Inside the Kaiser strike: Mental health workers say they refuse to continue providing substandard care - MedCity News

Kathy Ray works at Kaiser Permanente for 30 years. She said the organization was changing – it was now run by “MBAs” who she said were far more concerned with profit than the well-being of patients and staff.

That’s why she joined thousands of fellow members of the National Union of Health Workers (NUHW) on Monday when they started indefinite strike at Kaiser facilities in Northern California. Through details on its website, Kaiser denies the union’s claims.

The union is made up of more than 4,000 Kaiser mental health clinicians, including psychologists, therapists, social workers and chemical dependency counselors. More than 2,000 of them are expected to picket this week in several Northern California cities, including San Francisco, Oakland, San Jose, Sacramento, Fresno and Modesto.

Ray, a licensed clinical social worker, spoke with MedCity News by telephone as he struck on the front lines on Tuesday. According to her, the Kaiser is dealing with the nation surge in demand for mental health services by “burying their heads in the sand and pretending we don’t have a mental health crisis”.

She said NUHW is striking as part of its long fight to ensure that mental health care achieves parity with other care provided at Kaiser. For example, if a Kaiser patient breaks their arm or is diagnosed with diabetes, its clinicians are expected to respond quickly to the problem and create a treatment plan that includes continuity of care. Kaiser doesn’t hold its mental health workers to the same standard, according to Ray. She said that with the way Kaiser is currently run, immediate access to care and long-term treatment is not possible for people seeking psychiatric care at its facilities.

Before going on strike, Rae said new patients she saw would have to wait a month or more before their next appointment. Sometimes, if a patient was really in crisis, she would figure out a way to schedule an appointment during her examination hours.

“We’re forcing them to make an appointment that really isn’t there,” she said. “And then we work extra hours to get our paperwork done because by law we have to get it done within 24 to 48 hours. It was a common practice for us.”

Internal Kaiser documents show that patients who had an initial mental health evaluation on June 13 were not scheduled for follow-up appointments for a month in San Francisco, more than two months in Sacramento and three months or more in other parts of Northern California.

Ray called the dilemma “ironic” because she claimed Kaiser trained her and its other mental health doctors in a model where they had to meet with their patient every week. She said Kaiser trained them in this model and declared it a best practice when it knew its mental health clinicians were seeing patients every four to 11 weeks.

While Ray agreed that weekly patient visits are the most efficient way to deliver care, she said that kind of model just doesn’t work at Kaiser.

“The only way to make it work is at my expense,” she said.

Earlier this year, NUHW worked with the state government to pass a law stipulating that Kaiser must allow its mental health clinicians to see their patients within two weeks of a preliminary appointment. However, Kaiser doesn’t have enough staff to make that a reality, according to Ray.

“Kaiser says there are enough clinicians to make this happen, but they don’t,” she said. “For example, one of the things he keeps saying in the press is, ‘We’ve hired 200 new clinicians since January 2021.’ But we’ve lost 377 clinicians since then. They are not coping.”

The union recently surveyed the hundreds of clinicians who have left their roles to learn more about their decisions to leave. Many workers cited burnout that came as a result of having to use up documentation time to see patients whose mental health problems seemed too serious to be left on the back burner for weeks. Ray added that many also said they felt their work was unethical — that there was no way they could provide quality care to patients while they could only see them every four to 11 weeks.

For Ray, Kaiser’s failure to meet NUHW’s requirements has to do with the fact that it is “focused on being an institution that makes money, even though it’s a non-profit.”

“Kaiser is run by businessmen. it is no longer managed by medical professionals,” she said. “It is now run by MBAs who are more concerned with profits than care. Kaiser had $8.1 billion profits—if they threw $200 million into mental health and really invested in it, we’d have some of the best mental health in the country.”

Kaiser did not respond to a request for comment. However, the health system published a new page on its website last week denying NUHW’s claims. It said it hires mental health clinicians “at a higher rate than membership growth” and claims it has established escalation procedures that therapists can turn to if they are unable to schedule a needed follow-up appointment for a patient .

In addition to the strike that started on Monday, the NUHW has also started work full page ads in the larger Northern California newspapers. Those ads say the union “made proposal after proposal to Kaiser for greater investments in timely care, but Kaiser rejected them all.”

Union members vote in June to go on strike after what they said was a year of failed contract negotiations. Although Kaiser did not avoid this strike, she prevented about 40,000 Kaiser workers planned to strike last November. The workers planned to strike at 14 West Bank hospitals to demand better pay and benefits, but reached a four-year contract with the health system.

Still, this week’s strike isn’t the first mental health worker strike Kaiser has seen — mental health clinicians struck through Kaiser facilities in Hawaii in May, citing the same concerns as the workers currently holding the column in California.

These concerns seem to have been raised for some time. California fined Kaiser $4 million in 2013 for problems with access to mental health care, including making patients wait extremely long periods for an appointment. The state is too currently investigating whether the health system is providing adequate health care to its patients after a sharp increase in complaints.

Photo: FilippoBacci, Getty Images

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