Table of Contents Table of Contents
Previous Page  20 / 104 Next Page
Basic version Information
Show Menu
Previous Page 20 / 104 Next Page
Page Background

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.