Why Thousands of California Mental Health Care Workers Are On Strike

On August 15, 2022, more than 2,000 California mental healthcare workers went on strike. These members of the National Union of Healthcare Workers walked off the job after announcing an open-ended job action in order to protest the working environment and the level of patient care they say they are seeing at their employer, Kaiser Permanente. 

As one union member said in a statement at the outset of the action, “We’re not willing to be part of a system that disrespects the work we do and prevents us from providing ethical care. Kaiser has no excuse to continue treating mental health care as a separate and unequal service, and we’re going to keep striking until that changes.”

Experts, from local mental health practitioners to the US Surgeon General himself, are clear that the strain being put on healthcare workers is unsustainable.

The Root Cause of the Strike

Despite the comparatively low number of unionized mental health staff in the United States, this isn’t the first time that Kaiser has faced the prospect of a walkout.

In 2021, a deal was struck two days before 32,000 staff were set to strike across the western US; and, in 2019, 4,000 mental healthcare workers took to picket lines. Then, same as now, one of the core issues is that staff say patients are not getting timely care when they need it. Data provided by the union puts the average ratio between therapist and patient at 1 in 2600. 

California-based therapist Dr. Benjamin Caldwell, PsyD, LMFT, an instructor and author who is currently working on a book centered on burnout amongst those in critical fields like healthcare and education, says that this level of resistance is because staff believe that their employer is systemically failing at aligning with their values as mental health professionals. 

“Often, when you have clinicians who are experiencing burnout, it's framed as an individual problem. When instead, what many clinicians are experiencing seems to be this concept of moral injury, which happens when people come to realize that they are active participants in a system that operates in ways that are inconsistent with the individual's values.”

That’s a message that was echoed by Dr. Vivek H. Murthy, MD, MBA, US Surgeon General, in the New England Journal of Medicine last week when he wrote about the industry more generally.

“Burnout manifests in individuals, but it’s fundamentally rooted in systems. And health worker burnout was a crisis long before Covid-19 arrived…Burnout is not only about long hours. It’s about the fundamental disconnect between health workers and the mission to serve that motivates them.”

What Does This Mean for Care?

The strikes come amidst a wave of resignations that has hit the healthcare sector particularly hard. According to preliminary data from the US Bureau of Labor Statistics, the US healthcare sector lost 2.7% of its workforce due to resignations in June, equivalent to 551,000 staff.

What makes this strike different from the rash of recent actions taken at places like Amazon and Starbucks is that the core of the protest isn’t about staff wages. Instead, the main issue the union is pushing is a patient/staff ratio that they say is 2,600 to one.

Caldwell says that burnout at a practitioner level can lead to poorer quality care.

“In fact, one of the common indications of burnout is when you have providers who experience less empathy and more judgment toward their patients. In other words, we're not bringing our best selves to the table. And that that has predictable negative impacts on the care that we're able to provide.”

What Next?

In previous media coverage, Kaiser has repeatedly pointed to the pandemic as the reason why the demands of the union cannot be met. In turn, the union has highlighted the legal issues Kaiser has found themselves embroiled in and taken to Twitter to express their concerns under the hashtag #KaiserStrike.

Caldwell says that bringing staff back to the bargaining table will likely take more than just paying people better, or giving people more time off. For him, systemic failure is where the concept of self-care falls down as a human resources strategy. For these workers, it’s not about needing to find time for themselves, it’s about addressing the needs of their patients.

“Those things are nice, and they can help. But fundamentally, if you're a clinician and working in a system that you come to realize is structurally inconsistent with your values, then you're going to leave. If you don't feel like you can change that system from within, you have to figure out how to come to terms with this moral conflict.”