On the Infamous Q21, PTSD (Again) and High Threat Unaccompanied Assignments

The OIG has released its inspection report dated July 2010 on  the State Department's support for high stress, high threat, unaccompanied posts.  Some interesting details excerpted below. I have also republished the full report in ScribD for easy access (read below).

The Stigma of Seeking Mental Health Care:

The Department of Defense, led by the Secretary of Defense, has undertaken a campaign to reduce or eliminate this stigma. The Department also has made an effort in the past but can do more. The Department, as have the Department of Defense and other federal government agencies, now exempts mental health consultations relating to service in a military combat environment (i.e., Iraq and Afghanistan) from being reported on employees’ security clearance forms (it still has to be reported on medical clearance forms). That is just one, though important, step.

There is still a lack of clarity as to what employees must report on the security clearance form. For example, does a discussion between an employee and a health professional on how to manage stress have to be reported even if it does not involve diagnosis and treatment of a mental disorder? Opinions differ on that point. However, if such “preclinical” discussions have to be reported, that will ensure that fewer will take place, even if the Department is more successful than in the past in reducing the stigma. This would undercut the Department’s efforts to build resiliency among its employees.

The Department needs to address the overall issue of the stigma. The next step should be a message from the Department’s leadership to all employees making some of the following points (which have been made to the OIG team by MED and DS):

• The Department encourages its employees to seek mental health care. It is a positive act and a normal part of maintaining one’s health and preparedness.

• Employees could be more likely to put at risk their clearances and job performance when they do not seek such care.

• Only two employees have lost their security clearances over the past fi ve years because of mental health issues (which did not involve PTSD).

• Of the 517 cases concerning mental health issues that DS referred to MED during 2009, not one resulted in denial of a security clearance for mental health reasons.

Two years ago, we called for such a high level message from Secretary Rice in On the Infamous Q21, PTSD and the Wholeness of People in the Foreign Service(May 2008): 

Considering that State has its own clearance process and is a separate agency from DOD, I’m waiting for revised guidance for State Department personnel from Secretary Rice herself. Uhm, no offense intended; the guidance from “M” or “DGHR” or “DS” is fine but I don’t think that really cuts the cake here.

I’d like to see the Department of State, at the highest level of the 7th Floor, affirm and strongly endorse the practice of seeking professional help to address all health related concerns, including mental health. The press guidance above only refers to service in Iraq and Afghanistan, but what about service in the rest of the FS hardship assignments? The emotional toll of constant moving and relocation coupled with dangerous and challenging assignments is not something that we can or should ignore.

We're a small fly in a thick soup, of course; that did not go anywhere.  Secretary Clinton as far as we are aware has not issued a message similar to Secretary Gates' message. 

This report by the way, notes that "In the past five years, 18 employees have been formally diagnosed with PTSD. Of these, 10 had served in posts other than Iraq or Afghanistan." So there are more posts at play here than just the war zones. 

Leadership and Stress:

In practically any conversation about the causes of stress and inefficiency in the Department or at overseas posts, the issue of inadequate leadership/management comes up. For some employees, this is a greater problem than danger and hardship. Good leadership can do a great deal to create high morale and effectiveness at difficult posts. Poor leadership, of course, can be a problem at any post or bureau, but it can be especially harmful at a high stress, high threat post. In the OIG survey, leadership problems were cited by 45 percent of the respondents as a source of stress for them or their colleagues. As noted above, this was less than the percentage citing danger, workload, and separation from families, but leadership problems generated more passionate comments than any other issue. That is probably because, unlike danger and separation, employees feel that something can and should be done about leadership.

This is not to say that poor management is widespread at high stress or more “normal” posts. In fact, OIG inspections have found that at a substantial majority of posts, the top leadership is doing fairly to very well. Also, inspections have found that inexperienced personnel have put an additional burden on top leadership as well as middle managers. (See section below on whether the right people are being assigned.) However, recent inspections have found too many cases of managers at the top and middle levels who cause unnecessary stress and inefficiency and thus impair the morale and smooth functioning of their post, bureau, office, or section.

Are the right people on the right bus?

The OIG survey asked whether the Department generally was assigning employees with the necessary skills, experience, and temperament to high stress, high threat posts. Over 60 percent of respondents said no. In their comments, those who served in Iraq and Afghanistan and answered in the negative made observations such as: there are too many people who are there just for the money, their next assignment, or to save a failing career. There are people who do not have the necessary experience or the mental and physical resiliency to be effective; such people make work more difficult for the others. There was a feeling that taking virtually anyone who volunteers has a negative impact on the post.

Lessons not learned, again:

Care should be taken in setting numerical staffing targets. A smaller, higher quality staff can usually do a better job. The OIG inspection of Embassy Baghdad found that many employees thought that staffing levels were too high as a result of the “civilian surge,” even taking into account the need to compensate for the absence of staff because of rest and recuperation leave (R&R) and other factors. The OIG inspection of Embassy Kabul found that the Baghdad experience was being repeated, with staff added before functions were identified and job descriptions developed.

An ALMOST “fitness for duty” policy:

OIG would support the Department’s developing a stronger “fitness for duty” policy that would be fair not just to the individual, but also to his or her colleagues, and that would maintain the effectiveness of a high stress, high threat post. Administrative and legal barriers, however, limit the Department’s options. In a recent review of the issue of physical fitness for high threat posts, the Department concluded that providing employees with the information to make an intelligent self-assessment of their capabilities was the best available means of handling this problem.

Finally, in Recycling News:

Care should also be taken in reviewing the skills and experience of employees hired under the 3161 authority for Iraq and Afghanistan, both for fi rst-time hires and re-hires. A number of people in the OIG survey expressed concern that 3161 employees who did not do very well in Iraq were being hired to go to Afghanistan, and many more thought that 3161 personnel in general needed greater knowledge of the objectives and operations of the Department and other government agencies to be effective in their jobs.

The original OIG report is posted here (OIG Report No. ISP-I-10-44 - Review of Support for High Stress, High Threat, Unaccompanied Posts - July 2010).

State Department/OIG Report of Inspection | Review of Support for Employees (Unaccompanied Posts)

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• Robert Morgenthau: Ending the Stigma of War Related Stress (online.wsj.com)
• "About 1 in 10 Iraq veterans develops a serious case of PTSD, researchers say" and related posts (latimesblogs.latimes.com)
• Vets can lead fight on mental health stigma (airforcetimes.com)