Native Americans are among the most underserved groups in the United States, beset by alcohol and drug abuse and a high prevalence of depression and anxiety. In addition, they face a suicide rate for youth age 15 to 24 that is more than three and a half times the national average. Access to services is also difficult for these people, particularly those who live in rural Montana, North Dakota and South Dakota.
To improve care, Indian Health Service psychologists are participating in a collaborative project with APA Div. 18 (Psychologists in Public Service), Div. 55 (American Society for the Advancement of Pharmacotherapy) and Alliant International University.
The project — conceived and implemented by Div. 18 psychologists Robert Ax, PhD, and Randy Taylor, PhD, and Steven Tulkin, PhD, of the California School of Professional Psychology — seeks to train IHS psychologists to prescribe medications for this population.
In addition to improving the delivery of mental health care to Native Americans, making training in prescriptive authority more broadly available should help the IHS address its “significant” vacancy rate for clinical psychologists, says psychologist Rose Weahkee, PhD, director of the Division of Behavioral Health at IHS headquarters in Rockville, Md.
“It’s very difficult to recruit, or retain, psychologists in those remote locations,” she says.
So far, six psychologists enrolled as a cohort are almost halfway through a 28-month postdoctoral master of science program in clinical psychopharmacology at Alliant’s California School of Professional Psychology. The psychologists, who live in North and South Dakota, attend classes via telephone conference calls one weekend every month. Tuition and books for the program, pegged at almost $14,000 per student, are partially funded by a grant donated by Beth Rom-Rymer, PhD, on behalf of her family’s foundation, the Irving and Dorothy Rom Foundation, along with support from the IHS and Alliant.
Once the students complete the academic portion of the program, they will apply for conditional prescribing certification from New Mexico’s state psychology licensing board. New Mexico and Louisiana are the two states that currently offer prescriptive authority to appropriately trained psychologists. Five of the psychologists plan to practice in Indian Country, while one is now working for the Federal Bureau of Prisons.
IHS psychologists will be able to apply to prescribe with a New Mexico state license because they practice at federal facilities. To prescribe independently, the psychologists will be required to complete an 80-hour practicum, accumulate clinical experience with 100 patients under supervision of IHS physicians and pass the Psychopharmacology Examination for Psychologists (PEP), says Michael Tilus, PsyD, a psychologist with the Commissioned Corps of the U.S. Public Health Service.
“If we can add prescribing psychology as another tool to our tool kit, then we can offer an integrated, one-stop shop, especially for isolated people,” says Tilus, who directs behavioral health services at the Spirit Lake Health Center in Fort Totten, N.D. He completed Alliant’s program in January 2009 and is studying to take the PEP before applying for New Mexico’s conditional prescribing certification.
Meanwhile, psychologist Earl Sutherland, PhD, is working with Divs. 18 and 55 to enroll 16 IHS psychologists across the nation in a psychopharmacology training program. Sutherland, who directs behavioral health for the IHS’s Crow Service Unit about 65 miles southeast of Billings, Mont., completed Alliant’s psychopharmacology program in 2008 and is also getting ready to take the PEP.
His unit serves 22,000 members of the Crow and northern Cheyenne tribes in Montana and Wyoming. A consulting psychiatrist visits three days a month.
“We’re fortunate. There are other units that don’t have access to a psychiatrist at all,” he says. “We simply don’t have enough psychiatric resources.”