U.S. employees and their families overseas often work and live in stressful environments with limited or no access to local mental health services.
While the State Department and U.S. Agency for International Development offer some mental health services, providers and patients we surveyed identified challenges in delivering or accessing them. For example, providers reported increased workloads amid growing demand for services.
State has collected feedback on some of its mental health services. We recommended that it collect ongoing feedback on all of its mental health services to ensure the needs of overseas personnel are being met.
What GAO Found
The Department of State and the U.S. Agency for International Development (USAID) offer several mental health services to help sustain the well-being of employees and their eligible family members based overseas. For example, State employs overseas psychiatrists—each typically serving 12 to 15 posts—and both agencies offer counseling services. Of the 16 State overseas psychiatrists who responded to a GAO survey, 12 reported that their overseas workloads increased in 2022 because of factors such as a rise in demand for care and vacant psychiatrist positions. State officials told GAO that demand for its short-term counseling services had also risen, due to the war in Ukraine, the COVID-19 pandemic, and other stressors. In addition, USAID officials reported that demand for counseling had almost doubled since 2018 in response to those crises and other factors. To meet the increased demand, State is seeking funding for additional psychiatrists and social workers, and USAID plans to increase funding for its counseling services and for programs to build resilience.
Respondents to GAO's survey of psychiatrists identified several challenges related to delivery of, and access to, State's mental health services for overseas employees. (The figure shows 15 psychiatrists' ratings of such challenges.) Foreign Service members GAO surveyed reported some of the same challenges. State has undertaken efforts to address these challenges, such as conducting outreach to reduce stigma associated with mental health care.
Significance of Challenges in Providing Mental Health Services to State Department Employees and Family Members Based Overseas, Reported by 15 Overseas Psychiatrists
State has obtained some feedback about its mental health services from employees and their family members based overseas. For example, in 2023, State conducted two one-time surveys to identify concerns about its mental health services. USAID also surveys clients to collect feedback about the mental health services it provides. However, State does not collect ongoing feedback about all of its services to help ensure they are meeting the needs of those who receive them. Ongoing feedback about its mental health services for employees and family members overseas would help State ensure that employees maintain their ability to protect and promote U.S. interests abroad.
Why GAO Did This Study
State and USAID employees based overseas often face high levels of stress due to heavy workloads and to instability or conflict in countries where they are based. As of June 2023, about 15,000 State and about 1,600 USAID personnel and family members were based overseas.
GAO was asked to review State's and USAID's mental health services for employees based overseas. This report examines, among other things, (1) reported factors affecting workloads of State and USAID mental health providers, (2) reported challenges associated with delivering or obtaining mental health services overseas and efforts to address these challenges, and (3) State's monitoring of its mental health services for employees and their family members overseas to help ensure it is meeting their needs.
GAO reviewed documents and interviewed officials from State and USAID. GAO surveyed 17 State overseas psychiatrists in December 2022, asking about their workload and any challenges, and received 16 responses. (State has 21 overseas psychiatrist positions, but four were vacant or recently filled.) GAO also conducted a nongeneralizable survey of Foreign Service members, asking about their experiences in obtaining mental health services, and received 437 responses.
GAO recommends that State collect ongoing feedback from overseas recipients of all of State's mental health services to determine whether these services are meeting recipients' needs. State concurred.
Recommendations for Executive Action
|Department of State
|The Secretary of State should ensure that the Bureau of Medical Services' Chief Medical Officer collects ongoing feedback from overseas recipients of all State mental health services to determine whether these services are meeting their needs. (Recommendation 1)