The Foreign Service Journal, January-February 2016

THE FOREIGN SERVICE JOURNAL | JANUARY-FEBRUARY 2016 21 The notion of offering any sort of mental health counseling “in house” was new, so it took some time to implement. The State Department’s current approach to mental health support took shape during the 1960s and 1970s in response to two major requirements. First, the department is mandated by 22 Code of Federal Regulations 11.1 to ensure that employees posted overseas are free of any “physical, neurological or men- tal condition of such a nature as to make it unlikely that [they] would be able to function on a worldwide basis.” To implement this, the State Department must engage a group of mental health professionals who can assess employees for problem conditions—this is the medical clearances, or administrative, side of the house. Second, the Foreign Service Act requires that the department make provision for treating medical condi- tions—including psychiat- ric illnesses—that emerge during service overseas. Because a large proportion of overseas health problems have a psychological com- ponent, mental health per- sonnel posted abroad offer a first line of support to treat employees, keep them productive and reduce the likelihood of a mental health medevac—this is the mental health services, or clinical, side of the house. From the outset, this duality of function has posed a chal- lenge to program development (e.g., funding, contractors vs. direct-hires, confidentiality issues), and it remains a source of confusion and mistrust today among the program’s principal beneficiaries, the members of the U.S. Foreign Service. Yet despite shortcomings and inadequacies at some times and in some places, the program has grown and evolved over the years in response to the ongoing need for mental health support for employees and their families serving abroad. MED’s mental health program is unique among the world’s diplomatic services. Given the continuing need and the prolif- eration of new and more flexible models of care, MHS is poised to take new and innovative steps in the near future. Substance Abuse and First Efforts During the 1960s and 1970s, the Johnson, Nixon and Carter administrations all provided significant funding for mental health care in the federal government. The State Department took advantage of this to create and expand its domestic sub- stance abuse and employee assistance programs. These pro- grams received support initially through special federal funds designated for treatment of adolescents. Subsequently, legisla- tion mandating such programs for the federal workplace gener- ally led to development of MED’s Alcohol and Drug Awareness Program as we know it today. It was the department’s first substance abuse program, established in 1966 under a non-psy- chiatrist, Dr. Benedict Lanahan, who worked with local psychia- trists to provide treatment for members of the Foreign Service and their families who suffered from alcohol abuse. In 1971, the State Department retained its first direct-hire psychiatrist to function in a clinical capacity. Frank K. Johnson, fromMilwaukee, Wisconsin, a psychiatrist specializing in treat- ing adolescents, became the Drug Abuse Program coordinator. Though based in Washington, Johnson traveled abroad, coordinat- ing his work with the Office of Overseas Schools and focusing especially on the emerging problem of substance abuse among teenagers. Much of his work took place over the telephone, but he also estab- lished a departmental “youth development team” that traveled with him overseas, dealing with children, their families and overseas schools. In 1981, Johnson told a reporter from Psychia- try News that on one particularly harrowing day he had seen 17 families between 7 a.m. and midnight. Two years after Johnson began working in the Office of Medical Services, in 1973, State hired its first full-time psycholo- gist, Clark Slade. Slade had acquired a great deal of experience working with Foreign Service families during 15 years as a consultant to the American Foreign Service Association on child and adolescent issues. Under Frank Johnson, Slade began to do casework involving short-term therapeutic interventions for members of the Foreign Service. This arrangement worked well as a means of dealing with employees and family members with all sorts of mental health and school problems. Cases requiring lengthy treatment were referred outside the department. The notion of offering any sort of mental health counseling “in house” was new, so it took some time to implement. In 1976, the State Department created a position to oversee the alcohol abuse and general mental health programs, hiring Herbert C. “Pat” Haynes, a Civil Service psychiatrist, as assistant medical