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Permanente San Francisco Medical Center on December 10, 2018 in San Francisco, California.. (Photo: Justin Sullivan/Getty Images)

Denial of Mental Healthcare: 'Your Therapist Will See You Now or Will They?'

The denial of timely mental health care is immoral and unethical and it's the reason why therapists employed by Kaiser are on strike in Northern California and Hawai'i.

Sal Rosselli

Can you imagine breaking your arm and your doctor saying, "I think we can squeeze you in—in a month or two." Unimaginable. 

Medical care and mental health care are both health care—there shouldn't be a double standard.

Now, close your eyes, picture someone close to you, a friend or family member, maybe even you, feeling deeply depressed or having a high level of anxiety, even a suicidal thought. You call up your health provider, and you're told, "I think we can squeeze you in, in a month or two." Unfortunately, that scenario doesn't have to be imagined. For thousands of people seeking mental health care at Kaiser Permanente, the nation's largest nonprofit HMO, it's the reality. 

The delay of mental health care shouldn't be acceptable. It's a gross disservice to those who paid for it. The denial of timely mental health care is immoral and unethical and it's the reason why therapists employed by Kaiser are on strike in Northern California and Hawai'i.

In California, more than 2,000 members of the National Union of Healthcare Workers (NUHW), have been on strike since August 15. This strike, by Kaiser Permanente therapists, psychologists, social workers and chemical dependency counselors, isn't about wages and benefits. Those issues were settled before the strike began. NUHW members want Kaiser to wake up and confront the mental health crisis that has taken hold in their communities and is surging across the nation. They want Kaiser to create parity with medical services and they fundamentally want to improve access to care for Kaiser patients in need.

Last month month, John Oliver pointed out on his HBO program Last Week Tonight that four in 10 adults in the United States have exhibited symptoms of anxiety or depressive disorder during the pandemic, and that more than half of those who need mental health services don't receive it, with that rate being even higher for minority populations.

"If we want to be a society that truly respects and values mental health," said Oliver, "we have to respect and value mental health care, and that means supporting the people who deliver it." 

John Oliver nailed it.

Many insurance companies and healthcare providers across the country routinely violate federal and state parity rules. In the case of Kaiser, the record of delays and denials of mental health care to subscribers predates the pandemic. In response to concerns from Kaiser psychologists, the American Psychological Society told California regulators in early 2020 that Kaiser's appointment wait-times were the worst it had seen.

In California, the HMO has been fined by state regulators for denying members timely access to care and sued by local prosecutors. Kaiser is now facing a new state investigation following a sharp rise in patient complaints last year. Another state investigation was announced one week into the strike, after 19 Kaiser members filed complaints about canceled appointments and delayed care. 

Kaiser patients in California are routinely forced to wait four-to-eight weeks between therapy appointments in violation of a new state law that requires follow-up appointments be provided within 10 business days.

In Hawai'i, Kaiser staffs only 57 mental health clinicians to serve its 266,000 members throughout the state. As a result, Kaiser patients must routinely endure two-to-three month waits just to start therapy. Earlier this year, the National Committee for Quality Assurance downgraded Kaiser's accreditation status in Hawai'i, placing it under "corrective action" because its lack of access to mental health care posed "a potential patient safety risk." Kaiser is the only health plan in Hawai'i under corrective action.

Kaiser has pledged to increase staffing as part of its corrective action plan, but in negotiations with therapists, the HMO is insisting on wage freezes and retirement cuts that would make it harder for Kaiser to attract new therapists and keep the ones it has. Kaiser hasn't asked for takeaways from any of its unionized workers in Hawai'i—except its mental health therapists.

It doesn't have to be this way. Kaiser certainly has the money to beef up services. The HMO reported $54 billion in cash and investments and earned over $8 billion in profit last year.

Kaiser claims that it has trouble hiring therapists. Probably true. But it might have less trouble if Kaiser would invest in mental health; follow the laws on the books; have more staff; improve working conditions; and treat its mental health therapists no differently than its other caregivers in contract negotiations. Taking these actions also would bring an end to the strikes. 

Medical care and mental health care are both health care—there shouldn't be a double standard. Mental health shouldn't be treated as an afterthought. When Kaiser needed more medical doctors, they started their own medical school. When they had a surge in demand for mental health services, they did next to nothing. 

State regulators in Hawai'i have so far shown no interest in protecting the rights of residents to receive the mental health care they're paying Kaiser to provide. Last November, NUHW filed a 57-page complaint with the Hawai'i Department of Commerce and Consumer Affairs, citing internal Kaiser records to document that patients with severe mental health conditions were waiting months for initial therapy sessions in clear violation of clinical standards and that only 28 percent of Kaiser's out-of-network mental health providers were actually accepting new Kaiser patients.

Rather than challenge the complaint's findings, Kaiser issued a  7-page written response last December deflecting responsibility for its violations claiming that it's hamstrung by a shortage of behavioral health care workers in Hawaii. Nearly a year later, the regulators in Hawai'i have yet to take action against Kaiser.

In California, regulators are saying the right things, but they need to start taking action. This strike has laid bare that even in California, which has the nations' strongest mental health parity laws, millions of people with private insurance are still being denied the mental health care they're legally entitled to receive.

Therapists are taking a stand to protect their patients. They're refusing to do their jobs for a healthcare provider that refuses to provide adequate and legal mental health care. Now it's time for state officials to do their job, and hold Kaiser accountable. Your mental health may depend on it.

Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.

Sal Rosselli

Sal Rosselli is the president of The National Union of Healthcare Workers representing more than 16,000 healthcare workers in California and Hawaii, including 4,000 Kaiser mental health clinicians and medical professionals.

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