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Crisis team may get Southern Oregon version

When neighbors called about an elderly woman prowler at an apartment complex, police weren’t called to the scene.

Instead, a crisis team made up of a medic and a mental health counselor arrived in their van.

They found her in her apartment, eating dog food and throwing plates.

That’s when the medic noticed a prescription bottle for antibiotics and realized the woman was suffering from sepsis — severe inflammation triggered by an infection. Symptoms of sepsis can include confusion.

They rushed her to the hospital for treatment.

If she had been arrested, her life-threatening condition might not have been recognized by jail staff.

Even if they eventually realized it was a medical problem and sent her to an emergency room, the situation would have included an unnecessary police response and a jail booking.

Tim Black tells that story when people ask why Eugene, Springfield and Lane County back a crisis intervention effort that pairs mental health counselors with EMTs or nurses. The White Bird Clinic operates the Crisis Assistance Helping Out on the Streets program, known as CAHOOTS.

Black is the operations coordinator for the program that has attracted national attention.

When non-emergency calls come into the Eugene area’s 911 center, dispatchers assess whether to send out a CAHOOTS team. If the situation is life-threatening, involves violence or a serious crime, dispatchers send out police, paramedics or firefighters instead.

In 2018, CAHOOTS handled 24,000 calls — saving time for first responders and, in some cases, preventing arrests.

“We’re able to handle a lot of low-priority calls,” Black said.

Rogue Valley law enforcement, mental health professionals and advocates, elected officials and other concerned community members gathered earlier this week at the Medford Police Department to hear Black talk via Skype about the CAHOOTS program.

Rick Rawlins, manager of crisis and outpatient services for Jackson County Mental Health, said he’s interested in seeing whether the Rogue Valley can put together a similar program that pairs mental health workers with medics.

“I think that’s a great idea. I can see a lot of benefit to being able to respond in ways where it’s beyond the scope of a mental health practitioner to address the medical concerns,” Rawlins said.

Jackson County has pieces of the puzzle, but they aren’t connected.

While CAHOOTS has a team equivalent to 40 full-time workers, Rawlins has a team of 12 crisis response therapists who can go out and assist police officers who think mental health issues are playing a role in a situation.

“They have an awesome program. We have a baby team that has some of these components,” he said.

Law enforcement agencies throughout Jackson County can contact the crisis therapists 24 hours a day, seven days a week, Rawlins said.

Meanwhile, Mercy Flights, which operates a ground and aircraft ambulance service, launched a 2016 program in which specially trained paramedics make preventative house calls. They started by helping 62 people who frequented emergency rooms gain better control over chronic health conditions, including diabetes, alcohol abuse and chronic obstructive pulmonary disease.

Some of the patients had visited emergency rooms up to 80 times a year.

The program saved $737,300 in 2016 by reducing emergency room visits and cutting ambulance transport costs, Mercy Flight reported.

Ashland City Administrator Kelly Madding said dispatching an ambulance and assessing someone in an emergency room is the most expensive way to treat someone who isn’t actually suffering from a serious medical problem. She said the CAHOOTS model could save money for cities, Jackson County and residents.

“One of the most compelling things about what they do is it’s pretty low cost,” she said.

CAHOOTS estimates it saves the community $7 million annually by diverting patients from emergency rooms, plus another $8.5 million by going on calls that would otherwise be handled by police.

The CAHOOTS annual budget is $1.6 million, with the city of Eugene and a state grant passed through Lane County funding the majority of the budget, Black said.

Dividing the budget by the number of calls, the average price of a CAHOOTS response is $67.

The average cost of a police response is $800, according to the Eugene Police Department.

The cost of an emergency room visit averaged nearly $1,400 in 2017, according to a report by the Health Care Cost Institute.

CAHOOTS workers aren’t particularly well paid for the level of education, training and experience they bring to the table.

They earn $18-$22 per hour, despite having medical training or degrees in mental health, according to Black.

Many of the medics are cross-trained in crisis intervention, he said.

Black said many people drawn to the job have worked in homeless shelters, served on search-and-rescue teams or been otherwise involved in high-stress community service that requires patience and compassion.

The crisis teams can provide first aid, wound care, counseling, referrals to social services, welfare checks in the community and at homes, mediation and transportation to hospitals, urgent care clinics, social services agencies and addiction treatment centers. To avoid being used as a taxi, the CAHOOTS vans don’t give people rides home.

More than 60% of clients are homeless, and 30% live with severe, persistent mental illness, according to the organization.

Some community members who attended the presentation at MPD said a CAHOOTS-style program here could divert some people from the overcrowded Jackson County Jail.

Jackson County Sheriff Nathan Sickler is advocating for a new 800-bed, $166 million jail, but he couldn’t get enough support from all city councils in the area to put a funding measure before voters in November.

Inmates are regularly released from the current 315-bed jail due to overcrowding.

Meesha Blair, a board of directors member for National Alliance on Mental Illness Southern Oregon, said borrowing elements from the CAHOOTS model could divert some people with mental illness from jail.

“I think with the jail overcrowding, it’s one reason to look at it,” she said. “Even if we did get a new jail, it’s going to take time to build it, and we have issues right now. So I think diverting is always something that NAMI is for. There are many people that end up in jail with mental health issues that really just need help.”

Sickler said a CAHOOTS-style program could probably prevent some arrests.

“I don’t think this is going to replace our need for a new jail. I don’t think it’s going to divert everybody from jail. I do believe that our officers and deputies in our county already look for solutions that are outside of traditional custody situations,” he said.

Local law enforcement agencies work with Jackson County Mental Health to provide 40 hours of crisis intervention training to police officers and deputies. They learn to understand mental health issues and how to respond, Rawlins said.

Sickler said there will always be a need for a jail, and Jackson County’s population has grown too large for the community to be served adequately by the current jail, which was built in the early 1980s.

“This program is not a substitute for dealing with individuals who are committing crimes and victimizing our community,” he said.

Medford police Chief Scott Clauson noted CAHOOTS teams can handle low-level situations — such as trespassing, wandering into roadways and public intoxication — but they aren’t meant to take on serious crimes.

“CAHOOTS doesn’t really deal with the criminal aspect. So there’s still a whole other demographic of criminals that we do have to address,” he said.

To handle lower-level problems, MPD launched a livability team with three police officers and a code enforcement officer two weeks ago. They do outreach among the homeless, finding out what their needs are and linking them to resources in the community, Clauson said.

He said one strength of the CAHOOTS program is the medic and mental health counselor teams are able to spend a lot of time with people in need.

Teams often spend more than 45 minutes with each person, especially during hours when social service agencies are open and they can take those in need directly to places that offer help, according to CAHOOTS.

“It’s really exciting what’s happening in the Eugene area, and I think there’s certainly some opportunities to look at alternatives to how we respond to persons in need,” Clauson said.

Black said the CAHOOTS program isn’t a cure-all for issues involving mental health, addiction, homelessness and a lack of affordable housing in Oregon. And he said CAHOOTS is only successful because of its partnerships with law enforcement and community organizations.

“The biggest takeaways are we’re not the answer. We’re part of the answer,” he said.

If Jackson County decides to launch a similar program, Black said organizations will have to work together to make the effort a success in the Rogue Valley.

“It’s going to take a lot of hands to pull something like this off,” he said.

Rawlins said the foundation is there. Local law enforcement, government agencies and social services organizations have a long track record of working together in Jackson County.

“Even though we’re a small community, we have really good coordination of services and agencies coming together to solve problems,” he said.

Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or valdous@rosebudmedia.com. Follow her on Twitter @VickieAldous.

Medics have teamed up with mental health counselors to form mobile crisis teams in the Eugene-Springfield area. Rogue Valley groups are looking at whether a similar approach would help people suffering from homelessness, addiction and mental illness here.