Timely mental health care is a key factor in the Kaiser Permanente workers’ strike

[Editor’s note: KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.]

A California law that went into effect in July requires health plans to offer timely screenings for mental health and addiction patients. Whether that’s happening is a point of contention in the indefinite strike by Kaiser Permanente clinicians in Northern California, who say staff shortages are burdening them with suffocating workloads that make it impossible to provide adequate care.

KP says it is making every effort to recruit staff, but is hampered by a labor shortage. Therapists — and the National Health Workers Union, which represents them — counter that the managed care giant is having trouble attracting clinicians because its mental health services have a bad reputation.

The dispute has erupted at a time when demand for mental health care is on the rise. The proportion of adults in the United States with symptoms of depression and anxiety has nearly quadrupled during the covid-19 pandemic.

The new law requires state-regulated health plans to provide follow-up appointments no more than 10 days after a previous mental health or substance use session — unless the patient’s therapist approves less frequent visits.

The union-sponsored bill was signed by Gov. Gavin Newsom in October and included a grace period for health plans to comply.

Kaiser Permanente has not complied, said Sal Rosselli, president of the health workers union, which represents more than 2,000 KP mental health clinicians in Northern California and 4,000 statewide. “It’s actually getting worse,” he said. “Thousands of people are not getting the care that clinicians say they need.”

The union and its members said patients often had to wait up to two months for examinations.

Kaiser Permanente said in an online statement that HMO compliance with the new law “has advanced.”

KP has strengthened its mental health care capacity by adding nearly 200 clinicians since January 2021, expanded virtual appointments and offered more mental health services through its primary care providers, said Deb Katsavas, senior vice president of human resources for the division of KP in Northern California. In addition, she said, KP launched a $500,000 recruiting campaign and invested $30 million to “build a pipeline of new, culturally diverse mental health professionals in California.”

But the protesting clinicians, who began their strike on August 15, said they regularly faced disruptions in their work due to what they described as persistent staff shortages.

Alicia Moore, a psychologist at KP in Vallejo who leads group therapy sessions in an intensive outpatient program, said her patients can have difficulty maintaining the progress they’ve made after the program ends because they have to wait for follow-ups. “Our program does a pretty good job of immediately helping people in crisis, but then there are no prescribed therapies to discharge them,” said Moore, who protested Aug. 16 outside KP Medical Center in Oakland. “You’re looking for a date and it’s a few months away.”

Not only are therapists exhausted, she said, but many potential new providers don’t want to work for KP. “We actually have a number of open positions in our clinic, but I think it’s very difficult for Kaiser to fill positions when it’s known to mental health workers as a place where it’s really hard to do a good job because I just don’t have the appointments that to offer patients,” Moore said.

Alicia Moore dives outside Kaiser Permanente Hospital in Oakland, California. Moore, a psychologist, says her patients can have difficulty maintaining progress after group therapy because they have to wait for follow-ups.(Zinia Finn / KHN)

The union said KP also has a leakage problem.

Mickey Fitzpatrick, a psychologist who has worked at Kaiser Permanente for 11 years, said he resigned this year because he was unable to care for patients “the way we were trained in graduate school, in in a way consistent with my passion for psychotherapy, in a way that leads to healing.”

The union says KP has the money to fix the problem if it wants to, noting it posted $8.1 billion in net income last year and has nearly $55 billion in cash and investments.

The two sides also disagree about how much time clinicians should have to deal with patients’ cases outside of therapy sessions.

Katsavas said the union is demanding that the time clinicians meet with patients be reduced to allow more time than KP is willing to provide for administrative tasks. That request, she said, runs counter to “the union’s own commitments to help improve access to mental health care.”

The union says clinicians need time for non-administrative tasks that are an integral part of care — such as communicating with parents, school officials and social service agencies about patients who are minors and returning emails and phone calls from anxious adults whose next appointment may be six to eight weeks away.

The strike “will only reduce access to our care at a time of unprecedented demand,” Katsavas said. “Across the country there are not enough mental health professionals to meet the increased demand for care,” she said. “This has created challenges for Kaiser Permanente and mental health care providers everywhere.”

In an Aug. 15 statement, the California Department of Managed Health Care reminded KP that it must maintain timely access and clinical standards even when doctors are on call. “DMHC is closely monitoring Kaiser Permanente’s compliance with the law during the strike,” the statement said.

Agency spokeswoman Rachel Arrezola said the state has so far received 10 complaints related to the new law — all against Kaiser Permanente.

Katsavas said more than 30 percent of KP clinicians continued to care for patients during the strike, and that KP psychiatrists, clinical managers and outside mental health providers stepped in to help.

KP’s mental problems go back many years. The organization was fined $4 million by the state in 2013 for failing to provide timely mental health treatment. It has since been cited twice for failing to address the issues and is currently under investigation by regulators, who saw a 20 percent increase in mental health complaints against KP last year.

Barbara McDonald of Emeryville said she tried to get help from KP for her 19-year-old daughter, who was self-destructive. Multiple attempts with Kaiser Permanente over the past few years failed to get her daughter the help she needed, and McDonald said she ended up spending tens of thousands of dollars to be diagnosed and treated elsewhere. She has bipolar and borderline personality disorder, as well as attention-deficit/hyperactivity disorder, McDonald said.

MacDonald said at one point her daughter cut her own throat and ended up in a KP hospital for three days.

“The irony is that when you let mental health problems go untreated, they end up being physical problems as well,” she said. “You can’t tell me that my daughter’s stay in the hospital for three days costs less than regular therapy.”

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