December 10, 2018

Erica West , a social worker in Oakland, looks at the background to the strike and the larger challenges social workers face in their work — and why they can look to the example of teachers and other union workers in using the strike weapon to fight for themselves and their patients.

Thousands of social workers and other mental health professionals will begin a rolling five-day strike at more than 100 Kaiser Permanente facilities across California starting on December 10. The workers, represented by the National Union of Healthcare Workers, is to demand more resources for mental health services from the one of the largest HMOs in the country. “These clinicians are making timely access to mental health care the civil rights issue of our time, said NUHW President Sal Rosselli.

ONE OF the few bright spots of the past year has undoubtedly been the rise in strikes, with the “red state” teachers’ strikes this past spring and, more recently, the successful hotel strikes in Chicago, Boston, the Bay Area and elsewhere. Plus, teachers in Oakland and Los Angeles are looking to take to the picket line in January.

Now, it looks like the strike wave is spreading to a whole new profession: social workers and mental health clinicians. Some 4,000 Kaiser workers, represented by the National Union of Healthcare Workers, are planning a rolling strike at Kaiser facilities December 10-14.

This strike is a long time coming. Kaiser is notorious for its substandard mental health care. In 2013, paid a $4 million fine for violating the state’s Mental Health Parity Act and Timely Access to Care standards.

Members of the National Union of Healthcare Workers rally for safe staffing and better conditions (National Union of Healthcare Workers)

Conditions haven’t changed since then. Patients report having to wait weeks for an appointment and often being forced to accept psychiatric medication and group therapy instead of individual therapy.

Mental health clinicians know that mental health is anything but a one-size-fits-all model. In a 2015 article, the East Bay Express quoted Oakland psychiatric social worker Genna Brodsky, who described requesting help for a “depression stabilization group” that includes as many as 15 patients, some of them suicidal — but Kaiser had no assistance for her.

In another case, a woman in Richmond tried to get her husband access to individual therapy for weeks. Kaiser offered him group therapy and medication, both of which he found ineffective. Despite calling every day for two weeks to get him the care he needed, Kaiser was unresponsive. In June 2012, her husband took his own life.

People experiencing crisis need individual care, and need it immediately. Not allowing access to individual therapy is not only negligent, but often worsens any mental health challenges that already exists. If patients wanting to take their own lives isn’t enough to make Kaiser change their ways, then what is?

Kaiser mental health workers almost went on strike in 2015, but NUHW came to an agreement in the nick of time. Still, these conditions persist. Wait times are long, regardless of the severity of the diagnosis or the depth of trauma.

Kaiser claims to have increased staffing of mental health professionals — but fail to note that thanks to the Affordable Care Act, their number of patients has increased, too!

Clinicians still find themselves unable to provide the level of care their patients need, and they accurately put the blame squarely at Kaiser’s feet. While this situation is absolutely tragic, it represents an opportunity for social workers to get organized and fight.

SOCIAL WORKERS aren’t a profession that we typically think of as being part of labor, but that has the potential to change. In fact, social work is a natural next field to be hit by this strike wave. While it is an incredibly broad field and while social workers work in a variety of settings, we are often concentrated in two places where there is a militant labor presence: schools and hospitals.

Social work, like nursing and teaching, is a feminized profession that is often undervalued and disrespected, although it requires years of post-college experience and graduate school.

Like teachers, social workers are underpaid, despite working incredibly hard and facing the worst consequences of capitalism. Some have called social workers the “janitors of capitalism.” When capitalism leads to alienation, unemployment, substance use and violence, it is social workers who often come in to support the victims through the consequences.

The problems we are asked to confront often feel insurmountable. How are we supposed to work with someone with decades of chronic, complex trauma without the pay and support we need? We got into this field to help people, but that is impossible when we have to wait a month after their initial appointment to bring in a traumatized client.

Kaiser social workers often report staying late to be able to serve all their patients appropriately, a story that echoes the experiences of many teachers who work well over 40 hours a week. And like teachers, we are often asked to work within incredibly broken systems to do the impossible, whether it is teach to a class of 40 students or carry a caseload of 20 clients.

We often get into our respective fields to help people, only to have our time in these professions taken over with bureaucratic tasks. For teachers, it’s administering standardized tests — for social workers, it’s engaging in hours of Medi-Cal and Medicare billing.

At a time when proposals for Medicare for All and universal health care are becoming more popular, social workers have something essential to contribute to that conversation. We work in hospitals, provide mental health care and see the effects of systemic oppression up close and personal. We see the effects of folks going weeks, months and years without insurance, and how that impacts their mental health and well-being.

Social workers are a natural group to join this strike wave — but it won’t happen unless we understand ourselves as workers and get organized.

SOCIAL WORKERS and mental health professionals are often exploring the best and newest ways to support our clients — new therapeutic modalities, new ways to practice “trauma informed care” and the like.

One of the best ways for us to support our clients — and something our field has yet to explore completely — is to fully utilize our power as workers. Teachers and hotel workers have taught us a lesson learned by the labor movement time and time again over decades: strikes work. Whether or not the NUHW workers accomplish all their demands, this is a lesson that social workers cannot forget.

Just as teachers say, “Our working conditions are our students’ learning conditions,” social workers can say, “Our working conditions are our clients’ healing conditions.”

There is no therapeutic model that will make a huge caseload tenable. There is no workshop that can teach us the best way to eradicate decades of trauma and abuse in one session. To achieve the changes we need to see in our field, we need to do something radical — we need to withhold our labor, take our fight into the public eye, support each other and go on strike.

While many social workers in hospitals are unionized, others at nonprofits, are not. Models like the Tech Workers Coalition show us how we can bring together a profession that is often disparate, not fully unionized, and just learning to think of itself as part of a labor movement.

Beyond our workplace struggles, there are so many fights social workers can organize to be a part of. Fighting for universal health care is one example. Another is the fight against imperialism. When soldiers come back from war with post-traumatic stress, it is social workers who work with them. What if we were able to stop this trauma before it started by joining a movement to end war?

This seems far off now, but remember, the idea that thousands of teachers organizing statewide, across districts and unions, seemed like an impossibility at the start of this year.

The teachers and hotel workers won. We can, too.