Union accuses Kaiser of inadequate mental health evaluations

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The union representing Kaiser Permanente mental health workers is accusing the major health care provider of cutting corners on initial mental health patient evaluations, resulting in rushed and inadequate care, misdiagnoses and long waits for follow-up care.

The National Union of Healthcare Workers claims Kaiser’s mental health assessments via telephone do not meet professional psychiatric standards of care and are merely a way of getting around California requirements for timely initial treatment.

Kaiser, which remains in labor negotiations with the union, strongly rejects the accusations, calling the criticism “irresponsible” and a labor negotiating ploy. The union, however, claims Kaiser is opting for cost-cutting rather than hiring more therapists and mental health clinicians to increase in-person mental health assessments.

“The problem is that they’re requiring patients and therapists to perform these diagnostic assessments in half the amount of time Kaiser historically allotted to these appointments,” Fred Seavey, the union’s research director, said. “And half the amount of time recommended by professional associations like the American Psychological Association.”

In a letter last week to the state Department of Managed Health Care, which oversees HMOs like Kaiser, Seavey alleged that a lack of mental health staff has prevented Kaiser from providing first-time mental health patients with initial, adequate diagnostic evaluations within 10 business days, as required by state law.

The union said Kaiser’s new telepsychiatry program, called Connect 2 Care, uses 30-minute assessments over the telephone as a way of complying with the 10-day requirement. But Seavey said these 30-minute phone calls are a poor substitute for in-person evaluations that by professional standards should last 60 minutes for adults and 90 minutes for children. The union said the assessments are often incomplete or inadequate and sometimes must be finished, or even corrected, during a follow-up 60-minute in-person appointments with a therapist.

A spokeswoman with the state Department of Managed Health Care said last week in an email, “our Office of Enforcement is looking into the issues raised in the letter.”

A Kaiser document provided by the union shows that in 2018, 64% of initial mental health evaluations were finished within 10 days, up from 49% the previous year. Union officials contend 90% of these initial assessments should be completed in that 10-day window.

Kaiser launched its Connect 2 Care call center in San Leandro in June 2018 and has expanded it to 11 medical centers in Northern California, including Santa Rosa. Kaiser said the center, which started as a pilot effort at Kaiser’s medical center in Oakland, uses telemedicine to streamline access to care.

Kaiser called the union’s claims a smear campaign.

“Once again, NUHW leadership has attacked Kaiser Permanente’s reputation because they believe this tactic pressures management to agree to their demands during contract negotiations,” John Nelson, vice president of communications, said in an email. “Even worse, the union’s irresponsible action threatens to undermine patient confidence in an innovative way to deliver accelerated assessment and treatment through a welcoming and simplified process.”

Patients wanting help via Connect 2 Care call their local Kaiser mental health departments and all appointments not deemed urgent are then booked with the telepsychiatry center, according to the program description. Licensed therapists conduct an initial telephone or video assessment, depending on the member’s preference, and then make treatment recommendations, as well as schedule follow-up calls or appointments.

Concerns regarding Connect 2 Care from union leaders and some Kaiser therapists focus on time limitations, lacking face-to-face opportunities to wholly conduct a mental health exam and to assess complex behavioral health conditions, plus the challenge of caring for those with language barriers.

Kaiser has faced ongoing issues since December with its behavioral health staff, nurses and home health workers that have led to strikes and public protests.

Willow Thorsen, a social worker who is a member of the health workers’ union in Santa Rosa, said that even when mental health patients get adequate assessments they often face excruciatingly long wait times after their initial evaluations. She said the growing caseloads for mental health therapists have led to staff turnover and burnout.

“Long wait times are still plaguing us and patients can’t seem to get seen fast enough,” Thorsen said. “So even if you have a really good experience and it helped in that initial phone call, they (patients) are still waiting another month before they see a therapist, and then again a whole other month after that.”

Nelson defended Connect 2 Care and the telemedicine, calling it a convenient and innovative way of expanding access to Kaiser patients.

“The senior leadership of NUHW are at best misguided in their understanding of this innovative service, which union-represented therapists helped create and staff,” Nelson said.

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