Retailers could help shape future of mental health treatment

Retailers could help shape future of mental health treatment

By Chuck Nelson, Associate Editor
August 4, 2021 - Last updated: August 2, 2021

Is the future of mental health therapy right around the corner? Say, at your local CVS or Walmart?

That’s the concept some national retailers are growing through pilot programs at select locations. It’s one that could help improve access to mental health care in general – especially in underserved populations – while also providing a role for psychologists.

“What we know is that we have an access gap problem in this country that existed prior to the pandemic, where we have more people who needed services than we had a workforce to provide,” said Vaile Wright, Ph.D., APA senior director for healthcare innovation.

“That’s only been exacerbated by the pandemic. So, we need to think of innovative ways to address this access-to-care issue.

“And if one of those is bringing services to where the people are versus just expecting the sort of traditional model of individuals who need help seeking out providers, I think that can be one step in the right direction.”

That’s with the caveats that services are provided safely and effectively, that the providers are licensed, trained and appropriately supervised, and there’s some way to measure the outcomes to make sure the model achieves its goals, she said.

“In reality, it’s not that much different than what we’re seeing with integrated primary care, where you have a behavioral health provider that’s part of the primary care office, which we do know is effective” she said.

Currently, four national chains are offering mental health services, primarily through telehealth, The New York Times reports.

CVS has added licensed clinical social workers to 13 locations in Houston, Philadelphia and Tampa, Fla., offering mental health assessments, referrals and counseling in person or through telehealth. The company plans to expand to 34 locations in the same cities.

Rite Aid is offering a teletherapy model in 13 locations in Idaho, New Hampshire, Pennsylvania and Virginia.

Walgreens is providing therapy appointments through its web platform, Walgreens Find Care is linking customers to providers like BetterHelp. It also offers free online screenings through a partnership with Mental Health America.

And Walmart announced plans in May to acquire MeMD, which offers medical and mental health visits.

The shift to retailers follows the same changing healthcare dynamics of walk-in medical clinics and urgent care centers in consumer shopping zones, notes Advisory Board, which studies the challenges healthcare leaders are facing. Healthcare systems, which traditionally focused on inpatient revenue, shifted their thinking to make outpatient revenue part of their strategic plans, the site noted.

“To the extent that it can improve access as it relates to convenience, maybe reducing the stigma because people are more comfortable approaching their pharmacy, I think that can help,” Wright said. “I also think it has the potential to alert people to their mental health needs. Maybe they notice a sign that says, ‘free depression screenings,’ which maybe isn’t something they ever thought of doing before.”

CVS uses that approach on its program’s website: “Stressed? Feeling a little down? We want to help.”

“Someone could come in, be screened, receive some psychoeducation and some reading material and that might be sufficient,” Wright said. “Somebody may benefit from a 20-minute intensive behavioral session for something like smoking cessation.”

But not everybody needs the same care, she said, noting that these models could provide a more tiered approach to levels of service.

“Ideally, the model would be that you would have a robust referral source, so that if somebody needed more traditional, weekly 45- to 60-minute therapy sessions, you could ensure that you could consistently provide those,” Wright said.

Wright notes that providers in most of the retail settings are master’s level or licensed clinical social workers.

“So, depending on the state, the role of the psychologist could be twofold,” she said. “One could be providing some of the supervision services that might be required based on the scope of license of the practice. I think another could be psychologists learning more about what their local pharmacies are doing and then serving as a referral source for when somebody is identified for needing more traditional or intensive kinds of psychotherapy services.”

The models differ between companies, all of which will need to navigate licensing requirements on a state-by-state basis to determine who can interact with patients and what level of training would be required.

“We also still know that the No. 1 barrier is cost and I haven’t necessarily seen any discussions about how affordable these options are,” Wright said.

CVS – which has owned Aetna since 2018 – is covering the cost of sessions for Aetna insured-patients and negotiating for similar terms with other insurers, notes.

“But again, there are multiple barriers to access and if this addresses even a few, from a population health approach, it could help solve the mental health crisis that we fear we are approaching,” Wright said.

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