A California law that took effect in July requires health plans to offer timely follow-up appointments for mental health and addiction patients. What’s happening is a point of contention in an open-ended strike by Kaiser Permanente physicians in Northern California who are saddled with a workload that makes it impossible for them to provide adequate care due to staff shortages.
KP says that he is making every effort to adjust the staff, but the shortage of workers has hindered him. Therapists — and the National Union of Healthcare Workers, which represents them — counter that the managed-care giant has a hard time attracting therapists because of the low reputation of its mental health services.
This controversy has intensified at a time when the demand for mental health services is increasing. The share of adults in the United States with symptoms of depression and anxiety has nearly quadrupled during the COVID-19 pandemic.
The new law requires state-regulated health plans to provide return appointments no more than 10 days after a previous mental health or substance use session — unless the patient’s physician approves less frequent visits.
The bill, sponsored by the union, was signed in October by Gov. Gavin Newsom and included a grace period for health plans to comply.
Kaiser Permanente has not complied, said Sal Roselli, president of the Health Care Employees Union, which represents more than 2,000 KP mental health physicians in Northern California and 4,000 statewide. “In fact, it’s getting worse,” he said. “Thousands of people are not getting access to the care that physicians need.”
The union and its members said patients often have to wait up to two months for follow-up appointments.
Kaiser Permanente said in an online statement that HMO compliance with the new law is “going well.”
KP has strengthened its mental health care capacity by adding nearly 200 physicians, expanding virtual appointments, and offering more mental health services through its primary care providers starting in January 2021, said Deb Katsvas, senior vice president of human resources for KP’s Northern California division. In addition, she said, KP has launched a $500,000 recruiting campaign and is “investing $30 million to build a pipeline for new, culturally diverse mental health professionals throughout California.”
But the picketing doctors, who began the strike on August 15, said they regularly face disruptions in their work due to what they describe as persistent staff shortages.
Alicia Moore, a KP psychologist in Vallejo who leads group therapy sessions in the intensive outpatient program, said her patients can have a hard time maintaining the progress they’ve made after the program ends because they have to wait for follow-up appointments. “Our program does a great job of helping people who are in crisis right away, but then there’s no therapy appointment to discharge them,” said Moore, who demonstrated Aug. 16 in front of Oakland Medical Center in KP. “You look for an appointment, and it’s a few months away.”
Not only are therapists tired, she said, but many potential new providers don’t want to work for KP. “We actually have a lot of open positions in our clinic, but I think it’s very difficult for Kaiser to fill positions when mental health workers recognize this as a place where it’s really hard to do good work because you just don’t have appointments to offer patients,” Moore said. .
The union said there is also an attrition problem in KP.
Mickey Fitzpatrick, a psychologist who worked at Kaiser Permanente for 11 years, said he resigned this year because he was unable to care for patients “as we were trained in graduate school, matching my passion for psychiatry. The perfect way to heal.”
The union argued that KP had $8.1 billion in net profit last year and about $55 billion in cash and investments, arguing that if it wants to fix the problem, it has the money to fix the problem.
The two sides also disagree on how much time therapists should have outside of therapy sessions to handle patient cases.
Catvas said the union is demanding a reduction in physicians’ face time with patients to allow more time than KP wants to provide for administrative work. The demand, she said, contradicts the union’s “own commitment to help improve access to mental health care.”
The union says physicians need time for tasks that are not administrative but are an integral part of care — such as communicating with parents, school officials, and social service agencies about minor patients and returning emails and phone calls from concerned adults whose next appointment may be six to eight weeks away. .
The strike will “reduce access to our care at a time of unprecedented demand,” Katsvas said. “Across the country, there are not enough mental health care professionals to meet the growing demand for care,” she said. “This has created challenges for Kaiser Permanente and mental health care providers everywhere.”
In an Aug. 15 statement, the California Department of Managed Health Care reminded KP that physicians must respect timely access and clinical standards even when they are on the picket line. “The DMHC is closely monitoring Kaiser Permanente’s compliance with the law during the strike,” the statement said.
Agency spokeswoman Rachel Arrezola said the state has received 10 complaints related to the new law so far — all against Kaiser Permanente.
Katsavas said more than 30% of KP physicians continued to care for patients during the strike and KP psychiatrists, clinical managers and outside mental health providers stepped in to help.
KP’s mental health issues date back many years. In 2013, the state fined the organization $4 million for failing to provide timely mental health treatment. It has since been cited twice for failing to address the issues and is currently being investigated by regulators, which saw a 20% increase in mental health complaints against KP last year.
Barbara McDonald of Emeryville said she tried to get help in KP for her 19-year-old daughter, who was engaging in self-destructive behavior. Several attempts with Kaiser Permanente over the past two years failed to get her daughter the help she needed, and McDonald said she spent tens of thousands of dollars getting her diagnosed and treated elsewhere. He has bipolar and borderline personality disorder, as well as attention-deficit/hyperactivity disorder, McDonald said.
MacDonald said at one point her daughter cut her own throat and ended up in KP Hospital for three days.
“The irony is that when you stop treating mental health problems, it ends up being physical problems,” she said. “You can’t tell me that keeping my daughter in the hospital for three days costs less than regular treatment.”
This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
This article was reprinted from khn.org with permission of the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.