In many ways, it was the usual protest scene. Dozens of striking mental health care workers chanted and marched Tuesday outside a Kaiser Permanente medical center on a busy strip of Sunset Boulevard in Los Angeles. Passing cars honked in support. People vigorously waved homemade signs.

But a few of the striking workers sat quietly under a tent, conserving their energy and mixing electrolyte drinks – their only planned sustenance for five days.

Frustrated and feeling unable to get their voices heard after nearly six months of a strike to demand more pay and benefits, these eight therapists were taking their protest to the next level with a five-day hunger strike.

It’s “an effort on our part to let them know that we are serious,” said Aida Valdivia, a licensed marriage and family therapist, who is one of the hunger strikers.

Many workers on strike are already sacrificing, says Valdivia, by draining their savings accounts, going to food banks, and borrowing money from friends and family over these last months.

“We’ve had to limit our food anyway,” said Valdivia. “So basically you are kind of starving us, Kaiser.”

The workers began their strike in October, arguing that they deserve the same pension that other Kaiser Permanente workers receive, and pay equivalent to their colleagues in the same therapeutic positions in other parts of the state.

They also argue that other health care workers at Kaiser with similar levels of training, such as occupational therapists and radiation techs make up to 40% more than those in mental health.

Many say they don’t have time to eat or go to the bathroom in between clients. Their demands include more time in between patients for things like scheduling and paperwork.

Some workers have returned to their jobs, but hundreds remain on strike without pay. Organizers believe it is the longest strike of mental health workers in U.S. history.

Kaiser Permanente – an organization that functions as an insurer and as the largest provider of health care in California – has paid millions of dollars in fines in recent years to the state for its behavioral health system’s failure to provide adequate care. Many fines were related to long wait times, which mental health professionals hold up as another indicator of the overworked and understaffed workforce.

Kaiser Permanente representatives acknowledge that some benefits and pay are not equal with others, but argue that they still pay their workers competitively.

The mental health workers do receive retirement benefits, but argue that the benefit is not the same as the generous pension that their colleagues in other departments – including those that work in administration or service positions – earn. When asked if this was true, Kaiser representatives responded that they did not know.

In a written email statement, Kaiser Permanente spokesperson Terry Kanakri said the union was “demanding significantly higher pay to care for fewer patients.” He and other representatives argue that Southern California has different economic dynamics from other parts of the state, and maintain it is the company’s “responsibility to balance providing a generous contract for our employees with keeping high-quality care accessible and affordable for our members.”

Eight workers camped out in a church fellowship hall for a week together while they were on a five-day hunger strike. They rented one hotel room and took turns using the shower.

Katia Riddle / NPR

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Katia Riddle / NPR

Still, the hunger strike is making Kaiser Permanente management take notice. “Having our employees go on a hunger strike is very disturbing to us,” says Patty Clawson, senior vice president of the continuum of operations and clinical services for the company in the Southern California region.

Clawson says management is eager to get back to the bargaining table: “We are committed to finding the common ground for all of us.”

‘Is it normal to be getting chills?’

Sitting under the tent with other hunger strikers, Adriana Webb checked in with a nurse who came by to monitor their progress. “I felt like I was getting a little bit of chills,” said Webb, who was on her second day of the hunger strike. “I Googled it and it said it could be because I’m in ketosis from not eating.”

“It’s a little early for that,” replied David Verdiner, a nurse who works in the gastrointestinal department and was giving up his lunch hour to offer this medical counsel. “It could be your blood sugar is a little bit low.”

Verdiner is one of a number of volunteers from other unions who are doing medical oversight for these strikers. “The bigger thing is that you feel fine today,” he reassured her. “Your body’s going through withdrawals, right? You’re used to having three meals a day.”

Supporting the strikers nearby on the picket line, Sal Roseli held a sign that read “Same company, same work. Why not same wages, pension, benefits?”

Formerly president of the National Union of Healthcare Workers, Roseli says Kaiser Permanete has an opportunity to be a leader on the issue of mental health parity. He imagines this hunger strike could help lead the U.S. to a time when “the term mental health care doesn’t exist. It’s simply health care.”

Lack of mental health parity – equality in pay and investment between mental health care and physical health care – is a national issue. One report showed roughly two-thirds of Americans with a diagnosed mental health condition were unable to access treatment, though they had health insurance.

California has passed parity laws to put mental health on the same footing as physical health. Roseli says it’s time for the state’s medical institutions to show their commitment.

California’s history of hunger strike

While hunger strikes are not common as an organizing tool, some trace their history back to Cesar Chavez’s historic farm worker strikes. “ At least in my reading of it, a very California thing,” says Erik Loomis, a labor historian at The University of Rhode Island. “It’s very much connected to the Chavez experience.”

Loomis cautions that when strikes persist, it can be a challenge for workers to prevail. “When you have a strike that lasts a long time, it becomes very difficult to win that strike because usually that means the employer has the upper hand,” he says.

Doing something extreme like a hunger strike, says Loomis, could be a curveball. “ Given the goals of that strike, it may be quite effective,” says Loomis, but he cautions that in the competition for eyeballs and ears in America, “getting attention has become harder.”

On Friday, the union announced they had scheduled new bargaining dates next week with Kaiser Permanente. It was the first meeting in a month, since previous negotiations deteriorated.

Tom Morello, longtime member of rock band Rage Against the Machine, stopped by to cheer on the strikers on Tuesday with a quick concert. “I’m a union man,” he told the cheering crowd. “When you say union, I say power!”

Tom Morello of the band Rage Against the Machine told the striking workers that he’d grown up with a single mom who was a high school teacher, and in a union. “ We never had a lot of money, but we had enough money for food on the table. Shirts on our back and amplifiers in our basement.” None of that would have been possible, he said, without the labor movement.

Katia Riddle / NPR

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Katia Riddle / NPR

After a few songs on the sidewalk, Morello left the strikers with this: “It’s my belief that the future of the working class in this country will not be decided by Congress. It will not be decided in the courts,” says Morello.

“It’ll be decided by the solidarity of people just like you on days just like this.”