THE FOREIGN SERVICE JOURNAL
director for Mental Health
Services. Haynes worked
at developing a coherent
program that relied more
on direct-hire mental health
staff than on contractors.
Haynes also hired a psy-
chologist, Dr. Samuel Kar-
son, whose particular skills
and extensive experience
in personality testing were
well-suited to the depart-
ment’s growing need for experts in clearances in the 1980s.
(From the 1950s to the mid-1970s, the clinical backbone of the
department’s mental health clearance section had been a group
of six private-practice psychiatrists fromWashington who came
into the department for an hour once a week to do evaluations
for the Office of Medical Services.)
The Field Mental Health Officer
During the 1970s, another innovation in the use of overseas
mental health personnel occurred that ultimately resulted in
the regional medical officer/psychiatrist (RMO/P) program.
Specifically, in 1974 Embassy Kabul decided to deal with a
rash of mental health crises (including three suicide attempts)
by using post funds to hire a psychologist, Dr. Richard West-
maas, as a personal services contractor to establish a practice
at the embassy. His work was so helpful that the department
employed him as a direct-hire Foreign Service employee and
made him the regional mental health officer for Afghanistan,
India and Pakistan.
By the time Westmaas left his position in 1977, the idea of a
regional mental health officer had proven itself, and he was suc-
ceeded by former Peace Corps psychiatrist, Dr. Elmore Rigamer.
Like Westmaas, Rigamer proved his worth. During his second
year in Kabul, the Dubs assassination occurred, devastating
the entire embassy community. Rigamer met with members
of the community to discuss the psychological impact of the
event, providing vital assistance to the community’s recovery
from the trauma. By the time he left Kabul to continue regional
psychiatry in New Delhi in 1979, the Foreign Service psychiatry
program was off and running.
Between 1979 and 1982, mental health positions were estab-
lished in Vienna, Bangkok, Monrovia and Cairo. Although the
Bangkok position was first occupied by a psychologist, Sam
Karson’s two-year tour as a regional mental health officer in
Thailand (1981-1983) was
a one-off. MED preferred
psychiatrists, not just
because they could write
prescriptions, but because
they are physicians and
have broader training. Thus,
psychiatrists are in a posi-
tion to identify (and rule
out) any physical/medical
issues that might be the
cause of mental problems.
Foreign Service mental health positions subsequently went
to psychiatrists. In the RMO/P skill code, for example, the P
stands for psychiatrist; there is no skill code for a Foreign Ser-
vice psychologist position.
Funding mental health care had always been an issue,
because mental health care, even more than general medical
care, is fraught with confidentiality concerns. And, when the
psychiatrist works for the patient’s employer, the problem of
“dual agency” arises. As a result, efforts in the 1970s and early
1980s often involved support for programs located outside the
immediate influence of an embassy or the State Department.
The idea of using contractors, such as Westmaas had been
in Kabul, was an obvious one; because Westmaas’ position had
been created with local embassy funds, it reduced the dual
agency conflict. But he was soon hired directly by the depart-
ment as a Foreign Service regional mental health officer, and
since the 1970s mental health contractors have only rarely been
used by the department.
Other Models of Care
Embassies used other models of mental health care, too.
Several made use of mental health clinics for expatriates that
had been set up during the 1970s in cities such as Cairo, Tehran
and Kuala Lumpur. And embassy health units developed lists of
local practitioners they could work with.
One community mental health initiative during the 1970s
and 1980s that seemed to work for many embassies was the
“mental health grants” program. Established in 1974, the
program grew to more than $250,000 per year. Given out in
amounts ranging from $700 to $18,000, the grants paid for edu-
cational presentations, support groups, library resources related
to mental health, as well as programs related to crisis interven-
tion and referral for therapy. The grants also paid for “preven-
tive mental health” presentations and helped support expats
Between 1979 and 1982,
mental health positions
were established in Vienna,