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CAHOOTS joins the National Alternative Mobile Services Association

Hana Francis mental health abolitionism

The Crisis Assistance Helping Out On The Streets program, also known as CAHOOTS, has been running for over thirty years. In the late 1980s, staff and volunteers from White Bird Clinic, CAHOOTS’ parent organization, came together to form the CAHOOTS model. This was one of the first programs of its kind, but recently similar models have taken up in other cities as people across the country recognize the urgent need for trauma-informed mental health emergency response.

In February of 2022, the Alternative Mobile Services Association was launched in a collaboration between grassroots nonprofits, agencies and government organizations from across the nation who want to nurture emergency response services oriented to mental health in the United States. The goal is to have an ongoing platform so that people can better utilize and share this practice-based evidence; what people have been doing so far, and how has that been working.

The CAHOOTS model consists of a two-person team, a crisis counselor and a medic, that respond to crisis calls through the Eugene ambulatory-fire-police dispatch line. In Springfield, they are dispatched from the non-emergency line. The CAHOOTS vans run 24/7 in Eugene and Springfield, Oregon. At any given time there are never more than two active vans in Eugene. In Springfield there is only one van constantly on shift. Due to the high demand and limited capacity, wait times can be hours-long.

At CAHOOTS, Laurel Lisovskis fills two essential roles. She is a crisis worker and the clinical supervisor coordinator. This means that she holds shifts on the CAHOOTS vans and organizes mental wellness support for her peers. She also spoke at the recent Law and Mental Health Conference on behalf of CAHOOTS.

“Mobile crisis is weird because everyone isn’t hanging out in an office together,” Lisovskis said in an interview. “It can be kind-of a lonely job where you are in a vacuum of a van for 12 hours with your shift partner, and if you don’t create intentional spaces to be in community with one another, I think that can be kind of dangerous.”

Lisovskis said this work has historically been lonely not only because of the physical isolation but also because of the unique and emotionally intensive work that seemingly few people in our society are willing to commit to. Perhaps this won’t be the case anymore.

The initiative meeting of agencies within the Alternative Mobile Services Association was held at the beginning of February, at the 2022 Law and Mental Health Conference, “On Alternatives to the Police.” The event was coordinated by Jason Renaud, a well-known nonprofit consultant with over 35 years of open recovery from alcoholism.

“There is a national effort going on in dozens of different cities and counties across the country to develop a model of mobile outreach for people who are in some kind of crisis, we often call this a mental health crisis,” said Jason Renaud, who brought this association together. “They are all trying to solve the same problem, but they are all working alone. So, the idea is that through mutual support of these teams across the country we can learn more, faster, and get to that person on the street who is in crisis more effectively.”

For the first time there is a national link between these mobile crisis intervention programs. They can now share the experiences of trial and error, get more quantifiable data to show the success of their programs, contrast the variations on models and develop their services together.

One of the topics of debate among the organizations is the qualifications for being a crisis worker. Some models are opting for exclusively licensed mental health practitioners, but Chelsea Swift of CAHOOTS explains that this is a power dynamic which she actively tries to avoid. Licensed practitioners have the ability to diagnose and place a hold on someone which could mean forcing someone to engage in care against their will. The work that CAHOOTS does makes sure that every service they offer is voluntary.

“If people think, ‘at any given point this person can throw me in the back of a van and put me in a room with four white walls and a padded bench,’” said Swift, “they are not going to engage with you on the human level that we get to engage at CAHOOTS. And I think that keeps us safe too.”

Organizations like the Denver STAR program, Atlanta’s PAD program, and Oakland’s MACRO are among the 27 cities and agencies that have joined so far.

The main goal of the Alternative Mobile Services Association is to connect organizations that are practicing alternatives, but it also offers individual memberships to anyone who is interested in learning more about these alternatives.

The membership system is designed to be more accessible to people who may be more likely to be impacted by the increased availability of these crisis alternatives. Discounted prices are available for “peers" or students, this means anyone who has lived experience of mental illness, addiction, or alcoholism and/or is a full or part-time student.

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