What About Our Kids?

Foreign Service children are just as at risk of mental health problems as the average American child, if not more so.


Time to Put an End to the Stigma

Depression, ADHD, thoughts of suicide, mood disorder, anxiety disorder, somatic disorder, PTSD, rapid cycling bipolar type I, psychosis. These are evolving diagnoses that psychiatrists have applied to my daughter as her mental illness advanced and morphed throughout her adolescent years.

It is like a cancer that keeps returning, defying each drug combo that brought the last round of remission. Yet, while tragic, there is no shame in cancer, no stigma in talking about it. Not so when your child suffers from mental illness. And it’s worse when you add learning disabilities to the picture. All these insidious demons remain invisible to teachers and others who write your child off as lazy or unwilling to put in the effort to keep up.

No one would say that your daughter could fight off cancer if she just tried hard enough. Even though the majority of kids won’t have health issues as serious as mine does, FS children are just as at risk or even more vulnerable to mental health problems than the average American child.

For the sake of our children, it’s time we put an end to that stigma, get our heads out of the sand and intervene early when there are warning signs.

—A Foreign Service Mother

In the Washington, D.C., area, mental health topics are regularly featured in the media, on websites and in social media. There are workshops and support groups for parents and mandatory training in “mental health first aid” for school personnel. Students have direct access to licensed counselors, psychologists, social workers and crisis hotlines. Mental health topics are required components of health curricula for students of all ages. And although specialized medical professionals are in short supply across the United States, more children and adolescents are accessing treatment, including via telemedicine.

Foreign Service families have little exposure to the topic and, given the nature of our lifestyle, limited access to these kinds of resources; yet our families are not immune from mental health concerns. Parents are asking: Are we doing enough for Foreign Service kids?

Third Culture Kids

TCKs are children who spend most of their developmental years outside of their parents’ culture. Like their parents, TCKs weather frequent moves, separations, loss and trauma. Like their parents, our TCKs are assumed to be adaptable and resilient—and many are. But kids often lack the developmental maturity and a sense of identity or belonging that are essential to managing these transitions. This can result in symptoms of depression, anxiety, adjustment disorders and even post-traumatic stress disorder.

Among the global population, 20 percent of youth (ages 13-18) live with a mental health condition; and, according to the National Alliance on Mental Illness, half of all lifetime cases of mental illness begin by age 14. While the State Department does not track mental health data, Foreign Service families experience medevacs, assignment curtailments and even some painful tragedies due to child or teen mental health issues. Children of employees assigned to Washington, D.C., or college-age dependents may also need treatment, but families and young adults must negotiate the bewildering U.S. mental health care system on their own.

Research about TCK development suggests that kids benefit from strong family and community support, deliberate preparation for transition and affirmation of their emotions along with other resilience skills. Parents may assume their children have the same resilience as they do; but individuals, even within the same family, can have different abilities to cope. Counseling and other professional support should acknowledge the unique environment and history of the globally mobile child for optimal diagnosis and treatment.

Current Resources

This past year, available State Department and some external resources were compiled and disseminated—for the first time—via cable and in a global webinar. They are featured, along with relevant publications and websites, on the website of the Foreign Service Youth Foundation (www.fsyf.org). State Department offices focus their support for families overseas with information, consultations and training on resiliency. This support includes the Office of Medical Services’s network of regional medical officer/psychiatrists, the Employee Consultation Services and the Child and Family Program Office.

TCKs weather frequent moves, separations, loss and trauma.

In a survey about these resources conducted by the Youth Mental Health Initiative working group, FS personnel asked for more open discussion and greater visibility about youth mental health. They requested more information about services, particularly from the Child and Family Program Office and FSYF. They highlighted the need for specific information about topics such as transition issues, depression, anxiety, eating disorders, substance abuse and bullying. And they offered suggestions of ways to strengthen support, which included youth group activities and online networks; direct services by child psychiatrists, psychologists and social workers; and training for post and school personnel.

Kids themselves have pointed out in recent “TCK Chat” sessions online that “mental health is the most glaringly obvious issue that is avoided” in their households and communities. They note that “emotional turmoil does not get enough attention” and that their communities need to “promote the fact that grief and loss and feeling emotional are normal” and “getting support and advice is vital.”

What More Can We Do?

On a personal level, families can—

  • Maintain a close and supportive family structure with traditions and routines.
  • Enable kids to maintain links to friends and family.
  • Promote kids’ independence with chores, jobs or community service and help them develop their passions.
  • Allow kids to grieve well and to express their emotions.
  • Assess family needs before committing to a move.
  • Seek immediate help for any concerns.
  • Be especially attentive in preparing and supporting re-entry to the United States.
  • Join FSYF, which supports FS youth by encouraging resilience and fostering camaraderie.

On an organizational level, we can—

  • Openly discuss mental health issues.
  • Better educate ourselves and those who work with FS kids about mental health issues.
  • Collect data and seek research that addresses specific trends within our population.
  • Support integrated health care, including direct services by child specialists and case management across assignments.
  • Actively support returning families with support groups and referrals to specialists with TCK experience.
  • Work with schools overseas and in the United States to encourage training and raise awareness about TCKs.
  • Help kids support each other through group activities and online networks.

Kim DeBlauw is a member of the Senior Foreign Service, class of minister-counselor. She joined the Foreign Service in 1986 and has served at posts in Latin America, Africa and Europe, as well as in Washington, D.C. She and her husband, Juan Ramirez, have three children. The views expressed are those of the author and not necessarily those of the U.S. government.