This town of 170,000 replaced some cops with medics and mental health workers. It's worked for over 30 years
Updated 10:10 PM ET, Sun July 5, 2020
(CNN)Around 30 years ago, a town in Oregon retrofitted an old van, staffed it with young medics and mental health counselors and sent them out to respond to the kinds of 911 calls that wouldn't necessarily require police intervention.
In the town of 172,000, they were the first responders for mental health crises, homelessness, substance abuse, threats of suicide -- the problems for which there are no easy fixes. The problems that, in the hands of police, have often turned violent.
Today, the program, called CAHOOTS, has three vans, more than double the number of staffers and the attention of a country in crisis.
CAHOOTS is already doing what police reform advocates say is necessary to fundamentally change the US criminal justice system -- pass off some responsibilities to unarmed civilians.
Cities much larger and more diverse than Eugene have asked CAHOOTS staff to help them build their own version of the program. CAHOOTS wouldn't work everywhere, at least not in the form it exists in in Eugene.
But it's a template for what it's like to live in a city with limited police.
It's centered around a holistic approach
Nurse Celene Eldrich, a volunteer nurse for CAHOOTS, waits to screen guests for health concerns at the Egan Warming Center's Springfield location in March.
CAHOOTS comes from White Bird Clinic, a social services center that's operated in Eugene since the late 1960s. It was the brainchild of some counterculture activists who'd felt the hole where a community health center should be. And in 1989, after 20 years of earning the community's trust, CAHOOTS was created.
It stands for Crisis Assistance Helping Out on the Streets and cheekily refers to the relationship between the community health center that started it and the Eugene Police Department.
Most of the clients White Bird assisted -- unsheltered people or those with mental health issues -- didn't respond well to police. And for the many more people they hadn't yet helped, they wanted to make their services mobile, said David Zeiss, the program's co-founder.
"We knew that we were good at it," he said. "And we knew it was something of value to a lot of people ... we needed to be known and used by other agencies that commonly encounter crisis situation."
It works this way: 911 dispatchers filter calls they receive -- if they're violent or criminal, they're sent to police. If they're within CAHOOTS' purview, the van-bound staff will take the call. They prep what equipment they'll need, drive to the scene and go from there.
The program started small, with a van Zeiss called a "junker," some passionate paraprofessionals and just enough funding to staff CAHOOTS 40 hours a week.
It always paired one medic, usually a nurse or EMT, with a crisis responder trained in behavioral health. That holistic approach is core to its model.
Per self-reported data, CAHOOTS workers responded to 24,000 calls in 2019 -- about 20% of total dispatches. About 150 of those required police backup.
CAHOOTS says the program saves the city about $8.5 million in public safety costs every year, plus another $14 million in ambulance trips and ER costs.
It had to overcome mutual mistrust with police
White Bird's counterculture roots ran deep -- the clinic used to fundraise at Grateful Dead concerts in the West, where volunteer medics would treat Deadheads -- so the pairing between police and the clinic wasn't an immediately fruitful one.
There was "mutual mistrust" between them, said Zeiss, who retired in 2014.
"It's true there was a tendency to be mistrustful of the police in our agency and our culture," he said. "It was an obstacle we had to overcome."
And for the most part, both groups have: Eugene Police Chief Chris Skinner called theirs a "symbiotic relationship" that better serves some residents of Eugene.
"When they show up, they have better success than police officers do," he said. "We're wearing a uniform, a gun, a badge -- it feels very demonstrative for someone in crisis."
It seeks to overturn a disturbing statistic
And there's a great deal of people in Eugene in crisis.
Lane County, which encompasses Eugene and neighbor city Springfield, has staggering rates of homelessness.
The county's per-capita homeless rate is among the nation's highest. Recent data from the county also suggests mental health crises are widespread, too -- the suicide rate, at around 17 deaths per 100,000, is about 40% higher than the national average.
Police encounters with the homeless often end in citations or arrests. Of homeless people with mental health conditions, anywhere from 62.0% to 90% of them will be arrested, per one journal review of homelessness studies. They may end up in jail, not in treatment or housing, and thus begins the cycle of incarceration that doesn't benefit either party.
CAHOOTS was created in part because of another disturbing statistic -- around 25% of people killed by police show signs of mental illness, according to a journal review of the Washington Post's extensive officer-involved shootings database.
The Eugene Police Department has been criticized in years past for shooting and killing people with mental illnesses. Most recently, in February, the city won a wrongful death lawsuit brought by the family of a man who was shot by police. His loved ones said he was a veteran with PTSD who'd threatened suicide. (Skinner was appointed chief in 2018, three years after the shooting.)
I believe it's time for law enforcement to quit being a catch-base for everything our community and society needs.
Most of CAHOOTS' clients are homeless, and just under a third of them have severe mental illnesses. It's a weight off the shoulders of police, Skinner said.
"I believe it's time for law enforcement to quit being a catch-base for everything our community and society needs," Skinner said. "We need to get law enforcement professionals back to doing the core mission of protecting communities and enforcing the law, and then match resources with other services like behavioral health -- all those things we tend to lump on the plate of law enforcement."
Its staffers are unarmed
There's no such thing as a "typical" CAHOOTS shift these days, said Ben Brubaker, who worked as a CAHOOTS crisis worker before assuming the senior role of clinical co-coordinator at White Bird.
Staffers respond to substance addiction crises, psychotic episodes, homeless residents and threats of suicide. They make house calls to counsel depressed children at their parents' request, and they're contacted by public onlookers when someone isn't in a position to call CAHOOTS themselves.
Unlike police, CAHOOTS responders can't force anyone to accept their aid, and they can't arrest anyone. They're not armed, and their uniform usually consists of a White Bird T-shirt and jeans -- the goal is that the more "civilian-like" they look, the less threatened their clients will feel.
Their approach is different, too. They're taught in training to abandon the "pseudo-professional" affect that staffers inadvertently take on in talks with clients. And aside from an extensive background in medical care or mental health, all CAHOOTS employees are judged by their "lived experiences," Brubaker said -- people who've dealt with many of the situations CAHOOTS clients find themselves in are better able to empathize and serve those people, he said.
Building that rapport and trust with clients is part and parcel with their clinical work.
"That can be tricky," Brubaker said. "We show up in a white van."
The demand for its services continues to grow
Cahoots crisis councilor Ned White, left, and EMT Rose Fenwick wrap up a day shift with a stop in Eugene in December 2018.
For most people they assist, though, that's still preferable to a police cruiser.
They can call police or EMS for assistance if the case requires a "higher level of care" than CAHOOTS can provide, he said. But much of it they can do on their own. They can transport clients to hospitals, shelters or White Bird Clinic, where they'll have access to medical and dental care and counseling.
Support continues to swell -- CAHOOTS receives about $2 million, which Zeiss says is almost three times what its budget was when he retired in 2014. And CAHOOTS a few years ago expanded to serve neighboring Springfield.
But the program is still working with just three vans, which are staffed 24/7. The workload can be overwhelming, Brubaker said.
The high demand, low capacity model is holding CAHOOTS back, said Ibrahim Coulibaly, a former White Bird volunteer who serves as the president of the Lane County NAACP chapter. Expanding CAHOOTS' services so it had its own campus, too, could improve its reach, he said.
With more funding, he said, reallocated from the police budget or another source, the program could respond to even more crises, with even more employees and, hopefully, at least one more van.
CAHOOTS could use more than another van, though, said June Fothergill, a pastor at a Springfield church who calls CAHOOTS to pick up the homeless people or people with substance use issues that stop by for free meals.
Fothergill said while CAHOOTS does its part well -- providing immediate services to someone in crisis -- there's still a void when it comes to long-term solutions.
"You can call someone for the crisis, but what are they supposed to do for it -- where can they take them except for jail?" she said. "That doesn't necessarily provide much treatment."
They're better equipped than police to care for the people she serves, she said. But if there isn't space in affordable housing, Eugene's detoxing center or mental health facilities, those clients will turn into regulars.
"They're doing what they can do," she said. "There's wonderful work going on, but it isn't adequate at the moment."
It says a partnership with police is essential
The idea of "defunding the police" crept into the mainstream just one month ago, since the death of George Floyd sparked nationwide protests against racism and police brutality. But what the term means depends on who you ask.
Advocates for limiting the role of police have pointed to Eugene as an example of social service providers and law enforcement working in harmony.
But a growing group of dissenters feel there's little room for police in the movement to fundamentally change the American criminal justice system. Services like CAHOOTS, they say, may function better and more broadly without the assistance of police.
Zeiss isn't sure he agrees.
"Partnership with police has always been essential to our model," he said. "A CAHOOTS-like program without a close relationship with police would be very different from anything we've done. I don't have a coherent vision of a society that has no police force."
He said the current movement has seemingly pitted service providers like CAHOOTS against police, which may stoke suspicion among police over "whether we're really their allies or their competitors," he said.
"In some sense, that may be true. But I think we still need to focus on being part of a system, and a system that includes police for some functions," Zeiss said.
Partnership with police has always been essential to our model. I don't have a coherent vision of a society that has no police force.
Skinner, the Eugene police chief, said reallocating funds from Eugene police would stifle the department, which is already money-tight, and its ability to do the work to defend CAHOOTS when situations turn violent.
"Anytime you're thinking about what meaningful change looks like, especially that's sustainable, it takes a significant amount of engagement from stakeholders," he said. "While I totally understand people's desire to do something very, very quickly, we kind of need to keep our eyes on the prize here. If we want to reform police, we have to do it methodically and strategically."
It's become central in the 'defund the police' debate
Coulibaly said community leaders are in talks over what to do about police -- should their funding go to CAHOOTS, or should more funding be directed toward better educating police about deescalation techniques? They haven't reached a consensus, he said.
"If the city doesn't have enough money to fund CAHOOTS, probably they should think about reallocating some of the funds that go to police to support CAHOOTS," he said.
Brubaker said the relationship with police remains strong, but CAHOOTS is evaluating the calls for change from the public, who've directed their support toward the program. He said staff are figuring out what shape the program will take going forward, but there's no clear path.
"We're not trying to be the face of a mainstream institution," he said. "We're just people serving people."
Other cities are trying to develop a similar model
The idea of a separate entity in charge of alternative care is more enticing than ever as cities mull over the efficacy of their police departments.
CAHOOTS has met the moment. Brubaker said he's consulting with cities on how to implement their own CAHOOTS-inspired program, subbing White Bird Clinic for a local organization that serves a similar role.
There are a few criteria, though, that Brubaker considers immutable: The CAHOOTS stand-in should be operated by a local non-profit separate from the government that already has an established, positive rapport with the community, and it should ideally be staffed by people who reflect the diversity of that community.
CAHOOTS consulted Olympia, Washington, on the creation of its own Crisis Response Unit, which is staffed by two social workers. Denver is piloting a program, also inspired by CAHOOTS, led by a local social justice organization.
... but there is no one-size-fits-all solution
White Bird Clinic and CAHOOTS coordinators can't go into other communities and set up copies of CAHOOTS. What works in Eugene wouldn't work in New York, or in Miami, or in larger cities more diverse than Eugene (less than 2% of the population is Black, according to census data).
Brubaker knows that a "fill-in-the-blank" style of reform wouldn't work. But CAHOOTS does provide a template.
"I guess the role that I see for our agency isn't to go in and tell other communities what they need to do and should be doing," he said. "Our role is to assist those communities to have a conversation with each other about what they need and what that response can look like."
It's not an immediate fix. Zeiss said it took a lot of "patient plotting" for CAHOOTS to really have an impact.
"At this point, we've patiently waited out an entire generation of police officers," he said. "There's nobody on the Eugene police force today who can remember being a Eugene police officer without CAHOOTS. It's been that slow of a process."
That doesn't mean other cities shouldn't try.
"You have to start," he said. "You can start immediately by creating something and expand it as confidence in it grows."
Another city's CAHOOTS may not be called CAHOOTS at all, though it'll probably use another cutesy acronym. It's not likely to satisfy advocates who want to defund the police entirely. But, if done right, it could change the lives of some of a city's most vulnerable people.
