Timely psychiatric care is a key factor behind the Kaiser Permanente workers’ strike

A California law that went into effect in July requires health plans to provide timely follow-up appointments for patients with mental health and addictions. Whether that happens is a point of contention in an indefinite strike by Kaiser Permanente clinicians in Northern California, who say staff shortages are leaving them with stifling workloads that make it impossible to provide adequate care.

KP says it is making every effort to increase staff but has been hampered by a labor shortage. The therapists – and the National Union of Healthcare Workers who represent them – counter that the managed care giant is struggling to attract clinicians because its mental health services have a bad reputation.

The dispute erupted at a time when the demand for mental health care is increasing. 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 offer repeat appointments no later than 10 days after a previous mental health or substance use session — unless a patient’s therapist authorizes less frequent visits.

The union-sponsored bill was signed into law by Gov. Gavin Newsom in October and included a grace period for compliance with health plans.

Kaiser Permanente has not complied, said Sal Rosselli, president of the healthcare workers’ union, which represents more than 2,000 KP psychiatrists in Northern California and 4,000 statewide. “In fact, it’s only getting worse,” he said. “Thousands of people are not getting access to the care doctors say they need.”

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

Kaiser Permanente said in an online statement that the HMO’s compliance with the new law is “well underway.”

KP has strengthened its mental health delivery capacity by hiring nearly 200 clinicians since January 2021, expanding virtual appointments and offering more mental health services through its primary care providers, said Deb Catsavas, senior vice president of human resources for the Northern California Division by CP. In addition, she said, KP has launched a $500,000 recruitment campaign and is investing $30 million to “build a pipeline for new, culturally diverse mental health professionals across California.”

But pickets, who began their strike on Aug. 15, said they regularly encounter obstacles in their work, describing it as an ongoing staff shortage.

Alicia Moore, a KP psychologist in Vallejo who leads group therapy sessions in an intensive outpatient program, said her patients may have trouble maintaining the progress they’ve made after completing the program because they have to wait for follow-up appointments. “Our program does a pretty good job of helping people in crisis situations right away, but then there aren’t any therapy appointments that they could be discharged for,” said Moore, demonstrating Aug. 16 outside KP’s Oakland Medical Center. “You’re looking for an appointment, and it’s been a few months.”

Not only are the therapists exhausted, but many potential new providers no longer want to work for KP. “We do have a number of open positions at our clinic, but I think it’s very difficult for Kaiser to fill positions when it’s known by psychiatric staff as a place where it’s really difficult to do a good job, because you just don’t do it. I don’t have the appointments to offer patients,” Moore said.

The union said KP also had a wear and tear problem.

Mickey Fitzpatrick, a psychologist who worked at Kaiser Permanente for 11 years, said he quit this year because he wasn’t able to treat patients “the way we’re trained in grad school, in a way that my passion for psychotherapy corresponds to a path conducive to healing.”

The union argues that KP has the money to solve the problem if it wants, noting that it had net income of $8.1 billion last year and was on nearly $55 billion in cash and investment sits.

The two sides also agree on how much time clinicians should have to treat patient cases outside of therapy sessions.

Catsavas said the union is demanding that clinicians’ face-to-face time with patients be reduced to allow more time for administrative tasks than KP is willing to allocate. This demand, she said, contradicts the union’s “own commitments to help improve access to mental health care.”

The union says clinicians need the time for tasks that aren’t administrative in nature but are an essential part of care – like communicating with parents, school officials and social services about underage patients and responding to emails and calls from concerned adults, their next appointment could be six to eight weeks away.

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

In an Aug. 15 statement, the California Department of Managed Health Care reminded KP that it must respect timely access and clinical standards even when clinicians are on the picket line. “The 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.

Catsavas said more than 30% 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 health 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 charged twice for failing to resolve the issues and is currently under investigation by regulators, who have seen a 20% rise in mental health complaints against KP over the past year.

Barbara McDonald of Emeryville said she was trying to get help from KP for her 19-year-old daughter who was being self-destructive. Numerous attempts at Kaiser Permanente in recent years have failed to get her daughter the help she needed, and McDonald says she ended up spending tens of thousands of dollars to have her diagnosed and treated elsewhere. She has bipolar and borderline personality disorders, as well as attention-deficit/hyperactivity disorder, McDonald said.

McDonald said that her daughter once cut her throat and ended up in a KP hospital for three days.

“The irony is that if you leave mental health problems untreated, you end up with physical problems as well,” she said. “You can’t tell me that having my daughter in the hospital for three days costs less than regular therapy.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization not affiliated with Kaiser Permanente.

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