Update: A strike by 2,400 mental health care workers in Kaiser Permanente’s Southern California coverage area began on Oct. 21, 2024.
When it was announced in October of 2023, Kaiser Permanente’s massive settlement with California regulators over its inadequate mental health care services to its patients briefly raised hopes among Kaiser workers. They saw the settlement, which included a record $50 million fine and a required plan of correction, as an opportunity for the health giant to lead on mental and behavioral health care.
A year later, those hopes have been dashed. Kaiser’s leadership has yet to even agree with the state on the action plan to improve its services. And now thousands of mental health care professionals in Southern California are on the brink of a strike.
An Oct. 21 strike date was announced Friday morning by the National Union of Healthcare Workers. It came after months of bargaining on a new contract yielded little movement on key issues related to mental health care services. The union represents about 2,400 Kaiser Permanente psychologists, social workers, psychiatric nurses, addiction medicine counselors and marriage and family therapists in Southern California.
The union wants more staffing, more competitive pay and — critically — more time allotted for therapists and others to work on their patients’ cases outside of their scheduled appointments. It was the dire need for these same things that prompted a 10-week strike by NUHW workers against Kaiser in Northern California in 2022. (The union is a financial supporter of Capital & Main.)
Kaiser officials had not responded by Friday to a series of questions posed earlier in the week about the negotiations and the company’s mental health care practices. In previous communications, Kaiser representatives have decried a shortage of qualified mental health professionals nationally, not just in California, and said they are not waiting for a final action plan to begin improvements.
In interviews, members of the union said that despite last year’s settlement agreement with the state, they remain overscheduled amid a working environment that is still chaotic, and they said Kaiser patients still don’t have access to timely mental health care appointments and follow-ups.
“Things haven’t changed. They’ve only gotten worse,” said Adriana Webb, a medical social worker in Los Angeles who interacts primarily with HIV patients. “I was hopeful after the state deal, and they keep saying they’re investing in mental health care. But we haven’t seen it. We have less time to see more patients.”
It is a familiar refrain. Kaiser’s years-long inadequacy at providing needed mental health services led the state’s Department of Managed Health Care to levy the $50 million fine last year, one component of a $200 million settlement designed to force change.
Kaiser has repeatedly been cited by the state for not making enough mental and behavioral care appointments available to patients, failing to ensure timely follow-ups as required by state law, and including third-party professionals on its reference lists who also have no room for Kaiser patients.
The situation is more dire in Kaiser’s Southern California coverage area, which stretches from San Diego to Bakersfield. In a news release, the union said that Kaiser currently staffs roughly 40% fewer therapy sessions in Southern California than it does in Northern California, even though the managed-care organization has about 200,000 more members in Southern California, according to Kaiser’s own statistics.
Overall, the union said, Kaiser has one therapist on staff for approximately every 3,000 members in Southern California, compared to one therapist for every 2,000 members in Northern California.
Kaiser officials have consistently said they are trying to improve mental health care services in an environment in which a shallow talent pool means it’s harder to hire qualified professionals. Union workers counter that overscheduled days, persistent understaffing and comparatively low wages lead to worker dissatisfaction that creates constant churn.
According to the union, Kaiser’s own data shows that one-quarter of the mental health workers hired by the company since 2021 have already left — more than 60% of them departing within the first 12 months of their hiring.
“We’ll see open positions sit unfilled for long stretches of time,” said Webb, 38, who has worked for Kaiser for nine years, most of them at the company’s care facility in Panorama City. “When somebody leaves, it’s going to take three months to fill that job, and everybody else has to pick up the slack. And people are leaving. We get burned out and we leave.”
In negotiations to replace a contract that expired Sept. 30, the National Union of Healthcare Workers has pushed Kaiser to allow therapists more time for patient duties that can’t be completed during appointments. “I’m back to back all day in appointments,” said Kassaundra Gutierrez-Thompson, a Los Angeles-based therapist. “I have about three minutes to look at patients’ charts. That’s not enough.”
The union has also asked for wage hikes, arguing that Kaiser pays its mental health care professionals up to 40% less than it pays other health care workers in its system. And it is asking Kaiser to close a loophole through which the company doesn’t give pensions to mental health care workers hired after 2014, making them the only group of Kaiser employees in California without pensions.
Kaiser, which union members say did not agree to begin negotiating the new contract until July 31, has so far been unmoved on those issues. “They say they’ve made 12 counterproposals, but what those really are is 12 denials,” said Webb, a member of the NUHW’s bargaining committee.
The union has been more successful getting Kaiser to deal with its shortages in mental health care in Northern California, but it took the grinding 2022 strike to make that happen. The Southern California mental health professionals say they’re willing to go the distance as well.
“If we don’t do this, it will only get worse,” Webb said. “We are at a moment where we can change the landscape of mental health care at Kaiser, but right now we’re dealing with a broken system.”
