June 1, 2019
On Friday afternoon, we gave notice for 4,000 Kaiser Permanente mental health clinicians and health care professionals to begin an open-ended strike on June 11, all across California.
This is not an action our members took lightly. For the past decade, Kaiser psychologists, therapists, social workers and psychiatric nurses have been fighting management to fix its badly broken mental health system, which forces patients to wait weeks and even months for care. And these caregivers are committed to working around the clock over the next 10 days to find immediate solutions to address this crisis without a strike.
But the situation at Kaiser has become untenable for both patients and clinicians.
Last Tuesday, Kirstin Quinn Siegel, a Kaiser therapist, told Berkeley council members that she had a patient in one of her group sessions who recently had to defend her three children from an intruder in their home. “She’s clearly in distress,” Quinn Siegel told council members. “Her next appointment with an individual therapist is in July.”
Wait times are even longer in Southern California.
Tanya Veluz, a Kaiser therapist in Pasadena, told USC Annenberg Media last month that her patients have to wait three months for an appointment even if they’ve lost a loved one or have bi-polar disorder.
“It's extremely disheartening to sit there and tell someone you can't see them — And you watch them not getting better,” she said. “We do everything possible. We stay late, we call patients, we try, but definitely it's heartbreaking and burns people out."
Kaiser mental health clinicians sounded the alarm in December with a five-day strike. But Kaiser still refused to address the problem. Now appointment wait times are longer than ever. While we have seen some movement from Kaiser during recent negotiations, Kaiser’s most recent proposals won’t stem the crisis.
Kaiser’s proposal to add clinicians dedicated to doing intake appointments would help it meet regulatory requirements for new patients, but wait times for return appointments would grow even longer. Dedicated intake specialists would bring in more new patients faster, but Kaiser has no plan to increase staffing as needed to provide these patients with reliable and consistent ongoing care.
Adding appointment clerks won’t keep clinicians from having to use their lunch time and evenings -- all without pay -- to squeeze in calls to desperate patients who can’t be seen. These clerks won’t have the clinical training to know when patients need urgent attention and should go straight to the front of the line. Clinicians never asked for appointment clerks because they knew it would just create one more bureaucratic obstacle for patients trying to connect with qualified caregivers.
Kaiser is struggling to hire full-time therapists willing to accept its relentless working conditions. It surely won’t be able to hire enough temporary clinicians to significantly increase appointment availability in a system that staffs just one full-time equivalent therapist for every 3,000 Kaiser members.
Neither will Kaiser’s under-staffing of its mental health clinics be alleviated by dedicating more recruiters to fill those jobs. It can only be alleviated by Kaiser budgeting for more positions and improving working conditions to reduce turnover.
Our members have proposed real solutions that are focused on improving access to care.
We are proposing a requirement that Kaiser must hire new clinicians to fill its newly-constructed office spaces. This would avoid a repeat of what happened this year in Fairfield, where Kaiser built new office space for 38 mental health clinicians but didn’t hire any new staff.
We are proposing that Kaiser establish crisis teams at all locations, so new patients in crisis can get the care they need without clinicians having to cancel appointments with their current patients.
We are proposing that clinicians be given the right to convert appointment slots that have been set aside for new patients to serve returning patients who need immediate care.
We are proposing that clinicians get 20 percent of their time to meet patient care responsibilities that include answering email messages from patients, calling patients in need, charting, and communicating with a patient’s relatives or social service representatives. This work, which is critical to ensure the effectiveness of patients’ treatment, is often done during lunch breaks and after-hours, which leads to burnout and clinicians leaving for other jobs.
We are proposing a formalized, focused, and facilitated committee process in which labor and management would work together to expedite development and implementation of systemic reforms to address Kaiser's mental health crisis. Management instead wants only a loose committee process with no structure, no timelines, and no accountability to reach solutions to Kaiser's pressing problems.
Now, as before, when it comes to mental health care, Kaiser’s proposed “solutions” never get to the root of the problem, and often serve to obscure it.
Kaiser touts its newly constructed clinics, but never mentions that it primarily staffs them with its existing workforce.
Kaiser touts hiring hundreds of new clinicians without mentioning that at the same time, many over-burdened clinicians are leaving and tens of thousands of new members are enrolling, so that staffing ratios stay fundamentally the same.
Kaiser touts its tele-psychiatry program without mentioning that telephone assessments are far shorter and less thorough than the face-to-face assessments it used to provide.
Kaiser claims a statewide shortage of mental health clinicians impedes it from improving care, but never mentions that it is undercutting its own recruiting efforts by denying mental health clinicians the same raises given to every other unionized employee and singling out many recently hired mental health clinicians by eliminating their pension benefits, while all other Kaiser employees still receive them.
Kaiser’s mental health “innovations” are really shortcuts. Its initiatives are too often geared toward improving its image rather than its mental health care. Now, its clinicians and patients are at a breaking point.
This is a problem we need to fix now. Patients and clinicians have waited long enough.
Sal Rosselli, President
National Union of Healthcare Workers