Kaiser Permanente’s psychologists, social workers, psychiatric nurses and addiction counselors wrapped up a three-day strike Friday with picketing outside of Kaiser’s Waipio Medical Center on Oahu.

The approximately 50 clinicians have been in a years-long standoff with Kaiser management over their first contract since unionizing in 2018. They’ve been pushing for higher salaries and benefits, which they argue are critical to attracting more mental health professionals to Kaiser’s provider network.

The employees, who are represented by the National Union of Healthcare Workers, say a shortage of providers has left them with overwhelming caseloads and patients waiting months for their first therapy session to treat conditions such as depression, eating disorders and trauma.

“We’ve sent a clear message to Kaiser that we won’t let it get away with treating behavioral health as second class and making people wait months to see a therapist,” said Robert Locklear, a mental health and substance abuse counselor with Kaiser, in a news release. “Hearing patients and community leaders talk these past few days about the struggles they and their loved ones face getting care has made us even more determined to demand that Kaiser provide equal treatment for behavioral health care.”

The union says Kaiser is proposing wage freezes for many of the union workers and cuts to retirement and health benefits. The health maintenance organization’s management has countered that its salaries are already competitive.

In November, Kaiser said that its psychologists, on average, earn more than $120,000 a year, which it says is more than $17,000 higher than the market average. The HMO says its average licensed clinical social workers earn more than $91,000 in wages, more than $10,000 higher than the market average.

Kaiser has acknowledged it has a shortage of behavioral health clinicians but argues those shortages exist nationwide and have been exacerbated by the COVID- 19 pandemic.

Bargaining is scheduled to resume May 31, according to the union.

The union also has taken its fight to the state Department of Commerce and Consumer Affairs, filing a complaint in November with its Insurance Division that alleges long wait times throughout Kaiser’s system of care, from booking appointments to obtaining follow-up therapy sessions.

The complaint, which the union says is based on internal Kaiser documents, also alleges that only 28% of Kaiser’s out-of-network mental health therapists, who are supposed to augment services, are accepting new patients.

The union says the shortages appear to violate state and federal laws that require Kaiser to have sufficient numbers of clinicians available to ensure timely mental health appointments.

On Thursday the union held a rally outside of the DCCA offices where members demanded more follow-up to their complaint. “Our message to the Insurance Division is simple: Do your job,” said Andrea Kumura, a clinical social worker at Kaiser.

Earlier this month Arlene Ige, DCCA’s Health Insurance Branch administrator, sent a letter to the union saying it would seek additional information from Kaiser related to the complaint and will confer with the federal Centers for Medicare and Medicaid Services as to whether Kaiser is in violation of the federal Mental Health Parity and Addiction Equity Act.

Ige also asked that the union clarify whether its concerns pertained to its commercial plans or Medicare and Medicaid plans.

On Thursday, during its rally, the union presented a letter to DCCA expressing disappointment that the question was only being posed now and clarifying that the provider shortages apply to all plans.

We “are alarmed that only today — more than six months after you received our complaint — is the Insurance Division posing a basic clarifying question about our complaint,” the union wrote.