Mental Health Resources, Staff Care, Counseling Assistance, Hotlines For Furloughed Employees

Posted: 3:06 am EST

 

+ State Department Mental Health Resources

Via STATE: MED’s Employee Consultation Services (ECS) office remains open with reduced staffing during the furlough. You can reach ECS at 703-812-2257 or email MEDECS@state.gov.  We emailed MEDECS and received the following auto-response email:

Thank you for contacting our office. During this lapse in appropriation period, Employee Consultation Services (ECS) continues to provide urgent short-term counseling services for domestic and overseas staff, Family Advocacy case management, urgent consultations, and referrals. Please provide a short narrative of ‎the nature of your urgent request and one of our clinicians will correspond as soon as possible or you can reach our office during DC working hours at 703-812-2257. For other urgent requests after working hours, please contact us at 202-320-7493.

Worklife4you is also available for consultations and referral services 24/7 at 866-552-4748, worklife4you.com.

WorkLife4You (WL4Y) is a comprehensive and confidential resource and referral for employees. WL4Y specialists are accessible 24/7 by phone (1-866-552-4748) and online to provide expert guidance and referrals for a wide variety of services to help employees balance the demands of their professional and personal lives. Employees can view the services by logging into the website, www.Worlklife4You.com, with the Screen name: statedepartment and Password: infoquest. Employees will need to register individually to use the services.

+ USAID Staff Care

Via USAID Administrator Mark Green: Our colleagues who are managing the email box shutdown_info@usaid.gov briefed me that they have received several questions about whether Staff Care remains open. Yes, it does. Staff Care is available to the USAID workforce throughout the funding lapse. Staff Care does great work, and we encourage you to reach out whenever necessary. As we have heard about some of the challenges our colleagues are facing at this time, we encourage you to share this message broadly.

We encourage you and your colleagues to reach out whenever necessary to Staff Care, which will remain available throughout the lapse in appropriations. The Staff Care Call Center is open 24/7 and can be accessed through the toll-free phone number below or the website. The Staff Care Services Center in Washington, D.C., at 601 13th Street, N.W., Suite 900 South, is open for walk-ins and appointments from 9:00 a.m. to 5:00 p.m. on Monday, Wednesday, and Friday, and from 10:00 a.m. to 6:00 p.m. on Tuesday and Thursday. You may make appointments for the Staff Care Services Center through the call-center line as well.

Staff Care Services 24 Hours a Day, 7 Days a Week, 365 Days a Year
Free Phone: 877-988-7243
Direct Dial: 919-645-4960
Reverse Charge Calling: +44-0-208-987-6200 (Call your international operator and request the charges be reversed to the number listed above.)
TTY: 888-262-7848
SMS: 314-910-7728
EMail: support@usaidstaffcarecenter.net

Website: staffcare.usaid.gov
Registration code: USAID

USAID Staff Care Services Center
601 13th Street, N.W.
Suite 900 South
Washington, D.C. 20005

+Peace Corps: Personal Counseling Assistance – Employee Assistance Program

The Employee Assistance Program remains available throughout the lapse.  Feel free to contact 1-888-993-7650.

+ Washington, D.C. Behavioral Health Community-based Service Providers

You can call or visit a provider to help you make a choice. And, you can talk with a mental health counselor at our 24/7 Access Helpline 1-888-7WE-HELP to help you select the most appropriate provider. Check link for list of providers and contact info.

  • Same Day Urgent Care
    You can walk into a clinic located at 35 K Street N and be seen the same day without an appointment from 8:30 am to 3 pm. Services include assessment, counseling, psychiatric evaluation and medication management. You may be referred to a community provider for ongoing care. If you have questions, please call (202) 442-4202.

+ Alexandria VA Emergency Hotlines

If you are in a crisis and need to talk to someone, call the CrisisLink Hotline at 703.527.4077 or text “connect” to 85511 (for TTY, dial 711), or the Department of Community & Human Services Emergency Services at 703.746.3401.

+ Montgomery County Crisis Center

The Crisis Center provides crisis mental health services 24 hours a day/365 days a year.  Services are provided by telephone (240-777-4000) or in person at 1301 Piccard Drive in Rockville (no appointment needed).  Visit https://www.montgomerycountymd.gov/HHS-Program/Program.aspx?id=BHCS/BHCS24hrcrisiscenter-p204.html.

 

 

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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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Snapshot: Foreign Service Regional Medical Officers/Psychiatrists

Posted: 2:06 am EDT
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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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June Is PTSD Awareness Month — Let’s Talk Mental Health, Join Us at the Forum

Posted: 11:13 pm  EDT
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Join us at the forum today at http://forums.diplopundit.net, noon – 2pm, EST

I’ve blogged about mental health in the State Department for years now (see links below). I know that a mental health issue affecting one person is not a story of just one person.  It affects parents, spouses, children, siblings, friends; it affects the home and the workplace. It is a story of families and communities. While there is extensive support in the military community, that’s not always the case when it comes to members of the Foreign Service.

I once wrote about a former Foreign Service kid and his dad with severe PTSD. A few of you took the time to write and/or send books to the ex-FS employee incarcerated in Colorado, thank you.

I’ve written about Ron CappsRachel SchnellerCandace Faber, FSOs who came forward to share their brave struggles with all of us. There was also a senior diplomat disciplined for volatile behavior who cited PTSD, I’ve also written about Michael C. Dempsey, USAID’s first war-zone related suicide, and railed about suicide prevention resources.  The 2014 Foreign Service Grievance Board 2014 annual report says that eight of the new cases filed involved a claim that a disability, Post Traumatic Stress Disorder (PTSD), or other medical condition affected the employee performance or conduct that resulted in a separation recommendation.

With very few exceptions, people who write to this blog about mental health and PTSD do so only on background. Here are a few:

  • A State Department employee with PTSD recently told this blog that “Anyone outside of our little insular community would be appalled at the way we treat our mentally ill.”  The individual concludes with clear frustration that it “seems sometimes the only unofficially sanctioned treatment plan encouraged is to keep the commissaries well stocked with the adult beverage of your choice.” 
  • Another one whose PTSD claim from service at a PRT in Iraq languished at OWCP said, “I can assure you that OER and State Med have been nothing but obstructions… as a vet, I have been treated at VA for the past ten months, else I would have killed myself long ago.”
  • Still another one writes: “VA indicates the average time between trauma and treatment-seeking is eight years. The longer it is undiagnosed and treated, the more difficult to ameliorate. I have a formal diagnosis from VA but could not even get the name of a competent psychiatrist from DoS. The bulk of DoS PTSD claims are still a few years away (2008/2009 PLUS 8), with no competent preparation or process.”
  • A friend of a State employee wrote that her DOS friend was “deployed/assigned to a  war-torn country not too long ago for a year. Came back with PTSD and  was forced by superiors to return to very stressful/high pressure work  duties while also seeking medical attention for an undiagnosed then, but eventually diagnosed (took about 6 months) disease  triggered by environmental conditions where s/he was last posted.”
  • Another FSO said, “I actually thought State did a decent job with my PTSD. After I was subject to an attack in Kabul, the social worker at post was readily available and helpful. He indicated I could depart post immediately if I needed to (and many did after the attack). When I departed post I was screened for PTSD and referred to MED here in DC. After a few sessions here with MED, I was referred to a private psychologist who fixed things up in a few months.”
  • One FSO who suffered from PTSD assured us that “State has come a very long way since 2005” and that it has made remarkable progress for an institution. Her concerns is that PTSD is widespread in the Department in the sense that people develop it in a wide range of posts and assignments. She cited consular officers in particular, who evacuate people from natural disasters and civil wars and deal with death cases on a regular basis, and are particularly at risk.

 

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June is PTSD Awareness Month. We are hosting a forum at http://forums.diplopundit.net for an open discussion on PTSD.

It’s not everyday that we get a chance to ask questions from somebody with post traumatic stress disorder. On Monday, June 29, FSO Rachel Schneller will join the forum and answer readers’ questions  based on her personal experience with PTSD.  She will be at this blog’s forum from noon to 2 pm EST. She will join the forum in her personal capacity, with her own views and not as a representative of the State Department or the U.S. Government.  She’s doing this as a volunteer, and we appreciate her time and effort in obtaining official permission and  joining us to help spread PTSD awareness. Please feel free to post your questions here.

Rachel Schneller joined the Foreign Service in 2001. Following a tour in Iraq 2005-6, she was diagnosed with PTSD. Her efforts to highlight the needs of Foreign Service Officers returning from tours in war zones helped prompt a number of changes in the State Department, for which she was awarded the 2008 Rivkin Award for Constructive Dissent.

Prior to joining the U.S. Department of State, Rachel served as a Peace Corps volunteer in Mali from 1996-98. She earned her MA from the Johns Hopkins School of Advanced International Studies (SAIS) in 2001. We have previously featured Rachel in this blog here, and here.

The forum, specifically created for PTSD discussion is setup as an “open” forum at this time; readers may post questions without registration.  We’re hosting, same Privacy Policy apply.

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

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

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

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

Former Foreign Service Kid Writes About Dad With Severe PTSD  (Many thanks to readers who took the time to write and send books to Tony Gooch! We appreciate your kindness).

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

Rachel Schneller | PTSD: The Best Thing that Ever Happened to Me

Senior Diplomat Disciplined for Volatile Behavior Cites PTSD in Grievance Case, Fails

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

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

Ambassador Crocker Arrested for Hit and Run and DUI in Spokane

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

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

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

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

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

Join the Petition: Revised Q21 for the Foreign Service

State Dept’s WarZone Deployment Incentives, Programs, Training and Medical Support

DMW: Mental Health Treatment Still a Security Clearance Issue at State Department

Insider Quote: Returning to the Real World

What’s State Doing with Question 21?

 

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

 

 

* * *

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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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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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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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 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 —

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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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