CAHOOTS: An Alternative Approach To Mental Health

In most US states, police respond to mental health related 911 calls. But in Eugene, Oregon, CAHOOTS arrives to deescalate the situation. CAHOOTS, which stands for Crisis Assistance Helping Out On The Streets, is a mobile mental health crisis intervention team who answers calls regarding suicide, manic episodes, overdoses, and other mental health crises.

CAHOOTS was founded in 1989 and the model was developed through discussions with the city government, police department, fire department, emergency medical services (EMS), mental health department, and others. Although CAHOOTS had very limited availability in Eugene when it first started, it has expanded to a 24-hour operation in Eugene and Springfield, with several vans operating during peak hours. Last year alone, they responded to nearly 23,000 calls.

Since they are often called upon to respond to people in the midst of a mental health crisis, police officers have become de facto social workers, mental health counselors, and medical specialists, but most officers lack the experience and qualifications to handle these issues.

As a consequence incidents can easily escalate, in fact people with untreated mental illness are 16 times more likely than the general population to be killed during a police encounter. According to a report by the Treatment Advocacy Center, about 1,000 people are shot dead by police each year. It is estimated that severe mental illness is a factor in at least 25% of such shootings. CAHOOTS is fighting to drive that number down.

CAHOOTS personnel operate in unarmed pairs including a crisis worker as well as an EMT and respond to calls taken by police dispatchers. Using police radios they coordinate with the police departments and community partners to determine which calls are appropriate for their team, and then meet community members at their location. This takes these cases off of the local police officers plate allowing them to respond to the kinds of calls they are trained to address.

If a CAHOOTS member arrives at a scene and determines that they need police officers support, they can contact them over their radios. Thus far, no employee has ever lost their life or been seriously injured on the job despite never carrying a weapon, and no individuals have died as a result of CAHOOTS arriving to help.

These mobile crisis teams can also connect individuals with community resources such as walk-in crisis centers, permanent supportive housing, or substance abuse facilities. But communities must, in turn, identify these needs and invest in such programs.

The success of the program has not gone unnoticed, Denver is starting its own version of CAHOOTS and city leaders from Oakland, Olympia, Washington and even New York City are all considering similar pilot programs. 

With more programs like CAHOOTS, we can reduce the number of mentally ill people going into prison, admitted to the emergency room against their will, and the trauma experienced by those in a behavioral health crisis by modifying our 911 dispatch system. CAHOOTS is an innovative way to protect, serve, and potentially save a life.

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