A Flawed Model for Care 

Kaiser Permanente has been held up as a national model for healthcare, but critics contend that it routinely fails to adequately serve patients with mental health problems.

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In California, nearly one in six adults has a mental health need, and approximately one in twenty suffers from a serious mental illness that makes it difficult to carry out major life activities, according to the California Healthcare Foundation. Nationally, the rates are even higher. "Because mental illness is still so stigmatized in our society, administrative barriers to care that may seem reasonable for physical health can be insurmountable for people seeking mental health treatment," Schroeder said.

For patients like Paroutaud, Kaiser's administrative barriers have life-or-death consequences.


Charles Dion is another victim of Kaiser's allegedly flawed mental healthcare system. Dion is a plaintiff in one of the class-action lawsuits against the nonprofit, claiming that he was denied treatment at Kaiser Oakland for his severe obsessive-compulsive disorder (OCD). Dion said he was denied individual therapy and was referred to the Anxiety Treatment Center of Sacramento, a non-Kaiser clinic nearly one hundred miles from his Oakland home.

Kathleen (whom the Express has agreed to not fully identify) ran into similar problems when seeking treatment for her sixteen-year-old daughter's depression. Though Kaiser initially prescribed "talk therapy" for her daughter, Kathleen, who lives with her daughter in Martinez, found that sometimes it would take five weeks to get an individual therapy appointment. "While medication and group therapy have been made available and [my daughter] has willingly participated in both, talk therapy has been almost nonexistent," Kathleen wrote in a letter to Kaiser's Department of Mental Health in Walnut Creek. She was caught off-guard because her family had had such positive experiences with Kaiser's primary healthcare over the years. "We've had such good care and we really embrace Kaiser's model," said Kathleen. "It was jarring to have this experience with mental health services."

Both Dion's and Kathleen's stories fit the narrative Kaiser clinicians and therapists describe: Kaiser staffers have no way to keep up with the numbers of patients requiring services. In fact, there are currently no limits on caseload size for non-physicians in Kaiser's behavioral health departments.

Kaiser officials, for their part, strongly defend the quality of mental health services they provide. "We are really leading the country in terms of figuring out how to provide the best mental care we can to the largest number of patients," said Turner. Turner also said that since 2012, Kaiser has increased staffing in Northern California, and that a majority of the new staffers have been therapists. However, I was unable to verify this assertion.

He and other officials view the recent focus on mental healthcare quality partly as an effort by the NUHW to settle an ongoing labor dispute. After a one-day strike in April by Kaiser mental health services staff in Oakland, Don Mordecai, director of Mental Health and Chemical Dependency Services for Kaiser Permanente Northern California responded by stating, "We strongly disagree with the union's claims that this is about the quality of mental health care at Kaiser Permanente." In a prepared statement, he continued, "Over the past two years, we have increased staffing in our Oakland Psychiatry department nearly 20 percent. The union is objecting to changes which have already been implemented and which benefit our members. In addition, we are bargaining to establish a dedicated after-hours, on-call team to handle psychiatric emergencies at our Oakland and Richmond medical centers."

According to healthcare regulation experts, these issues are not completely unique to Kaiser. Both state and federal laws require that healthcare plans provide mental health services to the same standard as primary healthcare. But just how these health parity laws should be enforced is a matter of concern across the country. Currently, states have the primary authority to enforce mental health parity laws, but if the federal government determines that the state is not enforcing the law, then it can step in and enforce it. Federal parity laws, recently amended with the Affordable Care Act, are decidedly stronger than state laws.

In California, laws such as California's Mental Health Parity Act, the Knox-Keene Health Care Services Act, and Timely Access laws provide protection for mental health patients. But critics claim the DMHC has not been aggressive in its enforcement of these laws, which makes the fine against Kaiser particularly noteworthy.

In May, under pressure from the state legislature, the DMHC started holding monthly stakeholder meetings with the mental health community. According to Peter Schroeder of the California Coalition for Mental Health, the meetings are part of an effort to improve an agency he described as "excruciatingly slow" in completing enforcement actions. Although he admits that the DMHC is improving, Schroeder has been disappointed with its regulation of mental healthcare of all providers in the state — a problem he believes extends far beyond Kaiser.

While critical of Kaiser's mental health services, Schroeder sees a lack of regulation by the DMHC as the underlying issue. "Their job is not to make health plans more efficient," he said. "Their job is to help consumers. And they seem to interpret that in a way that is perplexing to many of us."

Randall Hagar, director of government relations of the California Psychiatric Association, likes the new direction the DMHC is heading, particularly the stakeholder meetings. "The department has shown that they get a very complex law, which is very hope-inspiring," he said.

After the Mental Health Compliance Act failed to pass the state legislature last year, Hagar has helped lobby for a bill currently moving through the California legislature. Authored by state Senator Jim Beall and recently amended in the state assembly, SB 628 includes more funding to the DMHC to conduct medical surveys for the enforcement of mental health parity laws. Advocates hope the bill will move rapidly through the legislative process to meet an upcoming August 31 deadline.

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