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CAHOOTS (Crisis Assistance Helping Out On The Streets) is a mental-health-crisis intervention program in
Eugene, Oregon Eugene ( ) is a city in and the county seat of Lane County, Oregon, United States. It is located at the southern end of the Willamette Valley, near the confluence of the McKenzie River (Oregon), McKenzie and Willamette River, Willamette rivers, ...
, which has handled some lower-risk
emergency An emergency is an urgent, unexpected, and usually dangerous situation that poses an immediate risk to health, life, property, or environment and requires immediate action. Most emergencies require urgent intervention to prevent a worsening ...
calls involving
mental illness A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
and
homelessness Homelessness, also known as houselessness or being unhoused or unsheltered, is the condition of lacking stable, safe, and functional housing. It includes living on the streets, moving between temporary accommodation with family or friends, liv ...
since 1989. This makes it the earliest, or one of the earliest, Mobile Crisis Teams. In most American cities, police have been responding to such calls and at least 25% of people killed in police encounters had been suffering from serious mental illness. Many cities in the US and elsewhere have been considering and implementing implementing something like CAHOOTS. In 2015, Stockholm a similar concept was considered a success. In early 2020, Denver started a similar program. After the
George Floyd protests The George Floyd protests were a series of protests, riots, and demonstrations against police brutality that began in Minneapolis in the United States on May 26, 2020. The protests and civil unrest began in Minneapolis as Reactions to the mu ...
that year, several hundred cities in the US interested in implementing similar programs requested information from CAHOOTS. In 2021, the US enacted legislation to cover 85% of the expenses for three years for Mobile Crisis Teams, directing $1 billion to the effort. By the end of the year, many cities were starting such programs, such as Minneapolis'
Behavioral Crisis Response Behavioral Crisis Response (BCR) is a behavioral health emergency response program in Minneapolis, Minneapolis, Minnesota. This program dispatches unarmed mental health professionals to 911 call center, 911 calls. It is run by Canopy Mental Heal ...
. By 2024, most US states had multiple cities implementing such programs, or had them available state-wide.


Program

Calls to
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, or calls to
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that are related to
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, disorientation,
mental health Mental health is often mistakenly equated with the absence of mental illness. However, mental health refers to a person's overall emotional, psychological, and social well-being. It influences how individuals think, feel, and behave, and how t ...
crises, and homelessness but which don't pose a danger to others are routed to CAHOOTS. Staff members respond in pairs; usually one has training as a
medic A medic is a person trained to provide medical care, encompassing a wide range of individuals involved in the diagnosis, treatment, and management of health conditions. The term can refer to fully qualified medical practitioners, such as physic ...
and the other has experience in homeless street outreach or mental health support. Responders attend to immediate health issues, de-escalate, and help formulate a plan, which may include finding a bed in a
homeless shelter Homeless shelters are a type of service and total institution that provides temporary residence for homelessness, homeless individuals and families. Shelters exist to provide residents with safety and protection from exposure to the weather whi ...
or transportation to a healthcare facility. CAHOOTS is dependent upon the availability of other services: a team may be able to talk a person in crisis into going to a hospital or a homeless shelter, but there must be a hospital or homeless shelter available to accept the person. In 2020, the service began operating 24 hours a day. CAHOOTS does not handle requests that involve violence, weapons, crimes, medical emergencies, or similarly dangerous situations. Some calls require both CAHOOTS and law enforcement to be called out initially, and sometimes CAHOOTS calls in law enforcement or law enforcement calls in CAHOOTS, for instance in the case of a homeless person who is in danger of being ticketed. About 60% of all calls to CAHOOTS are for homeless people. In 2019, CAHOOTS responded to 13% of all emergency calls for service made to the Eugene Police Department (EPD). Many of the calls made are requests for CAHOOTS service and not ones to which police would normally respond. In 2019, 83% of the calls to which CAHOOTS responded were for "Welfare Check", "Transportation", or general public assistance, none of which are traditionally handled by EPD. Thus the "true divert rate"—meaning the proportion of calls to which police would have responded were it not for CAHOOTS—was estimated to be between 5-8%. Calls handled by CAHOOTS alone require police backup only about 2% of the time, although that rate is much higher when responding to calls that police would normally handle. For example, in 2019 when CAHOOTS responded to calls for "Criminal Trespass" and located the subject, they needed police backup 33% of the time. The internal organization operates under a non-hierarchical, consensus-oriented model. As of 2020, most staff were paid US $18 per hour. In 2018, the program cost $800,000, as compared to $58 million for the police.


Challenges and resources for replicating the model

Some places have struggled to implement this model because it is dependent upon the existence of appropriate
social services Social services are a range of public services intended to provide support and assistance towards particular groups, which commonly include the disadvantaged. Also available amachine-converted HTML They may be provided by individuals, private and i ...
in the area. One director at CAHOOTS asks, "Where are you going to bring someone if not to the hospital or the jail?" Taleed El-Sabawi and Jennifer J. Carroll wrote a paper detailing this and other considerations for local governments to keep in mind, as well as offering model legislation.


History

CAHOOTS was founded in 1989 by the Eugene Police Department and White Bird Clinic, a nonprofit mental health crisis intervention initiative that had been in existence since 1969 as an "alternative for those who didn't trust the cops." From its founding, White Bird Clinic had an informal working relationship with local law enforcement. The establishment of CAHOOTS formalized the relationship. The name, an acronym for Crisis Assistance Helping Out On The Streets, was chosen because the White Bird Clinic "was now 'in cahoots' with the police."


See also

* Homeless street outreach


References

{{Reflist Eugene, Oregon Mental health organizations based in Oregon Law enforcement non-governmental organizations in the United States Organizations established in 1989 Non-profit organizations based in the United States Criminal justice reform in the United States Emergency mental health services