Above photo: After a mental health intake visit, even patients in crisis may wait weeks or months for a second appointment. NUHW.
Psychologists, social workers, therapists, and chemical dependency counselors are in the ninth week of an open-ended strike at Kaiser Permanente in Northern and Central California.
The 2,000 mental health care workers walked out August 15; their contract has been expired since September 2021. They’re members of the National Union of Healthcare Workers, which split from SEIU in 2010.
NUHW says Kaiser has failed to provide the staffing and wages to retain adequate and diverse staff—yielding unsustainable workloads and dangerous understaffing. After a mental health intake visit, even patients in crisis may wait weeks or months for a second appointment.
Clinicians also report managers pressure them to prescribe next appointments when an appointment is available, rather than when they think the patient needs it—a practice that’s dangerous for patients and demoralizing for mental health workers.
“It’s like if someone was given a cancer diagnosis, and the treatment prescribed was chemo twice a week,” said Sarah Soroken, a family and marriage triage therapist, “and we gave them a third of the chemo treatments they needed.”
Worse and worse
Pandemic death, illness, isolation, and unemployment have yielded a second pandemic of mental illness and substance abuse, which health care providers have struggled to keep up with.
At Kaiser, an NUHW survey found that the attrition rate doubled from 2019 to 2022; 76 percent of the clinicians surveyed cited an inability to “treat patients in line with standards of care and medical necessity” as a factor in their decision to leave.
“I have never been able to have enough appointments, but now it is mostly six to eight weeks [between appointments], said Kim Hollingsworth Horner, a child and teen psychologist at Kaiser for 22 years, and a member of the union bargaining committee.
“After Covid, it’s so much. We’re gambling with people’s lives.”
Kaiser clinicians also have no ceiling on how many patients they are assigned.
Sabrina Chaumette is one of two Black clinicians at the Oakland clinic, and one of 100 workers who struck on Martin Luther King, Jr. Day last winter. Kaiser had agreed to recognize the holiday, then backtracked on it.
Having so few clinicians of color to serve the predominantly Black population of Oakland is “racist and unsustainable,” Chaumette said, and it’s layered on top of so many other racial disparities that affect patients’ health: the impacts of Covid, discrimination, poverty, violence, gentrification, and generational trauma.
In diverse California, Kaiser has also canceled some services for Spanish-, Hmong-, and Chinese-speaking patients. The providers who supported those populations, as well as LGBTQ+ folks, have largely left for private practice or other work.
Health Care Strikes Surge
Another 50 Kaiser mental health workers in Hawaii joined the strike on August 29.
Across the country, labor activity among health care workers has surged since the pandemic. The praise for “essential” workers quickly rang hollow when employers did not match it with increased wages or adequate staffing for patient safety or to prevent burnout.
According to Cornell University’s strike tracker the number of strikes in the first six months of 2022 in the health care sector (21 strikes) was more than double the number for the same period in 2021 (10 strikes).
New Law In Effect
Kaiser, which is both a chain of health care facilities and the HMO that covers them, insures about 40 percent of Californians, through company and individual plans, and through the state Medicaid plan, MediCal.
That makes Kaiser’s inability to provide mental health treatment a huge public health risk, the union argues.
NUHW is pairing a legislative strategy with its bargaining fight. The union won passage of a safe staffing law for mental health services, Senate Bill 221, which took effect this past July.
The new law requires HMOs and insurers to provide mental health patients with follow-up appointments within 10 days, if needed, after their intake—thus implicitly requiring Kaiser to hire enough clinicians to see all those patients.
It will be interesting to see if the union is able to pair the regulatory power of the state of California with direct action to bring a giant like Kaiser to an agreement.
It is legally Kaiser’s responsibility to make sure its patients get treatment. NUHW members are pushing Kaiser, which has canceled thousands of appointments because of the strike, to pay for out-of-network appointments in the interim.
Kaiser was once heralded as an ideal labor-management partner, but this reputation has faltered in the last few bargaining cycles as new administrators played hardball with once competitive wages and benefits.
Last fall, the Alliance of Healthcare Unions and Kaiser narrowly avoided a massive “Striketober” event when those 60,000 members reached an agreement, though members of the Operating Engineers Local 139 struck the same facilities for 90 days and returned without a contract.
Open-ended strikes are relatively rare in health care settings. More common are short strikes, like a recent three-day strike by Minnesota nurses, or a one-day strike against Kaiser earlier this year by National Nurses United members at L.A. Medical Center.
As the strike approaches three months, an unknown number of strikers have returned to work. But there isn’t the animosity you would expect between those who have stayed out and those who haven’t.
At the seven-week mark, NUHW members voted 1,349 to 222 to reject the Kaiser offer on the table and continue the strike.
Among those voters were clinicians who have gone back in, but are still supporting the strikers and bringing the energy to their work, according to Hollingsworth Horner: “They are more likely to challenge their manager now, and hold the boundaries of good patient care.”
NUHW says these therapists and clinicians are holding Kaiser’s feet to the fire by documenting violations to the state and federal authorities.
’The Most Active We’ve Ever Been’
NUHW and Kaiser have agreed on wage increases but remain at odds over proposals to give practitioners more time to complete their work outside of patient time (for instance, coordinating care for patients with other medical professionals, schools, families, and social services) and ways to reduce the time between appointments for acute patients.
NUHW President Sal Rosselli announced today that Sacramento Mayor Darrell Steinberg, a longtime mental health care advocate and a former leader in the state senate, will mediate negotiations between Kaiser and the union.
“I hope within days we come to a resolution,” Rosselli told strikers at a rally in Oakland, the Sacramento Bee reported. “Our hope is a tentative agreement, and that tentative agreement must include a fundamental change in the relationship, where Kaiser executives agreed to collaborate with you, with our clinicians, to finally fix the behavioral health system.”
Since the majority of the Kaiser strikers work at smaller offices and clinics around California, they have rotated picket lines among different offices and the Kaiser headquarters in Oakland.
Patients and their families have been vocal on their therapists’ side, speaking at picket lines and rallying with elected officials for support. NUHW has been organizing patients to report canceled appointments to the state, leveraging additional pressure from the Department of Managed Health Care to push Kaiser back to the bargaining table.
The experience has already yielded a more militant membership, in Hollingsworth Horner’s estimation. “I’m a steward, and in my experience this is the most active people in Fresno have ever been,” she said. “This is one of the successes of this strike, so far. Unity among members is stronger than it’s ever been.”