A California law that went into effect in July requires health plans to provide timely follow-up appointments for mental health and addiction patients. It is the point of unrestricted strikes by clinicians at Kaiser Permanente, where understaffing plagues them with stifling workloads that make it impossible to provide adequate care.

KP says it is making every effort to increase its staff, but is hampered by a shortage of staff. Therapists and the National Federation of Health Professionals who represent them counter that the managed-care giant is struggling to attract clinicians because mental health services have a poor reputation.

The controversy erupted at a time when mental health care was in high demand. During the COVID-19 pandemic, the percentage of US adults with symptoms of depression and anxiety nearly quadrupled.

A new law requires state-regulated health plans to offer reschedules within 10 days of the last mental health or substance use session, unless the patient’s therapist approves less frequent visits. increase.

The union-sponsored bill was signed into law by Gov. Gavin Newsom in October and included a grace period for health plans to comply.

Kaiser Permanente did not comply, said Sal Rosselli, president of the Health Workers Union, which represents more than 2,000 KP mental health clinicians in Northern California and more than 4,000 statewide. “Actually, it’s gotten worse,” he said. “Thousands of people are not getting the treatment that clinicians need.”

According to unions and their members, 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 “on track.”

KP said it has strengthened its mental health care capacity by adding approximately 200 clinicians, expanding virtual appointments and offering more mental health services through primary care providers from January 2021 onwards. said Deb Catsavas, senior vice president of human resources for KP’s Northern California division. In addition, KP launched his $500,000 recruitment campaign, saying it will invest $30 million to “build a pipeline for new, culturally diverse mental health professionals across California.” .

But the picketing clinicians, who started the strike on August 15, said they regularly face obstacles at work due to ongoing staffing shortages.

Alicia Moore, a KP psychologist at Vallejo who leads group therapy sessions in an intensive outpatient program, said her patients had to wait for follow-up appointments, making it difficult to maintain the progress they had made after completing the program. said it can be difficult. “Our program is doing a pretty good job of helping people in crisis right away, but there are no discharge treatment appointments,” said KP’s Auckland Medical Center on Aug. 16. “When I search for reservations, it’s months away,” said Moore, picketing in front of the

Not only are therapists exhausted, but many potential new providers don’t want to work at KP. I think it would be very difficult for Kaiser to fill a position if it is known to be a really difficult place to work.There are no appointments to serve patients,” Moore said.

The union said KP also had a staffing problem.

Mickey Fitzpatrick, a psychologist who worked at Kaiser Permanente for 11 years, resigned this year after failing to care for patients “in a way that was graduate-trained and consistent with my passion for psychotherapy.” said he did. How to Facilitate Healing. “

The union claims KP has the money to fix the problem if it wants to, noting that it recorded a net profit of $8.1 billion last year and has nearly $55 billion in cash and investments. I’m here.

The two sides also disagree about how much time clinicians should be allowed to work on patient cases outside of treatment sessions.

Catsavas said unions are demanding that clinicians spend less time with patients so that KPs have more time for administrative work than they provide. She said it goes against “our own efforts to improve access to mental health care.”

According to the union, clinicians are encouraged to communicate with parents, school officials, and social services about minor patients, as well as respond to emails and phone calls from anxious adults about their next patient. They say they need to devote time to tasks that are not administrative but are an integral part of their care. Appointments may be 6-8 weeks in advance.

Strikes “will only reduce our access to care at a time of unprecedented demand,” Catsavas said. “This has created a challenge for Kaiser Permanente and mental health providers everywhere.”

In an Aug. 15 statement, the California Department of Managed Health Care reminded KP that timely access and clinical standards must be respected even when clinicians are on the picket line. “DMHC is closely monitoring Kaiser Permanente’s legal compliance during the strike,” the statement said.

Agency spokesperson Rachel Arezola said the state has received 10 complaints so far related to the new law — all against Kaiser Permanente.

Catsavas said more than 30 percent of KP clinicians 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 go back many years. The organization fined him $4 million in 2013 for failing to provide timely mental health treatment. He has since been cited twice for failing to resolve the issue and is now under investigation by regulators. Regulators have seen a 20% increase in mental health complaints against KP over the last year.

Barbara McDonald of Emeryville said she tried to get help at KP for her 19-year-old daughter who was exhibiting self-destructive behavior. Unable to get the help her daughter needed, McDonald said she spent tens of thousands of dollars getting her diagnosed and treated elsewhere. He also has attention-deficit/hyperactivity disorder, McDonald said.

McDonald said at one point his daughter cut her throat and spent three days in KP hospital.

“Ironically, leaving mental health problems untreated can eventually lead to physical problems, too.” I can’t say.”

This article was produced by KHN, which publishes California Healthline, an independent editorial service of the California Health Care Foundation.