Ana Megawati
Ilana Marcucci-Morris, a licensed clinical social worker at Kaiser Permanente’s psychiatry outpatient clinic in Oakland, California, expresses profound concern for her patients, particularly regarding the prolonged wait times they endure before reaching her office. She observes an alarming trend of individuals presenting with severe mental health issues that, in her professional judgment, should have warranted emergency room intervention weeks earlier. For those who do eventually secure an appointment, her immediate thought is often a relieved, yet unsettling, "Thank God they’re still alive." This sentiment encapsulates a growing crisis within Kaiser Permanente’s mental health services, a situation that recently culminated in a significant one-day strike by thousands of mental health professionals across Northern California.
A Fundamental Shift in Patient Triage
Marcucci-Morris, with years of experience, recalls a time when licensed professionals were almost invariably the initial point of contact for patients seeking behavioral health support at Kaiser. However, a significant shift occurred in January 2024, when the healthcare behemoth introduced a new screening process for first-time patients. This revised system integrated clerical workers, who lack clinical licensure, to conduct initial assessments using scripted "yes" or "no" questions. Their role is to gauge the severity of a patient’s condition and the urgency of their need for care. Concurrently, Kaiser rolled out "e-visits," essentially online questionnaires designed for patients to complete before being scheduled with a licensed healthcare professional.
This systemic overhaul has not gone unnoticed by frontline clinicians. Five licensed Kaiser therapists echoed Marcucci-Morris’s concerns, reporting that since the new assessment process was implemented, high-risk patients are experiencing longer waits for critical care. Paradoxically, they also note that lower-risk patients are sometimes being fast-tracked, inadvertently congesting an already overstretched system. The National Union of Healthcare Workers (NUHW), representing approximately 2,400 Northern California mental health professionals employed by Kaiser, cites over 70 documented instances of negative care outcomes attributed to Kaiser’s new mental health screening system since January 2025. These alarming statistics were presented in an administrative complaint filed by NUHW with the California Department of Managed Health Care against Kaiser.
The Strike and the Specter of AI
The discontent reached a boiling point on a recent Wednesday, when NUHW members launched a one-day strike. The primary drivers behind this industrial action were the contentious changes to the patient screening processes and profound anxieties about Kaiser’s potential plans to leverage artificial intelligence (AI) to replace licensed therapists for certain clinical functions. "Human work needs to stay with human beings," asserted Marcucci-Morris, encapsulating the union’s core philosophy. The union’s administrative complaint with the California Department of Managed Health Care, initially filed last year in Northern California, specifically alleges that Kaiser’s new patient screening system is illegal. A separate, but similar, complaint was also filed by NUHW in Southern California in April 2025, underscoring the widespread nature of these concerns across the state.
Kaiser Permanente, in an emailed statement, strongly refuted NUHW’s claims, characterizing them as "misleading" regarding access and care. The organization explicitly stated, "AI and Clerical staff are not conducting any assessments, making any clinical determinations nor conducting clinical triage." Kaiser clarified that clerical staff receive training to escalate critical cases to clinical staff through immediate transfers to crisis therapists. Furthermore, Kaiser affirmed its commitment to "growing our workforce, not shrinking it," directly contradicting NUHW representatives who believe the number of triage therapists has significantly decreased. Regarding AI, Kaiser’s statement articulated a nuanced position: "We believe AI can be helpful when it supports clinicians – by reducing administrative work or improving efficiency – but it does not replace clinical judgment or human assessment."
Workforce Anxiety and the "Writing on the Wall"
The introduction of AI tools has cast a long shadow over Kaiser’s mental health workforce. An internal survey conducted in 2025 among Kaiser’s mental health workers in Northern California, obtained by The Guardian, revealed significant apprehension. More than one-third of employees reported that Kaiser had already implemented AI or other technologies they feared could negatively impact their work or patient care. Alarmingly, almost half of Kaiser workers expressed being "somewhat or very uncomfortable with the introduction of AI tools into their clinical practice."
A particular source of concern revolves around transparency and data retention policies associated with the company’s use of AI software like Abridge for note-taking. While a Kaiser representative stated that staff are not mandated to use the tool and that patient consent is required, the underlying fear of technological displacement persists. Kristi Reimer, a licensed psychologist who previously conducted mental health triage assessments at Kaiser’s Walnut Creek facility, preemptively resigned from her position. She explained her departure by stating she "saw the writing on the wall," indicating that the drastic changes to Kaiser’s mental health assessment system compelled her to seek opportunities elsewhere.
The palpable anxiety among the existing workforce is exemplified by Harimandir Khalsa, who performs triage for Kaiser in Walnut Creek. Khalsa reports that her team of nine staff members has been reduced by two-thirds over the past two years. Despite her deep commitment to her role, where she utilizes decades of research and clinical experience to support vulnerable patients, she cannot help but feel anxious about her future. The realization that clerical staff and questionnaires are now performing aspects of her job, albeit inadequately in her view, leads her to ponder, "Am I next? What is my future?"
The Indispensable Role of Licensed Therapists in Triage
The NUHW contends that a patient’s initial interaction when seeking mental health support is pivotal, often determining whether they will ultimately see a licensed clinician and the nature of the care they receive. This underscores the union’s intense concern over Kaiser’s recent patient assessment modifications and its persistent demand for greater transparency regarding the company’s use of technology in initial evaluations.
In NUHW’s Southern California complaint filed last year, the union detailed how clerical staffers inquire about suicidal and homicidal thoughts before inputting this sensitive information into a software tool. This tool’s algorithm then purportedly generates a score and a suggested response to guide the staffer in scheduling further care. The union alleges that Kaiser is using an algorithm to make triage decisions, a practice that, if true, would violate state law. Kaiser, however, vehemently denies that this screening constitutes triage, maintaining that its clerical staff are not making assessments or clinical determinations. The precise involvement of an algorithm in Northern California remains unclear, though the union suspects its presence, and Kaiser has not provided definitive clarification.
The complexities of mental health triage demand the nuanced judgment of a licensed professional. Relying on unlicensed workers adhering to rigid scripts presents significant limitations. Therapists often leverage their extensive expertise to discern the true meaning behind a patient’s statements, especially in critical situations. For instance, when a caller expresses suicidal thoughts, a skilled healthcare worker needs to delve deeper: Are these thoughts active or passive? Has a method been considered? If a patient expresses uncertainty about their intentions, what specific ambiguity are they referring to? As Khalsa emphasizes, the answers to these questions are rarely straightforward and require sophisticated clinical inquiry. Conversely, patients may sometimes self-diagnose or exaggerate symptoms, inadvertently diverting crucial resources from those in more urgent need.
Carolyn Staehle, a therapist who joined Kaiser’s intake and assessment department in Pleasanton, California, in May 2023, witnessed firsthand the ramifications of the new system. After its rollout, Staehle, whose role was initially focused on non-emergency cases post-triage, encountered a surge of patients experiencing dangerous delusions and severe suicidal ideations. She recounted instances where she had to call ambulances because patients could not ensure their own safety or collaboratively develop a safety plan. More recently, Staehle, now on a crisis team for higher severity cases, finds her team receiving "people who don’t need [them]." This misdirection of resources, she argues, "gums up and slows down the work, so that people who are in immediate, desperate need might not get through."
A Pattern of Scrutiny and the Path Forward
Kaiser Permanente has a documented history of facing state and federal scrutiny concerning timely access to mental health services. In 2023, the healthcare giant agreed to a substantial $200 million settlement with the state of California to resolve investigations into these very delays. Just last month, in February 2026, the U.S. Department of Labor announced a $31 million settlement with Kaiser over similar allegations. The Labor Department specifically claimed that Kaiser "used patient responses to questionnaires to improperly prevent patients from receiving care." As part of this federal investigation, Kaiser also committed to reforms aimed at reducing appointment wait times and enhancing access to quality care.
Despite these commitments, Kaiser employees remain skeptical. They highlight the inherent shortcomings of relying on questionnaires and clerical workers in a field as sensitive and complex as mental health. Kaiser maintains that it delivers "timely, high-quality care to meet members’ needs" and asserts that its members receive non-urgent mental health appointments, on average, faster than state requirements. However, Staehle and her colleagues express deep concern for staff who fear AI-driven replacement and for overwhelmed patients who, she believes, often miss out on the empathetic and timely care they desperately need during the triage process. "It’s not the same level of care as being assessed by a licensed therapist," Staehle states emphatically. "It takes longer for each patient to find out whether they are going to be a danger to themselves or a danger to others, or is this an emergency or not? We actually have to waste time taking care of some of this fundamental stuff that used to be done by triage."
The current focus for Staehle and other mental health professionals is the ratification of a new contract, central to which is the demand for Kaiser to unequivocally commit to not replacing licensed social workers and therapists with AI. The ongoing dispute at Kaiser Permanente reflects a broader societal tension between the pursuit of efficiency through technology in healthcare and the imperative to preserve human-centered care, particularly in the delicate realm of mental health. The outcome of these negotiations and the resolution of the union’s complaints will undoubtedly have significant implications for patient care standards and the future of mental health service delivery, not only within Kaiser Permanente but potentially across the wider healthcare industry.
