Common Dreams Mental Health Sal Rosselli

Denial of Mental Healthcare: ‘Your Therapist Will See You Now or Will They?’

The denial of timely mental health care is immoral and unethical and it's the reason why therapists employed by Kaiser are on strike in Northern California and Hawai'i.
Permanente San Francisco Medical Center on December 10, 2018 in San Francisco, California.. (Photo: Justin Sullivan/Getty Images)

By Sal Rosselli / Common Dreams

Medical care and mental health care are both health care—there shouldn’t be a double standard.

Now, close your eyes, picture someone close to you, a friend or family member, maybe even you, feeling deeply depressed or having a high level of anxiety, even a suicidal thought. You call up your health provider, and you’re told, “I think we can squeeze you in, in a month or two.” Unfortunately, that scenario doesn’t have to be imagined. For thousands of people seeking mental health care at Kaiser Permanente, the nation’s largest nonprofit HMO, it’s the reality. 

The delay of mental health care shouldn’t be acceptable. It’s a gross disservice to those who paid for it. The denial of timely mental health care is immoral and unethical and it’s the reason why therapists employed by Kaiser are on strike in Northern California and Hawai’i.

In California, more than 2,000 members of the National Union of Healthcare Workers (NUHW), have been on strike since August 15. This strike, by Kaiser Permanente therapists, psychologists, social workers and chemical dependency counselors, isn’t about wages and benefits. Those issues were settled before the strike began. NUHW members want Kaiser to wake up and confront the mental health crisis that has taken hold in their communities and is surging across the nation. They want Kaiser to create parity with medical services and they fundamentally want to improve access to care for Kaiser patients in need.

Last month month, John Oliver pointed out on his HBO program Last Week Tonight that four in 10 adults in the United States have exhibited symptoms of anxiety or depressive disorder during the pandemic, and that more than half of those who need mental health services don’t receive it, with that rate being even higher for minority populations.

“If we want to be a society that truly respects and values mental health,” said Oliver, “we have to respect and value mental health care, and that means supporting the people who deliver it.” 

John Oliver nailed it.

Many insurance companies and healthcare providers across the country routinely violate federal and state parity rules. In the case of Kaiser, the record of delays and denials of mental health care to subscribers predates the pandemic. In response to concerns from Kaiser psychologists, the American Psychological Society told California regulators in early 2020 that Kaiser’s appointment wait-times were the worst it had seen.

In California, the HMO has been fined by state regulators for denying members timely access to care and sued by local prosecutors. Kaiser is now facing a new state investigation following a sharp rise in patient complaints last year. Another state investigation was announced one week into the strike, after 19 Kaiser members filed complaints about canceled appointments and delayed care. 

Kaiser patients in California are routinely forced to wait four-to-eight weeks between therapy appointments in violation of a new state law that requires follow-up appointments be provided within 10 business days.

In Hawai’i, Kaiser staffs only 57 mental health clinicians to serve its 266,000 members throughout the state. As a result, Kaiser patients must routinely endure two-to-three month waits just to start therapy. Earlier this year, the National Committee for Quality Assurance downgraded Kaiser’s accreditation status in Hawai’i, placing it under “corrective action” because its lack of access to mental health care posed “a potential patient safety risk.” Kaiser is the only health plan in Hawai’i under corrective action.

Kaiser has pledged to increase staffing as part of its corrective action plan, but in negotiations with therapists, the HMO is insisting on wage freezes and retirement cuts that would make it harder for Kaiser to attract new therapists and keep the ones it has. Kaiser hasn’t asked for takeaways from any of its unionized workers in Hawai’i—except its mental health therapists.

It doesn’t have to be this way. Kaiser certainly has the money to beef up services. The HMO reported $54 billion in cash and investments and earned over $8 billion in profit last year.

Kaiser claims that it has trouble hiring therapists. Probably true. But it might have less trouble if Kaiser would invest in mental health; follow the laws on the books; have more staff; improve working conditions; and treat its mental health therapists no differently than its other caregivers in contract negotiations. Taking these actions also would bring an end to the strikes. 

Medical care and mental health care are both health care—there shouldn’t be a double standard. Mental health shouldn’t be treated as an afterthought. When Kaiser needed more medical doctors, they started their own medical school. When they had a surge in demand for mental health services, they did next to nothing. 

State regulators in Hawai’i have so far shown no interest in protecting the rights of residents to receive the mental health care they’re paying Kaiser to provide. Last November, NUHW filed a 57-page complaint with the Hawai’i Department of Commerce and Consumer Affairs, citing internal Kaiser records to document that patients with severe mental health conditions were waiting months for initial therapy sessions in clear violation of clinical standards and that only 28 percent of Kaiser’s out-of-network mental health providers were actually accepting new Kaiser patients.

Rather than challenge the complaint’s findings, Kaiser issued a  7-page written response last December deflecting responsibility for its violations claiming that it’s hamstrung by a shortage of behavioral health care workers in Hawaii. Nearly a year later, the regulators in Hawai’i have yet to take action against Kaiser.

In California, regulators are saying the right things, but they need to start taking action. This strike has laid bare that even in California, which has the nations’ strongest mental health parity laws, millions of people with private insurance are still being denied the mental health care they’re legally entitled to receive.

Therapists are taking a stand to protect their patients. They’re refusing to do their jobs for a healthcare provider that refuses to provide adequate and legal mental health care. Now it’s time for state officials to do their job, and hold Kaiser accountable. Your mental health may depend on it.

Sal Rosselli
Sal Rosselli

Sal Rosselli is the president of The National Union of Healthcare Workers representing more than 16,000 healthcare workers in California and Hawaii, including 4,000 Kaiser mental health clinicians and medical professionals.

10 comments

  1. BROKEN BY THE SYSTEM

    The stark face of terminal capitalism. We workers were downgraded from “personnel,” as if actual individual persons, to “human resources.” Like the rest of the planet, things where whatever is of value to corporations is extracted from us and the unprofitable remains tossed out.

    The toll of this vicious system has become a huge health crisis. The symptoms of which are the nearly 50% of Americans on antidepressants or anti-anxiety meds. With climbing rates of addiction (self medication) and deaths of despair. All highly visible on the streets of any city.

    No national healthcare and an econ system where the common good is of no concern. In a culture that considers psychological problems as personal weakness, where advice is often “just get over it,” mental health is not a priority.

    No wonder therapists are overworked, underpaid, and experience burn-out. We expect them to carry the burden of trying to make everything better by fixing a person while ignoring the horrific system breaking us.

  2. If you’ve had a brush with mental health care it might have sounded like this:
    (Medical office assistant come in) “Are you depressed?” (tries to elicit a yes)
    “Are you feeling anxiety?”(tries to elicit a yes)
    Then the doctor (who has no mental health credentials) comes in and does commercial for a psychotropic medication, that may have dangerous side effects, and may be very expensive.
    No effort is made to explore the material circumstances or life experiences of the patient. It’s not like there is any possibility of referral to a mental health professional.

    1. Exactly. It’s not mental health treatment, it’s selling you a pill that will likely make things worse.

      I remember a history teacher telling me about medicine in the dark ages and how in truth the poor who couldn’t afford treatment were likely better off than the rich who could. It’s much the same now with mental health treatment.

      I once had a friend who was a therapist/social worker who told me after he changed professions, that all the system cared about was profiting off of the symptoms without ever addressing the real problems because to do that would require more time and effort and was therefore unprofitable.

  3. “Mental Healthcare” = a schlub? Category-wise.

    Simply give me a pretty girl [with colors reversed, according to the gender of the individual at hand] to blow a kiss into my ear from a short distance and I will start feeling better toot sweet. Now if the lead phrase is merely a typo for “Dental Healthcare”, then we’re really talking business.

    OTOH yowling for money to throw at “therapists” is aiming at putting out fresh fruit to attract swarms of tiny bugs.

  4. American “therapists ” unnecessary incompetent…”why are 31% US adults diagnosed mentally ill?—this excludes axis 2 personality disorders….Why have Americans consumed 80% legal psychotropics, 66% anti depressants on earth since 2010? why do only anglos consider a color depression—blue? why do americans consume more coke, heroin hallucinogens, meth, marijuana per capita? why does USA have the most violent non violent crime rape per capita all nations despite that experts claim little is reported? why are americans unable to feel? why do americans require experts to tell them how to think?
    “in America the citizen has been transformed into a client, the worker into a consumer”. Christopher Lasch. why do half om americans mainly atheists believe in ghosts? why do nearly 60 % of US adults, nearly all moron liberals believe astrology is scientific?

  5. I wish there was accurate reporting of how effective therapy is. There’s a lot of propaganda that this is the answer. Part of why is the narrative is that there’s money in this. The article was written by a representative of a health care union, who will benefit.

    This isn’t to say people won’t benefit to therapy, but there’s huge problems in implying it’s the answer. This is part of “cruel optimism”, where the structural problems that are causing mental health issues are completely ignored, suggesting all people need is therapy. There’s little focus on prevention and what’s causing this.

    What do we need? Less isolation, more community, and more agency in people’s lives. It’s well known that agency and empowerment is so important to mental health. And those without money are getting close to slavery at times.

    I myself have ptsd directly from a counselor and can say definitively that every therapy since then has made things worse. And all mental health professionals do is suggest more therapy and subtle implications blaming me for why their methods aren’t working.

    1. Dr. Gabor Mate’ says in his recent book that our society is so screwed up that no one escapes the traumas. We’ve been feeding heads with toxic and useless crap a long time. He’s been a doctor treating the poor in Vancouver, British Colombia for 45 years. If a society turns its population into detritus in an effort to profit off them things are gonna back up like a clogged toilet, and that is the state of things now. It’s not just the immigrants or the addicted that we wish would go away: It’s everyone.

  6. The illness of America is in its predatory capitalist system where short term profits are all that matters and humans are nothing but a means to an end–profit. No attempt is made to analyze the issues that face an American throughout life and no safety net is there when someone falls flat on their face. Only more drugs and opioids to cure a systemic problem.
    A society in full collapse and they only treat the superficial symptoms.

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