Jan. 22, 2019 — Some Walmart customers can now add mental health therapy to their shopping list.

In a store in Carrollton, TX, about 20 miles north of Dallas, the retail giant has rented space to Boston-based health care provider Beacon Health Options, whose clinic provides talk therapy to those seeking help for depression, anxiety, relationship troubles, and more.

This first-of-its-kind venture has two primary aims, says Beacon president and chief executive officer Russell Petrella, PhD, a clinical psychologist. “Part of the whole goal of this is to destigmatize behavioral health care and put it in places where people feel comfortable … and another big issue is access to such care when and where they need it.”

The clinic, called Beacon Care Services, opened in November. It shares a waiting room with an existing Walmart Care Clinic, which provides primary care services, such as physicals, lab tests, treatment for illness and injuries, and ongoing care. But, a Walmart representative says, “Walmart’s only role is as the landlord — we’re simply leasing space to Beacon.”

Petrella says the number of people who have either made appointments or walked into the clinic has slowly but steadily risen.

Right now, a single therapist handles all comers during a 40-hour week. Demand will determine whether Beacon brings in more staff and boosts the clinic’s hours. For people who can’t make it to the clinic, Beacon offers telehealth counseling via Skype. The clinic is offering an introductory 45-minute session for $25, but beginning Feb. 1, it will cost $110 for an individual and $125 for a family. The Carrollton clinic is applying with insurers to become an in-network provider, a company spokesperson says. Prices can be lowered for people who can show they have a financial need.

More Innovation Needed

Bonnie Cook applauds Beacon’s venture, but she wants to see other innovative ways of delivering mental health services. “Let’s discuss where individuals get their care and whether it’s better for us to come to where the person is as opposed to the person coming to us,” says Cook, executive director of the Greater Dallas chapter of Mental Health America. “Do we do mobile clinics for mental health? Do we start putting doctor offices with mental health care in airports? Where do we think outside the box?”

There are mobile clinics in some parts of the country. Cook points to Mobile Counseling PLLC, which makes house calls in the Dallas area and surrounding counties. Wright, meanwhile, says she expects innovation to come from several quarters: “I think what we are seeing in the U.S. is the use of mobile technology, like apps and online therapy, to deliver services, as well as in-home services such as those offered by the Veterans Administration, and services provided in community locations such as churches.”

What Beacon Care Services doesn’t offer is care for those with severe mental health problems, such as schizophrenia and major depressive disorder. “We’re not prepared to deal with such cases,” says Petrella. Instead, the staff therapist, a licensed clinical social worker, will refer people who need medication or more advanced care to other providers in Beacon’s network.

John Dornheim recalls feeling excited when he first learned that a clinic had opened in Walmart.

“This is a great outlet and a great beginning,” says Dornheim, past president of the board of the Texas branch of the National Alliance on Mental Illness. But he notes that it’s in a part of Texas where mental health care services are pretty easy to find. Much of the state, he says, remains a desert for such care.

“Fewer than half of the 254 counties in Texas have a mental health provider,” he says. “And 85 to 90% of the state’s psychiatrists can be found in only six counties.”

Dornheim hopes that the clinic will be a success, one that will lead to similar clinics in rural parts of the state, which desperately need mental health services. Once they’re there, he says, success will hinge, in large part, on ending the stigma of mental health issues. That gets complicated, he continues, in areas where everyone seems to know everyone else’s business.

“There are a lot of people who are so afraid of people knowing about their issues that they don’t get help, but at the Walmart, they might say to themselves, ‘I’m already here, let’s see if I can talk to somebody,’ ” he says. “To me, the tipping point will be if the rural community accepts it.”

Lack of Access Reaching Critical Stage

A report published late last year by the advocacy group Mental Health America evaluated and ranked the state of mental health care in the 50 states and Washington, D.C. In only three states was mental illness more common than in Texas, yet the Lone Star State was second to last in terms of access to care and whether mental health providers can be reached.

“Access to care, both geographically and financially, is something Texas has to address,” says Cook. She welcomes the new clinic with some reservations.

“At least we’re thinking outside the box to come up with viable solutions,” she says of Beacon’s unique venture, which could ease the stigma of care “if it becomes as commonplace as getting a pair of glasses. But the clinic can only handle minor issues, not serious problems.”

Like Cook, psychologist Vaile Wright, PhD, emphasizes the importance of having effective ways to give mental health treatment to more people.

“We need new models to increase access,” says Wright, director of research and special projects in practice research and policy at the American Psychological Association in Washington, D.C. “We need to think more innovatively about how to reduce the gap between who needs care and who receives it.”

Wright says health care clinics and kiosks have become a feature at nontraditional places. A 2016 study estimated that nearly 2,000 such health clinics are in retail stores, including pharmacies, supermarkets, and big-box stores like Walmart and Target. But, Wright says, “Mental health care has been later to the game.”

Wright points out that opening a clinic such as this is an excellent start, but there need to be ways to find out how well it works. In other words: Are patients better off at the end of treatment than they were at the beginning?

“You would hope that they are engaging in some sort of measurement-based care that determines that patients’ symptoms and functioning have improved,” she says. “The ultimate goal should be improving patient outcomes.”

Beacon has not finalized its plans for expansion, but it is in talks with Walmart about opening clinics in other places that, like the Carrollton location, include Walmart Care Clinics. Beacon is also exploring opportunities beyond Walmart.