Red tape is failing diplomatic personnel.
Suicide is a growing public health crisis in the United States.
In 2023, approximately 49,300 Americans died by suicide, with an age-adjusted rate of 14.1-14.7 per 100,000 people. The rate for men was 22.8 per 100,000, which is roughly four times higher than that of women, at 5.9 per 100,000. Suicide rates among young men have been rising steadily since 2010, with men ages 15-34 being the fastest-growing segment. In 2023, the suicide rate for men ages 15-24 was 21 per 100,000, compared with 5 per 100,000 for women of the same age.
Today’s suicide prevention efforts must focus more on men, yet public awareness and policy attention remain limited. Unsurprisingly, mainstream media coverage often fails to report these age- and gender-specific trends accurately, making it harder to direct resources and interventions where they are most urgently needed.
When Secretary of State Marco Rubio took the helm of the Department of State, he inherited an outdated system ill-equipped to address the medical challenges faced by U.S. civilian and military personnel serving across our 272 overseas missions. Burdened by excessive bureaucracy, a culture of compliance intensified by the COVID-19 vaccine mandates, and identity politics that at times prioritized ideology over need, the department’s medical services have struggled to deliver care to those most at risk.
Although procedures exist for handling “deaths in service,” the State Department does not publicly report suicide statistics for Foreign Service and Civil Service personnel or U.S. government employees (and their family members) serving at overseas missions. Unlike the Department of War, which publishes detailed annual suicide data, the Department of State lacks a centralized public monitoring system. Reporting remains anecdotal, fragmented, and insufficient to track trends, identify risk factors, or evaluate prevention programs.
America’s diplomats are deeply committed public servants, often living in profound isolation in war-torn or politically volatile environments. Their service entails serious health risks, personal sacrifices, and exposure to violence that affect not only themselves but also their families and U.S. government colleagues, including the Marines who stand watch beside them.
To ensure the effectiveness of the department’s medical system and protect national security personnel, a formal system should be established that tracks and monitors mental health issues at post, separates clinical care from compliance, and enforces a strict firewall for personal medical records, treating them like classified information. The department’s Office of Inspector General should review access to care, reporting mechanisms, and the handling of suicides or deaths in service in order to hold leadership accountable while shielding field personnel from systemic failures.
Gaps to Address
The State Department’s Bureau of Medical Services (MED) system is a case study in how government control over personal medical care can go wrong. Like the military, civilian federal personnel deployed abroad require medical services to fill gaps unavailable in local markets, to receive care in countries hostile to the United States, and to ensure preventative and comprehensive health coverage. This includes primary care, diagnosis and treatment of acute and chronic illnesses, health promotion, disease prevention, access to recommended vaccinations, health maintenance, counseling, patient education, and referrals to specialists or ancillary services as needed.
For federal employees serving overseas, MED often serves as the sole source of primary care—or the central point of contact, and a potential point of failure—in a foreign country. This includes the employee’s accompanying spouse, who may arrive without local language skills or cultural familiarity, yet remains responsible for childcare and securing his or her children’s medical services abroad.
MED’s network includes more than 200 clinicians across 170 countries, supported by personnel (chiefly civil servants with little overseas experience) in Washington, D.C., and regional medical offices abroad. In addition to providing medical care to U.S. government employees and dependents at embassies and consulates, the bureau determines medical clearances for assignments and advises on public health issues worldwide. Because MED is treated primarily as a tool to maintain the clearance system, its focus consistently prioritizes compliance and a saving-face mentality over the actual care and well-being of individual employees and their families.
Under U.S. law, the chief of mission (COM)—typically the ambassador or chargé d’affaires—has full responsibility for directing, coordinating, and supervising all U.S. executive branch employees in a host country. Family members are also subject to COM oversight. Military personnel attached to the embassy, such as a defense attaché or those in the Security Cooperation Office, fall under COM authority for their diplomatic activities, but not for operational command and control.
This also includes U.S. Marines serving as security guards, the only military personnel entrusted with providing security for U.S. embassies and consulates worldwide. In 2022, the Marine Corps had the highest suicide rate of any U.S. military branch, with 34.9 deaths per 100,000 active-duty service members, up from 23.9 in 2021. In 2022, 67 Marines died by suicide. Notably, the Marines who serve at overseas posts commit suicide at a rate lower than the overall average.
However, when it comes to suicide prevention, MED’s public guidance remains largely advisory: resource lists, hotline numbers, and general recommendations to seek help. While these are valuable, they fall short of addressing the systemic issues within the Foreign Service, such as prolonged isolation, limited access to mental-health professionals, and persistent stigma that seeking treatment can jeopardize one’s medical clearance or career. As one Foreign Service Officer put it, “Getting help for ourselves or our families affects our careers. I know many people getting help off the books for fear of being curtailed.”
The Department of State currently combines vital compliance functions and critical clinical services under a single bureau and authority, creating a conflict of interest. This leaves it without an accurate understanding of the health and well-being of its workforce. Just ask any U.S. Foreign Service Officer to quantify the number of steps and bureaucratic hurdles required to obtain a medical clearance to serve abroad. Add family members to the equation, and the process becomes a maze of confusing, time-consuming red tape. The system the current administration inherited resists feedback, avoids accountability, and hides behind digital firewalls rather than engaging constructively with those it serves. In an environment marked by limited confidence in retired-in-place senior bureaucrats, conflict-averse and underperforming officials within MED continue unchecked, to the detriment of the workforce and America’s diplomatic readiness.
The department’s medical infrastructure is also under significant strain. There are too few Regional Medical Officers and psychiatrists—and they are often assigned only to the most high-risk posts. Even basic morale lifelines, such as access to the diplomatic pouch for personal items from home, have been curtailed, deepening the isolation felt by those serving overseas. During the recent government shutdown, countless diplomats faced the added burden of financial uncertainty while continuing to serve without interruption. This moment underscores a broader truth: behind every budget impasse are men and women (and their families) who sustain America’s national security through quiet sacrifice and unwavering duty.
People Over Red Tape
Secretary Rubio’s reorganization presents a critical opportunity to modernize the department’s medical services and strengthen its capacity to confront pressing security and health issues—especially the urgent need for better mental health support and the prevention of suicide within the workforce. To restore confidence in the department’s medical system and safeguard national security, immediate action is needed, guided by the following recommendations.
- Monitor, Evaluate, and Communicate: The Department of State should establish a formal mechanism to track and monitor mental health issues at post, building a reliable database to inform prevention strategies and policy development. Medical units operating under chief of mission authority should be directed to provide regular, anonymized reporting on mental health trends while department leadership works to dispel persistent myths surrounding the use of psychological and behavioral health services, particularly the misconception that seeking care jeopardizes one’s security clearance or career progression.
- Foreign Service Chaplains: A Foreign Service Chaplaincy would fill a longstanding gap in the department’s employee well-being framework, particularly for those serving overseas under high stress and in isolated conditions. The program could operate under the Bureau of Personnel and Training, with chaplains embedded regionally or assigned to posts with significant staffing. Modeled on the military’s successful approach, this initiative would strengthen resilience, allow for greater involvement of one’s faith in recovery, improve morale, and enhance the department’s duty of care for its global workforce and their families.
- Establish a Firewall for Medical Information: The department must enforce a strict and permanent separation between medical care and clearance functions. Personal medical records should be treated with the same rigor and confidentiality as classified material, and shared only on a strict need-to-know basis. This measure is essential to restore trust in the medical system, encourage personnel to seek care without fear of reprisal, and ensure that health and well-being are prioritized over administrative compliance.
- Engage the Office of Inspector General (OIG): The OIG should review all access to mental health care, reporting mechanisms, and the department’s handling of suicides or deaths in service, while ensuring that field personnel are not unfairly blamed for failures originating in Foggy Bottom. Accountability should extend across the global chessboard, including chiefs of mission who fail to support their staff, regional bureaus that neglect to safeguard their missions, and MED leadership responsible for effectively providing medical services.
It’s time to move beyond symbolic gestures—our U.S. civilian and military personnel and their families serving abroad deserve meaningful action.
