Therapy on Aisle 7: Retailers Are Entering the Mental Health Market
Finding a therapist can be a tough and time-consuming process involving multiple phone calls, waiting lists and insurance hurdles.
But what if you were able to walk into your corner drugstore for a bottle of shampoo and also had the option of scheduling a walk-in session for mental health treatment?
That’s the future that CVS, the largest retail pharmacy in the United States, is envisioning. Since January the company has added licensed clinical social workers trained in cognitive behavioral therapy to 13 locations in the Houston, Philadelphia and Tampa metro areas. The providers will offer mental health assessments, referrals and counseling either in person or via telehealth, a CVS spokeswoman said, and this spring the company plans to expand to 34 locations in those same regions.
The social workers are available during the day, and also on evenings and weekends in the company’s MinuteClinics, which provide a variety of nonemergency health care services either via walk-in or by appointment. The hours are more flexible than what therapists might normally offer, and the social workers partner with the clinic’s nurse practitioners and pharmacists to give prescriptions when needed, said Dr. Daniel Knecht, the vice president of clinical product at CVS Health.
CVS is just one of a growing number of retailers who are recognizing the unmet need for mental health providers and hoping to fill the gap.
On Thursday, Walmart announced it is acquiring MeMD, which offers online medical and mental health care. Walmart currently provides counseling via Walmart Health, a health center located in a separate building alongside Walmart Supercenters. In Georgia, Walmart Health offers in-person mental health counseling and in Arkansas customers can receive online counseling. Later this year, counseling services will become available at Walmart Health locations in Illinois and Florida, a spokeswoman said.
In addition, Rite Aid is piloting teletherapy in the “virtual care rooms” of 13 stores in Idaho, New Hampshire, Pennsylvania and Virginia, a spokesman said. The company declined to elaborate on when the program started or whether there are any plans to expand.
And Walgreens is facilitating therapy appointments via the company’s web platform Walgreens Find Care, which connects customers to teletherapy from BetterHelp or Sanvello. Walgreens also offers free access to online mental health screenings through a partnership with Mental Health America, a spokesman said.
“I think it’s a smart model,” Dr. Kali D. Cyrus, a psychiatrist at Sibley Memorial Hospital in Washington, D.C., and assistant professor at Johns Hopkins, said of the various therapy programs.
“By expanding availability, you increase visibility — and that helps reduce stigma,” Dr. Cyrus said. But she questioned whether the therapy clinics will have a standardized approach when giving out mental health advice, making referrals or offering risk assessments. The licensing and training of providers may differ between states, she added, and different states might have varying protocols for managing psychiatric emergencies; or limited availability of outpatient providers or inpatient hospital beds.
A recent government accountability report found “longstanding concerns about the availability of behavioral health treatment, particularly for low-income individuals,” in part because of the shortage of qualified behavioral health professionals.
In the past year, the number of people reporting symptoms of anxiety or depression nearly quadrupled compared to the year prior, according to the Centers for Disease Control and Prevention. And in 2020, there was a 27 percent increase in calls to the Substance Abuse and Mental Health Services Administration National Helpline compared to the number of calls in 2019.
Some grocery chains with pharmacies located inside their stores are also addressing disparities in access to mental health services.
Albertsons, whose banners include Vons, Safeway, Shaw’s and Pavilions, does not offer therapy, but their pharmacists in 23 states administer injectable antipsychotic drugs as well as injectable medications to help treat substance abuse, a program that has been underway for nearly a decade.
Omer Gajial, the senior vice president of pharmacy and health at Albertsons, said the pharmacies offer convenient hours. Most Albertsons pharmacies are open from 8 a.m. to 9 p.m., he said, and some are open 24 hours a day, seven days a week.
If a patient is uninsured or underinsured, he added, the pharmacy will help connect them with manufacturer rebate programs or a nonprofit foundation that can help fund the treatment.
CVS, which merged with the insurance provider Aetna three years ago, aims to reduce overall health costs with its mental health pilot program, Dr. Knecht said. Mental health issues that are not addressed become crises, he added, “so our aspiration is to make mental health services accessible and locally available so we can address these issues before they continue to expand and result in substantial morbidity and poor outcomes.”
Removing obstacles to mental health care by making providers more accessible is helpful, said Vaile Wright, senior director of health care innovation at the American Psychological Association, “but they are never the No. 1 barrier to accessing treatment,” she said. “Cost is.”
Psychiatrists are less likely to take insurance than other types of physicians, and many psychologists, social workers and others who offer therapy likewise decline insurance because they say payments by insurers are relatively low and managed care companies sometimes subject them to intrusive audits.
The mental health services provided by the CVS MinuteClinics are covered by many major health insurers and Employee Assistance Program plans, a spokeswoman said.
“Pricing options without insurance range between $129 for an initial assessment to $69 for a 30-minute session, with many options in between,” she added.
At Walmart, the initial therapy session is $60 and the 45-minute follow-up sessions cost $45, according to the company’s website.
If you’re considering using a retail location to receive therapy, be sure to ask the same questions you would of any new therapist, experts advise. Some examples include:
Where were you trained?
What kind of license do you have?
What is your specialty?
How will we monitor my progress?
How long will my session last, and how many sessions are available to me?
Is there follow-through if I need a referral?
How much will this cost?
How will my data be stored and shared?
In addition, if you identify as L.G.B.T. or are a member of another minority group — or if you already know that you suffer from a particular condition like anxiety or depression — it’s helpful to know whether the therapist has worked with similar populations in the past and whether they have had cultural competence training, said Alfiee Breland-Noble, a health disparities researcher and founder of the AAKOMA Project, a mental health nonprofit for teenagers and their families.
“These are places where everybody goes,” Dr. Breland-Noble said of the retailers. “What remains to be seen is: How will increased accessibility limit — or manage, or reduce — stigma in communities where stigma is so high?”
“Are you going to walk into a store where everyone can see you walk into the designated clinical area?” she asked.
At CVS, sessions with a therapist are held in a private consultation room, Dr. Knecht said. Customers can also speak with someone virtually via a telehealth platform if they don’t wish to visit the store in person.
Riana Elyse Anderson, a clinical psychologist who researches how race and mental health care intersect, is hopeful that the mental health services offered by retailers could help make a difference in people’s lives.
“The average person doesn’t need intense long-term care,” Dr. Anderson said. “So even if only four meetings were possible with the possibility of a referral, that’s at least going to help the average person feel better — and that’s what’s needed during chronically challenging times like now. I think it’s a great way to get people some relief.”
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