State Department doubling mental health counselors in Iraq and Afghanistan, from two to four

After a Sept. 7 letter from Secretary of State Hillary Clinton to State Department employees encouraging them to seek mental healthcare after high-stress postings, the State Department is doubling its mental healthcare providers in Iraq and Afghanistan — from one to two in each country. But mental health experts believe that even the additional counselors are inadequate to deal with the needs of diplomats deployed in warzones.

Much concern has been devoted to the mental health care needs of returning soldiers and the struggles of a military healthcare system ill-prepared to handle their care. But the same crisis plagues State Department employees deployed abroad, who also suffer the invisible wounds of war such as Post Traumatic Stress Disorder (PTSD) and depression.

"State Department employees face the risk of being in danger just like soldiers," said Scott Payne, senior policy adviser at Third Way, a progressive think tank. "They see some of the same destruction and human carnage that the military sees. Everything in Afghanistan is the front line, so they live with that pressure every day. That adds up."

The Cable was able to confirm that in Iraq, Afghanistan, and Pakistan, the State Department has exactly one mental health staffer per country. A spokesman for the U.S. Embassy in Baghdad said that three more "regional" mental health care counselors provide remote care for diplomats serving in the warzone.

One social worker works with diplomats stationed in Baghdad while living in Amman, Jordan. Kabul diplomats are served by a mental health worker in Manama, Bahrain. Islamabad diplomats are apparently covered by one mental health care provider based in New Delhi, India.

These six mental health providers are tasked with covering over 800 State Department employees currently deployed in these three hazardous areas. One more health care employee is being sought for Iraq and Afghanistan, but that’s it. Pakistan will have to make do with the one it has.

Steve Robinson, a retired Army Ranger who works as a veteran’s advocate, has met with several State Department employees who have served at hazard posts and found that they often face difficulty getting access to mental health providers both overseas and here at home.

"Foreign Service officers are no less human than soldiers, and combat creates life intense experiences that have a direct impact on brain and body function," he said. "State Department people put themselves at the same risk, often without the same support as the military personnel."

And after returning home, State Department employees face unique challenges as they try to reintegrate to normal life. Unlike in the military, they don’t have the built-in structures that could help them readjust and share the burden of their experience with others.

"If you are a soldier coming back with your military unit, you have this support network. But people in the State Department may come home without that social network and have a lot more alienation and isolation," said Kayla Williams, an advocate for women’s mental health care and a board member of Grace After Fire, a group that supports women returning from war.

In July, the State Department’s Office of the Inspector General (OIG) reported that State had made some progress in addressing mental health needs but "may" need to deploy more mental health providers in theater. The OIG recommended State take a survey to see if employees felt well cared for.

The OIG also reported that State Department employees face a stigma when seeking mental health services and that Secretary of State Hillary Clinton should issue a high level statement encouraging suffering returnees to seek help. This prompted Clinton’s letter of Sept. 7. "Seeking help is a sign of responsibility and it is not a threat to your security clearance," Clinton wrote.

Our State Department sources say that while technically seeking mental health services is not one of the 13 criteria under which the Diplomatic Security service can revoke a clearance, there are instances where security clearances have been affected by an employee seeking mental health assistance.

"The problem associated with seeking help is the same in the State Department, which is that there is a stigma attached to seeking help," said Robinson. "There’s a culture that mental health issues represent a lack of moral character or intestinal fortitude, as opposed to thinking of this injury the same way you would a burn or a bullet wound."