Photo by Mitch
Mental health services are crucial to our well-being. I think that most people will agree with me. As a union member, I support mental health clinicians employed at Kaiser Permanente, an integrated managed care consortium headquartered in Oakland, California, who have gone out on strike over work conditions. As these essential workers see it, their employer’s rules are harmful to them and their patients. Count a young family member of mine among the latter. What follows are my reflections on his experience with Kaiser Permanente clinicians.
It is a truism that time is money in a capitalist economy. “Moments are the elements of profits,” Marx writes in the first volume of Capital, quoting factory owners. Accordingly, the time clinicians spend with their patients costs an enterprise such as Kaiser Permanente money. Nothing is free in a capitalist economy.
Following a Kaiser intake process, there were sessions with a clinician. He was a young man with a big smile and cheery demeanor. My hopes rose.
In the case of my youthful family member, he began to receive mental health services from Kaiser Permanente as a preschooler. Why? In desperate brevity, his behavior in and out of the home forced that move, taken with an eye to the benefits and risks involved. Social stigma is a possible pitfall to ponder. There are others. One is medication side effects. Big Pharma and its relentless pursuit of profits thanks to government-granted patents couldn’t care less. Corporate profits rule.
Following a Kaiser intake process, there were sessions with a clinician. He was a young man with a big smile and cheery demeanor. He spoke with us. We conversed with the clinician. He had a fondness for handouts and website referrals. I never thought of understaffing. It is a big issue among the Kaiser clinicians who have withdrawn their labor in protest over working conditions impacting them and their patients. To put a fine point on it, the clinicians oppose the lack of their time with patients. Later, this clinician referred the youngster to see a psychiatrist.
On one hand, the psychiatrist refrained from sharing handouts and website tips. This was a welcome relief. I saw this as a kind of self-serve process, a little like using a scanner for a retail checkout. In the meantime, the psychiatrist listened to him and me, also asking questions. On the other, she spent scant time getting to know the boy, in my view. I think that this approach did him a disservice. Maybe I am wrong. However, I know him. He relates to adults in and out of the health care field partly based on the time they take with him.
A consequence of the Kaiser clinicians’ time limits was a missed diagnosis. To be clear, they did diagnose the boy. I write this in hindsight, which is always clear. What the Kaiser clinicians failed to discover in their diagnosis was a condition that three years later a psychologist in private practice uncovered. How? As I see it, the answer is straightforward. She spent more time with him than did the Kaiser clinicians. I sit accused of simplifying this narrative, boiling it down to labor time.
The clinicians’ working conditions drive the quality of their patients’ mental health therapy. This private psychologist spent hours on his case. Many were her questions. Consider this. This psychologist spent an entire morning giving him a battery of tests. With her, he had breaks and treats to help him keep focused. I lost track of how many forms that I finished for her assessment of him. I am not complaining. I would do it again in a heartbeat.
This was a completely different experience in terms of quality and quantity of therapy that Kaiser clinicians provide. Once diagnosed fully, doors opened to services and treatment for his once-hidden conditions. Increased clinician time out of the Kaiser system improved his life, a step forward.
In the meantime, I learned much more about the new diagnosis reading The Reason I Jump: The Inner Voice of a Thirteen-Year-Old Boy with Autism by Naomi Higashida (Random House, 2016). The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder by Carol Stock Kranowitz (TarcherPerigee, 3rd edition, 2022) also opened my eyes.
At the end of the day, mental health therapy should prioritize the needs of the patient. It did not for the Kaiser clinicians who treated the boy. They lacked the time to diagnose properly what ailed him. Did they choose their time with patients? It would be easy to say yes.
However, I do not blame the clinicians who Kaiser employs for partial treatment of the boy. The National Union of Healthcare Workers blames Kaiser management for cutting clinicians’ time treating patients to allocate money elsewhere. In sum, the clinicians’ working conditions drive their patients’ mental health therapy, according to the NUHW. I agree.
Meanwhile, the youngster got a new Kaiser psychiatrist. She met him online a couple of times during the pandemic. Her predecessor treated him face-to-face, and it made a positive difference. Meanwhile, his medication allocation is the continuity of treatment from both Kaiser psychiatrists. There are many factors involved.
I understand that prescription medications can help people suffering from mental health conditions, but there are also long-term side effects. That is a concern. In the meantime, it seems that Kaiser psychiatrists’ focus is to prescribe and monitor medication. That action requires less time than getting to know patients. Is there a connection? I hold that this reliance on medicating patients versus spending time with them is an issue worthy of a closer look from state agencies and lawmakers, and professional licensing bodies. Patients and their allies joining organized labor members have the potential to make that happen. People, to quote singer Patti Smith, have the power.