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Still without a contract, Kaiser clinicians strike

Short-staffing leading to monthslong delays in mental health care, workers say

About a dozen Maui and Oahu behavioral health care workers and union reps line the sidewalk and wave signs fronting the Kaiser Permanente Maui Lani Medical Office on Wednesday morning as part of statewide “open-ended” strike for more staffing, better wages and increased access to mental health services for patients. Kaiser and the National Union of Healthcare Workers are struggling to form an agreeable contract, an effort that has been ongoing since 2018. The Maui News / DAKOTA GROSSMAN photos

MAUI LANI — Delayed mental health care services, understaffing issues and lack of a contract agreement are reasons why Maui psychologist Rachel Kaya went on strike alongside a dozen other Kaiser Permanente workers on Wednesday.

“We’re severely understaffed,” Kaya said while standing outside Kaiser’s Maui Lani clinic as part of an “open-ended” picket line as Kaiser and the National Union of Healthcare Workers struggle to form a contract, an effort that has been ongoing since 2018. “This is a good representation of how many staff we have for the 62,000 Kaiser insurance holders on Maui, so taking care of their mental health care, it’s not enough. We’re not able to see people often enough.”

Kaiser Permanente Hawaii has 266,000 subscribers across Hawaii, but only has 57-60 mental health care workers, according to the union, which represents about 50 mental health clinicians across the state. In other words, there’s one therapist per 5,200 members.

Though not every member requires a therapist, there are still only nine mental health clinicians available to Kaiser patients on Maui, handling about seven appointments a day. This results in extremely long wait times of up to two months, which goes “beyond clinical standards” and leaves behind untreated mental illness cases, according to the union.

Kaya, who’s worked for Kaiser for 12 years, does not have an opening until November.

Registered psychiatric nurse Rikki Patrizio (from left), clinical psychologist Cassendra Caceres-Licos, and licensed clinical social worker Kathleen Rubio stand in solidarity on Wednesday morning on Maui Lani Parkway fronting the Kaiser Permanente Maui Lani Medical Office.

“One of the things I like to somberly keep in mind is that Hawaii has a really high suicide rate and so when you think of the people who are at risk of suicide, calling into our call center and saying ‘hey I need help,’ but not being able to get a first-time appointment for maybe as long as two, three months is not OK,” said Kaya.

For the past three years, Lahaina resident Kayanna Bayly has been “severely frustrated” trying to access mental health services and schedule appointments for her adolescent son, including getting him the necessary psychological evaluation and medication management.

Bayly said it’s “ridiculous” that there are fewer than 60 mental health clinicians statewide considering the large demand for services.

“I’m mad at Kaiser for not supporting the doctors,” she added. “But from the patient’s perspective, the strike doesn’t do anything and it hurts them, too, because they’re losing out on money.”

With the goal to get her son back in school, she’s called 30 child psychiatrists and therapists and conducted her own research in hopes of nailing down the best care. She is now paying out of pocket for services.

“It’s really important that we unite in our advocacy,” she said. “My voice is about making change for keiki and adults with mental health issues.”

Having Kaiser address staff shortages is first on employees’ wishlist, Kaya said, which can be done by improving the work environment, upping wages to compensate for high costs of living in Hawaii and establishing a contract that’s sufficient for recruiting new employees and retaining current ones.

In 2021, the voluntary turnover rate for mental health employees in Hawaii was 11.5 percent, which is higher than Kaiser would like, but the employer said it’s still lower than the national average.

“The pandemic has challenged our frontline care teams, including nurses, health care workers, physicians, and of course our mental health clinicians,” KPH said in a statement. “We have the greatest respect and gratitude for our mental health professionals, and we are dedicated to supporting them in their important work.”

On the bullhorn leading chants on Wednesday morning was clinical psychologist Tami Swonigan, who’s worked for Kaiser on Oahu for 15 years.

Swonigan said that patients are reporting that delayed mental health care is leaving them feeling lost, hopeless, avoidant at work or reverting back to substance use.

“I’m out here with my peers to advocate for patients,” she said. “They’re losing out, they are getting sicker, they’re not getting the help they deserve, the help that they need or really, the help that they are paying for in their premiums.”

On the other hand, her co-workers are feeling burnt out, unheard and unsupported, so they are retiring early, changing employers or leaving the profession altogether.

Kaiser said that the union’s claims about the contract bargaining and staffing numbers are false and misleading, and that they’ve been on a “multi-year journey” to increase the number of behavioral health clinicians “to meet the needs of our members and patients.”

The employer added 11 new behavioral health clinical positions, slated to be filled this year, along with additional support staff. KPH plans to add the same type and number of positions each year through 2025.

Kaiser said 28 clinicians in Hawaii have been hired since the start of 2021, with eight people starting work in the next two months. They are currently recruiting for 14 open positions for psychologists, licensed clinical social workers and licensed mental health professionals.

“It is unfortunate that NUHW leaders are asking our caring and compassionate mental health employees to walk away from their patients,” Kaiser said in a statement Wednesday. “This is the second time in less than a year that the union has called on our 60 NUHW-represented mental health providers to strike in an attempt to disrupt care and create pressure at the bargaining table.”

Kaiser agreed that patients have been waiting weeks, even months for appointments. When appointments are not readily available, though, there is an “escalation process” in place to support patients with urgent needs and coordinate the appropriate care, according to KPH.

They’ve been reaching out to patients whose appointments have been affected by the strike to reschedule or offer another option, KPH added Wednesday.

Despite the strike, many mental health staff are still working — about half of behavioral health patients receive their care from providers who are not involved with the strike.

“We greatly respect the right of all our mental health professionals to decide for themselves whether or not to strike, and we appreciate those who chose to come to work for their patients,” KPH said. “In addition, our Kaiser Permanente psychiatrists, clinical managers, and other licensed clinicians have stepped in to meet with people needing care.”

Kelly Harnick, who has a doctorate in clinical psychology and is president of the West Maui Counseling Center, said that staffing shortages and delayed care is not just a problem at Kaiser as clinics statewide battle to improve access to mental and behavioral health treatments.

“Mental health is just as serious as any physical ailment and can be fatal,” Harnick said Wednesday afternoon via phone. “It’s very important that the community really understands that they have a right to better access to care and that we all take part in trying to make it better.”

At the West Maui center, there’s five clinicians, but one is on medical leave, and there’s one psychiatric nurse practitioner who does medication management.

Still, Harnick is actively hiring for up to three more psychologists or clinical social workers, including a child physiatrist, to meet the demands of the community — there are 500 to 600 active patients, some of which are waiting for new providers.

The center also sees a lot of patients who are Kaiser insurance-holders paying out-of-pocket, sliding fees to receive care, she said.

“We need clinicians of all levels of training, we need more of all of them on Maui,” she said.

Picket lines will move to Kaiser facilities in Hilo on Hawaii island on Thursday before returning to Oahu on Friday.

Kaiser’s mental health care workers in California also have been on strike over the same issues since Aug. 15.

* Dakota Grossman can be reached at dgrossman@mauinews.com.

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