THE FOREIGN SERVICE JOURNAL
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-
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.
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
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