Nearly 4,000 Kaiser mental health workers in California represented by the National Union of Healthcare Workers voted to strike the week of Nov. 11, the union announced Wednesday.
The union described Kaiser's mental health employees as the "proverbial stepchild," citing fragmented care amid an otherwise integrated system, overwhelming caseloads, excessive wait times for appointments and inadequate pay and benefits.
During more than a year and a half of negotiations, the NUHW has asked Kaiser to hire more psychologists, social workers and therapists under the guidance of current clinicians; restructure workloads; boost pay and benefits; and form geographically based crisis teams that manage emergency situations rather than pulling staff from their scheduled appointments. The strike would affect more than 100 Kaiser locations in California.
"When it comes to mental health, Kaiser is not providing good care," NUHW President Sal Rosselli said, noting that its patients often wait more than a month for appointments.
Therapists are forced to ration care given the scarcity of therapeutic resources, he added.
Kaiser said in a statement that the "divisive bargaining tactics" are counterproductive. The Oakland, Calif.-based integrated health system said it has moved forward with hiring more than 400 additional mental health professionals across California, allocating more than $10 million to expand its post-graduate training, investing more than $30 million in workforce development programs and adding new offices for mental health workers as part of a $700 million investment over the next several years.
"The union's bargaining tactics are delaying mental healthcare improvements," the company said. "Union leadership is putting its demands ahead of making real changes to benefit our patients."
But Fred Seavey, NUHW research director, said it is one thing to announce dollars for tuition reimbursement and another to fix the clinics and improve care. He disputed Kaiser's claims that mental healthcare is embedded into primary care.
Kaiser said its contract proposal includes new hires and training programs, a redesign of the mental health delivery model, and raises of $35,000 to $49,000 for individual employees over three years.
The country is grappling with a shortage of mental health workers, which has accelerated the push for video consultations and new training programs. Mental health clinicians are hard to come by in some areas of California, particularly in the Inland Empire and San Joaquin Valley, according to the California Legislative Analyst's Office.
A February report from the California Future Health Workforce Commission warned that over the next decade California will have 41% fewer psychiatrists and 11% fewer psychologists, marriage and family therapists, clinical counselors and social workers than it will need unless the state makes dramatic policy changes.
State regulators fined Kaiser $4 million in 2013 related to long wait times for mental health visits. The same agency cited similar issues in a 2015 report.
Members of the American Psychological Association urged the association to contact Kaiser Permanente after dozens of therapists requested the APA investigate Kaiser for excessive wait times for return appointments. In a letter sent in June to the APA, they wrote that Kaiser forces them to provide individual appointments only once every four to eight weeks regardless of the patient's condition. Kaiser does not cap caseloads, which means employees often have to work after hours.
In response, Kaiser outlined its investment in additional staffing and locations, improved quality oversight, embedded mental healthcare in primary care and its mental healthcare overhaul.
Mental health workers are expected to notify their department leaders to potentially adjust schedules, reduce the number of new patients or refer patients to an outside contractor if they are overburdened, Kaiser wrote in the letter.
Kaiser mental health workers represented by the NUHW went on strike in December 2018 after negotiations began in June of that year. The integrated health system recently reached an agreement with the Coalition of Kaiser Permanente Unions.