-- 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.”
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?
- USAID’s First War-Zone Related Suicide – Michael C. Dempsey, Rest in Peace (diplopundit.net)
- A USAID Worker’s Suicide Raises the Flag on a Troubling Issue (truthdig.com)
- Justin Verlander donates $1 million to support mental health of veterans (hardballtalk.nbcsports.com)
- Mental Health Awareness (everydayhealth.com)
- Smartphones, Trauma and the Mental Health Revolution (psychologytoday.com)
- Congressman confronts Camp Lejeune mental health furloughs (stripes.com)