A California law that took effect in July requires health plans to offer follow-up appointments for mental health and addiction patients. Whether that’s happening is a point of contention in an open strike by Kaiser Permanente clinicians in Northern California, who say staffing shortages burden them with suffocating workloads that make it impossible to provide adequate care.
KP says that it is making all efforts to increase the personnel but has been hindered by the lack of manpower. Therapists — and the National Health Care Workers Union, which represents them — counter that the managed care giant has trouble attracting doctors because its mental health services have a poor reputation.
The dispute has erupted at a time when demand for mental health care is on the rise. The percentage of adults in the United States with symptoms of depression and anxiety has nearly quadrupled during the Covid-19 pandemic.
The new law requires state-regulated health plans to offer return appointments no more than 10 days after a previous mental health or substance use session — unless the 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 implementing health plans.
Kaiser Permanente disagreed, said Sal Rosselli, president of the health care workers union, which represents more than 2,000 KP mental health doctors in Northern California and 4,000 nationwide. “In fact, it’s getting worse. “Thousands of people are not getting access to the care that clinicians say they need.”
The union and its members said patients often have to wait up to two months for follow-up appointments.
Kaiser Permanente said in an online statement that HMO compliance with the new law “is progressing well.”
KP has strengthened its mental health care capacity by adding nearly 200 physicians since January 2021, expanding virtual appointments and offering more mental health services through 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 recruiting campaign and is investing $30 million to “build a pipeline of young, culturally diverse mental health professionals across California.”
But the petitioning doctors, who began their strike on August 15, said they regularly face setbacks in their work due to what they describe as persistent staff shortages.
Alicia Moore, a KP psychologist in Vallejo who leads group therapy sessions in an intensive outpatient program, said her patients can have trouble maintaining the progress they’ve made after the program ends because they have to await subsequent meetings. “Our program does a pretty good job of immediately helping people in crisis, but then there are no therapy sessions to release them,” said Moore, who held the Aug. 16 picket outside KP Medical Center in Oakland. “You ask for a date and it’s been a couple of months.”
Not only are therapists tired, 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 difficult for Kaiser to fill positions when it’s known by mental health workers as a place where it’s really hard to do a good job because it just does” I don’t have 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 “the way we were trained in graduate school, in a way that was consistent with my passion for psychotherapy . 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 has about $55 billion in cash and investments.
The two sides also disagree about how much time clinicians should have to handle patient cases outside of therapy sessions.
Catsavas said the union is asking for clinicians’ face time with patients to be reduced to allow more time than KP is willing to provide for administrative duties. That requirement, she said, runs counter to the union’s “own commitments to help improve access to mental health care.”
The union says doctors need 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 for patients who are minors and returning emails and phone calls from anxious adults dating can 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 growing 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 adhere to timely access and clinical standards even when doctors are on the line of check. “DMHC is closely monitoring Kaiser Permanente’s compliance with the law during the strike,” the statement said.
Agency spokeswoman Rachel Arrezola said the state has received 10 complaints about the new law so far — all against Kaiser Permanente.
Catsavas said that more than 30% of KP 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 problems date back many years. The organization was fined $4 million by the state in 2013 for failing to provide timely mental health treatment. He was subsequently cited twice for failing to address the issues 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 had been engaging in self-destructive behavior. Multiple attempts with Kaiser Permanente over the past two 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 throat and ended up in a KP hospital for three days.
“The irony is that when you leave mental health issues untreated, it ends up being a physical issue 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 independent editorial service of the California Health Care Foundation.
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