Peace Corps sued over mental health policy

Thanks for the ‘heads up’ from John Pettit (Ethiopia 1965-67) & Matt Losak (Lesotho 1985-87)

 

Applicants have challenged the Peace Corps practice of rescinding invitations to applicants on the basis of mental health conditions.

by Ellen Barry
the New York Times
Sept. 27, 2023

Lea Iodice was thrilled to hear that the Peace Corps had accepted her application and was sending her to Senegal as a community health care worker. She shared the good news with her roommates, her family and her favorite professor and daydreamed about her last day at her job, managing a gym called SnapFitness.

She was crushed, about a month later, to receive a letter from the Peace Corps Office of Medical Services saying that her offer was being rescinded because she was in treatment for anxiety. Though she had been in therapy to manage occasional panic attacks, she had never taken any psychiatric medication, been hospitalized or engaged in any kind of self-harm.

“The reason for medical nonclearance is that you are currently diagnosed with an unspecified anxiety disorder,” read the letter, which appeared in her online application portal. “You indicated that your anxiety symptoms of increased heart rate and queasiness recur during periods of stress, which is likely to occur during service.”

Searching online, Ms. Iodice discovered that her experience was not uncommon. For years, comparing notes under anonymous screen names, Peace Corps applicants have shared stories about being disqualified because of mental health history, including common disorders like depression and anxiety.

The practice is the subject of a lawsuit filed this week in federal court, accusing the Peace Corps of discriminating against applicants with disabilities in violation of the Rehabilitation Act, which prohibits discrimination in programs receiving federal funds.

The lawsuit, which is seeking class-action status from the U.S. District Court for the District of Columbia, includes accounts from nine people whose Peace Corps invitations were rescinded for mental health reasons. The suit alleges that those decisions were made without considering reasonable accommodations or making individualized assessments based on current medical knowledge.

In a statement, a Peace Corps official said he could not comment on pending litigation, but added that “the health, safety and security of Volunteers are the Peace Corps’s top priority.”

“The agency has a statutory responsibility to provide necessary and appropriate medical care for Volunteers during service,” said Jim Golden, acting associate director of the Office of Health Services, in a statement. “Many health conditions — including mental health care — that are easily managed in the U.S. may not be able to be addressed in the areas where Peace Corps Volunteers are assigned.”

He said each candidate’s medical history is assessed individually to determine whether the agency can support the individual’s needs.

The three plaintiffs in the lawsuit are not identified by name in the court filings. But other Peace Corps applicants described rescinded offers as a major blow at a vulnerable time in their lives, throwing post-college plans into doubt and forcing them to explain to family, friends and supporters that they had been rejected because of a mental health condition.

“It was really heartbreaking to be dismissed like that,” said Ms. Iodice, now 26, who is not a party to the lawsuit. “It took a lot of processing to get over the initial feeling of unworthiness.”

The Peace Corps medically screens accepted applicants before sending them overseas to ensure that they do not face health crises when they are in locations where specialized care may not be available. Similar screenings are used in the State Department and the military.

But those policies are coming under pressure from legal activists. Early this year, the State Department agreed to pay $37.5 million to settle a class-action lawsuit, filed 16 years ago, challenging a hiring requirement that an applicant should be able to work in any State Department overseas post without the need for ongoing medical treatment.

In recent years, the Peace Corps has deployed around 7,000 volunteers to more than 60 nations, according to recent figures from the Congressional Research Service. A review of the medical clearance system found that, in 2006, around 450 applicants were medically disqualified from serving.

“I was shocked, at first, at how broad and antiquated some of these policies seem,” said Megan Schuller, legal director of the Bazelon Center for Mental Health Law, which, along with Bryan Schwartz Law, is representing the plaintiffs.

One party to the lawsuit filed on Tuesday, Teresa, 22, who asked to be identified by her middle name out of concern that stigma would damage her employment prospects, had been accepted this past January for a volunteer position in Mexico working on climate change awareness.

In March, before her planned departure, she was told that she had failed her medical clearance because of her history of treatment for anxiety and depression. She appealed the decision but was denied.

Like many undergraduates, she had struggled during the isolation of the pandemic and attended therapy and took an antidepressant medication in 2020, never considering that these treatments might disqualify her from serving in the Peace Corps, she said.

“There was part of me that thought, This can’t happen,” she said. “I do not know a single person throughout my whole college experience who didn’t struggle with their mental health.”

The letter informing her of her nonclearance cited “active symptoms of anxiety, increased heart rate, inability to sit still, inability to say no,” all symptoms noted down by her therapist in 2021, she said. She spent the weeks around college graduation explaining, again and again, that she wouldn’t be going to Mexico after all.

“It’s really humiliating to tell people that you got in and were then rejected because of your mental health,” said Teresa, who is now training to be a paralegal.

Another party to the case, Anne, 34, who also asked to be identified by her middle name out of concern for stigma, was offered a Peace Corps position in Mongolia teaching at the university level.

On her medical clearance forms, she shared that she had made two suicide attempts at age 15, she said in an interview. Since then, however, she had lived abroad as an exchange student and worked for more than a decade as a public school English teacher with no recurrence of suicidal behavior.

Her rejection letter, which arrived in November, said that she was assessed as a high risk for a recurrence of suicidal behavior. She scrambled to appeal the decision but was denied.

“When you get a denial based on something from half your life ago, it feels like a punishment for being honest, and it feels like part of your past that you can’t escape,” said Anne, who teaches at a high school. “I was very upset. I was confused and trying to figure out how to do it — to save this dream.”

Complaints over the policy have simmered for years in online forums and were the subject of a Change.org petition in 2019 and coverage this year in Worldview magazine, a news site for the National Peace Corps Association.

Applicants are increasingly forthcoming in discussing their experiences with medical clearance, said Jade Fletcher-Getzlaff, 33, who outlined her own denial and successful appeal in a YouTube video in 2019.

With each wave of deployments, she said, she receives between five and 10 inquiries from applicants who have been disqualified because of mental health conditions.

“As more people are seeking therapy, and more openly talking about these issues, I think it may be coming up more often,” she said in an interview from Japan, where she now teaches, after serving as a Peace Corps volunteer in Cambodia.

Rates of anxiety and depression among young U.S. adults have risen sharply in recent years.

In 2020, a Centers for Disease Control and Prevention study found that 63 percent of adults aged 18 to 24 years reported mental health symptoms, compared with 31 percent of all adults. Young adults also expressed greater need for mental health treatment, with 41 percent of adults aged 19 to 25 reporting unmet needs, compared with 26 percent of all adults.

Kirstine Schatz, 24, who is currently serving as a Peace Corps volunteer in Morocco, said she was initially denied a medical clearance because she took sertraline, a common antidepressant, for six months on the recommendation of her primary care physician.

She discontinued the medication seven months before applying and never received any mental health diagnosis, she said, but she was informed that she was denied medical clearance because the stressful environment of the Peace Corps might trigger a relapse.

Ms. Schatz appealed the decision, emphasizing that she had been off the medication and stable for six months, and the decision was overturned. She urged the agency to change its screening policy. “They are missing out on so many amazing people because of this archaic mind-set they have on mental health,” she said. “It’s 2023. They need to figure it out.”

As for Ms. Iodice, she never appealed her initial rejection and is still at SnapFitness, where she is the general manager. She said she had no regrets about receiving therapy, even though it might have kept her from serving with the Peace Corps in Senegal.

“If I had applied before I went to therapy, I could have gotten there, but I would have been a way worse worker, in my opinion,” she said. “In my perspective, I am a stronger person. I know myself better. I know how to cope.”

Ellen Barry covers mental health. She has served as The Times’s Boston bureau chief, London-based chief international correspondent and bureau chief in Moscow and New Delhi. She was part of a team that won the 2011 Pulitzer Prize for International Reporting.

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Below are a few of the 370+ comments made on this article

Sendero

The Peace Corps has a hiring process issue. It is easily rectified by having their mental health people (who are currently giving retroactive denials) review the mental health section before the Peace Corps accepts people for employment. There is no reason people with honestly stated mental health histories need to be on this roller coaster ending in humiliation.

Jenny

I was a Peace Corps Volunteer in Armenia from. 1995-97. It was definitely a tough experience for me in many ways, although one thing I learned is that not all countries are equal. My sister was a PCV in Morocco in the 80s, and her experiences were vastly different than mine. Different countries offer different levels of medical care. When I returned from Armenia, I did have problems with anxiety and depression, but they mostly weren’t due to my Peace Corps experience. Peace Corps probably did exacerbate them, but so would many experiences I could have had in the USA. My husband is a retired soldier who really needed mental healthcare for years before he finally sought it. Why? Because when you work for the US government, seeking mental healthcare services can ruin your career. In fact, as his wife, my history of taking psych meds could have threatened his ability to move into new jobs. It would be better if PC invitations were offered after the medical screening is done. That way, a lot of shame and embarrassment can be avoided. I also think some of the policies regarding mental health should be updated. People should be commended for seeking mental healthcare when they need it. Not a day goes by that I don’t think of my time as a member of the third group to go to Armenia with the Peace Corps. It opened my eyes and changed my life. I’d hate to think I could have missed out on that experience for seeking help for depression and anxiety beforehand.

Michael

I was a volunteer from 94 – 97 in eastern Europe. Not a typical Peace Corps experience by any means. However, I do have first hand knowledge of what I am about to write. First, there are many more applicants than people who are accepted and not just anyone can apply. Either a university education or a life-long history of working experience is required. It’s not a “right”, it’s a “privilege”. Second, the volunteer will almost always be sent someplace remote without any sort of close support. This support means cultural, linguistic, emotional – you name it. You’re on your own. It’s not easy. Third, things that many people take for granted – access to simple medical care (aspirin, band-aids, birth control, etc.) are generally not readily available. Driving is generally forbidden. Volunteers are given enough money per month to live at the same standard as a local. I received the equivalent of about $200 per month. The worst outcome is that a volunteer has a mental breakdown while alone in a foreign country. The second worst is that the volunteer goes home after the introductory 10-week in-country immersion – wasting time and money, as well as preventing the cultural and educational exchange that is the purpose of the US Peace Corps.

Kat Sko

And the medicalization of Americans to the benefit of Big Pharma comes back to bite our kids. This tendency to see everything through a medical diagnosis and magic pill takes a major toll in so many ways. As a RPCV your mental health and resiliency need to be strong for sure. But PC screens for a lot of things and is overly cautious for good reason. It is not a right to serve and there are high risks with limited rewards. This is not getting into an elite school or sports club. Most volunteers are sent to extreme conditions and being alone isolated and harassed is part of the job. PC should change its policy to make offers only after applicants complete the process. I was offered a spot in Kenya and did not pass my physical. After being cleared a year later I was sent elsewhere and was mightily disappointed but recognized that I can’t always get what i want. Are we going to start suing schools we don’t get into? Employers that don’t hire us? Will this generation ever become adults?

Citizen

As a psychiatrist, I strongly agree with others here that while it’s reasonable for the Peace Corps to have mental health screening, their approach seems outdated and lacking in common sense. There’s a big difference between major mental illness (schizophrenia, bipolar) mild depression or anxiety. Lumping them together makes no sense. I’m also taken aback by the PC’s stigmatizing attitude toward mental health. The rest of society is working hard to fight that stigm (including doctors lobbying to remove mental health questions from state medical board forms), but the PC is just perpetuating it.

Someone

I am a college professor who has taken students on short-term trips abroad to environments much less challenging than the ones PC volunteers go to. I’ve had issues come up with students who have some kind of minor mental health issue that isn’t really a problem at home. Being abroad is stressful. I can only imagine that being in an isolated environment in an even more dramatically different culture would have brought more challenges for these students. PC is also pretty strict about physical health needs that might be problematic during service, and rightly so. So I’m generally inclined to agree with PC on this one, especially in the case of recent grads who’ve been on meds or with active conditions in the past couple years. (Being off a med for 6 months doesn’t strike me as very reassuring.) But the person who’d been suicidal as a teenager but is now 34 and a well functioning adult? That seems extreme. Seems like PC should be more up front about their approach, though, so applicants know these issues could be problems and could just not apply or not tell anyone of their acceptance until medical clearance. Or there could be a policy that you have to have had no history of mental health issues in the past 5 or 10 years or whatever. People don’t have a RIGHT to do PC, but at the same time, we don’t want to lose out on having some great volunteers in service.

Hollis

I attended Peace Corps Training in Mauritania in fall 1997. I’d just graduated from college and was nervous about the “no toilet paper issue” but grew fond of the teapot. At the time it was the most difficult decision of my life, but I chose to return after training. In my exit interview the country director said, “Hollis, you’ve learned more in 10 weeks than most Volunteers do in 2 years.” I was 24 and went to save the world but after realizing I had nothing to give and everything to gain, I was paralyzed by middle class guilt. Before boarding the plane in Nouakchott, I peered one last time across Mauritania and thought at least the country is in good hands with Thomas, a lanky surfer who brought his longboard from Berkeley.I thought he was the best of the PCT crop.

Two weeks later, overwhelmed by the variety of cereal boxes at the grocery store, I got a call from Thomas. He was in Washington DC. He decided to fly home too. I’m writing to say that every Volunteer I met had mental health issues. Thomas ended up naming his daughter, Hollis. Mauritania, I haven’t forgotten you. I hope to give back some day. Inshallah.

David

I served in Azerbaijan ’04-06 and can confidently tell you that the Peace Corps is an incredibly stressful experience, exacerbated by routinely inept in-country staff. Readers should also understand that PC medical is often made up of host country nationals, who often have vastly different understandings of mental health treatment. Of my original group of 29 American volunteers, something like 15 of us made it all the way to the close of service 27 months later. It’s a brutally isolating experience. Everything you hear about PC difficulties (lack of sanitation, no electricity, cold weather, bad food) absolutely pales in comparison to the feeling of being alone for so long, in such a challenging environment, unsupported. That being said, PC shouldn’t be sending anonymous rejection letters to people saying, in effect, “sorry, you’re out”. Have the nerve to make a phone call and talk to people! Explain the process. I’m confident that a more personal touch is needed in these circumstances, helping people with mental health challenges understand why this isn’t the right avenue for their careers. The irony of adding to someone’s anxiety in this situation is very sad. PC can do better…but the anxious among us should not be placed in stresssful, isolating situations lacking access to adequate mental health care.

Marque Tres

There is a substantial literature on how disability is socially constructed by environmental and managerial systems, contrary to prevailing “medical” models. It could well be that different operational and cultural norms are needed in the Peace Corps.

SEH

I agree with the Peace Corps on this one. Why can’t people understand that not everyone is cut out for everything?

Jan

They should of course be judicious in using mental health to deny applications, but it is critical to have this as part of the review process. As a volunteer in the 2000s who served in a country with one of the most repressive regimes and challenging environments for Peace Corps, there is a lot than go wrong. Over half my group left early, many due to mental health and related issues. When that happens, it’s incredibly hard for the volunteer, unhelpful for the program’s image and challenging for the local partners. Upfront screening can help ensure this doesn’t happen more than necessary.

AhBrightWings

Am I the only one left wondering what happened to the right to privacy about our medical conditions? THIS is precisely why so many Americans do not access mental health care. If they even think a history of mental health treatment might go into a permanent record, it becomes a barrier to getting help. As I type, I’m remembering a dear friend whose daughter’s boyfriend committed suicide the day after he graduated at the top of his class from Annapolis. In his letter, the young man indicated that he had had mild stress that morphed into depression. He would’ve gotten help but he was afraid his career would be ruined. I know my friend, incandescent with fury and despair, reached out to the academy to share the letter and what their policies about mental health did to one of their best and brightest. That said, I’m a little torn on this one. Peace Corps volunteers are sent into war zones, violent places, places dealing with the horrors of famine, etc. I imagine that the Corps wants to shelter those who might suffer from being exposed to danger and suffering. I had a friend who volunteered in Ethiopia during the terrible famine of the 80’s. He was so traumatized he literally couldn’t eat normally when he returned. I once attended a “dinner party” at his house and he served us boiled grass for dinner. For real. His girlfriend told me she didn’t think he’d ever recover. The answer is transparency about policies and taking away the stigma about mental health care.

I was a happy and healthy recent college graduate with no history of mental illness when I joined the Peace Corps. I was sent to a Central Asian dictatorship. The experience broke me both mentally and physically. The hubris and naivety of those who filed this suit is striking. I am reminded of the college students (and their parents!) I encounter each day who demand something they think they deserve without ever understanding context or another person’s perspective. My advice to those feeling the sting of rejection: Take this as an opportunity to do something else. You can make a meaningful impact in your own community. You will not get any mental health support in the Peace Corps.

Minmin

I’m not sure where I land on this issue, but perhaps a law suit could have been avoided if semi finalists had an interview as part of the final decision making process. I also want to note that many of the drugs used to treat conditions successfully are banned by some countries.

I was a PCV in Bahrain 1976-78. Send someone to a very complex and stressful situation in a completely new culture, what could go wrong? Even on a small island with support from PC staff and other vols, we lost several to drugs, alcohol and depression who could not cope and were sent home early at great cost to the PC. Peace Corps is NOT a vacation.

Yeah, I think the article misses this on-the-ground perspective, and the ways things can go very wrong not just for the person but for the host community. The screening policy might benefit from a lot of refinement, but having one is informed by very real experiences on the other side.

Birdie

“It took a lot of processing to get over the initial feeling of unworthiness.”

I think the fact that the rejection was so emotionally devastating, with feelings of “unworthiness” for the person, can indicate that they were not mentally fit or resilient enough for the more complex and emotionally challenging situation in the PC. Resilience is a fundamentally important quality for the people in the Peace Corps when stationed in a lonely, rugged, remote place.

Elizabeth Zach

I’m a former volunteer (Poland, 1993-1995), and was the youngest in my group (age 22). I loved my village, school, students and very many Polish friends and colleagues. I disliked my fellow Americans, most of whom seemed to be abroad on a lark. My second year, I had a hard time – the long dark winter just about did me in – and was threatened by the in- country Peace Corps Medical Officer with dismissal. Not a single fellow volunteer supported me. But my Polish colleagues and friends did. I’ve now lived abroad more than 20 years, and I am the proud daughter of European immigrants, and my experience is that non-Americans have a far greater tolerance and understanding for the human condition.

Amy

It sounds as if applicants had no idea offers would be rescinded for a history of anxiety or depression. The Peace Corps should be transparent and specific about conditions that would preclude service, so potential candidates don’t waste time applying.

Donkey Spin

Some jobs require specific physical and mental dispositions. It’s not that hard to understand. If you are scared of heights, you cannot become a firefighter; if you have a stutter, you cannot possibly become a radio journalist; if you are very short, you’re probably not going to have a career as a basketball player.

Is it fair? No, it’s not. But that’s life: We all have strengths and weaknesses, and we cannot always do or have whatever we want. Working for the Peace Corps, similarly to being in the military(!), is about getting the job done in the best way possible, because lives are at stake. It cannot be about you, your needs and wishes, or how much you want it. Many years ago, I was told I could not become a Navy pilot because I had a deviated nasal septum, and my breathing was not perfect. I was very disappointed, but I understood the logic and accepted it. Suing the Peace Corps seems not only ludicrous to me, but it also confirms that these applicants should not be part of this organization. The Peace Corps should not spend its resources on lawyers, but pursue its mission to help defenseless people around the world.

SSC

Life in the Peace Corps is a terrible match for a generation brought up to believe the world provides ‘safe spaces.’ It does not. When I served, my housemate, also a volunteer, was gangraped while out for a walk. She was not American, though, and her training program was not anywhere as rigorous as the Peace Corp’s. If it had been, I doubt she would not have been, as she had ignored warnings from half a dozen people to stop taking walks in the woods, part of a self-destructive mental health pattern that, I imagine, might have been picked up on. It does seem, though, that their policy is too broad for today. My guess is that they will be happy to overturn a rejection on appeal, as filing an appeal would demonstrate gumption, self-assurance and determination on the applicant’s part, qualities that are will be required in service.

Ellen

Many of the comments here are simply depressing. I see the stigma is alive and well. I see words like “unbalanced”, “unhinged”, “hysterical” and it breaks my heart. Language matters. Who among us has not had some sort of psychological issue in our lifetime? For someone to recognize they have a problem, seek help, get treatment, recover, successfully manage their mental health (which is more than I can say for lots of so called “normal “ people) and then decide they want to pursue something as noble as the Peace Corps, only to be told “sorry, you took medication for depression 15 years ago so you are not eligible to serve” — this is not right. Good to know that anyone with any mental health issue should keep their aspirations-and their life-small.

Jan

@Ellen: Stigma is alive and well, and it’s been a challenge for my own family. That said, there are real risks and dangers, foremost to the volunteer herself, associated with someone with serious mental health conditions serving as a PCV, especially in certain roles. The challenge is striking the right balance in determining who is most at risk.

ixd

@Ellen: There are people on the other end as well, in the host country. They get impacted too. This isn’t just about the self-realization of people in the US with no experience of what they’re trying to sign up for. In fact, a lot of the comments really are coming from a place of getting, understanding, and respecting mental health issues (as well as host communities), and the importance of healthfully and sustainable managing those mental health issues. Which might sometimes mean not throwing people into a situation that can seriously destabilize them and harm them and others. The exact screening criteria they use might be able to benefit from refinement, even a lot of refinement. But minimizing that the situation they’re proposing to put themselves in is far more intense than it might seem is also not the way to go.

Moore Waite

How can people defend PC as “tough” for tough-minded volunteers, while at the same time PC is in the news for failing to treat physical and mental ailments of its volunteers already in the field that end up sick or worse? Either it needs to be tough to maintain a certain standard and protect its volunteers, or it’s just poorly administered. It can’t both be too challenging a program for applicants under law while also killing its current volunteers in the field with untreated ailments and violence. It’s not supposed to be the SEALS. Stop pretending it is. The Times has already written about how special forces programs are also defended as “too tough” for applicants while in reality are just poorly regulated, poorly medicated, anything-goes junkets.

Don Tartasky

As someone who worked in the State Department’s mental health shop, I’m surprised that rigorous face to face interviews weren’t conducted as part of the application process.

alan

Peace Corps volunteers are being sent to areas of the World that require help. Someone who requires help themselves due to mental health issues will hinder, not help.