CAHOOTS (Eugene, OR): the alternative-response model

In Eugene, Oregon, when someone calls 911 about a person who is intoxicated, suicidal, lost, having a panic attack, or in mental-health crisis, dispatchers often send a white van with no police involved. Inside the van is a medic and a mental-health crisis worker. The program is called CAHOOTS — Crisis Assistance Helping Out On The Streets — and it has been operating quietly in Eugene since 1989. In the last several years, dozens of US cities have built programs modeled on it.

How CAHOOTS is structured

CAHOOTS is run by White Bird Clinic, a non-profit community health organization. Its responders are pairs — typically one EMT or paramedic and one crisis worker (often with a degree in social work, psychology, or extensive lived experience). They drive vans equipped with first-aid supplies, blankets, water, and basic medical equipment.

Critically, CAHOOTS responders are dispatched through the same 911 system that dispatches Eugene Police and Fire. When a call comes in, dispatchers assess whether the situation requires police, fire/EMS, or CAHOOTS. About 17–20% of all Eugene 911 calls in recent years have been routed to CAHOOTS.

What CAHOOTS responds to

CAHOOTS handles a wide range of calls:

• Mental-health crises — suicidal ideation, psychosis, panic
• Substance-use crises — overdose, intoxication, withdrawal
• Welfare checks
• Disorientation or wandering, especially among older adults or unhoused people
• Conflict mediation, especially in encampments and in neighborhood disputes
• Transport to shelter, detox, or psychiatric urgent care
• Counseling, referrals, basic medical care on site

What CAHOOTS does not do

• Respond to violent calls or active threats — police handle these
• Make arrests
• Carry weapons
• Initiate involuntary holds — though they coordinate with police if a hold becomes necessary

Outcomes and impact

White Bird's published data and independent studies suggest that:

• CAHOOTS responds to roughly 17,000-24,000 calls per year in Eugene/Springfield.
• Police backup is requested in only a small percentage of calls (typically 1-2%).
• The program saves the city an estimated $8.5 million per year in police and emergency-services costs (per White Bird's own analysis), even after accounting for program costs.
• Use of force in mental-health calls in Eugene is significantly lower than national averages.

The program has been studied by researchers at the University of Oregon, the Vera Institute of Justice, and others. Outcomes are generally favorable but the studies note the same caveats as for similar programs — voluntary participation, varying populations, and the difficulty of randomized comparisons.

Why CAHOOTS works

Several features set CAHOOTS apart from many newer alternative-response programs:

• Long history — over 35 years of community trust and refinement.
• 911 integration — dispatched through the existing emergency system, not a parallel call line.
• Non-clinical home base — White Bird is a community clinic with deep ties to Eugene's unhoused, low-income, and mental-health communities.
• No clinical bias — many responders have lived experience with mental illness, addiction, or homelessness.
• Genuine independence from police — responders are not police, do not wear uniforms resembling police, and report to a different organization.

Programs modeled on CAHOOTS

Since 2020, US interest in alternative-response programs has surged. Programs explicitly inspired by CAHOOTS include:

• Denver STAR (Support Team Assisted Response) — operating since 2020, similar van-based model.
• NYC B-HEARD (Behavioral Health Emergency Assistance Response Division) — pairs EMT and social worker, dispatched through 911.
• San Francisco SCRT (Street Crisis Response Team) — clinician-paramedic-peer pairs.
• Albuquerque ACS (Albuquerque Community Safety) — a fourth city department alongside police, fire, and EMS, focused on behavioral-health response.
• Portland Street Response — similar model in Oregon's largest city, modeled in part on CAHOOTS.

Each adapts the model to local context. Few have CAHOOTS's longevity, but early data from the newer programs is similarly favorable.

The limits

CAHOOTS works in Eugene partly because of factors that may not transfer easily — a tight community, a strong base of peer-run organizations, longstanding 911 integration, and a deeply rooted non-profit operating it. Cities trying to replicate CAHOOTS sometimes underinvest in the dispatch and partnership work, treating the model as just two extra people in a van. The community-side infrastructure is what makes it work.

CAHOOTS also does not handle the most acute calls — by design. It is one piece of an emergency response system, not a replacement for police, EMS, or psychiatric crisis services. Critics from both sides — those who think police should respond to more calls and those who think police should respond to fewer — have made that point.

Why it matters for families

For a family with a loved one experiencing schizophrenia, an alternative-response program can mean that calling 911 doesn't necessarily mean officers in tactical gear. Where CAHOOTS-style programs exist, a panicked call about a son in psychosis can result in a clinical pair arriving in plain clothes rather than a uniformed encounter. That single change can reshape a family's willingness to call for help.

The bigger picture

CAHOOTS proved something quietly for thirty years before the rest of the country noticed: most mental-health, substance-use, and welfare calls do not need a police response, and a clinical pair in a van can handle them more safely and at lower cost. The challenge for the next decade is whether the CAHOOTS model — built on community trust, deep partnerships, and patient evolution — can be replicated in cities that want the outcome without doing the underlying work. Where it can, the experience of psychiatric crisis in this country may begin, finally, to look very different.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.