Should Walgreens be in the mental health business?

I hope everyone is trying to contribute to Mental Health Month. It seems like drugstore chain Walgreens is trying to make a difference this year.

Last week, Walgreens conveyed its new endeavor to address the need for mental health resources in honor of Mental Health Month. In partnership with the consumer-based Mental Health Association, Walgreens says that it will aim to expand access to information, resources, screenings and tele-psychiatry options. Leaders say that they will also increase the behavioral healthcare education of their pharmacists.

From what I can tell so far, it is another example of the best of times in behavioral health . . . maybe.

The problem that Walgreens is trying to address is a major one. Taking into account what epidemiology studies tell us, perhaps 25% of Americans have a diagnostic mental health disorder during any given year, abut at best only 25% get the treatment that may help. The consequences include:

• More physical illness;
• Lowered life expectancy;
• Job loss;
• Homelessness;
• $1 trillion in economic loss;
• Impaired relationships;
• Incarceration;
• Increased victimization and trauma;
• Increased suicide; and
• Increased violence, which most unfortunately includes an occasional mass murder.

Why does this happen? There is inadequate public knowledge of mental illness, stigma is still high, and resources continue to be limited despite the initial gains from healthcare reform.

So, where does Walgreens fit into this? Of course, for its own business case, Walgreens executives know patients who stay on their medication will increase the store’s profits. But it can help patients, too.

Visiting drugstores, akin to family physicians, is less stigmatizing than going to a mental healthcare clinician. People are also used to receiving some information about their medication from pharmacists. Therefore, people who may be reluctant to ask for formal mental healthcare are likely to be more comfortable with their trusted pharmacy. And, many people nowadays desire to get information and help online, which is a key aspect of Walgreens plan.

Drawbacks to consider

What's not to like? Maybe nothing, but it seems to me that there are some potential drawbacks or at least questions that need to be answered.

Will the information provided to consumers be accurate and unbiased? Will there be an even greater over-reliance on medications in comparison to other treatments, like psychotherapies, that are not part of Walgreens' business? Will what is provided be more of a bandage for problems that need more intense care? Will the Walgreens staff recognize and respect the crucial importance of confidentiality with mental illness? Will the pharmacists have enough time, given that pharmacists today seem even more harried than physicians?

Informally, I was curious about what other psychiatrists felt and asked them for their reactions on some on-line list-serves. Here are some representative responses:

"When it takes three to four months to get an appointment with a psychiatrist in many areas—and when patients continue to report that the psychiatrist 'never talked to me—just asked some questions and wrote a prescription'—then it makes sense that someone else is going to pick up the ball."

"The tele-health part is great—the military uses this a good bit, and it works quite well."

"Well intentioned—needs a road test over the next year."

"I think we are in big trouble if Walgreens becomes the go to place for mental healthcare."

"I am not convinced that screening is the best use of Walgreens considerable resources."

"Walgreen's chief medical officer is a really good guy. Instead of disparaging this program right out of the gate, it might be useful for the American Psychiatric Association to try to work with [him]."

What is your opinion and/or prediction?