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Mental Health Hurdles

Peace Corps Applicants with mental health conditions face an uphill battle

By Greg Emerson

Serving in the Peace Corps is hard. It’s right there in the tagline: “The toughest job you’ll ever love.” Arguably, the single most important trait of a Peace Corps Volunteer is the grit it takes to overcome the many challenges of working in a resource-poor environment.

Since the COVID-19 pandemic began turning lives upside down, more people than ever before have seen their resilience tested. The impact of the pandemic on mental health has been significant across the board, but especially for the young Americans who make up the bulk of the Peace Corps’ Volunteer applicant pool.

While the prevalence of symptoms of anxiety and depression in the U.S. decreased between 2020 and 2023 among the general population, according to the Centers for Disease Control, the decrease has been far less pronounced among those aged 18 and 29 years old, 46.1 percent of whom report experiencing such symptoms.

Meanwhile, treatment for mental health actually increased during the first two years of the pandemic, especially for younger Americans. The last time this question was asked in the Census Bureau’s Household Pulse Survey, 29.1 percent of respondents between 18 and 29-years-old reported taking prescription medication or receiving counseling for mental health.

Jade Fletcher was one of those people when she applied to join the Peace Corps in 2018. As a graduate student she was diagnosed with anxiety and saw a psychiatrist who prescribed a common medication to manage her symptoms. The medication and the therapy helped so much that she was able to taper off her medication before applying to the Peace Corps.

What most people, including her health care providers, saw as a successful effort to manage her anxiety turned out to be a liability when it came to Peace Corps medical clearance. Fletcher’s application was denied, citing her condition as “unstable” because of the changes in her treatment regimen.

 

“It has been a lifelong dream to join the Peace Corps. I see it as connected to my identity…I’ve put a lot of eggs in this basket.” —Anonymous Applicant, Medical Clearance Under Review

 

That left only one avenue to Peace Corps service: appealing the decision. Describing the process in a YouTube video during her service, she recalled that the nurse assigned to her “highly discouraged me from appealing my case.” Fletcher said she was told that less than 10 percent of cases actually get approved, and that hers was unlikely to be successful.

After painstakingly putting together a point-by-point appeal, supported by data on mental health and treatment outcomes, Fletcher was ultimately accepted to serve in Cambodia, and began her service in October of 2018. While early in her service she experienced anxiety triggered by the difficulty communicating with people at her site, the hoops she had to jump through with the agency just to get into the field made her reluctant to seek help in-country when she needed it.

“Going through the application and appeals process made it seem like everything about my mental health would be scrutinized,” she said. “There had been so much language and concern about me relapsing, so I was scared to show any signs that I was struggling in the beginning.”

After three months, she decided to open up to the Peace Corps Medical Officer and ask for help.

“It was such a different experience than I was expecting based on how the application process went,” she said. “The medical staff immediately offered help, they were very open with me and helped me get back on the meds I had been taking and find a great therapist. I felt very well supported.”

The treatment helped, and not only was Fletcher able to resume her service without incident, she thrived. After a bit more than a year in-country, she was invited to extend for a third year of service at a new, urban site, a role she was excited about. Unfortunately, her program was suspended, along with those around the world, in March 2020 due to the COVID-19 pandemic.

As candid conversations round mental health become more prevelent in American society, how will Peace Corps evaluate who is mentally ready to serve, and who isn’t?

 

“Following the pandemic, and the extraordinary stressors that it brought, the Peace Corps offers more robust mental health support options to Volunteers during service,” said Troy Blackwell, spokesman for the Peace Corps. “Now, Volunteers can access evidence-based tele-mental health services that provide targeted, situation-specific clinical care. Volunteers can also speak with a Well-Being Tele-Coach, and access ‘Be Well,’ a self-help app with resources dedicated to individual well-being.”

While Jade’s experience shows that living with a mental health condition need not stand in the way of a successful volunteer service, she is one of the lucky ones.

Another applicant, who asked to remain anonymous while he appeals his denial, is what many would consider a model candidate for Peace Corps service. Not only did he grow up in a Peace Corps family — his mother was a Volunteer and worked for Peace Corps later in life — he also served as a Peace Corps Ambassador while at NYU, helping recruit for the agency, and had already spent four months serving in Costa Rica with Amigos de las Americas before applying to the Peace Corps.

“It has been a lifelong dream to join the Peace Corps,” he said. “I see it as connected to my identity. Alleviation of poverty is very important to me. I’ve put a lot of eggs in this basket.”

Unfortunately, he was diagnosed with Obsessive-Compulsive Disorder (OCD) when he was a child. While this didn’t stand in the way of him excelling in school or successfully completing his previous service abroad, the Peace Corps medical staff, he says, didn’t take any of this into account.

After acknowledging his history of managing OCD during the medical clearance process, he says his application was denied without ever speaking with the Peace Corps nurse. He appealed the decision, but despite having two health care providers attest to his fitness to serve, and the fact that his medication is commonly available in Costa Rica, the program he was invited to, it went nowhere.

“This really had an impact on me and disrupted my life quite a bit,” he remembered. “I was devastated. I quit my job, moved back home, and ironically my symptoms flared up again as the shock of this experience had me doubting myself, that I was unfit to help others, and just felt all-consumed by this label they had put on me.”

While the whole process was traumatizing, his main frustration was being denied the opportunity to explain his situation in more detail and respond to what he characterizes as a “blatantly false justification, which contradicts what my health care providers had said about my fitness and that didn’t represent the ‘individualized assessment’” that the Peace Corps had referenced in its denial.

This experience echoes a complaint brought in a class action lawsuit against the Peace Corps in 2021 by an applicant who was denied medical clearance to Peace Corps Macedonia for mental health reasons. In Doe vs. Spahn, the applicant argued that the Peace Corps violated the 1973 Rehabilitation Act, a federal regulation that aims to prevent discrimination against people with disabilities. Specifically, the argument claimed Peace Corps failed to engage in an interactive process with the applicant, considered no reasonable accommodations or alternative assignments before the denial, failed to consider the resources available in the country of service and failed to perform an individualized analysis of her conditions.

Doe vs. Spahn was dismissed in February of 2022, but the lawyer who brought the case, Bryan Schwartz, says that he will be re-filing later this year as more plaintiffs have come forward reporting similar experiences.

For its part, the Peace Corps maintains that its screening process is sound, and that seeking treatment for mental health is not a disqualifier.

“The medical clearance process is extensive and the specific tasks, number of tasks required, and the time it takes to complete the clearance process is different for every person based on their health condition, individual medical history, and our medical assessment,” said Blackwell, the Peace Corps spokesperson. If an applicant received prior medical care that was necessary for them to be mentally healthy, this factor alone would not necessarily be a reason to preclude them from volunteer service.”

In its 2022-2026 strategic plan, Peace Corps has identified as one of its three strategic objectives to “build a volunteer corps and workforce that reflect U.S. and host country diversity and create inclusive and equitable systems and programs.” Specifically calling out disability as one of its areas of focus, the Peace Corps has committed to “review its policies, practices, procedures and programs with an equity lens.” On paper at least, neurodiversity in the volunteer population appears to be a goal for the agency.

Without changes to the way the Peace Corps evaluates applicants’ mental fitness though, many motivated prospective volunteers may continue to feel left behind. The impact of mental health screening policies could indeed diminish applications to Peace Corps at a time when the agency is seeking to ramp up and repopulate its posts after the unprecedented withdrawal of volunteers in 2020.

Lea Iodice, who applied to join the Peace Corps in 2020 while seeing a therapist for “generalized anxiety”, failed her medical clearance on mental health grounds without, she says, ever speaking to a nurse, despite successfully managing her condition through therapy alone.

“The worst part about it is that I have learned so much about myself and what I am capable of through therapy,” she said. “If I hadn’t gone through therapy at all, which I considered, I could probably have gotten accepted, but I would have had a much more difficult time.

 

Greg Emerson is a journalist and digital product manager who served in Morocco in 2003 and Peru from 2003-2005