Ilana Marcucci-Morris, a licensed clinical social worker at Kaiser Permanente’s psychiatry outpatient clinic in Oakland, California, has grown increasingly concerned about the mental health of her patients. More often, she finds herself evaluating individuals experiencing severe mental health crises who, in her opinion, should have sought emergency care weeks earlier. “Thank God they’re still alive,” she reflects on those who manage to attend their appointments.
This situation marks a significant shift in the delivery of mental health care at Kaiser, according to Marcucci-Morris. Traditionally, licensed professionals were the primary point of contact for patients with behavioral health issues. However, in January 2024, Kaiser introduced a new screening process for first-time patients, which involves clerical staff asking scripted “yes” or “no” questions to evaluate the urgency of patients’ needs. The healthcare giant has also rolled out e-visits—online questionnaires that patients complete before being scheduled with licensed professionals.
On a recent Wednesday, Marcucci-Morris joined about 2,400 mental health professionals in Northern California, represented by the National Union of Health Care Workers (NUHW), in a one-day strike. The protest aimed to highlight concerns over the new screening processes and fears that Kaiser plans to use AI to replace licensed therapists in certain capacities. “Human work needs to stay with human beings,” she asserted.
Five licensed therapists at Kaiser have reported that the new screening system has contributed to longer wait times for high-risk patients. Meanwhile, lower-risk individuals are sometimes fast-tracked, exacerbating an already strained system. Since January 2025, more than 70 instances of negative care outcomes linked to Kaiser’s mental health screening have been documented in an administrative complaint filed with the California Department of Managed Health Care.
Kaiser, in response, has claimed that the NUHW’s assertions regarding access and care are misleading. In an emailed statement, the company emphasized that “AI and clerical staff are not conducting any assessments, making any clinical determinations nor conducting clinical triage.” They added that clerical staff are trained to escalate urgent cases to clinical professionals. Kaiser also contended that it is expanding its workforce rather than reducing it, although NUHW representatives argue that the number of triage therapists has significantly declined.
“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,” Kaiser stated. Despite this, a 2025 survey of Kaiser’s mental health workers revealed that over one-third expressed concerns about the impact of emerging technologies, including AI, on their work and patient care. Nearly half reported discomfort with the integration of AI tools into their clinical practice.
Concerns Over AI Integration
Many therapists are particularly worried about the transparency and data retention policies associated with Kaiser’s use of AI software for note-taking. Kristi Reimer, a licensed psychologist who previously conducted triage assessments at Kaiser, preemptively left her position due to the significant changes she observed in the mental health assessment system. “I saw the writing on the wall,” she remarked.
Harimandir Khalsa, who conducts triage at Kaiser’s Walnut Creek facility, noted that her team has shrunk by two-thirds over the past two years, but she remains committed to her role. Despite her dedication, she harbors anxiety about her future as clerical staff and questionnaires increasingly take on responsibilities she believes should belong to licensed professionals. “Am I next? What is my future?” she wonders.
The NUHW’s complaints underscore the importance of initial patient assessments in determining whether individuals receive care from licensed clinicians. The union argues that the new screening processes, which involve clerical staff asking sensitive questions about suicidal thoughts, are inadequate. According to the NUHW, the algorithm used to guide care suggestions violates state law, although Kaiser disputes this characterization.
Kaiser has faced scrutiny over its mental health service access. In 2023, the company settled with California for $200 million following investigations into service delays. Additionally, the U.S. Department of Labor announced a $31 million settlement last month over similar allegations. Kaiser has agreed to reforms designed to enhance access to timely care.
Yet, employees remain skeptical of these commitments. They argue that reliance on questionnaires and clerical staff can lead to inadequate triage, risking the well-being of patients in urgent need. Carolyn Staehle, a therapist who joined Kaiser in May 2023, reported an increase in encounters with patients displaying severe mental health crises. “They needed me to call an ambulance for them because they could not guarantee their safety,” she said.
Despite Kaiser’s claims of delivering timely, high-quality care, Staehle emphasizes the need for licensed therapists in the triage process. “It’s not the same level of care as being assessed by a licensed therapist,” she noted. As she and her colleagues work to ratify a new contract, they are also advocating for assurances that AI will not replace licensed social workers in their critical roles.
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