LOS ANGELES (AP) — More than 2,400 Kaiser Permanente psychologists, therapists, social workers and other mental health workers in Southern California began an open-ended strike Monday over increased workloads and staffing shortages that their union said have created a “substandard” system of care.

The National Union of Healthcare Workers, which represents the employees, is negotiating a new contract with the Oakland-based health giant. It said the strikers demand Kaiser hire more people to ease the burden put on the current staff.

Kaiser said in a statement Monday that the union has been “slow-walking” negotiations, despite the strong proposals the health care company has put on the table. Meanwhile, the union’s proposals “have been overreaching and unreasonable,” the statement said.

Picket lines went up outside Kaiser facilities in Los Angeles, Orange, San Bernardino and San Diego counties.

Antonia Rodarte, a licensed marriage and family therapist for Kaiser, traveled to LA for the work action with about 35 colleagues from Bakersfield, California.

“We are seeing that burnout is getting worse and worse among our colleagues. People are quitting. They can’t keep up with the workload,” said Rodarte. “Kaiser is emphasizing numbers of patients to be seen over quality of care.”

Natalie Espinoza, a psychiatric counselor, said Kaiser facilities in Southern California are “understaffed and overworked.” She said she sees up to 10 patients a day, routinely works through lunch and rarely has time to keep up with her documentation and other required paperwork.

Workers prepared for the strike over the weekend after declining Kaiser’s terms on Friday.

Kaiser called the walkout “entirely unnecessary” and said the union is demanding more money for therapists to spend less time seeing patients.

“The union is proposing that full-time therapists increase the amount of time they are not seeing patients to nearly half of their time – at least 19 hours a week. This is unacceptable and would significantly decrease access to appointments for mental health care for our patients,” Kaiser said.

It’s the second strike by Kaiser therapists in two years. A 10-week walkout in 2022 by mental health workers in Northern California ended with Kaiser agreeing to provide more time for patient care duties that can’t be done during appointments, while also increasing staffing and providing more services at its mental health clinics.

Monday’s strikers want those same gains for Southern California workers, said Democratic state Sen. Maria Elena Durazo, who joined the LA picket line.

“These workers are saying, ‘Hey, wait a minute. You do this in Northern California. How about the people in Southern California? Don’t we deserve the same kind of working conditions?’” Durazo said.

Kaiser said that it was notifying patients whose appointments could be affected by the strike. “Patients will have the opportunity to be seen by another professional in our extensive network of highly qualified, licensed therapists if their regular provider is engaged in a strike,” the statement read.

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Associated Press writer Christopher Weber in Los Angeles contributed to this report.