A strong correlation between mental health issues, substance abuse issues, and diabetes has been found within the American Indian (AI) community. This multimorbidity exists at higher rates than any other population within the United States. As research shows that more AI are living outside of tribal statistical areas and opting to receive services from the general mental health community, knowledge of the possible interplay between physical and mental health for AI clients and the possible treatment issues they could represent has become increasingly important. Strategies and resources for referral and advocacy are also discussed.