Not Enough Therapists? In California?

In an August 13, 2015 article by KHN’s Jenny Gold, the director of the Department of Managed Health Care, Shirley Rouillard, was quoted as saying: “There just aren’t enough therapists to see everyone who needs help. It isn’t just a plan problem; it’s a societal problem. And that is really the crux of the matter.”

Not enough therapists? Where is this assertion coming from? And why is it coming now, in this edgy interlude between the DMHC’s second report about Kaiser’s misbehavior and the announcement of remedy from the DMHC’s Office of Enforcement?

In a September 16, 2015 press release Kaiser’s public relations people claimed that: “Kaiser Permanente’s significant hiring of mental health therapists comes during an overall shortage of these professionals in the U.S. According to an April 2015 report by the National Alliance on Mental Illness (NAMI), patients nationwide face difficulties in finding a mental health treatment provider because of the increasing demand for, and shortage of, mental health professionals available.” I read the NAMI report in its entirety and did not find anything to suggest that urban areas in California have a shortage of therapists.

I find it alarming that the head of the agency responsible for holding Kaiser accountable to State mental health parity laws might be considering legitimate Kaiser’s cry of therapist shortages. Perhaps the distribution of therapists is not uniform across the United States. But there are more than enough therapists to meet the need in the urban areas where Kaiser primarily operates. A cursory search on the Psychology Today website in the California cities where Kaiser sees most of its patients reveals hundreds of licensed therapists in Oakland, San Francisco, Los Angeles, San Diego… to name a few of the cities where the DMHC has identified deficits in Kaiser’s care.

There are two main reasons why Kaiser continues failing to meet basic community standards of care. Neither has anything to do with a scarcity of therapists.

The first is that most therapists do not wish to work for an organization that makes it impossible to practice psychotherapy.  A friend at Kaiser’s Psychiatry Department in Santa Rosa confirmed that in the past year new hires, even though they’re being well paid right off the bat, are quitting their jobs quicker than their managers can replace them. Why? Because therapists want to help people. If we can’t see them, we can’t help them. Therapists will continue to quit or refuse new opportunities to work at Kaiser until Kaiser puts in place a credible plan to fix the problems now on the table.

A credible plan would include a statement of intent to improve and a time frame to make the improvements. For example, “By 2018, 95% of Kaiser members with mental health parity diagnoses will be receiving the level of care deemed appropriate by the therapists evaluating their needs.” A credible plan would include steps to achieve its goals, with visible measures for each step. But instead of a credible plan, with goals and strategies to achieve these goals, Kaiser claims they are diligently hiring more staff and that this single strategy will take care of the problems.

The second reason that Kaiser is failing to meet community standards for individual therapy is that they are not paying their subcontracted therapists enough. For the past year or so Kaiser has been subcontracting with a group called ValueOptions to manage their overflow. In Sonoma County (my home county) a Licensed Clinical Social Worker is offered $65 an hour to see a Kaiser patient through ValueOptions. By comparison Medicaid (MediCal in California) is paying LCSWs $103 an hour. Not surprisingly, the numbers of private practice therapists signing on to accept MediCal is growing geometrically whereas the numbers accepting ValueOptions/Kaiser remains low and the growth is flat.

If Kaiser wants to attract and retain new hires, they will need to present a realistic plan to transform the current structure into one that works for therapists and their clients. If they want to attract therapists in the community to participate as subcontractors in the care of Kaiser patients, ValueOptions will need to match Medicaid’s reimbursement rate.

Attention, DMHC: there is no shortage of therapists willing to take care of Kaiser patients with mental illness. Instead of accepting their clever excuses, this is the time to leverage Kaiser into making the real (and really expensive) changes they’re doing their darndest to avoid.


1 thought on “Not Enough Therapists? In California?

  1. Keep up the good work, Andy. Today Patrick Kennedy, son of Ted Kennedy released a new book about his family’s struggles with mental illness and addictions. Patrick Kennedy resigned from congress and established The Kennedy Forum , which hopes to improve the mental health system in the U.S. in action. Included are State Parity Reports, which posts this about California – : The site rates California as “Neutral” for mental health parity laws, and “Promising” in Regulatory Overview. “California has been very active in the regulatory arena. Both the California DMHC and the Dept.of Insurance have issued regulations regarding mental health parity. The DMHC investigated and fined several insurers for parity violations. The steepest and most publicized fine was levied against the Kaiser Foundation Health Plan for $4 million.”

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