Into Reimagining Mental Health and Policing
Trymaine Lee: (CHIMES) A warning. There are graphic descriptions of violence in this episode.
Archival Recording: Get on the ground. Get on the ground, man.
Daniel Prude: No.
Archival Recording: Get on the ground.
Lee: In the dark, early morning hours of March 23rd, officers from the Rochester New York Police Department encountered Daniel Prude, standing naked in the middle of the street.
Lee: The 41 year old Black man was visiting family and his brother had called 911.
Lee: Saying that Prude was on drugs (BACKGROUND VOICE) and suffering from a psychotic episode.
Archival Recording: Put your hands behind your back. Behind your back.
Prude: Yes, sir.
Archival Recording: Don't move. Don't move.
Lee: Officers cuffed Prude and he began writhing and spitting on the pavement. The police later said Prude claimed he had coronavirus. And when Prude ignored orders to stop spitting, they placed a mesh bag over his head.
Archival Recording: (UNINTEL PHRASE) man, stay on the ground--
Prude: Let me go. Get the (BEEP) away from (UNINTEL). In Jesus Christ, I prayed. Amen.
Lee: Prude struggled under the hood.
Prude: (UNINTEL) away from (UNINTEL).
Lee: Then officers pushed him into the ground. His face against the asphalt, one officer's knee on his back.
Archival Recording: Stop.
Lee: Prude went limp and the paramedics were called in.
Archival Recording: I saw the ambulance coming so I (UNINTEL PHRASE).
Lee: Daniel Prude died on March 30th, after he was removed from life support in a New York hospital, seven days after being detained by police. In an autopsy, the Monroe County Medical Examiner ruled Prude's death a homicide. The cause of death is listed as, quote, "Complications of asphyxia." Under the spit bag, Daniel Prude couldn't breathe.
Compared to the general population, people with mental illnesses are 16 times more likely to be killed by a police officer. That's according to a 2015 study from the nonprofit Treatment Advocacy Center. Police body cam footage from the Daniel Prude incident wasn't released until earlier this month. But in the weeks since and under pressure from activists, the mayor of Rochester moved to shift responsibility for crisis intervention away from her city's police department.
Mayor Lovely Warren: We will take our family crisis intervention team, our FACIT, and move it and its funding to the Department of Youth and Recreation Services to better and more humanely serve our residents.
Lee: Major cities like Tampa, Denver and Oakland are also developing alternatives, programs to respond to mental health calls so that police don't have to. And they're all looking to one unlikely place for guidance, the small city of Eugene, Oregon.
Ebony Morgan: It's effective. It's more effective than I even thought it would be coming in. I thought I would need a lot more backup, a lot more help more often. But really, people wanna be heard. And people wanna be seen and they wanna feel safe.
Lee: I'm Trymaine Lee and this is Into America. Today, we're takin' a look at a model for rethinking public safety, using trained mental health workers to respond to 911 calls, along with and often instead of, police officers. We dig into how it works and what other cities can learn from this model.
Ebony Morgan is a crisis intervention worker and communications director for a program called CAHOOTS, working out of Eugene and Springfield, Oregon. CAHOOTS might sound funny, but it stands for Crisis Assistance Helping Out On the Streets. They launched 31 years ago in 1989. I wanted to know how CAHOOTS, or maybe a program like it, could've helped Daniel Prude and others like him.
Morgan: It's always really hard to talk about situations that you weren't there for. That's one thing I've learned, being in the field. But a loss of life is just always tragic. And I think, preventable. And largely, even if that prevention would've started at better supports earlier on, like community supports for people that have these mental health issues and plans in place and an alert that this person has this background and erratic behavior should be expected. Like, there are things that we could implement that wouldn't be that hard. But it's such a huge conversation.
Lee: Yeah. And, you know, we hate to speculate on what could've been done or been different, especially if we weren't in that moment. But say you arrive. Say the Daniel Prude just as an example, you arrive there. They call you. It's been deemed that this person isn't necessarily violent or too violent to prevent you from coming. What do you do? Like, how would you have handled that situation?
Morgan: I say, "Hey, hey, hey. You look like you're going through something really hard right now. What do you need? I'm here to help you. Are we fightin' somethin'? Do we need to fight somethin' together? Like, what's going on around you right now because I'm not seeing the same thing that seems to be stressing you out this much?"
Or, "I'm not experiencing what you're experiencing. Can you tell me what you're experiencing so that I can figure out how to help you?" We're not gonna put a spit bag over your head. We're not gonna put you on the ground. I can't put my hands on you.
"That's not my job." And that's why I took this job. My job is to use my body language, use my words, use the training that I have really. Even if you have the world's best and nicest officer who is so good at negotiating and deescalating, they have the badge, they have the gun.
And there are some people that are traumatized by that, right outta the gate. That person cannot deescalate the other person because that person triggers a trauma response. So being in a t-shirt and jeans and walking up and saying, "Hey, how can we help you" is a really different experience. So from the very onset, it looks so significantly different.
Lee: This really is kind of a unique scenario that you don't see playin' out in a lotta different communities. How did you actually get into this work?
Morgan: I was working in the emergency room and saw CAHOOTS bringing people into the emergency room. And that's when I found out about them. And I've lived here most of my life. And my father died during a police encounter here. So--
Morgan: --to me, seeing that there was an alternative when you're having an emergency was everything. And I decided to be a part of it. Halfway through nursing school, I signed up to be on CAHOOTS. And so now, I am a nurse, but I haven't left this work yet.
Lee: How has losing your father the way that you did, you know, shaped the way you approach your work with CAHOOTS and the folks that you engage with every single day?
Morgan: It makes me appreciate this work so much. And I receive the feedback from my clients a lot that I'm really genuine and I'm also really persistent. And that persistence is that I know what the alternative is. And I found, through this work, that the police are our community partners.
We do rely on them sometimes. But if someone insists on trying to hurt themselves or is trying to get into traffic, I can't restrain them. And I would have to call for officers to come help with that. So when I look them in the eye and say, "If we cannot figure something else out, I'm going to have to call for police backup," it's really sincere. And it generally works.
Lee: I know you put in a lot of hard, grueling work with CAHOOTS. But I wonder, what exactly do you do? Like, what does your job look like?
Morgan: So somebody will call in to either 911 or the non emergency police line. And they'll say, "I need CAHOOTS for X, Y, or Z." Or they'll call in with a CAHOOTS appropriate call, maybe not know that we exist, and the call taker can say, "Would you like this crisis response instead of a police response?" And they can offer that out.
From there, they will put that on a call screen for the dispatchers. And the dispatcher will send us over the radio to whatever the next, most important call is. So those calls come into us that way. And then the two of us that are on that van will head out to that location and take care of that call.
So we can be counselors on the spot. We can assess a medical thing and see if it needs attention. If someone needs to be deescalated, we can work with them and deescalate the situation and figure out what the real need is, right? 'Cause usually when people are in a crisis or havin' a hard time, if you can address the need, then the escalation resolves itself.
Lee: Do you remember your first call? Do you remember, like, what it was like to go out on that first one?
Morgan: Uh-huh (AFFIRM). It was terrifying. I had no idea. I thought I was gonna mess it up. I knew how to listen actively and try to make a plan, but I just, you never know. And this girl was crying. She was crying outside of a grocery store. And her pants had this huge tear.
And so she was mostly naked. And I just got down and I sat down next to her on the ground. And I just sat with her while she cried. And then, when there was a break in the crying, I introduced myself and asked her her name. And she was yelling.
She was yelling at me. And she was yelling about the day she'd had and the way that her boyfriend treated her and that she was stranded and she was cold. And all of these really reasonable things (MIC NOISE) to be upset about, right? And instead of criticizing the way she was coping with her feelings, I just said, "I would like to start by getting you pants. I think I have some pants on the van. Can I grab you some pants?"
And my partner went and got the pants. And I was, like, "These are for you. You can change later. Now, what do we need to do? Your boyfriend left you. Do you have a house?" "No." "Okay. Can we take you somewhere? Is there anywhere that you would feel safe right now?"
You just start going through the list, assessing what's available to this human. And she just needed some time. And so we took her to our local crisis center, where they could do some on scene crisis counseling and let her have a space to just sit and gather her thoughts since she'd clearly had this really traumatic day. And when it was over, I asked my trainers. I said, "Did that go well? Did I do that okay?" And they're, like, "That's exactly right. You just met her where she was and you helped her get where she needed to go." And that's the work.
Lee: What's wild is it almost sounds radical in the way we engage with people in America. You know, instead of coming armed with a gun and some mace and some rubber bullets, you're arriving with a shoulder, some words and resources. What is in your tool kit? So you got clothes in the car? Like, what else are you carrying (LAUGH) around with you?
Morgan: Yeah. So much stuff, Trymaine. (LAUGH)
Lee: All the stuff? Everything?
Morgan: Yes. We have clothes, we have food, we have water. We have tents sometimes. We carry a med bag that has Narcan in it in case of an overdose. It's got basic wound care supplies, Tylenol, Ibuprofen, stuff that might be helpful, antacids. Just basic things that people might not have access to on the spot or in general that we can easily provide.
The back of our van is set up for transportation. So we can transport you to services if we need to. We refer to ourselves as kind of the safety net below the safety net, where we're catching people that otherwise, if it was easy for them to engage in services, they wouldn't need our help to do so.
Lee: And how many people are responding? Like, CAHOOTS sends out, like, this little army of people? Like, how many people do you have?
Morgan: There are 45-ish of us altogether on--
Morgan: --the team. In Eugene, we have two vans on for half of the day. So there'll be two vans floatin' around the city. And in Springfield, we just have one van. And we have our medic and our crisis worker. And we respond in pairs so that there's two of us at a time that are responding to calls.
Lee: How are y'all funded?
Morgan: We are funded in a couple different ways. In Eugene, we're funded by the city, through a contract with the police department. So the police department gets some money from the city, gives it to us. In Springfield, which is the neighboring city, we are funded by a combination of the Springfield Police Department and the county. And then recently, we've gotten our local Medicaid partners to help with some wraparound funding. They give us some money because we fill some gaps.
Lee: And how many calls are y'all receivin' a year? Or just somehow gimme the volume of calls that y'all are responding to.
Morgan: Yeah. The last number we had was about 60 calls a day. And 24,000 calls in 2019, about.
Lee: That sound like a lotta calls, 24,000--
Morgan: It is.
Morgan: (LAUGH) It is. I love that number because it demonstrates that we are present and that we have an influence. That was 20% of the incoming calls for service.
Morgan: Part of that 20% are calls that are specifically coming in because we are a service. It's not necessarily that they would've been emergency calls otherwise 'cause we do some, like, counseling and stuff when people aren't necessarily in full crisis, but just, like, preventative, which is even better to me 'cause you don't have to go through all that pain and trauma (LAUGH) to get help, right? We can meet you before that point. So some of those calls might not have been a police response anyway. But yeah, 20% of the call volume for Eugene was ours.
Lee: Tell us about, like, your average call. Like, what kinda calls are you responding to? And what won't you respond to?
Morgan: We do a lot of welfare checks. If someone's worried about somebody, it could be that they said something concerning to you on the phone. You talked to your sister today and she said, "I don't wanna do this anymore. I'm just gonna end it all." Very vague, but very scary.
So we'll go out. We'll drive out to your sister's house, knock on that door and say, "Hey, your family's worried about you. Do you think they have a reason to be worried about you?" If you see somebody who looks like they've been layin' in the sun for a long time and maybe they're passed out, you can't quite tell if they're breathing, don't wanna get too close, we'll go by and make sure that they're okay.
People that are just acting oddly maybe. People'll be, like, "This person's talking to a tree. I don't know what they need." But honestly, sometimes we'll show up and that person doesn't want our help and they're not in any danger, and that's just gonna be their day.
And there's no reason to interrupt it. There's no reason to disrupt their day just because we're not familiar with what they're doing, you know? So we have quite a variety. When we won't be able to respond is largely scene safety. And then there's certain medical things that are too extreme for us.
And those would be routed to the paramedics appropriately. But we do sometimes be the first to respond to an overdose situation or an cardiac (SIC) arrest that somebody thought was just somebody down. And so we start the compressions and do those things.
So we're trained. We have EMTs. We have the medical equipment. We can start an intervention and all for the appropriate backup, 'cause we do carry police radios. And that is where the value of being plugged into that comes from. For me as an individual, you know, hearing that radio all day is sometimes kind of exhausting.
Lee: I bet.
Morgan: But that ability to plug into that system when it serves the community is (SIGH) sometimes really, really valuable.
Lee: You know, what do you say to those people that say, "Our police do a great job. They're equipped to handle any and all calls. Why do we need a separate unit"?
Morgan: I let them know that our relationship with the police is really positive because they often don't want to do what we're doing. The things that we pick up, the calls that we take, they don't want them. They wanna get the bad guy, right? They have their own mission.
We'll show up on a scene and officers will say, "Oh, we're so glad that you're here. I don't know what we would do without you." When I've had to call them for a code three lights and sirens response, I was pretty glad they showed up. I (LAUGH) needed their help. So there's a working relationship there. And it's effective because neither of us wants the other person's job.
Lee: How do you measure success? Like, what does success look like for you all?
Morgan: I think largely, success is what we're seeing, which is a continued demand and a growing demand in our community. The more calls that we get and that we struggle sometimes now to keep up with our call load tells me that we are being successful. That people are calling us, people are trusting us and people want us as a response.
Now finding in the middle of these fires that we can help in evacuations with people maybe who don't understand. If you walk up and say, "Hey, this is a level three evacuation. It is a leave now situation. Don't grab your stuff. Just get in your car and get down the hill," and the person says, "No, it's raining inside right now. What do you mean? There can't be a fire here," that's gonna take time. And officers are going door to door, tryin' to make sure that everybody is out. And they can call us. That, to me, is a measure of success.
Lee: (MUSIC) After the break, Ebony and I dig into the role of race in her work. She told me that, as a Black woman going out on these mental health response calls, she's determined to make sure CAHOOTS is as effective for communities of color as it is for Eugene's predominantly white population. Stick with us.
Lee: (MUSIC) We're back with Ebony Morgan. You know, one other thing that might speak to the success of the organization, I'd imagine, is, you know, other cities thinking about adopting what you are doin' in Eugene. You have Denver, Oakland, Tampa, all tryin' to reimagine how they can kinda, like, change their police department in a way that, you know, serves people in a better way. And I wonder what pieces of what CAHOOTS does you think could be translatable to other cities.
Morgan: I think we're not a cookie cutter. And I certainly don't think we're a perfect respond. CAHOOTS is only as strong as the resources we have available. If our van is empty, if we have no resources in town to connect you with, it's really hard to help you outta your crisis because all we can do is notice for you that your crisis is real. (LAUGH)
And that might help. Like, it helps to not be alone. But it doesn't help resolve anything. It can look a lotta different ways. If you don't wanna partner up with your police agencies and you wanna do somethin' different, do somethin' different. There's so many different ways to show up for the community.
Lee: Yeah. Given how there's racism baked into all of our American institutions, including the police department, and I wonder how an organization like CAHOOTS operates in a more diverse place. Eugene is 83% white. There are certainly a number of Black and brown folks in that community. What happens when you put race into the scenario?
Morgan: I would encourage anywhere that's implementing this to make sure that there's representation in that team because in social work specifically, it's often a very white field. And I think that it can make it feel out of touch. It can make it outta touch.
But meeting people where they're at requires that you be aware of where they are. And you can't know that entirely. You need people to help with that. You need people who understand. This lady opened the door to me the other day and she said, "I do not consent." And I was, like, "I am CAHOOTS. I'm a crisis worker. I am not an officer." She goes, "I saw your radio and I thought you were a cop. All right, you can come in." (LAUGH)
Lee: There we go.
Morgan: I just knew. My partner was, like, "Ugh." And I was, like, "Nah, she just thinks we're cops." I see. I know. Like, it's fine. (LAUGH) Because I went there too. Like, I get it. I'm already thinking that. I'm already thinking, "Are you threatened by me?"
And you see my radio, you don't know who I am. Like, you have a defense mechanism built in. And I can get around that. But he wasn't thinking about that. That's not something he ever thinks about. So there's a real value in having diversity of experience and opinion. And I think it should be prioritized literally everywhere.
Lee: And to a lot of people, bein' in cahoots with the police is an automatic, like, you know, it makes you an in-credible messenger.
Morgan: Uh-huh (AFFIRM). Absolutely. I've been workin' on some community education pieces to outline that we adhere to HIPAA rules, like, privacy laws. We can't share your information with them. We don't wanna share your information with them. Our jobs are very different.
But I absolutely respect and understand that there are people that will not trust us. And that's hard for me, to be honest, because a lotta the people that don't trust us are the people that I would love to help the most. About a month before George Floyd's death, we started doing some diversity trainings and trying to understand equity in the workplace because there was just a noticed imbalance and a lack of diversity. We have spent so much on training. And we're working on bringing in equity advisors to make sure that we are not perpetuating the system that we decided to be a part of.
Lee: A couple stats jumped out to me. And it's that people with untreated mental illness are 16 times more likely to be killed by a police officer. And Black people are more likely to struggle getting access to treat their mental health conditions. You know, and Black people are six times more likely to be killed by police. And so in that space, how does that change the way you engage with the community or do the work?
Morgan: Being aware of that is the first step, right? And having the humility to say, like, "We are a part of the system that causes this, you know? We're working with this." Part of it for us is advocacy for our communities and making sure that we're speaking up and trying to make sure that these are identified as, like, public health crises and systemic issues that we need to address at systemic levels.
Even if we could convince Eugene Police of things and make sure that in Eugene these things don't happen, that has not fixed the fact that this is a systemic problem and it is oppressive. And it's shaving years off of people's lives to drastic degrees.
So I think that it helps us remember that our work is bigger than just each day. And it helps me personally wanna advocate on a larger scale. Like, we need to go to our public health officials and acknowledge that that is absolutely unacceptable. How are you 16 times more likely to die by police because you are mentally ill?
How is mentally ill supposed to associate with a death sentence? It's not fair. It doesn't make any sense, you know? Like, logistically, I can understand how it happens. Just because we can understand the pathway that gets there, does not mean we should accept it or normalize it.
And I now sit in the meetings with the Eugene Police Department and talk about how it's going and what changes need to be made, and have helped advocate for us to get a separate phone line so that people don't have to feel like they're calling the police to contact us. Some of the things that have been requested by the community for us to be a more accessible service, I get to go to the table and talk about now.
Lee: What else is needed? Like, if you were able to direct a bunch of resources to a number of different spaces that could help prevent people from getting to CAHOOTS or getting to the police in the first place, what would those be? What would be most helpful?
Morgan: Housing and shelter options to start. If you are not meeting these basic needs, it is so hard to think past them. How are you supposed to level into thinking about a job or thinking about a responsibility or having any self-worth if you can't stop thinking about surviving long enough to think about how to live.
So getting people safe and sheltered and getting people fed and educated, get them the information that they need. There are so many people who know that they have a diagnosis, but don't really know what that means, don't necessarily know what alternative methods to take care of it with.
We all are familiar with medication and know that it can be effective, but some people really don't like it. What else can we do? How else can we support people? How can we be safe and also plugged in? What kind of community networks can we have where people can check in and touch base? And if maybe their mental state has changed, there's someone to notice that.
Lee: Does it feel overwhelming, just given the magnitude of the work and how important it is?
Morgan: All the time. Every day. (LAUGH) We've got a pandemic, we've got this rejuvenated social justice movement, right? And then we've got a fire now in our backyard. And it's overwhelming all the time because we still have exactly the same scenarios playing out.
Our baseline job still needs to be done, on top of adding these components and figuring out what does it look like to transport people during the pandemic? How do we make sure that we're staying distanced and wearing masks, but also being empathetic? It's a lot harder to have empathy eyes (LAUGH) when three quarters of your face is hidden.
You just root in the humanity of it, right? It gets overwhelming and I just remember that we're all just trying. I'm trying to help. This person's trying to make it. Like, we're just trying. And so being unattached to outcomes is one of the things that we're taught. And that helps sometimes reduce the sense of overwhelm.
Lee: On your toughest days, those really hard days, when you've given everything you can, what are you tapping into as your power source, pushing you forward to the next call, and the next call? What are you gettin' into?
Morgan: For me, I just ground myself in a reminder that I'm tryin' to help people do the best they can. And that (SIGH) maybe if there had been more supports along the way for my father, if people had met him where he was at once in a while, it would look different, right?
And maybe that's true for a lot of human beings. And the more people in this job that I encounter and find out their story and figure out what their barriers are to where they wanna be. It's not that person's fault. It's never all on one human being. We are meant to be a community.
Humans are social creatures. And we are meant to support each other. That's when we're happiest. There's research to support that, right? That we find joy in community, a sense of belonging. It matters to the human experience. And when you are cast out of that, that group, when you perceive yourself as an outcast and that you aren't worthy of the same things, that you aren't worthy of the shelter or the food or the basic needs, it's damaging.
I chose this because it matters so much. And that I wanna be here for my community. And I want the community to believe that public safety is safe. And anything I can do to help that be true, I'm gonna do. It's bigger than me, right? Like, my heart was broken. My family was robbed. But I am not alone in that. And if I can use that fuel, if I can use that loss and grief to help influence change and make someone else's life include their father, I'd do this all day.
Lee: (MUSIC) That was Ebony Morgan, a crisis intervention worker and communications director for CAHOOTS, Crisis Assistance Helping Out On the Streets. The mental health response team is based in Eugene, Oregon. Into America is produced by Isabel Angel, Allison Bailey, Aaron Dalton, Max Jacobs, Barbara Raab, Claire Tighe, Aisha Turner, and Preeti Varathan. Original music by Hannis Brown. Our executive producer is Ellen Frankman. Steve Lickteig is executive producer of audio. I'm Trymaine Lee. We'll be back on Thursday.