State Department foreign-service officers serving in “high-stress” areas may not avail themselves of the department's mental health services for fear of adverse effects on their career, according to a review by the Department's Office of Inspector General (OIG).
The review grew out of the OIG inspection of Embassy Baghdad in February/March 2009 but included personnel who had served in Afghanistan, Pakistan, Saudi Arabia, Lebanon, Sudan, Yemen, Chad, and other high-stress posts. It was based in part on a survey of about 1,200 Foreign Service and Civil Service personnel who had served in these posts since September 2007. Approximately 400 officers replied (75 percent of the respondents had served in Iraq, Afghanistan, or Pakistan).
More than 90 percent of the respondents reported an unusual amount of stress, with danger being the most-cited cause, followed by separation from families, workload, leadership, and management support. Yet the review also found that “employees believe there is still a significant stigma attached to seeking mental health assistance” and that few people availed themselves of the High Stress Assignment Outbrief, a screening tool for mental health problems.
The OIG submitted the following recommendations:
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Issue a high-level message that encourages employees to seek consultations with mental health professionals, notes the very low probability that this would have any negative impact on security clearances, explains the roles of the Bureau of Diplomatic Security and the Office of Medical Services in this process, and gives guidance as to what types of mental health consultations should be reported.
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Assign more returnees to the High Stress Assignment Outbrief in Washington, D.C., before they proceed to their next assignments; require regional medical officers/psychiatrists to offer the training about PTSD provided during the outbrief to overseas employees who miss the Washington outbrief; and implement a follow-up mechanism to ensure that all returnees who are required to take outbrief do so, and that more employees for whom it is voluntary take it as well.
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Task leadership at overseas posts and in the Department of State with responsibility for facilitating the adjustment of employees coming from high-stress, high-threat posts. This would include, among other things, facilitating returnees' attendance at the mandatory outbrief and requiring supervisors to take the Foreign Service Institute's Web-based seminar on working with employees from high-stress posts and implement its suggestions.
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Expand the counseling services for employees and establish a schedule for a 2011 survey of employees and health care providers to determine the effectiveness of the programs.
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Establish an entity to help resolve administrative problems for employees going to, serving in, or coming from high-stress posts when those problems cannot be resolved through normal procedures.
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Establish programs to offer thanks and recognition to employees who have served in certain dangerous and stressful assignments.
