The Mental Health App Cerebral has recently come under fire for numerous controversies related to its business practices. If you have spent any amount of time on Instagram or Tik Tok over the last two years, you have likely come across adverts for this popular influencer-backed mental health app. Cerebral is a direct-to-consumer service that connects users with licensed professionals who can provide therapy, care counseling, and medication. Many have likened Cerebral’s service to Uber for mental health and the company now faces criticism for providing substandard care, overprescribing medication, and fueling the mental health epidemic it claims to combat.
Cerebral was started by Kyle Robertson in January 2020. The company initially tackled anxiety and depression and only prescribed drugs like Lexapro and Prozac. With the onset of the pandemic that year, the demand for mental health services skyrocketed. The DEA also relaxed its regulations around the Ryan Height Act which meant patients could get access to stronger medication without needing to see a health professional in person. Cerebral was able to ride the pandemic surge in demand for mental health services and got a $300 million investment from Softbank at a $4.8 billion valuation.
Since 2020, Cerebral has grown at an exponential pace becoming one of the largest mental health platforms on the internet. A big part of Cerebral’s success comes from its use of social media and influencer marketing. Simone Biles the Olympian who withdrew from competition citing mental health concerns was announced as Cerebral’s Chief Impact Officer in October 2021— effectively becoming the public face of the company. Cerebral went on to deploy a robust influencer marketing strategy that utilized social media, specifically Instagram and TikTok to spread the word about the service and onboard thousands of new users.
As Cerebral scaled up its operations, it began to offer services in other mental health categories like ADHD. Instagram and TikTok ads featured variations of the message “Have you ever thought you might have ADHD?” While many issues with focusing, stress, procrastination, and disorganization could just be a part of being human in the digital age, Cerebral Ads would suggest that these common issues could be a case of undiagnosed ADHD. Cerebral could then guide impressionable users through their funnel and have them onboarded to their platform in a matter of minutes.
Cerebral’s approach to treatment seemed to put an emphasis on quick diagnosis and drug prescriptions. Nurse practitioners on the site would see upwards of 30 patients a day (twice the typical caseload) and would often prescribe them medication in the very first assessment. Instead of offering effective treatment, Cerebral employees were put in a situation where drug prescriptions were being used as a retention measure. The higher-ups were not even coy about the tactic. Cerebral’s Chief Medical Officer David Mou has said 95% of people who see a Cerebral nurse should get a prescription…however, the rate cannot be 100% — because Cerebral was not a “pill mill”. Matthew Treube who is the former vice president of product and engineering at Cerebral is currently suing the company. He alleges Cerebral had plans to prescribe medication to all of its ADHD patients as a way to increase customer retention.
“Seven former nurses for the company say they worried that Cerebral wasn’t merely meeting a demand but was also, by making access so easy, effectively creating it; they described a fear that they were fueling a new addiction crisis.” — Bloomberg
Beyond the overprescription of medication, there were quality control issues at Cerebral. When you have a service that is effectively the Uber for mental health counseling, you have to wonder how that is scalable? Nurse practitioners on Cerebral often had rosters of over 1000 patients and were overwhelmed with the prospect of providing quality care. Carlen Zhu for example fielded upwards of 100 messages from patients a day and at least a few were from people in crisis. The expectation that every customer would hear back from Cerebral within 24 hours meant that Zhu had to decide between providing a quick response and a quality response.
To no one’s surprise, many users of Cerebral have experienced substandard care. Patients often did not hear back from their care providers in due time if they heard back at all. Some patients who were unable to reach their care providers were unable to refill drug prescriptions and experienced withdrawals. Patients with a history of addiction were prescribed addictive drugs. Other patients were misdiagnosed or put on questionable treatment plans with lethal combinations of drugs. Cerebral also took on complex conditions like bipolar disorder when they lacked clinicians on staff with adequate training for treatment. The list goes on. The case of Cerebral clearly demonstrates that you cannot scale a solution to the mental health crisis without compromising on quality.
Business Insider recently uncovered a trove of leaked documents from Cerebral consisting of company policies, internal communications, meeting agendas, memos, and about 2060 incident reports filed in 2021. The incident reports in particular lend a lot of credence to the horrific stories coming out about Cerebral. While the company has countered by saying a set of incident reports cannot be used to make an assessment of Cerebral’s quality of care as a whole, many people including regulators are not seeing it that way.
With mounting public pressure, Cerebral might finally face consequences for their reckless and criminal behavior. The DEA and DOJ are investigating the company for their medication prescription practices. The FTC is investigating Cerebral to see if they have deceived customers. Major health insurers and pharmacies have cut ties with the service. As the Cerebral fallout continues, many people have been left wondering about the viability of mental health platforms like Cerebral.
Mental health is a serious issue globally and there is a dire need for affordable solutions. However, some things are not meant to be scaled with technology. Cerebral’s “innovation” in this space has already come with a flagrant disregard for medical standards and dire consequences for vulnerable patients. Moreover, the story of Cerebral has resurfaced discussions about DTC mental health services and their advertising practices. Given just how many notable creators worked with Cerebral, many are questioning the role influencers have in promoting these types of predatory companies to their young, impressionable audience. Simone Biles still appears on the top of Cerebral’s site though her picture is the only one with an asterisk. It reads: “*Simone uses Cerebral’s talk therapy services only.” I would imagine Simone is having second thoughts about being the Chief Impact Officer of a company that is having a very negative impact in the mental health space.
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