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.