A protester at SF General Hospital on Inauguration Day. Photo by Laura Wenus

After years of complaints from healthcare providers and patients on the extremely long waits to see a mental health practitioner at Kaiser Permanente, a San Francisco Board of Supervisors committee today heard from involved parties, including Kaiser management.

Supervisors Dean Preston, Rafael Mandelman, and Connie Chan questioned representatives from the healthcare giant on their standards for mental health care access — and generally found that the insurance and healthcare provider fell short. 

“As someone on the front lines of this worsening problem, let me testify that San Francisco patients are deteriorating and very frustrated at best,” said Ilana Marcucci-Morris, an intake clinician at Kaiser Permanente. 

Marcucci-Morris said months-long delays are typical for non-emergency patients seeking mental health care. 

She said that when she checked the Kaiser system today, the next available appointment she could offer a patient wasn’t until Jan. 27 — more than 3 months away. And San Francisco is “by far” the most difficult place to find therapy appointments, said Marcucci-Morris, who serves the Northern California region at a call center in San Leandro. 

California law mandates that mental health patients are seen for an intake appointment within 10 days of their request, and patients with urgent mental health needs are seen within 48 hours. For the most part, Kaiser meets these requirements at a rate of over 95 percent, said Leanne Jones, the healthcare provider’s director of behavioral health quality. 

But when it comes to follow-up care — the ongoing therapy that many people need after an initial intake appointment — patients and doctors alike say the process for non-urgent cases is so long, it can be dangerous. 

“Trying to navigate Kaiser Behavioral Health significantly exacerbated my already intense symptoms of depression and suicidality,” said a statement read aloud on behalf of one Kaiser patient during public comment.

Demand for mental health care has increased in recent years, and the pandemic has only exacerbated these needs. A CDC study in 2020 showed that one in four survey respondents across the United States had seriously considered suicide in the past 30 days. 

According to San Francisco Health Service System data presented during the hearing, 42 percent of those surveyed reported declining mental health during the pandemic, and 57 percent reported increasing levels of anxiety. 

Along with increasing demand for services, Kaiser says, is a shrinking workforce. 

“There’s this huge gap between demand and supply,” said Dr. Maria Koshy, Chair of Kaiser’s Chiefs of Psychiatry, adding that this is a national issue not specific to Kaiser. “Hiring is a big part of our strategy. But that’s not going to be enough because, without increasing the pipeline, we’re not going to have enough people to hire.” 

The company reported hiring more than 600 new mental health clinicians in California since 2016, and said it is on track to hire twice as many as the past 3 years in San Francisco. Kaiser is also investing $30 million to increase their numbers further. 

San Francisco’s government is a major purchaser of Kaiser services: According to the 2021 demographics report from the San Francisco Health Service System, nearly 70,000 city employees and retirees were enrolled in Kaiser care as of January. 

Union organizers hope that this stake means the city can push Kaiser to make some needed changes. But, they say, the issues raised at today’s hearing have been around for a long time, without much change. 

Former supervisor John Avalos, who is now the Assistant Director of Political and Community Organizing for the National Union of Healthcare Workers, pointed to a couple times Kaiser has already been accused of “cooking the numbers:” San Diego recently sued Kaiser for misrepresenting the size of its workforce, and, in 2013, Kaiser was fined $4 million for poor tracking of mental healthcare services.  

“Pretty much our [union’s] 10 year existence has been fighting Kaiser on providing greater access and timely access for mental health care,” said Avalos. 

He didn’t buy Kaiser’s excuse that a workforce shortage was solely to blame, saying the company simply doesn’t “value mental health care at the same level as they do the physical health care.” Mental healthcare, Avalos said, requires ongoing treatment and can be costly. 

In November, 2020, 65 San Francisco-based mental health clinicians signed a letter to management, alerting them that patients were waiting months to begin therapy and six to 12 weeks between appointments. 

“Clinician burnout and turnover are high,” the letter reads. “We are unable to provide the services that meet our professions’ standard of care. These practices violate legal parity mandates.” 

Jeffery Chen-Harding, another clinician at Kaiser who has worked in triaging and providing therapy to patients, was one of the 65 to sign the letter. 

“I found it so demoralizing to have to constantly tell people, ‘Yes, you should be getting care next week, and I cannot give it to you,’” Chen-Harding said.  

During today’s proceedings at the Government Audit and Oversight committee, Supervisor Dean Preston seemed in disbelief that even internally, Kaiser has no data on average or suggested timelines for follow-up care post-intake. 

Despite repeated questioning from Preston, Kaiser’s Dr. Maria Koshy insisted that wait time is not necessarily an indicator of proper mental health care. 

“Nowhere in any other field do we talk about frequency of care as being a primary indicator of quality of care,” Koshy said.  

Chen-Harding rejected this idea as simply untrue. 

“If you want to look in psychiatric and psychological journals, you’ll find plenty of evidence-based studies that feature weekly or more often individual therapy,” Chen-Harding said at the hearing. “That’s the recommended standard of care. So, let’s call things what they are.” 

Koshy and other Kaiser representatives acknowledged that the company is restructuring its care to prepare for July, 2022, when a new healthcare law will go into effect mandating timely mental health services. Under SB-221, healthcare providers will be required to provide follow-up care to mental health patients within 10 business days of their prior appointment. 

Avalos hoped today’s hearing would address inadequate data being self-reported by Kaiser. “Maybe the Health Service System can require a whole other level of reporting and compliance,” Avalos said. The hearing has been continued to an unspecified later date. 

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Eleni Balakrishnan

Eleni is our reporter focused on policing in San Francisco. She first moved to the city on a whim over eight years ago, and the Mission has become her home. Follow her on Twitter @miss_elenius.

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25 Comments

  1. I waited 6 weeks to talk to anyone at Kaiser. 4 months later, neither Kaiser nor the people they referred me to has seen me or set up an appointment. Because of this, I am leaving them for Blue Shield.

    1. The National Union of Healthcare Workers (NUHW), which represents Kaiser’s therapists, has been connecting with Kaiser patients who are interested in supporting efforts to fix Kaiser’s mental healthcare system. If you have experienced delayed or denied mental health care at Kaiser, please share your story with NUHW here: https://nuhw.org/kaiser-dont-deny/share-your-patient-story/ Please also NUHW’s follow the Kaiser Permanente Red Flag campaign on Facebook, Instagram, Twitter and LinkedIn.

  2. I reached out to Kaiser this summer for mental health support during a very dark and scary time. Even though I was in terrible shape during the intake, they helpfully suggested some meditation apps and called it a day. That was supposed to carry me through to a session 2 months later.

    My first session was so horrific that I almost cut it off after 10 minutes. I stuck with it for that hour, and promptly discontinued the therapy afterwards. It was a firing squad of questions trying to put my whole life – all the trauma and mental illness, with exact timeframes – into whatever system she was using on her computer. She repeatedly cut me off if I expanded on anything so we could move on to the next question.

    I happen to be one of the lucky ones with a strong support system and ability to pay out of pocket if I really need to. I can’t only imagine how many people are suffering and who finally take the huge step to get mental health care, and either never get it or have an experience like I did that will set them back for months.

    The lack of timely, quality mental health care at Kaiser is an outrage.

    1. The National Union of Healthcare Workers (NUHW), which represents Kaiser’s therapists, has been connecting with Kaiser patients who are interested in supporting efforts to fix Kaiser’s mental healthcare system. If you have experienced delayed or denied mental health care at Kaiser, please share your story with NUHW here: https://nuhw.org/kaiser-dont-deny/share-your-patient-story/ Please also NUHW’s follow the Kaiser Permanente Red Flag campaign on Facebook, Instagram, Twitter and LinkedIn.

    2. I had the exact same experience. It feels like you are being rushed through an assembly line – they do not care about your individuality as a patient.

      It also felt like they were trying to trick me with certain questions in order to disqualify my diagnosis. I have ADHD and also have trouble sleeping, which I told them. They said that my lack of sleep might cause ADHD symptoms, so they might not prescribe me the ADHD medication I’ve been taking for over 10 years. It really feels like they don’t want to help.

  3. In 2018 my Kaiser psychiatrist in Santa Rosa, California had to leave unexpectedly on disability and the way the department handled it was atrocious. They would call me the day before an appointment and say I had to be rescheduled but the closest next appointment was 8+ weeks away. This repeated multiple times and the people on the phone acted like I was being unreasonable in expressing displeasure over the stupidly long time waiting for an appointment and repeated rescheduling. They would say that if I really felt bad I could go to the ER – but I did end up in the ER at one point with an accidental injury and when I asked the doctor for a psychiatrist consultation he gave me the phone number for the psychiatry department and told me to call after 8am on Monday. When my psychiatrist finally retired/became fully unable to work I received a letter saying who I was being assigned to but when I called to make an introduction appointment I was told there were no appointments available for that provider as far out as their appointment system went. I also was told by someone on the phone while attempting to make an appointment that there is a national shortage of psychiatrists as though that excuses Kaiser neglecting patients to death. So I switched to Petaluma Kaiser which is slightly better but has gotten way slower in the past few years.
    From the time I requested specific psychological testing to when I got the results at the San Rafael branch was more than 6 months. When they administered the tests they told me they would have the results and report ready in 2 weeks. Two weeks later I call them and they say it will be another 2 weeks. Repeat ad nauseum for 3+ months before I am presented with a verbal report which I am not allowed to take audio recording notes, but they would not provide specific details as to why they wouldn’t allow it despite my request for written details explaining why I could not. I was not provided a written report but was told that if I waited 2 more weeks that I could request one from the records department. When I finally got the report a month later it was full of typos and partial comments that referenced more material but failed to provide it.

    Continuously disappointed and a waste of monthly premiums.
    Patients and the state providing healthcare subsidies should be refunded for every month that Kaiser makes them wait because Kaiser could not provide an appropriate appointment.

  4. I am normally seen in Canyon Crest office in the County of Riverside. My husband passed of Covid in November 2020. I have been trying to get a new provider. They want to out source me for a phone visit with someone I don’t even know and to spill my guts over the phone. I don’t feel that is the proper way to deal with a gieving patient who suffers from mental illness to begin with

  5. I have been reaching out for mental health care due to losing my husband to Covid in November 2020. Riverside California Kaiser wants to out source me to a provider for a phone visit to spill my guts to someone I never met over a phone call. I am not comfortable with this at all

    1. The National Union of Healthcare Workers (NUHW), which represents Kaiser’s therapists, has been connecting with Kaiser patients who are interested in supporting efforts to fix Kaiser’s mental healthcare system. If you have experienced delayed or denied mental health care at Kaiser, please share your story with NUHW here: https://nuhw.org/kaiser-dont-deny/share-your-patient-story/ Please also NUHW’s follow the Kaiser Permanente Red Flag campaign on Facebook, Instagram, Twitter and LinkedIn.

  6. This has always been the case at Kaiser. It’s not set up very well for long term individual mental health support. They do have good group therapy offerings though.

  7. I am also a kaiser patient, however in the state of georgia. I waited 12 months for a replacement therapist after my original clinician left her employment. At that long awaited appointment this week, i was told my next follow up appointment could not be scheduled until late February 2022. I am suffering.

    1. Thank you for sharing your story.
      Ask the psych dept, regarding getting a referral to Beacon Health Options. Kaiser contracts with for mental health services. The psychiatrist or a therapist has to put in a referral and it gets reviewed.
      It’s better dealing with Beacon than Kaiser. If approved you call Beacon and ask for list of therapist’s in your area and you have to call to find out if they’re accepting new patients.
      My young adult daughter has kaiser medi-cal and there’s a Beacon for medi-cal and for “business”, I’m guessing Kaiser through a work healthplan.
      I hope this info will help.

  8. I had a very bad and hard episode of depression and anxiety and I have to wait more that five months to see a psychiatrist I did my appointment two months ago and I have the appointment by the end of Jan 2022.

  9. I am a psychologist who works for a different organization. While I have certainly heard reports by clients that Kaiser’s mental health is not consistent with industry standards, the increased demand is not unique to Kaiser. There are wait times everywhere, even including clinicians in private practice. The country is in a mental health crisis and as a person on the front lines, I can tell you it is stressful, many clinicians are burned out, and it is heartbreaking to not be able to meet the demand. This is a huge and complicated problem and does not have an easy solution.

  10. Kaiser Permanente was able to get me in the very day I called about my mental health issue. They followed my case diligently.

  11. Due to unavailability, I asked to see a out of network provider, I was then informed that the contract had concluded (with Magellan and Kaiser) 7 months after starting therapy. I contacted intake and the next available provider was 6 months out… the intake clinician was transparent and seemed overwhelmed as well stating they don’t have enough staff. I got a call a few hours before my scheduled appointment after waiting 6 months, stating that the provider was out sick- understandable, they’re human too. The next available appointment was not for another 4 months out…. that is almost a year of waiting to be connected to a provider and completely unacceptable. I happen to work in social services and I also assist some of my clients in navigating the Kaiser mental health system which is absolutely egregious. Completely unsafe and a failed system

  12. I am a Kaiser patient at Lancaster’ California.
    I gave up on having a therapist because the appointments were 5 WEEKS apart.
    While I can’t believe what Kaiser is calling therapy I do want to say that the psychiatrist I have in charge of my medication is doing an excellent job. My appointment are appropriately spaced and he makes sure I don’t need more or less of my medication

  13. I’m wondering how anyone could think that Kaiser could help with mental health issues? Those people are entirely crazy!!

  14. My young adult daughter has kaiser medi-cal and has had serious mental health issues since 12/2020. (Has had mental health issues before that) I was told by her Alta Regional service coordinator about Beacon Health Options that Kaiser contracts with for mental health services. Ask the Kaiser psych dept about it, or your therapist about getting a referral to it. The therapist or psychiatrist has to put in the referral and then it gets reviewed and hopefully approved. My daughter has serious mental illness and intellectual disability.
    And she’s had horrible service from the Kaiser mental health dept. Took forever for her to get therapy after psych hospitalization and the IOP (intensive outpatient)program they suggested was BS. And had appt with therapist after 12/2020 hospitalization in Feb.2021 was told the therapist would only meet with her once a month! Outrageous! And the therapist gave some BS reason etc.

    Service with Beacon Health Options has been ok. You get a list of providers and you have to call if they are accepting new patients and I would suggest asking if they could help you with any specific mental health diagnosis you might have. I had to do that for my daughter. And as a consumer you have to ask about Beacon Health Options because none of the mental health kaiser staff we talked with ever mentioned Beacon.

  15. I waited nearly 2 months for Kaiser to call me with a list of three therapists. Not one was taking my insurance “at the moment,” whatever that means.

  16. I am a Kaiser RN and had to seek emergent mental health care after being denied urgent care repeatedly. What you all described is exactly what happened to me, cancelled appointments, excuses, treated as if I was just looking for drugs to get high when in fact I was almost about to commit suicide. Not even because I was a Kaisee RN in need to go back to care for my patients, the care was horrible. Thanks only to God and to my wife I was able to survive and not die, and the ability to be able to pay for a private therapist. Kaiser needs to step up and delivered the care people are paying for.

  17. “California law mandates that mental health patients are seen for an intake appointment within 10 days of their request, and patients with urgent mental health needs are seen within 48 hours. For the most part, Kaiser meets these requirements at a rate of over 95 percent, said Leanne Jones, the healthcare provider’s director of behavioral health quality. ”

    My intake appointment to request a psych assessment and diagnosis was a 15 minute conversation with someone who only determined whether I qualified for an assessment or not. That was in January and the person I spoke with mentioned I would have a wait and that the department was getting three times their usual number of people asking for this particular kind of assessment than they had seen in a decade.

    I had my first assessment call two months later at the end of March, another in April, and then my first appointment to discuss care in June.

    Five months between reaching out for care and talking to someone for treatment. And even then the appointment was a tight 20 minutes and the person I spoke with clearly wanted to move on to the next call, rather than talking through my questions about a life changing diagnosis in depth in my very first appointment. To be clear, I see this as a problem with the system this person is working in, rather than just a problem of one medical professional’s “bedside manner.” There’s no way the psych professionals working in these conditions want to have interactions like the ones they’re having with us.

    If NUHW wants to strike, they have my full support as a Kaiser patient currently in ongoing treatment!

  18. I lost my therapist 15 months ago when she left Kaiser for her own practice. I have been waiting for a local therapist since then. I’ve had a referral to someone in Folsom and in Virginia Beach, VA. Recently, I had an introductory session with a temporary therapist on a six month contract. It went well, but the only times available were around 9 am right when I’m teaching. Right now, when I’m feeling really stressed and overwhelmed, I use the Suicidepreventionlifeline.org chat service. I usually have to wait 40 minutes for someone, but it’s better than the alternative. It’s kept me from serious harm. I can’t go on like this.

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