Kaiser therapists take to the picket line in Hilo as open-ended strike continues

While holding a picket sign, Dr. Darah Wallsten, a psychologist at the Kaiser Permanente clinic in Hilo, said it is unacceptable there is only one therapist for every 10,000 Kaiser members on the Big Island — with patients having to wait two months or longer for an initial appointment with a mental health professional.

“Untreated mental health affects the justice system. It affects housing. It affects physical health care. It affects criminal justice, domestic violence, substance abuse,” said Dr. Rachel Kaya, a psychologist at the Kaiser Maui Lani Clinic.

The two psychologists and one other member of the National Union of Healthcare Workers picketed Thursday in front of the Kaiser Hilo clinic on Waiānuenue Avenue.

They have done so every Thursday for five weeks as part of an open-ended strike that began at the end of August by mental health professionals at Kaiser clinics throughout the state.

“When Kaiser shirks its duty, everybody pays,” Dr. Kaya said as she held a sign that read: “On Strike Day 32” on one side and “Patients Before Profits” on the other.

Kaiser and the National Union of Healthcare Workers are currently bargaining over a new contract. Kaiser clinicians joined the union four years ago to advocate for better access to mental health services. They hope the ongoing strike will prompt the health care provider to address those access-to-care issues.

This is the second time this year that clinicians have left their offices and took to the picket line in Hawai‘i. It comes as more than 2,000 therapists in Northern California continue an open-ended strike of their own in an effort to get Kaiser to improve access to mental health care there.

“I live here,” Dr. Wallsten said. “It’s important to me that the people that live here get the services that, really, they deserve.”

When she started at the Hilo clinic eight years ago, she was able to see patients in a timely manner and bring them in for follow-up appointments within a reasonable amount of time. Now, Wallsten said it feels like she is constantly juggling her caseload and just trying to fit people in when she can.

“That’s what all the therapists from Kaiser are experiencing,” she said.

Dr. Wallsten said Kaiser’s mental health services were understaffed four years ago when the clinicians unionized, but the situation has been compounded because the COVID-19 pandemic has triggered more people needing mental health services. The island’s population also has grown.

“So we have more members than when I initially started, so that’s another thing,” she said. “When you’re membership grows, you should add staff, and that has not happened.”

Dr. Kaya said while the union is happy the health care provider has informed regulatory authorities that it will hire additional staff, Kaiser needs to live up to its promises.

“So we are asking to actually embed in our contract language an accountability measure where if they can get net increase in staff, great. If they can’t, we’re asking for compensation,” she said. “We’re asking for compensation for current staff who are overburdened by understaffing, but also an increase to any new hires, which sweetens the pot.”

In her opinion, that’s a win-win, but Kaiser has so far said no.

Wallsten said it’s important for her to be on the picket line to put a public face on the issues the union is raising and let people know what’s happening. She thinks Kaiser serves patients medically fairly well, but for whatever reasons, it does not provide the same level service when it comes to the mental health piece of care.

“I think a lot of times my experience in Hawaiʻi, especially with people who lived and grew up here, there’s a way in which they may not be aware that really you’re not getting the service you should have,” she said. “It isn’t OK to wait a couple of months, and a lot of my patients, they’re very kind. They’ll say, ‘Oh, it’s OK, Dr. Wallsten, you can’t see me.’ And I’m like, ‘No, really it isn’t.'”

Dr. Wallsten said the strike and picket lines have allowed her and the other Kaiser mental health professionals throughout the state to let the public know that understaffing in this area needs to be addressed.

“Schoolyard bullies do not change their ways on their own,” Kaya said. “So really, when you have a billion-dollar corporation who is not doing what it’s supposed to, they will continue to do that until some sort of leverage is applied.”

She thinks the strikes and the picket lines are that leverage.

“We’re putting it out into the public so that Kaiser can’t quietly take advantage of the community without anybody knowing,” Dr. Kaya said.

Dr. Wallsten said the small group picketing in Hilo has seen an outpouring of support from the community that has taken many forms since the strike began, including motorists who “Honk for Mental Health” and drop off cookies. A kupuna who is a former member of another union led them in a union song. State Sen. Laura Acasio also came out to picket with the group for a couple of hours last week.

“I love the Big Island,” Dr. Walsten said. “I am a part of this community. I want us to serve our population better.”

There has been some movement since the beginning of the strike. While Kaiser waited a month to offer anything new since the strike began, the company has scheduled three upcoming bargaining sessions within three weeks. 

“So when you say: Is there progress? Yeah,” she said. “They are more frequently willing to sit at the table.”

Kaiser spokesperson Laura Lott told Big Island Now on Friday that the next bargaining session is scheduled for Oct. 6.

“We are pleased to have bargaining dates set as this strike does not need to continue,” said a statement from Kaiser. “We remain committed to reaching a fair and equitable agreement that is good for our clinicians and our patients. While (the National Union of Healthcare Workers) claims it is fighting for increased access to care, most of the issues the union has still on the table are about wages and benefits.”

There is still work to be done, according to Dr. Kaya.

“The CEO of Kaiser Permanente makes $17 million a year,” Dr. Kaya said. “The board of directors, all millionaire salaries. So when Kaiser is sniggling about the differences between a dollar an hour in contract language, that’s not OK. The public needs to know about that, and they need to know this company choosing to underserve mental health care affects the rest of the community.”

Kaiser said in its statement that it is unfortunate that the union is asking the health care provider’s mental health employees to walk away from their patients.

“This is the second time in less than a year that the union has called on our 60 mental health providers [represented by the National Union of Healthcare Workers] to strike in an attempt to disrupt care and create pressure at the bargaining table,” the statement said. “Kaiser Permanente continues to reach out to every mental health patient whose appointment has been affected by the strike to reschedule or offer another option.”

Kaiser said that about half of its behavioral health patients receive their care from mental health community providers who are not involved with the strike. For patients who cancel or reschedule appointments, the health care provider will conduct clinical quality reviews to ensure they receive the care they need.

“Despite the strike, many of our dedicated Kaiser Permanente mental health staff remain on the job caring for members,” Kaiser said in the statement. “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. In addition, our Kaiser Permanente psychiatrists, clinical managers and other licensed clinicians have stepped in to meet with people needing care.”

Kaiser Hawai‘i has been on a multi-year journey to increase the number of mental health clinicians to meet the needs of its members and patients, the health care provider said.

“Despite a local and national mental health workforce shortage, we’ve hired 25 clinicians in Hawai‘i since the start of 2021, three of whom will be starting work in the next two months,” the Kaiser statement said. “We’ve also added 11 new mental health clinical positions and additional support staff to be filled this year and subsequent years, nearly doubling our Integrated Behavioral Health staff by the end of 2025.”

The statement said Kaiser is committed to remaining an employer of choice for its mental health professionals.

“We do this in part by offering market-competitive wages and benefits to attract and retain top-quality employees,” the health care provider said.

Lott said she has seen some misinformation in other reporting about the current situation between the union and Kaiser, including caseloads and the numbers of members who seek mental health services.

“Less than 8% of Kaiser Permanente Hawai‘i’s total membership seeks mental health services in a given year based on our internal data from 2020 and 2021,” Lott said. “The approximately 60 mental health clinicians represented by [the union] are just one part of our Kaiser Permanente Hawai‘i mental health care team, along with psychiatrists and additional behavioral health care staff.”

About half of Kaiser’s behavioral health patients receive care from practitioners such as contracted mental health providers in the community, who are not involved with the strike, she said. Kaiser continues to hire additional clinical staff and is now recruiting for 14 open positions, including psychologists.

As far as claims about excessive workload for Kaiser mental health staff, Lott said the health care provider’s therapists are scheduled for an average of six to seven appointments per day.

“Our model provides our full-time therapists room to focus almost solely on their patients,” she said. “In addition, we have an administrative structure in place to ensure an appropriate amount of preparation time and time to support ongoing education.”

She added that economic issues surrounding wages and benefits are the main issues still on the table between Kaiser and the union, adding Kaiser provides market-competitive wages and benefits to attract and retain top-quality employees.

For more about Kaiser’s stance on the union’s claims, visit the Kaiser Labor Update site.