Q&A: Kaiser psychologist talks about upcoming strike and scarcity of mental health resources in California

Kenneth Rogers is a psychologist for Kaiser Permanente in Sacramento. He is one of the nearly 2,000 mental health clinicians that will be staging pickets outside Kaiser hospitals across Northern California on Nov. 19. They are represented by the National Union of Healthcare Workers (NUHW). 

In this Q&A, Rogers discusses the union’s key issues for striking, as well as his own insights about access to behavioral health services for Californians.

 

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Soraya Marashi: Why are you striking?

Kenneth Rogers: “There’s three reasons why we’re striking. One is related to patient care … we’re concerned about the level of access that patients have to services. We don’t feel like the access is enough. We’ve been bargaining with the employer since the summer to improve that access. They haven’t been responsive to us. We’re also striking for working conditions. But let me say, and this is very important, that we’re striking in support of other unions that are striking as well. 

The engineers have been out for eight weeks. And the Alliance of Kaiser workers is going to go out next week, and the pharmacists are going out, and there’s just a bunch of unions that are also going out for similar reasons. So we are striking in support of them as well.

Me personally … I’m a board member on the executive board of NUHW and I’ve been involved in union and labor issues for the past 15 years with them. So … I’ve helped organize every strike that we’ve ever had with Kaiser for the same issues that I mentioned earlier. And I would say that that is personally why I’m going out — that these are concerns that are ongoing, that the system has tried to handle at various times. But it’s always the same story when we try to get into bargaining and come to new arrangements and no agreements.”

SM: What do you think needs to be changed about the mental health care system that you work in? How can they change it?

KR: “I think they really need to put more resources into the system. And I know that they have committed additional resources throughout the years, but that was only after we pushed them through various past strike actions. And I think that one of the things that’s so important is we’re always trying to have mental health parity with medical concerns. 

We want people who have mental health problems to be treated exactly like you’d be treated if you had a cardiac issue, or you had some other medical concern. And this is an organization that, at least for mental health, has long short-changed its employees and short-changed its patients in terms of the level of resources that they’ve contributed. 

They need more providers, but they also need to change how much indirect service is necessary to provide care. I couldn’t tell you how much time I spend not talking to patients [and] just doing my job with every last regulation, and I’ve got to call this person, I’ve got to call that person … I mean, this is not how they treat medical doctors … 

If you go see the doctor, the doctor doesn’t take you out of the waiting room and check your vitals … you show up in a room, the doctor comes in and then the doctor leaves … with medical work, they’ve got it down to to science in terms of how we maximize our clinicians’ time. But with mental health, there’s just a variety of things that we have to do that takes time away from patient care.”

SM: Why do you feel that it’s important to advocate for issues like this?

KR: “If we don’t have a case for these issues, no one will. The patients don’t know [the members] well enough. They haven’t known well-enough for decades. They just kind of seek the help and they take what they can get. But this was always an opportunity for patients and patient advocacy groups to say the carrier providing isn’t enough, but nobody moved the ball until the employees themselves, the ones who provide the care, the ones who know that the care is inadequate, got involved and started advocating. It just didn’t happen before.

I’ve been with Kaiser since 2003. And in 2003, nobody was talking about these issues. If I saw patients six weeks later, eight weeks later, nobody cared. And I think as clinicians who know what the standards of care are for patients to be treated, that’s totally unacceptable. That’s not what we were trained to do. We were not trained to treat people who need to be seen weekly or every other week, in six to eight weeks … That’s not the care that we’re supposed to be providing. And so it got into the situation where nobody’s going to advocate if the employees themselves don’t, so it was really left to us to do so.”

SM: Why are you passionate about what you do in your job?

KR: “I’m passionate about what I do in my job because I think that all people have a right to quality mental health care, not just the people who can afford it. Psychological care, if you’re a working person and you have a lot of bills, you have a lot of other expenses, it’s not always going to be a priority. I mean, you have a heart attack, that’s a priority, right? You have some sort of medical condition, that becomes a priority … But if you’re depressed, if you’re anxious, if you have problems in relationships, these things affect people and they may have a terrible impact on people. 

But if your choices are, ‘Well, I can either suffer through this or come up with the $300 a session to go private’, that’s not really a good option for a lot of people. So I really thought it was important that psychological care be provided to the working people, and I will say that positively about the employer with their insurance system. They have enabled a lot of working people to get care through their system. I can complain about the level or the type or this or that, but I have to admit, at least it’s been present. Because the other way, there’s no options at all.”

SM: What do patients need right now that they’re not getting?

KR: “I do think we’re faced with some unique challenges. Let me be clear about something. Demand has always been high, with the exception of the first month or so of the pandemic … What happened at the beginning of the pandemic was there was a changeover from in-person services to virtual services, so I lost about half of my caseload. They just didn’t come back, they didn’t transition to the phones or the video services that we were providing. But that didn’t stay that way.

Eventually, people got used to video visits and they adjusted. And one of the things that we didn’t anticipate is that the access for care, which is what patients need right now … has actually improved with the video visits. More people show up, more people have access in that way, but with them utilizing that access, there isn’t enough time for everybody on our caseload. 

I think one problem is we don’t have caps. I think that would solve a great deal of this … We get new patients every week … So we have a caseload that’s constantly growing, and it becomes reliant upon us to either quickly solve whatever issues they’ve had, or hope that they don’t continue for services, which is a terrible thing but if you’ve got limited amount of time in a week, that’s what it ends up being. And that’s why the patient wait is so high. 

If there’s already 30 people on my caseload, and I’m adding people every week, then I have to keep pushing people out for return appointments because I don’t have the space, I don’t have the time. So this goes back to what I was saying before about it being a resource issue in terms of having more resources, having more clinicians, having more people spend the time, and I really do think they need to take a much stronger and better look at how we’re using our time as well.”

SM: How does this speak to the larger behavioral health crisis going on in California, especially in the aftermath of the pandemic?

KR: “I’ve seen things I’ve never even imagined … even with people being released from quarantine … People have come out hot, and they’ve got concerns … When you think about a population, when the whole population is under stress, they turn to mental health services for relief. And those services were already under strain. We already didn’t have the space or the capacity. 

So on top of this, it’s just getting worse, and the organization … [will] tell you, we’re hiring a bunch of people and we have a bunch of openings. But one of the things they won’t tell you is why people are leaving the system. People are getting burned [out and] they’re retiring. Our clinicians are retiring from this service. And they can’t fill these positions because the work is brutal. 

So one of the things that we’ve been really trying to work with them on and targeting has been working conditions, but they don’t want to hear it. They just want to talk about how well we’re paid … I do think there are some individuals at the highest levels of the organization that get it. I have talked with those folks, but the ones that are making decisions don’t get it. And now they’ve got an issue with a lot of their [other] unions … 

But I want to be clear, our concerns in our course are not primarily financial … If they improved access to care, if they improved working conditions for the clinicians, we’d take whatever they offered in terms of the raises. But having said that about the money, the cost of living has gone up quite a bit in California since the pandemic so [it’s] a consideration, but I wouldn’t say it’s our primary one.

I don’t think this action is going to be enough. I think that we are going to go out there, we’re going to reintroduce [this topic] to the public, because every few years we seem to have this conversation with the public about the issues at hand. But I think it’s going to require more if they are not going to become receptive and really engage with us … This is what we do every time and we’ve shown a decade’s worth of consistency around this figure. We’re obviously serious. We’re obviously going to do this and it’s probably not going to be the end. So I know what we’re up against.”

Kaiser Permanente didn’t respond to State of Reform’s request for comment before this story was published.

This interview was edited for clarity and length.