Walmart’s Mental Health Clinics Could Be a Game Changer

If it’s successful, the retailer could make therapy more accessible and affordable for rural Americans

Keren Landman, MD

Sep 24, 2019·5 min read

Amid the clatter of shopping carts outside the Dallas, Georgia, Walmart, Erica Rowell crinkled her nose as she glanced toward the other end of the store. There, past a Subway restaurant, a nail salon, a veterinary center, and an ocean of checkout lanes, stood Walmart Health, a clinic offering primary care, dentistry, and mental health services — the first and only one in the United States.

Rowell had heard of the clinic’s grand opening the prior week. Would she consider seeing a therapist there?

“No,” she said, “not at a Walmart.”

Like Rowell, some consumers may have early doubts about the quality of mental health services obtained from the same source as family packs of toilet paper. While deep discounts might not cloud trust in the quality of ordinary household goods, some may note a jarring incongruity in entrusting their fragile inner selves to a brand closely associated with a price-slashing smiley face.

Still, Walmart’s dominance as a retailer could make it a major player in the mental health space. While the clinic offerings are still in early testing stages, if the services are spread to more stores it could mean more accessible and affordable mental health care for rural Americans — and potentially normalize it in places where seeking care is often a source of shame.

In rural regions of the United States, the consequences of untreated mental illness are dire: A recent analysis published in JAMA Network Open revealed that suicide rates are higher, and rising more quickly, in rural than urban counties, and people living in rural areas are hospitalized for mental health issues at higher rates than residents of metro areas.

Experts attribute this in part to the expense of mental health care and the stigma associated with it, which together cause many rural Americans to avoid or delay seeking care for mental health symptoms. Rural dwellers with severe mental illness are more likely to self-pay for care than their urban counterparts, and likely to have higher out-of-pocket costs for health care in general. Studies in men, women, and children suggest that gender stereotypes, a cultural expectancy of self-reliance, and concern about stigma all contribute to rural residents’ reluctance to seek treatment for mental health issues.

There’s also a vacuum of rural mental health providers, which limits early and adequate treatment. The majority of government-defined mental health professional shortage areas are in rural counties. Non-metropolitan counties have one third to one half the psychiatrist and psychologist supply of urban counties, and 75% of more sparsely populated rural counties lack a psychiatrist.

What rural counties often do have is Walmart. The company’s nearly 5,000 stores predominantly serve areas at the intersection of low income and low population density. 90% of Americans live within 10 miles of a Walmart store.

For Ron Manderscheid, executive director of the National Association for Rural Mental Health, it’s hard to not see its store network as a scaffolding on which to build other services for remote areas. A decade ago, Manderscheid advised the state of West Virginia on ways to increase telemedicine access in regions where both health care and broadband internet access are scarce. His recommendation: “Sit down with Walmart.”

“Walmart was an infrastructure hub for facilitating the delivery of services that would have been delivered by the state,” he says. The state ultimately didn’t follow his advice, but he’s excited about the mental health initiative at the retailer.

As much as he views Walmart’s heft as a means to improve rural access to mental health care, Manderscheid also sees the potential for a monolith’s involvement to create unwelcome dynamics within the rural mental health workforce. If Walmart counselors’ salaries are higher than average for a given region, clinics could siphon off mental health personnel from other local facilities, including the Federally Qualified Health Centers that are often critical sources for rural health care. And Walmart’s low consumer prices could have negative effects downstream, said Manderscheid: “Is Walmart going to be another case where Walmart is basically reducing the income of behavioral health providers by offering the service at such a low cost?”

In states like Georgia, which has not accepted federal funds to expand Medicaid access, mental health providers and resources to pay them are particularly scarce. Manderscheid suspects that if Walmart provided these services more broadly, the demand for them would increase, resulting in pressure on states to do more, not less.

The Dallas, Georgia, clinic, which currently accepts Medicaid and Medicare — and plans to accept select private insurance plans — offers a range of services well beyond what most walk-in clinics provide: Adults and children older than 18 months can be seen for routine physicals or chronic conditions, and most ages can receive routine immunizations, hearing and vision evaluations, and dental services. Mental health counseling, managed by a subsidiary of the Boston-based Beacon Health Options, is provided for ages six and up by four licensed professional counselors and social workers. A clinical psychologist and psychiatrist remotely oversee the team.

This is not the first time mental health care has been offered inside a Walmart: Beacon opened a mental health clinic inside a Carrollton, Texas, Walmart in late 2018. “We have been pleasantly surprised at consumers’ openness to coming into a retail setting to seek health and therapy,” says Beacon’s chief growth officer, Christina Mainelli. Volume at the Texas clinic increased 350% between May and August of this year.

While it’s too early to tell what effect the clinic might have on the local mental health workforce, “the counseling staff have market-competitive salaries for each geography that we’re in,” said Mainelli, and all new hires were local. Paulding County, of which Dallas is the county seat, has no Federally Qualified Health Centers.

Walmart has not announced plans to expand its health clinics beyond one additional rural Georgia store in 2020. “We’re calling it more a prototype than a pilot,” says a representative.

At the store-side entrance to the Georgia clinic, framed by an arching spiral of yellow, white, and blue balloons, the pharmacy department’s fluorescent bulbs yield to warm, natural lighting, and staff members in grey scrubs stand ready to register patients. Prices for counseling sessions and other services flash on a wall-mounted screen: $60 for a 60-minute intake visit, $45 for a 45-minute return visit. These prices are low — about one-third to one-half of what others generally charge, says Manderscheid. Next to the sliding doors leading to the parking lot, neatly stacked weights and exercise balls sit in a sunny room where yoga and other wellness programs will be held.

The setting has the potential to destigmatize mental health care by giving it equal treatment and placement as its physical care offerings. If Walmart can say, “we have well-being work going on, we have yoga going on, we have mental health going on, we have health care, we have prescriptions going on,” says Manderscheid, “my God, we’ve arrived here!”

Venice Burchfield, who was resting on a bench after shopping, said local working-class people were starved for low-cost, convenient health care options. She welcomed the new clinic, and hoped it heralded even bigger things for Walmart Health.

“I’m hoping they’ll go beyond that with insurance policies,” she says. “If you buy their insurance, and you see their doctors, and you buy your prescriptions there, why wouldn’t it work?”