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. What GAO Recommends. 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.
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