A lot of your objections seem to assume this fantasy world where a person experiencing "difficulties" (maybe even meeting criteria for a depressive or anxiety disorder) can easily and quickly access adequate (not top-notch- but adequate) mental health care by simply picking up the phone and scheduling a visit next week with their local Psychologist/Health Services Provider. I accept that there might be regional differences, but this is how it works in my neck of the woods* (inspired by actual events!):
-You contact your insurance company (assume a standard HMO type group plan through your employee, with reasonable mental health benefits) for a list of providers, or you just do a web search for providers in your area
-If you have some knowledge of ESTs, you start to contact providers who's bios indicate experience with validated treatments for the "difficulties" in question, knocking off 50-75% of the providers on the list who say things like "expert in working with young children and the elderly" or "I integrate [non-validated, non-psychology nonsense] into my practice" or "I want to join you on your spiritual life journey of healing." If you have no knowledge of ESTs, you probably just start at the top of the list and work through it alphabetically (wow, Aadrian Aadleson LMHC, CAGS, ABCDEFG really has a busy practice!). In a list of 20 providers, there are maybe 2-3 doctoral level psychologists.
-10-20% of the numbers you call are either wrong or out of service. You leave messages at a dozen others (you think an actual person is going to answer the phone? How quaint!). Maybe half of them actually return your call. Of those, most say "sorry, no opening now. Have you tried calling [clinician who did not return your call]? Most of the rest have stopped directly accepting your insurance and require full payment at time of service, but are "pretty sure" you can submit your claim on your own and will probably get reimbursed.
-You finally speak with an actually person who will take your insurance and is accepting new clients. There are some things in their bio/training history you have to overlook, but hey, they actually called you back, accept your insurance, and have an opening!
-Turns out that opening is right smack in the middle of your work shift or school day! Oh well, you have some vacation/sick/personal time you can use, at least for a few weeks,(or it's ok to miss one day a week of 5th period AP Bio, but you'll have to make up that work on your own, at home, at night, alone, where your "difficulties" or seem to be most impactful and make it hard to concentrate.
-You get the approval from your boss/teacher to miss time (due to concerns about the stigma of mental health difficulties, you make up some story about why you need the time, both to tell your boss/teacher when asking permission, as well as to tell you coworkers/other students in your class when they ask why you aren't there). A month or two after you started looking, you go to your first session. Clinician seems nice enough, and you feel good about making a change and doing something active to address your difficulties. You maybe made some compromises in who you picked as a clinician, but still- this is better than nothing. Despite the clinician having to reschedule your next session, you get into a grove with them and you start to subjectively and objectively feel better.
[End story time]
The way I see, if we could skip right to the last part (meeting with a reasonably competent clinician, relatively quickly, in a manner that would be paid for by insurance, why wouldn't we. The stuff about location. security, HIPPA, etc., are just a red herring, and could be figured out just as easily in CVS as in our our offices (which, you might have noticed over the past year, are often the same as "the place we live"). The argument regarding inpatient care are an even bigger red herring, as that is not likely to be the population that the CVS clinic is set up to take (and you think my story about outpatient is long and convoluted, just you try to find an inpatient bed for a teenager).
Yes- easy and affordable access to a doctoral level clinician trained in a mentor-model, Boulder-model, training program might be better (the empirical jury is still out on that one), I'd also like to ride to my office on magical unicorn that poops gold coins and pees double IPAs and Imperial Stouts.
I find it interesting to see posts on other threads from the same posters who are de facto criticizing this model also recommending that new clinicians follow their lead and try to get to a point that they only need to deal with private pay clients. Some big issues with access to care there, don't ya think?
The CVS model might not, ultimately, be the best, but at least it's something.
*A rural/suburban area, but with multiple local social work and MHC training programs, as well as a Ph.D. clinical psych program and relatively decent public health system.
ETA after seeing Wisneuro's post above- the person my "story" was based on is not from an underserved community and, in fact comes from a relatively high SES, high-status group. Not high enough where paying $150 per week (after already paying hundreds per month for health insurance) is sustainable long term, but also no just scraping by.
www.npr.org
www.psychologytoday.com
