GoKawiilWhen Kaiser Permanente triage clinician Harimandir Khalsa began working in the psychiatry department at Kaiser’s Walnut Creek Medical Center in Northern California, she was on a team of nine people. Today, just over three years later, she is one of only three triage clinicians left. Some of the work once handled by employees has shifted to automated and algorithmic tools.
This change has coincided with a sharp increase in the number of patients who are upset by the time they speak to her. On a typical day, as many as a third of her almost two dozen triage calls are with patients who have struggled to access appropriate care.
“What has increased is frustration. Sometimes people are like, ‘I’ve been sent all over the place,’” she said. The decline in triage staffing and the increasing use of artificial intelligence-powered systems at Kaiser have also led to dangerous delays, missed diagnoses and inappropriate treatment decisions, according to multiple Kaiser mental health care workers.
To understand some of the ways that AI is affecting mental health care, Capital & Main spoke with more than a dozen therapists, clinicians, academic experts and advocates in Wisconsin and California, who said the hasty integration of the technology is eroding patients’ access to timely and appropriate mental health care. While AI is changing work in many professions, its use can have particularly high stakes in the mental health field, workers said, by creating barriers to care for patients who are already struggling with major depression, bipolar disorder and other serious conditions.
Increasing transparency around its use and blocking the deployment of AI in triage decisions have become major goals in collective bargaining for these workers. Already something of a national leader in AI regulation, the state of California, where Kaiser is headquartered, now has pending legislation that would create safeguards around the technology in medical settings.
Capital & Main interviewed mental health care workers employed by Kaiser and Rogers Behavioral Health, a Wisconsin-based provider of addiction and mental health treatment. Spokespeople for these health care providers denied that their AI systems are replacing the work of mental health professionals. “Clinical assessments, triage and treatment decisions are made by licensed clinicians, and any technology we use is designed to support — not replace — clinical judgment,” Kathleen Chambers, a Kaiser spokesperson, wrote in an email.
Distressed Patients and Dangerous Delays
About two years ago, Ilana Marcucci-Morris, a Kaiser therapist who works in Oakland, noticed that the path to mental health care was becoming increasingly dictated by technology. Instead of being referred directly by primary care doctors and contacted to schedule appointments, patients were routed through an app, nonclinical call center staff or simply given a phone number to call. “Now the onus is on the patients to be their own care coordinators,” she said.
This dynamic can be particularly challenging for some patients. “Lack of motivation and lack of follow-through are the most common symptoms of depression on the planet,” Marcucci-Morris said. “We wouldn’t tell a paraplegic, ‘Hey, walk down the hall in order to get your wheelchair.’”
Khalsa and Marcucci-Morris are now spending more time doing what is called “service recovery” — the effort to repair trust in patients whose expectations of care haven’t been met. Even when broader use of automated and algorithmic systems does not eliminate human jobs, it can change their nature, increasing the emotional labor needed to reassure patients disserved by those very systems.
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