Shortage of Kaiser Therapists Keeps Children Waiting

In June 2021, while 14 weeks pregnant, Alexandra Diamant tripped on the stairs of her Berkeley home and landed hard on her back. In excruciating pain, she visited the emergency room several times over three weeks until an MRI revealed she had suffered a severe herniated disc that, without emergency surgery, could result in paralysis. Today, she walks with a cane and requires ankle braces.

The accident was also traumatic for Diamant’s son, who turned 5 on the day of the fall and watched his mother deteriorate at home. He began to suffer panic attacks and would sometimes go quiet, uncharacteristic for the gregarious child. In August, Diamant received a referral to Kaiser’s mental health services, but learned that her son couldn’t be seen until December, a full three months away — and the month when she was scheduled to have her second child. Her attempts to move the date up led nowhere.
 

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“It was obvious he was dealing with trauma, was not coping well and needed help,” said Diamant. “And instead of providing mental health care, I felt like Kaiser was gatekeeping, with all these systems to get in the way of access.” By the time the December appointment rolled around, Diamant had to cancel because she had recently given birth. She was then given a new date, at the end of February.

Kaiser mental health clinicians who work with youth told Capital & Main that what Diamant experienced isn’t uncommon, and that the blame rests on their high caseloads. “It all comes down to treatment frequency,” said Michael Torres, who has been a clinical psychologist at Kaiser in San Leandro for 20 years and says he can go up to eight weeks between seeing a given patient. “The care that young people receive is horribly unethical and ineffective overall.”
 

“We all work really hard on building relationships, and it really doesn’t feel good when you have so many people on your caseload that you’re not remembering people.”

~ Alexis Petrakis, clinical psychologist

 
Torres is among the more than two thousand Kaiser mental health care workers, members of the National Union of Healthcare Workers, who have been on strike since Aug. 15 across Northern California. (Disclosure: NUHW is a financial supporter of this website). The strikers are asking for a series of changes to cut down on their ballooning caseloads, such as allowing clinicians to stop taking on new patients if they are unable to see their currents patients every two weeks, and asking that Kaiser — which saw a record $8.1 billion profit in 2021 — hire more mental health care workers. While the changes demanded would affect all patients, clinicians who work with youth said that the need is especially acute among children, whose lives were upended by COVID at a time when they were going through important developmental milestones.

In August, Gov. Gavin Newsom released a $4.7 billion plan to bolster mental health services for youth, which includes mental health care workforce development and increased funding for school counselors. But even with the expansion of state funding for youth mental health care services, it’s unclear how the state can truly overhaul the system when nearly one in four Californians receive their care through Kaiser.

For the last three years, Alexis Petrakis has been a clinical psychologist for Kaiser in Petaluma, about 40 miles north of San Francisco. Prior to Kaiser, she worked in the mental health field for more than a decade, often at community clinics. There, she said it was typical for her to see children weekly. Since joining Kaiser, she’s received four to five new patients every week and sees seven to nine children a day. She is normally booked out six weeks in advance, meaning she is lucky to see the same patient more than once a month. “I don’t even know how many people I have on my caseload,” she said.
 

Earlier this year, California passed a law that requires HMOs like Kaiser to provide follow-up mental health care appointments within 10 business days if recommended by a therapist.

 
Torres and Petrakis both stressed that working with youth means managing and developing relationships with both the caregiver and the child. “This requires time,” Petrakis said. “And time is the currency at Kaiser.” In the assembly line structure of her work environment, she has mistakenly merged patients in her mind and referenced siblings and stepparents that didn’t exist.

“We all work really hard on building relationships, and it really doesn’t feel good when you have so many people on your caseload that you’re not remembering people. It’s impossible to show up in a way that we were trained to show up, which is holding this individual person’s story and needs.”

Earlier this year, California passed a law sponsored by NUHW, SB 221, which requires HMOs like Kaiser to provide follow-up mental health care appointments within 10 business days if recommended by a therapist, though Torres and Petrakis said this remains impossible due to their caseloads.

Kaiser didn’t respond to a request for comment, but has previously cited the current nationwide shortage of mental health care providers when asked about access issues, though Kelly Shepherd, who works with special needs students in Santa Clara County, said that she encountered the same problem eight years ago when trying to find help at Kaiser for her youngest son, then 12. “He had dealt with trauma — a divorce, domestic violence — and appointments were four to five weeks out. There was no opportunity to build a trusting relationship and he wouldn’t engage. It was a failed experience.”

In Berkeley, Diamant’s son did eventually receive the services he needed. At school, his teacher had noticed changes, including frequent accidents, and connected the family to a school counselor, whom he began to see once a week. The improvement was dramatic. “It took a very short time with counseling for him to snap out of it,” Diamant said. “It shows that it’s possible. It just didn’t come from Kaiser.”

 
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