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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


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