What Happened When Cerebral Treated Complex Patients

Hi, it’s Polly and Caleb in New York. What happens when telehealth startups collide with patients who have complex mental health conditions? More on that in a moment, but first…

Back in March, we reported on the growing concerns among staff at the online mental health startup Cerebral. Employees were especially concerned about the company’s prescribing practices for the ADHD medication Adderall and other controlled substances.

In the wake of a global pandemic that has put a strain on everyone's mental health, the story resonated with readers more than we could have expected. We started hearing from more people familiar with the company. Some told us that, in its effort to grow its client roster, Cerebral was taking on patients with complicated problems that it was poorly equipped to care for, including those with substance use disorders. That led us to a new, heart-wrenching line of reporting that revealed overdoses and deaths among Cerebral patients.

One was Greg Grant, who died by suicide at the age of 51 after two months as a Cerebral patient. Greg told his Cerebral nurse practitioner that he would drink to cope with anxiety before going to work. In his time as a patient, a binge-drinking incident that he reported to the company also landed him in the emergency room. But his medical records give no indication that his nurse practitioner was concerned about alcoholism. Instead, Grant was given an antidepressant known to sometimes increase suicidal thoughts among patients who drink.

“He signed up with them, they sent him some meds. It just seems so easy,” Greg’s sister Rhea Anne Teague told us. “It struck me as colossally not a good situation for Greg.”

As Grant sought help for his anxiety, he found himself interacting with an unlicensed counselor, the company’s “Answer Bot,” and customer service staff using the alias “Eileen Davis.” After a coroner told the company that Greg had died, Cerebral messages continued to flood Grant’s phone and email. Over 23 days, the company sent him nine missives, including four inviting him to check in. The last, a cancellation email, arrived on Sept. 12 with a farewell message: “Sorry to see you go!”

Telehealth clearly isn’t going anywhere. The pandemic taught us all how much more convenient it is to visit the doctor virtually. But it was the pandemic that allowed companies like Cerebral to sell controlled substances online. And permission to continue doing that could disappear when the public health emergency eventually expires, which could come as early as this spring. Telehealth companies are hoping they will be allowed to continue with the status quo — but cases like Greg Grant’s may persuade lawmakers that’s not the best option. — Polly Mosendz and Caleb Melby