Kaiser mental health clinicians and patients protest long wait times

On Sunday afternoon, over 100 therapists, patients, and their supporters from across Northern California gathered in downtown Oakland to stage a vigil in front of Kaiser Permanente’s corporate office—one they said they’d run indefinitely until the corporation’s leadership takes big steps to make their clinicians’ jobs more sustainable and improve access to mental health care.

Protesters in bright red shirts chanted “Mental health, not corporate wealth!” into the hot, empty plaza. They unfurled a 60-foot banner onto a low barbed fire fence, showing block letters reading “KAISER DON’T DENY” along with stories Kaiser patients had submitted online that detailed times they said they were denied access to timely mental health care.

The crowd formed a circle, inside of which a Native American elder blessed everyone by burning a piece of sacred wood. Mickey Fitzpatrick, a clinical psychologist at Kaiser in Pleasanton, was the first to speak. “I want everyone to take a look at this monument over here. Give it a good read today, and over the course of the next several weeks,” Fitzpatrick said, pointing to the banner. “We are here to bear witness to the needless suffering that our patients have endured.” The protesters hissed in support.

In one entry on the website, a mother in Anaheim wrote that her young son had to wait a month for his initial intake appointment, and another month for his return appointment. She wrote that she decided to switch insurance providers during open enrollment. In another, a San Francisco woman described trying to safely wean herself off of the antidepressants she was put on after her mother died. While waiting eight weeks between appointments, she wrote, her primary care physician at Kaiser recommended she break the pills in half.

According to protester Kathy Ray, a clinical social worker at Kaiser in Walnut Creek and longtime member of the National Union of Healthcare Workers (NUHW), the union that organized the protest, the biggest problem for her patients is not being able to book their first appointment. California state law mandates that health plans must offer non-urgent psychiatry appointments within 15 business days and mental health appointments with non-physician staff (such as a social worker) within 10 days. The problem is with return appointments, for which state regulations are less stringent, said Ray. “My return appointments are out four to eight weeks. So I can see someone initially and then I can’t see them back. That’s not mental health care,” Ray said.

But it’s hard to get specifics from either side of this conflict about exactly how many clinician positions within the Kaiser system are needed to address the current patient load, how many positions are vacant, and how long wait times typically are.

A representative from the NUHW declined to comment on the record.

Representatives from Kaiser had not returned interview requests as of press time.

The two sides are also currently involved in contract negotiations. The NUHW is asking Kaiser to hire enough new staffers so that clinicians can spend 20 percent of their time doing duties beyond meeting with patients, such as necessary paperwork. Kaiser officials offered 15 percent. The union is also asking for crisis services to be staffed at every Kaiser clinic, and for guarantees that most new hires will be full-time, fully-trained people who can address the long wait times for return appointments.

Last September, Kaiser officials offered a final, three-year labor proposal, which the NUHW promptly rejected. The NUHW is the last in a coalition of 11 unions representing 85,000 Kaiser employees, ranging from optometrists and X-ray technicians to surgical technicians and housekeepers, to hold out on making a labor agreement.

Sunday’s vigil was only the latest battle in a fight that’s been being waging for years. In 2013,  Kaiser clinicians prompted a state-led investigation by the California Department of Managed Health Careinto their employer’s compliance with the Knox Keene Act, which states that HMOs must treat mental health and other medical care employees equally in terms of wages and benefits. Union officials also accused Kaiser employees of hiding documents showing how many weeks patients had to wait between appointments.

Upon completion of the investigations, California levied a $4 million fine against Kaiser in 2013. But the clinicians at the rally argued that little has changed. For the last few years, they feel, company officials have substituted a public relations campaign emphasizing self-care over meaningful improvements in access to care.

“Can’t see a therapist for four weeks, do some mindful breathing. Can’t see a therapist for six weeks, go for a run or do some paddle boarding. Can’t see a therapist for eight weeks, do some yoga and stretch that anguish out,” Fitzpatrick shouted as protesters laughed indignantly.

And the effects aren’t only felt within the company’s mental health departments, they said. Tim Moore, who works for a pain management rehabilitation program at Kaiser Santa Clara, often wants to refer his patients to his mental health colleagues, but said he is discouraged. “They might get some telephone call or initial intake, but might not get seen again for six weeks,” Moore said. 

Clinicians also argued that the Kaiser work environment makes them susceptible to burnout. In an effort to fit everyone in, Ray said she comes in early, leave late, skips lunches, and schedules during her charting hours—medical speak for paperwork. And, she said, the long wait times between appointments make it difficult to achieve any progress with patients. 

For Gretta Christina, a patient at Kaiser San Francisco who said she is suffering from depression, wait times average six weeks. “It’s not like I call to make an appointment. It’s just, at the end of the appointment, he says, ‘Here’s the next appointment—it’s six weeks from now,’” she said, making sure not to place blame on her therapist. “He’s great, he’s just slammed.”

“There’s no continuity, there’s no moving forward, I’m not getting better. And I really want to be getting better,” she said.

According to Matt Artz, the union’s communication director, mental health care workers and their supporters plan to maintain a “24/7 presence” outside the Kaiser’s downtown Oakland office—in the form of at least a handful of protesters—until progress has been made, or until the first two weeks of November, at which time the union may organize a strike.