Written by Bernard J. Wolfson and Xenia Finn
[Editor’s note: KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.]
A California law that took effect in July requires health plans to provide timely follow-up appointments for mental health and addiction patients. Whether that happens is a sticking point in an open-ended strike by Kaiser Permanente doctors in Northern California who say staff shortages are burdening them with stifling workloads that make adequate care impossible.
KP says it does its best to provide staff but has been hampered by a labor shortage. Therapists — and the National Federation of Health Care Workers, which represents them — argue that the managed care giant is having a hard time attracting doctors because mental health services have a bad reputation.
The conflict erupted at a time of increasing demand for mental health care. The proportion 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 provide return appointments no more than 10 days after a previous mental health or substance abuse session — unless a patient’s therapist agrees to less frequent visits.
Governor Gavin Newsom signed the bill, which was sponsored by the union, in October, and it included a grace period for health plans to comply.
Kaiser Permanente has not complied, said Sal Rosselli, president of the Health Care Workers union, which represents more than 2,000 mental health physicians at KP in Northern California and 4,000 statewide. “Actually, it’s getting worse,” he said. “Thousands of people are not getting the care doctors say they need.”
The union and its members said patients often have to wait two months for follow-up appointments.
Kaiser Permanente said in an online statement that the HMO’s commitment to the new law “is on track.”
KP has strengthened its mental health care capacity by adding nearly 200 clinicians since January 2021, expanding virtual appointments, and offering more mental health services through primary care providers, said Deb Katsavas, senior vice president of human resources in the Northern California division. in KP. Additionally, she said, KP has launched a $500,000 recruitment drive and is investing $30 million to “build a pipeline of new, culturally diverse mental health professionals throughout California.”
But the sit-in doctors, who began their strike on August 15, said they regularly face hurdles in their jobs due to what they described as an ongoing staff shortage.
Alicia Moore, a KP psychologist in Vallejo who leads group therapy sessions in the intensive outpatient program, said her patients may have difficulty maintaining their progress after the program ends because they must wait for follow-up appointments. “Our program does a very good job of helping people in crises right away, but then there are no treatment appointments to get them out of,” said Moore, who camped August 16 in front of KP’s Auckland Medical Center. “You’re looking for a date, and two months later.”
Not only are therapists tired, she said, but many potential new providers don’t want to work at KP. “We actually have a number of vacancies in our clinic, but I think it’s very difficult for Kaiser to fill positions when mental health professionals know it’s a place where it’s hard to do well because you don’t,” Moore said.
The union said the Pakistan Communist Party is also suffering from an attrition problem.
Mickey Fitzpatrick, a psychologist who has worked at Kaiser Permanente for 11 years, said he quit this year because he wasn’t able to care for patients “the way we trained in graduate school, in a way that matches my passion for psychotherapy, in a way that helps with recovery.”
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 generated nearly $55 billion in cash and investments.
The two sides also differ on the amount of time doctors should have to deal with patients’ cases outside of therapy sessions.
Katsavas said the union is calling for doctors to meet with patients to allow more time than KP would like to save for administrative tasks. She said the requirement contradicted “the union’s own commitments to help improve access to mental health care.”
The union says doctors need time to do tasks that are non-administrative but integral to care — such as communicating with parents, school officials and social service agencies about minor patients and returning emails and phone calls from anxious adults who follow. The appointment may be six to eight weeks later.
Katsavas said the strike “will only serve to limit access to our care at a time of unprecedented demand.” “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 providers everywhere.”
In a statement issued August 15, the California Department of Managed Health Care reminded KP of the need to respect timely access and clinical standards even while doctors are at the picket line. “The DMHC is closely monitoring Kaiser Permanente’s compliance with the law during the strike,” the statement said.
Agency spokeswoman Rachel Arizola said the state has received 10 complaints related to the new law so far — all against Kaiser Permanente.
Katsavas said more than 30% of KP clinicians continued to care for patients during the strike and that KP psychiatrists, clinical directors and outside mental health providers stepped in to help.
KP’s mental health problems go back many years. The organization was fined $4 million by the state in 2013 for failing to provide timely mental health treatment. It was subsequently cited twice for not solving problems and is currently being investigated by regulators, who saw a 20% increase in mental health complaints against KP last year.
Barbara MacDonald, of Emeryville, said she tried to get help in KP for her 19-year-old daughter, who was engaged in self-destructive behavior. Numerous attempts with Kaiser Permanente in the past two years have failed to get her daughter the help her daughter needs, and MacDonald said she has spent tens of thousands of dollars to get her diagnosed and treated elsewhere. MacDonald said she suffers from bipolar and borderline personality disorders, as well as attention-deficit/hyperactivity disorder.
MacDonald said that once her daughter cut her throat and ended up in KB Hospital for three days.
“The irony is that when mental health problems are left untreated, physical problems end up as well,” she said. “You can’t tell me that having my daughter in the hospital for three days costs less than the usual treatment.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and survey, KHN is one of the three major drivers of KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation. n