Expert Discusses CVS Health Survey on Mental Health

Cara McNulty, president of Behavioral Health and Mental Well-Being at CVS Health, discussed a recently published survey from CVS Health Study on rising concerns of mental health in Americans.

She discussed how the pandemic is increasing awareness about mental health concerns, why mental health is becoming less taboo, and how telehealth has impacted the trajectory of mental health conversations.

Ashley Gallagher: Hi, I'm Ashley Gallagher from Pharmacy Times, and today I'm speaking with Cara McNulty, president of Behavioral Health and Mental Well-Being at CVS Health, on a recently published survey from CVS Health Study. The survey found that mental health concerns among Americans are on the rise. What are some notable takeaways from this study for pharmacists?

Cara McNulty: Hi Ashley, it's great to be here. One of the things we're seeing is that take a pandemic, take all that's happening in the world, everyone's mental health has been impacted. Everybody is seeing some kind of additional stress, or situational anxiety, or sometimes even more, depression, substance use disorder, and when we think about the role of the pharmacist, most of us can picture the pharmacist that we go to in our local community, and maybe even at a CVS store. We can not only envision who they are, but we probably know their name. Pharmacists are people that are in our community, who we know to be trusted advisors, trusted health care advisors, and what we saw in our study is that people agree: a pharmacist is known to be knowledgeable, a health care advocate and someone really easy to talk to.

So what we found is people are willing to talk to their pharmacist willing to have their pharmacists ask them questions about their mental health well-being and also willing to take advice from their pharmacist.

Ashley Gallagher: How has the pandemic helps to increase awareness around the importance of mental health discussions in general?

Cara McNulty: It has done a lot for increasing the awareness, not only the awareness, but the action that people are taking around their own mental health well-being. We have seen because the pandemic has been long lasting, impacted all populations and all communities, that people are talking about the impact on themselves, on their communities, and on their loved ones.

If you look at our data, nearly 4 in 10 adults, so 4 out of 10 adults, feels comfortable talking not only with their friends and family about the impacts on their mental health, but also with health care providers. We also know that parents have used the tactic of talking and raising awareness with their own children to increase the openness, and we find that about 57% of parents are saying, the more they talk about mental health and talk about the realities of how hard things have been, the more their children are likely to engage and also share their feelings.

Finally, we know that in specific communities, the pandemic has hit even harder and think it might have the same outcomes around who's being affected because of the pandemic. But we're seeing in Black communities and in Hispanic communities, their increase in the need for mental health care and support because they're nervous. They want support, they want care, ut in both of those communities, it has been less likely that they're openly talking about their personal mental health and well-being.

Ashley Gallagher: Well said. Why do you believe that mental health is becoming less taboo? And why are more people starting to seek out these conversations around mental health?

Cara McNulty: We believe it's becoming less taboo the more we normalize that mental health is just like our physical health, your head health and your heart health are the same. So think about what we do for our physical health. We try to eat well and exercise and get sleep and get our preventive care all to maintain that physical body.

Well, our mental health needs that same nurturing, and that means daily care and feeding. Similar things like eating well, and getting sleep, and taking care of yourself exercising are good for our mental health well-being. It's also good to be talking about how we're feeling, sharing when we're anxious or nervous, and seeking care when things are really maybe not going as you thought or you're not engaging in activities or finding joy that you use to, or maybe you're relying on alcohol or other substances to just get you through the day.

We do see that the more we talk about mental health well-being as a part of your head and heart connected, not separate, the better it is for people to feel comfortable to share how they're doing and also to ask for help.

Ashley Gallagher: Has telehealth impacted the trajectory of mental health conversations? Has it made it easier for people to have these conversations?

Cara McNulty: Sure has, it has been profound: what it has done to meet people where they're at and get them the care and support they need. So, I'll just take one of the populations we serve, and that is people who have Aetna medical insurance.

Prior to the pandemic, we served about 1% of that population via tele-mental health. Now, 2 and a half years later, we serve about 60% of that population. It's a high utilization of tele-mental health services, and what that has done, and you can see that across many providers, that their tele-mental health rates have gone up. Why that is, is because people are feeling really comfortable connecting with a social worker, a therapist, a psychologist, a psychiatrist, via tele-video, it not only creates an easy way to get connected to your provider, but we're also seeing in some populations, like young adults, they feel more comfortable to even share some of the things that they might not share in person.

Now they're making that connection really quickly. So, we do see that people are engaging, using that tele-mental health. We're seeing that tele-mental health and the use of tele-video works really well for providers because it allows them to have more flexibility in their schedule, likely seeing people at different times that makes it more convenient for the population they're serving. Also, they're likely able to see more patients because there isn't the travel time. There isn't the setup and take down of what an in-person visit would look like. The use of tele-video and tele-behavioral health has really improved our access issues for people seeking care.

Ashley Gallagher: From a pharmacist’s standpoint, what can they do to help their patients who want to have these conversations about mental health?

Cara McNulty: Like I started with, most people can think about the pharmacist in their community, and likely even know their name. So, our pharmacists can lean into the fact that they are a trusted health provider in a community, which I know they understand, but continue to engage in those conversations.

They are seeing people when they're picking up medications or dropping off scripts, and they're engaging in conversations. They know who those people are, what kind of services they're on, and they can help to normalize the conversation by checking in with people: How are you doing? For example, in our CVS stores, a pharmacist, somebody might be picking up a script, and maybe they're a caregiver, that pharmacist is checking in on, “hey, how are you doing? And what's happening with you?” There's that conversation that pharmacist can suggest to that individual: “Did you know we have screening services within our medical clinics to help with depression and anxiety diagnosis? We have folks you can talk to if you're struggling or needing support.”

So you're really normalizing that conversation. Our pharmacists are doing this on a regular basis, and again, it removes the barriers for people feeling shame or alone or loneliness that they're the only ones suffering. The more we have pharmacists engage in these conversations and normalizing that mental health impacts us to all the better the outcomes for all of us specifically in those communities.

Ashley Gallagher: And what is the role of the pharmacist in these conversations?

Cara McNulty: So that pharmacist is engaging and understanding, asking questions and understanding what's happening or what is that person experiencing because most of the time people don't know what a mental health issue is supposed to feel like, and we don't need people to have to be experts in their own diagnoses.

So that pharmacist, by having the conversation, can assess: is this person a good candidate to have a conversation with someone to have an assessment to think about a telehealth video, to see one of our nurse practitioners in the Minute Clinic.

They are engaging in that conversation, sharing the resources available, for example, for us within CVS, stores and footprint, but for other pharmacists within the community and ensuring that people get the care and support they need from that trusted health care provider.