was never sure whether her clearance was the result of a friend pulling strings on her behalf, or a policy change at MED. The ambiguity meant that many recovered alcoholics kept their former addiction very much a secret. As this FSO comments, “the more senior the officer, the more se- cretive they felt they had to be, sometimes not even at- tending AA meetings for fear of being reported. And no one wanted it on their medical record.” Even a regional psychiatrist who works for MED says the policies sometimes confuse him. The psychiatrist long believed that officers “suffering from mild forms of depression should not have their clearances automatically yanked if the condition could be treated at post with mild medication.” After years of discussion, the psychiatrist said, the Bureau of Diplomatic Security reportedly agreed. So the psychiatrist decided to test the claim, ask- ing a friend who was retiring to be falsely diagnosed with F O C U S “The bottom line is that MED’s portfolio combines functions that should not necessarily be combined.” — Daniel M. Hirsch, AFSA State VP