The Cable

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."

The Cable

Briefing Skipper: India, Israel, North Korea, Chavez, Sudan

In which we scour the transcript of the State Department's daily presser so you don't have to. These are the highlights of Tuesday's briefing by spokesman P.J. Crowley:

  • Secretary of State Hillary Clinton had a 30-minute meeting Tuesday with Indian Defense Minister AK Antony. India is nearing a decision on some pending arms deals while also protesting U.S. arms deals with Pakistan. U.S. firms are vying for a potentially lucrative contract to sell India fighter jets, among other things. "We think we have the finest military hardware in the world, and if India is upgrading its defense capabilities, they should buy American," Crowley said.
  • Clinton will meet with the EU's top foreign representative Catherine Ashton Wednesday, who will help Clinton prepare for an upcoming trip to the Balkans.
  • Special Envoy George Mitchell and his team are in the Middle East to meet with both sides of the Israeli-Palestinian peace process as well as some of the Arab League countries that will meet on Monday. He'll meet with the Israelis Wednesday and the Palestinians Thursday. He said Mitchell has some ideas for how to move forward but wouldn't reveal what they are. "It is our absolute position that it is important for both the Israelis and Palestinians to remain in direct negotiations to reach an ultimate agreement," Crowley said. "We want the Palestinians to stay in the direct negotiations, and we want the Israelis to demonstrate that it is in the Palestinian interest to stay in these negotiations."
  • What's clear is that the U.S. wants Israel to do something to give the Palestinians incentive to stay at the table and that the U.S. wants the Palestinians to tell the Israelis what it will take for them to stay. What's not clear is how the deal could get done. "The Israelis, the Palestinians, others in the region, the United States, everyone is advancing ideas and formulas that we hope will convince, you know, the parties to stay in the negotiation and will convince countries in the region to continue to support this negotiation," Crowley said.
  • Crowley said he hadn't seen the speech by Israeli Foreign Minister Avigdor Lieberman, where he called for relocating large amounts of Israeli Arabs out of Israel as part of any peace deal. But Crowley did make clear that Lieberman is not one of the Israeli officials the U.S. is dealing with. "We are in direct discussion with the prime minister. We had meetings last week with the defense minister. And we are actively engaged in working to continue direct negotiations," he said.
  • No real comment on the promotion of Kim Jong Il's son Kim Jong Un to the rank of four star general during North Korea's Workers Party Congress. "I would suppose this is perhaps the ultimate reality show in North Korea. And we are simply watching this very closely," Crowley said. "And as Kurt Campbell said yesterday, it's a bit too early to assess what the implications are."
  • Crowley finally admitted that the State Department is aware of an Omani delegation that is in Iran now to lobby for the release of the remaining two hikers imprisoned there.
  • Larry Palmer is still the U.S. nominee to become ambassador to Venezuela, even though Hugo Chavez has rejected him. The U.S. is not concerned about any Venezuelan nuclear program. Crowley congratulated the Venezuelan people for holding parliamentary elections where Chavez' people only won 48 percent of the vote. "It would appear that the results suggest that there's now a real opposition. And President Chavez and his administration will have to govern as a part of a functioning democracy, and can't just dictate policies to a compliant legislature," Crowley said.
  • Following last week's high level meeting on Sudan, which Obama attended, the State Department thinks the parties are close to an agreement on how to hold the January referendum in the territory of Abyei. Crowley said there will be a follow up meeting next month in Addis Ababa. "And we would expect that the parties should come to that meeting prepared to reach an agreement on Abyei."