At a hearing before the House Foreign Affairs Subcommittee on the Middle East and South Asia, representatives from State indicated that while the department provides adequate mental health services for civilian employees deploying to and returning from Iraq, there is room for improvement, especially as civilians more often are embedded in dangerous war zones.
"Usually, when we talk about post-traumatic stress disorder, the conversation is about members of the military … whom we would unfortunately expect to have experienced the horrors of war," said Rep. Gary Ackerman, D-N.Y., chairman of the subcommittee. "But increasingly, the United States is sending civilian employees, not just to hardship posts, but to actual combat zones, and then expecting them to do their usual jobs under extraordinary and perilous conditions."
George Staples, director general of the Foreign Service and director of human resources at the State Department, said debriefings are voluntary for employees returning from war zones and on average only 10 percent choose to use the service.
Additionally, Laurence Brown, director of the Office of Medical Services at State, said about 70 percent to 80 percent of civilian employees returning from the Middle East develop emotional problems. But since the Iraq war started in 2003, there have been only 12 to 15 reported cases of full-blown post-traumatic stress disorder, he said.
Still, lawmakers argued that because debriefings are not mandatory, there could be many cases that have gone unnoticed. "I'm trying to understand the numbers," Ackerman said. "Those 15 cases of PTSD are based on the 10 percent of the people you've seen so far. Is it reasonable to assume that there would be 10 to 15 out of every 10 percent?"
Brown said it is possible that many cases have gone unnoticed, largely because many employees fear that seeking help would hurt their career by causing them to lose their medical or security clearances, or that colleagues would view them as incapable on the job.
Brown added State has developed a survey for all Iraq returnees, which was posted on the department's intranet on June 1. The survey will run until the end of the month, with the hope of capturing mental health information from most of the roughly 2,000 Foreign Service employees who have served under difficult circumstances since the start of the Iraq war, he said. In July, the department will offer support groups for employees returning from unaccompanied high-stress assignments, Brown said.
Steve Kashkett, vice president of the American Foreign Service Association, which represents Foreign Service employees, said preliminary results from the survey suggest that post-traumatic stress disorder may affect more than 40 percent of employees, a level similar to that in the military.
"Foreign Service members by nature are tough, adaptable individuals, accustomed to difficult hardship postings and used to putting up with adverse situations without objection," Kashkett said. "We are therefore concerned that many who are suffering from post-traumatic stress may not be coming forward out of fear of being labeled as complainers. They also fear retaliation for speaking out."
Staples said State recently has made outbriefings mandatory, but lawmakers said the department has not enforced this rule. Members of the subcommittee recommended that State put in place an outbriefing program that not only would assess employees' mental health but would also reassure them of privacy protections.
Lawmakers also recommended that the department work with insurance providers to make sure post-traumatic stress disorder treatment is covered and there are a sufficient number of qualified therapists available under the health plans provided.
"I think it's time for the department to … make changes so employees are confident that they have the information and support necessary to help them live and work in a war zone and to adjust to normal life when they return," Ackerman said.