Category Archives: Mental Health

Burn Bag: One RMO/P’s ‘just need a man’ prescription

Via Burn Bag:

“When I finally saw the Regional Medical Officer/Psychiatrist (RMO/P) for help, I was told I just needed a man to make me happy.”

Via reactiongifs

Via reactiongifs

 

 

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Filed under Foreign Service, Hall of Shame, Leadership and Management, MED, Mental Health, Realities of the FS, State Department, U.S. Missions

Former FSO Candace Faber on Coming Home With the Maladies of War

– Domani Spero

Candace Faber joined the Foreign Service when she was twenty-four. She learned Dari, Polish, and Russian. At twenty-eight, she was off to Afghanistan where she spent a year at a “a tiny, crowded, dysfunctional world—one we could not leave.”  She wrote that she “often fantasized about walking off compound, just like Sergeant Bowe Bergdahl did in Paktika. In my imagination, even the Taliban seemed kinder than my colleagues.”

She was thirty years old when she resigned from the the FS.

Via Candace Faber on Medium – The Other Veterans:

[S]eeing them take this woman’s very real suffering so lightly, dismissing both her service and her fears as a woman, did more than hurt. It invalidated my own experience.

If a military veteran on a PRT had no right to struggle with readjustment, then by comparison, my year at the U.S. embassy compound in Kabul was a joke. My closest brush with terrorism was a distribution of children’s books I attended in Logar Province, pulling schoolchildren, government officials, and journalists together in a single building. The next day, that building was attacked by a vehicle-borne IED, and two of my colleagues were injured. I was shaken, but I wasn’t there. I also wasn’t there during the September 10 attacks, a fact that only seemed to invalidate my experience further.

In my mind and that of my colleagues, neither that woman nor I had the right to struggle with our transition. There was no excuse save PTSD, and I didn’t have that. I couldn’t have it. I wasn’t a veteran.
[...]
It has been a hard journey, as everyone close to me can attest. Resignation has also had financial consequences. But money matters very little compared to having my mental health back. As of today, I have not had an anxiety attack in months. I credit psychotherapy for my recovery. The only question in my mind is why it took so long for me to get help—and why no one in the Department of State, not even when I announced my intention to resign, suggested the option. Instead, I suffered alone for a year and a half, convinced that I was simply a broken person who could never be put back together again. All of that could have been avoided.

 

Ms. Faber notes that “the paper-based screening” given to her in Kabul was very limited.   “This seems like more of a way to shield the Foreign Service from liability than a good faith effort to support its corps.” She suggested that this should be replaced with in-person screening at appropriate intervals.

Once more, we’re hearing about the security clearance process; she writes, “the federal security clearance process must get rid of its prejudice against mental health treatment, which deters people from seeking the care they need. There is a double standard here: If you are physically wounded in action, you are a hero. But if you come back from a theater of war psychologically broken, wired to treat everyone as a threat, and angry at the world, you cannot seek help without risking your security clearance—and with it, your job.”

Read in full here.

Below are some of our previous blog posts on mental health, PTSD, security clearance and the State Department’s programs:

 

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Filed under Afghanistan, Americans Abroad, Foreign Service, FSOs, MED, Mental Health, PTSD, Realities of the FS, State Department, U.S. Missions, War

Former Foreign Service Kid Writes About Dad With Severe PTSD

– Domani Spero

In 2012, we blogged about a retired FS employee, William “Tony” Gooch who was sentenced to 12 years in prison – the maximum he faced under a plea agreement in a Nov. 7, 2010 episode, in which he reportedly rammed a Jeep into his estranged wife’s home before setting it ablaze. (See Former FSO William Anthony Gooch: No Mercy for Broken Men?).  Colorado Spring’s The Gazette covered the hearing in 2012.

We recently received a note from his son, Andy Gooch (he was referencing our blogpost below):

I came across this article the other day while searching to see if there was anything out there on my father, William Gooch (Tony). He is currently incarcerated and subjected to the brutality of prison life. He was in fact diagnosed with severe PTSD, depression, and substance dependence after serving State Department which the court system neglected to take into consideration. This whole situation frustrates me everyday. In fact, I clearly remember like it was yesterday after I told the judge my little amount of overseas experience. “This sounds like something out of a Jason Bourne movie,” stated the judge. It was as though he was calling not only my statement, but my fathers career a fabricated story.

Anyway, since then, my father and I have published a book on Amazon about his life. It’s called “My Mind, A Different Place.” If you are interested in his story, please look into it. Below is the hyperlink.

http://www.amazon.com/My-Mind-Different-Place-familys-ebook/dp/B00IHOCAC2/ref=sr_1_1?ie=UTF8&qid=1392741948&sr=8-1&keywords=my+mind%2C+a+different+place

It’s unfortunate how the path of one’s career is often times vulnerable to acquiring PTSD, yet others don’t see/understand the reality.

Thanks,
William Gooch (Andy)

News report said that Tony Gooch’s career with the State Department ended with a medical discharge after he suffered a breakdown during an assignment in Kingston, Jamaica. On the prologue of the book, Andy Gooch writes that he moved to Centennial, Colorado in 2004 to live with his father  who was then retired from the State Department.  “It took me all these years to understand him, and to see what he was going through. At that time, my ignorance was bliss. Had I known then what I know now, I would have done a lot more to help my dad, ” he writes.

According to Andy , his father is not getting the mental health treatment he should be getting and his physical condition is deteriorating.  Due to this, he said his family is “currently filing action against the state.”  Andy also said that his father is allowed to accept some items like books and magazine through the mail writing,  “He is so isolated from the outside world I’m sure anything from anybody would be great.”

If you want to help, you may send cards, books or magazines to William “Tony” Gooch’s address below:

William Gooch #157833
AVCF Unit 4-B
12750 HWY 96
Ordway, CO 81034

Andy Gooch graduated from Virginia Commonwealth University in 2012 and is a second lieutenant in a Field Artillery Battery with the Army National Guard.

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Filed under Foreign Service, MED, Mental Health, PTSD, Realities of the FS, State Department

State Dept Regional Psychiatrist William Callahan, 53, Dies in Cape Town

– Domani Spero

We previously posted about the December 12 death of a U.S. Embassy Accra employee while visiting Cape Town, South Africa. (See US Embassy Accra Employee Falls to Death on South Africa’s Table Mountain). We subsequently learned the identity of the employee but decided not to publish his name as we could not confirm independently that the family back in California has been notified.  His hometown newspaper had since identified him in a news article as William E. Callahan Jr., 53, a prominent psychiatrist in Aliso Viejo, California.  He was the State Department’s Regional Psychiatrist covering West Africa. Below is an excerpt from OCRegister:

Callahan had left his private psychiatry practice in California last year to join the U.S. State Department as a Regional Medical Officer and Psychiatrist based out of the U.S. Embassy in Accra, Ghana, said Kenneth Dekleva, Director of Mental Health Services at the U.S. Department of State in Washington, D.C.

Dekleva said the news came as a shock to him and his department last Friday when he found out Callahan’s body had been recovered by South African authorities near the Table Mountain Range.

“His death has touched many people: my phone hasn’t stopped ringing since Friday…we lost one of our own,” Dekleva said. “It’s a huge loss for our organization. He represented the best in psychiatry in my opinion. We’re very proud to have known him and to have had him as part of our team.”

Dekleva said that the investigation surrounding the circumstances of Callahan’s death is ongoing in South Africa.

Memorial services are planned in Accra on Wednesday. Services in Greenfield, Mass. and Laguna Beach will occur in early 2014, the State Department said.

 

Dr. Callahan joined the State Department in July 2012.  Our source told us that “he was an avid outdoorsman and in great shape.  He was well-liked in Accra and at the other embassies he covered in West Africa.”

According to his online bio, he was a Special Forces flight surgeon turned psychiatrist.  “With the constant deployments in my military unit on clandestine missions, I observed how stress in a family member can jump from person to person and lead to physical illness as well.  After 5 years of active duty and 9 of total service, I left the military to get the training to become a board certified psychiatrist.”

He was previously the president of the Orange County Psychiatric Society.  For 15 years prior to joining the State Department, he  provided a two hour a week, free, open-to-the-public group for families dealing with a mental illness called Interactive Solutions.

Dr. Callahan’s service in the military included a general surgery internship at David Grant Medical Center at Travis AFB, CA followed by assignment to the 8th Special Operations Squadron as a flight surgeon, at Hurlburt Field, FL.  He served in both the First Gulf War and Panama Wars,  and received two Meritorious Service Medals. He was the 1988 Flight Surgeon of the Year within the First Special Operations Wing.

He graduated from Deerfield Academy (1978), Tufts University (1982), Tufts Medical School (1986) and did General Surgery Internship at Travis AFB, CA (1987), and his Residency in Psychiatry at UC Irvine (1994).

R.I.P.

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Filed under Africa, Foreign Service, MED, Mental Health, Realities of the FS, State Department, U.S. Missions

What to do when different voices start delivering multiple démarches in your head?

-- By Domani Spero

 

Below is the State Department’s High Stress Assignment Outbrief Implementation Guide – the FSI/MED Model.

Background of the High Stress Outbrief Program via fbo.gov

The High Stress Assignment Outbrief program was developed after the first groups of employees began coming back from assignments to Iraq and Afghanistan in 2002 and 2003 – posts that would have beenin evacuation status in more normal times. Returnees asserted that coming back from those posts wasn’t at all like coming back from a regular foreign affairs community assignment – that theDepartment needed to help with this particular transition in some way. Med’s Office of Mental Health Services asked the Foreign Service Institute’s Transition Center to assist in the development of a prototype training event, which was piloted in 2003. MED/Mental Health convened an Iraq Out-briefing Conference on July 29 & 30, 2004 at the Foreign Service Institute. The Outbrief program was reviewedand discussed by the full cadre of RMO/Ps, Dr. Robert Ursano and Dr. James McCarroll, from theUniformed Services University for Health Sciences, Dr. Carol North, Washington University (St. Louis),with guest presentations by (then) Director General of the Foreign Service Amb. Robert Pearson and others.

The program was endorsed by MED leadership and has run as a partnership between the FSI’sTransition Center and MED/Mental Health Services since then. All subsequent Directors General of the Foreign Service have mandated that all returnees from Iraq (and later Afghanistan) who have served for 90 days or longer be required to attend either a group or individual Outbrief upon return to CONUS.The realities of the Foreign Service assignment system brought complications – many officers had TDY-ed to Iraq or Afghanistan and were returning directly to their former posts. Others PCS-ed directly to follow-on assignments around the world. Clearly, a purely Washington-based program would not be effective in providing the service to all of our employees. Furthermore, many participants did not fit traditional Foreign Service employee profiles – special hiring authority hires (3161s), civil service employees, and third country nationals all stepped up to serve in those war zones. RMO/Ps were instructed to deliver Outbriefs at posts or during post visits, and to communicate the name of the Outbrief participant, date, and place back to the Transition Center for entry into the Department’sofficial training registration database to certify compliance.

Read more below:

 

I’ve requested help in understanding the usefulness of the Outbrief session and received a few responses below:

Comment #1: (from a twice-deployed employee)

“I have taken that half-day course twice in 2009 and 2013.  The class was almost the exact same.  They basically tell you to get sleep and try to adjust back and if needed, see someone.  The class I took in 2013 was 8 months after I returned because HR would not pay to send me to DC before home leave then I was in language training for six months.  If it was really important, HR would allow people to take it as early as possible otherwise, it must not be that important.”

Comment #2 (a State Department employee who served in Iraq and Pakistan)

“The description of the outbrief program seems reasonably accurate – although it’s been a while since I attended (in 2008 after Iraq, but not subsequently after Pakistan).  There’s a certain value to spending a bit of time (three hours?) with people that have been through similar experiences – probably including someone that you knew or at least shared acquaintances with.  It gives you a chance to talk with people who better understand your experiences.   It’s possible that some of our feedback made it back to decision makers in aggregated form.  For example, one of the themes of our discussion was that the Department (USG?) was doing itself no favors by sending warm bodies that lacked core qualifications (e.g. basic competence and a desire to be there.)  I think that the Department is now requesting 360s [360 degree feedback] for everyone that they send – although that may just be part of the general trend towards requesting 360s.  My memory is a bit hazy, but I think a key element was describing what other resources (e.g. clinical/therapeutic) might be available for those that needed them.”

Comment #3 (somebody once posted in Iraq— added at 6:48 am PST)
The high stress outbrief  is, as you noted, just an example of CYA– look, we have a program! A couple of voluntary hours with some contractor at cozy FSI with no follow-up, and especially no mandatory individual session is worthless. Many symptoms of PTSD evolve over time, and many returning-to-DC-stresses only become apparent after you have in fact returned to work and gotten the lay of the land in a new office. Speaking out in front of a group is not a core FS trait, and not something any person with real problems does easily. Imperfect as it is, the military does require formal screening and a brief one-on-one session with a counselor. Follow up care (imperfect) is available. At State, you’re told to “get help” without much help in getting it. After all, MED is not responsible for healthcare in the U.S.
 
Still not sure? Check with officers who were MEDEVACed for anything, not necessarily PTSD, and see if any of them got any follow-on from MED other than a new, career-crushing clearance status.

One of our readers commenting on mental health support suggested the following:

“While I know it wouldn’t solve everything, I think that anyone coming out of a post with danger pay should have some sort of mandatory sessions with some sort of licensed therapist. That would take away the stigma of the therapy and maybe get some people some help before they take out their PTSD on themselves or someone else.”

 

Remember the US Embassy Malta road rage meltdown that made the news? (US Embassy Malta Gets a Viral Video But — Not the Kind You Want).  We don’t know this individual nor his story, or which post he previously came from. But assignments to European posts like Malta have typically gone to employees who did tours in Iraq, Afghanistan and Pakistan.   We don’t know if this individual came from an AIP posts. Even if he did, it’s not an excuse for such a behavior, but it might help us understand his demeanor.  American diplomats normally do not go around looking for a fight.

Our concern is simple. We are sending people out to the war/danger zones.  The State Department touts its mandatory High Stress Outbrief, an educational program that only requires presentation/delivery skills from whoever delivers the program.  Less than 60 percent of returnees attend the program, and there are no consequences for non-compliance.  Who does the follow-up? Anybody?

Is it fair to say that the State Department does no follow-up beyond the Outbrief session and expects employees to simply self-report any mental health issue? And because no one fears the social stigma of seeking mental health help and nobody suffers from the fear of losing one’s security clearance over a mental health issue, everyone in the Service can be counted on to self-report if/when different voices start delivering multiple démarches in one’s head?

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Filed under Afghanistan, Diplomatic Life, Foreign Service, FSOs, Functional Bureaus, Govt Reports/Documents, Huh? News, Iraq, Leadership and Management, MED, Mental Health, Org Culture, Pakistan, State Department, War

USAID’s First War-Zone Related Suicide – Michael C. Dempsey, Rest in Peace

– By Domani Spero

On September 5, Gordon Lubold writing for Foreign Policy reported on USAID’s first known war-zone-related suicide and asks if America is doing enough to assist its relief workers. Excerpt below:

On Aug. 15, the U.S. Agency for International Development announced that one of its employees had died suddenly. The agency didn’t mention that Michael C. Dempsey, a senior field program officer assigned as the leader of a civilian assistance team in eastern Afghanistan, killed himself four days earlier while home on extended medical leave. However, the medical examiner in Kent County, Michigan, confirmed to Foreign Policy that Dempsey had committed suicide by hanging himself in a hotel-room shower. His death is USAID’s first known suicide in a decade of work in the war zones of Afghanistan and Iraq. And what makes the suicide particularly striking is that it came a year and three days after Dempsey’s close friend and colleague was killed in an improvised-explosive-device attack in Afghanistan.

Related posts:

More from Mr. Lobold’s A Death in the Family:

Shah left unspoken the issue of suicide that USAID must now confront. With Dempsey’s death as the first known suicide from either of USAID’s Afghanistan or Iraq programs, the suicide forces the agency to deal with an inescapable problem: how to help its employees who deploy to the same war zones as the military but who don’t always have access to the same kind of assistance. Civilian culture may not have the military’s taboo against seeking mental-health assistance, but unlike the Defense Department, which has struggled to arrest the vast suicide problem within its ranks, civilian agencies such as USAID and the State Department are governed by different privacy rules that hamstring those agencies as they try to help employees who may be suffering from post-traumatic anxiety, depression, or worse.
[...]
USAID has deployed more than 2,000 “direct hires” through Iraq and Afghanistan since 2003. Many of them, like Dempsey, are considered “foreign service limited” (FSL) officers. That means they enjoy many of the same benefits of Foreign Service officers, but can’t be promoted or moved to other offices or departments. About 150 FSL officers are in Afghanistan currently. After each deployment, each one gets a “high-stress outbrief,” but due to privacy concerns, USAID isn’t able to contact any of them after they leave federal service to ensure that they aren’t suffering from deployment-related issues or other maladies, like alcohol abuse or depression. After a deployment, supervisors may only hear about those kinds of problems unofficially, through the bureaucratic grapevine, because of the way privacy regulations govern civilian agencies. And even then, if a problem is identified, USAID, unlike the Defense Department, can’t force an employee to undergo treatment.

Click here for the memorial page of Michael Cameron Dempsey (May 26, 1980  -  August 11, 2013) where you may leave a note or share a photo with his family.

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Something about that “each one gets a “high-stress outbrief,” but due to privacy concerns, USAID isn’t able to contact any of them …” seem odd.

According to the State Department, Foreign Service and Civil Service employees from the State Department and USAID who have spent more than 90 days in Afghanistan, Iraq, Pakistan, Yemen, or Libya are required to attend its High-stress Assignment Outbriefing Program. Any State employee serving at any high stress post is also highly encouraged to attend.

However, a review of the program by State/OIG in July 2010 indicates that fewer than 60 percent of returnees from Iraq and Afghanistan for whom this is mandatory attend the High Stress Assignment Outbrief.   Apparently, very few employees from other high stress posts for whom it is voluntary take it.  State/OIG also stated that “If efforts to increase attendance fail, the Department will need to adopt stronger measures and a follow-up mechanism.”  Now, why would State/OIG propose the adoption of stronger measures to increase the Outbrief attendance if there were “privacy concerns?”

In any case, the Outbrief is mandatory but more than 40% of returnees mandated to attend it do not take it. FSI’s Transition Center admits that “compliance remains a difficult issue:”

“Compliance remains a difficult issue. While the program has received support and validation from a number of internal and external stakeholders, the unique requirement of a post-deployment “de-brief” coupled with a cultural reluctance in the workforce to deal with mental health or stress related issues mitigate against full participation. Since the essence of the program is to provide help to returning employees – and their family members – more rigorous measures to ensure compliance were seen as undesirable (e.g., holding up onward assignments or limiting or temporarily suspending clearances) and counterproductive.”

In a recent document published in conjunction with a solicitation for a High Stress Assignment Outbrief provider also states that the Outbrief “is a two-way educational program” and it is “not a clinical session or intervention.”  Asked by potential provider about “sources/citations for the interviewing methodologies utilized in the High Stress Assignment Outbrief”, the official response is as follows:

“The interview methodology was developed by trainers and psychiatrists working for the Foreign Service Institute and the Office of Medical Services of the Department of State. The interview protocol is not designed as a therapeutic intervention; it’s purpose is to have participants reflect on their experiences, offer advice to the Department, and to provide a conduit for such aggregated information for Department decision makers.”

The Outbrief implementation guide posted by FSI’s Transition Center at fbo.gov also states that “the Department is responsible for keeping track of compliance” and that there is a need (for the selected provider) to make sure that “accurate records are kept of who attended, when, and where.”

In short –

The Outbrief is not/not a clinical session.

It is not/not a therapeutic intervention.

It is mandatory but not everyone attends it.

The Department kept accurate records of who attended it, where and when.

But due to “privacy concerns” USAID isn’t able to contact any of them to ensure that they are not suffering from deployment-related issues.

Also a new contract was awarded to a new Outbriefer in May 2013 for $46,400 (Base and Option Years Estimate).

You know, I’ve lost my brain today. I just don’t get this. If you’ve been through the Outbrief session would you kindly write me and help me understand how this is helpful to returnees from high stress-high threat assignments.

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Filed under Mental Health, Questions, Realities of the FS, State Department, U.S. Missions, USAID, War

State Dept’s Suicide Prevention Resources — A Topic So Secret No One Wants to Talk About It

—By Domani Spero

This blog has been running almost uninterrupted for over five years now.  We have heard just about everything there is to hear about the worldwide available universe. While we don’t get shocked very often anymore, there are days when running this blog becomes heavy on one’s soul.

In the last few months we have heard allegations of sexual harassment, workplace bullying and an attempted suicide. All these have two things in common. One, the alleged perpetrators were senior officials in the Foreign Service who appeared able to skirt accountability.  And two, the informers all prefer to remain anonymous for personal and professional reasons.

The allegations are troubling and disturbing given how often we’ve seen officers get recycled to other posts when trouble comes calling.  A person who harasses one or more person at Post A is probably a serial harasser who will not stop when you move him to Post B at a different geographical location.  A person who routinely bullies subordinates probably think he/she is doing hands-on management and do not have the self-awareness to recognize his/her negative impact at post.  He or she rotates to the next post and do the same thing all over again to miserable consequences.   Yes, there are rules, but those apparently are quite useless when people look the other way.

Below is an excerpt from one of our correspondents:

“How many Foreign Service Officers have attempted suicide, and named [Senior FSO X] as the reason?  I personally know of at least one officer who did this.”

“[T]his attempt, PRECISELY BECAUSE of” Senior FSO X’s  “treatment/management of that officer.”

“Why is there only accountability for those who are new in their career, or who do not have the unwavering support of a career ambassador?”

The note was sent anonymously but there was nothing anonymous about the pain that leapt across the screen.  It kept me awake for days.  What happens when one feels suicidal while in an overseas posting?

Suicide is not unheard of in the Foreign Service.  In 2007, Colonel Thomas Mooney who was then with US Embassy Nicosia went missing, and after four days was found with reportedly self-inflicted wound.  In May 2012, Caribbean news reported as “apparent suicide” the death of RSO George Gaines of the US Embassy in Barbados.

Two cases too many.  What we don’t know is how many suicide attempts have occurred behind the embassy walls.  We have so far been unable to confirm that an FSO working for Senior FSO X attempted suicide.  According to save.org, there are an estimated 8 to 25 attempted suicides to 1 completion.  That’s an estimate for the general population, what is it in the foreign service?  When we asked around, our question was answered with another question by a blog pal –

What FSO is going to risk losing their security clearance by going to MED and saying they are thinking about suicide?” 

We know of one documented case of an attempted suicide:  an FS employee accused of raping his maid in Bangkok, Thailand.  The employee reportedly maintained the sex was consensual but aggressive interrogation techniques by DS agents allegedly drove this employee to jump off a hotel window.

[A]fter “being told he would end up in a Thai prison, his wife would lose her job and his children would be pulled out of school, [the man] attempted suicide by jumping out of the 16th-story window at a hotel in Bangkok … The man was flown back to Washington for in-patient psychiatric care, where the agents continued to harass him, the union charged. The rape charges were ultimately dropped.

Psychology Today explains that “the thought of suicide most often occurs when a person feels they have run out of solutions to problems that seem inescapable, intolerably painful, and never-ending.”

“Of all motivations for suicide, the two found to be universal in all participants were hopelessness and overwhelming emotional pain.”

We wrote to the State Dep’t’s Family Liaison Office (FLO)  inquiring what resources or material on suicide prevention are available to FS employees and spouses.

FLO’s response: “Please direct them to the Employee Consultation Service (ECS) here is a link to their website http://www.state.gov/m/dghr/flo/c21952.htm   They provide in-person and phone counseling.”

We wrote to the Employee Consultation Service at MEDECS@state.gov, with the same inquiry and received a response from one Pollenetta P. Douglas: “Good morning, Are you or your family member employed by the State Department?”

After being informed that we are writing about suicide prevention resources available to employees and family members, we never heard from Ms. Douglas again. You’d think that they would want that information widely disseminated.  But no, apparently, suicide prevention is a topic so secret no one wants to talk about it.

The State Department does have a “Do You Need Help?” page that says:

If you are feeling suicidal or homicidal, it’s important that you let someone know. You should seek help immediately by calling 911 or going to the closest emergency room.

It did not say what an FS employee/family member should do if one is in a foreign country where there is no 911 to call or no ER.  Perhaps that’s because the text of that web page is cribbed from DOD’s afterdeployment.org without attribution.

If you or somebody you know needs help, please –

Screen Shot 2013-06-16

If you have thoughts of suicide, these options are available to you (via save.org):

  • Dial: 911
  • Dial: 1-800-273-TALK (8255)
  • Check yourself into the emergency room
  • Call your local crisis agency
  • Tell someone who can help you find help immediately.
  • Stay away from things that might hurt you.
  • Most people can be treated with a combination of antidepressant medication and psychotherapy.

For FS folks overseas, this can get even more complicated. In some places, there is no 911.  In most cases, for language, logistical or other reasons, one may require the help of the mission’s MED or Health Unit to visit the ER.  Which means the incident could be reported up the embassy’s chain of command.  And certainly if one is at a post with very few foreigners, showing up at an Emergency  Room would probably be big news.  A medical evacuation is always an option but realistically, despite what officials say, there are ongoing concerns about security clearance and mental health issues, not to mention the stigma for people who have a mental health condition. That fact alone is enough to preclude people who needs help from asking for it.

Given the expanding number of people who served/are serving in the war zones or in unaccompanied, dangerous assignments, we suspect that there is a good number of people suffering quietly with PTSD, depression and other related issues.  Secretary Kerry needs to pay attention to this.  Asking for help while overseas is particularly complicated.  Secretary Kerry can make a difference by ensuring that people who needs help can get it without fear of jeopardizing their security clearance or their jobs. And he needs to do something about State’s recycle program.

In the meantime, we hope the following is helpful:

If you’re overseas and need help but do not want to call the ECS, please call the Military Crisis Line (1-800-273-8255 and Press 1), online chat or text (838255). In Europe call 00800 1273 8255 or DSN 118*. This is available for veterans, active duty/reserved service members, and family members and friends of service members. We recently used the online chat and we’re told that help is available even if you’re in the Foreign Service.  You do not have to give your name or other personal information. See the FAQs here.

Below are some common misconceptions about suicide (via save.org):

“People who talk about suicide won’t really do it.”

Not True. Almost everyone who commits or attempts suicide has given some clue or warning. Do not ignore suicide threats. Statements like “you’ll be sorry when I’m dead,” “I can’t see any way out,” — no matter how casually or jokingly said, may indicate serious suicidal feelings.

“Anyone who tries to kill him/herself must be crazy.”

Not True. Most suicidal people are not psychotic or insane. They may be upset, grief-stricken, depressed or despairing. Extreme distress and emotional pain are always signs of mental illness but are not signs of psychosis.

“If a person is determined to kill him/herself, nothing is going to stop him/her.”

Not True. Even the most severely depressed person has mixed feelings about death, and most waiver until the very last moment between wanting to live and wanting to end their pain. Most suicidal people do not want to die; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever.

“People who commit suicide are people who were unwilling to seek help.”

Not True. Studies of adult suicide victims have shown that more then half had sought medical help within six month before their deaths and a majority had seen a medical professional within 1 month of their death.

“Talking about suicide may give someone the idea.”

Not True. You don’t give a suicidal person ideas by talking about suicide. The opposite is true — bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do.

If you or somebody you know is contemplating suicide, please call the numbers above or contact one of these hotlines before you do anything else.

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Filed under Americans Abroad, Foreign Service, FSOs, Hall of Shame, Leadership and Management, MED, Mental Health, Realities of the FS, State Department

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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Filed under Foreign Affairs, Mental Health, People

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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Filed under Africa, Allowances, Counting Beans, Foreign Service, FS Funding, Govt Reports/Documents, Mental Health, Real Post of the Month, Realities of the FS, State Department, U.S. Missions, USAID

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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Filed under Foreign Service, FS Blogs, Functional Bureaus, MED, Mental Health, PTSD, State Department, War