Patient Stories: The High Cost of Kaiser Permanente's Mental Health Care
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Patient Stories: The High Cost of Kaiser Permanente’s Mental Health Care

For Kaiser member Victor Gomez, getting help meant going out of network.

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Illustration by Define Urban.

In May, a Capital & Main investigation examining Kaiser Permanente’s mental health care system revealed that many patients across California are unable to access treatment on par with Kaiser’s medical care — in some cases, patients are forced to wait a minimum of four to six weeks between therapy sessions, falling far below established clinical guidelines. Now, Capital & Main is covering the human cost of Kaiser Permanente’s broken mental health care system by telling the stories of patients who’ve been through it first hand. Welcome to the new series, Patient Stories.


 
Victor Gomez, a 53-year-old former respiratory therapist, has spent his life learning to cope with the symptoms of his mental health disorders. His diagnoses are varied, and include anxiety, depression, insomnia and post-traumatic stress disorder.

The many symptoms of his layered conditions manifest in different ways, but for Victor, one of the most common was uncontrollable emotional outbursts. By 2016, he’d reached a breaking point: He needed help, or he would never get better.

“I could already envision that I would just end up alone, a bitter person,” Victor said. “I didn’t want to end up alone when I had so many people who actually wanted to be with me. So I had to learn to be different.”

Victor sought therapy through his employer-based health insurance, Kaiser Permanente. He’d been given medical care through Kaiser previously, with largely positive results.

“As far as everything else that they’ve done for me, they actually are pretty good,” Victor explained. “This was the only time that I really can’t stand what they did.”
 


“The lack of access for people in Kaiser to adequate and timely mental health treatment is a matter of long standing. Sad to say it doesn’t seem to be fixed yet.”

~ Beth Capell, Health Access California

 
Almost immediately, Victor began to notice problems with the treatment plan Kaiser offered. He preferred one-on-one therapy — and would later learn that large group settings are a trigger for him — but his care team continually referred him to group therapy sessions. He needed to be heard and understood by his therapist. Instead, he felt shuffled through a system more concerned with meeting metrics than addressing his deeper emotional disturbances.

“The mental health care is sorely lacking,” Victor said. “It’s based on numbers. It doesn’t even take into account if you did anything about it, just that you talked about it.”

“The lack of access for people in Kaiser to adequate and timely mental health treatment is a matter of long standing,” said Beth Capell, a legislative advocate for Health Access California, a health care consumer advocacy coalition. “Sad to say it doesn’t seem to be fixed yet.”

*   *   *

Although Victor pushed back on the recommendations from Kaiser, his anxiety made it extremely difficult to advocate for himself — and he quickly withdrew from the system. It wasn’t until later that Victor would have no choice but to re-enter Kaiser’s care.

In 2019, Victor and his wife, Karol Jones, attended a San Jose Sharks hockey game. What was intended to be an evening of light-hearted entertainment quickly devolved into a nightmarish altercation that ended with Victor behind bars.

Victor and Karol allege that a woman sitting in front of them at the game instigated an argument with them — after flicking her hair into Victor’s beer and encouraging her husband to fight Victor, the woman accused him of pulling her hair.

Victor’s anxiety, made more potent by the crowd and unforeseen conflict, quickly evolved into a full-blown anxiety attack. Realizing the severity of the situation, Karol turned to gather their belongings and make a swift exit from the arena. At the same time, the stadium’s ushers arrived.

“They said he hit the usher,” Karol explained. “When he’s having an anxiety attack, he does not want to be touched. What I’m sure happened is they went to grab his arm and he flicked his arm away. So next thing I know, I turn around, they have him on the ground on the stairs. And it just escalated.”

Victor Gomez and Karol Jones.

The police arrived to handle the situation. They moved to the main concourse of the arena, away from the bulk of the crowd, and waited for the stadium to clear before an ambulance could take Victor to a county hospital for evaluation.

Karol said she tried to explain to security and paramedics that Victor was experiencing an anxiety attack. She asked if she could go over to try and help him calm down — and with permission, she made her way to do so.

“I went to do it and a paramedic literally picked me up and threw me backwards,” Karol said. “And it’s in the police report, if you read it, I interfered with his arrest. It was a horrific hour of my life. At one point he was so frustrated that he was banging his head on the concrete floor.”

Eventually the stadium cleared, Victor was transported to a hospital for evaluation and then to jail. He spent one night in a cell, and was released the next morning. He was charged with assault and battery and resisting arrest.

*   *   *

The two were lucky to find a lawyer specializing in cases involving mental health issues that they could afford. The lawyer had the case moved to a mental health court and arranged a plea deal avoiding jail time on the contingency that Victor maintain compliance with mental health treatment every two weeks.

Within days, Victor was back in the hands of Kaiser’s mental health care, trying to address the root causes of his inner turmoil. But he was met with more of the same: group therapy sessions that triggered his symptoms and individual therapy sessions that Victor says did not address the root cause of his issues.

“I would leave angry,” Victor said. “I’d be in worse shape than when I got there.”

Karol, looking in from the outside, understood this moment in her husband’s life as pivotal. Victor, back in therapy with Kaiser for a few months, was getting worse: Karol came home one night to Victor in the throes of another panic attack, so frustrated that all he could do was slam his head against their bedroom dresser.

“I was in a complete panic because I didn’t want to call the police. ’Cause I knew it was going to be just as ugly as it was in the arena. And that was not a path to help. Luckily I was able to get him calm enough,” Karol explained. “In the meantime, I left an emergency message for his attorney, and her and I had a long talk.”

Karol and the attorney came to an understanding that Victor needed treatment from somewhere else — that Kaiser was not able or was not willing to give him the serious consideration and treatment he needed.

Shortly after, Victor had an initial appointment with an out-of-network therapist at the recommendation of his lawyer, who they felt understood the severity of his situation.
 


According to Victor’s new therapist, after just one session, it was clear that Victor was very sick and needed much more help than Kaiser had offered.


 
“The first indication I got of just how badly a job Kaiser had done in treating him was when we met with Dr. C for the first time,” Karol said. “I clearly remember this because Victor and I were in a very dark time in our lives because of his condition. And these were some pivotal moments to me.”

According to the new therapist, after just one session, it was clear that Victor was very sick and needed much more help than Kaiser had offered. The therapist disagreed with Kaiser’s inclination to send Victor to group therapy, saying that it may work at some point, but was currently not helping.

Victor and Karol both agreed the path to healing would not involve Kaiser — and Victor began treatment with a new therapist and a new psychiatrist, both out of network, paid for out of their own pockets.

“I could’ve stayed with Kaiser and faked it,” Victor explained, noting that the care he received at Kaiser would have been in line with this plea bargain. “It wouldn’t have been a problem, but that still didn’t take care of everything that I was doing anyway.”

*   *   *

Victor has been receiving external treatment since then, with the costs totaling around $1,500 monthly. Victor thinks the treatment is working: Now, he says that he is able to find some peace and contentment that he couldn’t before — even though he still has bad days.

Karol and Victor both agree that the cost of treatment is worth it and they will do everything possible to ensure Victor continues to get the help he needs: but long term, they are unsure how sustainable the high costs will be.

In a statement to Capital & Main, Kaiser Permanente strongly disputed Victor and Karol’s account of his treatment, noting they could not disclose further information without violating federal law. Its statement read, in part:

“Our approach is that one size does not fit all, so our physicians and mental health professionals work closely with patients to understand their needs and tailor a treatment plan specifically for them that will be based on evidence of what works and measurable outcomes. As a patient’s needs change, we work individually with them to evolve the modes of treatment to address those changes.

Meeting the individual needs of every patient is a key reason why we have expanded and continue to expand our mental health services and programs. A patient’s treatment plan could include outpatient psychiatric services, individual therapy, group programs, medication management, crisis intervention, intensive outpatient programs, and inpatient psychiatric care or a combination of these. Patients can engage with their care team in person and using telehealth — video visits, telephone appointments and secure chat.”

“I really think that Kaiser delaying his treatment spiraled him into a worse situation. That was a missed opportunity for them that really spiraled him into further negative feelings about himself,” Karol said. “For a very long time, he thought the problem was him. Not that he wasn’t getting the treatment that he needs.’

Victor said that investing in his own mental health care has been essential — without it, he would have continued to spiral.

“There’s a lot of people that need help,” Victor said. “If you took care of these people, a lot of things could be done so that life isn’t so hard for everybody.”

Karol wonders how differently things may have turned out if Kaiser’s mental health care had met the standards of its medical care.

“They’re so good at making sure you get all your preventative medical stuff. I just got another message this morning that I need to go get my mammogram done. They’re great about it,” she said. “Why can’t they be great at mental health?”


 
If you’d like to share your experience as a Kaiser Permanente mental health patient, reach out to kristyhutchingswrites@gmail.com 

Copyright 2021 Capital & Main

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