A California law that took effect in July requires health plans to offer timely follow-up appointments for mental health and addiction patients. Whether that's happening is a point of contention in an open-ended strike by Kaiser Permanente clinicians in Northern California who say staffing shortages saddle them with stifling workloads that make providing adequate care impossible.
KP says it is making every effort to staff up but has been hampered by a labor shortage. The therapists — and the National Union of Healthcare Workers, which represents them — counter that the managed-care giant has difficulty attracting clinicians because its mental health services have a poor reputation.
The dispute has erupted at a time when demand for mental health care is increasing. The share of adults in the United States with symptoms of depression and anxiety has nearly quadrupled during the covid-19 pandemic.
The new law requires health plans regulated by the state to provide return appointments no more than 10 days after a previous mental health or substance use session — unless a patient's therapist approves less frequent visits.
The bill, which was sponsored by the union, 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 care workers union, which represents more than 2,000 KP mental health clinicians in Northern California and 4,000 statewide. "In fact, it's getting worse," he said. "Thousands of people are not getting access to the care that clinicians say they need."
The union and its members said patients often must wait as much as 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 bolstered its mental health care capacity by adding 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 in KP's Northern California division. 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 picketing clinicians, who started their strike Aug. 15, said they regularly encounter obstacles in their jobs because of what they described as persistent staffing shortages.
Alicia Moore, a KP psychologist 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 finishes because they must wait for follow-up appointments. "Our program does a pretty good job of immediately helping folks in crisis, but then there’s no therapy appointments to discharge them to," said Moore, who picketed Aug. 16 in front of KP's Oakland Medical Center. "You search for an appointment, and it's a couple of months out."
Not only are therapists worn out, 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 hard for Kaiser to fill positions when it is known by mental health care workers as a place where it’s really hard to do a good job because you just don’t have the appointments to offer patients," Moore said.
The union said KP also has an attrition problem.
Mickey Fitzpatrick, a psychologist who worked at Kaiser Permanente for 11 years, said he resigned this year because he was unable to care for patients "in the way that we are trained in graduate school, in a way congruent with my passion for psychotherapy, in a way that is conducive to healing."
The union argues that KP has the money to fix the problem if it wants to, noting that it posted $8.1 billion in net profit last year and sits on nearly $55 billion in cash and investments.
The two sides also disagree about how much time clinicians should get to handle patients' cases outside therapy sessions.
Catsavas said the union is demanding that clinicians' face time with patients be reduced to allow more time than KP is willing to provide for administrative tasks. 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 are not administrative but 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 might be six to eight weeks away.
The strike "will only reduce access to our care at a time of unprecedented demand," Catsavas said. "Across the country, there are not enough mental health care 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 respect timely access and clinical standards even while 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 spokesperson Rachel Arrezola said the state has received 10 complaints related to the new law so far — all against Kaiser Permanente.
Catsavas said that more than 30% of KP's clinicians have continued to care for patients during the strike and that KP psychiatrists, clinical managers, and outside mental health providers have stepped in to help.
KP's mental health woes date back many years. The organization was fined $4 million by the state in 2013 for failing to provide timely mental health treatment. It was cited twice after that for failure to resolve the problems and is currently being investigated by regulators, who saw a 20% increase in mental health complaints against KP last year.
Barbara McDonald, of Emeryville, said she tried to get help at KP for her 19-year-old daughter, who was engaging in self-destructive behavior. Numerous attempts with Kaiser Permanente in the past couple of years failed to get her daughter the help she needed, and McDonald said she ended up spending tens of thousands of dollars to get her diagnosed and treated elsewhere. She has bipolar and borderline personality disorders, as well as attention-deficit/hyperactivity disorder, McDonald said.
McDonald said that 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 issues go untreated, it ends up being physical issues 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 care policy research organization unaffiliated with Kaiser Permanente.