Therapists, Patients Criticize Kaiser Over Long Delays for Therapy

Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED)

Kaiser Permanente’s newly opened medical center in Oakland. (Lisa Aliferis/KQED)

This is the second of two parts about mental health services at Northern California Kaiser.

In January 2013 a woman named “Nina” had a terrible falling out with her father. Soon after, she found out he had incurable cancer and was going to die. In the ensuing weeks, she tried to patch things up, but with the pressures inherent in the last months of a dying man, was unable to attain any form of closure. Some six months after their fight, he was gone.

“People are suffering, and I fear some of my patients will commit suicide for lack of ongoing treatment.”

“Nina,” who did not want us to use her real name for reasons of privacy, had been prone to depression. Zoloft had helped, but the now irreparable family rift left her severely depressed, with occasional thoughts of suicide. “I was in a state of constant emotional pain and confusion,” she says. “It was affecting all aspects of my life.”

She went for an intake appointment at the psychiatric department at Kaiser Permanente’s Oakland Medical Center, with the expectation she’d be able to see a therapist for individual appointments during this severe emotional crisis. She requested those sessions, but the intake therapist told her Kaiser only offered group therapy.

“I said I’m not comfortable talking about my situation with a bunch of strangers,” Nina says. “She very kindly tried to make me aware of the value of group therapy. But I knew in my heart it wasn’t where I wanted to be.”

Nina left even more dispirited. Over the next year, she white-knuckled her depression on her own, before having the epiphany that maybe her medication needed adjustment. She went to see a Kaiser psychiatrist and mentioned she’d been told there was no individual therapy.

The psychiatrist seemed startled. She told Nina individual therapy was offered. “They probably just didn’t have the space,” the psychiatrist said.

Nina was shocked. “I could not believe that a professional therapist would lie to an obviously depressed patient who was sincerely seeking help.”

She finally did get to see a Kaiser therapist, whom she describes as “fantastic,” but who told her she could only book Nina maybe once every four weeks. At that point, Nina’s expectations had been lowered to the point she was grateful to get any therapy at all. She also availed herself of a free Kaiser yoga class, which she considers to have been useful in her recovery.

Her therapist, she says, is really helping her with the depression.

Still, Nina’s contact with Kaiser’s psychiatric department left her unnerved. “I started thinking maybe it’s my problem,” she says about her rejection of group therapy. “It just added to my anxiety. But to share with other people what I was going through was just too much for me at that time. How depressed did this therapist need me to be in order to make room in the schedule for individual therapy?”

Kaiser Under Fire

Last year, Kaiser was fined $4 million by the California Department of Managed Health Care for not accurately tracking patient waiting times for initial mental health appointments. And now the health plan is in the middle of another controversy over its mental health care: Some of its therapists and patients say there is a dangerous lack of access to individual therapy appointments and an over-reliance on group therapy.

Kaiser maintains that hiring in its psychiatric departments is up, and that patients do not have problems getting appropriate care. It points to its high rating in behavioral and mental health on the 2014 California Office of the Patient Advocate report card. In addition, it has asserted that much of the controversy has been fueled by the union representing mental health clinicians, the National Union of Healthcare Workers (NUHW), which has been embroiled in contract negotiations with Kaiser since 2010.

In reporting this story I talked to some two dozen current and former Kaiser clinicians and mental health patients as well as outside therapists. The vast majority express similar complaints: While health plans are required to provide medically necessary appointments within 10 business days, Kaiser patients have to wait long periods, sometimes months, between individual therapy appointments. These critics say Kaiser is referring patients to group therapy even in cases where ongoing individual sessions are clinically necessary. The reason, the union and clinicians say, is a serious staff shortage.

Therapists, Patients Speak Out

As we’ve reported, the issue came to a head this year when a behind-the-scenes blog by Andy Weisskoff, a now-former therapist at the health plan’s Santa Rosa Medical Center, detailed long waiting times for therapy appointments and the deleterious effects on both patients and therapists.

“When I see someone today with suicidal thoughts … I am often uncertain how well they’ll fare in the intervening weeks,” he wrote. “Did I miss something in our hour long interview?… Maybe I should have sent them to our intensive outpatient group instead of a skills group designed for people who are higher functioning. And then I wait, at least a month, to see if my intuition, one way or another, was correct.”

One Kaiser therapist from a Northern California facility described similar concerns. She wants to remain anonymous out of fear for her job. She is unnerved by the common practice of steering patients into groups instead of individual therapy sessions.

“I feel unethical when I go home at night, and feel really guilty,” she said. “People are suffering, and I fear some of my patients will commit suicide for lack of ongoing treatment, but I’m powerless to treat them because I don’t have return visits available.”

Another therapist who worked at a South Bay Kaiser says she quit her position earlier this year because she considered the treatment of patients there “unethical.”

“We believe these descriptions are not reflective of the millions of mental health visits we provide each year in Northern California.”
“Patients that need individual therapy are not getting it,” she said. “We had to tell patients we offer group therapy. … The patients that are the most severely mentally ill are the ones that can’t speak up for themselves, and the ones who get lost in the system. With the Affordable Care Act, we’re seeing more and more of those patients.”

A number of Kaiser patients also reported similar dissatisfaction with the unavailability of individual sessions. Loran Watkins’ story was typical of the complaints many patients described to me.

Watkins, 53, said that in 2010 her husband was battling cancer and “desperately needed therapy to get through this. They said he could go to a group. There was no way in God’s green earth he would have gone to a group. He was already a social introvert, was on six different kinds of pain medications so his ability to focus was very limited.”

After “pushing and pushing and pushing,” Watkins says, her husband was finally given the okay to see a therapist, but only once a month.

“Here you have a man actively battling cancer, was relapsing,” she said. “After the seventh or eighth appointment, the therapist said he was retiring, and that there were no more appointments available.”

Watkins added that when her own longtime therapist at Kaiser’s Walnut Creek medical center retired, she told Watkins there was no replacement available.

“I asked her for a referral. She said there’s no one to refer you to. The only thing I can do is they will place me in a group type setting; there’s no individual therapy appointments anymore.”

Kaiser responded to an email outlining these accounts and disputed the allegations that individual therapy is not available:

We apologize if there are members who may have received incorrect information about the availability of services. All of our medical centers provide individual therapy as part of the wide range of mental health treatments available to Kaiser Permanente patients.

We encourage our members and staff to share their concerns, and we investigate thoroughly and work to resolve any issues. We take the examples in your email very seriously. Out of respect for patient privacy, we cannot respond in the media about individual cases. Each patient’s concern is important to us and we will investigate with the information we have. We believe these descriptions are not reflective of the millions of mental health visits we provide each year in Northern California, but we recognize that we have opportunities to make our program even better and are committed to doing so.

Group Therapy vs. Individual Therapy

Dr. Mason Turner is Kaiser’s director of patient operations for regional mental health services in Northern California. He takes umbrage at the notion that individual therapy is the “gold standard,” as he puts it, and that group therapy is somehow inferior. “This is a disservice to the hundreds of thousands of Kaiser Permanente members — and millions throughout the country — who have benefited from this type of proven, effective treatment and to the mental health professionals, including our Kaiser Permanente therapists, who provide it.

“There is no evidence that individual psychotherapy is superior to group therapy.”

I asked Dr. John Norcross, a psychology professor at the University of Scranton, if that was true. Norcross’ research is on treatment adaptations — “how to tailor therapy for individual patients,” he says.

Norcross is a “big supporter” of group therapy, but only when indicated. And group treatment is contraindicated, he said, if the patient has a strong preference for individual therapy. That can make a difference in both retention of the patient and effectiveness of the treatment.

“There are dozens of studies that show we should always begin with patients’ preferences if ethically or clinically possible,” he said.

I recounted to him the experience of Nina, the woman who had expressed a preference for individual therapy at Kaiser Oakland and was erroneously told it wasn’t offered. Norcross said in her case a group would not be effective.

“If this woman wants 50 minutes to express and resolve longstanding conflicts, you’re not going to get that kind of opportunity in a therapy group of 6-12 people,” he said.

Andy Weisskoff, the former Kaiser therapist who blogged about his experience at Kaiser Santa Rosa, wrote that only a quarter of those who were referred to groups attended one.

“The assertion that groups are better than individual therapy is a little bit beside the point if they don’t go to the groups in the first place,” he says.

Some patients who I spoke with amplified his concern. For example, a 60-year-old woman who uses Kaiser’s Roseville facility and suffers from panic disorder said the last time she had an appointment, the therapist told her she could be seen maybe once every three months.

Instead she was sent to a group, where she says the discussions triggered her anxiety attacks. She estimated the number of patients in another group at about two dozen — “like cattle in there, how can anyone’s needs be met?” she said. So she quit.

On disability because of her anxiety, unable to tolerate medication, and with the cost of an outside therapist out of reach, she sees no available options. “There’s nowhere for me to go,” she said.

Corlene Van Sluizer described the same lack of options for her sister, 71. Her sister was ordered into an inpatient facility this year after telling her Kaiser Santa Rosa psychiatrist of plans to commit suicide, Van Sluizer says. Even with a diagnosis of major depression, after being released she was told she’d have to pay for any individual therapy on her own. Instead, she was sent to a group.

“It lasted 6 sessions. She got no benefit from it,” Van Sluizer says.

Many non-Kaiser therapists sent me emails asserting some of their patients have been forced to pay out-of-pocket because they cannot get individual therapy at Kaiser.

A typical response came from Karen Taylor, a therapist in Campbell: “(I) see a number of Kaiser clients. (Kaiser) tells them to go to a group or will only see them every six weeks for private therapy. Neither of these options have been appropriate or effective for my clients.”

A therapist who wanted to remain anonymous said that a patient was referred to her by Kaiser staff following his suicide attempt and hospitalization. “I considered him high risk for a second suicide. He attempted again soon after our intake. None of these incidents convinced Kaiser to provide individual therapy to him. … Kaiser continued to refer him to groups.”

In a statement, Kaiser said therapists have a responsibility to inform more senior staff of need for specific services:

The well-being of our patients is our primary concern. We would expect any therapist with concerns about a patient’s urgent needs to immediately respond and escalate appropriately, and we support them in doing so.

Kaiser Disputes Shortage of Staff

Kaiser’s Dr. Turner says any notion that a staff shortage is driving the choice of treatment options is untrue.

“We have nearly 14 percent more therapists in Northern California than three years ago, and we are continuing to recruit and hire,” he told me.

Some Kaiser mental health staff say any new hiring hasn’t kept up with the influx of patients due to Obamacare. But Turner disputes that. “Staffing increases (have) increased significantly ahead of membership growth,” he said. “Seventy percent of our therapy is individual psychotherapy.” While that figure includes the intake sessions for new patients, Turner said the “bulk” of the 70 percent figure is for return visits.

“To say that 4-6 weeks is the time between visits is not accurate,” Turner said. “We encourage therapists to look at all the different contact modalities: telephone appointments, email visits, and individual visits, to understand how best to reach out.”

He called Kaiser’s system of care “multi-modal, highly integrated,” and listed medication management, crisis intervention, “evidence-based group programs,” and intensive outpatient and inpatient services among its services for mental health.

Turner says patients can get individual therapy at more frequent intervals if they, in consultation with their therapist, consider that is the best course of treatment. He also put the responsibility for arranging appropriate care on therapists.

“We would expect our therapists, if they thought (a patient) needed to be seen sooner, would elect to discuss it with their manager and look for alternative times. Or have a discussion with their colleagues how they’ve managed patients like that before. It’s really up to the patient and therapist to make sure that occurs. …

“(But) we have ways of accommodating this when it comes up.“

Bringing Concerns to Management

Kaiser Oakland psychologist Melinda Ginne says she tried that, to no avail. She and other Kaiser clinicians eventually went to California’s Department of Managed Health Care with their complaints.

“For the past two-and-a-half years I have (been) writing my management about … the dangerously long wait times for a return appointment,” she told me. “The response was literally nothing.”

Ginne works with seniors and patients who have serious physical ailments like cancer. She sent me the email she wrote to Kaiser managers last September.

“My patients have been waiting 3 months for a routine follow-up appointment,” she wrote. “This has been a dire situation with often adverse consequences for the patients. But now they must wait 5 months.”

“Believe me,” she continued. “I can’t tell a patient with 3-6 months to live that I’ll see them in 5 months.”

One former Kaiser therapist said she brought her concerns about patients not getting enough individual therapy to management “multiple times throughout the five years I was there, and they just don’t want to hear it.”

She said it was possible for a therapist to get approval to see a client individually, but only by “really insist(ing). And even if they feel the patient needs it, they don’t have room on their schedule because of the way Kaiser books them back to back.”

Kaiser’s Regulator Weighs In

Marta Green, the California Department of Managed Health Care’s (DMHC) deputy director of communications and planning, said whether Kaiser is in violation of regulations would depend on whether it displayed a pattern of steering patients to groups instead of medically necessary individual sessions.

“If the medically necessary care to treat an enrollee’s condition is an individual therapy session, then the plan must make that session available within a clinically appropriate timeframe and comply with the regulatory timeframes” of 10 business days,” she wrote in an email.

However, if a physician or triage professional, using professionally recognized standards of practice, determines that a longer waiting time will not have a detrimental impact on a patient, that period between appointments may legally be extended.

Green said if Kaiser can’t provide individual therapy to a patient that needs it, then Kaiser would be obligated to partially pay for outside therapy. Any Kaiser enrollees who think this situation may apply to them should file a claim with Kaiser at the same time they ask the DHMC for a free independent medical review.

Against this backdrop of reports of patient and therapist dissatisfaction, Kaiser maintains that staffing complaints are driven by its four-year-plus contract negotiation with the National Union of Healthcare Workers, which represents many of the therapists. In its statement to KQED, Kaiser said the union “has not been cooperative in finding solutions that will enable us to meet our members’ needs.”

In particular, Kaiser has “entered into an agreement with Value Options,” a network of mental health providers, to “make sure that our members have timely access to therapists when we need flexibility in staffing.” But NUHW “has so far not agreed to this solution — despite the union making it clear that its members would not be able to take on the extra demand.”

Fred Seavey of the NUHW responds that clinicians have requested to bargain with Kaiser “about the impact of these changes — for example, how these changes in the acuity levels of their patients will affect clinicians’ schedules, caseloads, etc and whether Kaiser should alter the productivity quotas under which clinicians currently operate.”

Seavey says Kaiser’s clinicians have tried to get Kaiser to address staffing shortages for years. “Kaiser has simply turned a blind eye to them,” he says.

A follow-up DMHC report to the one that resulted in last year’s $4 million fine is due in the fall. The DMHC’s Marta Green said it will take into account any complaints about long waits for follow-up appointments to individual therapy.

 

Related
  • Bert Barth

    Thank you for keeping this dispute in the light. KP has been assuming its standards, based on a business plan, trump community standards of care. However, the reporting becomes harmful to the public if it feeds a misguided fear of all group therapy.Kaiser’s diluted version of group therapy is often poorly delivered, without the needed preparation of the members and careful composition of the group. This is not the community standard.Every time reporters use the phrase “thrown in with a bunch of strangers” they promulgate a harmful stereotype.

    • waraji

      Quit beating around the bush. It IS “thrown in with a bunch of strangers”.

      Unless an individual feels drawn to therapy with a bunch of strangers, they should not do it.

      Where is the confidentiality?

      • Bert Barth

        The therapist is also a stranger at first.

    • Tapati McDaniels

      I agree that I’ve seen group therapy done better than at Kaiser and it can be helpful for some as an adjunct to weekly therapy. It can never meet all the needs of someone with severe mental illness and I think it’s more suitable for extroverts. However, at Kaiser introverts are all seen as having social anxiety disorder which is a separate thing altogether.

  • KW

    My experience was almost identical to Nina’s except they called it a “class.” It wasn’t. It was group therapy.

  • DoingTheBestWithWhatI’veGot

    Thank you, thank you, thank you. This has been my long standing issue with Kaiser for the last decade. When I waa in the throws of panic attacks, severe anxiety and depression caused by serious trauma, Kaiser denied my request for individual therapy and referred me to group therapy, which I was too much to handle.

    Taking the step to seek out therapy can be half the battle for some individuals, and group therapy is a terrifying idea. Effective therapy, for many people, requires a safe place, trust and relationship building with an expert. Group therapy, particularly for those who have experienced trauma, suffer from severe social anxiety or other mental health issues, can be triggering and even more damaging.

    I’m lucky to have recently started a job at which our Kaiser health insurance is covered 100% by the employer and the other insurance options are much more expensive. I had to elect Kaiser for this reason, BUT I continue to pay out of pocket for therapy through a sliding-scale clinic that depends on students intern therapists, when what require is an experienced trauma expert.

    I hope this expose helps change Kaiser’s approach to mental health care.

    • wildhare

      God yes! After our daughter committed suicide (unsuccessfully treated by Kaiser between 2005-2009) a met a “therapist” there for my temporary depression, who coldly said… “So — what cause do you think you will pick up, now that your daughter is gone? So many of you parents do that you know….” Slowly now, my next “cause” is to “expose” Kaiser to have people like her fired. From the experience of our daughter though, I can say this. Every KP psych doctor she ever had during those years would leave (quit) Kaiser for a higher paying job with the California State prisons. What does that tell you? They would rather be paid $180K plus per year to treat their same patients who were jailed and imprisoned, because they could not receive decent medical care. Kaiser also “contracts” with local mental hospitals (Sacramento – has Sierra Vista, and Heritage Oaks) and those places would scare any normal person to death, if they saw the worst wards where the seriously mental ill patients are placed. These same facilities house detox for substance abuse, along with folks with depression, and serious mental illness. We have so much farther to go — so hopefully all counties will adopt “Laura’s Law” in California, and Congress can pass H.R. 3717 “Families with Mental Health Crisis Act” — and push to get these HMOs help us. Bottom line, people with mental illness (depression, anxiety, schizophrenia) should not be thrown in the same rooms (group therapy) with alcoholics and drug addicts (self-inflicted) illness.

      • Not a Kaiser Fan

        I will have to look into Laura’s Law. We have had so many problems with Kaiser and getting access to individual therapy for my daughter.(I just wrote a long description that disappeared.) Our journey has included all doctors (including therapists) missing the fact that our daughter has Aspergers. This lead to her becoming depressed, anxious, having panic attacks and suicidal ideation, and a hospital stay (with hard core kids on drugs, etc). We’ve gotten very poor access to individual therapy, and even when it’s been somewhat regular for several weeks in a row, there is the warning that therapy cannot go on at this level…despite suicidal ideation, etc. We are reminded regularly that my daughter was referred to a group but…if we refuse to go…that’s on us. Never mind that the group triggered panic attacks in her. It took going to a private therapist to get the Asperger’s diagnosis and even then, Kaiser wouldn’t provide appropriate services until their own ASD clinic made a diagnosis, which would take, wait for it… months. Once that happened, we were referred to a subcontractor who referred us to a sub-subcontractor for an assessment for in home services. That was 2 months ago. We’ve had an assessment and apparently it will take more months before they can write report, get it approved, make a recommendation, and schedule someone to come help my child!! I am beyond frustrated!! It’s been more than a year in the “system.”

        • Tapati McDaniels

          If you use services like gofundme or others, you can raise money for your own care. We shouldn’t have to do that but when we or our children need emergency mental health care, we are forced to. I wish your family the best, having been there.

      • Edmund Winslow

        Kaiser’s own mental health clinicians, working through their union, the National Union of Healthcare Workers, have led the effort to draw attention to Kaiser’s failures in mental health care. To help with that effort by sharing your experience, contact info@nuhw.org or call 866-968-6849.

    • Tapati McDaniels

      I had to pay for care out of pocket too. Good luck!

    • Tapati McDaniels

      Look to see if you qualify for Kaiser’s financial assistance program which covers your copays and frees up more of your money for your outside therapy. You don’t have to be poor to qualify.

  • diane

    I know from many clients that this is indeed true THROUGHOUT Kaiser’s system. But even worse, Kaiser delayed my friend’s MRI and made it so difficult to get the MRI that by the time she did her cancer had spread. She passed 18 months ago. Kaiser paid for all her medical bill for fear of being sued but none of this is right. Health care reform must continue. This is criminal. Shame on you Kaiser. And the insurance industry who walks away with billions my skimping on patient care.

    • diane

      by skimping on patient care.

  • Concerned HCP

    Kaiser should have the light put upon them in terms of how quickly they pull the walkig talkie card on patients and getting them out of rehab asap versus not to return with worse or even fatal problems!!! Ugh, as a healthcare provider, I am furious.

  • waraji

    Where is the confidentiality in group therapy?!

    • Tapati McDaniels

      Nonexistent. They tell everyone in the group to respect it but it is voluntary. They are not legally obligated. Thus no one with deeply personal abuse issues is going to open up in that environment.

  • waraji

    Nobody should EVER feel bad for not wanting group therapy.

    ONLY do group therapy if you are comfortable with it.

    Mental health is as important as EVERY other area of health.

  • Katie Houle

    It’s enough to make me think about going back to blue cross. Blue Cross was a pain in a lot of other ways like having to bill insurance and wait to find out how much is covered, higher copays on some drugs, and fragmented care at individual doctor’s offices. But they contracted with lots of therapists and getting regular therapy was no problem for my dx.

  • sus

    hi,

    I go to KAiser SF and had same experience, they lead me to group, I didn’t want to do that, so saw one of their great therapist but only few sessions about 4 then lead to group therapy again, I tried but never went, in then end I stopped going, the therapist was great but couldn’t do many sessions, plus the office for therapy are not inviting they are very small and more for intake rather than therapy, BUT again therapist was great would love to see him regularly

  • kppatient

    Thank you for writing this article. It is 100% in line with my experience. I went to see a therapist for some ongoing issues that were affecting my work and she told me there was no individual therapy, but that I could pay HER $120 a session for private therapy. I thought this sales pitch was extremely unethical. Fortunately I did end up participating in a group that had individual therapy tied to it and have since been able to see my individual therapist about every 3 weeks since, but my initial impression of their mental health services was very poor. Something does need to be done.

  • Jean Schreibstein Reed

    This just makes me sick, I’ve been stuck in this Kaiser web for 28 years, feel I have received no actual healthcare of any sort (not talking about psych care here, just general care), just emergent Band-Aid type care. If you didn’t have an anxiety disorder or depression going in, you can be sure they will label you as such somewhere along the line.

  • J. B.

    This problem has been going on for a long time. Even when you are able to see a Kaiser psychiatrist, the quality of the psychiatric care is often substandard. For example, I was prescribed the sleeping agent Ambien for years to treat my insomnia. I was a virtual zombie. Ambien is not supposed to be taken longer than a few weeks but I was taking it for four years.I was also prescribed Seroquel, (Quetiapine) which caused all kinds of serious medical side effects (gaining sixty pounds,for example) even though I did not exhibit any of the symptoms that would have warranted my taking this dangerous medication,other than depression, which could have been successfully treated with other,less dangerous medications.

    And yet, when I attempted to see a therapist, I was offered a thirty minute session every three weeks with a therapist whose sole attribute was that she said almost nothing. Her primary comments were designed to move me out of individual therapy. (In all fairness, I later saw a very skillful and caring Kaiser therapist who helped me immensely. But again, he did not have many time slots available to see patients.)

    To further exacerbate my depression, when I attempted to apply for a disability policy through my private insurance, I was told that the doctors and therapists at Kaiser had not documented my depression adequately and so they denied my application. I am still doing battle with Northwestern Mutual over this and I am appealing through the State Insurance Department, a seemingly futile endeavor as they appear to be a toothless consumer agency.

    I fought for years to stay alive and I’ve gotten better despite my mental health treatment through Kaiser Permanente, not because of it. The management at Kaiser and the state agencies that are supposed to be overseeing them should be deeply ashamed. State lawmakers also need to act. Human lives are at stake here and when poor care is rendered by a medical entity, they need to be held responsible. Is anyone listening?

  • Indigo415

    This is exactly what happened to me at Kaiser San Francisco when I was suffering from severe anxiety and panic attacks in 2010. It took several days to get an appointment and after my first session I was referred to group therapy but was told it was more like a class. I refused and asked to stick with individual group sessions in which I had to wait 2 months for my next appointment. I was told they were overbooked. The LCSW who saw me there told me that if I needed to see someone sooner, I could look into the services provided by mental health counselors outside of Kaiser but any fees incurred would have to come out of my own pocket and he gave me a handout continuing to push me into group therapy. The day before my next appointment, I was contacted by therapist and told that he could not see me because he was going in strike on that day and he asked me to reschedule. I was so hurt by this and at such a low point in my life that I contemplated suicide. If it wasnt for the help of a close friend, I probably wouldn’t be alive to tell you about this….

  • Frustrated Nurse

    Same here, I work at Kaiser, I’m an RN. I had a bad breakup on top of a heart attack, which led to severe depression. I was constantly undertreated, and sent to classes. I tried in vain to get more frequent individual appts. It cost me countless hours of lost work, and quality of life. I hope to see things improve, but I’m very skeptical it will get better.

  • JB

    Why isn’t any law firm willing to work with those of us who have been harmed by the poor mental health care Kaiser has provided and undertake a class action lawsuit against KPF? They have a virtual monopoly on healthcare provision in northern California and are raking in record profits. My guess is that there would be a large class of people who were denied care, given care that isn’t consistent with professional standards and/or had their care delayed so long that it created detrimental outcomes. Attorneys who like to sue,where are you? This is a great case as the state of CA has already documented many of the bad practices Kaiser used when they fined Kaiser last year. Unfortunately, the million dollar fines the state issued are pocket change to Kaiser so perhaps this should end up in court. A big settlement agreement might result in actual damage to Kaiser’s finances. It seems a lawsuit is the only way to get results for consumers and to force Kaiser to change.

  • Edmund Winslow

    Kaiser’s own mental health clinicians, working through their union, the National Union of Healthcare Workers, have led the effort to draw attention to Kaiser’s failures in mental health care. Everyone who has experienced delays or denials of care at Kaiser can help with that effort by sharing their experiences. Contact NUHW at info@nuhw.org or 866-968-6849.

  • Tapati McDaniels

    I was severely depressed and suicidal, and my self-care for heart disease was suffering as a result. When heart disease wasn’t killing me quickly enough I became more acutely suicidal but for the sake of my family I sought therapy at Kaiser. I was given appointments with a therapist at the rate of 5-6 weeks until I indicated I was going to file a complaint with Member Services. That was in June, 2013.

    Suddenly they could fit me in for more frequent half hour appointments for a couple of months while my complaint was processed. I was denied weekly therapy as not being “medically necessary” and criticized for not attending the depression groups they offer. I tried a couple but I had explained that for several reasons, group therapy was not the best fit for me. I’m sure there are people with certain issues who are more extroverted for whom groups are really helpful. A Kaiser psychiatrist cited a study that 2/3 of people benefit from groups. I’d encourage Kaiser to consider the other 1/3 of patients.

    I appealed to the state and my case was reviewed by their third party (Maxiumus) who believed I was only “passively” suicidal and could get by on therapy once a month on a maintenance level. Immediately my Kaiser therapist went back to offering monthly appointments. I felt like everyone was saying my life didn’t matter to them. I felt expendable and worthless as a result. Chronic illness and pain brings up feelings of low self-worth and they were being exacerbated by this process of seeking care and being denied. I felt like a burden to my husband and family.

    My suicidal feelings increased dramatically and I finally held an internet fund-raiser to get some emergency appointments with my pre-Kaiser therapist who knows me and my issues very well. That saved my life although it was humiliating to beg for money for my care. Once I was stabilized I’ve continued with him once a month at my own expense, figuring that if I was only going to have therapy that infrequently it ought to be with someone who knows me well. It’s hard to get to know a therapist at that slow pace.

    My reduced self-care caught up with me several months after my complaint and I recently had two stents and angioplasty at Kaiser Santa Clara. Perhaps Kaiser should consider that the money they save by not providing weekly therapy for those who need it ends up costing them in greater physical health care costs. Penny wise and pound foolish, I believe the saying goes.

    We are about to return to our former town and will finally be able to afford another insurance package that includes therapy for those who need it. I look forward to becoming more functional with regular therapy and more able to deal with chronic pain and heart disease. For those of us who also have issues of past abuse, groups may never be the best fit because it is difficult to talk about these things with strangers. Kaiser is being disingenuous when they say they do offer weekly therapy because I needed it desperately, begged for it, fought for it–and they adamantly refused. I’m lucky to be alive and that is only because people contributed to my emergency therapy appointments. Thrive? I just want to recover.

  • Tapati McDaniels

    If anyone does go through the complaint process please read this first: http://tapati.livejournal.com/749509.html It’s a list of things to know before you challenge Kaiser for your mental health care and includes information about what happens when you appeal to the state after they (most likely) deny you. If you have a relationship with a therapist outside of Kaiser they may be very helpful in pointing you to studies that support your case and I would include those. I also think it’s valuable to present records of mental health care and whatever diagnosis you had prior to Kaiser because I felt like Kaiser deliberately minimized my condition in their records. I had always qualified for unlimited weekly therapy before.

    I will warn you that the process is very difficult emotionally so have good support in place. I had to engage my former (non-Kaiser) therapist to get through it. Good luck! I think the more people who file complaints, the more attention their broken system will receive.

  • Tapati McDaniels

    Thank you for running this series because a lot of us have felt helpless for a long time.

  • Patient Advocate

    Obviously Mr. Turner is not aware of what commands Kaiser has placed upon mental health clinicians. Many responsibilities that they are ordered to do take away time from individual therapy sessions they could otherwise schedule with patients.

  • gsunday123

    Kaiser officials need to pay more attention to what is actually happening on the ground level when clients are being treated by mental-health therapists. Obviously Mr. Turner does not understand. First of all Kaiser clinicians are ordered to participate in psychiatric on call on a regular basis. They must carry a pager and must take time off from work with individual patients to do this. They can earn and store up to 80 hours of available time that they must take off first prior to using vacation time. Secondly, Kaiser mental health clinicians must listen to and return regular phone calls from patients and staff, read regular private emails from patients and return/respond those, and read multiple emails from staff and the Kaiser system on a daily basis. Thirdly, Kaiser employees must attend regular weekly staff meetings and consultations with fellow staff members regarding various patients. They must also participate in regular required training and commanded information reading. All this must be done on time they are required to find by themselves on their regular schedule. Obviously Mr. Turner does not understand how many clinicians force book return appointments into their lunch hour on a regular weekly basis. Etc., etc.,