Thousands of psychologists, therapists, social workers and psychiatric nurses will begin a five-day strike Monday against Kaiser Permanente at more than 100 facilities across California, demanding one of the nation's largest non-profit HMOs devote more resources to mental health services.

The shortage of mental health professionals is a growing problem nationwide.

"These clinicians are making timely access to mental health care the civil rights issue of our time," said Sal Rosselli, president of the National Union of Healthcare Workers (NUHW), which organized the strike of approximately 3,600 Kaiser mental health professionals and 400 support staff, including dietitians and health educators.

The union is protesting the services Kaiser is giving to patients insured by the company. It wants Kaiser to increase staffing to reduce the length of time patients must wait for an appointment, to reduce the number of patients sent to non-Kaiser therapists, and to increase the ratio of returning patients to intake patients.

John Nelson, vice president of communications at Kaiser Permanente, strongly condemned the strike, calling it "completely unnecessary" and "a bargaining tactic."

Several families who have lost loved ones while waiting for mental health care through Kaiser have shared their stories publicly: 83-year-old Barbara Ragan, a retired Kaiser employee whose family said she was suffering from depression, killed herself in 2015 after her family said she was told she would have to wait weeks for a psychiatric appointment. Susan Futterman, who is part of a class-action lawsuit alleging inadequacies in Kaiser’s mental health care, says her husband, Fred Paroutaud, killed himself in 2012 after failing to get an appointment with his psychiatrist.

Sonoma County Supervisor Shirlee Zane's husband, Peter Kingston, killed himself in 2011 after struggling with anxiety and depression. Zane said her husband tried to see a Kaiser therapist in early December 2010, but was initially sent to an anxiety group instead. He was assigned a therapist later that month and had two appointments, an initial intake and one follow-up. On Jan. 15, Zane said her husband told her his therapist couldn't see him again until March. He took his life 3 days later.

"I lost my beloved husband," Zane said. "We had an incredibly wonderful and happy life and marriage. He got sick and he didn't get treated by his provider."

A national problem

The strike comes as diagnoses of major depression are rising dramatically across the country — 33 percent since 2013, according to a report this year from Blue Cross Blue Shield. The suicide rate also has increased 33 percent since 1999, according to a CDC report last week. The National Alliance on Mental Illness says 43.8 million people experience mental illness in a given year. But there is a shortage of mental health professionals to treat people who are suffering.

“The demand for mental health care services far outstrips supply because we aren’t recruiting or educating people to join the mental health workforce," said Imelda Padilla-Frausto, a research scientist at the UCLA Center for Health Policy Research and the UCLA Center for Health Services and Society. "Once doing so becomes a priority, then maybe we’ll see fewer strikes among the few overworked therapists who remain in the field.”

A 2016 report from the Health Resources and Services Administration says by 2025, workforce shortages are projected for psychiatrists, psychologists, mental health and substance abuse social workers, school counselors, and marriage and family therapists. It projected mental health and substance abuse social workers and school counselors will have shortages of more than 10,000 full time employees.

A federal mental health parity law passed in 2008. While it doesn't require health insurers to cover mental health services, if they do offer mental health benefits they must be comparable to physical health benefits. Plans under the Affordable Care Act were required to offer mental health and substance use disorder services. However, even with these improvements, many insured Americans say they struggle to find a therapist or psychiatrist. Many professionals don't accept insurance saying the reimbursement rates are too low.

A 2017 report from the National Council for Behavioral Health cited research that shows 77 percent of U.S. counties already had “severe shortages” of psychiatrists and other behavioral health providers.

"When you delay treatment appointments it substantially delays recovery times, and it increases morbidity rates and mortality rates," said Fred Seavey, the union's research director. "It has huge implications for people's lives. ... It has impacts on their incomes, their families and their relationships with loved ones."

Holiday vulnerability vs. constant crisis

Kaiser and the NUHW have been embroiled in what the union calls a multi-year "war" over the quality of mental health care services. Following a complaint filed by the union in 2011, Kaiser was fined $4 million in 2013 for violating the state's Mental Health Parity Act, which requires insurers to provide equal coverage for physical and mental health conditions, and the Timely Access to Care standards, which limits how long you have to wait to access to care. A strike similar to Monday's occurred in 2015 resulting in Kaiser agreeing to make improvements to its clinician-to-patient ratio and other issues, but the union says it has not lived up to them.

Kaiser has "increased the number of mental health professionals statewide by about 30 percent since 2015," Nelson said. "And when necessary we contract with community providers to further ensure our members have access to the care they need."

The union says while many Kaiser patients now receive intake appointments within the state-mandated timeframes, they then have to wait one month or more for return appointments. The union said one-third of patients in Southern California are sent out of Kaiser for therapy, which places the burden of finding a quality, affordable therapist on patients, many of whom the union says are suffering from serious illnesses.

Kaiser has criticized the union for organizing a strike during the holiday season, when it says many of its patients are especially vulnerable. Nelson says Kaiser is asking patients with routine mental health appointments to reschedule, but will continue to provide urgent care.

Rosselli says from the perspective of the striking workers, there is "a crisis constantly," and they didn't feel they could wait any longer to get Kaiser's attention.

Zane balked at Kaiser's argument that therapists were being reckless.

"They're making the point that somehow or other this is irresponsible for therapists to leave their patients for 5 friggin' days," she said. "They could put a patient on a five-week waiting list and not blink an eye and, 'oh, by the way, go pay for your own care outside of the system,' and then they're worried about five days?"

Zane said Kaiser asked her to stay neutral in the strike. She shared an email with USA TODAY from community and government relations manager Carol Harris, who asked Zane and her colleagues on the Sonoma County Board of Supervisors not to "participate in the union’s public efforts to influence the bargaining process."

"My husband's dead, my kids don't have a father, my grandkids don't have a grandfather," Zane said. "I'm glad these therapists are striking."

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