Long wait times at Kaiser Permanente for mental health care are persistent and may violate a state law aimed at addressing the problem, according to testimony at a state Senate hearing this week.
Kaiser patients and clinicians addressing the Select Committee on Mental Health and Addiction on Wednesday said getting a follow-up mental health appointment at Kaiser facilities throughout California could take up to 12 weeks. In some cases, no new appointment slots were available.
“From what I can tell, Kaiser is not complying with SB 221, and it’s been ongoing issue,” said Sen. Scott Wiener, who represents San Francisco. “Health plans have an obligation to provide timely access to mental health treatments, and that doesn’t appear to be the case consistently at Kaiser.”
Weiner authored the state bill, SB 57, which requires Kaiser and other private health care plans in California to provide follow-up mental health care appointments within 10 business days, unless a longer time is deemed appropriate by a clinician.
It also requires that health plans arrange out-of-network care if an appointment with Kaiser is not available within those 10 business days.
The issue comes as San Francisco and California grapple with a mental health crisis and high turnover among clinicians during the pandemic.
“In San Francisco, our patients in the general psychiatry department wait six to 12 weeks before their return visit. In my department, we have a real problem being able to provide continuity of care,” said Caleb Birkhoff, a marriage and family therapist at Kaiser’s addiction medicine clinic in San Francisco.
Long lag times between appointments can delay or worsen progress for people struggling with mental illness, several mental health experts said at the hearing. For those who struggle with severe depression, suicidal thoughts, schizophrenia or other mental illness, inconsistent access to care can increase chances of harm.
State lawmakers at the hearing probed whether Kaiser Permanente and other health plans are complying with the state law, which was approved by Gov. Gavin Newsom in October 2021 and went into effect on July 1.
Nearly 2,000 Kaiser mental health workers across the Bay Area and Central Valley are preparing to strike indefinitely beginning Monday, including psychologists, therapists, chemical dependency counselors and social workers. They allege that their employer is failing to comply with the new requirement to provide care within two weeks of an initial appointment.
On Wednesday, clinicians shared recent screenshots of weekslong and monthslong wait times for members across Northern California and the Central Valley following initial intake appointments.
Kaiser officials told the Examiner that its model provides members with timely mental health and substance use disorder care. It has added a net 200 new clinicians since January 2021; launched a $500,000 recruiting initiative to fill more than 1,000 open positions; and has invested $30 million in educating and training new mental health professionals.
However, a shortage of mental health care workers stemming from the pandemic has made it even more difficult to provide follow-up appointments within 10 days, representatives from Kaiser said.
“We worked diligently to meet the requirements of the new law and to fully integrate them into our model of mental health care and substance use disorder treatment,” said Adriann J. McCall, a spokesperson for Kaiser Permanente in an email. “The implementation of SB 221 is challenging for all health plans and providers given the overall demand for mental health care and substance use disorder services — exacerbated by the pandemic — and the shortage of trained professionals both nationally and in California.”
Ex // Top Stories
Checking in with SF’s leading mayoral candidates to talk climate change and the environment
City leaders grapple with how to bring street vendors back to Mission Street while continuing a clampdown on illegal fencing operations
UCSF infectious disease experts weigh in on the impacts of climate change temperatures and other events change disease patterns
The contract dispute between Kaiser and its employees over mental health therapy dates back to before the pandemic. In 2018, the Department of Managed Health Care help center received 550 complaints about Kaiser involving behavioral health. So far in 2022, there have been 429 complaints through the help center. Since SB 221 went into effect, the call center has received two complaints specifically regarding compliance with the new law, according to data provided by the department.
Burnout stemming from the pandemic has also exacerbated pre-existing workforce challenges.
From July 2020 to May 2021, 12% of clinicians including psychologists, therapists and social workers left Kaiser in San Francisco, according to membership data provided by the National Union of Healthcare Workers. That increased to 16% the following year, from June 2021 to this May.
The high rates of turnover mirror trends across Northern California, where 17% of clinicians left Kaiser between December 2021 and May, compared with 10% from December 2019 to May 2020.
Mary Watanabe, director of the California Department of Managed Health Care, said her department has experienced a 20% increase in complaints for timely access to behavioral health care from Kaiser enrollees in 2021 compared with 2020.
Following the uptick in complaints and meetings with unions, consumer organizations and the health care provider, the department in May launched a special examination into Kaiser. Health plans are surveyed every three years unless unforeseen issues lead the agency to conduct an investigation in between those three-year reporting cycles.
The agency is now examining Kaiser’s behavioral health operations, including timely access to care, processes for intake and follow-up appointments, appointment scheduling processes, levels of care and associated decision-making processes and monitoring of urgent appointments. The survey is expected to take 12 to 18 months to complete.
“I’m happy the department is taking that step. It shows the administration is committed to mental health treatment access, and it sends a signal to Kaiser and other health plans that when we pass a law we mean it,” Wiener said.
The upcoming strike will almost surely put extra strain on already difficult wait times. Kaiser will continue to be held accountable to the new state requirements during the strike, state regulators said in Wednesday’s hearing.
The agency last week sent Kaiser officials a letter asking for information on how the health care plan will fulfill appointment requirements during the strike.
“Strike or no strike, as the regulator, we are going to hold them accountable to the law,” said Watanabe. “If the plan can’t provide it in network in timely access, they need to arrange for out-of-network care at the in-network rate. It’s not the consumer’s responsibility to go through the list of providers and make calls.”
Prior to SB 221, California law required HMOs and health insurers to provide initial mental health assessments within two weeks, but follow-up therapy appointments didn’t have the same requirements.
“This stems from many years or society viewing mental health not as a health issue but as a personal failing,” Wiener said. “We are going through a very awkward phase where we are conveying to plans over and over again that you have to change and you have to cover mental health.”
