A California law that went into effect in July requires health plans to provide timely follow-up appointments for mental health and addiction patients. Whether that will happen is at the center of an open-ended walkout by Kaiser Permanente clinicians in Northern California, who say staffing shortages are burdening them with a stifling workload and unable to provide adequate care.
KP said it was making every effort to increase staff but was hampered by labor shortages. Therapists — and the National Federation of Healthcare Workers, which represent them — counter that the managed care giant has trouble attracting clinicians because of its poor reputation for mental health services.
The dispute erupted at a time when the demand for mental health care was increasing.The percentage of U.S. adults with symptoms of depression and anxiety has nearly quadrupled during the covid-19 pandemic.
This new law State-regulated health plans are required 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, sponsored by unions and signed by Gov. Gavin Newsom in October, includes a grace period for health plans to comply.
Sal Rosselli, president of the Health Care Workers Union, which represents more than 2,000 KP mental health clinicians in Northern California and more than 4,000 mental health clinicians statewide, said Kaiser Permanente had not followed the rules. “In fact, it’s getting worse,” he said. “Thousands of people don’t have access to the care clinicians say they need.”
The union and its members say patients often have to wait up to two months for follow-up appointments.
Kaiser Permanente in online statement HMO’s compliance with new law is “in progress.”
KP strengthens its mental health care capabilities by Add nearly 200 clinicians Deb Catsavas, senior vice president of human resources at KP’s Northern California division, said that since January 2021, virtual appointments have been expanded and more mental health services are offered through its primary care providers. In addition, she said, KP launched a $500,000 recruiting drive and invested $30 million “to build a pipeline of new, multicultural mental health professionals in California.”
But picket clinicians, who began their strike on Aug. 15, said they were often hit with roadblocks at work because of what they called persistent staffing shortages.
Alicia Moore, a KP psychologist in Vallejo who leads group therapy sessions in an intensive outpatient program, said her patients may have difficulty maintaining the progress they have made after the program ends, Because they have to wait for a follow-up appointment. “Our program has done a great job of helping people in crisis immediately, but there are no treatment appointments to discharge them,” said Moore, who picketed in front of KP Auckland Medical Center on Aug. 16. “You search for an appointment and it’s months away.”
Not only are therapists exhausted, but many potential new providers don’t want to work for KP, she said. “We actually have a lot of open positions in our clinics, but I think it’s hard for Kaiser to fill those positions because mental health care workers think it’s a hard place to do a good job because you just don’t have ‘no appointments’ for patients Provide service,” Moore said.
The union said KP also had staff attrition issues.
Mickey Fitzpatrick, a psychologist with Kaiser Permanente for 11 years, said he resigned this year because he could not “care for patients in the way we were trained in graduate school, which is incompatible with my approach to psychotherapy. The passion is consistent, in favor of the healing approach.”
The union argues that KP has the money to fix the problem if it wants to, noting that it issued Net profit of $8.1 billion last year, sitting nearly $55 billion cash and investments.
The two sides also disagreed over how much time clinicians should have outside of the treatment period to deal with patient cases.
Catsavas said unions are demanding less face-to-face time between clinicians and patients to allow more time than KP is willing to provide for administrative tasks. She said the request contradicted the union’s “commitment to help improve access to mental health care”.
The union says clinicians need time for non-administrative tasks that are integral to care — such as communicating with parents, school officials and social services about underage patients, and responding to emails and emails from anxious adults. Phone, and their next appointment could take six to eight weeks.
Catsavas said the strike “will only reduce our access to 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 creates challenges for Kaiser Permanente and mental health care providers everywhere.”
in a August 15 Statement, the California Department of Managed Healthcare reminded KPs that it must respect timely access and clinical standards even when clinicians are on picket lines. “The DMHC is closely monitoring Kaiser Permanente’s compliance with the law during the strike,” the statement said.
Rachel Arrezola, a spokeswoman for the agency, said the state has received 10 complaints about the new law so far — all against Kaiser Permanente.
More than 30 percent of KP’s clinicians continued to care for patients during the strike, and KP’s psychiatrists, clinical managers and outside mental health providers have stepped in to help, Catsavas said.
KP’s mental health problems go back many years.The organization is $4 million fine Penalized by the state in 2013 for failing to provide timely mental health treatment. It has since been cited twice for failing to resolve issues and is now under investigation by regulators, with a 20 per cent increase in mental health complaints against KP last year.
Barbara MacDonald, of Emeryville, said she was engaging in self-destructive behavior while trying to get help for her 19-year-old daughter at KP. Multiple attempts by Kaiser Permanente over the past few years have failed to get her daughter the help she needs, and McDonald said she ended up spending tens of thousands of dollars to get her diagnosed and treated elsewhere. She suffers from bipolar and borderline personality disorder, as well as attention-deficit/hyperactivity disorder, MacDonald said.
On one occasion, MacDonald said, her daughter slit her own throat and ended up in KP Hospital for three days.
“The irony is that when you leave a mental health problem untreated, it ends up being a physical problem as well,” she said. “You can’t tell me that keeping my daughter in the hospital for three days costs less than usual care.”
This story is made by KHNrelease California Healthlineeditorial independent service California Healthcare Foundation.
KHN (Kaiser Health News) is a national newsroom that provides in-depth news coverage on health issues.Along with policy analysis and polling, KHN is one of the top three operating programs in the U.S. KFC (Kaiser Family Foundation). KFF is a donating non-profit organization that provides information on health issues to the state. KHN is not affiliated with Kaiser Permanente.
Photo: Filippobach, Getty Images
