The dark side of therapy & medication tech companies
Published May, 2022
I’ve been on vacation, off the computer, and logging 12+ miles of walking around NYC and DC so I’m way behind on the news. Despite that, Cerebral has popped into my ears/eyes at least three times in the last five days:
A friend of mine who is also a therapist turned to them to discuss a medication evaluation because they couldn’t find a prescriber available anytime soon in Portland (they had a horrible experience and felt like they were paying to have whatever they wanted dispensed),
I keep running into their ads in various places I’ve been in NYC and DC, and
I just received an email newsletter from the fabulous, Jeff Guenther about Cerebral’s legal woes with the FEDS.
Cerebral is apparently under investigation by the US Department of Justice for prescribing controlled substances and has suspended prescriptions for new patients at this time. The private sector already weighed in when Walmart, CVS, (and maybe others?) stopped filling prescriptions for common ADHD drugs from Cerebral in April. Now the feds are on the case. The allegations from major pharmacies and the Feds align with my friend’s observations as a Cerebral client: It felt like a pill-mill situation.
For the record, I can’t say what’s going on at Cerebral other than what I’ve heard from personal accounts of friends and colleagues who have either personally been Cerebral clients OR have therapy clients who are, and the media coverage anyone can see. If the allegations are true, however, this type of low-quality, high-volume care is EXACTLY what my colleagues and I have been concerned about for years now.
Look at that - I literally just walked by the DOJ!
Big tech can’t solve the core problems
These companies are creating giant infrastructures of technology and non-clinician people to “fix” mental health care when the real problems are NOT solvable by technology companies.
We need more well-trained clinicians doing high-quality therapy, across the country.
We need well-designed and staffed centers to provide higher levels of care for people who are severely and persistently mentally ill (SPMI) and those who are in temporary crisis with their mental health. (Right now there’s nowhere reasonable to send people in crisis and some folks with SPMI are simply on the streets.
We need to fund both drug and non-drug treatments and re-fund psychosocial research on addressing mental illness. Drug treatments are NOT ENOUGH TO SOLVE THE MENTAL HEALTH PROBLEM.
We need a social safety net that is sufficient to help folks through difficult times so that we have a floor of existence for being a human being in American society. We also need to have very difficult conversations about our tolerance for folks who do not WANT to live above that floor and what that means (I have no answers there - only really painful questions). But of course we can’t address that until we have a path to get everyone to the floor.
There is not a damn thing in here that big tech can solve for. They can help clinicians like me provide more convenient therapy to folks with resources but I’m still a limited resource as one person. With all of the regulatory, privacy, and ethical issues going on for me in practice, I can’t see more than 20 clients a week no matter how much administrative support you give me. It’s simply the limit of my capacity as a caring clinician, to be able to provide care for that many people. You can smooth out the admin bumps a bit and I might be able to see 21 or 22. But after 10 years in private practice, I’ve figured out a lot of those things for myself. I see mostly cash-pay clients. You cannot make it appealing for me to see more.
Do you REALLY want to solve mental health? Here are some ideas:
Incentivize the best and brightest to go into mental health. This job is HARD WORK (and I LOVE it) and a lot of folks who go into the field burn out because most jobs don’t pay enough compared to other jobs available to folks with the same education. Why would you take a huge hit to your own physical and mental health to help others if you could just go work at a tech company doing non-client work for so much more money?! If you want clinicians, pay hazard pay.
Remove layers of bureaucracy, administravia, regulatory bullying, LIABILITY, and fear for clinicians and treat them more like physicians in terms of respect (although doctors, I know that you’re getting treated like crap in the system too… I just think that perhaps you have it a little better than us midlevels).
Give us a PAID seat at the table for discussions on how to solve problems. I’m NOT giving you free advisory services. I bill for that. Offer to pay me if you want consultation on how to make your business better. <argh>
Oh and when I say “us” I mean clinicians who are actually practicing and know what they’re talking about. You cannot hire Ph.D.s who don’t even see clients and got hired right out of Stanford, to design systems for patient care. Oh and psychiatrists should not be making decisions for therapists because they’re often not well trained in therapy (again, I love you MD friends and I know some of you DID do a lot of therapy training in school.. so I don’t mean all of you).
PAY ENOUGH SO THAT THERAPISTS CAN PAY BACK THEIR STUDENT LOANS. Some of the most successful therapists I know are actually struggling to pay back student debt. What the hell!? How can someone in practice over 10 years who is known as the best in her field, still be paying back student loans!? It’s total BS.
It’s not a technology problem but can big tech start the movement?
Again - are any of these five things big tech wants to solve? No. These ideas don’t make money for founders or shareholders. These are societal problems which require society-wide solutions. These are cultural problems that require cultural shifts. These are policy issues that require legislation and enforcement changes. Importantly, they aren’t going to show a quarterly or even annual return for tech companies. That said, it’s possible that the workers within the tech industry could start a movement (and perhaps already have) with expecting more from mental health care and that expectation could spark a larger social movement.
Perhaps the fact that so many companies are TRYING to solve mental health in this country could generate enough interest to bring awareness to the scale of the problems we face. But in the meantime, people are probably going to get hurt.
Big tech plays fast and loose. Remember Facebook’s mantra (I think it was them) “Move fast and break things?” As big tech mental health moves fast, PEOPLE are going to get broken. People will get bad diagnoses, wrong treatment, and bad outcomes. Are we willing to go through that? Or is there another path that could be a bit more measured and thought out and perhaps funded in a more logical way? Given our policy-makers’ reluctance to do anything useful legislatively, I doubt it. But it sure would be nice.