Calif. Strike Highlights Larger Issues With Mental Health System

Jan 18, 2015

This past week, more than 2,000 mental health workers for the HMO health care giant Kaiser Permanente in California went on strike.

The strike was organized by the National Union of Healthcare Workers. The union says Kaiser Permanente patients have been the victims of "chronic failure to provide its members with timely, quality mental health care."

On Thursday, about 150 Kaiser Permanente employees picketed the Woodland Hills Medical Center in the San Fernando Valley. One of them was therapist Deborah Silverman. In her eyes, the biggest problem at Kaiser right now is understaffing.

Silverman says there are so many patients waiting to see therapists, that Kaiser sends new patients to see her, even if she's already overbooked. She says for three days over a two-week period she had four people she didn't know.

"I have to put them some place, and I didn't have any appointments for at least three weeks. So that's a huge emotional cost to me," Silverman says. "I either have to try to find someone else who has an open slot, which means the person has to switch, or people have to wait, and they've come to see you. It makes you feel — it really bumps up against our ethical standards."

Silverman says switching therapists often makes it difficult to establish a bond and make progress.

John Nelson, Kaiser Permanent's vice president of government relations, says the company delivers some of the highest-quality mental health care in California and in the country. But, he says, they absolutely want to get better.

"Really the only way we can do that is by working together," Nelson says. "So we need our therapists and psychologists and others to be working with us, and constructively on how to get better, and not walking away from patients and being gone for seven days."

But it's not just the union saying there's a problem at Kaiser.

In 2013, the state of California fined Kaiser $4 million, finding that some of these problems — like the long wait times, and the company discouraging people from seeking costly individual therapy — violated federal and state laws about mental health care.

April Dembosky has been following the story for NPR member station KQED. She says even though Kaiser paid the fine last September, the union is still unhappy.

"They're arguing that Kaiser has simply shifted resources," Dembosky tells NPR's Arun Rath. "So that fine was directed mainly at initial visits ... [those] arguing they had to wait an unreasonably long time" to be seen for their first visit.

Dembosky says the union is alleging that now patients might get that initial appointment faster, but "good luck with a follow-up appointment."

"They're saying people are still being made to wait two, four, six weeks," she says.

Dembosky says she thinks what might be happening now, as far as patient wait times, is a result of campaigns that have sought to reduce stigma around mental health services. Some of that seems to have worked and more people with mental health problems are coming forward, she says.

"In my reporting I'm seeing this come up in several other venues, not just at Kaiser," she says, including the state's university system. "This is something that ... is an issue that's coming up in other health care systems."

Dembosky says there is also a shortage of mental health care professionals to meet the demand of new patients — not enough people are completing the lengthy licensing process necessary to provide care.

Meanwhile, there's no sign that an agreement between Kaiser Permanente and the union is imminent — but Kaiser's mental health workers will be back on the job Monday.

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ARUN RATH, HOST:

This past week, over 2,000 mental health workers for the HMO health care giant Kaiser Permanente, here in California, went on strike.

(SOUNDBITE OF STRIKE)

UNIDENTIFIED WOMAN: What's this about?

UNIDENTIFIED PEOPLE: Patient care.

UNIDENTIFIED WOMAN: When do we want it?

UNIDENTIFIED PEOPLE: Now.

RATH: The strike was organized by the National Union of Healthcare Workers. The union says Kaiser patients have been the victims of, quote, "chronic failure to provide its members with timely, quality mental health care."

UNIDENTIFIED MAN: I'm also talking about a 24-year-old Hispanic male who's had a psychotic break, in college, schizophrenic, and the best that I can say is five to six weeks.

RATH: One-hundred-fifty or so Kaiser employees picketed the Woodland Hills Medical Center in the San Fernando Valley on Thursday. One was Deborah Silverman, a therapist. In her eyes, the biggest problem at Kaiser right now is understaffing. She said there are so many patients waiting to see therapists that Kaiser sends new patients to see her even if she's already overbooked.

DEBORAH SILVERMAN: So I had three days over a two-week period where I had four people that I didn't know. So that's 12 new people and I have to put them someplace. And I didn't have any appointments for at least three weeks. So that's a huge emotional cost to me that I have 12 people that I either have to try to find someone else who has an open slot, which means the person has to switch, or, you know, then people have to wait. And they've come to see you and it makes you feel, you know, it really bumps up against our ethical standards.

RATH: Silverman said switching therapists often makes it difficult to establish a bond and make progress. John Nelson, Kaiser's vice president of government relations, had this to say about the union's allegations.

JOHN NELSON: Kaiser Permanente delivers some of the highest-quality mental health care in California and in the country. That said, we absolutely want to get better, and, really, the only way we can do that is by working together. So we need our therapists and psychologists and others to be working with us and constructively on how to get better and not walking away from patients and being gone for seven days.

RATH: But it's not just the union saying there's a problem at Kaiser. In 2013, the state of California fined Kaiser $4 million, finding that some of these problems - like the long wait times and discouraging people from seeking costly individual therapy - violated federal and state laws about mental health care. April Dembosky, of member station KQED, has been following the story. She says even though Kaiser paid the fine last September, the union is still not happy.

APRIL DEMBOSKY: What the union is pointing out is - they're arguing that Kaiser has simply shifted resources. So that fine was directed mainly at initial visits. So people who called in for the first time saying they wanted to get an appointment, arguing that they had to wait an unreasonably long period of time. And so what the union is saying is, well, now you can call and you'll get that initial appointment in a reasonable period of time, but good luck with a follow-up appointment. They're saying people are still being made to wait two, four, six weeks. Kaiser, again, disagree with this characterization.

RATH: You know, April, it feels like, gosh, you know, for decades we've been having this debate in America about needing to provide more mental health care services to people and people to provide them quickly. How do you see what's happening here with Kaiser fitting into that debate?

DEMBOSKY: Well, it's interesting. I think what might be happening here is a result of some of those former advocacy campaigns that are aimed at reducing stigma around mental health services. So in the past, the fear was that people who had problems weren't coming forward because they didn't want to admit that they had a problem because they were afraid of being judged for having a problem. And so one theory is that some of that work around stigma has really worked, and people are coming forward. And so, in my reporting I'm seeing this come up in several other venues, not just at Kaiser.

The University of California system is undergoing a review of its mental health services right now. They've been finding that students who come in at the beginning of the semester asking for help with some depression and anxiety can't get seen until finals time, you know, when they're at a crisis. So this is something that is impacting not just Kaiser. It's certainly an issue that's coming up in other health care systems. And one other theory is that we're seeing a shortage of mental health professionals, that there aren't enough professionals being graduated from schools, not enough people completing the long licensing process that are needed to meet this demand.

RATH: April Dembosky of KQED, thank you.

DEMBOSKY: Thank you.

RATH: There's no sign that an agreement between Kaiser and the union is imminent, but Kaiser's mental health workers will be back on the job tomorrow. Transcript provided by NPR, Copyright NPR.