On Oct. 2, a federal jury in Michigan convicted Dr. Jonathan Decker of distributing more than 2 million stimulant pills through Done, a subscription ADHD telehealth platform. Prosecutors said he prescribed without examining patients and was paid more than $1 million. He is the 11th person convicted in what prosecutors describe as a $100 million drug distribution and health care fraud scheme tied to the company.
Most of the coverage has focused on the scale. One detail stopped me cold. According to prosecutors, Dr. Decker kept prescribing Adderall to a patient with schizophrenia after her mother told him, and told Done, that the drug was making her psychotic symptoms worse.
She did what families are told to do. She spoke up. She named the diagnosis. She described what she was seeing. And nothing changed.
This is not only a fraud story
It would be easy to file this case under bad actors and move on. The people responsible are being held accountable, and they should be. But as a mother and family caregiver for someone living with serious mental illness, I see a second story here, one that does not end with a verdict.
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Stimulants can trigger or worsen psychosis. For someone with schizophrenia, a family member’s report that symptoms are escalating after a new prescription is not background noise. It is clinical information, and often the earliest warning anyone will get.
Yet in most care settings, there is no clear place for that information to go. Families learn quickly that privacy rules limit what a clinician can tell them. What many clinicians and platforms seem to forget is that those same rules generally do not stop them from listening. A prescriber can hear a mother’s concern, document it, and act on it, even without a signed release.
As a National Alliance on Mental Illness (NAMI) Family-to-Family facilitator, I hear versions of this story constantly. A parent calls the clinic and is told the doctor cannot discuss the patient. A sibling leaves a voicemail no one returns. Somewhere along the way, “We can’t share information with you” became “We can’t hear from you.”
Telehealth is not the problem. Design is.
I want to be careful here, because telehealth has been a lifeline for many people with serious mental illness, especially those in rural areas or those for whom a crowded waiting room is its own barrier. The answer is not less telehealth.
The answer is building family input into the system on purpose. Done was designed to make prescribing fast and frictionless. That is exactly what a subscription model rewards. But a platform that can process a refill in minutes should also be able to stop and route a family’s safety concern to a clinician who must respond.
That means, at minimum:
- A visible way for family members to report a safety concern, on every telehealth platform that prescribes controlled substances
- A requirement that a documented report of psychosis or worsening psychiatric symptoms pauses stimulant prescribing until a clinician reviews it
- A standard in every practice, virtual or in person, that family reports are recorded in the chart, with or without a release on file
None of this requires new technology. It requires deciding that families are part of the safety net, not an obstacle to it.
What families can do now
If you are caring for someone with schizophrenia or bipolar disorder, put your concerns in writing: an email or a message through the patient portal, not just a phone call. Name the diagnosis, the medication, and what you are seeing. Ask that it be added to the chart. If you are ignored and you believe the person is at risk, escalate to the practice’s medical director or the platform’s compliance team.
It should not take a federal trial to reveal that a mother’s warning went unheeded. The next platform, and the next prescriber, can choose to listen the first time.
Nicole Drapeau Gillen is a mother, advocate, and author who translates the fast-moving landscape of technology in serious mental illness (SMI) care into guidance families and clinicians can use. Thrust into caregiving for a loved one with SMI, with no direction on how to help, she turned that experience into a mission, writing two books and building an ongoing effort to bring families and clinicians into the conversation.
Her first book, Schizophrenia and Related Disorders: A Handbook for Caregivers, is a reference for every stage of caregiving, endorsed by Dr. E. Fuller Torrey as a must-read for SMI caregivers. Her second, Connected Care: A Practical Guide to Technology for Serious Mental Illness, maps apps, artificial intelligence tools, telepsychiatry, and brain-based treatments for a field moving faster than anyone can track. Dr. Akira Sawa, director of the Johns Hopkins Schizophrenia Center, has said the book “directly addresses” significant gaps.
