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Crisis 101

Responding to someone in crisis can be difficult, and knowing someone is suicidal can be scary, especially when we’re not sure how to respond. For many of us, our natural reactions to crisis can quickly escalate a situation and make things worse. That’s why professional crisis workers seek out training and practice crisis intervention strategies so that they’re prepared to navigate a crisis situation and offer support. When we develop a plan for offering support in crisis situations, it is more likely we will not go into crisis ourselves when assisting someone.

Often, for those experiencing suicidal thoughts, help can be as simple as having someone to talk to. For many, social isolation, history of trauma, mental health issues, or belonging to historically oppressed groups can lead to periods of suicidal ideation. But how do you know if someone is experiencing suicidal ideation? Often there may be signs of suicidal thoughts or behaviors.

Some warning signs of suicidal ideation can include:

  • Threatening to hurt or kill oneself
  • Seeking access to means to hurt or kill oneself
  • Talking, thinking or writing about death, dying or suicide
  • Increased use of alcohol or drugs
  • Withdrawing from family, friends or society
  • Showing rage or talking about seeking revenge, appearing agitated or angry
  • Talking about feeling empty, hopeless, or having no reason to live, or being a burden to others
  • Making a plan or looking for a way to kill themselves, such as searching online, stockpiling pills, or buying a gun
  • Talking about great guilt or shame
  • Feeling unbearable pain (emotional pain or physical pain)
  • Acting recklessly or engaging in risky activities that could lead to death, such as driving extremely fast
  • Giving away important possessions

If these warning signs apply to you or someone you know, get help as soon as possible, particularly if the behavior is new or has increased recently. Suicidal ideation is complex and there is no single cause, people of all genders, ages, and ethnicities can be at risk. In fact, many different factors contribute to someone making a suicide attempt. But people most at risk tend to share certain characteristics known as risk factors.

Often, family and friends are the first to recognize the warning signs of suicidal ideation and can be the first to assist in reaching out and getting help. Showing someone who may be experiencing a crisis that you care can make a world of difference in their life. Know how to start the conversation. Know how to ask, “Are you suicidal?” Know how to say, “I’m here for you,” and really mean it. Be aware of resources available in your community like the White Bird Crisis Line, CAHOOTS Mobile Crisis Services or the Help Book.

Risk Factors vs. Protective Factors

Characteristic and attribute that reduce the likelihood of attempting or completing suicide are known as Protective Factors. They are skills, strengths, or resources that help people deal more adequately with stressful events. Protective Factors enhance resilience and help to counterbalance Risk Factors.

Protective Factors:

  • Effective clinical care for mental, physical, and substance abuse disorders
  • Easy access to a variety of clinical interventions and support for help seeking
  • Family and community support (connectedness)
  • Support from ongoing medical and mental health care relationships
  • Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes
  • Cultural and religious beliefs that discourage suicide and support instincts for self-preservation

Risk factors impact our ability to manage high stress situations. Being aware of these factors can assist if you are in crisis or helping someone in crisis.

Risk Factors:

  • Being exposed to others’ suicidal behavior, such as that of family members, peers, or celebrities
  • Depression, other mental disorders, or substance abuse disorder
  • Certain medical conditions
  • Chronic pain
  • A prior suicide attempt
  • Family history of a mental disorder or substance abuse
  • Family history of suicide
  • Family violence, including physical or sexual abuse
  • Having guns or other firearms in the home
  • Having recently been released from prison or jail

Suicidal thoughts can come on at any time like a tidal wave. Like a tidal wave, suicidal thoughts can leave a wake of destruction in their path.  It is important for someone experiencing these strong thoughts and emotions to have an anchor during one these episodes. Suicidal ideation can make it seem like death is the only way out in that moment. Our rational mind may not be able to see any other solution when amid suicidal ideation. If we can help someone ride out the wave until they receive professional help, the likelihood of suicide is greatly reduced. Below are 10 steps to assist you in helping someone in crisis.

Ten Steps to Help a Person in Crisis

Step 1. Encourage the person to communicate with you.

Step 2. Be respectful and acknowledge the person’s feelings.

Step 3. Don’t be patronizing or judgmental.

Step 4. Never promise to keep someone’s suicidal feelings a secret.

Step 5. Offer reassurance that things can get better.

Step 6. Encourage the person to avoid alcohol and drug use.

Step 7. Remove potentially dangerous items from the person’s home, if possible.

Step 8. Encourage the person to call a suicide hotline number. You as the helper can also call.

Step 9. Encourage the person to seek professional help.

Step 10. Offer to help the person take steps to get assistance and support.

For our 24/7 CAHOOTS mobile crisis services, call the police non-emergency numbers 541-726-3714 (Springfield) and 541-682-5111 (Eugene). For our 24/7 crisis hotline, call 541-687-4000 or toll free at 1-800-422-7558.

Senators Propose Funding to Improve Public Safety with Mobile Crisis Response Teams

Press Release from Jeff Merkley, US Senator for Oregon

After Down Payment on the Policy Included in Reconciliation Relief Legislation, CAHOOTS Act Builds on Proven Models to Help Americans with Mental Illness and Enhances Medicaid Funding to States

Washington, D.C. – Senate Finance Committee Chair Ron Wyden, D-Ore., Senator Catherine Cortez Masto, D-Nev., and six senators today proposed a bill to help states adopt mobile crisis response teams that can be dispatched when a person is experiencing a mental health or substance use disorder (SUD) crisis instead of immediately involving law enforcement. The funding is provided through an enhanced federal match rate for state Medicaid programs.

“I’m proud there is a down payment on CAHOOTS in the emergency relief package moving through Congress now,” Wyden said. “Every day there are stories across the country of Americans in mental distress getting killed or mistreated because they did not receive the emergency mental health services they needed. White Bird Clinic in Eugene, Oregon has been a pioneer for years in this area, and it’s high time the CAHOOTS model is made available to states and local governments across the country. I am eager to get the down payment signed into law and continue working to get further investments in mobile crisis services made under the bill across the finish line.”

“Individuals experiencing a behavioral health crisis deserve to be treated with compassion and care by health care and social workers,”Cortez Masto said. “These professionals are extensively trained in deescalating situations and addressing mental health crises, and this legislation would help more states across the country fund mobile crisis teams. I’m hopeful that these investments in community-based crisis intervention services will be included in the final version of the current coronavirus relief package, and I’ll continue to advocate for effective, trauma-informed care for those in need.”

Earlier this month, the House Energy and Commerce Committee included a provision in its budget reconciliation language for COIVD-19 relief that makes an investment in these services by funding state Medicaid programs at an enhanced 85 percent federal match if they choose to provide qualifying community-based crisis intervention services and funding state planning grants to apply for the option. The pandemic has taken a serious toll on the mental health and wellbeing of Americans with studies showing a four-fold increase in the rates of anxiety and depressive disorders since the beginning of the pandemic.


The bill, the Crisis Assistance Helping Out On The Streets (CAHOOTS) Act, grants states further enhanced federal Medicaid funding for three years to provide community-based mobile crisis services to individuals experiencing a mental health or SUD crisis. It also provides $25 million for planning grants to states and evaluations to help establish or build out mobile crisis programs and evaluate them.

Senators Jeff Merkley, D-Ore., Bob Casey, D-Pa., Tina Smith, D-Minn., Dianne Feinstein, D-Calif., Sheldon Whitehouse, D-R.I., and Bernie Sanders, D-Vt., are co-sponsors of the CAHOOTS Act.

 

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A one-page summary of the bill can be found here. Legislative text can be found here.

CAHOOTS: A Model for Prehospital Mental Health Crisis Intervention

By Ben Adam Climer and Brenton Gicker

From the January 2021 edition of Psychiatric Times

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CAHOOTS (Crisis Assistance Helping Out On The Streets) is a mobile crisis-intervention program that was created in 1989 as a collaboration between White Bird Clinic and the City of Eugene, Oregon. Its mission is to improve the city’s response to mental illness, substance abuse, and homelessness.

CAHOOTS is operated by White Bird Clinic, which was formed in 1969 by members of the 1960s countercultural movement. They were interested in alternative and experimental approaches to addressing societal problems. Today, White Bird Clinic operates more than a dozen programs, primarily serving low-in-come and indigent clientele.

The CAHOOTS model was developed through discussions with the city government, police department, fire department, emergency medical services (EMS), mental health department, and others. The name CAHOOTS is based on the irony of White Bird Clinic’s alternative, countercultural staff collaborating with law enforcement and mainstream agencies for the common good.

cahoots medic

Photo by William “Bill” Holderfield

When it began, CAHOOTS had very limited availability in Eugene. It has grown into a 24-hour service in 2 cities, Eugene and Springfield, with multiple vans running during peak hours in Eugene. The program—which now responds to more than 65 calls per day—has more than quadrupled in size during the past decade due to societal needs and the increasing popularity of the program.

Programs based on the CAHOOTS model are being launched in numerous cities, including Denver, Oakland, Olympia, Portland, and others. Federal legislation could mandate states to create CAHOOTS-style programs in the near future.

Senators Ron Wyden of Oregon and Catherine Cortez Masto of Nevada have proposed a bill that would give states $25 million to establish or build up existing programs. 

How Does It Work?

When CAHOOTS was formed, the Eugene police and fire departments were a single entity called the Department of Public Safety. CAHOOTS was designed to be a hybrid service capable of handling noncriminal, nonemergency police and medical calls, as well as other requests for service that are not clearly criminal or medical.

Eugene’s police and fire departments eventually split. CAHOOTS was absorbed into the police department’s budget and dispatch system. It continues to respond to requests typically handled by police and EMS with its integrated health care model.

CAHOOTS operates with teams of 2: a crisis intervention worker who is skilled in counseling and deescalation techniques, and a medic who is either an EMT or a nurse. This pairing allows CAHOOTS teams to respond to a broad range of situations. For example, if an individual is feeling suicidal and they cut themselves, is the situation medical or psychiatric? Obviously, it is both, and CAHOOTS teams are equipped to address both issues. Typically, such a call involving an individual who engaged in self-harm would result in a response from police and EMS. This over-response is rarely necessary. It can also be costly and intimidating for the patient. They are not criminals, and their wounds are often not serious enough to require more than basic first aid in the field. These patients are usually seeking help, and a CAHOOTS team is trained to address both the emotional and physical needs of the patient while alleviating the need for police and EMS involvement. If necessary, CAHOOTS can transport patients to facilities such as the emergency department, crisis center, detox center, or shelter free of charge.

CAHOOTS is contacted by police dispatchers. If you call the nonemergency police line or 911 in the cities of Eugene or Springfield, you can request CAHOOTS for a broad range of problems, including mental health crises, intoxication, minor medical needs, and more. Dispatchers also route certain police and EMS calls to CAHOOTS if they determine that is appropriate.

CAHOOTS, to a large extent, operates as a free, confidential, alternative or auxiliary to police and EMS. Those services are overburdened with psych-social calls that they are often ill-equipped to handle. CAHOOTS staff rely on their persuasion and deescalation skills to manage situations, not force. Only in rare cases do CAHOOTS staff request police or EMS to transport patients against their will.

CAHOOTS Crisis Worker

Photo by William “Bill” Holderfield

A Backup Plan

If a psychiatrist or other mental health provider in the Eugene/Springfield area is concerned about a patient, they can call CAHOOTS for assistance. This usually results in a welfare check.

Let us say, hypothetically, that you are concerned about a patient with bipolar disorder. After a lengthy period of stability, they have been complaining to you that they feel like their prescribed medication is no longer working effectively. You begin receiving phone messages and emails from them consisting of fanatical rantings and incoherent gibberish.

You are concerned, but it is not so severe that you feel compelled to call the police. Perhaps you are reluctant to call law enforcement for a variety of reasons. What do you do? You call CAHOOTS.

Having responded to a similar scenario recently, let me describe what occurred. The patient, although not expecting us, welcomed our response. They explained to us that they felt like their medication was ineffective, and, after days of mania, they were feeling depressed and suicidal.

The patient recognized their own decompensation, and eagerly accepted transport to the hospital. Their mental health care provider was informed that we were transporting them and called the hospital to provide additional information.

We transported the patient to the hospital, and they were admitted to the inpatient psychiatric unit for stabilization. Collaboration between prehospital, hospital, and outpatient services facilitated that incident as smoothly as possible.

Barriers and How to Help

Prehospital mental health crisis response is underdeveloped. Most often, police and EMS are the only options. In some cities, clinicians with masters or doctoral degrees are sent with first responders. Unfortunately, the supply of these clinicians is not enough to meet the demand, but does it need to? Ambulances do not staff medical doctors. Why should prehospital mental health care require masters/doctoral level licensed clinicians? Telepsychiatry services, while important, are no substitute for direct human contact, especially given that some patients will need to be transported to a higher level of care and many do not have the means or ability to participate in telehealth services (because of lack of capacity or lack of resources).

The biggest barrier to CAHOOTS-style mobile crisis expansion is the belief that without licensed clinicians and police, prehospital mental health assistance is ineffective and unsafe. If psychiatrists want a program like this in their area, they can help by using their considerable authority to assure the community that response teams like CAHOOTS can work. Because of their direct lines of communication to the police and familiarity with police procedures, CAHOOTS staff are able to respond to high acuity mental health crisis scenarios in the field beyond what is typically allowed for mental health service providers, which often facilitates positive outcomes and can even prevent deadly outcomes. Their support is vital for program success.

Mr. Climer worked for CAHOOTS as a crisis worker for 5 years and an EMT for 2.5 of those years. He now lives in Pasadena, CA where he helps Southern California cities develop CAHOOTS-style programs. Mr. Gicker is a registered nurse and emergency medical technician who has worked for CAHOOTS since 2008.

Crisis Lines for Support

White Bird Clinic’s 24/7 Crisis Services program is available 24/7 for Lane County residents. Trained counselors have a deep ability to empathize with clients, as well as extensive knowledge of local resources that are appropriate to provide ongoing care. https://whitebirdclinic.org/crisis

The Oregon Behavioral Health Support Line is a free and confidential resource for all Oregonians who are looking for emotional support. Call 1-800-923-HELP (4357). You do not need to be in mental health crisis to call this line. If you need or want help beyond what the line can provide, you will be connected to those services. This can include community-based services such as housing, food assistance or clinical services. Certified interpreters are also available for those who speak a language other than English. Through this number, you can also connect with Lines for Life (linesforlife.org), a suicide prevention organization with specific resources for youth, military personnel and their families, and those affected by substance abuse problems.

SAMHSA’s Disaster Distress Helpline provides 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters. Call SAMHSA’s Disaster Distress Helpline at 1-800-985-5990 or text TalkWithUs to 66746 to speak to a trained crisis counselor.

15th Night’s Crisis Line at 541-246-4046 assists in locating and leveraging existing community resources in order to help a youth who has run away or is currently experiencing homelessness to meet their needs. https://www.15thnight.org/get-help-now

The Child Center’s Crisis Response Program is available 24/7 at 1-888-989-9990 for families with children & youth experiencing mental or behavioral health crises in Lane Cty. https://www.thechildcenter.org/press-releases/


Alternatives To Calling 911 https://whitebirdclinic.org/resources/emergency-crisis-lines/

Mental Health Resources During COVID-19

Looking for our COVID-19 community resource page? We moved it over here.

As leaders on the frontlines of mental illness and substance abuse disorder treatment, we know how difficult it can be to cope with the outbreak of coronavirus disease 2019 amidst the loss of familiar resources. Fear and anxiety about a disease can be overwhelming and cause strong emotions. Coping with stress will make you, the people you care about, and your community stronger.

People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms. The White Bird Crisis line will continue to be accessible 24/7 by phone at (541) 687-4000. For an in-person response, CAHOOTS continues to operate 24/7 at this time, if you are in Eugene please call (541) 682-5111, for those in Springfield please call (541) 726-3714.

Telehealth

Telehealth appointments are available for both new and returning Counseling and Chrysalis clients. Intake forms for new clients are now available online.

Online Support Groups

AA   NA   GA

7 Cups: www.7cups.com Free online text chat with a trained listener for emotional support and counseling. Also offers fee for-service online therapy with a licensed mental health professional. Service/website also offered in Spanish.

Emotions Anonymous: www.emotionsanonymous.org An international fellowship of people who desire to have a better sense of emotional well-being. EA members have in person and online weekly meetings available in more than 30 countries with 600 active groups worldwide. The EA is nonprofessional resource and cannot be a replacement to therapy.

Support Group Central: www.supportgroupscentral.com Offers virtual support groups on numerous mental health conditions – free or low-cost. Website also offered in Spanish.

The Tribe Wellness Community: www.support.therapytribe.com Free, online peer support groups which is tailored to members who are facing mental health challenges and/or difficult family dynamics. Support groups include Addiction, Anxiety, Depression, HIV/AIDS, LGBT, Marriage/Family, OCD and Teens.

For Like Minds: www.forlikeminds.com Online mental health support network that allows for individuals to connect with others who are living with or supporting someone with mental health conditions, substance use disorders, and stressful life events.

Guidebooks & Tip Sheets

The NAMI HelpLine Coronavirus Information and Resources Guide may be helpful if you have questions or concerns.

SAMHSA’s Tips for Social Distancing, Quarantine, and Isolation tip sheet describes feelings and thoughts you may have during and after social distancing, quarantine, and isolation. It also suggests ways to care for your behavioral health during these experiences and provides resources for more help.

Text/Chat

News about the coronavirus can increase feelings of anxiety. If you’re struggling, text Mental Heath First Aid to 741-741 to talk to a CrisisTextLine counselor.

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Mental Health First Responders Visit Oakland

White Bird Clinic’s CAHOOTS program is meeting with stakeholders to share an innovative model for mobile crisis intervention that would otherwise be handled by public safety or emergency medical response.

OAKLAND, CA – White Bird Clinic of Eugene, OR has developed an innovative public/private partnership delivering crisis and community health first response effectively and at significant cost savings. For thirty years, CAHOOTS (Crisis Assistance Helping Out On The Streets) has been providing mobile crisis intervention 24/7, dispatched through the EMS non-emergency system. This week, members of CAHOOTS are in Oakland to meet with the Mayor, the Coalition for Police Accountability, and other community stakeholders to discuss implementing the innovative model locally.

Each CAHOOTS team consists of a medic (a nurse or an EMT) with a crisis worker who has substantial training and experience in the mental health field. The team provides behavioral health first response/responders, immediate stabilization in case of urgent medical need or psychological crisis, assessment, information, referral, advocacy and, when warranted, transportation to the next step in treatment.

White Bird Clinic started CAHOOTS in 1989 in partnership with the Eugene Police Department as a community policing initiative. CAHOOTS offers compassionate, effective, timely care while diverting a considerable portion of the public safety workload, freeing the police and fire departments to respond to the highest priority calls. CAHOOTS handles 17% of the Eugene Police Department’s non-emergency calls. In 2017, police officers nationally spent 21% of their time responding to or transporting people with mental illness.

CAHOOTS focuses exclusively on meeting the medical and mental health needs of the community, making it both more economical and more effective than traditional models involving agencies with a larger scope of responsibility. Police officers and firefighters receive comprehensive training in a broad set of skills, making their deployment to non-emergent situations unnecessarily costly. The CAHOOTS model also ensures that health and behavior health care are integrated from the onset of intervention and treatment, adding to the efficacy and economy of the model.

White Bird’s CAHOOTS program has attracted notice, from national news media as well as from communities across the country. The Wall Street Journal’s November 24th article When Mental- Health Experts, Not Police, Are the First Responders showcased CAHOOTS as an innovative model for reducing the risk of violent civilian/police encounters. Communities from California to New York have asked for strategic guidance and training so they can replicate CAHOOTS’ success.

Currently, CAHOOTS is working with the following communities:

  • Olympia, WA
  • Portland, OR
  • Denver, CO
  • New York, NY
  • Indianapolis, IN
  • Roseburg, OR


In 1969, a group of student activists and concerned practitioners came together to provide crisis services and free medical care for counter-culture youth in Eugene, OR. Having grown continuously since then, today White Bird Clinic has 10 programs, 220 staff members, and more than 400 volunteers each year. White Bird Clinic is a collective environment organized to empower people to gain control of their social, emotional, and physical well-being through direct service, education, and community.

The mission of the Coalition for Police Accountability is to advocate for accountability of the Oakland Police Department to the community so that the Oakland Police Department operates with equitable, just, constitutional, transparent policies and practices that reflect the values and engender the trust of the community.

White Bird Offers Mental Health First Aid Classes

Mental Health First Aid is an 8-hour course that teaches you how to identify, understand and respond to signs of mental illnesses and substance use disorders. The training gives you the skills you need to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis. Most of us would know how to help if we saw someone having a heart attack—we’d start CPR, or at the very least, call 9-1-1. But too few of us would know how to respond if we saw someone having a panic attack or if we were concerned that a friend or co-worker might be showing signs of alcoholism.

Mental Health First Aid takes the fear and hesitation out of starting conversations about mental health and substance use problems by improving understanding and providing an action plan that teaches people to safely and responsibly identify and address a potential mental illness or substance use disorder. When more people are equipped with the tools they need to start a dialogue, more people can get to the help they may need. Mental Health First Aiders can even save lives.

Trainings will be from 8:30 am-5:30pm and will have light breakfast & lunch provided. Students can register using the links below or go to https://whitebirdclinic.org/education to register for multiple classes at once. For more information, including alternate payment options, please contact anne@whitebirdclinic.org.

Mental Health First Aid is intended for all people and organizations that make up the fabric of a community. Professionals who regularly interact with a lot of people (such as police officers, human resource directors, politicians, and primary care workers), school and college leadership, faith communities, advocates for the unhoused, friends and family of individuals with mental illness or addiction, encampment managers and allies, parents, or anyone interested in learning more about mental illness and addiction should get trained.