About 270 mental health and addiction recovery workers at non-profit Cascadia Behavioral Healthcare unionized with Oregon AFSCME in a series of elections held in October and November. The newly unionized workers staff a mobile mental health crisis response team and five outpatient clinics in Portland and Milwaukie, Oregon. Cascadia is the area’s largest behavioral health provider, but workers say low pay and heavy case loads contribute to high turnover.

Mathias Quackenbush, for example, manages a case load of 70 clients as a counselor and case manager, and earns $44,500 a year in a position that requires a masters degree in social work. He says burnout is high and turnover is rampant: When he arrived, one client told him he’d seen three clinicians in a year. Workers hope with a union to improve conditions and have more of a say in client care.

The union campaign has been under way for two years, and is part of United We Heal, a union-initiated effort to raise standards industry-wide.

Cascadia managers didn’t welcome the union. They held multiple anti-union meetings, and may have even fired one union supporter unlawfully, according to charges filed by AFSCME. Daneen Pray, a 16-year employee, sent a picture of her workload to a union organizer and was fired Sept. 17 because the image contained a patient’s name. To generate that pretext, an AFSCME spokesperson says, Cascadia managers had installed a camera and were surveilling Pray. But workers weren’t intimidated. When it came time to vote, the union won by big margins: 71 to 34, 43 to 23, and 32 to 0.

[MORE: Pray talks about her firing in this video produced by the union.]