Kaiser Permanente’s Hawaii mental health clinicians launched a three-day strike Wednesday amid stalled contract negotiations. The approximately 50 psychologists, clinical social workers, psychiatric nurses and addiction counselors are pressing for better compensation packages and say that Kaiser’s current proposal would result in a wage freeze for more than 60% of its mental health workforce, as well as cuts to retirement and health benefits.

Kaiser management, in response, has criticized the union negotiation tactic and urged employees to remain on the job.

“It is especially disappointing that the union is asking our dedicated and compassionate employees to walk away from their patients,” Kaiser said in a statement. “The need for mental health care among our members and patients has never been greater, and the stress and disruption caused by the ongoing pandemic has made it even more important.”

The clinicians, who are represented by the National Union of Healthcare Workers, say the proposed compensation package won’t help alleviate Kaiser’s shortage of mental health professionals, which they say has resulted in overwhelming caseloads and substandard care.

“This strike is about patient care,” said Daniel Meier, a psychologist at Kaiser’s Ala Moana clinic in Honolulu, in a press release. “We’ve hit a crisis point where we’re being forced to tell people with serious mental health conditions that they’ll have to wait months for their next appointment. Kaiser has gotten away for years with underfunding mental health care and we’re taking action to put an end to that.”

Meier was among about two dozen clinicians who picketed Wednesday in front of Kaiser Moanalua Medical Center with signs that read, “Don’t Deny My Patients Mental Health Care,” as cars sped along Moanalua Road honking their horns in support. Employees plan to picket in front of Kaiser Maui Lani Medical Office and Kaiser Honolulu Medical Office today and Kaiser Waipio Medical Office on Friday.

Kaiser says that it has hired 21 behavioral health clinical staff in the past 12 months. But union members say that last year there were 51 mental health clinicians at Kaiser and now there are just 47. “We are already losing people who have just recently been hired,” Meier told the Honolulu Star-­Advertiser.

Asked to comment, Kaiser didn’t dispute those figures, but also didn’t explain them.

“Kaiser Permanente continues to actively recruit in Hawaii to ensure care is available for our members,” according to emailed responses from Kaiser.

Kaiser has about 260,000 members in Hawaii. The union notes that this translates to one mental health therapist per 5,500 people.

“We cannot keep up with the patients. There are so many,” said Meier, who has been with Kaiser for 15 years.

Andrea Kumura, a licensed clinical social worker who has worked for Kaiser for 16 years, also picketed Wednesday. She said that patient care at Kaiser has declined over the past decade and worsened with the pandemic as the need for mental health services soared.

Kumura estimates that she has a caseload of more than 200 patients and said it can take Kaiser members two to three months to obtain an initial appointment for conditions such as depression and post-traumatic stress disorder.

“I know that our patients are frustrated, sometimes even feeling defeated,” Kumura said. She said that she has been on the phone with people who are distressed because they can’t get timely appointments for a family member in need.

“They are crying on the phone with me, saying, ‘I don’t understand. Why do we have to wait three months for them to actually be seen for the first time?”’ she said.

Johann Hepner, a psychiatric nurse practitioner who has worked for Kaiser for almost five years, also said a high caseload is degrading the quality of care. He says that he sees 10 to 15 patients a day in back-to-back appointments. On top of his patients, Hepner said that he has to handle a portion of the administrative duties, such as contacting patients about missed and follow-up appointments.

“I feel that it is less than par,” he said of Kaiser’s mental health services.

Kaiser has conceded that it has a shortage of mental health professionals, but says that the shortage exists nationwide and is particularly acute in Hawaii.

“We have the greatest respect and gratitude for our mental health professionals and are committed to supporting them in their vitally important work,” said Kaiser in a statement. “We urge our employees to reject the union’s call for a strike, continue to focus on providing high-quality care and work with us through the bargaining process to finalize a new mutually beneficial agreement.”

Kaiser said that it has been contacting all patients with appointments scheduled for this week to alert them of the situation and that it has psychiatrists and licensed behavioral health managers available to respond to urgent needs.

Kaiser’s mental health clinicians in Hawaii unionized in 2018, but still haven’t been able to finalize an initial contract with Kaiser.

Last year the union filed a 57-page complaint with the Hawaii Department of Commerce and Consumer Affairs against Kaiser management. The complaint alleges long wait times throughout Kaiser’s system of care, from booking appointments to obtaining follow-up therapy sessions. The union says the delays appear to violate state and federal laws, including Hawaii’s provider network adequacy rules, the Patients’ Bill of Rights and Responsibilities Act, and the federal Mental Health Parity and Addiction Equity Act.

The union says that Kaiser management has been slow-walking negotiations and won’t come back to the bargaining table until May 31. Kaiser declined to comment on the timeline.

“Kaiser Permanente will continue to bargain in good faith with NUHW to reach a fair and equitable agreement,” Kaiser said in a statement. “We are confident that the best place for us to resolve the economic and other issues, still under discussion, is at the bargaining table.”