@StateDept’s Blackhole of Pain Inside the Bureau of Medical Services (MED)

Posted: 12:46 am  PT

 

We previously blogged about the ongoing problems encountered by Foreign Service families with special needs children when dealing with the State Department’s Bureau of Medical Services (MED) (see @StateDept’s Mental Health Services Drive Employees with Special Needs #FSKids Nuts).  Note that as employees prepare for the summer job rotation, MED will be reviewing the medical clearances of employees and family members in preparation for their transfer.  Whatever is the number that is now stuck in MED’s labyrinth, expect that number to go up with the upcoming rotations as kids with special needs are snared in the system that is supposed to help but instead has caused so much disruption and pain.

We understand that medical clearance decisions can be appealed to a panel of three doctors. But we’ve been informed that one of the three in this review panel is the reviewing officer of the the other two. We’d like to know how many cases that come before this review panel are decided in complete agreement by all panel members, and how many cases are decided by the two panel members against the decision of the third panel member/rating official? Perhaps something for the congressional oversight panels to look into? Or something to FOIA if this is going the class action route.

Congress should also look into State’s Medical Services perspective on risk. Would it surprise us all if State/MED doesn’t want to take any? State/MED’s mission is “to safeguard and promote the health and well-being of America’s diplomatic community.”  Does that mean keep everyone with the slightest issue inside the United States instead of sending them on overseas assignments? Bad things can happen just the same in the United States – but of course, MED won’t be responsible when employees are on domestic assignments. It is responsible once employees/family members are overseas. So again, what is State/MED’s perspective on risk, and how much does this inform its decision on the medical clearances issued to FS employees, spouses and their kids?

FP’s Robbie Gramer recently had a lengthy piece on FS families in State’s medical labyrinth. It is quite a read, and don’t miss the quotes.

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@StateDept’s Mental Health Services Drive Employees with Special Needs #FSKids Nuts

Posted: 12:26 pm ET

 

The Department of Defense Education Activity (DoDEA) operates 168 schools in 8 districts located in 11 foreign countries, seven states, Guam, and Puerto Rico. All schools within DoDEA are fully accredited by U.S. accreditation agencies. Approximately 8,700 educators serve more than 73,000 DoDEA students. This is what it says on special education:

Special education is specially designed instruction, support, and services provided to students with an identified disability requiring an individually designed instructional program to meet their unique learning needs. The purpose of special education is to enable students to successfully develop to their fullest potential by providing a free appropriate public education in compliance with the Individuals with Disabilities Education Act (IDEA) as implemented by DoD Instruction 1342.12, “Provision of Early Intervention and Special Education Services to Eligible DoD Dependents.”

In DoDEA, special education and related services are available to eligible students, ages 3 through 21 years of age. To be eligible for special education: the child must have an identified disability; the disability must adversely (negatively) affect the child’s educational performance; and the child must require a specially designed instructional program. DoDEA recognizes clearly defined categories of disabilities with specific criteria for determining eligibility such as physical, communication, emotional and learning impairment, and development delay.

The State Department does not have its own schools so Foreign Service children go to local schools and avail of local school services. Is the State Department required to meet the requirements of the Individuals with Disabilities Education Improvement Act (IDEIA) with regard to the education of special needs children overseas? Here is what state.gov says:

No. The Individuals with Disabilities Education Act (IDEA) and its 2004 reauthorization, the Individuals with Disabilities Education Improvement Act (IDEIA), are federal funding laws ensuring a free and appropriate education to children with disabilities in the United States. IDEA/IDEIA governs how states and public agencies provide early intervention, special education and related services to eligible children and youth. While existing law does not require DOS to replicate what a public school would provide to a student in the United States, our goal is to approximate what a child would receive in a good US public school system. Per the Overseas Differentials and Allowances Act and the Department of State Standard Regulations (DSSR), the IDEA/IDEIA framework is the basis for the allowable reimbursable services for the Special Needs Education Allowance (SNEA). DOS is committed to assisting employees in meeting the necessary expenses incurred when deployed overseas in providing adequate education for their school-age children. The education allowances are designed to assist parents in defraying those costs necessary to obtain educational services which are ordinarily provided free of charge by public schools in the United States.

Prior to 2013, we understand that the State department took a flexible, supportive approach that ensures support for dependents while creating maximum flexibility for Foreign Service employees to serve overseas. In October 2013, SNEA management was switched to the then newly created Child and Family Programs (CFP).

The Department’s Standardized Regulations or DSSR was also amended to state that “There must be a formal Individual Education Plan (IEP) or equivalent prepared by a professional medical or educational expert which delineates the educational services required to provide for the child’s special needs.  Reimbursement may only be for those services provided for in the IEP which are actually required, as opposed to those services which a parent or school may recommend as desirable.”

Between 2013 and early 2017, we were informed that “SNEA benefits are reined back dramatically.”  Previously authorized uses were  either denied or dramatically restricted.  One parent told us, “No explanations or justifications are provided for the change in policy despite many requests.  At the same time, parents are increasingly challenged by CFP staff, often rudely, about the way in which they plan to educate their children overseas.”  A direct suggestion that the parent curtail his/her assignment was not unheard of.

That suggestion may become more real for parents of approximately 1400 special needs children in the Foreign Service. We understand that in spring 2017, the Office of Allowances formally ruled that 1) based on DSSR language the only dependents who can receive SNEA are those specifically given a MED clearance that allows them to reside full time at post; and 2) No other clearance is sufficient (such as a Class 6 that allows for a child to reside at post outside of the school year in a boarding school situation).

What was the result of this official determination? Apparently, MED started “aggressively” issuing Class 5 clearances to children with educational, mental health and other disabilities even though there are many/many overseas posts where services have been and could be provided to successfully support such children.  It was reported to us that when challenged, MED doesn’t back down, claiming that their decisions are in the best interests of the child since “everyone knows” that only the “mildest” of special needs can be met in an overseas school situation.

Class 5 medical clearance means  domestic only assignment and it is supposedly issued “to those with complex medical conditions.”

For the FS employees with approximately 1400 special needs kids, a Class 5 medical clearance for a family members potentially means 1) DC/domestic assignments for the foreseeable future only; 2) an overseas assignment that leaves the family at home on a voluntary separation, or 3) back to back to back unaccompanied assignment to priority posts while the family stays behind in the United States on a voluntary separation.  We understand that not all these kids are given Class 5 clearance now but as their clearance gets reviewed, families anticipate that the numbers will continue to grow.

“It appears that any child deemed to have “moderate to severe” needs is being given a Class 5 at the time a MED clearance review is triggered.”

When we inquire about potential issues with the SNEA funds, our source speaking on background told us that SNEA has “always been under the administration of MED, and SNEA spending could only be reimbursed after approval by MED authorities.”  We were told that previously, in some cases SNEA was allowed to be used “for therapies that some would argue were either non-traditional or perhaps not fully established as effective” so the source said it is understandable to see the need to standardize the application of SNEA when the Child and Family Programs (CFP) was created and took over management of SNEA. But the source also said “it doesn’t explain the inflexibility CFP staff have employed since” when dealing with families with special needs FS kids.

Who’s doing this and why? Families are pointing at the MED/MHS (Mental Health Services), which oversees the Child and Family Programs (CFP) in the State Department’s MED org chart.  That office is headed by Dr. Kathy Gallardo, the former Deputy Director and now Director in MED/MHS. She reports to Dr. Charles Rosenfarb who is currently the Medical Director of the Bureau of Medical Services. Dr. Rosenfarb reports to the Under Secretary of Management, an office that sits currently vacant and is overseen by the “M Coordinator” and Acting DGHR Bill Todd, who in turn reports to somebody inside Secretary Tillerson’s 7th Floor bubble.

As to why? Well, no one seems exactly sure why. The State Department does not talk to this blog anymore for juvenile reasons but we cannot overlook the elephant in the room. The State Department is looking to cut cost across the board. We expect that it will be looking at everything and inside every cupboard to come up with its desired 37% cuts.  How many families will endure the separation with employees deploying overseas, and families staying behind because their special needs children are not authorized to be overseas?  Last year, Bloomberg  reported that Secretary Tillerson was seeking a 9% cut in State Department staffing with majority of the job cuts, about 1,700, through attrition, while the remaining 600 will be done via buyouts.

So in the case of the special needs FS kids, the State Department is potentially hitting two birds with one big rock? Anyone at State/MED wants to chat, we’re happy to talk and update this post.

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@StateDept Diplomat: Why would any woman in her right mind choose to report harassment? See me? #MeToo

Posted: 1:31 am ET

 

The following came to us from a Foreign Service Officer who said she is in the middle of an Equal Employment Opportunity (EEO) complaint, has already waited 16 months to get her appeal heard, and now, could face firing from the State Department.  We are republishing below the entire text:

#MeToo In the wake of the Weinstein allegations and the blessed floodgates they have opened, many people have asked why more women don’t report sexual harassment and assault, and called upon women to do so in order to out the harassers and protect other women from them. I offer my story fighting harassment and bullying at the U.S. Department of State as an example of the huge cost women can pay when they have the courage to take a stand. It is a story of a system that is designed to silence and indeed, punish those who come forward, while protecting the institution and the abusers at all costs.

I have served as a dedicated and decorated Foreign Service officer in the Department of State since May 2011 when I left my practice as a litigation attorney to serve my country. My first tour was in Port-au-Prince, Haiti where I worked with the Haitian parliament and political parties to improve their electoral system, including supporting women seeking and serving in elected office, as well as strengthening the rule of law, improving democratic processes, and protecting human rights. I was awarded the Department of State’s Meritorious Honor Award for my work advancing women’s rights in Haiti in 2013, called a “rising star” by my supervisors, and recommended for immediate tenure and promotion. On the strength of those recommendations, I was tenured on my first try in the fall of 2014 after only serving one overseas assignment – a rarity in the Foreign Service.

In early 2015 I was sent to a small Consulate in Latin America to serve as a vice consul adjudicating visas for my second tour. I eagerly threw myself into my new work. After less than 120 days, in May 2015 the Department of State medically evacuated me back to the United States and curtailed my assignment. Why? Because I was suffering from severe physical and mental health issues stemming from a months-long concerted campaign to harass, bully, and intimidate me on the basis of my gender. I filed an Equal Employment Opportunity (EEO) complaint with the Department of State, returned to Washington, D.C. and tried to move on with my life professionally and personally.

Little did I know the harassment, bullying, intimidation, and retaliation had only just begun. Over the course of the summer and fall of 2015 the individuals I had filed my EEO complaint against engaged in numerous acts of retaliation against me, including writing and filing a false, defamatory, negative performance review which to this day remains in my official employment file and has led to the complete ruin of my career at the Department of State. They also spread vicious, false, and defamatory rumors about me, stating that I had been forced to leave Post because I was having an affair with a married American working at the Consulate – an absolute falsehood. Finally, they refused to ship home all of my personal belongings that I had had to leave behind when I was quickly evacuated from the Consulate. After months of delay, all of my things arrived in D.C. covered in toxic mold – tens of thousands of dollars of personal property and memories destroyed. I filed an amended EEO complaint alleging that these actions were all taken in retaliation for filing my first EEO complaint and retained an attorney.

The Department assigned my case to an outside investigator in early 2016. I submitted hundreds of pages of affidavits, briefs, and exhibits detailing the harassment and bullying as well as the concerted and ongoing campaign of retaliation against me. The six individuals I accused submitted virtually identical and brief statements categorically denying all of my allegations and offering absolutely zero corroborating evidence. The investigator failed to interview any of the additional witnesses we proffered and issued a brief report denying my claims and failing to include or address much of the evidence I had proffered.

In July of 2016 I filed an appeal with the U.S. Equal Employment Opportunity Commission and was told by my attorney that it would be at least six to nine months before an administrative judge was assigned to my case due to the backlog of EEOC complaints and lack of sufficient resources to timely adjudicate them. After 16 months, an administrative judge was finally assigned to my appeal at the end of October 2017. But it is likely too late for her to help me.

In the intervening time, the State Department has refused to remove the false, negative, defamatory performance review filed in retaliation against me from my official performance file – stating that they could not do so unless and until ordered by a judge. I have been up for promotion two times since that review was placed in my file in November of 2015. Each time the promotion boards have denied me promotion and issued a letter stating that I was “low-ranked” in the bottom two percent of officers in my grade and cone. As explanation, each letter quoted extensively from the 2015 false, negative, defamatory review filed in retaliation for my EEO complaint, citing this review as the reason for my low ranking.

On November 8, I received notification that because of these consecutive low-rankings I had been referred for “selection out” of the Foreign Service, a polite way of saying I had been referred to a Board for firing. That Board will meet sometime before the end of 2017 and decide whether or not to fire me. The rules state that the Board will not accept any additional evidence or witness testimony and will make its decision instead based solely on my written performance file which includes the false, negative, defamatory, review filed in 2015 in retaliation for my EEO complaint.

By contrast, every individual I accused in my EEO complaint has been promoted and continues to serve at increasingly high ranks in the Foreign Service. They have faced absolutely zero consequences for their unlawful harassment, bullying, and retaliation against me – while I have suffered greatly for coming forward and reporting their unlawful actions and am about to pay the ultimate price: the loss of my job and livelihood.

I followed the rules. I worked within the system to come forward and report the harassment, bullying, and retaliation I have faced and continue to face. I continued to serve my country and work hard to represent the United States throughout this time. In fact, I have continued to receive awards for my work – most recently in September 2017. Yet I have paid and continue to pay dearly for my decision to come forward. So to those who ask why more women don’t come forward, I ask “why would any woman in her right mind choose to report harassment in the workplace when this is the result?”

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Foggy Bottom Rambles: Remaining resilient in the face of uncertainty

Posted: 1:06 am ET
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The following is from the Center of Excellence in Foreign Affairs Resilience posted on the Foggy Bottom Rambles, the blog for unaccompanied tours (UT) employees and family members:

These are uncertain times for foreign affairs professionals. Much of our foreign policy is unclear or changing dramatically. There is a hiring freeze across the federal government impacting family member employment and making it harder to get the job done in understaffed offices and overseas posts. We face potentially severe budget cuts. The more resilient we are, the easier it is to be flexible and adaptable in times of uncertainty and stress. We are more likely to collaborate with others to find innovative solutions to the problems uncertainty brings to the workplace. This is why it is critically important to focus on building or maintaining high resilience during these uncertain times. Here are some tips on how you can enhance your resilience during this challenging period.

The Man and the Expanding Universe Fountain, by Marshall Fredericks, inside the South Court of the Department of State Headquarters (Harry S. Truman Building), Washington, D.C. (Photo by G0T0, Wikimedia Commons)

Take care of yourself: Prioritize taking care of yourself and carve out time on your calendar for recovery, whether it’s taking a 10 minute walk every afternoon, joining friends for lunch, or cooking yourself a healthy meal after work. Resist the temptation to just work longer and harder since this will actually reduce productivity in the long run. Minimize alcohol and ensure you get 7-8 hours of sleep.

Focus on what you can control: Identify what you can control, influence, and not control. Use active problem solving to take more control over important issues. For example, if you feel like you cannot control your work load, practice saying no and setting boundaries to give yourself more control. Develop strategies to influence issues that are important to you and try to stop thinking about concerns outside of your control.

Maintain meaning and purpose: Remind yourself why you work in foreign affairs and explore what you need to stay passionate and committed to the work you do. Look for meaning and purpose outside of work through volunteerism, hobbies, family, and spirituality. Explore your alternatives if you no longer find meaning and purpose at work.

Practice reframing: Look for the positive aspects of challenges you face. If your budget is cut, what are the potential positive outcomes? If you have fewer staff, how can you turn this challenge into an opportunity?

Seek social support: One of the most important ways we enhance our resilience is to spend time with other people. Invite colleagues to lunch and commit to spending more time with family and friends.

Laugh: Watch more funny movies and television shows, listen to funny podcasts, spend more time with friends and colleagues who make you laugh.

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How are you dealing with Foggy Bottom’s bad jujus?

Posted: 2:45 am ET
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How are you dealing with the bad vibes, and negative energy in the Foggiest Bottom these days?  We don’t care what a billionaire says, but health is wealth, so guard it fiercely and faithfully. Will the Deployment Stress Management Program soon include employees on domestic assignments? That is, until that gets gutted, too.  Sigh! If you have coping strategies you want to share, contact us via our Foggy Bottom nightingale line.

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From Someone Who Has Unfortunately Been There: Sexual Assault Trauma Triage in the Foreign Service

Posted: 1:51 am ET
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In response to our post — First Person: I am a ✂️ FSO who was ✂️ raped in ✂️… Continuing on has been ✂️ incredibly difficult…, we received the following from a Foreign Service member who does not want to be identified but sent a note that says “here are some suggestions for sexual assault trauma triage in the FS, from someone who has unfortunately been there.”  

1. Reach out to someone outside of DOS for support, like friends and family back home whose discretion you trust. There is so much shame involved in sexual assault, but you do not have to go through this alone.

2. Find a therapist (PhD preferable). Sexual assault survivors report the most improvement with Cognitive Processing Therapy (CPT) and EMDR (you’ll likely have to do this domestically). If you can’t find a CPT sexual assault specialist, try going to your closest VA hospital’s website and look for one there. Reach out to her and ask for a private practice referral for sexual assault in a military-like service. Since you’re overseas, you may be able to find a private CPT specialist who does Skype/telephone. Be prepared to pay out-of-pocket, and it won’t be cheap. And speaking of costs: CPT for sexual assault may be the most psychologically taxing thing you’ve ever done, but it is worth it. I promise.

3. Consider a medical curtailment to get yourself out of the situation immediately. The only department that I trust at DOS is MED. Fill out a MED update form, and note the questions on what should be the second page (related to PTSD). Check whichever boxes are relevant to you. You can also write down there what happened to you—something as simple as “Sexual assault at Post” will suffice. They will have a psychiatrist reach out to you—and you can request a female psychiatrist. If they don’t immediately contact you, start calling twice a day until you get what you need. Depending on your symptoms, you may qualify for a Limited Class 2, but if you need to be back in the U.S. for intensive counseling (and there is no shame in doing so, your well-being is the priority), they can work with you on getting you a Class 4 so that therapy can happen domestically.

4. FSO Friend who wrote in: I know that curtailment can seem like he wins. But this is emergency triage, and you may need to retreat to a place of safety (far away from him) until you have healed enough to decide your next steps. This is a “put on your oxygen mask before attempting to help others” level-situation. Please don’t be ashamed of curtailment if that is what you need to do for you. You are the priority right now. Please don’t tough it out and expose yourself to further harm–including the psychological trauma of being around him regularly. And please don’t suffer in silence. Out of all of the organizations at DOS that claim that they can help, I believe that MED actually can help you. Please use MED if it’s appropriate for you.

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This is one person’s suggestions based on her experience and perspective and we’re passing this along for consideration. Since the sender did not provide a return email, we have not been able to ask follow-up questions. We have to respect that this is all that she is able to share at this time. She reached out to this blog out of concern for the FSO who was raped.  We will leave this up to you to consider which of her suggestions may be worth exploring depending on what feels appropriate in your case.

Read more about Cognitive Processing Therapy (CPT) (PDF).

Read here on the Eye Movement Desensitization and Reprocessing (EMDR).

Curtailment is the shortening an employee’s tour of duty from his or her assignment.  It may include the employee’s immediate departure from a bureau or post, or from assignments in the U.S.  3 FAM 2440 says that curtailment is an assignment action, not a disciplinary one. Folks, of course, know that in real life that’s not always true.

Please note that 3 FAM 2444 allows an employee assigned within the United States to request voluntary curtailment of his or her tour of duty for any reason “by submitting the request and an explanatory memorandum to the assignments panel via his or her counseling and assignments officer. The bureau of assignment must state its support for or opposition to the employee’s request.”  What happens if one is a sexual assault victim in a domestic assignment or while on extended TDY or on training and have to go through this to get curtailed from an assignment where the perpetrator is also located? Imagine this happening to an untenured employee. What  does one write in the explanatory memo — I was raped, and I need to curtail my assignment because my attacker is right next door? How many folks will get to see that memo? Something for the new State Department task force to think about.

We should add that another FS member’s medical clearance was downgraded to a Domestic only (Class 5)  after reporting to MED.  12 FAM 210 notes that Class 5 is issued to all who have a medical condition which is incapacitating or for which specialized medical care is best obtained in the United States.  Employees or eligible family members with a Class 5 medical clearance may not be assigned outside the United States.  So right there, that’s really scary stuff for Foreign Service folks.

On November 22, the State Department directed a task force to create a new Foreign Service Manual section for sexual assault (see U/S For Management Directs Task Force to Create New Sexual Assault FAM Guidance).

 

Sexual Assault Related posts:

 

 

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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#WorldMentalHealthDay: Living with a Black Dog

Posted: 1:25 pm PDT
[twitter-follow screen_name=’Diplopundit’ ]

 

Saturday 10 October is World Mental Health Day, hosted by the World Federation of Mental Health.  According to the World Health Organization (WHO), there are more than 800,000 deaths by suicide each year – more than 41,000 of them in the United States.  To help mark WMHD2015, we’re sharing a collection of links below; by understanding the illness, we can help erode the stigma and relate to those who suffer with understanding, and compassion.

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We also did one forum in June on PTSD, check it out here.

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Snapshot: Foreign Service Regional Medical Officers/Psychiatrists

Posted: 2:06 am EDT
[twitter-follow screen_name=’Diplopundit’ ]

According to a job announcement posted earlier this year, there are Foreign Service Regional Medical Officers/Psychiatrists assigned at the following locations:

  • Accra
  • Amman
  • Athens
  • Bangkok
  • Beijing
  • Bogota
  • Cairo
  • Dakar
  • Frankfurt
  • Jakarta
  • Lima
  • London
  • Manama
  • Mexico City
  • Moscow
  • Nairobi
  • New Delhi
  • Pretoria
  • Tokyo
  • Vienna
  • District of Columbia

RMO/Ps also serve on temporary duty in high threat locations (e.g., Afghanistan, Iraq, Libya, Pakistan and Yemen etc.) and in post-disaster environments (e.g., post-earthquake Haiti, etc).  The U.S. embassies in Libya and Yemen are currently on suspended operations, and temporarily located in Tunisia and Saudi Arabia respectively.

The latest available data on FS skills group published via afsa.org in 2013 indicates that the State Department has 24 psychiatrists and 4 mental health specialists. There are 275 overseas posts. As of 2014, there are 13,801 employees (FSOs – 8,042; Specialist – 5,759) and 11,701 adult family members overseas according to an April 2015 FLO data; a total FS population overseas of 25,202.  If we include the Civil Service employees and the locally employed staff, the State Department has a total workforce of 71,782. Let’s try and do the math.

— That’s one psychiatrist/mental health specialist for every 492 Foreign Service employees.

— Or one psychiatrist/mental health specialist for every 900 FS employees and family members.

— Or one psychiatrist/mental health specialist covering at least nine diplomatic/consular posts overseas.

— Or one psychiatrist/mental health specialist for every 2,562 State Department employees domestic and overseas.

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