Sutherland and his team don’t just focus on psychological
“In our psychopharmacology training, they always talked
about the bread-and-butter issues of anxiety and depression,”
says Michael R. Tilus, PsyD, one of the other prescribing
psychologists at the hospital. “But in Indian Country, everyone
In addition to standard psychological problems, he says,
Native Americans may face historical trauma, fetal alcohol
syndrome, drug and alcohol abuse, domestic violence, child
neglect and abuse, high rates of diabetes and other chronic
conditions, even malnutrition.
That complexity is why integrating with primary care is so
important, says Tilus. If patients with diabetes aren’t taking
their medication, for example, Tilus and his colleagues offer tips
on exercise and diet and cognitive-behavioral therapy, as well as
order blood work so that both the providers and patients can
monitor the diabetes.
“In Indian Country, we’re not auxiliary. All of the medical
The prescribing psychologists also need to make sure the
psychologists have full medical privileges in the hospital and
are full members of the medical team,” says Tilus. “In the more
isolated parts of Indian Country where I’ve served, it’s such
frontier medicine that the medical providers have tremendous
support for us.”
The prescribing psychologists also order EKGs, thyroid
tests, metabolic panels and similar tests to check for underlying
medical conditions before they prescribe psychotropic
medication. For one thing, says Sutherland, they want to
make sure the patient doesn’t have a previously undiagnosed
condition. “We’ve identified a number of cardiac problems and
patients who were undiagnosed diabetics,” he says, explaining
that prescribing psychologists are trained to interpret lab studies.
medication they prescribe won’t cause any medical problems.
“A lot of the medications we prescribe can induce metabolic
changes,” Tilus points out. For example, mood stabilizers and
antipsychotics could raise patients’ lipid levels. In some cases,
RxP in action at the Crow/Northern Cheyenne Indian Health Service Hospital: From left to right, Dr. Michael Tilus, Deborah Russell,
Dr. Marie Greenspan and Dr. Earl B.H. Sutherland Jr.