Long Past Time to Talk About Trauma—Raising Awareness and Resilience
Taking better care of employees—from pre-employment to post-employment—makes economic sense, creates better morale and is the right thing to do.
BY ANGELA R. DICKEY
The Foreign Service Act of 1980 mandates a “career foreign service characterized by excellence and professionalism” as “essential in the national interest to assist the President and the Secretary of State in conducting the foreign affairs of the United States.”
Excellence and professionalism are difficult to maintain in an environment that requires repeated exposure to stressful and potentially traumatic situations. The January-February Foreign Service Journal, devoted to mental health care, contained the poignant and distressing stories of 45 anonymous Foreign Service personnel. These reports describe an insensitive and inadequate response from the department to an unprecedented level of trauma in the workforce.
The testimonies of those who wrote to the FSJ illustrate powerfully that Foreign Service employees enjoy no separation between home and job, at least not when they are posted abroad. The experience is immersive. Note also the following realities for the typical Foreign Service professional:
• During the past two decades, the Centers for Disease Control & Prevention and other researchers have documented that trauma is prevalent in daily life in the United States. Therefore, the department must assume that at least some of the persons it hires have had previous exposure to trauma—even before being sent abroad. Any employee joining the workforce may have life experiences that weigh heavily and negatively on his or her wellness.
• More than 25 percent of today’s Foreign Service members have served in Afghanistan, Iraq, Pakistan, Libya or Yemen—the Priority Staffing Posts. Many more have served and are serving in other dangerous places such as Somalia, South Sudan and Lebanon. Prior to September 2001, embassies were generally evacuated once they came under fire from hostile forces, but since the ramping up of “expeditionary diplomacy” in the post-9/11 era, that is no longer the case.
• Of the 200-odd American posts worldwide, between 30 and 40 percent may be classified as “unaccompanied” at any one time. Scientific studies show that being separated from family members is one of the most traumatic experiences an individual can face.
• More than a quarter of FS personnel, after serving in so-called “danger zones,” have moved on to other posts and to Washington, D.C., presumably bringing along with them unaddressed mental or emotional issues.
• No baseline study of trauma in the Foreign Service workforce has ever been done.
• Traumatized individuals are working in Washington, as well as abroad. For example, during an October 2015 open meeting at State on post-traumatic stress disorder (PTSD), department-based employees reported “secondary trauma” from constant exposure, via phone calls and email, to the catastrophic experiences of their colleagues working in foreign countries.
• Traumatized individuals may also pass on the effects to family members in the form of domestic violence and abuse. Research has shown that abusers are often themselves the victims of trauma.
The obvious bears repeating: The State Department is the only federal agency that requires a subset of employees—Foreign Service personnel—to spend a majority of their careers abroad. And it requires them to work in combat or otherwise extremely difficult posts to qualify for promotion into the senior ranks. To comply with international best practice with regard to managing personnel posted abroad, State leadership can no longer turn away from the reality of trauma in the Foreign Service experience.
The good news is that there are new models of management that can help. Increasingly, international organizations that operate globally are adopting a concept of “duty of care” regarding employees. Medecins sans Frontières and the German Development Agency (GDZ) are among the organizations that have recognized that taking better care of employees—from pre-employment to post-employment—makes economic sense, creates better morale and is the right thing to do.
The Antares Guidelines
A few years ago, the CDC and the Antares Foundation in the Netherlands collaborated on a project to advise organizations that manage employees who live and work in hostile contexts. The result was the 2012 publication of Managing Stress in Humanitarian Workers: Guidelines for Good Practice. The Antares guidelines recognize that the stressors experienced by professionals in humanitarian and associated fields (like diplomatic and development work) can be greater than those experienced in more familiar situations. Here is the summary of the guidelines:
• Policy: The agency has a written and active policy to prevent or mitigate the effects of stress.
• Screening and Assessing: The agency systematically screens and/or assesses the capacity of staff to respond to and cope with the anticipated stresses of a position or contract.
• Preparation and Training: The agency assures that all staff have appropriate pre-assignment preparation and training in managing stress.
• Monitoring: The agency ensures that staff response to stress is monitored at all times.
• Ongoing Support: The agency provides training and support on an ongoing basis to help its staff deal with its daily stresses.
• Crisis Support and Management: The agency provides staff with specific and culturally appropriate support in the wake of critical or traumatic incidents and other unusual and unexpected sources of severe stress.
• End of Assignment: The agency provides practical, emotional and culturally appropriate support for staff at the end of an assignment or contract.
• Post-Assignment: The agency has clear written policies with respect to the ongoing support it will offer to staff who have been adversely impacted by stress and trauma during their assignment.
Studies show that continuous exposure to live combat and extreme violence can lead even the hardiest individuals to develop PTSD.
The guidelines posit that the employing organization should look after all its employees, regardless of nationality and whether they are full-time or part-time employees or contractors, through all stages of the employment cycle. The organization’s responsibility to its employees extends to post-employment, because PTSD and related disorders may appear only long after the first exposure to a potentially traumatizing event.
Studies show that continuous exposure to live combat and extreme violence can lead even the hardiest individuals to develop PTSD. Trauma can trigger a cycle of violence, with some people “acting in” against themselves (e.g., alcoholism, drug addiction) and others “acting out” (e.g., beating their spouses, screaming at their employees). This kind of violence can also be seen as an ethical violation of FS norms: It is not only illegal to beat your spouse, it is unethical, too. Especially in the foreign context, where one’s behavior takes place “in a glass house.”
The Department of State needs to rethink and reform the way it cares for employees and their families, adopting systems and processes that are compassionate and consumer-friendly. Failing to provide this care has consequences for the individual concerned, his or her family, the larger Foreign Service and foreign affairs community, and U.S. foreign policy generally.
Helping Employees Help Themselves
Providing such care is a matter of both political will and resources. While the department lacks the funding to develop an adequate mental health and psychosocial support infrastructure to help employees cope with the demands and consequences of repeated stressful assignments abroad, a system of peer-led interventions could help support colleagues who may be suffering from illnesses and challenges. Peer trainers could supplement the work of the Bureau of Medical Services (MED) and the National Foreign Affairs Training Center/Foreign Service Institute in helping participants become more aware of the linkages between brain and body—particularly in relation to trauma—and learn to care for themselves and others.
A wealth of management literature supports the proposition that healthy, well-led teams are happy, more productive and better equipped to carry out their tasks than those worried about family problems, illness and so forth. As the Antares guidelines put it: “Under conditions of chronic stress, staff may be poor decision-makers and may behave in ways that place themselves or others at risk or disrupt the effective functioning of the team. Their own safety and security and that of beneficiaries may be put at risk, and their team may experience internal conflict and scapegoating. ‘Stressed out’ staff members are less efficient and less effective in carrying out their assigned tasks. Stress fundamentally interferes with the ability of the agency to provide services to its supposed beneficiaries.”
A country team that does not function smoothly can have a direct, deleterious impact on U.S. policy toward the host country. As the faces of America in a given country, FS personnel shape attitudes toward the United States and any given bilateral relationship. When a U.S. diplomat abroad behaves in an unethical manner, the action reflects poorly on the U.S. government and people.
Given the perennial and persistent pressures on the U.S. budget, it is unlikely the U.S. Congress will provide significant new mental health resources (e.g., large numbers of additional psychiatrists, psychologists and counselors) for the Foreign Service. This is especially so since the department has no baseline data on the prevalence of trauma among employees.
The programs give participants practical tools to recognize and deal with the stressors in their lives and professional environments.
True, MED is expanding its resources, research and outreach to the FS population. But without cooperation from Human Resources and all the geographic and functional bureaus, change cannot occur. At present, the workings of HR are not transparent regarding staff care. Geographic bureaus run their own personnel empires, with unwritten and unstated policies that may or may not be congruent with overall department policy. All parts of the organization must resolve to abandon “stovepipe” approaches and work together to provide the necessary knowledge, skills and care to optimize the health and wellbeing of the foreign affairs community.
In the past two years NFATC/FSI has launched pilot programs in individual and community resilience. This new curriculum is not only for personnel coming out of combat zones but also for A-100 (entry-level), deputy chiefs of mission and new ambassadors. It also is being introduced in leadership courses required of all employees. The next step in spreading knowledge about this topic would seem to be to train trainers who can help deliver training to their colleagues.
A peer-led program on trauma awareness is not a substitute for psychological or psychiatric care, of course. However, peer training can help embassy country teams identify personnel who are having trouble and can refer these cases to the appropriate medical officer.
A Pilot Project to Introduce Trauma Awareness
The work that NFATC/FSI is already doing in terms of resilience training is admirable and needs to be reinforced. Other models could supplement what is already being done. For example, one model that could be adapted to the Foreign Service is the STAR—Strategies for Trauma Awareness and Resilience—curriculum at Eastern Mennonite University in Harrisonburg, Virginia.
The STAR program, in which several employees from the U.S. Agency for International Development and from the School of Professional Studies at FSI have participated, describes itself as “a five-day research-supported trauma awareness and resilience training program . . . [that] brings together theory and practices from neurobiology, conflict transformation, human security, spirituality and restorative justice to address the needs of trauma-impacted individuals and communities. STAR training sessions are multicultural, multifaith gatherings in which all are welcome to use the language of their own culture and faith traditions. Openness, sensitivity and respect are encouraged.”
George Mason University, the U.S. Institute of Peace and several other conflict-resolution institutions also offer programs that have been used successfully domestically and abroad to train social workers, emergency response personnel and others living and working in conflict situations. They give participants practical tools to recognize and deal with the stressors in their lives and professional environments. The programs typically include information on how trauma affects the brain, body and behavior. They also provide an opportunity to practice emotional first aid, compassionate listening and transforming conflict nonviolently.
STAR, or a program like it, could be tailored to fit the Foreign Service and embassy contexts. Adopting the program would require training facilitators who could carry the knowledge forward and disseminate it through embassy communities abroad. Additional material would be developed addressing the specific stressors of living and working in an embassy (e.g., how to nurture productive relationships with host-country nationals working in the embassy).
To launch such a program, a pilot “country team” could be trained together. The key would be to capture the group as it cycles through its pre-deployment training at NFATC/FSI. Most State Department personnel are required to take the foreign language of their country of assignment prior to deploying; therefore, they are already in class together for periods ranging from six months to two years. The trauma awareness training could be introduced as part of required training, just as security training and other country-specific courses are required. A key player in the establishment and maintenance of such a process would be the deputy chief of mission, who normally runs the embassy. Of course, a successful program would require the full-hearted support of the ambassador at each mission.
After the pilot group has been posted abroad and has worked together for a year or so, a training and evaluation team would be sent to evaluate how the group is managing in handling the stresses of living and working together. The evaluation team would visit again after another year. The trainers/evaluators could provide additional training to the original group and observe their facilitation of the country team in situ. Perhaps the program could be offered at the embassy at the same time as the annual Crisis Management Exercise in which each country team must participate. Feedback from the visits could be used to inform Phase II, in which a second pilot embassy team is trained and prepared for deployment.
Beyond observing the embassy country team pilot in its setting abroad, the master trainers would need to devise a monitoring and evaluation instrument to assess whether the pilot is having the desired effect.
More than four decades ago, a USAID FSO named Barbara Dammarrel survived the April 1983 bombing of the U.S. embassy in Beirut. She later wrote a master’s thesis about her experiences with PTSD following that terrorist incident. In her study, she recommended that the Department of State and the other foreign affairs agencies implement policy and procedures to prepare employees better for service in highly stressful situations.
Today it is clear that repeated exposure to trauma in the Foreign Service and larger foreign affairs community has reached a crisis level that affects office colleagues, families, bilateral relations with certain countries and foreign policy writ large. Although State has taken some preliminary steps to deal with this complex problem, much more needs to be done. The Antares guidelines offer a blueprint for beginning to address some of the root causes of distress in the foreign affairs community. There are a number of trauma-informed training programs that could provide ideas for State to follow in providing better care.
Additional programs to help employees manage stress would require additional resources that only Congress can provide. But the State Department should start planning for a baseline survey of all employees that can inform leadership about the extent of trauma in the foreign affairs community.
It is high time to begin mainstreaming trauma awareness throughout the Foreign Service.
- Focus on Mental Health Care (The Foreign Service Journal, January-February 2016)
- “Mental Health Effects of Serving in Afghanistan and Iraq” (U.S. Department of Veterans Affairs)
- “PTSD: A Growing Epidemic” (National Center for PTSD, U.S. Department of Veterans Affairs)
- “Focus on PTSD and the Foreign Service” (The Foreign Service Journal, January 2008)
- Seriously Not All Right: Five Wars in Ten Years by Ron Capps (book review, The Foreign Service Journal, June 2014)
- “USAID Must Weigh Cost of Longer Critical Priority Country Tours” by Sharon Wayne (The Foreign Service Journal, October 2014)
- “AFSA’s Dissent Awards: Honoring the Best Among Us” by John Limbert (The Foreign Service Journal, September 2013 ─ regarding 2008 Rivkin Award recipient, Rachel Schneller, and her struggle with PTSD)
- “War Zone Diplomats: Stress Taking Toll on Foreign Service” by Robin Wright (The Washington Post, June 20, 2007)
- “War Zone Safety” (Wikitravel, May 2016)