It’s been nearly two months since CAHOOTS, Eugene’s groundbreaking street response program, shut down in the city after decades of service. Now, community members and former crisis workers are trying to bring the program back.
This story includes discussions of suicide.
If it weren’t for CAHOOTS, Rebecca Hill doesn’t know if she’d still be alive.
Over a 15-year period, she said crisis workers helped her through five different emergencies.
"In 2006, I was up on top of the famous parking garage that folks like to jump from,” said Hill. “And someone from the community saw me there, and they asked me if I needed help, and I said, ‘not unless you're going to push me.’
“Thankfully, they called CAHOOTS,” said Hill. “The response time was almost immediate, which was wonderful. They spoke to me for over an hour, and ultimately they drove me to [a local behavioral health treatment facility], where I was able to receive the help that I needed.”
She says she was saved in part by the kindness and calmness that CAHOOTS workers showed her.
“They're respectful of each individual as an individual–which is something that I have not received from others in the medical community or the psychiatric community,” said Hill. “I believe that they are personally invested in every single person that they come across."
CAHOOTS was founded in 1989 as an alternative to police response for people who were facing homelessness, mental illness or substance abuse.
Driving through Eugene and Springfield in white vans, workers provided medical aid, medical transports, de-escalation for people in crisis, and more.
Stacy Bierma Welch, a founder of the homeless outreach group RAVEN, said the program built trust with the local community.
“I have a family member that has needed their help multiple times. The times that he's been most successful is when CAHOOTS was able to help him to the hospital and do the warm handoff of behavioral health,” she said. “They're not imposing. They're non-threatening. They're there to meet people's needs, as opposed to police their behavior.”
CAHOOTS drew a burst of national attention in 2020, following the murder of George Floyd. Some advocates touted it as a potential model that other cities could use to prevent police violence.
But that all changed in April of this year, as CAHOOTS services in Eugene came to a screeching halt.
The shutdown
The organization behind CAHOOTS is White Bird Clinic, a nonprofit that’s been showing signs of turmoil for months.
Last December, White Bird shut down its long-standing Front Rooms department, and laid off its workers there. Then, in February, its executive director abruptly resigned.
And while White Bird had city funding for its CAHOOTS services, its contract with Eugene only covered about 40% of the cost to operate in the city, according to interim Executive Director Amée Markwardt.
Justin Madeira, CAHOOTS’ program coordinator, said there wasn’t enough support to keep the mobile crisis service operating as it was.
“We didn't foresee some of the expenses that we have raising with inflation, cost of living, moving up cost of providing our services,” said Madeira. “And with our new administration, federally, there were just a lot of fiscal changes that occurred very quickly."
White Bird then announced it was going to dramatically cut CAHOOTS services in Eugene starting in early April. The plan was to go from 24/7 services to just two shifts a week.
Instead, the City of Eugene and White Bird ended up severing their contract entirely. City officials said CAHOOTS could no longer provide the service hours it had previously agreed to.
Michelle Perin, a former CAHOOTS worker, said staff had already experienced a growing sense of corporate hierarchy at White Bird. She said news of the layoffs and the closure left care workers feeling completely powerless.
“We were advocating for the team continuing to be viable 24/7 and to be able to work with all of our community partners and our parent agency to make that happen,” said Perin. “We saw that that was maybe not the same vision that our agency had.”
After the end
Today, CAHOOTS only operates in Springfield. Madeira said that means there are people in Eugene who can’t access some services where and when they need it.
“One of the big ones is wound care, especially for people who don't meet the need of the emergency room or who are unable to get to our local hospitals,” said Madeira.
Eugene-Springfield Fire Chief Mike Caven told KLCC the loss of CAHOOTS hasn’t yet resulted in a significant increase in emergency calls. But he said it may be too early to know the full story.
Perin, the former care worker, argued it’s only a matter of time before the preventative work CAHOOTS has done wears off, and people begin falling back into crisis.
“We don't know how many people aren't calling because they don't have that option anymore,” said Perin. “Some family members of people who are struggling with mental health behaviors, if they know that all they're going to get is a law enforcement response, they're going to be waiting until it is absolutely a critical moment before they reach out.”
For Eugene residents, there are still crisis responders available through Mobile Crisis Services of Lane County. Although it’s not currently running 24/7, program leaders say the plan is to scale up to those hours by the end of June.
There are several differences between that program and CAHOOTS, however.
Lane County's program is funded through the state. As part of that mandate, it bills Medicaid for its services, collecting information from the clients it interacts with.
But while Medicaid covers those crisis responses, It doesn’t pay for other types of outreach services that CAHOOTS previously provided in Eugene.
“We have to focus on the folks that are in acute crisis by statute,” said Olivia McClelland, the Principal Manager of Behavioral Health for Lane County, which oversees the county’s service. “That’s what we are.”
Unlike CAHOOTS, the county’s service can also take a client to a hospital involuntarily. Julie Speir, a supervisor with the program, previously told KLCC that's only used as a last resort when someone poses a danger to themselves or others.
Hill, the former recipient of CAHOOTS services, said there’s also the problem of branding. She said Lane County’s program is visually tied with the government—which could discourage clients who have previously experienced system trauma, or are suspicious of institutions.
“Anyone who has been involved in those kinds of systems does not want a vehicle that visibly represents one of those systems to show up at their house when they are in crisis,” said Hill.
Perin argued that while more social services are always a good thing, the county still needs CAHOOTS.
Returning to Eugene
White Bird still hopes to reintroduce CAHOOTS to Eugene, said Madeira. But he said the first step is making sure the program is fiscally stable.
To do that, he said White Bird has been working to get CAHOOTS approved to offer billable behavioral health services, so it’s not entirely reliant on contracts for its funding.
“We're working hard to be able to do that eventually–getting to a point where we're able to start doing that rehiring, retraining, if necessary, and bringing on enough staff where we could support Eugene,” said Madeira, “but doing so in a responsible and just-as-slow-as-necessary way to make sure that if and when we return to Eugene, we stay.”
At the same time, a new organization is also trying to recreate CAHOOTS’ services, but separate from its former parent organization.
Willamette Valley Crisis Care was founded by Perin and three other former or current CAHOOTS workers. She said the goal is to find new sources of funding to support CAHOOTS-like services—including leveraging workers’ experiences through paid consultations with other cities looking to provide similar services.
“The amount of experience that our CAHOOTS workers or former CAHOOTS workers have–we’re talking like 100 years of experience,” said Perin. “They are credentialed, trained, and truly understand how to do client led, non-coercive mobile integrated crisis care.”
Perin said WVCC is in final talks with a fiscal sponsor which could give it access to Medicaid billing, which she declined to name.
The workers are now seeking city funding. Those efforts are backed by a community organization called Friends of CAHOOTS.
Eugene is currently facing a significant budget shortfall, and its attempt to pass a fire services fee has been challenged.
But after the City Council voted last month to raise stormwater fees for additional revenue, the Budget Committee recommended that the city allot $500,000 in one-time funding for an alternative response transition.
Eugene City Manager Sarah Medary said this money could be for training for existing staff, or towards a “Request for Proposal” for a new service.
“It felt like it was a good faith effort to show that the city supports this CAHOOTS-like model being brought back to the city as quickly as possible,” said Perin, “and that the maneuvering to make sure that it's fully funded, that it'll be fiscally supported, is the intention of everyone.”
The Budget Committee has also asked Eugene City Council to have staff explore ways to find $2.2 million for CAHOOTS-like services, and to present those results in October.
The Eugene City Council is expected to pass a finalized budget in late June, which would take effect July 1.
Rebecca Hill
Today, Rebecca Hill works as a mental health peer support specialist in Eugene, and serves as the co-chair of the Lived Experience Advisory Guild for Unhoused Engagement, an advisory group for the county.
She said she’s been well for several years. But she said she still has family members and clients who rely on CAHOOTS for services.
Hill said it's embarrassing that the Eugene community has let the service go unfunded. She said they should be ashamed.
She said everyone in Eugene—poor or rich, homeless or housed—deserves to have a program like this available when they need it.
"I never once imagined that CAHOOTS wouldn't be here. I could always call on CAHOOTS. I could always count on them,” said Hill. “And it's a tragedy that they're gone, and I hope they don't stay gone for much longer."
If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline by calling or texting 9-8-8, or the Crisis Text Line by texting HOME to 741741.
