Kaiser Mental Health Therapists Strike Again Over Long Wait Times

Four thousand mental health clinicians are walking off their jobs at Kaiser Permanente today, affecting care at more than 100 clinics across the state. The week-long strike is the second in a year, as the workers’ union and Kaiser management remain deadlocked on a new contract.

Therapists’ main complaint is long wait times for patients. While industry best practice is to see clients every one to two weeks, the majority of Kaiser clinicians say their patients with anxiety and depression are forced to wait four to eight weeks between appointments.

“That is substandard care, that is unethical care and that is dangerous care,” said Mickey Fitzpatrick, a clinical psychologist at Kaiser in Pleasanton. “That increases the risk of suicide and, indeed, people have taken their lives.”

They're asking Kaiser to hire more therapists to reduce wait times and ease the workload on employees. They also want higher wages and more time to complete administrative tasks.

Under the current contract, Fitzpatrick said he sees four to five new patients every week, in addition to all his current patients. Unlike therapists in private practice, Fitzpatrick can not turn patients away or tell them he doesn’t have room to see them.

“There's no cap to my caseload,” he said. “It just grows and grows and grows.”

Kaiser executives say they are investing millions of dollars in new facilities and workforce development, including educational programs for new therapists to meet the increasing demand for mental health care.

The company says it increased its workforce by 30% in the last three years, including hiring nearly 500 new therapists last year, but patient demand has grown 23% in the same time.

“The good news is that the stigma has been removed and people that need care are actually coming forward to get it,” said Michelle Gaskill-Hames, senior vice president for hospital and health plan operations at Kaiser Northern California. But, “it's creating a rise in demand at a time when there is a shortage of workers.”

Research shows there is a shortage of clinicians in some positions in some regions of the country, particularly for psychiatrists and adolescent psychiatrists in rural areas. But union members say that's not the case in most Kaiser locations, where graduate schools are “pumping out” masters and doctorate level mental health clinicians.

“The issue is that few people want to work for Kaiser,” said Fitzpatrick, “because once they’re working for Kaiser, they quickly burn out. They’re overloaded, they're overworked, and so they leave.”

California regulators have substantiated some of the therapists’ allegations. In 2013, the state Department of Managed Health Care fined Kaiser $4 million for long wait times for individual appointments and for forcing patients into group therapy who didn’t want it. The agency cited Kaiser again in 2015 and 2017 over wait times.

Kaiser executives say the company has improved since then, meeting the state’s standard for timely access 90% of the time in 2019, according to its own data.

But therapists say Kaiser is crunching the numbers to make the situation look better than it is on the ground. For example, one of Kaiser’s solutions to improving wait times for initial appointments, which they must provide with 48 hours for urgent needs and 10 days for non-urgent matters under state law, is to do intakes over the phone through its Connect 2 Care program.

Clinicians say this means patients get quick access to an initial 30-minute phone appointment, but are still waiting weeks or a month to start therapy in earnest with a clinician who can see them on a regular basis, and are then waiting months between appointments.

“It’s mainly giving patients more of the run-around, of needing to talk to multiple providers before getting to their assigned therapist,” said Kirstin Quinn Siegel, a licensed marriage and family therapist at Kaiser’s Richmond clinic, who marched on the picket lines on Monday. “So right now they have improved their initial access, but it hasn't really made a dent in our return access.”

During the strike, emergency mental health services will be available and Kaiser is working to minimize disruption to ongoing care, but some appointments may need to be rescheduled.

“We have plans in place, but we're really disappointed that we haven't been able to draw this to resolution,” said Kaiser’s Gaskill-Hames. “This is the sixth time that there's been a strike called in 12 months, and each time it can be disruptive to our members.”

Two previous strikes were called off, once in June, after state lawmakers asked both sides to return to the bargaining table, and another time in November, after Kaiser CEO Bernard Tyson died unexpectedly.

Sara Hossaini contributed reporting.