Category Archives: Mental Health

December 6, 2012 · 3:20 am

Serbia’s Ambassador To NATO Jumps to Death From Multistory Building

Via NYT:

The Serbian ambassador to NATO, Branislav Milinkovic, jumped to his death from a multistory parking garage on Tuesday afternoon at the Brussels airport, diplomats said Wednesday.

Mr. Milinkovic, 52, a respected diplomat, lawyer and intellectual appointed to the ambassadorship in 2009, was at the airport to meet a visiting Serbian delegation, officials said. B92, an independent broadcaster in Belgrade, Serbia, reported that the country’s assistant foreign minister, Zoran Vujic, was with Mr. Milinkovic at the time and witnessed his death.

Serbian officials said that the motive was not known, and that Mr. Milinkovic gave no sign of what he intended in the moments before he leapt to his death.

PSA from the Suicide Prevention Lifeline:

Every year, millions of Americans are directly affected by the more than 37,000 suicides and hundreds of thousands of suicide attempts made by friends or loved ones.

The following signs may mean someone is at risk for suicide. The risk of suicide is greater if a behavior is new or has increased and if it seems related to a painful event, loss, or change. If you or someone you know exhibits any of these signs, seek help as soon as possible by calling the Lifeline at 1-800-273-TALK (8255).

  •     Talking about wanting to die or to kill themselves.
  •     Looking for a way to kill themselves, such as searching online or buying a gun
  •     Talking about feeling hopeless or having no reason to live.
  •     Talking about feeling trapped or in unbearable pain.
  •     Talking about being a burden to others.
  •     Increasing the use of alcohol or drugs.
  •     Acting anxious or agitated; behaving recklessly.
  •     Sleeping too little or too much.
  •     Withdrawing or isolating themselves.
  •     Showing rage or talking about seeking revenge.
  •     Displaying extreme mood swings.

- DS

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August 22, 2012 · 1:17 am

US Embassy Sudan and Those Critical Pool and Picnic Resources

Every now and then we get tips for blog post ideas, sometimes offline, via email or sometimes via social media as was the case a few days ago:

‏@tradeaidmonitor
Hope @Diplopundit catches “U.S. State Dept. Sending Critical [Pool & Picnicking] Resources to Sudan” http://www.tradeaidmonitor.com/2012/08/state-dept-resources-sudan.html …

Sometimes we catch the toss, sometimes we don’t, primarily because we have some time constraints.  But this one, we thought we’d catch because in a place like our US Embassy in Khartoum, pool and picnic resources are critical resources in our view.  And we’ll tell you why.

Let’s start off with Sudan as the third largest country in Africa.  Slightly less than a quarter the size of the continental United States. It achieved independence on January 1, 1956 from the British, and has been at war with itself for more than three-quarters of its existence.

The USG designated Sudan as a state sponsor of terrorism in 1993 and the U.S. Embassy operation in Khartoum was suspended in 1996. According to the no longer updated Background Notes in October 1997, the U.S. imposed comprehensive economic, trade, and financial sanctions against the Sudan. In August 1998, in the wake of the East Africa embassy bombings, the U.S. launched cruise missile strikes against Khartoum. The last U.S. Ambassador to the Sudan, Ambassador Tim Carney, departed post prior to this event and no new ambassador has been designated since.

We do have a Special Envoy to Sudan –Ambassador Lyman since 2011; he succeeded Ambassador Gration who was appointed to office in 2009.

The U.S. Embassy is headed by a series of Charge d’Affaires. Joseph D. Stafford, III, a career Foreign Service Officer has been Charge’ d’ affaires in Khartoum since June 2012. The US Embassy reportedly continues to re-evaluate its posture in Sudan, particularly in the wake of the January 1, 2008, killings of a U.S. Agency for International Development (USAID) officer John Granville and local USAID employee, Abdel Rahman Abbas.

(see How much does a US diplomat’s life worth? About $1,800 US dollars, and look there’s no raging mob…)

The U.S. Mission in Sudan has declared disasters due to the complex emergency on an annual basis since 1987. On October 1, 2009, President Obama renewed the Sudan complex emergency disaster declaration for FY 2010.

Sandstorm Over the Nile
(Photo by US Embassy Khartoum/Picasa)

So let’s just agree that it’s not a very nice, cushy place when its dry. And it’s not a very nice place when it’s wet.

In fact, it’s one of those places where family members of embassy personnel under age 21 are not allowed to reside.  State Department employees in Sudan also get a 30% cost of living allowance, a 25% hardship differential and a 25% danger pay differential, and for good reasons.

Cost-of-living allowance (COLA) is granted to an employee officially stationed at a post in a foreign area where the cost of living, exclusive of quarters costs, is substantially higher than in Washington, D.C.

Hardship differential is established for any place when, and only when, the place involves extraordinarily difficult living conditions, excessive physical hardship, or notably unhealthful conditions affecting the majority of employees officially stationed or detailed at that place.  Living costs are not considered in differential determination

Danger pay allowance is designed to provide additional compensation above basic compensation to all U.S. Government civilian employees, including Chiefs of Mission, for service at places in foreign areas where there exist conditions of civil insurrection, civil war, terrorism or wartime conditions which threaten physical harm or imminent danger to the health or well-being of an employee.

So in a country where Al Qaeda has a long history, what do people do to entertain and de-stress themselves?  You can go to a fitness club where the monthly fee for adults is $192.50 (or 352.94 % more than what you’d pay in WashDC) according to numbeo.com. Or you can eat out where the combo meal similar to McDonald’s is $11.14 (except that you’re a real moving target).  Or you can go to the movies for $5.00, certainly cheaper than DC but do you want to be in the dark with people with guns? Probably not.

You can stay home and surf online; 6 Mbps Internet is at $67.50 a month whether it works or not. Or have a roaring pool party. Maybe. And invite even people you can’t stand. In which case you need to shop for party food.  You can shop for chicken breasts which at $8.00/kilogram is actually cheaper in Khartoum than in DC. You can also buy 12 pack eggs at $2.93, and a kilogram of fresh cheese at $16.33. Beer, the 0.5 liter bottle is reportedly $5.00. And there goes your COLA.

Then there’s the haboob, a small one or a big one, it doesn’t matter, it gets into everything. And they don’t have haboob days like snow days back in WashDC, which frankly, isn’t fair.   We terribly missed our undiplomatic diplomat from Facts Are Strictly Optional; you betcha she would have had insightful things to say about these critical resources.

The patio furniture below is similar to those required under the solicitation mentioned above and posted by US Embassy Khartoum at fedbiz. The complete solicitation is here: https://www.fbo.gov/notices/b8deabb7df3866417121ac528cf8a837.

Wave Square 4 Seater Set”Weatherproof, Rust-Free Guaranteed, 5 Year Warranty, Durable, UV Resistant, Powder Coating, Door to Door Free Delivery, All prices include VAT.
Manufactured by Golden Barley Garden Furniture Trading as HomeGarden.co.za, South Africa
(Photo from Golden Barley Garden Furniture Trading) 

Rust-fee, weatherproof, five year warranty – what’s not to like? More to the point, and this is important — you can hose them down after a dust storm, they’re too heavy to fly away in a sandstorm and they are deliverable from South Africa, just 2900 miles from the Sudan instead of some 6,000 miles from the United States.

So frankly, we cannot find it in our hearts to quarrel with these pool and patio furniture. All that dust and sand would probably drive us nuts ala The Shining if we live down there.  And anyways — what use is a pool if you cannot sit down or lounge or have a picnic with people you see every single day at work and at play?

Dear US Embassy Khartoum – we hope you folks enjoy your new pool and patio furniture. The bronze ones look really lovely.

The end.

Domani Spero

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June 29, 2012 · 12:49 am

Ron Capps | Back From The Brink: War, Suicide, And PTSD

Ron Capps retired from the Foreign Service and the Army reserve in 2008. During a twenty-five-year career, he served  in Kosovo, Rwanda, Afghanistan, Iraq, and Sudan, just about all the hell holes on earth.  He is founder and director at Veterans Writing Project.  He blogs for the Battleland blog at TIME Magazine and in his personal blog, The Next Lost Generation.

In a 2010 issue of Health Affairs, Mr. Capps wrote, Back From The Brink: War, Suicide, And PTSD. The piece is one of the most poignant agonies of post-traumatic stress disorder I have read.  He imagined the dead coming to talk to him every night asking, “Why didn’t you do more to save us?”  He had memories of “the dead, the mutilated, the burned.”  He wrote a story where the protagonist shoots himself in the head with a pistol.  He borrowed a gun, and put a gun to his head.  A timely phone call from his wife saved him.

“When the phone rang I jumped—startled—and nearly shot myself. This was almost comic, because I was already planning to kill myself and was holding the pistol in my hand. So I would have pulled the trigger while the pistol was pointed at my foot rather than my head. The ringing phone broke the spell.”

He was afraid to ask for help, writing, “I thought I would be ridiculed, considered weak and cowardly.”  This from a man who had two Bronze Star medals and tours in Airborne and Special Ops units.

He also writes about Question 21, the one that keeps many soldiers from asking for help. This was changed under Secretary Gates but apparently some things remain the same.

The magazine won’t allow republication on the web (we asked), so go read it in full at the HA website.
Domani Spero

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· 12:45 am

Quickie | Running Amok: Mental Health in the U.S. Foreign Service

Via Diplo Denizen by James Bruno (author and ex-diplomat comments on foreign affairs & writing). Mr. Bruno is the author of political thrillers Permanent Interest and Chasm and an Afghanistan thriller, Tribe; all available via Amazon Kindle:

In the second year of my Foreign Service career, I was assigned to Vientiane, Laos.  My deployment was accelerated by my predecessor’s seeking and being granted a one-year curtailment of his tour of duty because he was going bonkers.  Moreover, an admin officer had to be removed in a straitjacket after holing himself up in his house and smearing the walls with his own feces, another victim of mental and emotional stress.  I, on the other hand, thrived at this isolated outpost, our only one in Indochina five years following the fall of Saigon.  The setting was a cross between “Heart of Darkness” and “Casablanca.”  My seizure at gunpoint and brief incarceration by the authorities, which prompted a diplomatic row, was just one of the pressures at this surreal place.  Years later, in civil war-torn Cambodia, the State Dept. regularly sent a psychiatrist to post to measure our stress levels amid coup attempts, assassinations, 12-14-hour work days seven days a week and an unhinged ambassador.  At another embassy, one of our largest, the Secretary of State discreetly sent out two senior officials to gently pry our prominent career ambassador out of his job in the wake of his increasingly bizarre behavior, including public denunciations of an American ally.
[...]
In recent years, the number of Foreign Service personnel medevacced for mental health reasons has doubled.  One study revealed 15 percent of FS members suffered from PTSD.  A similar study done by the Defense Dept. found that 17 percent of soldiers returned from Iraq and Afghanistan suffered from the same condition.  As the U.S. has gotten involved in more overseas conflicts, the pressures on our diplomats have compounded.

A particularly sad case was documented in the September 2010 issue of the Foreign Service Journal.  A former military officer and tsunami survivor, this FSO was assigned to one of the most dangerous war zones six years into his State Dept. career.  He worked 12-14-hour days amid gun and mortar fire.  After being injured in a roadside bomb attack, a State Dept. psychiatrist prescribed an antidepressant for his PTSD.  But the medication caused lack of sleep, loss of appetite and high blood pressure.  When he complained about the side effects, he was prescribed a different antidepressant.  But the side effects continued and he was evacuated from post and placed in psychiatric hospitalization in Washington.  State Dept’s MED office failed to provide him with a doctor proficient in treating PTSD, so he found one on his own.  He was told he could not return to post.  Further treatment did not resolve his problem and he was medevacced again from another post.  He lives in Washington, separated from his wife, and essentially grounded for medical reasons.  His career prospects don’t look good.  This officer is convinced that, had he received better treatment, his current situation could have been avoided.

Continue reading, Running Amok: Mental Health in the U.S. Foreign Service.

Domani Spero

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June 28, 2012 · 12:18 am

Former FSO William Anthony Gooch: No Mercy for Broken Men?

On May 12, 2012, William Anthony Gooch, 52, was sentenced to 12 years in prison – the maximum he faced under a plea agreement in the Nov. 7, 2010 episode, in which Gooch rammed a Jeep into his estranged wife’s home before setting it ablaze.

What was not widely reported is that he’s a former Foreign Service officer.

In the July/August 1998 issue of State Magazine, he was listed as an “FS Specialist Intake.”  In the February 2003 issue of the same magazine, he was listed under “Foreign Service Retirements”

There is no public catalog of what happened to him after he left the Foreign Service. But apparently in 2005, while visiting Roswell, Ga., Mr. Gooch broke into his brother’s gun safe and ended up in a standoff with police where he begged to be shot.

In 2008, he reportedly shot himself in the chest, narrowly missing his heart. The suicide attempt led to a period of sobriety, and a seeming improvement, according to unnamed relatives cited in local reports.

In August 2009, Mr. Gooch was arrested after a six-hour standoff. This time, he also had a gun and was threatening suicide.

In 2010, El Paso County sheriff’s deputies told local news that Mr. Gooch crashed his car into the Black Forest home of his estranged wife, set the house on fire and then barricaded himself inside.  He was reported to be in critical condition in the burn unit at the Anschutz Medical Campus in Denver, according to hospital officials cited in local reports.

On May 12, 2012, he was sentenced to 12 years in prison – the maximum he faced under a plea agreement in the Nov. 7, 2010 episode.

Colorado Springs’ The Gazette had a write up on the hearing that details the unraveled life of former foreign service officer.  Excerpt below:

According to the family’s account, Gooch served in the Navy and the U.S. Agency for International Development before his 1998 transfer to the State Department, where he worked in the security office.

Within months of accepting the new post, Gooch and his family were assigned to Kinshasa in the Democratic Republic of Congo, where tensions were mounting between warring factions, according to his son, Andy Gooch, a private first-class in the Army National Guard and senior at Virginia Commonwealth University.

The six families in their compound were eventually moved out of Kinshasa as violence ramped up, Andy Gooch told the court, describing how they were driven past the dead and wounded on their way to the airport.

His father remained behind to help evacuate other Americans and nongovernmental aid workers, he said.
Gooch told his family that he was detained and beaten by Congolese police during the ensuing choas. He said a fellow Foreign Service officer secured his release.

Later that year the family was sent to Nairobi, Kenya, where according to Andy Gooch’s account, his father helped identify victims in the wake of a 1998 bombing that killed hundreds at a U.S. Embassy.

In Nairobi, the family survived an attempted car jacking when William Gooch shouted for his wife and children to get down while he drove around a road blockade past men armed with AK-47s, Andy Gooch said.

“When I was 10 or 12 years old, I saw things most people don’t see in their whole life,” Andy Gooch said. “If I got that little piece, I can’t imagine what my father saw.”

Said Sotela: “His mental health was deteriorating through the years that he was exposed to that situation.”

Gooch’s career with the State Department ended with a medical discharge in the early 2000s after he suffered a breakdown during an assignment in Kingston, Jamaica, family members said.

According to The Gazette, Mr. Gooch addressed the court in a soft voice, apologized and said he never meant to hurt anyone except himself – by swallowing pills, shooting himself and trying to get “someone else” to shoot him.  “Jumping off a bridge is about my last resort,” he told Judge Greg Werner, before ending his comments with a pledge to take treatment seriously.

I had this story the same week that George Gaines died in Barbados.  I just could not get myself to write about two tragic episodes that same week. The prosecutor in this case, suggested in court that Mr. Gooch exaggerated his experiences in a bid for leniency.  Nothing in the press reports suggested that Mr. Gooch was diagnosed or treated for PTSD. But it says he was medically discharged after he suffered a breakdown in Jamaica.

Domani Spero

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June 26, 2012 · 1:36 am

Pick the Long or Short Form, But Take the Post-Traumatic Stress Disorder (PTSD) Screening

Here’s how VA explains PTSD:  Posttraumatic stress disorder (PTSD) can occur after you have been through a traumatic event. A traumatic event is something terrible and scary that you see, hear about, or that happens to you, like:

  • Combat exposure
  • Child sexual or physical abuse
  • Terrorist attack
  • Sexual or physical assault
  • Serious accidents, like a car wreck
  • Natural disasters, like a fire, tornado, hurricane, flood, or earthquake

During a traumatic event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening around you. Most people have some stress-related reactions after a traumatic event; but, not everyone gets PTSD. If your reactions don’t go away over time and they disrupt your life, you may have PTSD.  Read more here.

The Department of Veterans Affairs also put together a PTSD screening online which has 17 questions on problems and complaints that veterans sometimes have in response to stressful military experiences. All references are to stressful military experience.  Click here to read each question carefully, then select the answer that indicates how much you have been bothered by that problem in the past month.

I don’t think I’m going bonkers but I took the screening anyway.  The portal says that no information is collected, stored or sent over the Internet. To ensure complete privacy, exit your web browser after completing the screening.

See the text-only version.

Results between 0 and 20 indicate few or no symptoms of PTSD. Results between 21 and 29 indicate minimal symptoms of PTSD. Results between 30 and 85 indicate many of the symptoms of PTSD.   The PTSD Screening is, however, careful to explain that it is not designed to provide a comprehensive assessment or diagnosis of PTSD:

“Only a qualified physician or mental health provider can provide a complete assessment and diagnosis of PTSD. Only a qualified physician or mental health professional can differentiate symptoms of PTSD from other medical conditions. Only a qualified physician or mental health provider can prescribe appropriate treatment for PTSD or other medical conditions.”

The State Department has its own  Four Question PTSD Screener and says, “If you have answered “yes” to three (3) items or more it is considered “positive” and your screening results are consistent with symptoms of PTSD.  Also that if the screening results suggested the need for further assessment/evaluation, to check out the following resources:

  • Visit a primary or mental health care provider.
  • If you are not sure about benefits or don’t have a primary care manager:
    Contact the Employee Consultation Service at MEDECS@state.gov or Call 202-663-1815.
  • Contact the Deployment Stress Management Program at MEDDSMP@state.gov or Call 202-663-1903.
  • Contact MHN Support Services are available through web, phone, and in-person.
    Internet: https://members.mhn.com/ company code: ‘unaccompanied tour’.
    Phone: Call toll free, 24/7 at 1-800-213-5811

As you can see, we tried that company code and it’s a dud.

Domani Spero


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June 25, 2012 · 3:18 am

Post-Traumatic Stress Disorder: The Ticking Bomb in the Foreign Service

Rachel Schneller joined the Foreign Service in 2001, serving in Skopje, Conakry and Basrah, where she was a Provincial Action Officer from 2005 to 2006. In the January 2008 issue of the Foreign Service Journal, she wrote a piece about her personal struggle with PTSD  (See Recovery: When  Surviving Isn’t Enough, FSJ, p. 35). That same year, she was awarded the William R. Rivkin Award for Dissent. The excerpt below is from her 2008 FSJ article:

Since returning from Iraq over a year ago and being diagnosed with the disorder, I’ve gotten a crash-course on the subject. So perhaps I can contribute to the dialog in a way others cannot, by describing what it is like to recover from PTSD.

My PTSD came about due to the conditions I endured while on assignment with the State Department, but State left me to fend for myself when it came to seeking treatment. In June 2006, after having worked in Basrah for several months, I took leave to return to Washington for a few weeks. A Foreign Service National employee in my office had been murdered, and I’d dreamed of hanging myself from my office light fixture.

During leave, I asked the Medical Services Bureau for help and they referred me to an in-house social worker. While telling him about the whole horrible situation, including the dream about killing myself, I broke down in sobs. The social worker was nice but offered me no actual treatment. He did not refer me to a psychiatrist for an evaluation; he did not offer me medication for my depression; and he did not address my thoughts of suicide. Disappointed, but fearful of being labeled a “quitter” or worse, I chose to return to Iraq.

When I think about how poorly State treated me when I sought help, I am outraged. After all, I was in no condition to make decisions about my own well being, any more than an alcoholic can make a well informed decision in a liquor store. Any competent, qualified mental health care provider would have known this. I had requested help but found only more danger. It was as if the ambulance coming for me in my elevator dream not only did not stop for me, but ran over me in the process. I — and everyone else  serving our country in a war zone — deserve much better.
[...]
In any war zone, some people going through the experience will likely come out of it with PTSD. But if the State Department is going to post its employees to war zones, it should be prepared to deal with the mental health aftermath and offer treatment to those who need it.

I completed my Iraq tour at the end of July 2006 and returned to Washington, where I began my next assignment, long-term training at the Foreign Service Institute. After all I’d been through, I was grateful  to be home alive and in one piece, reunited with family and friends. But soon I just stopped functioning normally. I was unable to sleep. I started getting lost on my way home from work, waking up in a sort of fugue state blocks away from my apartment in Georgetown. I don’t remember precisely how, but I burned myself several times so badly that I scarred — yet I didn’t feel it. I only noticed the burns the next day. Rage overwhelmed me. I nearly attacked another person in one of my FSI training classes, but walked out of the class in time and had a meltdown in the bathroom. (That poor woman had no idea how close she came to being strangled by me for making a completely innocent comment.) I couldn’t keep up the  pretense of being normal any longer.

Regions of the brain affected by PTSD and stress.
National Institutes of Health

Last week, I posted about a grievance case by a Senior Foreign Service Officer who claimed PTSD and whose suspension was affirmed by the Foreign Service Grievance Board. In its FSGB filing, the State Department contends the following:

“Grievant served approximately one year in [REDACTED], [REDACTED] and returned to the U.S. on August 11, [REDACTED].  He served nearly seven months at the [REDACTED] without incident, and then, on March 2, [REDACTED] was assigned as Office Director to the Bureau of [REDACTED] and his misconduct began. Grievant waited until almost six months after he was removed from [REDACTED] to seek any medical advice.”

The Foreign Service Grievance Board in affirming the suspension writes:

“The year and a half referred to by the social worker encompasses the first seven months after his return to the U.S. from [REDACTED] when grievant served at the [REDACTED] apparently without incident. Grievant has not stated what he did in {REDACTED]  or what experiences he had that could have caused PSTD. He has presented no testimonials from others at the [REDACTED] or prior to his service in [REDACTED] to support his claim that PTSD accounted for his “out of character” behavior afterwards. There was no evidence that the claimed PTSD impacted any other aspects of the grievant’s life beyond the threatening and demeaning and bullying behavior that formed the basis for the discipline in this case.”

See, nothing happened in seven months, so how could he possibly have PTSD?

I don’t know how knowledgeable is the FSGB about PTSD, including an occurrence described as Delayed Onset PTSD, which can happen anywhere after six months to four years of the traumatic event. Or much longer than four years in some cases.  In fact, according to the LA Times, just a few weeks ago, Tech Sgt. Stanley Friedman, 92 was finally compensated for PTSD by Veterans Affairs (it was called shell shock or battle fatigue when he served nearly 70 years ago) for his service during World War II.  Our Foreign Service folks have not only served in war zones but have been subjected to  terrorist attacks, natural disasters and other traumatic events overseas.  I fully expect that the FSGB will be called on many more times in the foreseeable future to adjudicate cases relating to PTSD in the Foreign Service.

There is no question that the State Department needs to do a better job at screening for PTSD in the Service rather than its “cursory 3 hour High Stress Debrief session” plus handouts or one-day High Stress Assignment Outbrief Program, MQ-950 (which appears to be available only to employees and not/not to family members).  And by the way, spouses/partners who may be working in high-stress posts will not necessarily be working when they are back in the U.S., so they would presumably fall under the Non State Employee category.  The tuition rate for that category for taking MQ-950 is $260.

Rachel commented about the grievance/PTSD blog post, which I am highlighting below.

My heart goes out to everyone involved in this case. The employee having served in a PRT in what must have been extraordinarily difficult circumstances. The bewildered employees who felt threatened by the disturbing behavior of their boss. The State Department system, which has so little capacity for dealing with situations like this, which will only become more prevalent as more and more of us serve in combat zones. And come back.

A couple of things- a diagnosis of PTSD is your best defense, and can only be made by a qualified professional. A social worker cannot diagnose. If you have served in a combat zone and come back acting weird, please do everyone a favor and go see a psychiatrist or psychologist who can actually give you a diagnosis. You will not know you have a PTSD when you come back. You will just feel different and angry all the time. Trust me, get diagnosed. It is the only way to get good treatment.

Second, PTSD is a ticking time bomb. It is completely to be expected that someone with PTSD will come back from their service in a combat zone and be able to hold it together for a while. Luckily for me, I lost it only a few weeks after coming back and so was able to get treatment quickly. But in many cases, someone will not “lose it” for months or years afterward. You get triggered by something and BAM! You are right back in the war zone. That trigger may happen soon or it may not happen for a long time.

Third, you are an adult and so even if you have PTSD, you still are responsible for not attacking people or otherwise breaking the law, and you can and will be held responsible. PTSD is not a license to break the law. It does not make yelling at people OK. The soldier who “lost it” and killed all those innocent Afghani civilians a few months back? He probably had major PTSD, but he also killed a bunch of innocent people. Getting suspended from State is a good thing, because if you have PTSD you need to get treated, and this is your wake-up call.

And State, this sort of situation is going to keep happening. We need to do a better job of handling this sort of PTSD situation. It is only a matter of time before someone comes back and instead of yelling at their employees, actually does someone, or themselves, physical harm.

While I do believe that the State Department has the responsibility for conducting more effective PTSD screening for returnees, I also agree with Rachel’s point that mental health is an individual responsibility.  As she puts it plainly, “if you wait for State to get its act together on PTSD, you will be crazy for a long time.”

Wednesday, June 27 is PTSD Awareness Day. DiploPundit will be blogging about this topic the whole week.

Domani Spero

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February 14, 2012 · 12:09 am

EFM shouldn’t have to see three RMOs, do a PPT presentation and wait 352 days for help

Below is an excerpt (used with permission) from a blog post by Amy, a diplomatic spouse posted in New Zealand who was traumatized by the Christchurch earthquake last year. Her full post, It takes a lot to piss me off is here:

Last week we had yet a new RMO come and I was ready this time. I prepared a power point presentation for her to let her know how I really felt. The system is broken sister and here’s why….I thought it was a very good presentation and I left with a new prescription for antihistamines! No wonder there are so many alcoholics in this business (or so I’m told, I haven’t met any yet). Luckily I am not so fearful and even enjoy NZ though I’d never live here permanently and am looking forward to our new post in India. But I am thinking that to be a part of this business you have to look after yourself. Nobody is going to hold your hand and make sure you get the help you need. I didn’t even know I was eligible for medivac back to the States just after the quake until 8 months after. A nice quake break would have been helpful. Someone really should have told me that was an option.

So yeah, I took a power point presentation to my shrink after receiving help 352 days after my crisis. I’m such a drama queen.

What kind of Whiskey-Tango-Foxtrot help is this?  An EFM (eligible family member) who needs help should not have to see three RMOs, create a PowerPoint presentation and wait 352 days to get help!

The State Department has shrinks, politely known as Regional Medical Officers/Psychiatrists or RMO/Ps.  The RMO/Ps are presently serving in Accra, Amman, Bangkok, Beijing, Cairo, Dakar, Frankfurt, Lima, London, Manama, Mexico City, Moscow, Nairobi, New Delhi, Pretoria, Tokyo, Vienna, and the District of Columbia among other locations. RMO/Ps also serve on temporary duty in high threat locations (e.g., Baghdad, Kabul, etc) and in post-disaster environments (e.g., post earthquake Haiti, etc).

I don’t know which RMO/P covers New Zealand.  In my old life, I went through natural disasters here and there, a couple or so coup d’états and two broken hearts, not all at the same time, silly.  Saw no shrink, but now see how I turned out?

Below are two of an RMO/P’s responsibilities:


Embassy or State Department Specific Responsibilities: Makes regular visits to regional posts, as frequently as necessary to determine ongoing mental health needs and provides needed services.

Clinical Responsibilities: Provides ambulatory and emergency psychiatric care for employees and eligible family members including children, assesses post morale responds to emergencies 24-hour/7 days a week, performs telephone consultations, assures patient confidentiality, responds to crises at the home post or regional posts, renders clinical consultations on workplace and family violence events (including child and spousal abuse cases), provides educational and treatment services as feasible for alcohol and drug abuse prevention at post, renders psychiatric consultations for Regional Medical Officer, helps employees in problems of adjustment to life style, creates and provides educational and therapeutic presentations to officers and families at post, and assists with establishing life style programs.

State also has a much touted, Deployment Stress Management Program (DSMP) located in Mental Health Services within the Office of Medical Services. This office apparently provides information, education, referrals, initial assessment and brief treatment for problems related to the stress of deployment to high threat areas, unaccompanied tours, overseas crises and other stressful situations encountered by Foreign Service Officers, family members and State Department employees overseas.

Deployment Stress Management Program
Office of Medical Services
1800 North Kent Street
Arlington (Rosslyn), VA 22209
Tel: 703-875-4828
Fax: 703-875-4952
Email: MEDDSMP@state.gov

Oh, and a Happy Valentines to you, too, especially the folks at MED.  I’m sure she appreciates the antihistamines, but she needs more than damn itchy pills for emergencies.

The State Department’s Office of Medical Services  is headed by Medical Director Gary D. Penner, M.D.  If there is a part of his office not doing its mission to “safeguard and promote the health and well-being of America’s diplomatic community,” he ought to know about it.  Because the buck stops on his desk.  Um, unless it stops elsewhere upstairs ….

Domani Spero

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September 10, 2010 · 7:15 pm

Clinton issues note on mental health; seeking help a sign of maturity and professionalism

Slightly over two years after Secretary of Defense Robert Gates issued the DOD guidance on the mental health question, the infamous Question 21 in SF 86 and strongly endorsed the practice of seeking professional help for mental and physical issues, the State Department, at the highest level of the 7th Floor — that’s the Secretary of State — has now publicly endorsed the practice of seeking professional help to address “unique stresses” including mental health issues. HRC writes that “No one at State has lost a clearance because he or she sought mental health counseling or treatment” and that “recognizing the need for help is a sign of maturity and professionalism.” We have previously posted about this here and here.

via Josh Rogin of The Cable:

THE SECRETARY OF STATE
WASHINGTON

Dear Friends and Colleagues:

As the summer winds down, I want to take this opportunity to thank you for your hard work, commitment to excellence, and service to our country. At the State Department and USAID, we work long hours on complex problems with few clear-cut solutions. Many of you serve in dangerous and remote posts, often far away from friends and loved ones. Your dedication is inspiring, and you have my gratitude and that of President Obama and the American people as well.

I know that your service here comes with sacrifice, both for you and your families, and with unique stresses. We are committed to ensuring that every member of the State Department and USAID family has all the support they need. That’s why we’ve made it a priority to provide access to social workers and mental health counselors, a mandatory high-stress outbrief program and training for anyone who seeks it and particularly for those who are returning from or working with returnees from high-stress posts.

These are important resources and I hope more of you will take advantage of them in the future.

Seeking help is a sign of responsibility and it is not a threat to your security clearance. No one at State has lost a clearance because he or she sought mental health counseling or treatment. In fact, Diplomatic Security has advised that receiving recommended treatment for mental health concerns is a favorable factor during security clearance determinations. For all of us, managing our mental health is an essential part of maintaining our well-being, and recognizing the need for help is a sign of maturity and professionalism. Talking to someone can make all the difference in the world.

To learn more about the Department’s Deployment Stress Management Program and the resources available to you and your family through the State Department, I encourage you to visit MED’s website at:

If you have questions about security clearances, you can always contact the Office of Personnel Security and Suitability Customer Service Center at 1-866-643-4636 or send an e-mail to 

As we head into the fall and the holidays to come, please consider making use of the excellent programs and staff that are available.

We have a lot to do, and I know you are up to the job. I am proud of the work we are doing together every day on behalf of our nation. It is an honor to be your Secretary and I look forward to all we will continue to achieve together.

Sincerely yours,

Hillary Rodham Clinton

Related items:
DOD: Mental Health Questions, Standard Form (SF) 86, Questionnaire for National Security Positions

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July 29, 2010 · 3:09 am

On the Infamous Q21, PTSD (Again) and High Threat Unaccompanied Assignments

The OIG has released its inspection report dated July 2010 on  the State Department’s support for high stress, high threat, unaccompanied posts.  Some interesting details excerpted below. I have also republished the full report in ScribD for easy access (read below).

The Stigma of Seeking Mental Health Care:

The Department of Defense, led by the Secretary of Defense, has undertaken a campaign to reduce or eliminate this stigma. The Department also has made an effort in the past but can do more. The Department, as have the Department of Defense and other federal government agencies, now exempts mental health consultations relating to service in a military combat environment (i.e., Iraq and Afghanistan) from being reported on employees’ security clearance forms (it still has to be reported on medical clearance forms). That is just one, though important, step.

There is still a lack of clarity as to what employees must report on the security clearance form. For example, does a discussion between an employee and a health professional on how to manage stress have to be reported even if it does not involve diagnosis and treatment of a mental disorder? Opinions differ on that point. However, if such “preclinical” discussions have to be reported, that will ensure that fewer will take place, even if the Department is more successful than in the past in reducing the stigma. This would undercut the Department’s efforts to build resiliency among its employees.

The Department needs to address the overall issue of the stigma. The next step should be a message from the Department’s leadership to all employees making some of the following points (which have been made to the OIG team by MED and DS):

  • The Department encourages its employees to seek mental health care. It is a positive act and a normal part of maintaining one’s health and preparedness.
  • Employees could be more likely to put at risk their clearances and job performance when they do not seek such care.
  • Only two employees have lost their security clearances over the past fi ve years because of mental health issues (which did not involve PTSD).
  • Of the 517 cases concerning mental health issues that DS referred to MED during 2009, not one resulted in denial of a security clearance for mental health reasons.

Two years ago, we called for such a high level message from Secretary Rice in On the Infamous Q21, PTSD and the Wholeness of People in the Foreign Service(May 2008): 

Considering that State has its own clearance process and is a separate agency from DOD, I’m waiting for revised guidance for State Department personnel from Secretary Rice herself. Uhm, no offense intended; the guidance from “M” or “DGHR” or “DS” is fine but I don’t think that really cuts the cake here.

I’d like to see the Department of State, at the highest level of the 7th Floor, affirm and strongly endorse the practice of seeking professional help to address all health related concerns, including mental health. The press guidance above only refers to service in Iraq and Afghanistan, but what about service in the rest of the FS hardship assignments? The emotional toll of constant moving and relocation coupled with dangerous and challenging assignments is not something that we can or should ignore.

We’re a small fly in a thick soup, of course; that did not go anywhere.  Secretary Clinton as far as we are aware has not issued a message similar to Secretary Gates’ message. 

This report by the way, notes that “In the past five years, 18 employees have been formally diagnosed with PTSD. Of these, 10 had served in posts other than Iraq or Afghanistan.” So there are more posts at play here than just the war zones. 

Leadership and Stress:

In practically any conversation about the causes of stress and inefficiency in the Department or at overseas posts, the issue of inadequate leadership/management comes up. For some employees, this is a greater problem than danger and hardship. Good leadership can do a great deal to create high morale and effectiveness at difficult posts. Poor leadership, of course, can be a problem at any post or bureau, but it can be especially harmful at a high stress, high threat post. In the OIG survey, leadership problems were cited by 45 percent of the respondents as a source of stress for them or their colleagues. As noted above, this was less than the percentage citing danger, workload, and separation from families, but leadership problems generated more passionate comments than any other issue. That is probably because, unlike danger and separation, employees feel that something can and should be done about leadership.

This is not to say that poor management is widespread at high stress or more “normal” posts. In fact, OIG inspections have found that at a substantial majority of posts, the top leadership is doing fairly to very well. Also, inspections have found that inexperienced personnel have put an additional burden on top leadership as well as middle managers. (See section below on whether the right people are being assigned.) However, recent inspections have found too many cases of managers at the top and middle levels who cause unnecessary stress and inefficiency and thus impair the morale and smooth functioning of their post, bureau, office, or section.

Are the right people on the right bus?

The OIG survey asked whether the Department generally was assigning employees with the necessary skills, experience, and temperament to high stress, high threat posts. Over 60 percent of respondents said no. In their comments, those who served in Iraq and Afghanistan and answered in the negative made observations such as: there are too many people who are there just for the money, their next assignment, or to save a failing career. There are people who do not have the necessary experience or the mental and physical resiliency to be effective; such people make work more difficult for the others. There was a feeling that taking virtually anyone who volunteers has a negative impact on the post.

Lessons not learned, again:

Care should be taken in setting numerical staffing targets. A smaller, higher quality staff can usually do a better job. The OIG inspection of Embassy Baghdad found that many employees thought that staffing levels were too high as a result of the “civilian surge,” even taking into account the need to compensate for the absence of staff because of rest and recuperation leave (R&R) and other factors. The OIG inspection of Embassy Kabul found that the Baghdad experience was being repeated, with staff added before functions were identified and job descriptions developed.

An ALMOST “fitness for duty” policy:

OIG would support the Department’s developing a stronger “fitness for duty” policy that would be fair not just to the individual, but also to his or her colleagues, and that would maintain the effectiveness of a high stress, high threat post. Administrative and legal barriers, however, limit the Department’s options. In a recent review of the issue of physical fitness for high threat posts, the Department concluded that providing employees with the information to make an intelligent self-assessment of their capabilities was the best available means of handling this problem.

Finally, in Recycling News:

Care should also be taken in reviewing the skills and experience of employees hired under the 3161 authority for Iraq and Afghanistan, both for fi rst-time hires and re-hires. A number of people in the OIG survey expressed concern that 3161 employees who did not do very well in Iraq were being hired to go to Afghanistan, and many more thought that 3161 personnel in general needed greater knowledge of the objectives and operations of the Department and other government agencies to be effective in their jobs.

The original OIG report is posted here (OIG Report No. ISP-I-10-44 – Review of Support for High Stress, High Threat, Unaccompanied Posts – July 2010).

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