OAKLAND, Calif. — Californians’ long struggle to access timely mental health care is entering a new era. On July 1, a new law, Senate Bill 221, by state Sen. Scott Wiener, D-San Francisco, went into effect to address a major ongoing problem — the extremely long waits patients must endure between their initial appointment and follow-up care. .
The measure targets a longstanding loophole in California law: While health maintenance organizations and insurers must provide initial mental health evaluations within two weeks of a patient’s request, they are not required to provide follow-ups within the same. period of time, resulting in long waiting times for many patients.
SB 221 passed the Legislature with an overwhelming bipartisan majority in the 2021 legislative session. The law was signed into law last October but did not go into effect immediately to give providers time to prepare to meet the new requirements. Under its provisions, health insurance companies must provide a follow-up behavioral health appointment within two weeks of the initial intake appointment, unless the therapist determines it is not medically necessary.
Speaking to reporters on June 30, Wiener said the measure “means that health plans have to provide timely access to mental health appointments, that you can’t give someone an initial appointment and then make them wait two or three months for their second and subsequent appointments because it completely undermines effective mental health treatment.
Wiener said he stands with Kaiser Permanente mental health frontline workers and Kaiser members because they are very concerned that health plans, and Kaiser in particular, are not yet ready to meet the demands of SB 221.
“These are people with serious mental health issues and addiction challenges, and they need quick access to treatment, just like if someone breaks an arm or has another serious health problem.”
Wiener was joined at the Zoom conference by Kaiser triage therapist Sarah Soroken and clinical social worker Josh Garcia.
Soroken, who said she works with people in crisis and those who need an initial appointment, told reporters that wait times have actually gotten worse since SB 221 became law. She recounted many calls from patients who had waited weeks or months to get an individual therapy appointment and whose symptoms often worsened during the long wait.
When, as often happens, she can’t offer them timely appointments in Kaiser’s system, Soroken asks managers to provide immediate care through Kaiser’s network of outside providers. But, she said, “unfortunately, Kaiser doesn’t allow patients with the most severe symptoms to be referred outside the treatment system, and they end up waiting six to eight weeks or more.”
Meanwhile, many patients with mild to moderate symptoms who are referred outside of Kaiser can’t find an available therapist in the healthcare giant’s overburdened network of outside providers and end up calling back with worsening symptoms.
Soroken shared redacted patient records showing wait times ranging from one month to more than three months between intake appointments and the first therapy appointment.
“Kaiser can say it has a lot of plans to comply with SB 221,” she said, “but this is the reality for patients: The law goes into effect tomorrow and they still can’t be seen for months.”
Garcia expressed concern that Kaiser has not shared any specific plans with clinicians at his clinic and said the only idea he has heard includes reducing mental health appointments to 30 minutes; Soroken later confirmed that even shorter appointments had been instituted at Kaiser’s psychiatric office in Vallejo.
“We want to work with Kaiser leaders to implement SB 221 because it would greatly benefit all of our patients,” Garcia said, “but the only way to do that is to add more sessions of 45 minutes or longer” with intervals of seven to 10 days between appointments and even more often in some cases.
The human toll of Kaiser’s long wait times was graphically described by longtime Kaiser patient Jasmin Hakes, whose daughter, now 21, was first diagnosed with multiple serious mental health issues in 2013. In 2019 and again in 2020, her daughter was hospitalized with severe depression and suicidal ideation, even ending up on life support at one point after an overdose.
Hakes said that despite daily calls, voicemails and emails and repeated assurances that Kaiser would contact them once she had a therapist, “to this day she still does not have a therapist.”
Kaiser’s mental health clinicians are represented by the National Health Workers Union, whose president, Sal Rosselli, described the clinicians’ 12-year battle with the health giant’s administration and physician leaders over “a lack of timely access to reentry care caused by Kaiser’s severe understaffing of its mental health clinics.”
Rosselli credits that fight with contributing to SB 221’s near-unanimous bipartisan passage.
“This law has the potential to help so many Californians, and that’s why it’s so disappointing that Kaiser, as the provider for more than a third of all insured Californians, has taken no steps to comply,” he said.
In fact, the California Department of Managed Health Care launched a special “non-routine survey” in May to see if Kaiser is providing adequate mental health coverage to its 9.4 million California enrollees.
Disputing Kaiser’s claims that it is having trouble preparing to comply with SB 221 because of a national shortage of clinicians, Rosselli pointed out that mental health clinicians are leaving Kaiser in record numbers — 668 in the past 12 months — which he said is double the number leaving in each of the two previous years. He also noted that Kaiser reported $8.1 billion in net income in 2021.
“If our members got the tools they need, including the right staff, Kaiser could have the best mental health system in the country,” he said. “But once again, Kaiser executives have refused to invest in its mental health services, and its members are suffering the consequences.”
Rosselli said Kaiser therapists and their union are ready to help Kaiser comply, “but right now the best way to get Kaiser and all health insurers to comply is to make sure everyone knows their right to timely care’. He urged patients, their families and those concerned about the issue to learn more about the new law and ways to file a complaint when providers don’t comply by going to nuhw.org/sb221 and a related website, kaiserdontdeny. org.
He also drew attention to another measure by state Sen. Wiener, SB 858, which passed the Senate last month and is currently before the Assembly. This bill would sharply increase fines for violating mandatory consumer protections, which in many cases have not been updated since the 1970s.
Unfortunately, Rosselli said, “organizations like Kaiser Permanente see fines as the cost of doing business, so this is another piece of legislation that we certainly hope and envision that will pass this year, and we hope that the governor Newsom will sign to re-increase pressure on providers to comply with the law and ensure adequate access to care.”