Mental Health responders sent to 911 calls are a way of reimagining of public safety.
Calling mental health workers, not police, to deal with mental health crises
Emergency medical technician Elle Natchke sits in the driver’s seat. Natchke often partners with mental health crisis worker Lo Webb, providing crisis response through CAHOOTS to people in Eugene, Ore. (Rob Waters)
By Rob Waters
June 20, 2021 at 6:00 a.m. PDT
Spencer Merritt thought he was going to die. He couldn’t breathe and voices in his head told him he had been poisoned and that his beloved dog, Lulu, who died a year earlier, had been, too. He thought the voices were talking to him through hidden microphones and speakers, although he couldn’t find any. His cluttered bedroom seemed like a death trap, and Merritt, 32, was terrified his parents were going to kill him. He ran down the stairs and out the front door. It was 1 a.m. and he was wearing jogging pants and a bathrobe. He paced and ran, falling to the ground as pain shot to his chest. Maybe he was having a seizure, he thought. He called his best friend, Brandon Adams, who convinced him to go home. Locking himself in his room, Merritt managed to sleep for a few hours and began a panicky, desperate broadcast on Facebook Live. His cellphone videotape shows Merritt sitting for long stretches, holding his head and staring grimly, his face a picture of misery. He holds up an art pad with messages scrawled in pencil: “Meth it sux hard,” “I think I had a heart attack” and “Help please.” On Facebook Live, his pleas find a response — 150 friends watch and 95 post messages of love and support. “Someone’s on there [sic] way now, bro,” Adams writes, 40 minutes in. Ten minutes later comes a knock on the door. His mother tells him an ambulance has arrived. Merritt paces, debating the voices, then goes downstairs where emergency medical technicians test him with a portable electrocardiogram. He hasn’t had a heart attack, they say, but suggest he come with them anyway. Merritt declines, returning to his bedroom. Eleven minutes later comes another knock. “CAHOOTS?” Merritt says. “Wow.” He opens the door. A voice, off camera, greets him. “Hi, Spencer, I’m Christian. This is my partner, Lo.” They’re from a mobile crisis team called CAHOOTS (Crisis Assistance Helping Out On The Streets). Like many people in Eugene, Ore., Merritt knows about CAHOOTS, a service that sends a mental health crisis worker and EMT, rather than police, to people in mental health distress. Started 30 years ago by White Bird Clinic, a community health center, CAHOOTS morphed from the “Bummer Squad” that helped hippie drug users survive bad trips. Merritt, who was then using methamphetamines, tells the CAHOOTS team he has been having anxiety, hearing voices and being spied on. “I guess it’s possible my perceptions aren’t okay,” he adds. “I’m well aware of substance-related psychosis.” The crisis workers listen and then Lo Webb asks Merritt some questions. After he mentions that a drug “may have been slipped into my food,” causing seizures, she encourages him to see a doctor and get more sleep: “If you miss out on that, you start to lose track of what’s real.” They give Merritt a card and invite him to call CAHOOTS’s crisis line any time. White Bird Clinic can help him get on state health insurance and enroll in counseling or detox, they say. “That’s incredible,” Merritt says. “I think I’ll be okay.” 'The secret sauce' Months later, Merritt is out of crisis and living and working in Portland. He recognizes how lucky he was that day in June 2020. Lucky he didn’t encounter police while raving in his bathrobe at 1 a.m. Lucky, numerous studies suggest, that he is White, since Black people in the United States are almost three times as likely to be fatally shot by police as Whites. Mostly, he was lucky to live in Eugene, birthplace of this mental health program that is starting to be replicated by cities nationwide. Since the beginning of 2015, 1,430 people with a history of mental illness have been shot and killed by police in the United States, according to a Washington Post database, almost a quarter of all fatal police shootings. Other bad outcomes are more common. American prisons and jails are filled with people suffering from mental illness. Confrontations between police and people with mental illness also cause nonfatal injuries and consume the time of officers who often lack the training and expertise to de-escalate. “For years, we’ve been sending cops to things we shouldn’t be sending cops to,” Eugene Police Chief Chris Skinner told me. “When they show up, they look like this,” he says, pointing to his own uniform, “and they’ve got guns and badges.” When CAHOOTS shows up, “it has a tendency to de-escalate a situation,” Skinner said. “That’s the secret sauce.” The most common reason for a CAHOOTS call is to do a “welfare” check on people who appear to be in serious emotional trouble or dead. Four times a day, on average, CAHOOTS is called to help a suicidal person. I spent a day with two CAHOOTS teams as they fielded more than 20 calls over 12 hours. A young homeless man had fallen into a stream. He pulled himself out but was at risk for hypothermia; the team brought him clothes and food. An intoxicated man who called to say he was suicidal was found face down on the sidewalk. He accepted a ride to a sobering center. Many calls involved homeless people, though not all. An older woman, who had come to CAHOOTS attention before, came out of her house to ask the team if machines were coming out of her head. Reassured that they were not, she thanked them and returned inside. CAHOOTS hasn’t been independently evaluated but the Eugene Crime Analysis Unit estimates it diverts 5 to 8 percent of calls to 911 that would otherwise have been dispatched to police officers. Over 30 years, it has earned broad trust from homeless people, business owners and police officers, said a wide variety of people interviewed for this story. Other programs nationwide Now, at a moment of national reckoning over police shootings, often of people of color and of those in mental health crisis, cities around the country are looking into or already pursuing similar efforts. In Phoenix, a consortium of nonprofit agencies led by Solari Crisis and Human Services, has built a crisis line and mobile response system that, in one recent 30-day period, handled 20,000 calls and dispatched mobile crisis teams composed of a mental health clinician and a paraprofessional — and not police — 2,200 times. Denver’s one-year old Support Team Assisted Response, or STAR, program, modeled on CAHOOTS, has diverted about 3 percent of 911 calls for assistance in a downtown area from police to its mobile crisis team during a six-month trial, according to an evaluation released in January. The program is now being expanded. “Our officers are seeing the value in this and [asking], ‘When can we get more STAR vans?’ ” Denver Police Chief Paul Pazen said. The Biden administration’s $1.9 trillion stimulus package, passed in March, will help fund such programs. Incorporating elements of a bill introduced last year by Sen. Ron Wyden (D-Ore.), the package provides $15 million for grants to start mobile crisis programs and three years of enhanced Medicaid funding to cover 85 percent of operating costs. The Congressional Budget Office estimates the price tag to Medicaid at about $1.1 billion over 10 years. For Wyden, the issue is personal. His brother, Jeff, suffered from schizophrenia. “Night after night after night, the Wyden family went to bed worried that he would be on the streets, and he would hurt himself or somebody else,” he said. Jeff died in 2002 at age 51. This push to bring CAHOOTS-like programs to cities across the country “is a direct response to the national call to reimagine public safety,” Wyden said. The effort to enhance mobile response efforts dovetails with another federal law passed in 2020 that creates a nationwide, three-digit suicide prevention and mental health crisis phone line — 988 — to take the place of the 10-digit suicide prevention line. The law and a companion Federal Communications Commission regulation require telephone carriers to enable calls to 988 and empower states to set up call centers by July 2022. Advocates say the 988 line will provide people in crisis with an alternative to dialing 911 and a way to summon mental health responders rather than police. Tying together the two efforts can create a system that provides “people to call, people to come, and places to go,” said Jonathan Goldfinger, chief executive of Didi Hirsch Mental Health Services, a Los Angeles nonprofit. 'I'm so grateful' For Spencer Merritt, the CAHOOTS crisis workers who showed up last summer in Eugene helped start him on a path to recovery. “She heard me out. She made me feel comfortable,” Merritt said of his interaction with Lo Webb. He left his mother’s house that day, helped by friends who stayed with him and hunted for detox programs while he went through withdrawal from methamphetamines. But no programs were available then because of the pandemic. So he moved to Portland with friends and enrolled in an online addiction group with White Bird Clinic. Today, he said, he is drug-free, rents a shared apartment and works as lead cook in the deli department of a Safeway supermarket. “I’m so grateful,” he said. “It could have been a tragedy.” Rob Waters is the founding editor of MindSite, a digital publication covering mental health news that will begin publication this fall. This report is a shortened version of a story that appeared in the June issue of Health Affairs. Police encounters with the mentally ill often end in violence. These counselors in suburban Maryland know how to de-escalate — but still want police backup. Post Reports podcast: Policing mental health crises. What can go wrong when police are the ones responding to mental health crises. Fatal police shootings of mentally ill people are 39 percent more likely to take place in small and midsized areas