Over 2,000 mental health workers at Kaiser Permanente facilities across Southern California went on strike in the fall of 2024. This was the longest mental health worker strike in U.S. history.1 The work stoppage involved issues with pay equity and burnout, with some therapists noting they were seeing up to 14 patients per day with no time between appointments.2
The strike ended last May. However, the battle over long wait times for therapy services, unmanageable caseloads, and an ongoing mental health workforce shortage continues to impact service delivery across California and the nation.
But what does this mean for you and your mental health? This article will explore how therapist strikes are affecting treatment access across the state, along with:
- What happened during the Kaiser therapist strike
- How strikes affect mental health treatment access in the short and long-term
- Why California’s mental health system was already under tremendous strain
- What the therapist shortage means for those seeking mental health care
- What to do if your access to services has been disrupted, and where to find support
The Kaiser Therapist Strike in California
Nearly 2,400 mental health therapists, psychologists, social workers, and psychiatric nurses walked off the job on October 21st, 2024. This was after their contracts had expired earlier that month and negotiations had stalled. The strike lasted for 196 days in all, ending on May 5th, 2025, when workers ratified a new four-year agreement.
The Southern California-based clinicians were largely advocating for benefits already granted to their colleagues across the rest of the state. This was because Kaiser staffed around 40% fewer mental health workers in the southern half of the state, despite having somewhere around 200,000 more members there.3
Clinicians were also demanding greater pay equity, restored pensions, and dedicated time each week to handle the administrative work that high-quality patient care requires.
On the patient side, the impacts of the strike were immediate: therapy sessions were canceled at what California Senate President Pro Tempore Mike McGuire described as “an alarming rate.”4 Kaiser directed all affected clients toward outsourced telehealth services they established, with many finding themselves starting over with an unfamiliar therapist or forced to wait for a resolution to the strike.
Workers on the picket lines had previously complained of patients having to regularly wait for months between appointments due to therapists carrying unmanageable caseloads before the strike began.
Eventually, the contract workers agreed to a 20% raise over the course of the new four-year contract. This was along with a modified pension plan and five guaranteed hours per week for administrative tasks to be completed.5 The workers’ union, for their part, acknowledged the agreement wasn’t a complete win – Kaiser therapists still earn far less than their colleagues on the medical side.
Strikes and Their Impact on Treatment Access
Unfortunately, therapy appointments for those in need are canceled indefinitely when workers strike for better pay or working conditions. There are also several other critical areas that equitable mental health treatment access can be impacted by a strike. These impacts include:
Short-Term Effects
When therapists strike, health systems usually look to bring in replacement workers to maintain some level of service. In this instance, Kaiser paid replacement therapists $13,000 a week during the Southern California strike.6
Replacement workers can cover appointments, but they can’t replace the continuity and history of well-established therapeutic relationships. A therapeutic alliance and relationship built over time is vital to therapy. So a patient who has spent months working through their trauma or trying to stabilize their mood can’t necessarily pick things up with someone new at the drop of a hat.
Long-Term Effects
The longer-term effects of strikes in California reveal therapy access issues in the state that have existed for years. Mental health care waitlists tend to get even longer during a strike and don’t always recover quickly when an agreement is reached.
What’s more, strikes often happen when working conditions have deteriorated to the breaking point, and therapists who left their jobs during the dispute don’t always come back. According to Kaiser’s own figures, one in four Southern California therapists hired between January 2021 and August 2024 had already left the company before the strike began.7
California’s Ongoing Mental Health Challenges
In October 2023, one year before Kaiser’s strike began, the California Department of Managed Health Care fined the company 50 million dollars. This was the largest fine in state history for violating mental health parity laws. State investigators found that, in 2022, less than half of follow-up appointments were completed within ten days of the prior appointment. Kaiser accepted the fine and acknowledged the problem, but the issues continued, leading up to 2024’s strike.8
On the whole, mental health care in California has long been understaffed, undefined, and held to much looser standards than physical health care. While mental health parity laws were created to make these issues better, the gap in day-to-day operations remains troublesome, as it leads to workforce shortages.
Workforce Shortages
The mental health provider shortage in California predates any single labor dispute, as demand for therapy has grown markedly since the pandemic. At the same time, the pipeline for trained clinicians simply hasn’t kept up.
Therapists working in community and institutional settings are often forced to carry caseloads that make providing meaningful care all but impossible. This causes many to leave for private practice where they can decide their own pay and hours.
Years of low wages, limited administrative support, and the resulting burnout have all become commonplace in these settings, depriving vulnerable client populations from the benefits of ongoing and accessible care.
The Ramifications of California’s Therapist Shortage
The mental health workforce shortage affects everyone looking for care, not just Kaiser patients. Reduced therapy access in the state means communities have fewer available providers – and also leads to practicing therapists and agencies struggling to absorb the people left behind.
This means that communities with fewer private providers, including low-income areas, rural regions, and non-English speaking populations, have been left at a loss.
A system stretched this thin also directly contributes to high therapist turnover, meaning people in ongoing treatment are forced to start over again with new providers. Each restart has the potential to disrupt their progress and creates a major ask of someone who may already be dealing with difficult symptoms and overall instability.
What to Do if Your Access to Therapy Has Been Disrupted
Losing access to your therapist can be disorienting, especially if you’re in the middle of treatment or dealing with circumstances outside your control. But your insurance company has a legal obligation to provide you with access to covered mental health services in a reasonable timeframe. So call the member services number on the back of your card and ask them about what alternatives they can arrange. Be sure to document these calls – they may be required to provide out-of-network access if they can’t find you an in-network provider.
The following are other steps you can take if you find yourself without access to your therapist:
Consider Telehealth as a Bridge
Therapy access in California has expanded rapidly over the past six years, and virtual providers can sometimes offer an appointment much faster than in-person clinics. If you’re feeling left in the lurch, telehealth can help support you in maintaining your momentum.
Know When to Get Immediate Help
If you’re experiencing a crisis, don’t wait for an appointment to open up. Most health systems have same-day services, and the 988 Crisis Line is available by call or text 24 hours a day, 7 days a week. This service can provide you with support and potential referrals to ways you can access care.
Find High-Quality, Dependable Care at Mission Connection
Mission Connection offers outpatient, telehealth, and many more mental health services designed around continuity and accessibility. We’re here to help you get started and access the support you need for continued and sustained recovery. We provide evidence-based care, holistic interventions, and the respect and dignity you and your loved ones deserve.
Contact our admissions team today to learn more about our programs and verify your insurance coverage, free of charge. We’re here for you and eager to help you get started.
Frequently Asked Questions About California Therapy Strikes
If the therapy strikes in California have affected your access to care, you might still have some questions after the information in this artice. If so, the following answers to FAQs on the strikes may help.
Can I File a Complaint if My Care Was Disrupted?
You can file a complaint with the Department of Managed Health Care if you think your insurance provider failed to provide you with timely access to care. California has a history of holding insurance companies accountable, and mental health parity laws mean they should work with you to find a solution in the short term.
Do Mental Health Workers Strike More Often in California?
Ultimately, conditions are what drive a strike. Low pay relative to training requirements, high caseloads, inadequate support, and high levels of burnout – all of these issues are sadly common in mental health care. Provider shortages and chronic underfunding can create rising pressures that build up until workers feel they have little option but to act.
Is California’s Access Problem Getting Better?
Legislative pressure and high-profile strikes such as those undertaken by Kaiser’s workers have pushed the issue further up the agenda for lawmakers. But the mental health workforce shortage has been structural for many years, and these issues will take time to reverse. Demand for care continues outpacing the supply of trained clinicians, a gap that isn’t likely to close quickly.
References
- Garcia, J. (2025, April 15). A Kaiser strike by mental health workers drags on — setting a US record — as talks resume. CalMatters. https://calmatters.org/health/2025/04/kaiser-strike-mental-health-workers/
- CBS 8. (2024, October 21). 2,400 Kaiser staff walk out, citing “broken” mental health care system. Cbs8.com; KFMB. https://www.cbs8.com/article/news/local/2400-kaiser-staff-walk-out-citing-broken-mental-health-care-system/509-2f299a76-9965-4d4d-9df6-aef167adce52
- California Healthline. (2025, February 7). Kaiser Permanente Back in the Hot Seat Over Mental Health Care, but It’s Not Only a KP Issue – California Healthline. California Healthline. https://californiahealthline.org/news/article/kaiser-permanente-mental-health-parity/
- Garcia, J. (2024, December 20). “I have no safety net”: Mental health patients anxious as Kaiser SoCal strike hits week 10. CalMatters. https://calmatters.org/health/2024/12/kaiser-strike-mental-health-southern-california/
- Vogel, S. (2025, May 9). After 6-month strike, Kaiser Permanente mental health workers ratify a new contract. Healthcare Dive. https://www.healthcaredive.com/news/kaiser-permanente-mental-health-workers-contract-southern-california/747638/
- Labor Notes. (2025, May 29). Long Strike Yields Big Gains for Kaiser Mental Health Workers. https://labornotes.org/blogs/2025/05/long-strike-yields-big-gains-kaiser-mental-health-workers
- National Union of Healthcare Workers (2025, May 8). Kaiser mental health workers ratify contract after 196-day strike. https://home.nuhw.org/2025/05/08/kaiser-mental-health-workers-ratify-contract-after-196-day-strike/
- California Department of Managed Health Care. (2026). DMHC Press Releases. Ca.gov. https://www.dmhc.ca.gov/Resources/Newsroom/PressReleases/October12