On Tuesday, mental health clinicians for Kaiser Permanente in Northern California went on strike. While Kaiser and the union representing the therapists appear to have reached agreement on wages, the sides remain in dispute on issues related to staffing, working conditions, and client access to care. Kaiser reps have responded by calling the strike itself “unethical.” They have said that union leaders were asking therapists to “walk away from people who need help.” Suggesting that your own employees are unethical when they are striking to force Kaiser to improve patient access to mental health care is, as they say, a choice. It’s one that would seem destined to only worsen Kaiser’s ability to recruit and retain therapists in the future.
Chronic understaffing in Kaiser mental health care
Staffing might be a major area of contention between the union and the healthcare giant, depending on whom you ask. Kaiser barely mentions staffing in its statement about the strike, saying that the sticking points were wage increases and administrative time. The National Union of Healthcare Workers contends that Kaiser simply doesn’t hire enough mental health staff to meet the needs of patients, who often are left waiting weeks or months without needed mental health care.
Inadequate access to mental health care has long been a problem for Kaiser, which was fined $4 million by state regulators in 2013 over similar access issues. California has tightened access-to-care rules in direct response to Kaiser’s failings. Regulators are closely watching the strike and began a non-routine audit of Kaiser mental health care in May. That may be a sign that additional enforcement action is on the horizon.
Kaiser has no shortage of money to throw at the problem if it wanted to. It reported $8 billion in net profits last year, and has more than $50 billion in reserves. Kaiser says it has hired hundreds of additional clinicians and invested in training and recruiting efforts, but acknowledges that it has more than 1,000 open mental health clinician positions across its system, including more than 400 such positions in California alone.
And Kaiser’s boast that it has added “nearly 200” clinicians since January of 2021 looks less impressive when compared with the number of clinicians leaving. The union puts that number at more than 650 in the past year alone, including 377 just in northern California. According to a union survey, overwhelming majorities of those who have left reported that unsustainable workloads, and an inability to treat clients in accordance with standards of care, contributed to their departures.
Threading the needle
Kaiser’s representatives seem at least somewhat aware that trashing their own employees in public isn’t a great look. So they’re trying to thread a needle of trashing the therapists’ union while flattering the therapists themselves. This is best exemplified in a statement that Kaiser regional senior VP of human resources Deb Catsavas gave to SFGATE. “It is especially disappointing that NUHW is asking our dedicated and compassionate employees to walk away from their patients when they need us most,” she said.
This needle-threading simply doesn’t work. The union isn’t separate from the workers; it is made up of them. When Kaiser reps suggest that the union is asking its members to abandon their patients, they’re equally suggesting that striking therapists are abandoning their patients. (Kaiser was notified well in advance of the strike action so that crisis and emergency care would not be disrupted.) The organization has a history of misleading statements about patients in need, designed to make its own workers look bad. For demanding better patient access to mental health care.
Kaiser has a well-documented history of mental health care failures. It has the money to fix these issues but appears to lack the will to do so. Now Kaiser’s representatives are making public statements trashing the ethics of its own clinicians. These suggest to me that the organization simply does not share most therapists’ mission of providing timely, high-quality mental health care to those who need it.
It’s easy to understand why many therapists would not want to work for such an organization. Pay and benefits can only buy off a therapist’s conscience for so long.