Mental Health Treatment Now Available at Walmart

Nancy A. Melville

December 17, 2018

Mental health care in the United States is going mainstream with the opening of the first mental health clinic housed in a retail setting — a Texas Walmart.

Russell C. Petrella, MD, president and CEO of Beacon Health Options, based in Boston, Massachusetts, said the concept was rolled out to bring behavioral services to a convenient setting in the community.

"We chose a retail setting for the first practice because it offers the convenience of a local neighborhood location that is close by and easy to get to, and our evening hours accommodate our patients' schedules," Petrella said in a press release.

The clinic is the first to be launched through the company's Beacon Care Services umbrella, the company's first foray into provider services. Beacon Health Options is a privately held behavioral services company serving as an intermediary between insurers and providers.

The clinic in Texas is staffed with one licensed clinical social worker and is designed to provide treatment to patients with anxiety, depression, grief, relationship problems, and other stresses, the company notes.

Patients with more serious mental illness or who require prescription medication will be referred to other professionals within the Beacon Health system. Patients are able to make appointments in person or online, and services can even be provided through Skype.

The clinic will have a sliding fee schedule for patients without health insurance, and the company is reportedly working to receive approval for Medicaid reimbursement in Texas. Initial assessments cost $140 at the clinic, and individual sessions cost $110.

The company points out that more than 10.1 million Texans reside in areas considered to have shortages of mental health professionals. It is estimated that only 35% of the state's mental health care needs are currently met.

"Our hope is to help close this gap by providing more trained clinicians in neighborhoods throughout the country, starting in 2018 with Texas," Petrella said.

Beacon Health Options did not respond to Medscape Medical News' request for comment.

Concerns, Skepticism

However, as reported by the Boston Globe, the news of the clinics has been tempered with some skepticism in Beacon's home state of Massachusetts. Critics have suggested that company practices such as requiring multiple prior authorizations and offering inadequate pay put up unnecessary hurdles to care.

"If Beacon were serious about expanding access to mental health services, it would focus on doing a better job in its current lines of business," Vic DiGravio, president and CEO of the Association for Behavioral Healthcare, told the newspaper.

Several mental health care experts who were contacted by Medscape Medical News applauded Beacon's efforts to address the urgent need for better access to mental health care in rural areas but echoed the strong caveat that services provided to patients, as well as organizational policies, need to be up to par.

"Expanding access to mental health care, and behavioral healthcare more broadly, in rural communities is absolutely critical," said Claire Snell-Rood, PhD, an assistant professor of public health at the University of California, Berkeley, and a member of the Haas Institute's Diversity and Health Disparities research cluster.

"However," she told Medscape Medical News, "quality does matter — something is not always better than nothing, with research showing that bad experiences in treatment can not only prevent people from seeking out help in the future but can worsen mental health outcomes."

Regarding the quality of a mental health clinic in a Walmart store, Snell-Rood said several factors need to be considered, including how treatment is delivered, the use of evidence-based care, the consistency of care, and its relevance to the problems faced by patient.

Also important is whether the organization supports its staff to prevent turnover, provides ongoing training, and addresses systemic factors, such as prior authorizations.

High staff turnover, in particular, puts organizations in a cycle of frequent hiring and retraining, which impedes treatment of patients, Snell-Rood added.

"How well Beacon Health is able to address these factors critical to quality would shape whether their approach to delivering mental health in Walmart stores is a good idea," she said.

A Step in the Right Direction?

With respect to tackling the ongoing stigma of mental health disorders, having clinics in a high-profile setting such as a Walmart could be a step in the right direction, Snell-Rood added.

"Offering mental health care in novel locations, such as community businesses like Walmart, could absolutely play a role in reducing stigma and could help potential patients remain anonymous, since they are appearing at a community space, not a dedicated mental health clinic," she said.

"However, again, the quality of care experienced also plays a big role in whether stigma is experienced. Location alone does not reduce stigma," she said.

Jose Canaca, MD, of the Division of Community Behavioral Health, Department of Psychiatry, the University of New Mexico, Albuquerque, also said he would welcome such clinics if they helped increase access to mental health services.

"We in New Mexico are familiar with the problem [of access to mental health care], and it is a fact that several communities in our state and around the country have significant challenges accessing mental health services," he told Medscape Medical News.

"As a provider, I can say that any ideas that try to promote mental health access should be explored," he said.

Canaca also agreed that the location may help destigmatize the seeking of mental health services.

"Stigma is a very complex issue that all of us have a responsibility to fight against. Having a clinic in a familiar place where people feel comfortable is a step forward in decreasing mental health stigma," he said.

The company's website notes that the Beacon Care Services model is evidence-based with a "focus on integrated health" and a "whole person/whole health" intervention.

"We assess a wide range of possible life and health factors to make sure the treatment plan addresses both the obvious and less obvious issues," the website states.

Dr Snell-Rood and Dr Canaca have disclosed no relevant financial relationships.

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