Kaiser Permanente’s mental health therapists in Hawaii went on strike today, still unable to come to an agreement on a contract four years after unionizing.

The 57 clinicians, including psychologists, social workers, psychiatric nurses and chemical dependency counselors, say the understaffing within Kaiser’s mental health clinics has led to overwhelming caseloads and is putting patients’ health at risk. They’ve been pushing Kaiser to increase salaries and benefits to attract more staff.

“People’s lives are at stake,” said Andrea Kumura, a licensed clinical social worker at Kaiser’s Waipio Medical Office, in a press release announcing the strike. “Kaiser is making us violate our professional ethics by delivering care that doesn’t meet the needs of our patients, and the proposal that Kaiser has on the table would result in people waiting even longer for care.”

This is the second time this year that Kaiser’s mental health staff, who are represented by the National Union of Healthcare Workers, have gone on strike. They went on strike for three days in May. This time, the union says the strike is open-ended and was launched as a last resort.

Kaiser has criticized the union’s bargaining tactics and says it has already taken steps to increase staffing. In addition to the strikes, the union has filed complaints with regulators.

“We take any potential disruption of services very seriously and have plans in place to help our members and patients continue to receive safe, high-quality care,” Kaiser said in a statement posted online. “NUHW leadership continues its corporate campaign tactic of using complaints to media and regulators to create pressure at the bargaining table. Although we disagree with this bargaining approach, we continue to negotiate with NUHW in good faith and are committed to reaching a fair and equitable agreement.”

The union plans to picket at the following locations throughout the week and Kaiser has urged patients to consider arriving early for appointments in case there is added traffic due to picketing:

Monday, Aug. 29

Kaiser Honolulu Medical Office, 1010 Pensacola Honolulu

6 a.m. to 4 p.m.

Tuesday, Aug. 30

Moanalua Medical Center, 3288 Moanalua Road, Honolulu

8 a.m. to 2 p.m.,

Wednesday, Aug. 31

Kaiser Maui Lani Medical Office, 55 Maui Lani Pkwy., Wailuku

8 a.m. to 2 p.m.

Thursday, Sept. 1

Kaiser Hilo Clinic, 1292 Waianuenue Ave., Hilo

8 a.m. to 2 p.m.

Friday, Sept. 2

Kaiser Waipio Medical Office, 94-1480 Moaniani St, Waipahu

8 a.m. to 2 p.m.