Former Cerebral employees say company's practices put patients at risk: "It's chaotic. It's confusing. It could be extremely dangerous"
Dr. David Mou believes that Cerebral "saves lives."
The startup treats people for conditions such as depression and ADHD, and is the largest online mental health care provider in the world.
But last month, the U.S. Department of Justice launched an investigation into Cerebral's prescribing practices.
Mou, the company's president and chief medical officer, said Cerebral is cooperating, and that he's "confident" the DOJ investigation won't find any problems. The company, formed in 2020, exploded during the pandemic, thanks to relaxed prescribing regulations and high demand for virtual care. By the end of 2021, they were valued at $4.8 billion, and had signed Olympic gymnast Simone Biles as its chief impact officer.
Meanwhile, a CBS News investigation found that some users have had problems with Cerebral's quality of care.
Twenty-eight-year-old Rachael Costar believes Cerebral failed her during her time of need. She developed severe anxiety after the birth of her second child, and had seen ads on social media for Cerebral that offered affordable mental health services online.
"Every single night I would go to bed just, 'Tomorrow I'm gonna do it. I'm gonna be better tomorrow,'" Costar told CBS News consumer investigative correspondent Anna Werner.
Costar signed up, met with her prescriber online, and got a prescription all in a single day. But after that, she said she couldn't reach her prescriber when she needed instructions from her prescriber on how to safely switch to the new medication they gave her.
"Every time I needed her help, she was never available," said Costar.
After six days of no response, Costar said she started the medication she was prescribed but soon broke out in a rash—a potential side effect for which the drug's maker advises patients to contact their doctors immediately if experienced. Costar contacted Cerebral to help her try to reach her prescriber—with no luck.
"I messaged back letting them know it was spreading and getting worse. And they said that they were still trying to get a hold of that prescriber," she recalled.
She finally went to the emergency room, where doctors treated her with IV steroids and told her to stop taking the medication. She then canceled her Cerebral membership.
"They make it seem like they wanna help. And then they get you and they're gone," said Costar.
She is one of a dozen patients who told CBS News they have had a negative experience with Cerebral's quality of care.
Mou, who took over as CEO last month, said that their system works.
"If you look at our outcomes, and this is what's most important, do the patients get better? They do. They absolutely do," Mou said.
Documents obtained by CBS News show Cerebral leadership was informed about risks the company was facing, including patient and clinical safety issues, hires who may not meet Cerebral's hiring standards and staff practicing with expired suspended licenses.
Many customers complain that they have experienced similar issues to Costar and couldn't reach their prescribers.
Mou said that the average wait time to get to a prescriber is "days" – a metric he says the company is "very proud of" because many patients wait months before they can "get to care."
An internal log CBS News obtained shows the company's own staffers flagged nearly 1,200 instances of prescribers being "unresponsive" over the past 11 months.
Mou acknowledges the dangers of patients not being able to get hold of their prescribers and is looking to improve this.
"I will say we'll definitely take a look into this. And we're very serious about continuous improvement here," he said.
Aside from patient concerns, some former employees are also worried about some of Cerebral's practices. Melissa Butorac worked as a client-coach for Cerebral, and compares it to a "fast-food restaurant."
"Get as many people in as fast as you can," she said.
She is particularly concerned about patients who may be suicidal and believes they are not in safe hands with Cerebral.
Butorac said the company handles suicidal clients through Slack, a messaging app.
Mou said the system allows staff to quickly respond to suicidal patients.
"Within minutes, a crisis specialist would help triage this patient to the most appropriate level of care," said Mou.
But Butorac believes that this messaging system could be dangerous if messages aren't followed up or are missed.
"It's chaotic. It's confusing. It could be extremely dangerous, right, if you, somebody misses the message or doesn't follow it," she said.
A former Cerebral phone coordinator, who spoke on the condition of anonymity out of fear of reprisal, said that he handled calls from suicidal patients despite having minimal training.
"I'm not trained, I don't wanna say the wrong thing. And I didn't want that on my conscience, let alone anybody to die because of something I said wrong," he said.
Mou said he would have to review this case but that the company has devoted a lot of resources to "save lives."
"We've invested a lot of resources, and for the most part, as you can tell by our aggregate numbers, we're able to save lives. You have to take this in aggregate. And many of our patients do really well. If you look at our ratings," he said.
Mou said that Cerebral is devoted to quality of care.
"Our commitment here is the quality of care. And now that I'm CEO, we're gonna double down and triple down on that thesis," he said.
Cerebral said it has reduced suicidal thinking in 50% of patients it studied, and that its internal logging of prescription issues shows the "safety checks and balances" it has in place.
After CBS News' interview with Costar, Cerebral apologized to Costar, said the clinician who worked with Costar did not follow procedures and is no longer working with the company.
If you or someone you know is struggling, help is available 24-7 at the National Suicide Prevention Lifeline. Just call 1-800-273-8255. For more resources, please click here.
If you want to share your experience using online mental health services, email us at mentalhealth@paramount.com.