Therapists employed by Kaiser Permanente in Hawaii — members of the National Union of Healthcare Workers — voted overwhelmingly Saturday to ratify a new contract ending a nearly six-month strike that the union says is the longest work stoppage by mental health care workers in U.S. history.

Key contract provisions in the three-year contract include wage increases of at least 3% in 2023 and 2024 and 2% in 2025; preserving pension benefits for new hires; and an extra $1.50 per hour for bilingual therapists to help Kaiser meet the needs of non-English speakers.

The newly signed contract was the first for Kaiser’s mental health therapists in Hawaii since they formed a union in 2018. It applies to approximately 50 mental health workers that Kaiser employs in Hawaii to care for its 266,000 members.

The Kaiser workers, including psychologists, social workers, psychiatric nurses and chemical dependency counselors, went on strike in late August, citing concerns that Kaiser was understaffing mental health clinics and not doing enough to attract new hires who could ease overwhelming caseloads. The union was fighting for higher salaries and better retirement packages.

The union halted picket lines Thursday when it reached a tentative agreement with Kaiser. Therapists are expected to return to work Tuesday.

In a statement issued Sunday, Kaiser Permanente said it is “pleased with the outcome of the NUHW ratification vote and appreciates our mental health staff’s confidence in this fair and equitable agreement. We are glad to have them back, doing what they do best, caring for patients. We are also extremely grateful to the many community providers who opened additional appointments during the strike to ensure Kaiser Permanente members received the care they needed.”

Rachel Kaya, a psychologist for Kaiser on Maui and co-leader of the strike, said in a statement, “I’m excited to return to work and treat my patients, but I’m disappointed that Kaiser still devalues mental health care and treats its patients in Hawaii as second class.” Additionally, she said, “I’m so grateful for our community that has supported our strike and kept us going all these months by contributing to our strike fund. Our strike is over, but our fight to make Kaiser deliver timely, accessible mental health care for the people of Hawaii is only just beginning.”

Kaya told the Honolulu Star-Advertiser on Sunday that she and other union members were disappointed that Kaiser rejected several proposals aimed at increasing staffing and improving access to care, including a proposal that would have required Kaiser to increase hiring bonuses and bump up financial incentives for existing staff following years when it failed to meet its required mental health hiring benchmarks.

She said understaffing was already an issue for Kaiser in 2018 when its Hawaii therapists unionized, and the situation was later made worse by the COVID-19 pandemic.

Kaya said Kaiser had told the National Committee on Quality Assurance, in response to a complaint filed by the NUHW, that it would hire 11 new therapists every year for four years starting in 2022, which by 2025 would almost double therapist staffing. Instead, she said, it finished 2022 down roughly 10 therapists. “I hope that they (committee members) take note of Kaiser’s inability to hire those 11 therapists in 2022 and take some action,” Kaya said.

Much of the strike was about the fight for patients to have better access to mental health care, Kaya said, noting that her caseload at the Maui Lani Medical Clinic just before the strike started was about 150 patients, which she said is too many to consistently fit everyone into a weekly one-hour time slot.

Kaya said due to the understaffing problem, new patients were told that first availability was anywhere from six weeks to three months out. “For somebody that has had the bravery to finally realize, ‘Hey, what’s going on is not OK, I need help,’ and then they face that obstacle to even get a first-time visit,” the matter is disheartening, she said.

Union workers were pleased, Kaya said, that they were able to ensure new hires get a Kaiser pension, which is probably the biggest draw in attracting employees from private practice.

“Preserving pensions for new hires was one of our big successes — that and also getting raises, because Kaiser had initially proposed a situation where most of us would get zero increase in salary,” she said.

While Kaiser has said it provides competitive compensation, the union has countered that even with the wage increases in the new contract, wages for the therapists who work for Kaiser in Hawaii lack parity with Kaiser’s union therapists in Northern California, who ratified a new contract in October after a 10-week strike.

For instance, the hourly wages for a licensed clinical social worker in the new Hawaii contract is $45.89, as compared with a starting rate of $54.46 in Northern California, where the contract allows for additional pay step-ups.

In Hawaii a psychologist has an hourly rate of $62.93. That hourly rate starts at $66.92 in Northern California. The hourly rate for a substance abuse counselor is $33.39 in Hawaii. It starts at $39.45 in Northern California. In Hawaii a licensed mental health professional at Kaiser makes $37.60 an hour. Northern California’s the hourly rate starts at $54.45.

Andrea Kumura, a social worker at Kaiser’s Waipio Clinic and member of the NUHW Bargaining Committee, said in a statement, “This contract is a lot better than what Kaiser was offering when we started our strike last August, but it’s still not enough to address the understaffing crisis that forces Kaiser members to wait months for mental health therapy. I’m proud that we took a stand for patients, and I’m ready to keep fighting to make Kaiser deliver mental health care that meets the needs of its members.”

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Star-Advertiser staff writer Sophie Cocke contributed to this report.