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Andrea Kumura’s career came to a halt on Aug. 29 when she and about 60 other mental health providers went on strike against Kaiser Permanente, spurred by staffing shortages, poor working conditions and comparatively low wages.

The longtime clinical social worker for youth and kupuna has been part of the negotiations between the and Kaiser, but so far they have been unable to reach an agreement.

“It’s not a Covid issue like Kaiser is saying,” Kumura said. “It is way beyond that.”

The bargaining committee rejected Kaiser’s latest offer this week, and the next meeting is set for Thursday, according to Laura Lott, a Kaiser representative. Kaiser declined a request for an interview.

The workers range from full-time to per diem psychologists, social workers and counselors, as well as three nurses from Kaiser in Honolulu. Kumura said the majority of psychologists and social workers from the in the state are on strike.

In a press release, Kaiser says it is reaching out to every mental health patient whose appointment has been affected by the strike to reschedule or offer another option. The release says about half of Kaiser’s behavioral health patients receive care from mental health providers not involved in the strike, and that patients who cancel their own appointments or choose not to reschedule will receive clinical quality reviews.

Currently, there are . Kumura said in a perfect world, they would have double the amount of mental health therapists, because if everyone needed therapy, with the number of therapists right now, the ratio would be roughly 1 therapist to 5,300 Kaiser members.

According to Kaiser, about seek mental health services, which would mean each mental health worker has about 400 patients on average. Though unlike other medical fields, in behavioral health, psychologists and social workers are not allowed to stop accepting new patients.

“The patients just keep coming and coming and we can’t do anything about it,” Kumura said.

Since last year, Kaiser has hired in Hawaii and added 11 new mental health and support staff positions to be filled in the future.

Bob Condon, a clinical social worker among the 25 new hires, is now on strike. He said within a year he had 125 open patients, peaking at 160 at one point.

Condon previously worked at Adventist Health Castle in Kailua, Child and Family Service in Ewa Beach and had a private practice on the mainland for years. He said while most literature on best practices doesn’t suggest a cap of patients a clinician can see, it does say they should be able to see any crisis patients within two to three days. With Kaiser’s model, Condon said patients were waiting two to three months.

“There’s no continuity of care,” Condon said.

In May, the National Committee for Quality Assurance downgraded Kaiser’s status by placing it under  due to its .

Fred Seavey, a researcher at the , said if Kaiser fails to correct its violations in six months, NCQA can either strip Kaiser of its accredited status, assign a lesser one, or extend the time frame for corrective action oversight.

Seavey said Kaiser, one of the largest HMOs in the nation, reported $8.1 billion in profits last year, and definitely has the resources to fix its issues.

As of March 2021, Kaiser held , and in previous years, its CEO earned in compensation, according to Forbes, which also put Kaiser on its .

The mental health workers first formed a union in 2018. But Kumura said the 20 to 30 times they’ve met with Kaiser over the past four years have been futile.

are seven weeks into their own strike, for similar reasons as Hawaii workers.

But Kaiser is offering the staff in Northern California raises, unlike in Hawaii, even though the staffing is lower in Hawaii and the challenges in recruiting are most likely higher, according to Matt Artz, a union representative.

Another disparity is that California implemented this year that mandates a return access time of 10 business days between appointments, unless the therapist determines a longer wait would be detrimental.

Justin Maeda, a clinical psychologist who is also on strike, said he is anxious to see his patients again. He worked with Kumura at the Waipio clinic in Waipahu, where they saw patients from all over Oahu. They both said their interest in serving a diverse community was the main reason they didn’t want to go into private practice.

“I really do appreciate Kaiser’s vision,” Maeda said, adding that Kaiser was one of the first HMOs to offer transgender care. “I appreciate their motto of ‘thrive,’ but my colleagues and I weren’t able to thrive in our working environment.”

Maeda said culturally speaking, “picketing” is not something he was raised to do, but he believes he is doing the right thing.

Meanwhile, patients who need care are struggling to find it.

A Kaiser member who asked her name be withheld over privacy concerns, has been with the HMO for almost three decades. She said her husband has had suicidal episodes since 2020. But, with months in between visits, he has not been able to receive the therapy he needs, which she said would ideally be at least once a week.

“It took him years to admit he needed help, and when he finally did, there was no one available,” she said.

Now, she too is struggling with mental health, but feels that if she were to seek treatment, others such as her husband would be further neglected.

Kumura said under-treated and undiagnosed mental health patients are among the highest utilizers of medical care, and often choose to visit the ER where they can’t be turned away — which drives up insurance premiums and medical costs for everyone else.

“This affects us all,” Kumura said.

Civil Beat’s health coverage is supported by , Swayne Family Fund of Hawaii Community Foundation, Cooke Foundation and