EUGENE, OREGON – In Josie McCarthy’s 17 years as a program manager at The Dining Room, she says she has never needed to call police to break up violence or disputes. The dine-in restaurant serves 1,000 meals per week to low-income and unhoused people in downtown Eugene, Oregon. Servers deliver steaming plates of food to booths and counter seats inside the cozy, colorful building.
But when a diner refuses to leave, shows up without shoes, or is disoriented or agitated, McCarthy has a few different options. She can either use her training as a social worker to resolve the situation. Or, she can request backup from the city’s mobile intervention unit called Crisis Assistance Helping Out On The Streets (CAHOOTS).
“Many struggle with mental wellness, and we depend on CAHOOTS whenever one of our guests is in crisis,” McCarthy said in an email.
She adds, “Just because you’re mentally ill doesn’t mean you’re a criminal.”
Available 24/7, CAHOOTS offers counseling, conflict resolution and mediation, information and referral, transportation to social services, first aid, basic-level emergency medical care and more. While many communities dispatch a police officer as the de facto response to a mental health crisis, this program in Eugene sends two-person teams of crisis workers and medics as an alternative. Employees wear polos and sweatshirts rather than bulletproof vests and guns, and they have no authority to arrest or ticket someone.
There remains growing interest around the country in rethinking how law enforcement responds to residents in mental health crises, with some programs, like CAHOOTS, working to take them out of the equation when possible.
Wichita is among the cities that are adapting. The county’s community mental health center, Comcare, operates a non-911 phone number for mental health emergencies. Teams of therapists and case managers respond to situations, but funding and manpower has been limited.
In 2019, the city and the county established a pilot program within the police department called Integrated Care Team (ICT-1) in response to an increase in calls related to mental health. Similar to Eugene, teams of qualified mental health professionals and paramedics respond to 911 calls involving a mental health crisis, including suicidal ideation, substance use and psychosis and delusions. But for every situation, regardless whether it’s nonviolent, law enforcement officers on duty are also sent as a co-responder.
A new collaboration between Wichita and Comcare will add four mobile mental health response teams of one crisis clinician and one integrated care specialist each in 2023. These teams can be dispatched with or without law enforcement, officials say.
Eugene has a population of 175,000, with 15% in poverty, according to the most recent Census data. About 1% of the population is unhoused adults and many experience mental illness, according to the police department.
Wichita’s population is more than double Eugene’s, at 395,000, with 15% in poverty. The main differences between CAHOOTS and ICT-1 is that police are sent no matter what in Wichita whereas there’s a separation from the police through White Bird Clinic in Eugene.
Because the ICT-1 program is still so new to the community and the public perceives it as extra police response, there’s still confusion about how ICT-1 can help without making things worse in a mental health crisis. CAHOOTS has been around long enough that people know who to call.
In the past, ICT-1 has had limited hours, from 8 a.m. to 6 p.m. Monday through Thursday, which Sedgwick County said was based on data about the busiest times for mental health needs. The four new crisis response teams next year will ensure that mental health professionals are on call to respond to mental health crises between 8 a.m. and 3 a.m. seven days a week.
But the newness of Sedgwick County’s efforts stand in contrast to the longevity of Eugene’s approach.
CAHOOTS has been around since 1989, when the first shift was funded by the Eugene Police Department. It is one of 10 programs staffed and trained by White Bird Clinic, which was started in 1969 by a grassroots group of medical workers, university grad students, and other citizens wanting to help people who felt alienated and disenfranchised from the mainstream system.
After many years operating a 24-hour crisis line, the clinic decided to create a response program to provide on-site support at the community’s request. They then formalized their relationship with police through CAHOOTS.
The program receives funding through the police department’s budget for community crisis response, which equals around $2 million annually, which equals 2% of the total budget.
As a result, CAHOOTS’ role in advancing public safety in Eugene is visible and widely known in ways that Wichita’s ICT-1 has yet to reach. With Wichitans becoming more familiar with the co-responder model, the Eugene experience suggests that alternatives to traditional law enforcement interventions can become accepted over time as key infrastructure within the system.
LIGHTENING THE LOAD
Here’s how CAHOOTS works:
When a 911 or nonemergency call comes to the city’s public safety communications center, dispatchers assess the situation and decipher who to send. Sometimes people will directly request CAHOOTS if they know about the program; other times dispatchers decide. But if the situation involves any indication of crime, violence or life-threatening emergencies, police are assigned as either primary or co-responders.
Amid nationwide conversations about police reform, Eugene has received an influx of requests from outside communities looking to model policing alternatives after CAHOOTS, such as two hours north in Portland where the city implemented a street response team.
Evidence from the Vera Institute, an independent research nonprofit and policy organization dedicated to criminal justice reform, shows that police across the U.S. have become the default first responders for a variety of social issues. They’re then overburdened by an ever widening scope of duties, even though they aren’t always appropriately equipped or even needed.
In a study of 911 call data from nine cities,of the 15.6 million community-member initiated calls from January 2019 to November 2021, Vera researchers found that an average of 19% of calls could be answered by unarmed crisis responders. These calls include welfare checks, complaints, vehicle towing, loitering and mental health concerns.
The study also revealed that no more than 7% of calls are for situations involving violent crime that pose a public safety risk, requiring a police response.
In Eugene, CAHOOTS has meaningfully lightened the police’s load over its 33 years. In 2021, dispatch received 137,527 calls for service, according to data provided by the city. Of those, CAHOOTS was dispatched and arrived at 16,479—nearly 12 percent of all calls. And older data from the city shows that out of 24,000 calls to CAHOOTS in 2019, 311 required police backup.
By reducing unnecessary police contact and policing’s overall footprint, officers can prioritize public safety and law enforcement, jobs they’re better trained to handle, said Eugene Police Chief Chris Skinner. Instead of sending people through the criminal justice system, CAHOOTS helps reroute them to available services in town where they can get continued care.
“It’s not lost on me that when we deal with somebody in crisis, it shouldn’t take too long to identify how many different systems in our society have failed that person before law enforcement arrives,” Skinner said in a prerecorded video provided to the media, given the spike in interest for the program. “What we want to do is get back to fully funding some of the systems that are going to better result in successful outcomes and wellness for people that we’re dealing with out on the streets.”
According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) best practice guide, a successful system is a stool with three legs: a crisis call center, a crisis mobile team and adequate crisis receiving and stabilization facilities.
The last leg of the stool isn’t whole across Oregon, though. Lane County District Attorney Patricia Perlow said the state’s mental health system is completely broken. Firstly, the newest state hospital built in 2012 isn’t taking new patients. Due to lack of funding, she said, multiple local services have diminished over the years, including the psychiatric hospital once connected to the Lane County Jail, assisted living facilities and substance treatment.
Further exacerbating the community’s mental health problems, she adds, there are very few circumstances in which the court can order somebody to take medication or get treatment. “This issue is huge and the state, not just here but around the state, has hoisted off the responsibility and the liability to the counties,” Perlow said.
Tailoring a program to community needs
A single program like CAHOOTS can’t effectively be a catchall.
The support systems in Eugene, though scarce, include the food bank, senior and disability services, housing agencies and organizations serving families. Without this network, CAHOOTS wouldn’t have anywhere to refer people dealing with substance abuse, homelessness, disabilities, and other social and health issues.
Many of the existing providers are government-run, but folks who prefer an intermediary to the system seek out places like Relief Nursery, an independent nonprofit that serves vulnerable families through respite childcare, basic needs and parenting education. Its model has been replicated in 41 other communities, said Kelly Sutherland, the organization’s executive director.
Collaborating with the other providers is key to the network’s success. “We really see White Bird Clinic and CAHOOTS as a critical piece of the infrastructure of this community,” she said.
However, the heavy workload and high turnover of CAHOOTS workers is a continuous challenge, said Skinner. With only two to three units on the streets every day, resources are severely limited, especially as calls have increased by 6,800 since 2014. Additionally, workers are paid a starting wage of $18 an hour, only $4.50 higher than Oregon’s minimum wage.
McCarthy of The Dining Room said there’s always a delay when she requests CAHOOTS. “Frankly, if someone is here with shorts and no shirt freezing, we think that’s urgent,” she said. “A lot of times if we don’t say the emergency status of it, there’s a wait.”
And sometimes CAHOOTS won’t even show up because its channel is so overwhelmed.
“Most of the time they do a really good job, but they are just so limited in what they can do,” said Rhaichelle Aphrodite Missathena, who uses White Bird Clinic as her mailing address. “When they stack up 20 or 30 deep on the calls, who do you go to first or which is the most important?”
The safety of non-police workers is also top of mind for Skinner, and it’s a question public safety professionals around the country are grappling with as cities adopt policing alternatives.
Laurence Miller, a Florida-based psychologist who consults with regional and national law enforcement agencies, is an advocate for training a special cadre of police officers to handle mental health situations. That way, mental health professionals who aren’t trained in public safety wouldn’t be putting their lives at risk in the event a scenario turns dangerous.
“The proof of this is that there is already a group of law enforcement officers who are trained to use verbal intervention strategies quite effectively: These are hostage negotiators,” Miller said.
“They deal with what are arguably the most critical situations you could possibly have.”
But research from the American Psychological Association suggests that uniformed officers with police vehicles and handcuffs can actually escalate mental-health-related situations, particularly in communities of color, contributing to mass incarceration and distrust in the criminal justice system. In comparison, a program like CAHOOTS has the ability to build trust within the community by providing advocates rather than enforcers because of its arms-length separation from the police department.
“We know what happens when police intervene if they take a mentally ill person into custody,” Sutherland said. “They end up in (inpatient services) or somewhere else and then they’re right back on the street again.”
There is certainly room for improvement in Eugene, say experts and community members. To remove the barrier of police involvement and serve more people, White Bird Clinic has a long-term goal of creating a crisis line that doesn’t intersect with the city’s communication center. Empathy is its leading principle.
“We have made a strict ethical commitment to being a voluntary service, so we cannot inflict care upon someone who is able to refuse, and we cannot force someone to go anywhere,” said Arlo Silver, a program coordinator at CAHOOTS. “This has definitely played a part in the trust folks have for us. I also think that our workers care deeply about the clients they serve and this care is felt by our clients.”
When implementing CAHOOTS as a model in another community, one size does not fit all. Municipalities and jurisdictions in states and cities across the U.S. must figure out what non-police programs work best for their community’s needs.
“What we do in Eugene doesn’t necessarily mean it’s going to work wherever you are,” Skinner said. “What happens in Eugene is unique to Eugene because we have unique needs.”
One way to find out is by asking the community what resources would be helpful, Sutherland suggests. As it has evolved, Relief Nursery continues to base programming off the desires of the families.
If Wichita can learn anything from Eugene’s mobile crisis team, it’s that resources are needed around the clock, money must be made available for it to work, demand requires more than two teams on the streets, and a successful infrastructure requires an abundance of community-based resources where people can get help for a spectrum of issues.
At the very least, if communities design a system around their unique needs like Eugene has attempted, Skinner said, “there’s a tremendous chance that you could free up law enforcement resources to do the other things that we all are trying to find time to do.”
Crisis Intervention: Key Differences between Eugene, Oregon, and Wichita
- Eugene implemented its program in 1989 and is a well known entity in the community, while Wichita is just getting started
- Annual funding ($2 million) comes from the police department’s budget
- CAHOOTS is staffed and trained by White Bird Clinic, an independent health clinic
- Mental health-related calls either come through Comcare or 911 in Wichita, but calls in Eugene filter through the centralized public safety communications center
- In the past, ICT-1 teams have included police, whereas CAHOOTS sends police only if the situation involves crime, violence, or life-threatening emergencies.
- In 2023, four mental health response teams in Wichita will be dispatched with or without law enforcement
- CAHOOTS is 24/7, while ICT-1 has limited hours
Amelia Arvesen is a freelance journalist based in Portland, Oregon. She writes most about the intersection between people and the outdoors, but she also closely follows mental health and criminal justice reform. She graduated from the University of Kansas William Allen White School of Journalism and Mass Communications in 2015 and went on to work at The Ottawa Herald as her first job in the field. Her recent bylines can be found in Outside, Via Magazine and Texas Monthly, among other publications.
This story was produced as part of the Wichita Journalism Collaborative, a coalition of 10 newsrooms and community partners including The Journal. Kylie Cameron of KMUW and Matthew Kelly of The Wichita Eagle contributed to this story.