The Foreign Service Journal, January-February 2016

THE FOREIGN SERVICE JOURNAL | JANUARY-FEBRUARY 2016 25 plan for the response to the Iranian hostages. Ultimately, sev- eral of the hostages did, in fact, have a difficult time adjusting to life after captivity, and MED’s response reinforced the value of behavioral health services. Crises Highlight the Value of Services In the wake of the hostage crisis, the mental health program expanded further. Overseas psychiatrists viewed themselves as reducing the need for medical evacuations and as having the ability to respond to crises in ways that psychiatrists covering the world from Washington could not. The department agreed and subsequently authorized the placement of four additional psychiatrists overseas. During the 1980s, the newly organized RMO/P group faced yet another organizational challenge: the April 18, 1983, bombing of Embassy Beirut. Though the Iran hostage crisis had been a huge event, it was a situation that lent itself to advance planning, and the psychiatrists and psychologists had expended tremendous energy in plan- ning and implementing support for the hostages. The Beirut bombing was dif- ferent: It was an unexpected catastrophic disaster with serious immediate health and mental health implica- tions. The Aug. 7, 1998, bombing of the U.S. embassies in Nairobi and Dar es Salaam put the demand for mental health services on yet a new trajectory, and the invasion of Afghanistan and Iraq in the early 2000s compounded the need for sophisticated services. (The story of this latter period requires its own sepa- rate treatment.) As a result of the new pressures created by large numbers of people serving in warzones or in unaccompanied assignments, the need for mental health services in the Foreign Service is greater than ever. During the 21st century the RMO/P program has grown dramatically and now comprises some 50 licensed mental health professionals working under the umbrella of the Office of Medical Services. The overseas program relies on 24 career-appointment psychiatrists, most working in health units around the world, and five limited non-career appointment social workers in high-threat posts such as Baghdad, Kabul and Islamabad. The department’s employee assistance program, ECS, has grown to eight social workers and one psychologist, all Civil Service employees working largely on the domestic men- tal health issues of the department. The Alcohol and Drug Awareness Program, the first of MED’s mental health clinical programs, has three positions. A Unique Program The mental health program at the Department of State evolved in response to the unusual needs of the Foreign Ser- vice. The initial involvement of psychiatrists during the 1940s and 1950s was very much a Washington, D.C., phenomenon; the department used psychiatrists to treat personnel suffering from psychiatric disorders and to render opinions on issues related to clearances. The State Department drew from local psychia- trists in the Washington, D.C., area who worked as consultants to the depart- ment rather than employees until the 1970s. At that time, State hired its own mental health personnel—alcohol abuse counselors, social workers, psychologists and psychiatrists—who staff the federally mandated substance abuse and employee assistance programs. The increasing needs of stressed and distressed members of the Foreign Service during the late 1970s led to an initiative to place a Foreign Service psychiatrist overseas. Despite the fact that Foreign Service psychiatrists have proved themselves useful in a wide range of settings, the complexity of the mental health needs of employees and children in today’s Foreign Service suggests the need for considering models of care that would include a widening array of mental health providers. The department’s adaptation of psychiatry to an organiza- tional setting is unique in scope among the diplomatic services of the modern world; and whatever its faults, it represents a major commitment on the part of the United States govern- ment to the mental health care of the foreign affairs commu- nity. n Given the continuing need and the proliferation of new and more flexible models of care, MHS is poised to take new and innovative steps in the near future.