Foreign Service Members Offer Candid Views of @StateDept Mental Health Services (via FSJ)

Posted: 3:04 am EDT
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The January issue of the Foreign Service Journal is out. The issue is focused on mental health care for the Foreign Service.  Dr. Samuel Thielman,  a recently retired regional medical officer/psychiatrist for the Department of State writes about how MED’s mental health program has grown and evolved over the years to address the unusual needs of FS employees and their families serving overseas in The Evolution of State’s Mental Health Services. Chantay White, the chief of the Employee Assistance Program with the State Department Employee Consultation Services and Paulette Baldwin, a Licensed Clinical Social Worker write about Mental Health and ECS—What You Should Know. Dr. Stephen A. Young, the director of Mental Health Services for the State department since September 2015, writes about The Face of Mental Health Services Overseas.

One part of the bureaucracy that is glaringly missing here is, of course, Diplomatic Security.  A majority of these comments express concern about DS and security clearance. The most instructive part is probably the section on MED/MHS Checkup: Foreign Service Members Weigh In that offers very candid views from people in the field.

The FSJ writes that the compilation includes 45 responses from FS members in Washington, D.C., and overseas, some entry-level and a few retired, from the foreign affairs agencies, primarily State and USAID. The gender split was about even. “Due to the sensitive nature of the topic, and known concerns about privacy, we took the unprecedented step of offering to print comments without attribution,” the editors write.

Some excerpts below, each paragraph selected from a separate FS member response.  The last one It’s No Joke is in full; the contributor appears to be part of US Mission Libya following the 2012 attacks. The full comments are available to read here.

“Dealing with the bureaucracy after having sought mental health treatment is itself enough to cause PTSD.”

“Senior officers, in particular, need to set the example by ensuring that their employees understand that a mental health issue, like any ailment, is best addressed early. Until they do, we will all still sign notes like this as… Anonymous.”

“During a rough patch in a relationship, my partner and I sought couples counseling. When my security clearance was up for renewal, I was grilled by the investigator regarding this counseling. I had to defend myself for wanting counseling, and the harsh and critical tone she took for me wanting to do what I needed for my relationship was upsetting. I got the clearance, but it was a stressful process.”

“After service in Iraq, there is no doubt in my mind that I suffered from PTSD. Now (several years later), I see my symptoms as both classic and obvious. At the time I was suffering, however, I hid my symptoms out of fear that knowledge that I suffered from PTSD would harm my career. That concern was heightened by the intense questioning I endured by a Diplomatic Security agent conducting a security clearance update when I was serving in Iraq. When it became known that I had sought mental health care, I was hassled and forced to repeat the content of a private discussion with a mental health professional to a DS agent with zero mental health training. I found the entire episode both distasteful and inappropriate.”

“My mistake—I was told by MED that I’d be given a Class 2 because of seeking continued therapy. I thought that showing that I’d made arrangements for my mental health would ensure a Class 1, but instead that’s what gave me the Class 2. Geez, why be honest with MED—it could have cost me my assignment.”

“I met with a therapist who told me he never wrote anything down because all of his FS clients were terrified of getting caught seeking assistance for their stress-related problems. It’s sad. Concerns about security clearances have a big effect on whether or not I seek mental health care.”

“I feel that if I had declared myself an alcoholic I would have gotten more attention from MED than when I was traumatized and sat in my office working, feeling like an isolated zombie.”

“Once I joined the Foreign Service, I could easily understand why there is an impression that the Service has an alcohol abuse problem—it’s self-medication that is easy to hide from a clearance process. I find that distressing and disturbing and extremely unsupportive.”

“Despite former Secretary of State Hillary Clinton’s message a few years ago telling employees that their clearance will not be affected by seeking mental health treatment, that is not what happens in practice. DS investigators zero in on this, considering it a red flag, as if mental health were any different than physical health.”

“No matter what management says about the importance of mental health, if there are no real changes, then the Foreign Service will continue to be an ineffective and unsupportive mental health environment.”

“You also do not know who the regional psychiatrist’s client really is: you or the State Department? Does a psychiatrist see you as a patient who needs help or just a problem for the Foreign Service best remedied by removing you from post?”

“The mandatory out brief improved between the time I returned from Afghanistan in 2007 and 2012, when I returned from Iraq. However, both times I was told that the symptoms in the PTSD questionnaire are normal for six months and not to worry unless they persist. (And I was offended when taken aside after the briefing and asked how pervasive I thought infidelity was in Baghdad.)”

“During the onward assignments process, MED refused to consider my needs as identified by my therapist, instead assigning me to a post where there was no one in-country who could serve as an appropriate psychiatrist. There, I raised an issue of concern with the health unit nurse, who in turn shared it with the management officer, who then told my supervisor that I was “nuts.” This was not only a violation of my privacy; it reflected total ignorance on the management officer’s part of what PTSD and its symptoms are.”

“I would rate the mental health support at 3 out of 10, with 10 being the best. Working in a high-stress post that was not a “high-threat” post, my colleagues and I were given limited support in a time of crisis.”

“I am grateful for the mental health assistance available to me. If it weren’t for grief counseling, I would have qualms about seeing the RMO/P, because I’d need to disclose this in the five-yearly security update. And while that disclosure might not affect my security clearance, I still think there’s a stigma attached to the fact that I needed mental health assistance.”

“As a veteran of two priority staffing post (PSP) tours—one in Iraq (2007–2008) and the other in Afghanistan (2013–2014)—my experience with transition support has been abysmal. Just getting authorization to attend out briefings and to access mental health services was impossible.”

“I am not concerned about medical and security clearances as they relate to mental health care. Most people have seen a therapist at one time or another, and I don’t think it would affect a security clearance. But corridor reputation is a concern. Even when people need to talk to a mental health professional, they’re more worried about their corridor reputation and often won’t seek help due to the stigma of being “weak.”

“In my final post, when I had finally had enough bullying from my fourth bully boss (three of whom were DCMs and one a GS-15), I worked with the regional psychiatrist who prescribed two anti-anxiety/anti-depressants and a sleeping pill to help me cope. I sought assistance from the ombudsman, but received no help, so I resigned.”

“I had discussed my mental health with the regional psychiatrist during his visits, but he just gave me Xanax and told me panic attacks were normal. He asked me about work-related stress, but reported the results of our meetings with post leadership, contributing to my stress.”

“When State does not actively intervene in cases of abusive behavior, managers are given the impression that they have carte blanche to do whatever they want. Even if victims get mental health care afterwards, the damage has been done. From what I hear, the problem is getting worse and more widespread. It doesn’t have to be this way. Instead of sending out feel-good cables on workplace atmosphere and bullying, put policies in place that have real teeth. A zero-tolerance policy for workplace bullies, administered neutrally and enforced by D.C., would lead to an instant decrease in unacceptable behaviors and the resulting damage they cause.”

It’s No Joke

The first MED-directed mental health intervention that was provided in Tripoli after the Benghazi attacks on Sept. 11, 2012, was a video conference in April 2013, conveniently less than a week before the Director General arrived for a visit to Libya. Prior to that, the only service provided was a discussion with the nurse about “fostering resiliency” several months after the attack…hardly a useful assist.

The half-day course for those returning from hardship posts is a joke. I took it after my first (!) unaccompanied tour (UT), and both the instructor and some of the other students made fun of me for enrolling, since at the time my tour was seen as one of the “cupcake UTs,” without an active war going on outside the embassy walls. I refused to take the course after my second UT. No one from HR or my bureau asked if I’d taken it or even how I was doing after the second UT.

An RMO/P made fun of some of my coworkers in a high-stress, high-threat post that happened to be a popular destination for American tourists. He told them that they had no idea what serving in an actually difficult post was like, comparing it to the regional city where he was based. Never mind the fact that almost every person at that highly desirable but still challenging post got there via a tour in Iraq or Afghanistan.

I have neither respect for nor faith in MED’s mental health efforts. As long as MED is staffed with people who see mental health as an inconvenience, supported by State leadership (from the very top down) who barely pay lip service to mental health and a work-life balance, there’s no hope for anyone who suffers in the aftermath of an emotionally catastrophic tour abroad. At least there is solidarity among those who survived terrible times abroad.

Read in full the candid views from the filed via the Foreign Service Journal.

 

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US Mission Afghanistan Contractor Survives Taliban Car Bomb, Takes Photo, Quits Job, Goes on Reddit

Posted: 2:19 pm EDT
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On January 4, two attacks were directed at USG personnel in Afghanistan (see US Embassy Kabul: January 4 Attacks Target USG Employees at Camp Sullivan).  On January 5, the “I survived this yesterday, took a photo and then quit my job” thread went live on Reddit with user DanDalVlan, an Air Traffic Controller contractor in Afghanistan who survived the VBIED attack of a USG site near the Karzai International Airport.

He opened his Reddit thread with “Make money, they said. See the world, they said. It’ll be fun, they said.”

[–]DanDalVlan[S] 1706 points 1 day ago 

It was worth it, at first.  Even after the first attack I went through, it was worth it. After this, though? Nope. Big fucking nope. My entire room imploded around me in a surreal blur of glass and brick. If I had been standing instead of laying in bed, I wouldn’t be typing this. permalink

[–]DanDalVlan[S] 4895 points 1 day ago* 

Sorry, I forgot to put the story up. I was living at the compound that got attacked by a Taliban VBIED (Vehicle-Borne Improvised Explosive Device) that was inside of a very large truck. It rendered our compound pretty much useless. Luckily, we had no fatalities with mostly minor injuries (myself included). 

I was working as an Air Traffic Controller out there. The country of Afghanistan doesn’t have the infrastructure to control their own air traffic, so it is contracted out and I was one of those contractors.

Edit I’m editing this just to say that I’m falling behind on answering questions, but I’ll answer them as soon as I can.

2nd Edit I’m officially failing in my attempts to answer questions and reply as fast as they come in. Sorry if I have missed anyone.

3rd Edit I’ve tried replying to all the questions I could find. I’ve gotta stop now though so I can pack my dirty and glass-covered clothes and get on this flight out of here. I’ll try to respond more when I land. permalink

He was asked about how successful the Taliban has been in attempting to influence the region.

[–]DanDalVlan[S] 3171 points 1 day ago

I’ll be honest, I’m not a very good source when it comes to that type of information. We live a VERY sheltered life. We go from secure facility to secure facility, with absolutely zero time spent amongst the local nationals. Unless things like this happen, we hear about stuff at about the same pace as the rest of the world, and with the same twists and biases. Sorry I couldn’t be more help. permalink

He was asked if entertainment is imported?

[–]DanDalVlan[S] 250 points 1 day ago

Yes, luckily we were still able to get mail. I had quite the collection of board games that my friends and I would play. Then there’s internet/youtube, it’s extremely slow, but better than nothing.permalink

[–]DanDalVlan[S] 261 points 1 day ago

We had booze.I’ll just leave it at that. permalink

He was asked about his Top Ten Favorite Boardgames.

[–]DanDalVlan[S] 2 points 22 hours ago

Top 10 in no particular order: 1. Smash Up 2. Revolution 3. Catan 4. Ticket to Ride 5. Kingdom Death: Monster 6. Risk Legacy 7. Betrayal at House on the Hill 8. Rebellion 9. Munchkin 10. Dixit. I don’t usually like games that are “work together” games. They can usually just be played single player and they usually end up with one person “in charge” anyways. permalink

Another user said his relative was in Afghanistan as an air traffic controller about 5 years ago and didn’t think he ever ran into anything such as this though. permalink

[–]DanDalVlan[S] 102 points1 day ago

It’s been getting slowly worse ever since the “official” pullout last year. Usually the winter time is the quietest time since it’s very cold. This year, however, they have been unexpectedly active. permalink

One Reddit user write the question in the American public’s mind: what we are are trying to achieve in a country long known as the graveyard of empires.  “How will Afghanistan come to control their own air traffic in the future if US contractors are doing it all? Is there movement towards Afghanis ever taking it over? Is the US working towards that end, or is this about supplying Americans with jobs? I’m trying to understand what it is we’re trying to achieve there.”

[–]DanDalVlan[S] 58 points1 day ago

Short answer is yes, we are working towards that. We are currently training a handful of Afghanis. However, they have to learn English as well as all the complicated rules governing ATC. They will not be completely taking over anywhere in the foreseeable future. permalink

He was asked how close he was to the VBIED that blow up the compound”

[–]DanDalVlan[S] 150 points 1 day ago

My room was the closest room to it for our building. Probably about 200 feet.permalink

Somebody wanted to know if the bomb ruptured his ear drums?

[–]DanDalVlan[S] 26 points 23 hours ago

No, I kind of felt it coming before anything else and I opened my mouth to avoid having my eardrums pop. permalink

Another user cited a most appropriate use of this video: NSFW Lyrics

[–]DanDalVlan[S] 181 points 1 day ago

That was absolutely amazing and almost entirely accurate. The only difference being that I didn’t really have much of anything left to grab. I’m just glad I have renter’s insurance. permalink

[–]DanDalVlan[S] 122 points1 day ago

I have my ID and passport and some clothes. Everything else is pretty much toast. I’m most sad about my boardgame collection.

He was asked if it is “good pay for risking your neck?”

[–]DanDalVlan[S] 193 points1 day ago

It was before, now it’s not even close. To be clear, the pay didn’t change, my perspective did. permalink

One Reddit user says, “I haven’t seen this mentioned yet, but your still probably in shock from it all, but remember, PTSD is real. I strongly recommend, when you are ready, a therapist. Someone who you can brain dump it all out. Everyone handles near death experiences differently. I was a medic, and addict/alcoholic, and I am one of those whom never got help, and it nearly killed me. I don’t mean to impose any fear or anxiety on you, I just say from personal experience.”

[–]DanDalVlan[S] 11 points21 hours ago

That’s actually why I did this. So I could share and talk about it.permalink

The Reddit post was submitted on January 5.  It currently has 2605 comments, and 5,867 points (96% upvoted). The photo submitted in the aftermath of the attack is here.

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According to SIGAR, since 2004, FAA—primarily through the Office of the Transportation Counselor at the U.S. Embassy in Kabul—has received $56.5 million from State and USAID to train Afghan civil aviation personnel, assist the Ministry of Transport and Civil Aviation in developing its regulatory regime, and improve Kabul International Airport’s infrastructure and services. There’s more:

Due to difficulties associated with developing Afghan capacity for managing the civil aviation system, FAA officials and coalition forces concluded that effective future operation of Afghan airspace would require the development of a third-party contract for providing airspace management services. Accordingly, in 2013, FAA and coalition forces assisted MOTCA in preparing a contract that included provisions requiring the contractor to train Afghan personnel, similar to the structure of the Afghan-centric aviation security contract.
[…]
The United States planned to transition airspace management responsibilities back to the Afghans at the end of 2014, but, partly due to a lack of certified air traffic controllers, that did not occur.[…] Due to the potential for air service disruption, the Department of State funded an interim, DOD-managed contract for $29.5 million to provide the services through September 2015. If a follow-on contract is not awarded before this contract expires, the United States could be called on to fund another interim contract.

 

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Foreign Affairs Security Training Center (FASTC) Gets Some Love From Congress

Posted: 12:53 am EDT
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A section of the ‘‘Consolidated Appropriations Act, 2016’’ which became Public Law No: 114-113 on December 18, 2015 includes an item on funds available for the contentious Foreign Affairs Security Training Center (FASTC) project.

(E) Funds appropriated under this heading in this Act that are designated for Worldwide Security Protection shall continue to be made available for support of security-related training at sites in existence prior to the enactment of this Act: Provided, That in addition to such funds, up to $99,113,000 of the funds made available under this heading in this Act may be obligated for a Foreign Affairs Security Training Center (FASTC) only after the Secretary of State—

(i) submits to the appropriate congressional committees a comprehensive analysis of a minimum of three different locations for FASTC assessing the feasibility and comparing the costs and benefits of delivering training at each such location; and

(ii) notifies the appropriate congressional committees at least 15 days in advance of such obligation: Provided, That such notification shall also include a justification for any decision made by the Department of State to obligate funds for FASTC.

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