Caseloads a keyfactor in Kaiser strike

Kelsey Walling/Tribune-Herald From left, psychologists Wendy Biss and Tami Swonigan and union representative Haley Showell strike outside the Kaiser Permanente Hilo clinic on Thursday.

From right, Tami Swonigan, Darah Wallsten, Rachel Kaya and Haley Showell picket Thursday outside the Kaiser Permanente Hilo clinic. (Kelsey Walling/Hawaii Tribune-Herald)

Kaiser Permanente mental health professionals who are on strike picketed Thursday outside the Hilo clinic to let the public know they are fed up with staffing shortages, flat wages and increasing patient caseloads.

“There’s only around four of us serving about 30,000 patients on the Big Island,” said clinical psychologist Darah Wallsten, who is on the bargaining committee representing the National Union of Healthcare Workers. “I have a waitlist of 83 patients, and on my caseload, I have probably hundreds of patients.”


While not every Kaiser patient requests mental health services, staffing shortages have resulted in weekslong and sometimes monthlong waits. The overwhelming number of patients continues to pile up as clinical psychologists have no cap regarding the total number of cases they can take on.

“Only one of our providers on the Big Island is seeing children under 13, and she’s in Kona,” added Wallsten. “Over the years, the need has grown, the population on the Big Island has grown, and we’ve kept staffing the same.”

Wallsten recounted a recent story involving a 17-year-old suffering from depression and weight loss. Due to the backlog, the patient was directed to an affiliate provider who had minimal experiences with eating disorders.

“By the time I saw her weeks later, she had gone from 140 to 90 pounds. She could have been hospitalized,” said Wallsten. “If things happen in this monthslong time frame, with certain disorders, this could be life-threatening.”

The waiting periods were evaluated by the National Committee for Quality Assurance in May, which placed Kaiser’s accreditation status in Hawaii under “corrective action,” regarding its access to care.

Kaiser responded by outlining several action plans to address the waits, including increasing and advertising positions, offering sign-on bonuses, and updating its recruitment strategy.

“Despite a local and national mental health workforce shortage, we’ve hired 28 clinicians in Hawaii since the start of 2021. Eight of whom will be starting in the next two months,” said a statement from Kaiser released Wednesday. “We’ve also added 11 new mental health clinical positions to be filled in 2022, along with additional support staff, and plan to add the same type and number of positions each year through 2025.”

But the picketers insist there are qualified people on the island, and widespread workforce shortages are not the only issue.

“On our island, there’s 228 LCSWs (licensed clinical social workers) that are licensed,” said Wallsten, adding there are roughly 2,700 licensed therapists in the state, although many already work for other facilities and providers. “The argument there isn’t enough people isn’t accurate.”

Wendy Biss, a clinical psychologist who joined Kaiser from a private practice four years ago, cited several benefits to working with the company, including easy integration between departments, which can alleviate case management burdens, and the company’s overall insurance policy.

“There’s a lot of great benefits, but salary wise, they’re not very competitive,” she said. “In a private practice, I can make an equivalent wage seeing 10 less clients a week. And that would be true for most people.”

Flat-rate salaries for mental health workers will be brought up as well at the next bargaining committee meeting on Sept. 6.

“Most organizations have step increases,” Wallsten said, where annual salaries increase the longer someone stays with the company, often helping with retention rates. “The current proposal is a flat rate for every discipline, so all psychologists make this no matter how long you’ve been here.”

Retention is a key concern among those picketing.

“Keeping providers at Kaiser on our island is very tough,” said Biss. “In our department, typically people stay one to three years because of the conditions.”

The increasing number of patients seeking services has also led to ethical concerns from Wallsten.

“I feel like I’m really on the edge of unethical practice because of not being able to bring people back soon enough,” she said. “That’s why we’re working longer hours. We’re constantly hypervigilant to fill any cancellations. It’s a lot of work.”

Wallsten remains skeptical about reaching an agreement with Kaiser.

“I’m pretty disheartened,” she said. “They have not moved on some pretty significant issues. The wages they are proposing are poor, a lot of people would be frozen, so they wouldn’t get any kind of wage increase, and there’s also takeaways regarding our benefits.”

Kaiser on Monday said in a press release “it is disappointing that the National Union of Healthcare Workers … has again called on our dedicated and compassionate mental health professionals to walk away from their patients in Hawaii at a time when the need for mental health care is so critical.”

In a followup release, Kaiser said it remains hopeful it can reach an agreement with the union while finding ways to continue providing services for patients during the strike.

“Approximately half of our behavioral health patients receive their care from mental health community providers who are not involved with the strike,” the press release said. “We remain committed to reaching a fair and equitable agreement that is good for our clinicians and our patients.”

Email Grant Phillips at

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