This 10th year of Daily Tech News show is made possible by you the listener Thanks to all of you including Kevin Paul Teeson and Ali Sanjabi coming up on DTNS video games are in the cloud But should you play them there? Let's find out Welcome to our special DTNS video game round table show in Los Angeles. I'm Tom Merritt in Salt Lake City I'm Scott Johnson, and I'm Roger Chang the show's pretty and we have guests today pretty excited about this We're gonna be talking about video game streaming services with the following wonderful human beings Please welcome to the show Trisha Hirschberger TV host and streamer. Hello, Trisha. Welcome to the show. Hi. It's so wonderful to be here Thank you guys for having me. We're gonna chat all the things. Yeah, we're gonna get we're gonna get into it Pretty pretty pretty hardcore here and thankfully we also have with us Max Scoville senior writer and host at IGN Welcome back Max. Hey, thanks for having me. It's good to be here. Yeah, it's good to have you as well We're gonna we're gonna dive right into this because one of the big seismic changes in Video games in the last few years is arguably the shift toward Subscription services in a lot of ways you're seeing video game companies and publishers move the direction That video did or music did Before and it's now time for video games to shine in a bunch of different ways Sometimes it's just hey I want to subscribe to all your video games and sometimes it's why don't you stream something to me and Some people are doing it through TVs other people are doing it through consoles and some people are doing it on their phones so it's all a little bit weird and We're gonna try to break down what these different services are how they work together some of our opinions on each and what you might be paying If you decide to sign up for one of them the big one out there is obviously Microsoft Xbox game pass which Features basically three flavors. There is the PC game pass There's Xbox game pass and then there's game pass ultimate if you buy PC alone or Xbox alone You're gonna pay nine bucks or 10 999 And if you want the whole thing the whole shebang and have those two ecosystems crossing over with each other and sharing saves You can pay 15 and you also gain at least their current beta version of xCloud to their game streaming service Sony has their PlayStation plus tiers Which we'll get into a little bit more detail a little bit later We'll talk about how that maybe stacks up to what Microsoft is doing as well and Nintendo switch online which just got a bump in content the other day. So that's sort of interesting There's also others like EA play. They have a $5 a month program You can pay a little more to get more services out of that Coincidentally also included in game pass a little bit of a perk for the ultimate users And then there's some side stuff like Ubisoft plus and we might even talk about g-force now and a few others The focus entirely on just a streaming model But we do live in the time of this is happening. This is going and whether or not it will be successful in the long term Well, we're gonna talk about that a little bit. First off, let's just throw it out there Trisha, do you think these services compare well to each other as currently? Constituted like do you how do you think the the Xbox? Offering with game pass and game pass ultimate stacks up to with with Sony's answer with their there, you know, they're three plus tiers The short answer is I think game pass ultimate has been doing it a little longer And therefore they do have the edge But ultimately when you're comparing game pass ultimate to Stay play say PlayStation Plus premium and I'd love to get Max's take on this I feel like they're inherently different services. So Microsoft is coming at it with the angle of you know Almost game pass is that's that is what you're buying into and the hardware itself is seen as secondary, right? So you're getting the service. That's what you're buying into hardware secondary Whereas PlayStation Plus and PlayStation Plus premium is still very much an add-on where you're someone who already has a PS4 or PS5 and you're getting this as an add-on to add to your game library get your extra perks get your discount, etc And so the two of them just inherently your different models I think that Microsoft does a much better job of letting you play on multiple different devices I know PlayStation has an app that lets you do some streaming to a PC But in my experience, it's been a bit of a mixed bag not quite as reliable Whereas, you know Microsoft that this is what this is the strategy They've been going with now for years And so they're they kind of are king of that castle if you will but again, I'd love Max's take on this I would too like this the way Microsoft works. They've got a lot of back backbone in this game They've got a lot of back end I should say and in some ways that gives them an advantage But Max do you think Sony with their offerings at least currently or at least giving a little bit of competition in the space? Are they not quite there yet? It's weird because you know Trisha to your point I think Sony's sort of been doing this longer but in a different shape like PlayStation Plus started out as a kind of Make good for the fact that originally it was free to play multiplayer online on PlayStation on PSN Whereas Xbox you had to play for Xbox gold and then when Sony started charging for that They decided to kind of throw in a few extra games a month and early on PlayStation Plus was was phenomenal You'd get you know that you'd get new games that had just come out that were just you'd get them for free with part of your You know part of your monthly fee for you know for playing online with your friends And then that sort of got copied by Microsoft with games with gold Which they're sort of slowly phasing out that lives in kind of a weird a weird spot right now But I think as far as game pass being the thing that Microsoft's really putting their way behind at the end of the day Yeah, I don't think they care where you're playing I mean they're demonstrating by that by the fact that you can you can do x-cloud on an iPhone like they're not at you Know Microsoft is they make software they make operating systems They make the the the thing you're using to engage with the hardware that it's the direct interface rather than the actual hardware itself Whereas Sony is a consumer electronics company. They want to say what a cell playstations They want to sell dual-shot controllers and you know, it's a different approach for both of those the thing that that bugs me about What happened to PlayStation Plus is they recently introduced the tier system, which I think is just It hasn't been messaged. Well, I think it's just there's a sort of you know There's the there's the classic sort of like in and out menu and then there's the 17-page like New Jersey diner menu and it's like in and out You're like I'll have that one and the other one you're like flipping through trying to choose your options And in the case of PlayStation Plus, there's a fair amount of fine print to read And to sort of figure out what you're what you're getting and the the premium tier is awesome It's got a lot of really cool stuff in there But as far as sort of you know having to sit down and be like just pull the trigger on on picking one I think game pass ultimate is a is a much sort of it's easier to bite the bullet on that one And it's also it's interesting that Microsoft is often criticized for their naming conventions You know they went from Xbox to Xbox 360 back to Xbox one and Xbox one X and then series X and series that like It's a mess and I don't know why they do it the way they do it It drives me absolutely crazy whereas Sony's like hey But if we just called these one two three four and five and it makes perfect sense to me yet on this services end Microsoft has a very simple offering if you're PC only here are those games if your Xbox only here are those games And if you're both here's this opportunity and those all make really easy sense when you see those offered in the Sony case And this is a relatively recent change over there at Sony went from being plus to these three tiered plus premium back down They're confusing you don't really know what to do and I know a lot of people they're just like well, which one's around 15 bucks I'll do that and it's the middle tier. Okay, great That'll get me most of what I want and they don't really understand that upper tier And I like what you said by the way about Microsoft sort of saying well We don't care where you play our games. We just want you to play them So they sell them on Steam they have approached Sony and Nintendo about putting some form of game pass on their devices And those people of course said no, but but it does seem like a different Movement to say well, we want services and games to be what you want from us. We don't care so much about the hardware I'll take either of you on this. Do you guys think that's the right strategy like in the long term Who who wins out in this in this different approach? I Mean I have thoughts on this and I'm probably gonna sound like a fangirl and I'm not meaning to because I Absolutely am console agnostic or platform agnostic when it comes to where I game But I do think game pass ultimate has been rocking that strategy for a while and I think it's paying off hardcore for them I think it's been real a really successful move that they went to a couple years ago And I mean I have to say, you know dropping day one Launches on game pass ultimate has been huge bringing in Bethesda offering EA play with it Like it's they're really appealing to a wide variety of gamers And I think they've brought a lot of people into the game pass ultimate ecosystem So given more time, maybe PlayStation Plus premium would you know eek that out, but I like Microsoft strategy I think it's I think being hardware agnostic for people is a smart move, especially given You know that not everyone has access to super high-end hardware So giving them still the ability to play those triple-a titles some of those more demanding titles I think it's a good move. I do too. Yeah, Max. Do you have a take on that? How do you think that'll suss out in the long run? I mean, there's a few things that we haven't had on one is that as the long list of Recently added first-party Microsoft studios like there's the whole ongoing sort of active acquisition But on top of that they've got you know Bethesda. They've got you know, they've been they've been like investing in studios Which means that they can just say hey, here's our here's our brand new game It's it's their day-and-day for your subscription fee Whereas Sony's first-party offering has always been phenomenal, but I feel like they're a little bit a little bit more I don't know They're really hesitant to give that stuff away because they still want to they still want to sell games sell some copies They very recently one of the sort of very nice guy Sony things that happened in recent memory Was if you bought a PlayStation 5 and you were a PlayStation plus subscriber out of the box You had access to like the greatest hits of ps4 games It was like you know the last of us was God of Wars all this stuff that maybe you maybe you missed If you didn't have a ps4 at all like that is it that is a hell of a bonus to sign on for And then just recently they were kind of like no we sold 30 million PlayStation 5 Maybe we don't need to do that so much and so they kind of yanked that away meanwhile You know some of the biggest games Coming out this year are going to be you know day and date on on game pass because Microsoft owns the studios that are making them. Yeah, if there's a dividing line there for me It's this it's that they've got these they're stacking third-party developers into their own teams They're getting their own you know their own kind of mega powerhouse development Behind everything they make that's a big strategy that goes long time. That's a 20-year strategy or more But not only that they are the company that says when our big game like starfield comes out Very highly anticipated game that comes out day and date on game pass You can also go buy it on steam You can play in these other places buy it on our own store if you don't want to do game pass But however you want to do it day-in-day game pass and it will always be on game pass. That is a perpetual piece of content that will never leave whereas Sony's not offering that with any of their tiers if they have a brand new game come out They'll say last of us three that comes out as a $70 product or more depending on your where you live And there is no playstation plus gets a day one They'll get it later when it kind of hits classic status. I think that's a big dividing line for them at the moment Well part of part of the reason they can do that is because microsoft is run by sachin adela Who sees it as a cloud company that makes most of their money off microsoft azure? And so they don't have to charge for every copy of windows And while they can't quite do exactly the same thing with gaming they have more flexibility To say you know what we we don't have to make every cent we can off of each one of these because this is all running in azure And people who provide the games that are going to be on these services Also probably have a good chance of running on azure. And you know what else is running on azure? Sony's services that we've contracted in so it it doesn't replace the need to make money off the gaming But it definitely gives them a little more room to maneuver Yeah, for sure Uh, let's ask this question Uh, the high price of new games. We're in a new era Everyone's sort of it's you know embracing it now. Nintendo just announced that tears of the kingdom is going to be 70 bucks We're going to have to get used to this new reality. I think for triple a games and their new price Do you think high prices in games even though, you know, they've been a little bit resistant to inflation over the over the decades Um, do you think that will help the growth of subscription services across the board? No matter who's providing it? Let's I'll throw this one over to trisha. Do you think that's a that that makes sense that I don't want to go spend 70. I'd rather spend a little bit per month and just sort of experiment I definitely do I mean like I was saying earlier when it comes to people that might not have the funds to get the super high end hardware The same thing goes with these $70 triple a titles, right? And when you think about it is, you know, if I have xbox for pc, let's say And that's $10 a month that seven months of xbox of game pass for pc That I could be getting Instead of that triple a title You know and still play that triple a title on day one and maybe if I finish it before seven months Try some other stuff for the same price. Um, I think it makes a lot of sense I think it makes it more accessible for a wider variety of people and again You know microsoft kind of bringing those people into the fold and we haven't mentioned this about playstation plus premium But to their credit and I wish I wish game pass would steal this They do the limited time trials for new games as well So for someone who might be hesitant to buy a $70 title If there is a time trial that they can test it out before they drop that 70 bones That's great too. Um, so I do think it's doing a lot for these subscription library services To be able to offer that for a more accessible price point. Yeah demos are back is the way I look at it It's back and one form or another we are happy to have demos back in our life That's one thing that bugs me about playstation plus premium is I feel like the demos It's like you're paying extra and it's it's obviously it's an added value But at the same time it's still it's still marketing like I kind of wish that that was just you know If it's the demos used to come it was like a free thing There's a cd that came with your with your magazine or whatever, but again magazines for subscription models So maybe it's just the same logic as that um, the church's point about the you know about uh Spending 70 bucks for a year and getting to play a bunch of games on xbox pc Conversely if you are horrified at the thought of paying 70 bucks for a new video game But you're a game pass ultimate subscriber and you only play starfield for three months You just paid 75 bucks for it. So it's kind of like what's the moral of the story there? Yeah, the one the one really important thing everyone I don't I feel like isn't come up enough in these discussions But the one thing I do like about game pass and to some degree what sony's offering and others is that there is a bunch of Let's call it middleware for lack of a better term But let's call it b-tier triple b titles for example that are maybe 40 or 50 dollars That used to have their own little place on shelves, but in this digital space It's not as easy to get those games in front of people and you may look at and go I don't even know what this is not an ip. I recognize not a developer. I recognize So i'm just gonna pass my gonna spend 50 bucks But under these systems I can experiment and go Ooh, I found an india. I had no idea was so good And I might actually pay for that long term somewhere else And I like a rebuy it on steam to play it on my deck or something This happens to me constantly because game pass playstation plus and so on are saying Here's some stuff that you probably aren't gonna buy So try it out and then you find these little wonderful games these little sleeper hits you never knew existed Absolutely scott some of the stuff that's come out of id at xbox is just chef's kiss and I think outside of kind of the gaming industry Uh, you know professionals and outside of the journalistic space you may not have had a chance to look at them So Right on code totally agree with you scott the best sort of like I don't know public secret Is the x or is microsoft rewards? Which gamifies trying out new games and like I have a friend who not only has been paying for his game pass subscription Through just playing game pass. He managed to rack up enough points that he bought a he bought a series s And a spare controller and it's just like it's if you play enough games and you get enough achievements It feeds it feeds back into your you know your points or whatever and it's it's wild that you can You can kind of have this sort of perpetual motion of of game pass and like sony has a A reward system, but it's all kind of like cosmetics.  I don't think any of that can actually be paid towards You know renewing your subscription, which you know again point for microsoft there Well, we want to hear where everybody in the audience falls on this sort of thing Uh subscription versus individual titles. We know you have opinions So send us your emails folks feedback at daily tech news show dot com All right, let's talk about game streaming. We mentioned xcloud, of course, which works really well Um across most of the platforms it's available on and they are still in beta But I feel like they're getting close to calling that thing 1.0 Um, but they offer users gaming without expensive hardware You don't have to have a big fancy pc or a brand new 500 console to play it Um, you don't need anything specific other than a subscription So the way it works with microsoft's uh ultimate is to let android or ios users play games Written for xbox one x and s or pc or whatever on their tablets phones and smart tvs or junkie old notebooks By the way is a great way to extend the life of your of your crappy slow notebook, but the question is Can game streaming be a serious option for gamers at least maybe Maybe the question is that time here yet or we have a way to go I know I will sometimes Use xcloud to to preview a game Play 15 minutes make a save and decide whether I want to keep playing and if I do I'll download it because I want that like on the hard drive Piece of mind the internet's not going to go out kind of thing. There's still a little bit of that in my head But I wonder if you guys, uh, you know, if you if you think max this this is this is just me being old And the the kids are going to be the same exact way, but I might be old too. So I don't I don't know I was I was completely completely doubtful of of cloud gaming Like I remember what was the one that uh Was it gone live was it online one of those those two that was that was 10 years ago and like trying it back then on Maybe even dsl. I was like this is this almost kind of works Okay, whatever and then fast forward 10 years and I was like kind of thought that that's how it would be and You know rest in peace stadia, but the first time I tried that I was like Oh like this is if you're on if you're hardwired on a fast enough connection It's the the lag is or the the difference between playing locally is pretty negligible And it's that same kind of magic moment of like the first time you watch Netflix on a browser as opposed to Getting a paper envelope with a piece of physical media in the mail You had to send back like it was it was pretty cool. And I think that it's definitely going to be a thing In if if it isn't already a thing It's gonna it's it's that's where it's going But I think the infrastructure hasn't caught up and a lot of people don't have a stable enough interconnection internet connection to really Um You know make it a sustainable option But yeah, like jumping in it into x-cloud and just sort of like You know taking a game pass game for a spin or like again If you want to be like just a real little sneak and just get those rewards very easily as opposed to having to download the games You can just you know pop them in the you know the cloud and then you know Kill three sheep or whatever it is. They're asking you to do that day and then you get the extra points there But it's it's it's fascinating. It's also um, I think it's the easiest way to play Fortnite on a mac Yeah, since they're having that whole like weird war over there I actually I wound up playing um, I played fortnight on my laptop on german hotel internet And it was it was uh preferable to playing it locally on switch It was It was neck and neck it was a little bit a little bit choppy But it was actually more manageable to play it on like a large, you know screen and yeah, I don't know It's it's I think it's cool. I think it's phenomenal. I think it's really cool Um Still not my first choice on how to play a game, but I'm happy to exist there Weird thing the the playstation 3 is so not backwards compared or so hard to Backwards compatible emulate whatever you call it that you have to you have to stream PS3 games That's the only way you can play ps3 games on a ps5. Um, which is yeah, it's you know, it's weird I want not weird. I know that that stuff was inherently kind of complicated But um, it is a little funky to think that they've got this service where you can do all these games and download them But hey, you want to play these ps3 classic titles or these psp titles Uh, they don't have any beat on there. I don't think yet, but uh, you've got to stream. I'm sorry It's the only way to do it and you just don't realize you're streaming it on microsoft Azure servers while you're doing it. Which is pretty funny Uh trecia, do you picture yourself ever feeling 100 cool with uh, just putting your hands and streaming and Putting your whole life and streaming and saying, okay, give me the games I believe that you will not have any problems or glitches for the full four hour stream I'm about to do I mean, it'd be hard for me to exist without collector's editions of stuff sitting in my house on display Um, but if we did move hypothetically to an all digital future, I love the idea of cloud gaming I love it. I feel like you're getting a great gaming experience ideally In more people's hands and more gaming for everyone makes my heart very happy. However, it's so connection dependent Um, I've had demos of various cloud gaming services over the years that have just blown my mind and been amazing And like max said is negligible to playing uh locally on your hardware And then I've had some real stinker cloud gaming experiences So it it really is so connection dependent and especially with timing dependent titles, right? So there's certain titles if there's if there's a little bit of input lag not a huge deal You can still play get a great experience if it's something like I don't know if I'm playing spirit fairer on my pc And then I've got to go somewhere else and want to pick up where I left off on my phone But then be able to come back to my pc. Totally fine. Great experience. Thank you microsoft Um, but I can't imagine trying to play like god forbid a like hi-fi rush or something that's rhythm dependent, right? And needing to have that very specific timing over cloud gaming. I don't think we're there yet I love the concept of it. I hope for a future in the next. I don't know 20 Years maybe I don't know where cloud gaming can be at the same place Or it's that premium of an experience like we have now on local hardware But uh scott you mentioned earlier being able to test out a demo Through cloud gaming, uh, and then locally download it for your more premium experience when you decide you've wanted to make that investment That's that's the sweet spot right now. I agree that that to me is is the the The middle bit we're in the middle place, right? We can't go full that way quite yet The full stadia method is not here yet or stadia would be doing gangbusters. They would have succeeded wildly in my opinion Uh, and we can't go back to what we were doing before. This is definitely a thing So I think both sony and microsoft have done a pretty good job of straddling the middle and saying Here's multiple ways to do this and we're going to let you cloud save through all of it So you're not going to lose any any hours that you spent here if you want to play it over there So that's all in place. So that's a good step and the other good step is saying Well, let's make it so that that this content is Available in any of the ways you might want to play it And we still got hard drives on our hardware and your pc still has hard drives Like we we know that you still kind of want to do this I think that's really smart for them not to try to jam it down our throats Which they kind of tried to do with the xbox one announcement Because they were already leaning this way. We're just all now embracing finally some of those ideas And they were pretty bad at presenting on this, you know, if we're gonna be honest, but It's interesting now. Do you do you see parallels trisha? If I if I was to ask you if you see any parallels between I don't know the netflix model And where we're at now. Is this netflix 2007 2008 but in gaming and we have that much growth to go through Or do you think it's not a fair comparison because we're just talking about static video versus, you know These interactive medias Well, yeah, I mean that's what I was going to do is the big difference between something like a netflix experience Is that we have to be able to give active input and the timing of that active input is important So from a you know back end tech standpoint, it's obviously very different and therefore from the consumer Experience standpoint, it's still very different. So Hopefully we'll get there. I I personally am a big netflix fan for consuming content So I hope that I hope that gaming gets to that point But amazon luna is doing it right now where you can buy the luna controller with the hopes that that will reduce about half of your input latency Um, because it's communicating directly with the service instead of having to go to your device to the service back to your device and You know through um, so I think I think that it's something everyone's aware of that's in the cloud gaming scene Um, and we'll we'll just have to see when the tech catches up with the experience that they're selling They're marketing a premium experience and I don't know that that's what people are getting at Whereas netflix is delivering a premium experience right and max we there's a There's a future in gaming that we may be not quite be able to see it I don't know if you remember what it felt like when everyone said that we would all be getting digital and forget about physical copies of Stuff with very few exceptions of you know collectors editions or something We're there and I'm all in but I remember being very resistant to this concept of I'm not going to have a disc I'm not going to have a thing to put on my shelf now. I could care less. I love how de-junked it makes my life Uh, I try to remember that when I think about these other weird ideas that we might only be streaming games one day Which seems a little insane to me today But maybe we're maybe this model happens again and we're and we're there Yeah, I mean the the fear of I think physical media enthusiasts is that one day your digital copy will just stop working Which is you know, that's a valid concern It's an even more valid concern if you're playing through a subscription because they pull stuff off of the library Or they change what's available, which is a that's a huge pain to just sort of be like Oh, I'm going to play this thing and then it's like I've had that happen with game pass where I install a ton of stuff And I'm like I just you know, it's it's just adding to the backlog What have you and then I try to load it up and it's like you have to buy this Because it's not a game pass anymore. Sure tough tough luck, buddy too bad Yeah, that's too bad because the third party stuff is mostly affected by that obviously because the first party stuff should stay in perpetuity but I think maybe that's also why microspying all these studios and really ramping up their development because they want to be able to say These are not only day-in-day game pass games But they're also not going anywhere and they're also from companies like obsidian entertainment who makes no garbage They make nothing but wonderful games and now we own them So you'll always have them, but it still happens. It'll be like spirit fair is a good example That's still on there and has been on there forever And I love that game, but I'm terrified they're going to pull it Because it's not their game. It's somebody else's so there are these caveats, right? And who knows where those go or where they take I think a great great thing to remember in when you talk about parallels is that The music streaming was considered to be something that people couldn't do I don't know if you remember e-music, but they had a situation where you could subscribe And download a certain number of tracks and they were DRM free That was the that was the big feature and then spotify came around in 2006 and people were like Yeah, but who has bandwidth to do that? You know, how are you going to listen when you're walking around?  It's all good and you can still download some tracks Locally on spotify and apple music and all the rest But you don't really think about it that often at the time that netflix launched streaming Everyone said well video is way different than music. You have to have sync between the sound of the video That that kind of lag just is going to kill it. There's no way people can do video bandwidth improved and Now people stream netflix is like trisha said a premium experience So there are different things to happen for game streaming to get that to that same point You have to reduce the latency to almost zero. You have to get rid of things like jitter and judder Uh, but those are the kind of promises that 5g and 6g make I wonder if it's the mobile internet That becomes the place that has like the really optimize low latency services that power this Whether that's it or not, whether it's 5g or 6g or something else I do think the latency there's enough motivation to get that latency down that it'll happen and and then these things are going to proliferate sure, uh Like the idea too that we might all have multiple versions of a streaming game service at one day at one point And we're less worried about the tribalism of sega versus nintendo or in this, you know In this day and age microsoft versus sony. There's a lot of tribalism around gaming. I don't have to tell anyone that I don't think but uh The idea that that people have multiple streaming services for video content say netflix disney plus and hbo max I have all three of those because there's a bunch of stuff on all three. I feel like I can't live without Do you see a future where that's the same got to have game pass got to have sony's thing And I got to have whatever nintendo's doing And whatever other players out there because how else am I going to get these exclusive games like as much as we've moved away from Less overall exclusivity, especially in the case of microsoft Maybe sony hasn't budged as much but a little bit they put stuff on pcs now and I can there's a couple of their games on xbox So maybe even they've let loose a little bit nintendo's a weird egg and they control everything that they have but But there is a future I feel like where if the infrastructure is there then we will just Like we do with these streaming movie services.   I think max you brought that up earlier But you know if you just play starfield or you just play splatoon 3 all the time You're probably not going to invest in these various different libraries If you only play fifa save that money just get ea play you're doing great But if you're someone who's a variety, you know, you like to enjoy a wide variety of games Then you it might be worth it for you to invest in the various services So I think it completely comes down to what what type of video games you enjoy Yeah, I think it's been gonna be wild when and this this does this seems like a when rather than an if When there's an option to just Just pay a subscription fee to call duty Like because there's a lot of people who that's the game they buy every year That's all it is and this next year is the first year when there isn't one coming out because they're you know It's become so much of a service like it's just patches to war zone and it's you know Uh kind of gradual updates and that's really that's the thing is kind of in tandem with Subscription services. We're also seeing games as a service Which is at a whole other a whole other arms race that's happening where it's you're you're competing for people's attention you're competing for people's time and You know, I mean you look at A whole bunch of games as service just just kind of closed up shop like, uh, I know there's rumbleverse knockout city ea killed apex mobile What have you and it's um You know, it's because you can you can only really play one game at a time and for games that are You know competitive it requires you to practice a fair amount.  You don't beat fortnight It's just you know, it keeps it gives you more and more stuff to do and you you know You try to up your stats or whatever it's it's that's That's a whole other conversation to have but I think like I don't I think people are They're always going to be people who are going to buy games in some capacity But I think we're going to see like we're maybe weirder subsubscription models come along where it's if you only want this thing Like I mean ea plus play whatever it's called is the kind of beginning of that because you know Like Call of Duty, there's a lot of people who are just there for madden or fifa and that's you know It's kind of a if they can cut out the The console maker like if you know people don't want to shell out 500 bucks for a new box to play one game And instead they can just play one game on their phone or their smart tv through an app That is money going directly to ea as opposed to any middleman or you know third party That seems kind of like a no-brainer there. Do you either uh, either you think that Mobile services has currently constituted. Anyway, apple's got it's it's a arcade subscription service which I use and Sadly, I don't use it as often as I pay for it But it's there Um google play pass, uh as well. These are these are I won't call them up and coming but they're Established services that are mobile focused and while they don't either of them Don't currently offer a streaming style service. They let you download games that are otherwise premium games Uh in apple's case, it's they're only available there Sometimes the remakes of older games that perhaps were you know cost you money in the past But you're playing them as long as you're subscribing you have access Access to those games It feels like that's smart for them to do because they need to have some skin in this game And it is the most played platform for games whether we hardcore gamers like it or not mobile is a threat I I still feels like though that's real tenuous and these other companies are going to figure out ways to dominate those platforms Curious of either of you have any we'll start with trisha any thoughts on on mobiles Um role in this moving forward I mean you really have to be into mobile gaming. I feel like to go with google play pass or apple arcade Um because again, it's that how many games do you play if you play one game all the time I don't know that you're going to want to invest in a mobile library However, uh, if you if you're an android person and all you like to play is android mobile games Then have at it. Enjoy all those games. I'm not a huge mobile gamer So I don't foresee a world where I would be paying for a variety of mobile games But you know in especially in different parts of the world Mobile games are where it's at. So max. I'm gonna hand that over to you. I don't know if you play a lot of mobile games Not not really. That's one thing. I've just it's never really clicked for me. Um, I mean It's less so than ever now that I'm not really commuting or Riding planes as much. So it's I don't know. Yeah, I've had apple arcade for a second I love that there are a handful of, you know bespoke Games that make use of the actual device you're using which is has something special to it, but Uh, yeah, I mean the mobile market is an entirely different beast I think there is definitely some there's it's kind of the the console pc market and the mobile market are kind of You know bleeding together in certain areas.  It's like this is You know now it's the fact that mobile is capable of that. It's really not I don't know what's holding it back from from doing the same stuff at this point Yeah, I think it's interesting too that the that mobile Has embraced one aspect sooner than these other services and that is a family plan of some sort or a way to get greater value out of it for more people And apple does that they include apple arcade in with their Music subscription, which also includes the news subscription. I believe whatever it is. I'm paying for every month the bundle the apple Yeah, the bundle and I think that is a bundled service is actually a really nice ad For a service I was going to get anyway, and it's costing me about the same Um consoles have been slower to do that like there are three tiers for sony's Plus now and there are multiple tiers depending on where you want to play for game pass But none of them account for Any sort of like hey do you want to do this with a household of five people? We'll make you this deal and you can all log in as these these different names and download stuff separately and have all These saves like I feel like there's an opportunity there And they haven't done it yet. Maybe the pressure isn't on I don't I don't know but that could be that could be one interesting effect of what mobile is doing If that side of it bleeds over into the console side I want to see more of that. Um microsoft I want to know one thing really badly microsoft is testing out game pass family plan The only place they're doing it is in ireland and columbia, which seems like I i'm not an expert on this stuff, but it seems like a very arbitrary territories to try this out in but I mean happy for anybody who's there who gets to take advantage of this That seems having a family plan for gaming seems like really really important Uh because you know, you don't want your little brother playing your starfield file Like you don't want that seems I gave I gave a game pass like subscription to my My nephews and there's two of them plural and I felt kind of bad about that afterwards I'm like are they going to be kicking each other's ass because one of them wants you know Mom said it's my turn on the xbox or whatever Like it's it's it's a thing and uh, that's one where area or nintendo like they're doing their own little thing in the corner They're like every month you get maybe some forgotten nes game or like finally you can play minish cap on a portable device again Uh, but they're also like yeah, you can you can share with your with your family because that's always been a family first company And I think they understand that which is very cool. Yeah, I agree I wish they understood more about how consoles and stores worked and things like that But that is a topic for a different time as well um to kind of Round things out here. I thought it might be kind of fun to pick what we would pick today So that listeners can kind of make a decision. I guess what they what we would pick in various environments So let's say we're console gamers and we are and we want to we want the best possible possible bang for our buck Obviously depends if you've already got one of these consoles that may make the decision for you But if you had to vote for the best thing and going right now Max start with you who has the best console service subscription service right now. I'm gonna say game pass You think so too trisha. Where are you at with that? Yeah, I mean it's so hard. It's so platform specific You know what types of games you like to play and where you like to play them But a game pass for xbox. I think would be the win for me as well On pc. I'm tempted to say the same although. I think g4's now is real good Uh, there's it's a strong streaming competitor. Um, I really quite like it But I also think it's very specific to a certain kind of gamer and it's a little less mainstream But even there I would probably say game pass Do you guys agree? I would say game pass ultimate over game pass for pc only because it gives you a little bit more options In case you do want to take your game on the go Like you paused it on your on your pc and you want to take it on the go or something like that I agree. I think having ultimate is the way to do any of that Plus I like both places and I spend a lot of time in both places and having all that stuff synced is If it used to feel like magic now it feels required and I don't want to ever not have it Uh, how about how about you max anything on the pc that the jumps outside of a game pass that you would recommend to listeners I'm not I'm not a huge. I don't play a lot on pc, but again game pass seems pretty solid I think depending on what you're interested in those are areas where Maybe that's where ea player ubisoft plus are You know good options to choose from like we're talking about this is ea ea play is what is it five five bucks a month Five bucks by itself and if you if game pass just includes it if you get ultimate There's also a fin dollar version of game pair of a of ea play that lets you have early access And day and date releases So they've they've got some they got a little bit of granularity there as well But I it's best use case. I believe is an add-on to game pass if I if I was to make it hard Casual gamers they run into a little bit of a different problem Although as this streaming stuff starts to converge It's less and less of a problem because even if you're casual no matter what you're playing on you You'll be able to stream from some service But I think apple arcade is a decent value if you're in that ecosystem nothing wrong with that They also make it so every one of those games has to support a controller All of them have to do cloud saves and all of them have to play on The mac The ipad and the phone So they've got you know kind of a good continuity going there if you're in that ecosystem I would also make a big Thumbs up for just about all of these options where possible on m1 or m2 max The silicon max are really running everything really well including stuff They used to run poorly on intel through steam and other services Um, so I would recommend most of what we've talked about today on those devices, especially in the case of game pass ultimate Streaming to a mac is a no-brainer. It's really really easy But if you're feeling like a casual player, you're really not sure about that android has their thing apple arcade's okay And um, you know the mac the mac, you know still not like a powerhouse game machine But it's it's a machine that is much more capable now, especially if you're getting something with the new apple apple silicon stuff in it I hope that helps somebody out there listening to today's show and having you guys on was fantastic today A big round of applause for our moderator scott johnson as well I don't know about that There we go. Well, thanks. It was an honor. I could talk about this stuff all day, of course Tom already knows that so having a chance to sit and to talk to some like-minded about it and and hopefully inform people A little more about how this is all shaping up has been a pleasure. So thank you so much for letting us do it Tom Before we go scott where can folks find more of what you do? Well, I just finished a big huge three hour episode of core last night And so I'm going to point people toward a video game podcast I do on the weekly called core You can find it at frogpants.com slash core where me and my co-host Go over all the big news and the little stuff in gaming including the things we play every week It's a big meaty show and it's a lot of fun and we make people laugh apparently So check it out and let me know what you think you can find it wherever you find your podcast Just search for core trisha hershberger a pleasure as always. Thank you again for sharing your knowledge with us Where can folks find more of what you do? Thank you for having me Tom. It's always such a good time Um, you might see my face if you follow a lot of pc gaming news pc building news That's some launch events coming up soon As well as on all the socials at that girl trish. No, I in the girls So just that grl trish and I try any day. I'm not on set hosting I really do try to stream on my twitch channel twitch.tv slash trisha hershberger So hit me up somewhere online and stay in touch fantastic max scoval. Uh, pleasure to have you back as well my friend Thanks for sharing your knowledge with us. Uh, where can folks find more of what you got going on? I'm over on ign.com. Uh, you know the various media tendrils of ign its apps and Channels and whatnot. I host a weekly playstation show called podcast beyond which exists in audio form and in video form Whichever you prefer, uh, there's considerably less Game pass worship on that show We try to say nice things about playstation plus but uh, you know, it's plenty good stuff playstation stuff to talk about these days So check that out if you're interested. Excellent. Thanks again everybody and uh, special thanks to drew tober One of our our top dtns lifetime supporters. Thank you drew for all your years of support Folks, uh, we need patrons. Uh, we we can do these special round tables because we have people who are patrons So if you're hearing this on the free feed, you've got a couple bucks a month You'd like to get some extras. Maybe things like this earlier Uh, sometimes then then they are elsewhere by all means, uh, go check out see what the free stuff is There's even some merch perks in there. You might get a hoodie. You might get a coffee mug patreon.com dtns You can also catch the show live monday through friday 4 p.m. Eastern 2100 utc find out more about that at daily tech news show Dot com slash live back tomorrow with our special monthly dtns weekend edition all about photo news We'll talk to you then This show is part of the frog pants network. Get more at frogpants.com Diamond club hopes you have enjoyed this program


Good afternoon. Welcome to the Kabul experience. As Chairman of the Mental Health Committee, may I say on behalf of the entire committee how very glad we are that you have come to this presentation. I should like to thank the many people who have been instrumental in arranging this afternoon's program. In addition to the Mental Health Committee, the Office of Medical Services, the Director General's Office, the Family Liaison Office, the Foreign Service Institute, and the International Communications Agency have all made enormous contributions, some in the form of financing, all in the form of moral support, logistics, and just plain work. Our thanks to all of you. I should like to read to you a letter we received from Mrs. Carter. Dear Betty, thank you for telling me about the Kabul experience. As you may know, the President's Commission on Mental Health, on which I served as honorary chairperson, gave high priority to the prevention of mental illness. It is clear that one of the greatest obstacles to more effective prevention efforts is our unwillingness to admit that not only do mental problems exist, but that we must begin to speak openly about them, removing the stigma so often associated with them, seeking ways to deal with them before they become serious. I commend the Mental Health Committee for its public presentation of the Kabul experience. I hope this will be about one of many steps to encourage greater awareness of mental health problems. We must acknowledge their existence and dedicate ourselves to finding new ways to prevent them. Sincerely, Rosalind Carter. May I now present our panel members here on the stage. As the Kabul experience unfolds, they in turn will introduce the other participants at Kabul who are seated in the audience. Ambassador Ted Elliott, who many of you know, was most recently our ambassador in Kabul and was instrumental in getting the program going. Dr. Pettinga, regional medical officer for the area at the time. Dr. Westmas, the first mental health expert at POST. It gives me great pleasure to present a person we all admire not only for his tireless efforts in the field of diplomacy, but also for his interest in and concern for the people who work with him throughout the State Department, Secretary of State Cyrus Vance. Betty, Ted and Mrs. Elliott, guests and State Department colleagues. I'm very pleased to be able to personally express my full support for the important work that is being done by the Mental Health Committee and by our own Family Liaison Office. I particularly want to commend all of you who have organized this program today. At the opening of the Family Liaison Office almost a year ago, I spoke of the importance I attach to meeting the needs of the entire Foreign Service family as well as the Foreign Service officer. A healthy and stable Foreign Service family is essential to the successful conduct of our responsibilities here in Washington and particularly in overseas posts which can place a strain on family life. Without strong Foreign Service families, we won't have a strong Foreign Service. I'm greatly encouraged to know that a growing number of posts have developed programs designed to raise the morale and improve the quality of life for Foreign Service families. They've been initiated in places as diverse as Tokyo, Bonn, Singapore, Rome, Kuala Lumpur, Vienna and Kabul. The Kabul experience about which you will learn today was a successful, innovative and effective experiment in improving morale at one of our most challenging posts. Kabul is a different, difficult and isolated post and many of the problems that face Foreign Service employees and their families are particularly acute there. There was an enormously high number of medical evacuations, suicides and a serious teenage drug problem. The people who creatively tackle these problems with such notable success are with us here and they will tell you what they did and how they did it. At a time of limited resources, it is essential that the many agencies representing the United States abroad work together to build the strong sense of community and the strong sense of purpose that can contribute to our overseas efforts. We must find ways to support such programs. As you learn about the Kabul experience and discuss what we can learn from it, I want to underscore that your efforts have the full and enthusiastic support of Mrs. Vance and myself and I shall do everything that I can to work with you to help in furthering this and similar programs. Thank you very much. Thank you, Mr. Secretary. I should like to say just a few words about the family liaison office. Under Janet Lloyd's leadership, it is constantly seeking ways to improve the quality of life for all of us, as the Secretary said. There are now over 30 overseas family liaison offices, many of them providing counseling or having referral services for counseling, along with the many activities for the benefit of everyone. They work closely with the regional medical officers and nurses at post. Here in Washington, flow acts as liaison between the medical and personnel divisions and the members of the family's Medevac. When the panel is finished, Dr. Haynes, Director of Mental Health Services in the Office of Medical Services State Department, will give us an update on the Kabul Regional Program and we hope to have time at the end of the presentation for a question and answer period. I should like now to turn the meeting over to our three panelists. Mr. Secretary, Mrs. Vance, Betty, I think I have to say at the outset that those of us who worked on the problems that we saw and faced in Kabul are immensely gratified at the support we received in those days from the department and we're, of course, immensely gratified by the support, Mr. Secretary, you have given this effort, by the support that this effort has gotten throughout all the foreign affairs agencies. The three of us, I think, sitting here and the many others who worked with us, both in Kabul and here in Washington in all the agencies, have to feel being here on this platform today that we got something started and I think it's something extremely helpful, extremely useful, extremely important for the Foreign Service as a whole and I'm not just talking about the State Department, I'm also talking about AID, ICA, the Peace Corps, the various defense agencies and so forth. I also want to reiterate that we panelists alone are not responsible for what happened in Kabul for the program that existed in Kabul, many other people helped us, many other people played major roles in this effort and, of course, with the exception of Frank Pettinger, many other people are going to be carrying this on in the future. Let me give you a very brief history of how the Kabul Mental Health Program got started. It begins with a conversation that Dr. Pettinger and I had in the early fall of 1973 before either of us were assigned to Kabul. We met here in the office of the desk officer for Afghanistan and we talked about some of the problems that we thought might be facing the American community, then about 600 strong, including men, women and children in Afghanistan. We thought that this was going to be a difficult experience in many ways for us as leaders in a community, in a country which is very isolated geographically and also a country where, for cultural and political reasons, the American community is, to a very great extent, isolated from the local community. The problems of isolation and claustrophobia impose special pressures on the American and the rest of the foreign community in Kabul. In addition, we were aware that there was a serious teenage drug problem. When we both arrived in the later part of the fall of 1973, we stayed in very close touch with each other. Frank Pettinger took the lead in getting a teen center started. We worked together to revise a drug abuse program for the community, which, when we arrived, was a punitive program. That is to say, anybody involved in drug abuse was, after a due number of warnings, to be expelled from the country. We found that this was not working. The children of senior officials of the mission, for some reason or other, weren't being sent home. That the program needed to be altered, and we did alter it to emphasize that a drug abuse question, a drug abuse problem, should be addressed first and foremost in the family, in the community, and with the medical services that are available, and only as a last resort, should one think about disciplinary action for the members of the family or for the employee involved. And I think it's fair to say that in the succeeding months and years, at least I cannot recall any time when I had to take disciplinary action against an employee or a family member once we got this program going. The next thing that happened was that Dr. Pettinger came to me one day and he said, you know, our problems are sufficient here that we should see if we could get a professional mental health person on our staff. And we then launched on a project to convince the medical division back here that Kabul would be an interesting post to start an experiment with a full-time mental health practitioner. And the net result was in the summer of 1974, Dr. Richard Westmas, who is a clinical psychologist, arrived on the scene. I'm going to let Dr. Pettinger and Dr. Westmas give the details of what they did. Suffice it to say that Dr. Westmas' program was such a success that by the summer of 1975 the department had decided that he should expand his activities to include foreign service posts in India, Pakistan, and elsewhere in that area of the world. He was followed himself when he left Kabul in the summer of 77 by a psychiatrist, Dr. Elmore Riggimer, who is still in Kabul, although there was some thought being given to transferring his home base from Kabul to New Delhi for transportation and political reasons. That's the brief history. Let me say just a word about the role of the ambassador in an exercise of this kind. And I think what I'm saying about the role of the ambassador applies also to the role of a DCM, to the role of an administrative counselor. Of course, it's first and foremost important for the leadership of a mission to support a program like this. And we, I think, in Kabul, the DCM, who during most of this period was Ted Kern and the administrative counselors who I see in the audience today, Paul Kelly and Don Woodward, and the chiefs of the various other elements of the mission did what we could to see that Frank Pettinger and Rich Westmas got the logistic and other support and also the support from Washington that they needed. But I think what I want to stress most particularly is how essential it is for the administrators of a mission to stay out, completely out, of the doctor-patient relationship. We, from the very beginning, Frank and Rich and I were very concerned that this program would not work if potential patients thought that their consultations with Rich Westmas were going to come to my attention or to the attention of anybody else in a position of authority in the mission. We succeeded in maintaining this confidentiality. There were occasions where Rich would feel that a certain patient, his job effectiveness or her job effectiveness was being affected by mental health problems. There were some cases where medical evacuation seemed to be a possibility. In cases like that, I was informed or the DCM was informed or the administrative counselor was informed merely of those facts. We were never brought into, we never were asked to be brought into any of the details of any of the therapy or consultations that were going, that were in progress. I might also add that my wife, who's sitting here in the front row, was also throughout this program extremely supportive, but of course she also had absolutely nothing to do with the inner workings of Rich's or Frank's work in this field other than to make it clear to the members of the community that she was wholeheartedly supportive of the effort that was being undertaken. I think this program was successful. Frank and Rich will give you some details which will support that statement. I think that this program is something which commends itself to all the agencies working abroad for the United States government. For all these agencies, the principal resource is people. And the effectiveness of our people overseas should be a paramount concern to the management of all these agencies. And of course that effectiveness is in turn affected by the health of the families of the employees. I would urge that all of us go away from this meeting today thinking about how we can use this experience in other places in the Foreign Service, how we can make resources available to carry on this work, not only in South Asia, but in the other parts of the world. After all, Americans have mental health facilities available to them at home. I think it's high time that similar facilities were available for the Foreign Service. Thank you very much. When people talk about the experience in Kabul, two questions come up so frequently. One is, do Foreign Service families really have more problems than most American families? And to that I would like to say an emphatic no. I was in practice in Michigan for many years before coming to the Foreign Service and dealt with families. And after going to Kabul, found that Americans are the same no matter where they are in the world. They did have some different stress situations that they were exposed to in Kabul that Ambassador Elliott was just speaking about. Certainly we did have parents who in their diplomatic responsibilities felt they had to go to cocktail parties and working dinner meetings and affairs at the Pakistani embassy, et cetera, four or five or six nights a week leaving their children home. Yes, that's true. But we find that also in the American businessman. Yes, we did have drug problems and they were significant, but no more so than in Muskegon, Michigan where I came from. At characteristic that was slightly different of course was the high school senior who was going to be out of the nest the following year going to a college in the States and for once being on his own and being very apprehensive about that. But we have that experience also in families back home. The other question is what happened in Kabul that was so different that you needed a psychologist there? And again, Kabul was no different from many of the other foreign posts around the world. In my last experience, I covered 41 posts in Europe and the same stresses, the same problems, the same difficulties were present in all those posts as they were in Kabul. Some slightly different of course depending on the number of parasites that were involved in a particular area but certainly families were under the same stresses and so Kabul was no different than any other post that I've had an opportunity to be acquainted with. When I first came into the department during my indoctrination here I was briefed on my responsibilities and that these would come under two main categories certainly treatment of disease as it existed but even more important was the prevention of disease or the prevention of problems before they arose. As far as treatment is concerned these were usually fairly straightforward they were not much different from a practice back home except for a few things like again parasites but prevention, this was a bit different because we had circumstances that were a little different than the usual American community at home and we looked at the different possibilities of how we could prevent some of the mental stresses from occurring and becoming significant and being transferred into physical problems. Ambassador Elliott briefed you just a moment ago about his change in the policy of drug enforcement what to do about the person who is utilizing drugs and over a period of warning would still use him should we send him home or not? No, we decided not to because all you're doing is transferring a problem to another community and you're not doing that person any serious good usually you're not doing him any benefit. We saw that there was a need for a youth center and we got many of the leaders of the community together including the Elliott's and the Curran's the head of the different missions the AID director, Vince Brown the Colonel Eliason from the DOD Jerry Werner of ICA and we got these people together on a couple of occasions presented the problem to them and they all agreed yes they thought that a youth center would be advantageous and it's surprising once you present the problem to a community where your resources come from AID provided a house and one of the people on the mission provided a car for an old car for a mechanics shop and there were some photographic equipment and another man donated his talents in that regard and so it went on and on but I must say right at the outset that unless you have good leadership for this kind of a project it's going to fall pretty much flat on its face and we had that experience the first year we had a leader in this group in the youth center that was not well qualified the following year we went to overseas schools asked them for a grant so that we could hire a person from the Mott Foundation and the University of Michigan who was trained in community projects and community leadership and it was much more successful still left many things to be desired but certainly the principle that you need a well qualified person to handle a particular project came forward very clearly and it was much more successful the second year my wife who isn't here today because she's a new grandmother and the doctor guest who was a superintendent of schools and I put on a seminar again in the preventive area this was a family involvement training seminar that I had learned a lot about from Rich Westmas in my days in Michigan this was a seminar for parents on how to improve communication in families what do you do if your youngster seems to be going off the deep end and you don't seem to have any communication with them to make any influence surprisingly we had a great response we limited it to 12 couples but we could have doubled the size of the seminar the first time and I never forget the third session when one of the mothers came back to that session saying just for face all aglow I had an hours conversation with my teenage son last night and that's the first time that's happened in two years you can imagine how good that makes you feel we also got meaningful jobs for students in the summertime and the clue there is the meaningful job if you make a job that that child does not feel as worthwhile and he's just putting in his time it's not going to be a good experience but through again the Ambassador Elliott and the A Director primarily we did find meaningful jobs for the students well we were going through these projects and once you find that you do present a listening ear and that you are available to listen to problems suddenly problems come out of the woodwork and because of these things that we had going and because of the fact that people knew that they could come to the medical unit for any kind of problem we suddenly were deluged with all kinds of problems from many different kinds of people and to the point where we felt that we needed expert advice I had taken a seminar with Rich Westmas a number of years before on this family involvement training or similar to the parent effectiveness training that many of you know about and we talked to the Ambassador and he agreed we talked to the heads of the different agencies who were going to have to support our projects financially and they all agreed that this would be a good idea and we went to the Department of State to the medical section they also thought it was an excellent idea but as usual there was an austerity program going on there were no slots and we couldn't get a man from the states to help us out fortunately Ambassador Elliott and through the admin officer who was at that time Paul Kelly and later on Don Woodward who followed Paul as admin officer and these men really are experts in finding ways around legal ways around regulations and around government agencies and they did make it possible so that we could hire a clinical psychologist in a contract basis at post it was done through the medical department they interviewed Rich they passed on his credentials and it was with their blessing that he came out and we feel that the total experience that he will elaborate on was a very much of a success one question again old timers or people who have been in the department for a long time say we did it on our own we didn't need all this extra help we were able to support ourselves and it is true we give those people credit but these days we find that when we do help people out and we do make them more efficient the Department of State is the gain in addition to the individual person and I think we could prove many times over that we were effective in maintaining the efficiency of the department a brief example before Rich Westmas came I was involved in 11 people who for one reason or another we post early an early transfer or not allowed to come back to post or medically evacuated for some kind of psychological problem after Rich was there we didn't have a single one or very few I should say including the three suicides that Betty was talking about who we kept at post who remain very effective and we think suicidal attempts are back to life in summary what are some of the factors that I see for a successful program number one as I alluded to before the mental health worker that you hire or find or arrange for has to be competent if he is a poorly qualified person the program will be a complete failure and the whole idea of a mental health program will go down the drain if you have a good man it will support itself and so from this standpoint I think any future program should have the approval of the medical department should have the approval of the person who is going to go into the field second thing you should certainly have the approval backing support by the whole community from the ambassador on down the DCM the heads of all the departments if you have two program programs who are in competition with each other I think you'll have problems in Kabul it's fortunate we had a very willing group who were willing to work together number three was also alluded to assurance that the mental health records will never become a part of the official record the doctor patient confidentiality must never be violated and this is very important to be successful and the third thing is to have an admin officer who knows the way around the ropes to allow it to be done thank you I just wanted to ask one question right now was the term man generic or could we assume that a well qualified woman might also be okay excuse me his wife isn't here today to begin by saying that it's just delightful to be back in Washington amongst old friends from Kabul and meeting new friends my wife who's in the audience today and I have been in Michigan since we left the Foreign Service last year and I should mention too we're in a small community called Cadillac my overseas experience working with a small American community has been excellent training to work in a small rural type community back home because the small community dynamics the fishbowl atmosphere knowing everyone else in their business has a lot of commonality between these two settings I'd like to answer a question that the others have already alluded to that nearly everyone who's talked with me about my experience in Afghanistan has asked and that is why Kabul the assumption is usually made in having more than its share of problems there must have been some tremendous crises going on terribly unmanageable and so on well, Kabul has its share of problems to be sure but so do other posts and as I later had a chance to visit other posts in Pakistan, India and Nepal and Bangladesh and Tehran Kabul certainly had no more than its share of problems and I don't think was any more difficult than these others what Kabul did have as you can now see very clearly was a group of people such as Patinga and Ambassador Elliott and many others who recognized mental health problems when they saw them and were not so paranoid about admitting them that they saw the need to get some help it's really impressed me especially as I've gotten together and heard more story I came in sort of halfway as you can see as to how many people it took to work together to put this program on and to make it function and I came in at a stage where success was almost guaranteed I felt because there were so many good things that had already gone on to prepare the way for what I was to do and along with the support and spade work and intelligence support at Post of course there was support from ImMed and I had very little orientation by the way going overseas perhaps some of you were in that boat too we stopped very briefly in Washington about three or four hours as I recall that was our orientation but one very important thing happened I asked Dr. Carl Neidell who at that time was the medical director about this question of confidentiality I said who in their right mind would see a psychologist if they're working for the government and he assured me that Med had no interest whatever in knowing the names or the details of the clinical work that I was doing that the only time this information would be important was if there was a medical evacuation and they would of course need the background which was fair enough so I made a plan then to keep my notes in longhand pencil they went through a shredder when I left except for a few that I referred on to my successor Dr. Rigomer but there was great cooperation in ensuring confidentiality there was also support at Post which was continuing and vigorous and the last ingredient was a number of people with problems and you need that a psychologist needs people with problems like a teacher needs students they go together well there was no lack of this there and I found no lack anywhere that I've gone and this leads to the second question that people always ask of me and that is what kind of problems did you encounter with the people overseas and I was asking myself that question too with a little bit of anxiety I wondered if my previous experience in clinical practice in Grand Rapids, Michigan would be sufficient to handle the kinds of people and their problems that I saw overseas to my relief it was I found that people are much the same Americans anyway wherever you find them the most common problems I saw in my office in Kabul, Afghanistan were not that different from the problems I saw in my office in Grand Rapids, Michigan the most common problems were depression and anxiety and marital problems in roughly that order or not much difference anyway those three types of problems I would say would account for more than half of the clinical work that I did family relation problems would occupy another good chunk and this is very typical of my practice right now the first year contract was as was already said a pilot program and my job description involved direct clinical services of psychological assessment, psychological testing and psychotherapy individual group, family, marital therapy however I found I did not do any group therapy overseas the setting in a small community like that just did not lend itself to group therapy kind of activity I did do a lot of individual and marital therapy and working with families in a therapeutic setting I also saw a number of people whose who had concerns about a spouse, a child or an employee sometimes and served in an advisory role not seeing the person who was identified as having problems but seeing people look I know this person won't go see I've talked with them about it and I'm concerned about them you know you have any suggestions how can I handle or you know how could I talk them into coming to see you I know they need to and they don't seem to be willing to so a big part of my job and I felt really the key part perhaps of my job was the clinical services area because that is where the crucial events would occur of a person either working out the problem on the spot or having to be transferred out and it occurred to me as we were putting together this program that we really were practicing something in the Kabul experience that has been learned good many years ago in World War II that it was much easier much more efficient and much more effective to treat the problems of the combat troops up near the combat zone and return them to action and effectiveness than to transfer them out deal with them in a different setting all the complications of failure dealing with strangers not understanding your original setting and all of those kinds of things and this experience in World War II led to programs in the other conflicts since that have been implemented for that many years so we're not doing something that new and it's not a great surprise that people were receptive and the program was effective by the measures that we used and part of my job I should mention is consultation with the American International School Dr. John Gist who was at that time superintendent of the school was very supportive and very eager to have us involved I worked in consultation with him and in regular weekly sessions with the school counselor I did some training programs and communication skills and helping skills with the staff and of course worked with students and then in the summers along with assisting in the coordination of the summer job program that Frank has mentioned I developed a peer counseling program for teenagers to help them communicate with each other with more effectiveness and to assist in the process of assimilation of new teenagers into the program and to attack whatever other issues related to choices in regard to drugs and behavior that came up in the course of the program this went on for all three years and with good feedback about it then another part of my job was involving community education prevention and perhaps even a better term is mental health development I like to think even a prevention term is a little bit negative you know taking care of things that might go wrong I like to think that all of us can develop to a higher level our mental health, our attitudes about ourselves, our effectiveness and communication our effectiveness in caring about other people and some of the efforts in this direction included the program that Frank mentioned the family involvement training basically a communication training program for parents the peer counseling which I've already mentioned and a marriage enrichment program for couples whose marriages are basically good but who, like all of us can have better marriages with a little attention a little practice like Charlie Brown's Christmas Tree all it needs is a little love and it'll grow more so that was another part and finally the fourth role was consultation with community organizations and community action programs such as the youth center and the teen job program I was not directly involved as an administrator in these programs more as a resource person and a backup and a support person to the program that pretty well describes the first year of our stay the second year as was mentioned I became a foreign service officer and this opportunity presented great decisions for my wife and myself and our entire family we left with the idea of spending one year and wound up spending three I'm sure that's happened to other people so you may know the kind of agonizing that we went through as we try to determine what our course should be as an individual and as family members the second two years in produced an added dimension of regional mental health consultation to Pakistan and India especially but also to Kathmandu and Dhaka and Tehran the format for this service included referrals from the regional medical officer for evaluation and sometimes for psychotherapy to the extent I could follow through on successive visits and also involve consultation to the school which would mean seeing students who are referred for psychological services workshop of some kind with the staff sometimes a meeting with parents to discuss problems and mutual concerns and consultation with the school counselor or the person serving that function not always a formal position as that program developed I saw also another need and that was instead of just visiting these posts individually to bring together representatives from these posts for regional consultation and so the last two years I was there we also had regional workshops bringing in people from the various posts that I visited sharing ideas and most of all sharing solutions I was glad to hear from Clark Slade that this program is still going on that he attended one recently in New Delhi that Dr. Rigmar is now leading and a very beneficial thing a chance to share and to compare notes I'd like to say just a word or two about evaluation of the program I'm a psychologist and trained to some extent in research and I have to say from a scientific standpoint we don't have all that great a data because it's very difficult to evaluate a program and especially to evaluate when you're doing yourself we did try to build in from the very start certain mechanisms for monitoring and evaluating the program I'll review them briefly first we had a six month report accounting for what I did how many people I saw types of problems men or women, employees or dependents etc secondly at the end of the first year we developed a consumer questionnaire asking all the people who used the services in any way to respond and evaluate the effectiveness and the helpfulness of this service and whether or not they felt it was something that should continue we also made a special point to try to get at the factor of how many medical evacuations were prevented you know it's hard to do but we got people to estimate that then the second and third year we did a questionnaire of the regional posts, a regional post questionnaire asking again the effectiveness of the program and how well it was received all of these data indicated that the program was being used and the consumers felt they were very helpful and the estimates were that yes we were indeed preventing medical evacuations my personal impressions and personal conclusions is that it is a worthwhile program that early intervention does pay off that the crisis theory indicating that when a crisis is dealt with on the spot successful resolution can be made and sometimes even a higher level of effectiveness can result rather than a diminished level that there is a great deal of security for people at post knowing that help is available I know that I was talked about a great deal in many homes, shall we see Rich Westmas about this and even though people might choose not to the knowledge that I was there I think diminished some anxiety that the final conclusion is that people working together can solve problems mental health problems do have answers that many of them if not most of them I would like to say all have satisfactory solutions that we don't have to live with them hide them and deny them and that people working together can do a great deal to improve the quality of life in overseas posts I've asked Dr. Haynes to speak as our last speaker and then we'll have our question and answer period Dr. Haynes what you've been treated to of course is really a case book study a special kind of case book study and community action the special aspects of course are that the activity began at a fairly high level if not the highest level and involved a degree of cooperation between the ambassador and the regional medical officer I am here in a obvious it seems to me way to confirm something that you all know and that is that the cobble experience is quite alive and quite well approaching about age 5 and then the second generation hands of Dr. Elmore Riggimer is also continuing to be an evolving and very lively activity you've already heard what to me in a programmatic sense is most interesting that is that what took place in cobble could not stay confined to cobble that the demands were such that it had to move out into India Pakistan and so on and so forth in the last few months I've seen cable requests for Dr. Riggimer's services in Madrid I believe Rome Tel Aviv and so on and so forth and there's a very important message it seems to me in that at this point we do have one overseas mental health expert who replaced Dr. Westmas after he came back to the states and with this one man we attempt to cover a rather broad area again from our perspective from Med's perspective from the mental health perspective we're very grateful to the cobble experience because it turns out to be a demonstration project there are obviously many many areas throughout the world where something of this type is or could be quite applicable so we are going to have and will continue to take advantage of what became started in cobble and which became regional in a very very functional sense I think it's already been mentioned that Dr. Riggimer we plan and this is ironic that we should try to take Dr. Riggimer or that position away from cobble but it's sensible from a programmatic point of view to put it in a more central place where there are more employees and dependents and youngsters and in a place where transportation is available not only for people to come to the regional mental health expert but for him to move out on the basis of the experience in cobble and also on the basis of the experience we're acquiring from our support of the social development center in Tehran which is another long story which I won't start but we did propose and we are ready to propose at any time that teams be made available overseas roughly and I must emphasize this roughly along geographic bureau lines depending on how many teams we have or might get and these teams would be composed of basically a psychiatrist a clinical psychologist and maybe at least one and maybe more psychiatric social workers this team could support one another they would not necessarily be based at the same post but they would be in communication and could provide different functions but we are currently in a highly competitive situation when it comes to obtaining positions you're all very well aware of the cuts that are presently necessary but I'm not entirely discouraged about this because I think there's multiple evidence already and we can see it all around us about departmental awareness and sensitivity to what I consider to be the human needs I like very much I like to comment on Dr. Westmas' preference for the use of mental health development rather than preventive program I like the positive aspect of that and I'd like to reaffirm it I'd like to make a brief comment on what I think are some of the major things that are a crew from a program in which there are mental health people in the field that is the intervention can take place early intervention which is always crucial with the possibility of treatment on the site and now we can talk about such things as cost-effectiveness but I don't think that's the real issue first off my impression that and I see most of them I see them all if I'm here but medical evacuation to come back which have averaged up until this year approximately 40 and this year may actually run over 50 for the calendar year but it's my impression that perhaps half at least half of these evacuations are really unnecessary there are necessary in that they could have been handled in the field or they are necessary because we're the only we have to do the evaluation you have to move the person here now there's something that happens when you medically evacuate a person I can't really tell you what it is but it's not necessarily in the person's best interest unless it's necessary by that I mean it's comparable to hospitalizing somebody unnecessarily if there is psychiatric hospitalization it's something to be avoided if possible so again I think that the what can take place in a program of this kind again I would stress the cost-effectiveness is there when you think of what it costs to pull out a family and replace a family it can run at least 50 to 100 thousand dollars in some instances but I think the issue is really a humanistic one and in that we are offering the best possible care for our own people and doing our best to see that that's accomplished thank you Dr. Hayes thank you we do have a few minutes for questions may I ask if anyone has a question if you would just stand up so the camera can catch you yes you mentioned that the problems in Cadillac, Michigan would normally not be so very different than the problems that you would find in an overseas community such as Kabul but wouldn't you serve find the differences of language the differences of religion the differences of culture and so forth creating a far greater potential for mental health breakdown than your normal community of the United States yes those are realities and they hit women I would say dependent spouses women who do not have a career job situation going whose life situation and role in the home is very different and in a culture where women are not very easily accepted in the streets that certainly does intensify the adjustment problems I would say though that at Cadillac there's a lot of people moving up from downstate and the adjustment problems that some of these people from the large cities have coming to a small community where everyone knows each other and so on they feel kind of isolated I see the same psychological reactions even though the situation is very different and it's the people and their reactions to the situations that I as a psychologist deal with you can't always change the situation many times you can't you can do something about how you handle it how you react to it we have time for one more question yes you spoke of not being able to do group work in Kabul is that because of hierarchy in the department or because of the fishbowl or some other reason it would be the the fishbowl thing of those two more people know each other see each other socially as well as in group therapy I found even in my seminars people were probably more reluctant to disclose very much personal material as compared with in the states that is one difference that I did find but on an individual basis that didn't bother I have a question of Ambassador Elliott you mentioned the involvement of parents in the planning stages my question is did you involve teenagers and if you did at what point in the planning process I think I really should ask you Frank because you were the organizer of the teen center and I think it was really Dr. Pettinger who referred to that and you might want to say a little bit more about how you got the teen center started because you of course did involve teenagers very definitely we did have the heads of the departments as we spoke about the ambassador and the head of aid and the and et cetera but at each planning session we also had four students who did have their input and who did straighten us out on many different aspects we had a lot to learn there's no doubt about it I think this was one of the reasons why the program was a success because we dealt with their needs as they saw it and this is important in fact it wouldn't have been a success any other way Rich was the services provided to Peace Corps volunteers and used by Peace Corps volunteers yes they were fairly extensively in fact Rich you know you'll be able to judge this better than I but I think Peace Corps volunteers had some special problems in a country like Afghanistan which AID and state and ICA and so forth employees did not have I don't know whether the proportion of Peace Corps volunteers but they certainly I think found this a very supportive and useful facility to that point regulations say that the medical department should not be taking care of Peace Corps but it was Ambassador Elliott's edict that he wanted the people under his jurisdiction to have the advantage and that's why we took care of them by another question yes to what extent have other nations diplomatic services expressed an interest in this or done something similar to this and is there any liaison with other governments that might want to go into this mental health program such as you've done I can't speak for any other governments I can't speak for what is a rather uniquely American enterprise in Tehran in which the department has led the way it seems to me for U.S. corporations and their people in Tehran by the establishment of an outpatient mental health clinic staff with a well-qualified psychiatrist, psychologist, psychiatric social workers international I cannot sorry I don't have any answer to that could I ask if there's anyone in the room who would like to address or answer that or give some information on that I'd like to speak to that in my experience the Americans are the only one who take care of their own the Germans in Kabul had one doctor who would cover about 15 countries the British I think now have three doctors overseas they used to have a fairly large medical program the Italians have four or five overseas as far as I understand we are actually the only country that does have programs when a C-141 comes in after one of our badly injured patients all the rest of the diplomatic community stands in awe and says my country wouldn't do that for me at this point that the Foreign Service Education and Counseling Center has received requests from foreign embassies here in Washington for help in that endeavor and that the Association of American Foreign Service Women get frequent requests from foreign embassies to liaise with various permanent matters between the women's affairs thank you very much that's for sure yes I wonder if Ambassador Elliott might give some of us who are at a lower level who have the desire to try to mobilize the demand for these services some clues on what the best way to approach our senior officials might be going knock on their doors if you don't feel you can do it alone for whatever reason get a group together go and lay it out and discuss it with them I would hope that all our ambassadors would be open enough to receive visitations of this kind if they aren't then you'll have to come back to Washington come to the Medical Division express a need for this kind of service to the Medical Division here in Washington but I certainly if you feel the need I think you should express the need and if under Secretary Reid and the other people in charge the department's resources here don't hear about these needs he's going to feel that they may not exist to the extent you think they do thank you I think that's a terribly good note to add on thank you all very very much for coming we really appreciated it your participation and your listening and let's all go out and fight the good fight thank you


Welcome, folks. We had the Dow Industries finish up 30, NASDAQ down 54, S&Ps up 3, gold contract up $4 trading at 12.85 an ounce. We had Silver Up 5 cents, $14.90 an ounce, Light Sweet Crude, flat, $63.89 a barrel, notes and bonds, they just continue on higher price, lower yield. You had the 10-year note, up 8 ticks, $123.22, 30-year up $17 at $147.16. They both look like they're setting up for higher price tomorrow. Dollar looks like it's setting up for lower price. This is the first time that we did get any movement on the way down as well as some volume on the way down. A dollar out here today, down 346 ticks, $96.138. What that does now is that it gives the dollar a failure. As it broke out of its high last Friday, came back inside it today, had some volume back inside it. Now we'll see who will get any follow-through. We haven't gotten any follow-through for a long period of time inside the dollar each and every time that has gone into lower price. What we're going to have out here tomorrow is that we have the Federal Reserve statement at 2 o'clock, news conference at 2.30, bottom line, the consensus is that it's going to be dovish. Where the dollars trading, where gold's trading, where bonds are trading, it could be more dovish than we think. Euro. Euro's trading at 112.16. What the euro did out here as the dollar went lower, the euro did get back inside its higher range. Euro rate now is trading at 112.16. Anything inside of the 111.77 gets it back inside the higher range. That's after the downdraft and it broke lower last week. NDX100 out here today, you can expect that we're going to get some movement after the futures open back up. We're going to have Apple come out with numbers and the way that Apple looks to me that's trading, I expect we're going to see lower prices out here. Apple did come down in volume today. We broke a little swing, had 38 million shares, plenty of people getting out of Apple that say, okay, I'm not going to sit around and wait for this number to come out. We're going to have a heck of a run from the lows of December. No doubt we went from $142 up to $208 last week. I suspect Apple's going to take a run down to this 184 number and right now you're at 200. We're also going to see these numbers are going to be important for the NDX100. To recap out here, we had the Dow Industries close up 38, NASDAQ down 54, SAP is up 6, come right back.