Ezekiel Koontz recalls being a Kaiser Permanente patient “forever, for as long as I can remember” — first as a child and now as a working adult receiving gender-affirming treatment.

But while battling severe depression and experiencing suicidal episodes for the last several years, the 26-year-old teacher struggled to find a therapist with whom they felt comfortable.

“I went jumping from therapist to therapist to therapist,” Koontz said. “I think the last time I tallied it up, it was like 10 different therapists.”

Then after almost two years of sessions, their preferred therapist went on strike, and Koontz was without a steady person to talk to about their depression and suicidal ideations.

“They keep on offering scab therapists,” said Koontz. “It’s the same issue that I had before, but worse now. It feels scummy in a way, because it’s like they are trying to pity us while shaming and trying to make an example of them — and offering nobody a solution in the process.”

Their predicament reflects the strain on patients and providers as a consequence of the mental health strike at Kaiser Permanente in the past three years. Approximately 2,400 Kaiser therapists, clinicians and other National Union of Healthcare Workers members went on strike Oct. 21 in Southern California, calling for more time and resources of their workday to be allocated toward critical patient care duties; restored pension benefits; and cost-of-living wage increases. A handful of nonproductive bargaining sessions ended in standstill by Oct. 28, with no further meetings scheduled.

In a recent statement, Kaiser Permanente called the strike “unnecessary.” It claimed the union proposal — which mandates seven hours a week of non-therapy session time for therapists — would “decrease the time therapists see patients to nearly 50% of their week, reducing critically needed patient appointments by 15,000 every month.”

Political push

Top Democratic lawmakers this week began pressuring the company to end the strike on the union’s terms. California Senate President Mike McGuire and Assembly Speaker Robert Rivas joined forces on Dec. 12 to petition Kaiser Permanente Chief Executive Officer Greg Adams to do more to resolve the strike.

“My undersigned colleagues and I urge you to resume good faith negotiations with NUHW as soon as possible, and to agree to the union’s reasonable contract proposals to ensure the delivery of timely and appropriate behavioral health services to your patients,” McGuire and Rivas each wrote in identical letters signed by 20 fellow senators and 40 Assembly members.

In 2022, Northern California Kaiser mental health workers went on strike over similar contract disputes. After 10 weeks, Sacramento Mayor Darrell Steinberg stepped in to mediate negotiations, and Kaiser ultimately agreed to a package of wage increases and staffing commitments similar to what Southern California workers now fight to acquire for themselves.

Kaiser further paid a $200 million settlement to the state of California in late 2023 for failing to provide mental health patients appropriate and timely access to treatment. The deal included a $50 million fine, along with the promise of investing $150 million over a five-year span to improve its behavioral health care response protocols.

“Especially with Southern California Kaiser, I think the mental health system is even more broken,” said psychiatric social worker Linda Cortes, a strike captain at organized union picketing events throughout the southland. “There’s only 2,400 of us for the whole entire Southern California region. Kaiser deemed us essential workers during COVID. They even gave us a little card stating we were essential workers. But now all of a sudden, they don’t see us as that.”

The mother of two has worked for Kaiser almost 10 years and worries about her family’s future as the strike drags on. “It’s been difficult, a lot of emotions. How am I gonna make ends meet every week? I have gone to food banks for the first time as an adult. We all went and got a turkey for Thanksgiving to help us get by.”

Kaiser has said its last offer for the next four-year union contract provides a 5% wage increase each of the next two years, with a 4% bump each of the following two years after that. The strikers, however, also seek additional adjustments to recompense for the lack of any cost-of-living increases in 2018 and 2019, as well as only 2% bumps in 2022 and 2023.

Benefits ‘leader’

Kaiser asserts itself as “a leader in pay and benefits” — noting that it also offers a fully subsidized retiree medical plan.

But the disparities between Kaiser employees who receive defined pension plans and the ones who don’t is a sticking point for the Southern California mental health workers.

“I feel like I’m less valued as an employee at Kaiser,” said Jade Rosado, a Kaiser employee who does not receive a pension. “Especially when you look around and everybody has the pension, everybody from food service workers to janitors. As a mental health care worker, am I less?”

David Zelen, a social worker within Kaiser for the last 37 years who will retire in 2025 with a full pension, pickets alongside Cortes and Rosado. “Everyone should have the pension,” he said. “It’s one of the benefits of working here at Kaiser, and working so hard. In a 40-hour work week, we’re scheduled to see about 35 patients.”

Pressure on providers

Cortes, Rosado and Zelen all worry about the patients who were previously under their caseloads. “I’m scared for them,” said Cortes. “I know during the holidays, suicide rates go up. Divorce rates go up. Violence goes up, unfortunately. So why doesn’t Kaiser care?”

Like most patients affected by the Kaiser strike, Koontz has been offered outsourced access to therapists, including online services like Rula. Koontz gets texts and emails from Kaiser about every two weeks to remind them that these resources are still available.

But so far, Koontz has been relying on happenstance to try and remain mentally stable and positive.

“I assure you, if anything goes wrong here, I have no safety net,” he said. “I’m just doing okay, but that is pure dumb luck.”

Another patient, Erin Hartman, also shared her frustrations about Kaiser’s response to the strike. In July, the 42-year-old San Diego mom started receiving one-on-one sessions to help cope with the loss of her father and the added stressors of parenting a kindergartner while also looking for employment. She credits her therapist with helping her navigate grief and manage her anxiety.

“Even in a short amount of time, I can see a huge difference from July to October,” said Hartman. “And then when she told me about the strike, my anxiety immediately bubbled back up because I didn’t know when I was going to see her again.”

Although Kaiser offered to provide Hartman with replacement therapists, she declined. “I won’t be doing that,” she said, instead opting to wait for her therapist to return after the strike. “We have that rapport, which is so important. Therapy is kind of like dating. I got really lucky.”

She describes herself as a patient whose level of treatment can withstand waiting for weeks between sessions or until the strike ends.

“I understand why they’re striking, and I totally empathize with them,” she said. “Where it gets scary is that there are people out there with mental health issues who can’t wait. What if you really needed your person and they’re not available?”

Two weeks ago, Hartman thought the strike was over when she found out her therapist had returned to work.

“I got a call from Kaiser, and was really excited to meet with her again,” Hartman said. “She said she weighed how long she could remain on strike, and she just couldn’t do it anymore for financial reasons. So now, she’s working alongside scabs.”