@StateDept’s Mental Health Services Drive Employees with Special Needs #FSKids Nuts

Posted: 12:26 pm ET

 

The Department of Defense Education Activity (DoDEA) operates 168 schools in 8 districts located in 11 foreign countries, seven states, Guam, and Puerto Rico. All schools within DoDEA are fully accredited by U.S. accreditation agencies. Approximately 8,700 educators serve more than 73,000 DoDEA students. This is what it says on special education:

Special education is specially designed instruction, support, and services provided to students with an identified disability requiring an individually designed instructional program to meet their unique learning needs. The purpose of special education is to enable students to successfully develop to their fullest potential by providing a free appropriate public education in compliance with the Individuals with Disabilities Education Act (IDEA) as implemented by DoD Instruction 1342.12, “Provision of Early Intervention and Special Education Services to Eligible DoD Dependents.”

In DoDEA, special education and related services are available to eligible students, ages 3 through 21 years of age. To be eligible for special education: the child must have an identified disability; the disability must adversely (negatively) affect the child’s educational performance; and the child must require a specially designed instructional program. DoDEA recognizes clearly defined categories of disabilities with specific criteria for determining eligibility such as physical, communication, emotional and learning impairment, and development delay.

The State Department does not have its own schools so Foreign Service children go to local schools and avail of local school services. Is the State Department required to meet the requirements of the Individuals with Disabilities Education Improvement Act (IDEIA) with regard to the education of special needs children overseas? Here is what state.gov says:

No. The Individuals with Disabilities Education Act (IDEA) and its 2004 reauthorization, the Individuals with Disabilities Education Improvement Act (IDEIA), are federal funding laws ensuring a free and appropriate education to children with disabilities in the United States. IDEA/IDEIA governs how states and public agencies provide early intervention, special education and related services to eligible children and youth. While existing law does not require DOS to replicate what a public school would provide to a student in the United States, our goal is to approximate what a child would receive in a good US public school system. Per the Overseas Differentials and Allowances Act and the Department of State Standard Regulations (DSSR), the IDEA/IDEIA framework is the basis for the allowable reimbursable services for the Special Needs Education Allowance (SNEA). DOS is committed to assisting employees in meeting the necessary expenses incurred when deployed overseas in providing adequate education for their school-age children. The education allowances are designed to assist parents in defraying those costs necessary to obtain educational services which are ordinarily provided free of charge by public schools in the United States.

Prior to 2013, we understand that the State department took a flexible, supportive approach that ensures support for dependents while creating maximum flexibility for Foreign Service employees to serve overseas. In October 2013, SNEA management was switched to the then newly created Child and Family Programs (CFP).

The Department’s Standardized Regulations or DSSR was also amended to state that “There must be a formal Individual Education Plan (IEP) or equivalent prepared by a professional medical or educational expert which delineates the educational services required to provide for the child’s special needs.  Reimbursement may only be for those services provided for in the IEP which are actually required, as opposed to those services which a parent or school may recommend as desirable.”

Between 2013 and early 2017, we were informed that “SNEA benefits are reined back dramatically.”  Previously authorized uses were  either denied or dramatically restricted.  One parent told us, “No explanations or justifications are provided for the change in policy despite many requests.  At the same time, parents are increasingly challenged by CFP staff, often rudely, about the way in which they plan to educate their children overseas.”  A direct suggestion that the parent curtail his/her assignment was not unheard of.

That suggestion may become more real for parents of approximately 1400 special needs children in the Foreign Service. We understand that in spring 2017, the Office of Allowances formally ruled that 1) based on DSSR language the only dependents who can receive SNEA are those specifically given a MED clearance that allows them to reside full time at post; and 2) No other clearance is sufficient (such as a Class 6 that allows for a child to reside at post outside of the school year in a boarding school situation).

What was the result of this official determination? Apparently, MED started “aggressively” issuing Class 5 clearances to children with educational, mental health and other disabilities even though there are many/many overseas posts where services have been and could be provided to successfully support such children.  It was reported to us that when challenged, MED doesn’t back down, claiming that their decisions are in the best interests of the child since “everyone knows” that only the “mildest” of special needs can be met in an overseas school situation.

Class 5 medical clearance means  domestic only assignment and it is supposedly issued “to those with complex medical conditions.”

For the FS employees with approximately 1400 special needs kids, a Class 5 medical clearance for a family members potentially means 1) DC/domestic assignments for the foreseeable future only; 2) an overseas assignment that leaves the family at home on a voluntary separation, or 3) back to back to back unaccompanied assignment to priority posts while the family stays behind in the United States on a voluntary separation.  We understand that not all these kids are given Class 5 clearance now but as their clearance gets reviewed, families anticipate that the numbers will continue to grow.

“It appears that any child deemed to have “moderate to severe” needs is being given a Class 5 at the time a MED clearance review is triggered.”

When we inquire about potential issues with the SNEA funds, our source speaking on background told us that SNEA has “always been under the administration of MED, and SNEA spending could only be reimbursed after approval by MED authorities.”  We were told that previously, in some cases SNEA was allowed to be used “for therapies that some would argue were either non-traditional or perhaps not fully established as effective” so the source said it is understandable to see the need to standardize the application of SNEA when the Child and Family Programs (CFP) was created and took over management of SNEA. But the source also said “it doesn’t explain the inflexibility CFP staff have employed since” when dealing with families with special needs FS kids.

Who’s doing this and why? Families are pointing at the MED/MHS (Mental Health Services), which oversees the Child and Family Programs (CFP) in the State Department’s MED org chart.  That office is headed by Dr. Kathy Gallardo, the former Deputy Director and now Director in MED/MHS. She reports to Dr. Charles Rosenfarb who is currently the Medical Director of the Bureau of Medical Services. Dr. Rosenfarb reports to the Under Secretary of Management, an office that sits currently vacant and is overseen by the “M Coordinator” and Acting DGHR Bill Todd, who in turn reports to somebody inside Secretary Tillerson’s 7th Floor bubble.

As to why? Well, no one seems exactly sure why. The State Department does not talk to this blog anymore for juvenile reasons but we cannot overlook the elephant in the room. The State Department is looking to cut cost across the board. We expect that it will be looking at everything and inside every cupboard to come up with its desired 37% cuts.  How many families will endure the separation with employees deploying overseas, and families staying behind because their special needs children are not authorized to be overseas?  Last year, Bloomberg  reported that Secretary Tillerson was seeking a 9% cut in State Department staffing with majority of the job cuts, about 1,700, through attrition, while the remaining 600 will be done via buyouts.

So in the case of the special needs FS kids, the State Department is potentially hitting two birds with one big rock? Anyone at State/MED wants to chat, we’re happy to talk and update this post.

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EEOC Finds @StateDept Liable Under the Rehabilitation Act in US Embassy Kabul Medical Clearance Denial

Posted: 12:21 am ET
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This is a case where an FSO previously diagnosed with rheumatoid arthritis was granted a Class 2 medical clearance for an assignment at the US Embassy in Kabul, Afghanistan.  While at post, the FSO developed pericarditis and was hospitalized in Kabul in 2013; she was subsequently medevaced to Texas. The FSO was later told by State/MED that she retained her Class 2 Medical Clearance, but it was not Kabul-approved.  In August 2013, the FSO filed an EEO complaint alleging that the State Department discriminated against her on the basis of disability. The State Department’s decision  notes that in denying her clearance, its medical officers failed to conduct a sufficient individualized assessment of the risk posed by Complainant’s medical condition and its impact on her ability to return safely to Kabul.  It held “that there was no evidence that the medical officers and Medical Review Panel took into account the duration of the risk, the nature and severity of the potential harm, and the likelihood that the harm will occur or the imminence of the potential harm, as required by the law.”  It also concluded that MED“improperly denied Complainant a Class 2 medical clearance (Kabul-approved).”  The FSO on appeal asserted that she was not provided with full relief, including reasonable attorney’s fees and costs. In response to that appeal, the State Department noted that its final decision was, get this — “erroneously issued.”

Summary of Case via EEOC:

In September 2011, Complainant was assigned to work as an Administrative Officer at the Agency’s Embassy in Kabul, Afghanistan.  Complainant had been diagnosed with ongoing rheumatoid arthritis since 1999. In conjunction with her assignment to Kabul, Complainant was reviewed by the State Department’s Office of Medical Services (State/MED) for a medical clearance.  Complainant was granted a Class 2 (Kabul-approved) medical clearance 2 and she started her duties in Kabul.  While on leave from Kabul in the United States in June 2012, Complainant saw a doctor and was prescribed a new medication for her arthritis called Leflunomide. At the time, Complainant did not report that she was taking this new medication to Agency medical officials.

In April 2013, Complainant developed pericarditis which led to her hospitalization in Kabul.  At that time, her physicians at the hospital advised her to stop taking Leflunomide and she did so.  Upon her release from the hospital, Embassy medical officials made the decision to send Complainant back to the United States for an evaluation by her own physicians. On May 7, 2013, Complainant departed Kabul for El Paso, Texas.

Upon her return to El Paso, Complainant was examined by her own physician (“Complainant’s Physician”) for clearance to return to Kabul.  She provided documentation to the Agency’s Office of Medical Services indicating that her physician had no concerns with her return to Kabul. On May 31, 2013, Complainant was initially informed by the Agency’s physician (“Agency Physician”) that her medical clearance for Kabul would be renewed.

However, on June 3, 2013, the Agency Physician informed her that she retained her Class 2 Medical Clearance, but was not Kabul-approved.  Complainant was told that the reason for the denial of her clearance to return to Kabul was her use of Leflunomide, a drug banned by the Department of Defense for use by personnel assigned to Afghanistan.3  As Complainant had stopped using the medication since her April 2013 hospitalization, she appealed the denial of her medical clearance for Kabul.  Her appeal was denied by the Agency’s Medical Review Panel on the grounds that her cessation of Leflunomide was too recent. The Panel indicated that Complainant needed to show a period of at least 12 month of “clinical stability” before she could return to Kabul.  The Panel defined clinical stability as “the absence of systemic clinical manifestations of pericarditis and rheumatogic problems.”  There was some speculation that, because Leflunomide reduces resistance to infection, Complainant’s pericarditis may have resulted from its use.  Complainant then requested an Administrative Waiver to allow her to return to her position in Kabul.  That waiver was also denied on June 19, 2013.  Since May 2013, Complainant has been working from the Agency’s El Paso, Texas, Intelligence Center.

On August 22, 2013, Complainant filed an EEO complaint alleging that the Agency discriminated against her on the basis of disability (rheumatoid arthritis) when her “Return to Post Authorization” was not reinstated and she was prevented from returning to work at the U.S. Embassy in Kabul.

At the conclusion of the investigation, Complainant requested a hearing before an EEOC Administrative Judge (AJ).  However, on March 10, 2014, the Agency issued a final decision pursuant to 29 C.F.R. § 1614.110(b). In its decision, the Agency conceded the Complainant was an individual with a disability as defined by the Rehabilitation Act.  The Agency further determined that Complainant was an otherwise qualified individual with a disability, as she had been performing in the position in question in Kabul for the preceding two years, and had the requisite knowledge, experience, skill, and education to perform the position.

The Agency’s decision then noted that Complainant was denied a Class 2 Medical Clearance (Kabul-approved) because of the perceived risk of harm she posed to herself due to her recent use of the drug Leflunomide. As a result of this determination, Complainant was prevented from returning to her previously-approved assignment in Kabul.  The Agency’s decision went on to conclude that, in denying her clearance, its medical officers failed to conduct a sufficient individualized assessment of the risk posed by Complainant’s medical condition and its impact on her ability to return safely to Kabul.  Specifically, Agency held that there was no evidence that the medical officers and Medical Review Panel took into account the duration of the risk, the nature and severity of the potential harm, and the likelihood that the harm will occur or the imminence of the potential harm, as required by the law.  The Agency decision noted that medical opinions that supported Complainant ability to safely return to Kabul were improperly given little weight during the medical clearance determination.  Accordingly, the Agency’s final decision concluded that it improperly denied Complainant a Class 2 medical clearance (Kabul-approved).

Based on its finding that Agency medical staff had failed to provide Complainant with an individualized assessment, the Agency ordered the Office of Medical Services to go forward and actually conduct the required individualized assessment of Complainant’s medical condition and her ability to return to the Administrative Officer position at the Agency’s Embassy in Kabul without posing a significant risk of substantial harm to herself or others.

This appeal followed.  On appeal, Complainant did not challenge the findings by the Agency, but asserted that she was not provided with full relief, including reasonable attorney’s fees and costs.

In response to the appeal, the Agency noted that its final decision was erroneously issued in light of Complainant’s previous request for a hearing.  As such, the Agency argued that the final decision should be voided.  In response, Complainant argued that the final decision should not be considered void and the matter should not be remanded for a hearing.

EEOC ANALYSIS AND FINDINGS: Violation of Rehabilitation Act

As an initial matter, we find that Complainant’s statement on appeal constitutes a withdrawal of her earlier hearing request.  As such, we deny the Agency’s request to void its final decision.

In that decision, the Agency found that its medical staff failed to conduct a proper individualized assessment as required by the Rehabilitation Act when Complainant was prevented from returning to work at the U.S. Embassy in Kabul.  Complainant does not challenge the Agency’s findings in its final decision.  As such, we affirm the Agency’s specific findings.  However, the Agency did not expressly state that its actions constituted discrimination in violation of the Rehabilitation Act.

As evidenced by the Agency’s final decision, there is no dispute that Complainant is an individual with a disability who was otherwise qualified for the position in she had previously held in Kabul. In other words, she met the skill, experience, education and other job requirements to perform the duties of the position in Kabul, apart from the Agency’s decision to retract her medical clearance for work in Kabul.

The Agency noted in its findings in its own decision that Complainant’s Physician provided medical documentation that Complainant was no longer taking Leflunomide, the drug of concern, had not had flare-ups of her medical condition, and had embarked on a healthier lifestyle. However, the Agency conceded that Complainant’s supporting medical documentation was improperly “given little if any weight.”  The Agency also admitted in it decision that the denial of the Class 2 Medical Clearance was due to the “perceived risk of harm she posed to herself or others” and not on an actual risk.  Based on the record including the medical evidence provided by Complainant’s Physician, we find that Complainant has shown that she was qualified for the position in question in Kabul and was only prevented from doing so based on the Agency’s perception that she posed a safety risk.  This moves the burden of proof squarely to the Agency to prove that there is a significant risk of substantial harm. Massingill v. Dep’t. of Veterans Affairs, EEOC Appeal No. 01964890 (July 14, 2000).  See also, Branham v. Snow, 392 F.3d 896 (7th Cir. 2005) (“employer’s burden to show that an employee posed a direct threat to workplace safety that could not be eliminated by reasonable accommodation”); Hutton v. Elf Atochem N. America, 273 F.3d 884, 893 (9th Cir. 2001) (direct threat affirmative defense).

Here, as already noted, the Agency’s own decision concluded that Complainant was denied a Class 2 Medical Clearance because of perceived risk of harm she posed to herself or others.  Our regulations permit the Agency to deny job assignments on the basis of disability where such an assignment would pose a direct threat. See 29 C.F.R. § 1630.2(r). A “direct threat” is defined as a “significant risk of substantial harm” that cannot be eliminated or reduced by reasonable accommodation. Interpretive Guidance of Title 1 of the Americans with Disabilities Act, Appendix to 29 C.F.R. Part 1630, § 1630.2(r); Echazabal v. Chevron U.S.A., Inc. 536 U.S. 73 (2002); 29 C.F.R. § 1630.2(r).

The issue in finding direct threat is “not…whether a risk exists, but whether it is significant.” Bragdon v. Abbott, 524 U.S. at 649. A direct threat must be based on an individualized assessment of the individual that takes into account: (1) the duration of the risk, (2) the nature and severity of the potential harm, (3) the likelihood that the potential harm will occur, and (4) the imminence of the potential harm. Interpretive Guidance on Title I of the Americans With Disabilities Act, Appendix to 29 C.F.R. § 1630.2(r). The individual assessment must be based on a reasonable medical judgment that relies on the most current medical knowledge and/or on the best available objective evidence. Id. A determination of significant risk cannot be based merely on an employer’s subjective evaluation, or, except in cases of a most apparent nature, merely on medical reports.

The Agency held in its final decision that it “failed to conduct a sufficiently individualized assessment of the risk posed by Complainant’s medical condition, and its impact on her ability to return safely to Kabul.  There is no evidence that the following factors were taken into account: 1) the duration of the risk; 2) the nature and severity of the potential harm; 3) the likelihood that the potential harm will occur; and 4) the imminence of the potential harm.”  Based on the record and the Agency’s own findings in its decision, we determine that the Agency has not met its burden of establishing that Complainant’s return to Kabul would have posed a direct threat.  Accordingly, the Agency’s defense to denying Complainant the Class 2 Medical Clearance was not established, and the Agency is liable under the Rehabilitation Act.

As a result of this violation of the Rehabilitation Act, Complainant is entitled to make-whole relief, which the Agency did not provide her in its final decision.  First, the Agency should offer Complainant the assignment in Kabul if she chooses to return. See Nathan v. Department of Justice, EEOC Appeal No. 0720070014 (July 19, 2013) (awarding the complainant the position for which he applied following a determination that the agency violated the Rehabilitation Act when it medically disqualified him without an individualized assessment). In addition, Complainant correctly argues that she should be awarded reasonable attorney’s fees and legal costs for processing her EEO complaint, as well as the opportunity to support her claim for compensatory damages. Also, we find that the Agency provide training to relevant management highlighting the Agency’s obligations with respect to the Rehabilitation Act.

The EEOC concludes the case with a modification of the State Department’s  final decision and remanded the matter to the agency with the following order signed by Carlton M. Hadden on October 25, 2016.  The EEOC case file notes that compliance with the Commission’s corrective action is mandatory.

The Agency is ordered to take the following remedial action:

1. Within 60 calendar days from the date this decision is issued, the Agency shall offer Complainant an assignment in Kabul substantially similar to the one she lost. If Complainant rejects the offer of the assignment, the Agency shall use the date of rejection for purposes of back pay calculations as noted below.  If Complainant accepts the assignment, the Agency shall use the date Complainant assumes the assignment for purposes of back pay.

2. The issue of compensatory damages is REMANDED to the Agency. On remand, the Agency shall conduct a supplemental investigation on compensatory damages, including providing the Complainant an opportunity to submit evidence of pecuniary and non-pecuniary damages. For guidance on what evidence is necessary to prove pecuniary and non-pecuniary damages, the parties are directed to EEOC Enforcement Guidance: Compensatory and Punitive Damages Available Under § 102 of the Civil Rights Act of 1991 (July 14, 1992) (available at eeoc.gov.) The Agency shall complete the investigation and issue a final decision appealable to the EEOC determining the appropriate amount of damages within 150 calendar days after this decision is issued.

3. The Agency shall determine if Complainant is entitled to an award of back pay as a result of the denial of her return to her assignment in Kabul.  The Agency shall determine the appropriate amount of back pay, with interest, and other benefits due Complainant, pursuant to 29 C.F.R. § 1614.501, no later than sixty (60) calendar days after the date this decision is issued.  The Complainant shall cooperate in the Agency’s efforts to compute the amount of back pay and benefits due, and shall provide all relevant information requested by the Agency.  We note that the Agency should consider if there would have been a difference in locality pay and benefits to Complainant including but not limited to promotions or other incentives for an assignment in Kabul, Afghanistan.

If there is a dispute regarding the exact amount of back pay and/or benefits, the Agency shall issue a check to the Complainant for the undisputed amount within sixty (60) calendar days of the date the Agency determines the amount it believes to be due.  The Complainant may petition for enforcement or clarification of the amount in dispute.  The petition for clarification or enforcement must be filed with the Compliance Officer, at the address referenced in the statement entitled “Implementation of the Commission’s Decision.”

4. Within sixty (60) days from the date this decision is issued, the Agency is ordered to provide at least eight (8) hours of training to the responsible officials covering their responsibilities under the Rehabilitation Act. The training shall cover the Agency’s obligations regarding the provision of reasonable accommodation, as well as its obligation to conduct an individualized assessment pursuant to the direct threat defense.

5. If Complainant has been represented by an attorney (as defined by 29 C.F.R. § 1614.501(e)(1)(iii)), she is entitled to an award of reasonable attorney’s fees and costs incurred in the processing of the complaint, including this appeal.  29 C.F.R. § 1614.501(e).  The award of attorney’s fees shall be paid by the Agency.  The attorney shall submit a verified statement of fees to the Agency — not to the Equal Employment Opportunity Commission, Office of Federal Operations — within sixty (60) calendar days of this decision is issued.  The Agency shall then process the claim for attorney’s fees in accordance with 29 C.F.R. § 1614.501.

The State Department was also ordered to post this order within 30 days of the date of the decision for a duration of 60 consecutive days.

The Agency is ordered to post at its Washington D.C. facility copies of the attached notice.  Copies of the notice, after being signed by the Agency’s duly authorized representative, shall be posted both in hard copy and electronic format by the Agency within 30 calendar days of the date this decision is issued, and shall remain posted for 60 consecutive days, in conspicuous places, including all places where notices to employees are customarily posted.  The Agency shall take reasonable steps to ensure that said notices are not altered, defaced, or covered by any other material.  The original signed notice is to be submitted to the Compliance Officer at the address cited in the paragraph entitled “Implementation of the Commission’s Decision,” within 10 calendar days of the expiration of the posting period.

 

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Foreign Service Members Offer Candid Views of @StateDept Mental Health Services (via FSJ)

Posted: 3:04 am EDT
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The January issue of the Foreign Service Journal is out. The issue is focused on mental health care for the Foreign Service.  Dr. Samuel Thielman,  a recently retired regional medical officer/psychiatrist for the Department of State writes about how MED’s mental health program has grown and evolved over the years to address the unusual needs of FS employees and their families serving overseas in The Evolution of State’s Mental Health Services. Chantay White, the chief of the Employee Assistance Program with the State Department Employee Consultation Services and Paulette Baldwin, a Licensed Clinical Social Worker write about Mental Health and ECS—What You Should Know. Dr. Stephen A. Young, the director of Mental Health Services for the State department since September 2015, writes about The Face of Mental Health Services Overseas.

One part of the bureaucracy that is glaringly missing here is, of course, Diplomatic Security.  A majority of these comments express concern about DS and security clearance. The most instructive part is probably the section on MED/MHS Checkup: Foreign Service Members Weigh In that offers very candid views from people in the field.

The FSJ writes that the compilation includes 45 responses from FS members in Washington, D.C., and overseas, some entry-level and a few retired, from the foreign affairs agencies, primarily State and USAID. The gender split was about even. “Due to the sensitive nature of the topic, and known concerns about privacy, we took the unprecedented step of offering to print comments without attribution,” the editors write.

Some excerpts below, each paragraph selected from a separate FS member response.  The last one It’s No Joke is in full; the contributor appears to be part of US Mission Libya following the 2012 attacks. The full comments are available to read here.

“Dealing with the bureaucracy after having sought mental health treatment is itself enough to cause PTSD.”

“Senior officers, in particular, need to set the example by ensuring that their employees understand that a mental health issue, like any ailment, is best addressed early. Until they do, we will all still sign notes like this as… Anonymous.”

“During a rough patch in a relationship, my partner and I sought couples counseling. When my security clearance was up for renewal, I was grilled by the investigator regarding this counseling. I had to defend myself for wanting counseling, and the harsh and critical tone she took for me wanting to do what I needed for my relationship was upsetting. I got the clearance, but it was a stressful process.”

“After service in Iraq, there is no doubt in my mind that I suffered from PTSD. Now (several years later), I see my symptoms as both classic and obvious. At the time I was suffering, however, I hid my symptoms out of fear that knowledge that I suffered from PTSD would harm my career. That concern was heightened by the intense questioning I endured by a Diplomatic Security agent conducting a security clearance update when I was serving in Iraq. When it became known that I had sought mental health care, I was hassled and forced to repeat the content of a private discussion with a mental health professional to a DS agent with zero mental health training. I found the entire episode both distasteful and inappropriate.”

“My mistake—I was told by MED that I’d be given a Class 2 because of seeking continued therapy. I thought that showing that I’d made arrangements for my mental health would ensure a Class 1, but instead that’s what gave me the Class 2. Geez, why be honest with MED—it could have cost me my assignment.”

“I met with a therapist who told me he never wrote anything down because all of his FS clients were terrified of getting caught seeking assistance for their stress-related problems. It’s sad. Concerns about security clearances have a big effect on whether or not I seek mental health care.”

“I feel that if I had declared myself an alcoholic I would have gotten more attention from MED than when I was traumatized and sat in my office working, feeling like an isolated zombie.”

“Once I joined the Foreign Service, I could easily understand why there is an impression that the Service has an alcohol abuse problem—it’s self-medication that is easy to hide from a clearance process. I find that distressing and disturbing and extremely unsupportive.”

“Despite former Secretary of State Hillary Clinton’s message a few years ago telling employees that their clearance will not be affected by seeking mental health treatment, that is not what happens in practice. DS investigators zero in on this, considering it a red flag, as if mental health were any different than physical health.”

“No matter what management says about the importance of mental health, if there are no real changes, then the Foreign Service will continue to be an ineffective and unsupportive mental health environment.”

“You also do not know who the regional psychiatrist’s client really is: you or the State Department? Does a psychiatrist see you as a patient who needs help or just a problem for the Foreign Service best remedied by removing you from post?”

“The mandatory out brief improved between the time I returned from Afghanistan in 2007 and 2012, when I returned from Iraq. However, both times I was told that the symptoms in the PTSD questionnaire are normal for six months and not to worry unless they persist. (And I was offended when taken aside after the briefing and asked how pervasive I thought infidelity was in Baghdad.)”

“During the onward assignments process, MED refused to consider my needs as identified by my therapist, instead assigning me to a post where there was no one in-country who could serve as an appropriate psychiatrist. There, I raised an issue of concern with the health unit nurse, who in turn shared it with the management officer, who then told my supervisor that I was “nuts.” This was not only a violation of my privacy; it reflected total ignorance on the management officer’s part of what PTSD and its symptoms are.”

“I would rate the mental health support at 3 out of 10, with 10 being the best. Working in a high-stress post that was not a “high-threat” post, my colleagues and I were given limited support in a time of crisis.”

“I am grateful for the mental health assistance available to me. If it weren’t for grief counseling, I would have qualms about seeing the RMO/P, because I’d need to disclose this in the five-yearly security update. And while that disclosure might not affect my security clearance, I still think there’s a stigma attached to the fact that I needed mental health assistance.”

“As a veteran of two priority staffing post (PSP) tours—one in Iraq (2007–2008) and the other in Afghanistan (2013–2014)—my experience with transition support has been abysmal. Just getting authorization to attend out briefings and to access mental health services was impossible.”

“I am not concerned about medical and security clearances as they relate to mental health care. Most people have seen a therapist at one time or another, and I don’t think it would affect a security clearance. But corridor reputation is a concern. Even when people need to talk to a mental health professional, they’re more worried about their corridor reputation and often won’t seek help due to the stigma of being “weak.”

“In my final post, when I had finally had enough bullying from my fourth bully boss (three of whom were DCMs and one a GS-15), I worked with the regional psychiatrist who prescribed two anti-anxiety/anti-depressants and a sleeping pill to help me cope. I sought assistance from the ombudsman, but received no help, so I resigned.”

“I had discussed my mental health with the regional psychiatrist during his visits, but he just gave me Xanax and told me panic attacks were normal. He asked me about work-related stress, but reported the results of our meetings with post leadership, contributing to my stress.”

“When State does not actively intervene in cases of abusive behavior, managers are given the impression that they have carte blanche to do whatever they want. Even if victims get mental health care afterwards, the damage has been done. From what I hear, the problem is getting worse and more widespread. It doesn’t have to be this way. Instead of sending out feel-good cables on workplace atmosphere and bullying, put policies in place that have real teeth. A zero-tolerance policy for workplace bullies, administered neutrally and enforced by D.C., would lead to an instant decrease in unacceptable behaviors and the resulting damage they cause.”

It’s No Joke

The first MED-directed mental health intervention that was provided in Tripoli after the Benghazi attacks on Sept. 11, 2012, was a video conference in April 2013, conveniently less than a week before the Director General arrived for a visit to Libya. Prior to that, the only service provided was a discussion with the nurse about “fostering resiliency” several months after the attack…hardly a useful assist.

The half-day course for those returning from hardship posts is a joke. I took it after my first (!) unaccompanied tour (UT), and both the instructor and some of the other students made fun of me for enrolling, since at the time my tour was seen as one of the “cupcake UTs,” without an active war going on outside the embassy walls. I refused to take the course after my second UT. No one from HR or my bureau asked if I’d taken it or even how I was doing after the second UT.

An RMO/P made fun of some of my coworkers in a high-stress, high-threat post that happened to be a popular destination for American tourists. He told them that they had no idea what serving in an actually difficult post was like, comparing it to the regional city where he was based. Never mind the fact that almost every person at that highly desirable but still challenging post got there via a tour in Iraq or Afghanistan.

I have neither respect for nor faith in MED’s mental health efforts. As long as MED is staffed with people who see mental health as an inconvenience, supported by State leadership (from the very top down) who barely pay lip service to mental health and a work-life balance, there’s no hope for anyone who suffers in the aftermath of an emotionally catastrophic tour abroad. At least there is solidarity among those who survived terrible times abroad.

Read in full the candid views from the filed via the Foreign Service Journal.

 

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