Meeting demand – or creating it?

March 15, 2022

Good morning, MindSite readers. Today’s top story is Bloomberg Businessweek’s investigation that found overprescribing at Cerebral Inc., a two-year-old company valued at $4.8 billion that MindSite News included in our investigation of digital health companies last year. In other news, Chicago hospitals rally to support physicians, nurses and other hospital workers burned out by the ongoing COVID crisis, a student who loves the “sleep and serenity” linked to online learning, and how meal timing affects mood.

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Booming Cerebral overprescribing psych drugs, disillusioned staffers charge

A Bloomberg Businessweek investigation into the biggest and fastest-growing telehealth service for mental health, Cerebral Inc., found numerous insiders and outside experts who charge that the company is overprescribing medications. The company, which was founded in 2020 and now has 200,000 patients nationwide, said in a statement that it aims to “reduce the amount of controlled substances used and the overall reliance” on drugs. But disenchanted staff and patients tell another story.

Client Jeneesa Barnes, who has bipolar disorder, told Bloomberg that Cerebral made her mental health worse, not better. Over the course of three months, Barnes paid $325 a month for a therapist, a psychiatric nurse practitioner, and a care coordinator. Her treatment was overseen by a “care coordinator” named Eileen Davis who actually did not exist – that was a moniker for hundreds of care coordinators operating under the same pseudonym. Barnes had 11 hour-long therapy sessions – the best part of the program, she told Bloomberg – and was prescribed five medications (three antidepressants, an antipsychotic and an anticonvulsant). During her time with Cerebral, Barnes’ mental health deteriorated to the point of auditory hallucinations – hearing voices, “as if people were just out of sight, discussing her flaws, picking her apart, even when she was home alone,” according to Bloomberg reporters. Barnes ended up admitting herself in a hospital to be treated for a mental crisis.

Angela Rasheed, a nurse practitioner who treated Barnes, was let go by Cerebral in a billing dispute and is critical of the company. She thought Cerebral would help make mental health services accessible to people needing help, but instead, she told Bloomberg, the company pressured licensed professionals to overprescribe medication after brief virtual sessions. Just as concerning, said Rasheed, Cerebral sent an average 30 patients per day to each provider – at 15 minute increments – twice the usual caseload.

The article notes that while Cerebral treated some patients that did not receive prescription medications, seven former Cerebral nurses told the publication that they “worried Cerebral wasn’t merely meeting a demand but was also effectively creating it” – and perhaps contributing to a new addiction process. Cerebral executives declined to talk with Bloomberg and refused to say how many of its clients are prescribed medications, but two people familiar with his comments told Bloomberg that Chief Medical Officer David Mou told managers that 95% of people who see a Cerebral nurse should get a prescription – but not 100% lest the company be seen as a “pill mill.” A company spokesperson told Bloomberg that the 95% figure refers only to a “subset of patients.” (Last year MindSite News published an investigation of virtual mental health startups, including Cerebral, in “A Digital Mental Health Revolution, But For Whom?”)

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Hospitals rethink how to keep employees and address their burnout 

Wellness Week at Rush University Medical Center (YouTube)

Early in the pandemic, there was widespread concern that healthcare workers were burning out from sheer exhaustion. In many places these frontline workers were treated like the heroes they were. They ended shifts with applause, fielded thank you cards, and enjoyed break rooms inundated with pizza. But two years later, the exhaustion is still there, compounded by mental health challenges triggered by fear, overwhelm, and grief from continuing to treat waves of patients sick or dying with COVID-19. “I probably signed more death certificates in the past two years than I have in my entire career,” Dr. Vivek Cherian told the Chicago Tribune. “It takes a toll on people.”

Now, the Tribune reports, hospitals are scrambling to keep hospitals fully staffed. Strategies for hospital staff retention and support include bringing back food and water carts at Rush University Medical Center in Chicago, plus programs like a Joy in Work group where staffers from entry level to hospital administration talk about self-care and work-life balance. Eve Poczatek, who leads the Center for Clinical Wellness at Rush, told the Tribune it’s like emotional PPE. “You need to build a consistent support system,” she says. 

Other institutions have instituted peer support programs, while others have allowed part-time work to honor the changing needs of families. Dr. Anne Boat, associate chief medical officer at Chicago’s Lurie Children’s Hospital, said, “What we’ve learned is that we’re going to have to be more flexible…The pandemic has changed our thinking.”

Tattoos for the blues?

Tattoos and other body modification can offer help for people struggling with generalized anxiety and other mental and physical health conditions, according to Allure magazine. Its reporters spoke to patients and psychologists who have seen helpful results: A 27-year-old travel nurse tattooed with the outline of a sun and the words “here comes the sun” underneath says it reminds her that better days are ahead. A 25-year-old with panic disorder said the tattoo of a crescent moon on her rib reminds her that something difficult can become something beautiful that brings her joy. And Quincee Gideon, a licensed psychologist from Los Angeles, told the magazine: “When we are anxious or chronically ill, we usually feel like our bodies, nervous systems, and perceptions of danger are betraying us. In some ways, tattooing can be a way to take control again or make our bodies more representative of us.”

In other news…

Zoom learning preferred? This teen says, ‘Absolutely.’ Many teens longed for a return to in-person school and sports, but not everyone. In an essay for Chalkbeat, Tamar Coon, a 15-year-old tenth grader from Washington DC, says the initial shift to virtual school took some getting used to, but it gave her more time to engage with her family and get much needed rest. It also released her from the pressure she felt to take on a heavy load of extracurriculars. Better yet, she developed such a level of organization that she made the school’s honor assembly with every marking period. The return to in-person learning, on the other hand, brought with it increased anxiety and a renewed sense of pressure.

When you eat might matter more than you think, according to researchers at the Centre for Neuroscience Studies at Queen’s University in Ontario, Canada. In The Conversation, Dr. Elisa Brietzke and doctoral student Elena Koning wrote about new studies that show irregular eating times contribute to mental health conditions like depression and anxiety. Limiting eating to daytime hours – 9am to 7pm, for example – supports a healthier mood, they write, and “optimizes brain function, energy metabolism and the healthy signaling of metabolic hormones.”

View patients as experts on themselves and get full agreement from them before beginning treatment. That’s the perspective of Saretta Lee, a Sydney, Australia-based psychologist, in The Modern Mind, a Guardian column featuring mental health professionals considering new challenges in their work. Dr. Lee has noticed that her patients simply don’t follow prescribed treatments when they disagree with them or feel their voices are dismissed by their doctors.

Coping with “chemo brain.” Dr. Jennifer Kilkus, a clinical health psychologist and professor of psychiatry at Yale University, wrote a piece for Psychology Today on chemo fog, known colloquially as chemo brain. The condition is treatment-related cognitive impairment that manifests as trouble with attention, concentration, working memory, and executive function. Though dismissed for years by some doctors because chemo drugs aren’t known to cross the blood-brain barrier, Kilkus says it’s real and there are multiple ways to treat it. In addition to exercise and a nutritious diet, strategies include brain games like crosswords; talking to yourself while conducting an activity or working to jog your memory; making use of notebooks and calendars; and generally just giving yourself more time and patience.

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If you or anyone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255. And if you’re a veteran, press 1.

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