[Mara Cavallaro is El Tecolote’s Report for America Corps Member who reports on mental health & healthcare inequality in the Latinx community. Photos by Jeremy Word]
On Monday August 15, more than 2,000 Kaiser mental health clinicians went on strike in Northern California and the Central Valley to demand the work conditions necessary to provide adequate care. According to therapists, Kaiser mental health is understaffed, employees are overworked, and patients—including those at high risk—have to wait months for appointments.
Outside of the San Francisco Medical Center on Geary Street, on the first day of the open-ended strike, some 100 picketers could be heard from a block away. “Healthcare not corporate welfare! Care delayed is care denied! Workers united will never be divided!” These call-and-response chants are memorized—many have done this before. In the last four years, Kaiser’s Northern California mental health clinicians have gone on strike six times.
Last week, clinicians agreed to Kaiser’s wage offer, but the HMO rejected the bargaining team’s demands for increased staffing and reduction of appointment wait times, according to the National Union of Healthcare Workers (NUHW). The strike, a “last resort” for the union, comes after 13 months of negotiation. “I was pregnant when we started… My baby turned one,” Ilana Marcucci-Morris, an adult psychiatrist in Oakland, said in a midday speech.
This year alone, 668 therapists have left Kaiser—double the rate of the year prior, when 335 clinicians left. An overwhelming majority of departing providers surveyed by the union—85 percent—said they chose to leave because their workloads were unsustainable. 76 percent described being unable to “treat patients in line with standards of care and medical necessity.” Kaiser employs just one full-time mental health clinician for every 2,600 Kaiser members in Northern California, according to the NUHW.
“Care Delayed is Care Denied”
Despite SB 221, a law that went into effect this July that requires timely mental health care, Kaiser patients are routinely made to wait as long as months for appointments. According to Luz Maria Daley, a psychologist at Kaiser’s Women’s Health Department in Modesto, the delay for follow-ups with patients can be anywhere from six to twelve weeks. “When I’m…trying to transfer a patient to a higher level of care, there’s so many hoops that I have to go through to get management to find somebody to see them at a sooner time than three months from now,” she told El Tecolote. “We’re talking women with postpartum depression, or that are at risk for suicide—and I can’t get them to be seen by anyone.”
When Julia Gitis had her first baby, in April of 2018, she struggled with postpartum depression. She recalls not experiencing any of what she had been taught to expect from motherhood—that “‘it [was] going to be so beautiful, it’s going to be so great, I’m going to be a natural mother, my baby is going to fall asleep in my arms and we’re going to snuggle.’ None of that happens when you have a colicky baby and none of that happens when you have postpartum depression…there was nothing beautiful about it.” None of the parenting classes she took at Kaiser in San Francisco talked about postpartum depression, she recalled. She wasn’t prepared.
Gitis expressed that she was struggling to her OBGYN, but didn’t get an appointment with a psychologist until October—six months after childbirth. “I got a lot of value out of it,” she said, and wanted to come back. But “it basically wasn’t an option at all.” Instead, she said she was asked if she wanted to come back in “four to six months.”
In February of this year, Cynthia Valencia, a UC Berkeley graduate student in psychology, tried to see a therapist through Kaiser. At the time, she was going through infertility treatments that were “causing a lot of depression and anxiety,” she recalled, and wanted a therapist she could see long-term.
After doing a screening that demonstrated she qualified for care, she asked Bakersfield Kaiser to see a woman of color therapist. “I remember them saying, ‘we don’t have any,’” she told El Tecolote. So she asked to be referred outside Kaiser, and a few days later was contacted by white therapist. “I was so specific about what I wanted and they still referred me to her…I’m anxious, I’m overwhelmed, I don’t have time for this. It should be easy and it should be a seamless process for [Kaiser] to find me someone. And they didn’t,” she said.
Valencia gave up her search. “I never got any care through [Kaiser]. I’ve been without therapy since then,” she said. “It set me back significantly with my dissertation to the point where I have to do another semester. And I really feel like had I gotten the mental support that I needed…perhaps I could have found a way to manage my emotions.”
Spanish Language Care
For patients with limited English proficiency, wait times for therapy appointments can be even longer. When Daley started working for Kaiser, at the Stockton clinic, she recalls there being around six or seven Spanish-speaking providers. When she left, there was just one on the adult team and one on the youth team. “Most of my caseload had to be transferred over to the remaining Spanish speaking clinician, and she already had more than a full caseload. So for [Spanish speakers] to be seen it takes much longer…to be seen initially [and for follow ups],” she said.
Jeffery Chen-Harding, a clinical social worker in Kaiser’s San Francisco psychiatry department, passed the exam that registered him as a bilingual clinician in 2017. He also recalls joining a group of about six Spanish speaking providers. But “over the last five years, everybody has left except for [three] of us,” he said. And people aren’t being replaced.
Last December, Kaiser cut San Francisco’s La Clinica group—a Spanish language weekly therapy meeting for about 4-8 people that had been in place for nearly 10 years. “We used to have such an amazing set of services for folks to come in and be heard and validated…and that’s gone. It doesn’t have to be gone,” Chen-Harding said. He was the one who had to break the news to his group patients, and became emotional remembering the moment. “You have people who are already separated from their country and their culture and their families and then you’re ripping this other source of support away from them,” he said of Kaiser’s decision. Last year, Kaiser reported a net profit of 8.1 billion dollars.
In total, an estimated 36 percent of Spanish speakers in San Francisco—32,452 people—have limited English proficiency (LEP), according to Census figures from 2015-2019. Data also demonstrate that surveyed Latinx adults were more likely to report symptoms of depression than their white counterparts. At a time when demand for Spanish language services is palpable and increasing, cutting Spanish language programs and not hiring or supporting bilingual providers marks an institutional disregard for the health and well-being of Latinx communities. “Not being able to retain more Spanish speaking clinicians at Kaiser is something that can be addressed and should be addressed. And they’re not doing anything about it,” Daley said.
Latinx and Bilingual Clinicians
San Francisco and the Central Valley are far from alone in their ‘shortage’ of bilingual therapists (shortage is placed in quotations here because there are bilingual clinicians ready to provide care—institutions like Kaiser just aren’t retaining them, or consistently replacing them when they leave). By 2028, California is predicted to have 41 percent fewer psychiatrists than needed, regardless of language, according to a UCSF study. Nationally, just seven percent of licensed psychologists nationwide are Latinx, and just 5.5 percent are able to provide services in Spanish, according to the American Psychological Association.
At Kaiser, bilingual providers like Daley and Chen-Harding are paid just one dollar extra per hour for their skills. “This is [a] joke,” Daley said. “We have been fighting…Kaiser has refused to move from one dollar per hour.”
For Daley, the differential pay is not the biggest source of frustration, however. Often, she said, she is asked by Kaiser management why she is still seeing a patient. “That’s the part that’s very difficult, especially as a Latina woman—having my clinical judgment be second guessed. I know what I’m doing, and for Kaiser management to tell me otherwise is very disrespectful and very demoralizing. As Latinas, that’s part of why a lot of us have left,” she told El Tecolote. “I’ve been working since I was 14 years old—and I’ve never worked anywhere where I felt disrespected like I do at Kaiser.”
Mental Health Interpreting
When patients are seen by therapists who don’t speak their language, Kaiser employs medical interpreters that provide translation services, typically over the phone. This means communication takes longer—but according to Daley, who is on the bargaining team, Kaiser has refused to extend appointment length for patients using interpreters.
Phone interpreting is often used by Kaiser because it is cheaper than both video and in-person interpreting, but over-the-phone interpreters are unable to see patients, read their body language, or pick up on cultural cues. The result is an often stilted and rushed exchange where patients are effectively penalized for not speaking English. “The saying ‘it gets lost in translation’—it’s never more so than when you’re trying to do psychotherapy,” Daley said.
According to Bettina Iantorno, a freelance medical interpreter in San Francisco, “Over the phone interpreting…doesn’t really work because a lot of times the connection isn’t good, you can’t see the doctor, you can’t see the patient, it’s very messy.” And even though video interpreting is better than over the phone, “it’s nothing like being in person,” she told El Tecolote.
New Strike, Same Struggle
Willow Thorsen, a social worker who started at Kaiser in Santa Rosa 15 years ago, said that the negotiations happening now are “the [same] conversation we were having when I started.” Eight years ago, in 2014, Sal Rosselli, president of the NUHW, wrote a statement on Kaiser’s Mental Health Crisis. “Understaffing has forced patients to endure lengthy, illegal waits for appointments, and these delays have sometimes had tragic results for patients, and have even led to suicides,” it reads. The letter may as well have been written last week.
“I want to be very optimistic but when you look at the longevity of this problem and the number of lawsuits Kaiser has had, the number of times they’ve been investigated…I often wonder how likely significant change is to happen,” Chen-Harding said.
But this strike is different, for several reasons. It’s Kaiser’s first open-ended strike—meaning it has no set end date. It’s also the first strike since SB 221 went into effect, and already, the Department of Mental Health Care has expressed concern over Kaiser’s alleged illegal cancellations of appointments during the strike. State Senate President Toni Atkins, Assembly Speaker Anthony Rendon, and Lieutenant Governor Eleni Kounalakis have expressed their support of the strike. And it’s happening during a surge of labor organizing and union power across the country and across sectors.
Today, clinicians are rallying outside Kaiser’s corporate headquarters in Oakland.
“When Kaiser officials look out their window…they’re going to see a lot of people who are never going to give up until we see a real commitment…to prioritize mental health care,” Natalie Rogers, a Santa Rosa therapist, told the NUHW. “It’s time for Kaiser to stop padding its pockets and start providing care that helps patients get better.”