The state of mental health care

On August 15th, the National Union of Healthcare Workers launched a strike with the principal goal of reducing the workload for the nearly 2,000 mental health clinicians it represents at Kaiser.

For years Kaiser’s mental health clinicians have made it known that their clients face weeks-long waits for necessary return appointments. In addition their own grueling schedules leave clinicians little time to write medical notes or to connect patients to wraparound services.

At Kaiser patients face waiting periods of six weeks or more between appointments. Evidence based research and broader industry standards state that patients be seen on a weekly or bi-weekly basis.

The Visalia Times recently covered the experience of therapist Mickey Fitzpatrick, who worked at Kaiser in Pleasanton. He says that he had caseloads into the hundreds at Kaiser before he left for private practice. “If even a fraction of those new clients wanted to meet as frequently as is recommended, I didn’t have the availability to see folks for multiple weeks to months at a time,” he says.

In May of this year, the California Department of Managed Health Care got involved again. Spurred by the numerous Kaiser member complaints, it informed Kaiser that it would be subject to an audit of whether the company is providing adequate mental health care services to its California members.

Kaiser’s response has always been that their mental health providers are some of the highest compensated in the country. While this is factually true, clinicians are often forced to work much longer hours and handle far more patients than the average clinician. These working conditions have led to record turnover amongst mental health providers.

Data from the National Union of Healthcare Workers found practitioners have left Kaiser in steadily increasing numbers over the past three years. Most recently, from December 2020 through May 2022, 850 practitioners left Kaiser, and the average annual turnover rate was more than 12% in Northern California and 10% in Southern California.

This turnover is occurring in a time where the demand for mental health treatment is rising and the supply of mental health professionals is already low.

This Thursday will mark six weeks since Kaiser mental health clinicians have gone on strike. Due to dwindling strike funds many strikers are going unpaid. They are putting themselves on the line to push for more equitable care for their patients and a more balanced work environment to prevent future workers from leaving.

Kaiser’s treatment of their mental health program is analogous to the overall treatment of mental health care in our society. There is an incredible amount of lip service and advertisement space dedicated to espousing the value of getting mental health treatment. However, this lip service does not come with actual action and resources.

Mental health care has gotten a lot of press over the past few years of the pandemic.

A New York Times headline reads “‘It’s Life or Death’: The Mental Health Crisis Among U.S. Teens”. The Washington Post presents “8 ways to feel less anxious about things beyond your control”. Even the Wall Street Journal ran an article titled “Mental-Health Care Shortage Is Being Treated With Outdated Ratios”. If you crack open the East Bay Times editorial page, every month you’ll read a concerned letter by a local about how the services available locally are inadequate.

Though there is much attention on this issue, it is still harder than ever for people to be connected to mental health professionals. There continues to be a lingering stigma over treating mental health the same as physical health.

In their reporting on the state of mental health care the Visalia Times also profiled Richard G. Frank, a director of the USC-Brookings Schaeffer Initiative for Health Policy, about this issue. “Ever since mental health started being covered by insurance in the ’60s and ’70s, the incentives have been to avoid enrolling people with mental illness in your plan,” says Frank.

This is by design, says Frank. Mental health patients are more expensive than physical health patients — not because the cost of care is higher, but because mental health patients tend to come with substantial physical health needs, too.

Fortunately, there are positive developments in this space. Health care workers are seizing their power and demanding that the institutions they work for allow them to provide evidence based care to their patients. On the state level, Governor Newsom has signed SB 221, which requires that follow-up appointments for mental health sessions be scheduled within 10 days of the previous session. Community sponsored pilot programs such as Allcove have begun to administer free youth mental health care to all.

As a community we must work to continue to remove the stigma of mental health treatment and push for increased funding for community based programs to support all individuals. Accessible, consistent care allows us to address mental health issues early and effectively.