Mental health professionals employed by Kaiser Permanente say they are ready to strike next week as contract negotiations drag on, four years after they unionized.

The clinicians, including psychologists, licensed clinical social workers, medical social workers, psychiatric nurses and chemical dependency counselors, who are represented by the National Union of Healthcare Workers, say noncompetitive salaries and benefits are contributing to a major shortage in mental health care providers for Kaiser members and leaving clinicians in Hawaii with overwhelming caseloads.

“We cannot keep apologizing daily to patients in need and members seeking serv­ices, for Kaiser’s lack of available care,” said Tami Swonigan, a psychologist at Kaiser Permanente’s Waipio Medical Office, in a news release. “Kaiser refuses to take any meaningful steps and the crisis just keeps getting worse.”

A three-day statewide strike is scheduled to begin Wednesday and last through May 20.

The are about 50 clinicians covered under the contract negotiations, a number that the union says is woefully inadequate for a health maintenance organization that serves 260,000 Hawaii residents.

Kaiser, in response, issued a statement saying that the strike notice was unproductive as it continues to bargain with its employees. Kaiser’s mental health clinicians also threatened to strike in November.

“We are not surprised that NUHW is now threatening to strike — this is a bargaining tactic this union has used every time it has bargained for a new or renewed contract with a Kaiser Permanente entity, over the past 12 years of its existence,” Kaiser said in a statement.

Kaiser said that it’s working on contingency plans in case the strike is carried out. “If there are changes in our services, patients will be contacted,” said Kaiser.

Negotiations between the union and Kaiser have been highly contentious. In August, Kaiser clinicians sent a letter to company executives detailing the “horrendous state of affairs” of mental health and substance abuse services.

That was followed by complaint filed in November with the state Department of Commerce and Consumer Affairs, in which the union argues that patients’ long delays in obtaining care appear to violate state and federal laws, including Hawaii’s provider network adequacy rules, the Patients’ Bill of Rights and Responsibilities Act and the federal Mental Health Parity and Addiction Equity Act.

The complaint, which the union said was based on records provided by a whistle­blower within Kaiser, said the HMO’s call center was woefully understaffed, making it difficult for those suffering from mental health problems to obtain appointments, and that Kaiser members often have to wait six to seven weeks to obtain initial and return appointments for conditions such as depression, panic attacks and post-traumatic stress disorder.

Kaiser has relied on out-of-network mental health therapists to supplement care, but only 28% of those providers were actually accepting new members, according to the November complaint.

Kaiser has questioned the accuracy of the complaint’s data but doesn’t deny that it has a shortage of mental health care providers. The company says those shortages exist nationwide and have been exacerbated by the COVID-19 pandemic. It’s cited a 2021 Kaiser Family Foundation study that found that the shortages are particularly bad in Hawaii, where just 14.6% of the need for mental health professionals is met, compared with 27.2% nationally.

“Hawaii has a longstanding, well­ documented shortage of health care providers, and in particular, behavioral health providers,” Kaiser wrote in a letter to DCCA that was in response to the complaint. “It has been a struggle to meet the behavioral health needs of Hawaii residents for many years, and the state has consistently ranked among the most challenged in the nation in terms of access to mental health care. The pandemic brought increased demand to a system already plagued with demand far outpacing supply.”

Kaiser says it’s trying to attract new therapists in Hawaii, but the union says it’s not doing enough and that in order to retrain and attract mental health professionals, the company needs to provide them with higher wages and benefits, particularly given the state’s high cost of living.

The union says about two-thirds of the unionized mental health clinicians would not receive a raise under Kaiser’s proposed salary scales, and that the company is looking to eliminate pensions for new hires and reduce pensions for current workers. The union says Kaiser also wants to eliminate a retirement savings account for current workers and get rid of educational leave.

“Kaiser executives are making it crystal clear that mental health care does not matter to them,” said Rachel Kaya, a psychologist at Kaiser Permanente Maui Lani clinic, in a news release. “As a therapist, my caseload is five times what it should be, and my patients can’t get the care they’re paying to receive. The problem isn’t that there are too few mental health clinicians in Hawaii; the problem is that Kaiser doesn’t want to pay to provide the level of mental health care that its members need.”