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Two thousand mental health clinicians have won; Kaiser Permanente has lost. The 10- week strike has ended in near total victory for the National Union of Healthcare Workers (NUHW). The therapists, walked out on August 15; it became the longest mental health care workers’ strike recorded.

Two issues dominated negotiations from the start: workload for Kaiser therapists and wait time for Kaiser patients. The strikers won on both, forcing concessions until now all but unheard of. The strikers won break through provisions to retain staff, reduce wait times for patients and a plan to collaborate on transforming Kaiser’s model for providing mental health care. The new four-year contract is retroactive to September 2021 and expires in September 2025. Darrell Steinberg, Mayor of Sacramento served as a mediator. Members of the NUHW voted 1561 to 36 to ratify it.

Braving three-digit heat, strikers walked picket lines throughout Northern California and the Central Valley. They picketed, marched and rallied at Kaiser hospitals – in a strike that caught the attention of mental health care advocates everywhere. “Our strike was difficult and draining, but it was worth it,” said Natalie Rogers, a therapist for Kaiser in Santa Rosa. We stood up to the biggest nonprofit in the nation, and we made gains that will help better serve our patients and will advance the cause of mental health parity throughout the country.”

The mental health clinicians I’ve met are almost universally modest and careful in their choice of words, and here is an example. To say that that Kaiser is “the biggest non-profit” is an understatement to say the least - its revenues are in the billions, and its managers make millions while this giant among giants, typically in the world of corporate health care, oversees its empire as if it were making cars and trucks.

I’ve seen NUHW rallies well-attended by patients themselves, also family members and supporters who are angry, bitter. Where frequently they carry signs to the effect that the issues here are life and death, rallies where speakers break down in tears, where placards tell us that suicide can be the outcome of care denied – “Stop the Suicides!” It’s a wonder more therapists don’t move on. The world of pain of the mental health patient can be just as acute as that of the medical patient. Ask a therapist. It’s not that the clinicians don’t want to tell us this.; it’s that, in their own way, they are telling us. It’s why they fight so hard.

“It was difficult getting up and going on the picket line, juggling other responsibilities. We don’t get paid when we’re on strike,” Natalie Rogers, a licensed marriage and family therapist who works in the emergency department. Rogers is also a member of the Santa Rosa City Council. “We knew it was worth it. We knew why we were out there.”

NUHW, 16,000 strong, finds power in the fact that its members understand its mission and support it – building a worker led union, democratic and militant. Its therapists have been on strike a half dozen times with Kaiser, though this has been the first open-ended strike. Twenty working members represented the union in bargaining. Bargaining sessions were open.

Here are some highlights from the union, more can be seen at NUHW.org (at the time of writing Kaiser has not commented):

Nearly two additional hours per week for therapists to perform critical patient care duties such as responding to emails and voicemails, tailoring treatment plans, communicating with social service agencies and charting appointments A recent union survey found that lack of time to perform these duties has been the primary reason for Kaiser’s overall high turnover rates, which has doubled over the last year. Staff departures combined with overall understaffing has resulted in longer appointment wait times for patients.

An increase in extra pay for bilingual therapists from $1 per hour to $1.50 an hour. This will help Kaiser recruit and retain therapists who can meet the needs of non-English speakers. This new rate is the highest differential for bilingual workers that Kaiser has agreed to in California.

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A commitment by Kaiser to hire more therapists and expand its new treatment track programs which allow certain patients better access to appointments over a shorter period of treatment.

A commitment by Kaiser to work with therapists to expand crisis services to nearly all of its clinics.

An agreement to increase from 60 to 90 minutes of time therapists have to conduct initial assessments of children seeking mental health care.

Wage increases, including retroactive pay, will be as follows: Year 1: 4 percent. Year 2: 3 percent plus a 1 percent lump sum bonus. Year 3: 3 percent. Year 4: 3 percent plus a 1 percent lump sum bonus.

“Model of Care” committees will be convened to see that Kaiser meets its contractual obligations as well as state regulations. Right now, SB221 requires all health insurers to provide therapy sessions within 10 business days. Currently Kaiser is not in compliance with state law.

“It took much longer than it should have to reach this agreement, but, in the end, we succeeded in securing important improvements in patient care that Kaiser negotiators told us across the bargaining table that they’d never agree to,” said Jennifer Browning, a licensed clinical social worker for Kaiser in Roseville who served on the NUHW bargaining committee. “At a time when there are so few appointment cancellations because we’re seeing patients remotely, giving us enough time to perform all of our patient care duties is going to help keep a lot of us at Kaiser, and it's going to help Kaiser hire more therapists.”

Sal Rosselli, president of the National Union of Healthcare Workers, “I’m proud of Kaiser therapists for standing up for their patients and their profession,” and their union which represents Kaiser therapists in California and Hawaii. “Therapists, like other professionals, join unions so that they will have a voice on important professional issues along with leverage on wages, benefits and quality of life issues. Our members want to apply their professional judgment to better serve patients and they want to be treated with respect by their employer, rather than as cogs in a wheel. They want to be given the time necessary to do their jobs properly. Kaiser wanted to give orders, but not listen. This contract will help reset that relationship.”

As it is, patients can see conflicts, the turmoil that exists, that exist now in COVID time, time when caregivers truly are on the front lines, when hard work and short staffing is intensified by danger. Big banners praising “Our Heroes” don’t make up for the array of indignities our heroes endure. Patients, they see comforters and miracle workers, people on their side. We know that if we scratch the surface we will expose the dark side of the healthcare world, the huge place it occupies in our economy and society. These hospitals can be massive, the “campuses,” for example, of Orlando Health, Indiana University, Yale New Haven. The Cleveland Clinic has swallowed up great chunks of the historic back neighborhoods of the city’s East Side. These thousands of hospitals and clinics, almost all of which are violently anti-union, are bastions of the low paid and temporary – corporations just as brutal as Amazon. They send out the bills and the collection agencies; they bombard us with robo calls, the messages of mail order pharmacies and automated “surveys.” Bernie Sanders is right that we have to have the courage to stand up to them – all of them large and small.

The struggle to achieve parity for mental health care at Kaiser is far from over. In Hawaii, there is still no settlement to the strike by Kaiser therapists. Kaiser has not only refused to provide similar terms for its Hawaii-based therapists as for its California-based therapists, it’s demanding that that they accept wage freezes and cuts to retirement benefits that would make it harder to recruit and retain therapists. There will be a fight to force Kaiser to live up to its bargain.

Rosselli, “We won more than Kaiser executives ever imagined they’d have to offer, and we couldn’t have achieved that without the support of elected leaders, community allies and Kaiser patients, who bravely talked about their struggles to access mental health care. On behalf of our members thank you so much for your support”