Why Senior Agency Leaders Wait for the Breaking Point

By Elijah Fernandez

In Washington, the end of a senior leader's long stretch of strain usually arrives as a short announcement. Personal reasons. More time with family. A medical leave that starts on Monday. By the time it is public, the pressure behind it has typically been building for well over a year.

It does not have to work that way. Confidential options exist, including private-pay executive therapy in Washington, DC that never touches an agency system, a company benefits portal or an insurance claim. Most senior leaders still wait.

A 2026 CEREVITY report, Why Executives Wait 21 Months for Therapy, reviewed 307 executives who sought therapy through the CEREVITY network. The median gap between first recognizing serious strain and a first session was 21 months, and 58 percent waited for a crisis or near-miss before reaching out. These are self-reported figures from a help-seeking group, not a survey of federal officials. Nothing about the senior ranks of an agency suggests the pattern is any gentler there.

Why the top of an agency waits

Part of it is visibility. A deputy administrator or program executive is watched by staff, by the Hill, by the press and, for the contractors who support the mission, by the customer. Any sign of strain feels like a headline waiting to happen.

Part of it is the clearance. As I wrote in these pages earlier this month, the security clearance form says plainly that counseling, in and of itself, is not a reason to deny eligibility. Plenty of senior cleared officials still behave as if it were.

And part of it is proximity. Federal employees already have an Employee Assistance Program, which the Office of Personnel Management describes as "a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services." That is a real resource, and for many employees it works well. For the leader whose own office oversees the program, approves its budget or sees its usage reports, it can feel far too close to home, so the leader uses nothing.

An operations problem with an operations fix

I spent about 20 years in healthcare IT, including as director of IT operations at a national mental health company. In operations, nobody waits for the outage. You set thresholds, alert early and treat a small anomaly as far cheaper to fix than a failure at 2 a.m. Senior leaders apply that discipline to every system they run except themselves. Four changes would close the gap.

Set the threshold in advance. Decide now, while clear-headed, what will trigger a call: two weeks of broken sleep, dreading every Monday, snapping at a deputy you trust. A rule written down in a calm month is far easier to follow than a decision made while depleted.

Put support outside the chain. Agencies and contractors should make sure their leaders know about at least one channel that does not run through a supervisor, a shared employer system or the program office they manage. The goal is not more coverage. It is a door the leader will actually use.

Rehearse the acting designation. Leaders delay partly because stepping back feels like leaving the mission uncovered. Agencies already name acting officials. Treat that handoff as a routine drill, practiced in quiet weeks, so a short absence becomes an ordinary event rather than a crisis.

Say it from the top. When a senior executive tells a room that they worked with a counselor during a hard stretch, everyone below them hears that it is allowed. One sentence from the right person does more than a year of wellness emails.

Washington is very good at preparing for risks it can name. The leader quietly running out of road is one of them. The breaking point is not a plan, and it should never be the first warning anyone gets.

Elijah Fernandez, MSW, PMP, CISSP, is co-founder and CTO of CEREVITY, a private-pay concierge network of independent licensed clinicians built for high achievers: executives, founders, physicians, attorneys and finance leaders. He has spent about 20 years in healthcare IT, including as director of IT operations at a national mental health company, and holds a Master of Social Work from the University of Southern California.