The strike by over 2,400 Kaiser Permanente mental health workers in Southern California is now entering its sixth week. Psychologists, social workers and therapists working without a contract since September are protesting unbearable workloads, insufficient pay and dangerous staffing shortages that deny patients timely care and force workers into burnout.
This struggle is a stark indictment of the entire healthcare system in the US: It highlights the subordination of mental health and all other social questions to profit, including through nominal “nonprofit” entities such as Kaiser Permanente. Meanwhile, the union bureaucracy has isolated the strike by limiting a walkout of nearly 40,000 healthcare and service workers at the University of California system to only two days.
Kaiser’s mental health services are plagued by chronic understaffing. Patients often wait months for appointments, and workers face impossible choices between meeting clinical standards and rushing care. Striking therapists reported to the WSWS seeing patients only once every six to eight weeks, far below what is necessary for effective therapy, especially for those in crisis.
Kaiser’s refusal to hire adequate staff and provide proper support has escalated a mental health crisis, leaving both workers and patients in peril. The situation has worsened since the 2019 strike, when the same demands were advanced.
Last week, the WSWS spoke to workers at the Irvine Kaiser Permanente facility.
Mayra, a case manager for the Kaiser Santa Ana Clinic, told the WSWS that they are so understaffed that she is “the only Spanish-speaking case manager for all of Orange County. And we only have one psychiatrist that also speaks Spanish.” The population in Santa Ana is approximately 46 percent immigrant. “My patients are severely and persistently mentally ill: schizophrenia, bipolar. My case load is 45-50 patients, from ages 7 to 73, and during COVID they got rid of the Spanish-speaking Intensive Outpatient Program,” she said.
Yazmin, an associate clinical social worker at Irvine Kaiser, also highlighted horrific conditions. “We see patients back to back without any breaks, we don’t get time to prepare for patients or do treatment planning. Our patient management time—four hours a week—is unprotected. This means that if we don’t meet what is called a net loss, that is, if there’s more than three slots that are not filled by patients’ cancellations, there’s a sanction against us.”
Patients have to wait weeks, if not months, to get a second appointment. People who are suicidal or severely impaired end up barely being seen.
Jeremy, a case manager in the South Bay psychiatry department, told the WSWS, “I see a lot of people who escalate to the level of being hospitalized or being at risk of hospitalization because they aren’t getting adequate care at the basic level. They get bounced around between therapists. They don’t know who to talk to. They end up in crisis and then end up in the emergency room.” He explained that often “somebody who’s been hospitalized for a suicide attempt ends up seeing a therapist once a month: that’s what Kaiser sees as adequate to deal with their thousands and thousands of patients in this region.”
In the first nine months of 2024, Kaiser’s year-to-date net income was $10.3 billion, compared to $3.5 billion in net income for the same period in 2023. This includes a one-time net gain of $4.6 billion related to the Risant Health, Inc. acquisition of Geisinger Health, reported in the first quarter, evidence that the “nonprofit” organization operates no more nor less than a private equity firm.
“Kaiser is only half non-profit,” Jeremy continued. “The other half, our employer is actually a for-profit organization. The Southern California Permanente Medical Group is for-profit. They’re not interested in quality care as far as what we believe is clinically appropriate. They only want the perception of quality care. As long as they can sell their health plan, they’re fine.”
Despite unprecedented profits, the company has imposed grueling working conditions on its staff. Workers are forced to complete “indirect care” tasks like treatment planning and documentation during hours meant for patient sessions. This practice mirrors industrial speedups, increased workloads, strict performance methods, lean management practices and other methods utilized in every industry. While Kaiser advertises itself as a leader in healthcare, its mental health workers warn of a system that prioritizes numbers over lives.
This strike is part of a broader wave of labor struggles across the healthcare industry. Last year, 85,000 Kaiser Permanente workers staged the largest healthcare strike in US history, while mental health workers have joined picket lines at CVS and Rite Aid facilities. These strikes reflect growing frustration with underfunded, overburdened systems that prioritize executive salaries and shareholder profits over workers’ living standards and patient care.
However, the union bureaucracy has limited and isolated the strike by refusing to wage a united struggle of healthcare workers across the state and the country. Such a struggle is necessary but can only be accomplished by workers organizing rank-and-file committees in order to impose their democratic will on the conduct of the strike and to establish lines of contact with other healthcare workers.
The National Union of Healthcare Workers, which has covered Kaiser mental health workers since 2010, has a track record of limiting strikes and undercutting workers’ demands. In the contracts between 2010 and 2015, significant wage freezes left Southern California mental health workers underpaid compared to their Northern California counterparts.
In 2015, NUHW did nothing to stop Kaiser from eliminating pension benefits for new hires, replacing them with 401(k) plans for Southern California workers. This decision created a major disparity in retirement benefits, which remains a contentious issue.
During the 10-week-long 2022 Northern California strike, NUHW negotiated a four-year contract that left systemic problems unaddressed. Therapists received limited increases in administrative time but saw no substantial changes in staffing levels.
The union has direct financial ties with Kaiser Permanente, which funds the unions to the tune of tens of millions of dollars through corporatist schemes like the Labor-Management Partnership. According to its website, LMP was founded in 1997 to prevent strikes that “threatened to derail the organization.”
Both the NUHW and Kaiser have deep ties with the Democratic Party. Since 2019, Kaiser has contributed nearly $100 million in charitable funding and grants to initiatives championed by Newsom. In 2022, his administration negotiated a no-bid Medi-Cal contract with Kaiser Permanente, allowing the healthcare giant to bypass the competitive bidding process required of other Medi-Cal providers.
The union’s promotion of the pro-corporate Democratic Party also played directly into the hands of Trump, who is preparing historic attacks on healthcare through cabinet members such as anti-vaxxer Robert F. Kennedy Jr. Rather than raising the alarm about the threat of a fascist dictatorship under Trump, the Democratic Party has stressed it wants a “smooth transition” in order to ensure Trump’s “success.”
While workers have taken a courageous stand, The Kaiser strike demonstrates the urgent need for rank-and-file committees, independent of the union bureaucracy and political establishment. These committees empower workers to unite across sectors, regions and countries, breaking the isolation imposed by the union leadership.
This strike is not just about better contracts; it is a fight against the capitalist structure that prioritizes profit over human lives. Workers must take the struggle into their own hands, building an independent movement to fight for socialist policies.
To win this fight, workers must reject the limitations imposed by the union bureaucracies and take direct control of their struggle. This movement must transcend narrow economic demands and become a political fight for a system that values human needs over profit. Only through unified, independent action can workers lay the groundwork for a future built on equality and peace.