Few would argue that 2020 was a watershed year in many respects. The COVID-19 pandemic, social and economic inequities, a racial reckoning, and environmental disasters collided and coalesced into a reality marked by tremendous challenges, the likes of which could hardly have been predicted. This confluence of factors has created an increasing need for counseling and mental health care.
The dramatic increase of individuals reporting mental distress has garnered national attention and sharpened societal recognition of the relationship between mental and physical health. Consequently, mental health and well-being, or a lack thereof, have taken on new urgency and can no longer be ignored.
Our recent work, respectively, as a mental health counselor in an urgent care setting and a professional counselor supervisor and educator has given us a unique, firsthand perspective on this valuable opportunity. We believe that the immediate/urgent care facility offers a promising new setting for the provision of mental health care. A number of urgent care facilities have already incorporated mental health services into their practice with positive results. Mental health providers have become vital components of integrated and interdisciplinary teams. Therefore, the primary objective of this article is to promote and highlight the integration of collaborative mental health resources into these care clinics.
Mental health care and urgent care
A drive down most urban thoroughfares, suburban boulevards or even rural town roads often leads to a sighting of an urgent/immediate care facility or at least an advertisement for one. The proliferation of these clinics over the past few decades has resulted in their ubiquitous presence on the community landscape and the health care scene.
The dramatic increase in mental health issues across the population, exacerbated by the COVID-19 pandemic, demands a mitigation strategy. An effective intervention that has also seen a rapid increase recently is the incorporation of mental health care within the urgent/immediate clinic setting. There have been positives and negatives regarding both results and outcomes, inspiring us to examine the advantages and disadvantages of this burgeoning concept.
The urgent care concept of providing accessible health care emerged in the 1970s. Initially, these clinics were staffed by physicians who provided basic care for minor issues such as colds and sore throats and minor accidents requiring first aid. Over the years, the number of immediate/urgent care facilities increased and the range of treatments expanded.
Increased treatment options, expanded availability, timely care and affordability are among the reasons that an estimated 3 million patients visit urgent care centers weekly. Their convenience, accessibility and omnibus approach of addressing various medical issues, including the acquisition of a primary care doctor, make them an attractive alternative to the bureaucratic and often alienating nature of the traditional health care industry. The COVID-19 pandemic also exposed various weaknesses and inequities within our traditional health care system, positioning the urgent/immediate care industry as a vital component of a comprehensive plan to prevent and mitigate such crises.
Mental health issues
Urgent care, COVID-19 and lingering effects
The vital role of the urgent/immediate care facility has been confirmed throughout the pandemic. These facilities have functioned effectively as testing centers, providing rapid testing and results to the public. They provided access to health care providers as the pandemic burdened and overwhelmed traditional health care access.
With the growing relationship between mental health care and urgent care, providing mental health services for the increasing prevalence of mental health symptoms seems an essential and effective strategy. The COVID-19 pandemic is leaving a trail of lingering implications, including economic and psychological effects, that are not yet fully known.
Whereas physical risks and symptoms of the pandemic will improve with vaccines and increased knowledge of the virus, mental health issues may endure as people struggle from serious issues that may become chronic or episodic. As reactions to the pandemic and the accompanying stressful environment increase negative symptomology, an overall benefit may be the increased exposure of mental health issues.
Growth of delivery systems
Other trends, primarily driven by the pandemic, include an exponential increase in the use of telemental health options. These include various mental health providers opting to use these delivery platforms with their clients and clients seeking mental health services from online counseling companies.
Online counseling service companies usually provide subscription plans and packages and match clients with a qualified provider. These companies have experienced strong growth recently, with the appeal being that all aspects of the care can be provided through an online platform. These aspects may include insurance utilization, intake interviews, therapy sessions and the ability to schedule appointments.
Traditionalists and critics argue that a vital element of the counseling relationship and process are forfeited in the telemental health format. In addition, most insurance companies have not embraced or reimbursed these efforts. Some disadvantages of online counseling include the loss of intimacy in the in-person counseling relationship, the lack of coverage by insurance, unreliable technology, the difficulty of treating serious mental health disorders, and the general absence of nonverbal communication.
Omnibus service and accessibility: Urgent/immediate care facilities currently have a large capacity and continue to expand in all areas of the country. The addition of providing mental health services in these existing and future facilities would expand exposure and treatment (proactive, reactive and crisis) to reduce the prevalence of mental health disorders — disorders that cost billions financially through expenditures and loss of work.
This omnibus approach is conducive to “one-stop shopping.” Many mental disorders present initially as physical symptoms. Thus, these can be treated by the health care provider, who can then refer the patient/client in house for mental health evaluation. This would prevent long delays in accessing services rather than patients being referred to outside mental health professionals who may have long waiting lists or may not be accepting new patients. The amalgamation of mental and physical health services in one facility would create a comprehensive continuity of care.
COVID-19 implications: The pandemic has increased the prevalence of mental health needs across all populations. Like the distribution challenges of the COVID-19 vaccine, distribution of mental health services is also a challenge. Using the existing delivery system and structure of the urgent/immediate care industry could provide a substantial increase and reinforcement to the existing mental health services that can be offered or provided to individuals in need.
Professional practitioners: Access to professional mental health providers, especially psychiatrists, has reached a crisis stage. The number of new physicians choosing psychiatry has been declining over the decades, whereas the number of retiring psychiatrists is increasing. Rural access to mental health care is extremely limited or unavailable, and urban access is limited by long wait times and “no new patient” policies. These factors are not conducive to successful treatment of mental health conditions.
Medical professionals available at immediate/urgent care facilities can collaborate with experienced licensed professional counselors/therapists who are educated and skilled in the treatment of mental health to successfully assess, diagnose and treat through medication, psychotherapy or a combination of the two.
Loneliness: AARP has warned that the coronavirus pandemic is also causing a loneliness epidemic, which with the aging population, accounts for almost $7 billion a year to the cost of Medicare. Loneliness is also a contributing factor in other conditions, making people more vulnerable to Alzheimer’s disease, high blood pressure, suicide and even the common cold. Some researchers propose that loneliness is more dangerous to people than obesity and smoking. Like mental health, loneliness carries a stigma that hampers assistance efforts.
The simple presence of another human with whom to converse, witness or socialize leads to more positive outcomes. One of the most effective methods of improving loneliness is cognitive behavior therapy (CBT), which helps individuals examine their thoughts, perceptions and assumptions and how they affect behaviors — including behaviors that may be leading to loneliness. Increased access to mental health providers in affordable, accessible and convenient urgent/immediate care facilities can help stem the negative effects of loneliness and other social isolation ailments that are growing as a result of the pandemic environment.
The parity of behavioral/mental and physical health services has long been an issue. The Affordable Care Act addressed many of these issues by enacting legislation that required equal coverage of mental and physical health, but there is room for improvement.
The National Center for Health Statistics reported in 2018 that suicide ranked as the 10th-leading cause of death across all ages in the United States. In 2016, suicide became the second-leading cause of death for ages 10-34 and the fourth-leading cause for ages 35-54. Having immediate access to mental health care is critical to reducing this rate and many more mental health diagnoses.
The immediate/urgent care system, in concert with the mental health community and their professional providers, can be a strong partner in addressing these societal concerns. Counselors should take leadership roles in advocating for change, especially in these delivery systems. Appeals to local governments, insurance companies and counselor training programs may result in easier accessibility for all populations. Mental health professionals can advocate for urgent care clinics to create mental health positions in their groups, as many clinics have more than one location.
It is important that we highlight the potential of a seamless, omnibus approach of a single comprehensive visit or location for addressing all health needs or issues. Ultimately, with a marriage between urgent/immediate care clinics and mental health counselors, accessibility and quality of care can be increased and challenges and obstacles reduced.
James “Todd” McGahey is a licensed professional counselor, a national certified counselor and an associate professor of counselor education at Jacksonville State University. He also serves as a consultant and mental health provider at Beach Family Urgent Care in South Carolina. Contact him at email@example.com.
Melanie Drake Wallace, a licensed professional counselor supervisor and national certified counselor, is a professor and department head of counseling and instructional support at Jacksonville State University. She also serves on the Governing Council of the American Counseling Association. Contact her at firstname.lastname@example.org.
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.