A Post-CAHOOTS Eugene

The Next Chapter in Crisis Assistance

When CAHOOTS shut down Eugene operations on April 7, we lost a critical public service. Replacing it will require close collaboration among several stakeholders. It seems unlikely that the piecemeal replacement system will work as well as the original.

CAHOOTS—Crisis Assistance Helping Out On The Streets—was a service of White Bird Clinic, a non-profit founded in 1970. CAHOOTS began as the “freak out van” operated by a group of volunteers. Their mission was to help people with substance abuse or mental health crises avoid negative interactions with police. It evolved into highly effective response to a variety of public order and health issues on the streets, and it was funded in part through the police department. The model worked so well to help those in trouble without deploying public safety professionals that it was publicized and widely imitated across the country in recent years.

A CAHOOTS crew and van, courtesy of White Bird.

What caused CAHOOTS’ Closure? Can It Be Revived? While opinions differ about the specific causes of the closure, almost all agree that it lacked the financial resources necessary to continue. Restoring CAHOOTS in Eugene requires new funding. CAHOOTS fell victim to a larger crisis in local government funding, driven by costs that rose faster than revenue grew. Having served on both the Eugene Budget (and Revenue) Committee and in the Legislature, I see this mismatch of funding to need as the natural conclusion of a series of decisions by the voters and the Legislature to restrict local decision-making in this area of community life. The fire fee on the November ballot provides the best possibility of at least a partial restoration of this or a similar service. If the fire fee passes, CAHOOTS may rise again.

Can Other Services Fill the Gap? Replacing CAHOOTS with other services requires covering the variety of roles it filled in town - non-emergency medical response, transportation to service providers, and crisis de-escalation. At Egan Warming Centers, for example, CAHOOTS provides non-emergency medical response for circumstances that require more than the basic first aid volunteers can offer but that did not require a full EMS response. Largely due to advocacy by Rep. Nancy Nathanson, Eugene-Springfield Fire has expanded their Basic Life Support (BLS) service with assistance from the state. This service filled an important gap in the EMS training pipeline and freed up more highly-trained and better-equipped EMS crews for more serious calls. However, BLS also currently lacks a sustainable funding model. The County could provide a street medicine service through the Community Health Centers of Lane County (CHC), offering a degree of prevention and perhaps some limited-hours response capacity. Although County revenues are similarly constrained, the the CHC has the capacity to bill insurance for these services.

CAHOOTS provided non-emergency transportation to medical and shelter services for people living on the streets. During cold waves, they brought many people to Egan Warming Centers. They brought people to medical services when their needs exceeded those CAHOOTS could meet, but did not rise to needing an emergency response. As long as BLS lasts, its ambulances will likely get stuck providing this service by default. Lane Transit District could also provide rides to shelters and greater access to paratransit during emergencies. However, transit services are also at risk, due to reduced ridership after the pandemic.

LTD RideSource paratransit, courtesy of LTD.

Eugene police will likely handle street crisis de-escalation. CAHOOTS and EPD collaborated most closely in this service, with both responding to calls. EPD officers cleared the scene once it was stable enough to be safe for CAHOOTS to handle independently. While EPD has significantly increased mental health training for its officers, ratios of police officers to population remain low, leaving little time for police to do more than address the immediate public safety needs in a crisis. Put another way, without CAHOOTS, people in crisis will have less opportunity for the kind of care that will immediately address the problem and reduce the chances of a crisis happening again.

Unfortunately, we lack a good alternative to CAHOOTS at the moment, although the County’s plan for a stabilization center and PeaceHealth’s new mental health facility may take up some of the burden when they come online sometime in 2028.

Proposals to fill the gaps left by CAHOOTS’ Eugene closure all rely on new funding from government sources, either in the form of tax revenues or public health insurance payments. Until these funds are realized, Eugene will likely address crises on the streets through a variety of services less well designed to handle them. In a city where few disputed the need for CAHOOTS, it’s a shame to see so little planning to replace it.

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