mental health

As a psychiatric nurse practitioner in training (circa 2024), I am *somewhat* qualified to talk on this topic. Even back while I was in the Peace Corps, I had some experience working in mental health as a psychiatric RN having graduated in 2017 with my Bachelors of Science in Nursing. So professionally, I had a clue. Personally, however, I had never experienced anything more than “stage fright” aka performance anxiety related to public speaking/ giving presentations/ drama club, etc., Who I am to talk about mental health in the Peace Corps.

So statistically speaking, mental health disorders affect a shit ton of people each year, and as you can imagine some of those people are Peace Corps Volunteers. I’ve wanted to talk about this issue for some time now, but until I’d been in the Peace Corps, and more importantly OUT of the Peace Corps, I didn’t really feel qualified to speak on the topic. But here I am, 6 months shy of having a whole-ass doctorate degree in Psychiatric Mental Health. I can confidently say I’ve learned some things.

WHAT IS MENTAL HEALTH?

According to MentalHealth.gov, “Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices.” The Mayo Clinic says that mental health illnesses include depression, anxiety, schizophrenia, eating disorders, and addictive behaviors (to name a few). However, psychiatric disorders are not the same as medical diseases. Some doctors argue that the term ‘mental illness’ may be misleading because mental disorders are simply descriptions of observations as opposed to physical illnesses. Anxiety doesn’t show up on a blood test. An x-ray of someone with depression looks the same as the x-ray of someone without. There is no urine test that can diagnose anorexia, and someone with alcoholism doesn’t have a brain tumor to explain his or her addiction. Mental health rarely leaves physical signs, but that is why it is so sneaky. And it’s just as dangerous as a physical illness.

MY HISTORY WITH MENTAL HEALTH PROBLEMS

I have never been clinically diagnosed or taken medications for any mental health problems which means on PC forms I’m not lying when I say ‘I’ve never been diagnosed with ________”. However, I do have a reasonably traumatic personal history from earlier in life which I dealt with most of my life by avoiding it <——– [not the best way in life or in Peace Corps]. I’m reasonably self-aware so I’ve been able to straight up avoid a lot of situations that would cause me personal distress.

I’ve never been one to suffer with depression or anxiety –other than in situational circumstances.

PEACE CORPS’ APPROACH TO MENTAL HEALTH

Mental Health is something that PCVs become very aware of during their service. If not because of PC staff constantly reminding us, then because we deal with struggles in-country that we never faced in the States. Living in isolation from friends and family, in a village without constant electricity, running water, indoor plumbing, and Internet, where you most likely don’t speak the language of those around you, and witnessing racism, poverty, and abuse (and sometimes being subject to those things), can all take a toll on the psyche. Without proper coping mechanisms, PCVs can develop anxiety, depression, and other mental health issues. Some volunteers even develop addictions to cigarettes or alcohol as a way to cope with these newfound struggles.

Apparently, Peace Corps’ approach to mental health as changed a lot in the 21^st century. PC staff is now very hands-on in ensuring that every volunteer is mentally healthy and stable. During PST, PC medical staff holds sessions to teach PCVs warning signs of mental health problems and healthy coping mechanisms. In fact, medical comes to every training, even one year into service, to reiterate these lessons. Peace Corps has a psychiatrist on staff who meets with volunteers who are struggling at site. She also works with PCVs who have experienced assault and/or trauma. The PC psychiatrist serves all Southern African countries (she counsels PCVs over the phone or Skype if they are too far away to meet in person) but luckily for PCSA, she is based out of the Pretoria office. Another way that PCSA helps with the struggles of service is through the Peer Support Network, a committee made up of two currently serving PCVs from each cohort who are available for additional support (much like an RA in college). They are given extra money each month to buy airtime to call other PCVs, and they also help medical staff at our trainings. They also work with diversity in PC, specifically how diversity affects the PC experience (i.e. race, gender, age, sexual orientation, religious beliefs, etc.) During PST, each trainee is assigned a PSA member as his or her “mentor” of sorts, to help with the transition to village life.

When applying to Peace Corps, PC Medical in Washington goes through your personal medical history with a fine-toothed comb. In addition to a myriad of doctor’s appointments, PC also wants a record of every medicine you’ve ever been prescribed. If you report any history of mental health issues (which you must if you want to continue on medication) they require even more information. Despite PC’s hesitation to accept volunteers with mental health problems, I think having health with some of these things before is a good thing and can enhance a Peace Corps’ experience. The coping mechanisms I developed over the years are easily transferred to coping with my new living and working situation. I cannot tell you how many PCVs have developed anxiety in-country and have been put on anti-anxiety medication by medical staff. Not only are they trying to adjust to life in a rural village, they now have to learn to live with a giant cloud of anxiety over their head.

My only issue with PC’s approach to supporting mental health is the limit on therapy sessions. Med staff only approves 3-6 visits to the PC psychiatrist before they reevaluate your mental health and have to decide if you are mentally fit to serve. In their opinion, if you are still struggling at site after 6 sessions, more sessions aren’t going to help. In my opinion, ongoing therapy sessions aren’t a sign of weakness, but rather, strength. I believe I could see the PC therapist once a month and still be a successful volunteer. I understand their concern that therapy sessions take the volunteer away from their work at site, but I don’t think one meeting a month would be detrimental to success.As someone training in the administration of psychiatric medications and *some* forms of therapy, I wish the PC had the option available for people to have mental health check ins in a totally unbiased manner, but alas that is not the world we live in. Not in the Peace Corps and certainly not in the US Health care system.