The Foreign Service Journal, January-February 2016

20 JANUARY-FEBRUARY 2016 | THE FOREIGN SERVICE JOURNAL FOCUS ON MENTAL HEALTH CARE FOR THE FOREIGN SERVICE The Evolution of State’s Mental Health Services MED’s mental health program, unique among diplomatic services, has grown and evolved over the years to address the unusual needs of Foreign Service employees and their families serving overseas. BY SAMUE L TH I E LMAN Dr. Samuel Thielman is a recently retired regional medical officer/psychiatrist for the Department of State. He was director of Mental Health Services for the Department of State from 2004 to 2006 and chief of crisis response from 2003 to 2004. He developed the depart- ment’s high-stress out-briefing program for returnees from Iraq and Afghanistan, a program that continues to be required of all returnees fromhigh-stress assignments. Dr. Thielman served in London, Frankfurt and Nairobi (two tours). He was the regional psychiatrist for East and Central Africa in Nairobi in the aftermath of the bombing of the U.S. embassies there and in Dar es Salaam. In 2011, he received the Presidential Meritorious Service Award for his work as director of Mental Health Services and his service in East Africa. This article is an abridged version of a significantly longer, fully documented history of Mental Health Services. Amajor source of information for the article is Virgil T. DeVault, The Origins and Development of the Office of Medical Services: Department of State (Department of State Publication 9277, Department and Foreign Service Series 312, 1982). The views expressed here are those of the author and do not represent any position of the U.S. Department of State. W hen kidnapped Ambassador Adolph “Spike” Dubs died during a shootout in Kabul on Feb. 14, 1979, Elmore Rigamer, the newly hired embassy psychiatrist, spent large amounts of time with members of the community helping to heal the wounds of the trauma. Rigamer’s efforts paid significant dividends to the community and the State Department. In the violent years that followed, the department began to use mental health personnel more extensively, expanding a domestic employee assistance program and developing a number of strategies to address men- tal health problems overseas. Often organizational mental health services, as well as general medical services, lie in the domain of human resources, and that is where physicians were located organizationally when the State Department’s Health Branch (as the Office of Medical Services was originally called) came into being in 1947. Interestingly, two years later, a study of the utilization of medical services overseas showed that “emotional problems” was the third-largest expense, behind surgical intervention and gastrointestinal diseases. And in 1950 the Health Branch esti- mated that 60 percent of patients who came to embassy health units were experiencing emotional rather than primary physical problems.