Cerebral: More Customers and Employees Express Concern About Diagnosing and Prescribing Practices

September 13, 2022

More users of Cerebral, one of the largest online mental health care providers, are reporting they have problems with Cerebral's quality of care. 

In June, CBS News reported on how some users were concerned about how the startup was treating people for conditions such as depression and ADHD.

Since then, CBS News has heard from more patients and employees who are concerned about the way Cerebral diagnoses and prescribes medications.

One woman told CBS News consumer investigative correspondent Anna Werner that she has long suffered from severe depression as a result of sexual trauma in her youth.

She said she struggled to pay for therapy and was drawn to Cerebral after seeing their ads on social media offering fast and affordable mental health care.

"I thought I was honestly signing up for something that was gonna change my life in a good way," the woman who asked to be called Yvette said.

After she joined, Yvette said she went through a short assessment and was matched with a prescriber. Yvette says in her first roughly 15-minute appointment with a Cerebral prescriber she was prescribed three medications and in a second, equally brief appointment, was given two more drugs. 

But she says her symptoms got worse. Yvette said she contacted her Cerebral prescriber again to tell her she was having nightmares about hanging herself but said she was brushed off during a short appointment.

"I was scared and when I reached out to her and I was just crying to her because I didn't know what to do, she said, 'I don't have enough time. I have to go to my other appointment. I've already spent enough time with you,'" Yvette recalled.

The next day, a family member found her hanging from a dog leash in her bathroom.

Yvette said she does not remember anything from the incident and that she thought she was "dreaming."

After attempting to take her life, Yvette was hospitalized and says she underwent a lengthy evaluation with a new doctor who changed her medications.

She said her new health provider were confused about the medications Cerebral prescribed her.

"Whenever she got the list of meds that I was on, she's like, 'I don't understand why they would put you on this,'" Yvette said.

Clinical professor of psychiatry at NYU and President of the American Psychoanalytic Association Dr. Kerry Sulkowicz said he would not feel comfortable diagnosing someone in 15 minutes. 

"It takes longer than 15 minutes to get to understand someone's life story. Diagnoses have to be made in context," Sulkowicz said.

"Psychological diagnoses are almost, by definition, far more complex. And it requires obtaining both a medical and psychological and a social history. Just having that kind of conversation takes more than 15 minutes," Sulkowicz added.

In June, Cerebral CEO Dr. David Mou told CBS News that the company's overall outcomes are positive.

"I refer my close friends, my family members, to use Cerebral," Mou said. "And I would say that it's important to also see the other side of the story, which is the-- the vast majority of our cases where we are changing lives, we're reducing suicidal thinking."

But a CBS News review of Cerebral's more than 1,500 prescribers, listed on its website, found only five are board-certified psychiatrists. The majority – some three-quarters of Cerebral's prescribers – are nurse practitioners from specialties outside of mental health.

And an internal log obtained by CBS News shows Cerebral's own staffers flagged at least 280 instances where one patient was prescribed "5+ medications."

Sulkowicz said he found that "rather alarming."

"Diagnosing a mental illness is a complicated endeavor. There's a reason why it takes years of training," he said. "These are serious medications that we're talking about. These things are not to be prescribed or taken lightly."

Cerebral declined to answer CBS News' specific questions about Yvette's case. 

In a statement, the company said:

"Cerebral clinicians are on the front-lines of our country's mental health crisis every day treating patients in need, many of whom would not be able to access quality mental healthcare before the emergence of telehealth companies. We know that our clinical standards meet and exceed those of many conventional brick-and-mortar facilities, and our clinicians have access to more tools and capabilities than many of their counterparts working in brick-and-mortar locations. Our highly qualified credentialing team led by two medical directors, who are psychiatrists, and includes four senior clinical managers who are nurse practitioners, oversee all our hiring and professional development of patient-facing clinicians. Under our new CEO, Dr. David Mou, we have doubled down on our focus on clinical quality and safety and believe that telehealth has the potential to democratize access to mental health care that has traditionally been inaccessible to many people in need."

Source: Anna Werner, “Expert alarmed by mental health app Cerebral's speedy sessions and prescriber qualifications,” CBS News, Sept. 7, 2022, URL: https://www.cbsnews.com/news/cerebral-app-mental-health/