Jessica Dominguez went to work at Kaiser Permanente Hospital in Richmond, California in 2014, enthusiastic about working with Spanish speaking patients. A licensed marriage and family therapist and daughter of Mexican immigrants, she had worked in East Bay Latino communities for a number of years. Richmond, she figured, would keep her on her toes: the city as a whole is 44% Hispanic, and in some neighborhoods around the hospital, that number climbs to over 80%.
However, she found that Kaiser offered very little to Spanish speakers. There was a poorly attended meditation class and another support group that ministered to about half a dozen people. “There weren’t any other services in this large Latinx community, although there were robust services in English,” Dominguez said. She inquired about the injustice. “I was literally told by management: Spanish speakers don’t come,” Dominguez recalls. “I thought, well, that’s bullshit because I’ve been working in this space with the Spanish-speaking community for a long time.”
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In 2015, she convinced Kaiser to start a pilot program aimed at strengthening its services in Spanish, which grew into a permanent program in Richmond called La Clínica, where she is the lead clinician. It wasn’t long before attendance rates for Spanish speakers surpassed those of English speakers. The clinic team grew from six to 20. When they interviewed patients, they learned that a third had heard of La Clínica through word of mouth. It was a success story that Kaiser trumpeted.
But La Clínica’s ability to bridge the gap between Kaiser and Richmond’s Spanish-speaking community created a new problem: The therapists were overwhelmed and unable to keep up. “How do we support people when we don’t even have time to go to the bathroom?” asked Dominguez. She said she raised the issue of needing more resources and staff to meet the mental health needs of the Latino community in half a dozen meetings with Kaiser leadership, but gotten nowhere. “My team is burning out – we’re falling like flies.”
At the end of the month, La Clínica will lose another clinician: Dominguez himself. “I couldn’t go on and be part of a system that hurts people,” she said, referring to the burden on both therapists and patients, many of whom are six Having to wait weeks between follow-up appointments.
Dominguez is one of more than 2,000 Kaiser psychiatric workers who have been on strike since Aug. 15 as members of the National Union of Healthcare Workers. (Disclosure: NUHW is a financial supporter of Capital & Main.) Her criticism of Kaiser echoes that of other clinicians, who cite an inability to provide quality care due to high caseloads. But Dominguez and other clinicians also point to the unique challenges faced by immigrants trying to access mental health services in languages other than English, who are bearing a disproportionate amount of the trauma caused by COVID-19.
“There’s a lot of stigma around therapy and mental health in the Latino-Latinx community,” said Jesus Solorio, a bilingual Kaiser therapist in Oakland. “It takes a lot of courage to approach and use these services. Patients are really disillusioned — it took them so much energy to request services and now I’m telling them they won’t be able to see me for six weeks.” Before moving to Kaiser, Solorio worked at a small community mental health agency in Hayward, who he believed had more Spanish-speaking therapists than the entire Oakland psychiatric department. “The resources are not there for us.”
In the wake of the nationwide protests sparked by the killing of George Floyd, Dominguez helped spearhead a survey on racial justice issues of more than 1,500 psychiatrists at Kaiser facilities across California that also included challenges for their non-English speaking patients. More than a quarter of respondents indicated that they had patients who were unable to access treatment in their native language and 36% indicated that their patients were struggling because materials were not available in their native language. Among the top recommendations was hiring more bilingual and culturally diverse staff.
In an emailed statement, a Kaiser representative said that more than 18% of its therapists identify as Hispanic or Latino and more than 7% as Black or African American, and that it is investing $30 million to create a new and to recruit and train a diverse mental health professional workforce. “At Kaiser Permanente, we are building a highly inclusive, engaged and psychologically secure workplace where everyone has an equal opportunity to reach their full potential and use their diverse perspectives and strengths in support of our mission.”
Last December, Dominguez learned from colleagues in San Francisco that Kaiser was planning to cancel its only Spanish- and Chinese-language therapy groups in the city because attendance was low. “It’s a pervasive issue at Kaiser,” she said. “If people from other cultures or languages don’t show up, the first course of action is to cancel it and reallocate resources elsewhere.” In San Francisco, there are 90,000 Chinese speakers with limited English skills and another 32,000 Spanish speakers. Classes were canceled despite protests from Dominguez and others.
For Dominguez, it was another painful example of why, after eight years at Kaiser, it was time to move on. “When I see a Kaiser poster in Spanish, I want to scream,” she said, fighting back tears. “Because what you say on that billboard you don’t deliver in Spanish. I don’t care if you show brown people. It is not true.”
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