She doesn’t know the person who’s coming home — the person who she said has been doing every drug he can get his hands on inside the Alabama prison system. She can hear it in the 34-year-old’s voice when he calls her on the prison phone.

Her son is one of almost 20,000 inmates in the Alabama prison system living in conditions the U.S. Department of Justice has called inhumane. In , it found that the rampant use of drugs causes sexual abuse and “severe” violence in the state’s prisons. The department has sued Alabama, alleging conditions in its prisons violate inmates’ civil rights. According to the Alabama Department of Corrections’ , almost 60 pounds of illicit drugs were confiscated from its prisons in the first three months of this year.

Even if Alabama’s prisons and jails are especially overrun by drugs, death, and violence, their problems are not unique in the U.S. Within three weeks this spring, incarcerated people died of overdoses in , , , and the .

The alcohol and drug overdose death rate increased fivefold in prisons from 2009 through 2019, according to a — a surge that outpaced the national drug overdose rate, which tripled in the same period.

As the opioid crisis ravages America, overdose deaths are sweeping through every corner of the nation, including jails and prisons. Criminal justice experts suggest that decades of using the legal system instead of community-based addiction treatment to address drug use have not led to a drop in drug use or overdoses. Instead, the rate of drug deaths behind bars in supposedly secure facilities has increased.

This rise comes amid the decriminalization of cannabis in many parts of the country and a drop in the overall number of people incarcerated for drug crimes, according to the Pew report.

“It certainly points to the need for alternative solutions that rely less on the criminal justice system to help people who are struggling with substance use disorders,” said Tracy Velázquez, senior manager for safety and justice programs at the Pew Charitable Trusts.

For decades, drug use in America has mainly been addressed through the penal system — behind bars are there for a drug offense. Drug crimes were behind 30% of new admissions to Alabama prisons in March. Nationally, they were the leading cause of arrest, and almost 90% of arrests were for possession of drugs, not sale or manufacturing, according to the Pew study. The researchers also found that fewer than 8% of arrested people with a drug dependency received treatment while incarcerated.

Velázquez said a lot of drug use is spurred by people with mental health issues attempting to self-medicate. Almost have a history of mental illness, according to the Bureau of Justice Statistics.

Holland said her son was diagnosed with schizophrenia and PTSD six years ago after struggling with drug use since his teens. The son, who asked that his name not be published for fear his comments could jeopardize his release from prison or subsequent parole, said a schizophrenic episode in 2017 led him to break into a house during a hurricane. He said he didn’t realize people were in the house until after he ate a sandwich, got a Coke from the fridge, and looked for dry clothes. They called the police. He was sent to prison on a charge of burglary.

“They don’t put the mental health patients where they should be; they put them in prison,” Holland said.

She’s not only frustrated by the lack of medical care and treatment her son has received, but also horrified at the access to drugs and the abuse she said her son has suffered in the overcrowded, understaffed Alabama prison system.

He told KHN he’s been raped and beaten because of drug debts and put on suicide watch more than a dozen times. He said he turned back to using heroin, meth, and the while incarcerated.

“We need to really focus on not assuming that putting someone in jail or prison is going to make them abstinent from drug use,” Velázquez said. “We really need to provide treatment that not only addresses the chemical, substance use disorder, but also addresses some of the underlying issues.”

Beth Shelburne, who works with the American Civil Liberties Union, logged in Alabama prisons in 2021, the most she has seen since she started tracking them in 2018.

She said those numbers are just a snapshot of what is going on inside Alabama’s prisons. The Justice Department found the state corrections department failed to accurately report deaths in its facilities.

“A lot of the people that are dying, I would argue, don’t belong in prison,” Shelburne said. “What’s so disgusting about all this is we are sentencing people who are drug-addicted to time in these ‘correctional facilities,’ when we’re really just throwing them into drug dens.”

The corrections department’s at least seven overdose deaths in 2021, three of which officials classified as natural deaths. It reported 97 deaths in the first three months of this year that have yet to be fully classified.

Though Republican Gov. Kay Ivey a grant of more than $500,000 for a program to help incarcerated people address drug use disorders, the number of graduates of drug treatment programs in the state’s prison system has plummeted in the past decade to record lows. About 3% of prisoners completed a treatment program in 2021, down from 14% in 2009.

In contrast, California reported a in overdose deaths in its prisons in 2020, which state officials attributed to the start of a substance use treatment program and the widespread availability of medication-assisted therapy.

Alabama’s system is developing a plan with its health contractor, said Alabama Department of Corrections spokesperson Kelly Betts. Before 2019, medications that curb drug cravings or mute highs were given only to those who could be separated from the general prison population, according to Deborah Crook, the department’s health services deputy commissioner.

“The science has changed considerably and there are more medication options that are safer to prescribe — even in general population,” she wrote in a statement.

Though prison officials have long blamed visitors for bringing in drugs, the ban on visitation during the pandemic did not lead to a inside. were arrested in Alabama last year and into jails and prisons, and the Department of Justice’s found dozens of officers arrested in the previous two years on charges related to drug trafficking and other misconduct.

Illegal drugs are “a challenge faced by correctional systems across the country,” Betts wrote in an email. “The ADOC is committed to enforcing our zero-tolerance policy on contraband and works very hard to eradicate it from our facilities.”

Betts did not specify how these policies are enforced. The department also refused to respond to a detailed list of questions about drug use and overdoses in its prisons, citing the litigation with the Justice Department.

Holland doesn’t know what will happen when her son gets out. He said he hopes he can restart his business as an electrician and provide for his family. But the four years of his so-called rehabilitation have been a nightmare for both of them.

“They’re released messed-up, hurt, and deeply dysfunctional. What do you do with someone that’s been through all that?” Holland said. “That’s not rehabilitation. It’s not.”

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But when he saw her, she was heavily sedated. A ventilator was helping her breathe as she struggled with covid-19. Rebecca “Maria” Adams, 59, died 18 days after Christmas in the same hospital bed.

The pandemic has proved especially deadly behind bars. Inmates are as the general population. And the deaths continue to pile up.

Adams was the second of three women incarcerated at Alderson Federal Prison Camp to die of covid in less than a week in January. The prison that holds fewer than 700 inmates had 50 cases as of Feb. 8. When U.S. case numbers surged in December because of the omicron variant, an understaffed and still underprepared federal prison system was once again swamped by covid cases.

The deaths of these three women imprisoned in West Virginia reflect a federal prison system plagued by chronic problems exacerbated by the pandemic, including understaffing, inadequate medical care, and few compassionate releases. The most recent statistics from the Federal Bureau of Prisons report 284 inmates and seven staff members have died nationwide because of covid since March 28, 2020. Medical and legal experts say those numbers are likely an undercount, but the federal prison system lacks independent oversight.

Alderson, where Adams was incarcerated, was one of the first federal prisons to have a covid outbreak in December in this latest national surge. But as of the first week of February, 16 federal facilities had over 100 cases. More than 5,500 federal inmates and over 2,000 BOP staffers had tested positive for covid, according to BOP data. At one prison in Yazoo City, Mississippi, over 500 inmates — almost half the prison — tested positive in late January. Including the three women from Alderson, 12 federal inmates died while sick with covid in January.

The Bureau of Prisons has come under fire in the past few months after investigations by and alleged widespread corruption and called the agency a “hotbed of abuse.” In January, before all three Alderson inmates died, the head of the BOP, Michael Carvajal, , although he remains in charge until a successor takes the helm.

The criticism of the agency continued in in January after the deaths at Alderson. Legal and medical experts specializing in the federal system, as well as members of Congress, accused the BOP of hiding covid deaths and cases, repeatedly failing to provide adequate health care, and failing to properly implement the compassionate release program meant to move at-risk inmates to home confinement. Five recently released inmates, two incarcerated inmates, and six family members of women incarcerated at Alderson, confirmed these allegations to KHN.

The Alderson inmates and their families reported denial of medical care, a lack of covid testing, retaliation for speaking out about conditions, understaffing, and a prison overrun by covid. Absences by prison staff members sickened by the virus led to cold meals, dirty clothes, and a denial of items like sanitary napkins and clean water from the commissary.

In an email, BOP spokesperson Benjamin O’Cone said the agency does not comment on what he called “anecdotal allegations.” He said the BOP follows covid guidance from the Centers for Disease Control and Prevention.

O’Cone pointed to the BOP’s about covid statistics when asked how many inmates have died since Dec. 1 and how many had tested positive for covid before death. A day after KHN emailed the BOP about the deaths of the three inmates from Alderson, two appeared on the dashboard and were published. The women had been dead for almost a week.

All three women — Adams, Juanita Haynes, and Bree Eberbaugh — had sought compassionate releases because of preexisting medical conditions that made them more susceptible to dying from covid, including Type 2 diabetes, hypertension, congestive heart failure, obesity, and chronic obstructive pulmonary disease.

Nationwide, over 23,000 people were released from the federal system from March 2020 to October 2021, but more than 157,000 people are still imprisoned. After early pandemic releases, the prison population in the U.S. is climbing back to pre-pandemic levels. Some of the early drop was due to inmate deaths, which rose 46% from 2019 to 2020, according to the most recent data from the Bureau of Justice Statistics.

For people like Adams, compassionate release never came. The BOP reports that only two women have been granted compassionate release from Alderson since the outbreak began in December. One was Haynes, who was granted release while intubated. She died four days later, in the hospital.

“They will literally be released so they don’t die in chains,” , clinical associate professor of law at the University of Iowa, said in congressional testimony in January. She called BOP facilities “death traps,” referring to the BOP’s “inability or reticence to control the spread of covid-19 behind bars by engaging in aggressive evidence-based public-health measures.”

Guernsey testified that the BOP death data is “suspect” because of delayed reporting, the exclusion of deaths in prisons run by private contractors, and those released just in time to “die free.” Haynes’ death, for example, is not counted in BOP data even though she got sick with covid while incarcerated because she was freed through compassionate release right before she died in January, months after her first applications were denied.

Guernsey questions the BOP’s covid infection numbers because the agency does not report the number of tests administered, just the number of positive tests. “The BOP can hide whether low infection rate is due to low covid cases or inadequate testing,” she said. All these factors mean the numbers of deaths and cases are likely “substantially” greater than reported, Guernsey said.

The impact of incorrect data trickles down to the denial of compassionate release requests. One factor that judges consider is the level of covid cases and risk within that prison. Eberbaugh, the third inmate from Alderson to die in January, applied in March 2020 for compassionate release from her 54-month sentence, citing preexisting medical conditions.

In August 2020, a court denied Eberbaugh’s motion, in part citing the lack of covid cases in the prison. A few days later, she responded in a , appealing for legal counsel from the public defender’s office. “Your honor, it is only a matter of time before it reaches here and I am in fear of my life,” she wrote.

The court denied that appeal in April 2021. Within nine months, she had died of covid.

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Durante las tres semanas siguientes, la familia luchó contra la enfermedad en aislamiento, mientras amigos y vecinos dejaban comida en la puerta de su casa en Colorado Springs, Colorado. Ana y sus hijos nunca se hicieron una prueba para confirmar que contrajeron el virus, pero la presión en sus pulmones, la fiebre, el dolor de cabeza, y la pérdida del olfato y el gusto la convencieron de que no podía ser otra cosa.

“Fue horrible”, dijo Ana, residente de Colorado por más de dos décadas, quien solicitó que no se usara su apellido debido a su estatus migratorio.

Casi un año después, los efectos del virus van mucho más allá de una persistente falta de aire para Ana. Perdió su trabajo limpiando casas, cuando se enfermó en marzo, y no pudo pagar la renta.

La asistencia en efectivo de una organización local sin fines de lucro la ayudó a ponerse al día en el otoño, pero no podía seguir pagando el alquiler sin trabajar. Finalmente, el propietario echó a la familia a principios de enero con sólo 30 horas de aviso.

Ana es una de los casi 11 millones de inmigrantes que viven en el país sin papeles, y que son particularmente vulnerables a las consecuencias económicas provocadas por la pandemia: no tienen acceso directo a una parte de los miles de millones de dólares en ayuda federal que se han repartido.

Se estima que cuatro de cada cinco de ellos tienen trabajos esenciales que los ponen en alto riesgo de contraer covid-19. También es más probable que sufran las consecuencias económicas, incluso cuando existen protecciones, como la moratoria de desalojos de los Centros para el Control y la Prevención de Enfermedades (CDC) , porque temen que, si piden ayuda, o denuncian a los propietarios, podrían ser detenidos o deportados.

La toma de posesión del presidente Joe Biden trajo algunas noticias alentadoras, ya que dijo que quiere crear para muchos de los inmigrantes indocumentados de la nación. También dijo que deberían poder vacunarse contra  covid .

A pesar de que las vacunas contra covid están disponibles para todos sin importar su ciudadanía, la desconfianza en el gobierno y las fuerzas del orden entre la comunidad inmigrante, la desinformción y la falta de información sobre vacunas culturalmente competente, han hecho que algunos inmigrantes indocumentados se muestren reacios a ir a vacunarse.

Incluso si Biden cumple su promesa de acceso equitativo a una vacuna, los inmigrantes indocumentados continúan sin tener acceso a ayuda económica.

El tema se planteó nuevamente el 6 de marzo cuando el senador republicano Ted Cruz afirmó que el nuevo paquete de ayuda de $1,9 billones de Biden enviaría cheques de estímulo . El senador demócrata Dick Durbin aclaró que los inmigrantes indocumentados .

Los grupos de defensa han abogado por paquetes “inclusivos” que brinden ayuda directa a la mayor cantidad posible de inmigrantes sin importar su estatus migratorio. Aunque algunos estados ofrecen ayuda a indocumentados, no es suficiente, según Marielena Hincapié, directora ejecutiva del National Immigration Law Center.

“El estatus migratorio no debería ser un requisito para ninguno de estos programas. En última instancia, se trata de la necesidad y de garantizar que las familias tengan la estabilidad económica, no solo para sobrevivir, sino para superar esta pandemia que nos afecta a todos”, dijo Hincapié. “El 80% de los inmigrantes indocumentados están en trabajos esenciales. Confiamos en ellos y, sin embargo, les negamos a sus familias este apoyo básico que todos los demás están recibiendo”.

A las parejas con estatus migratorio mixto, en las que solo un cónyuge es ciudadano, también se les bloqueó la ayuda hasta diciembre. Ahora pueden solicitar pagos de estímulo de forma retroactiva, pero seguirán recibiendo menos que las parejas en donde ambos son ciudadanos.

Así y todo, también la ayuda infantil quedó fuera. Un grupo de familias demandó a la administración Trump en mayo de 2020 después que excluyera a los niños en el primer paquete de ayuda por covid-19 conocido como Ley CARES. La decisión judicial está pendiente.

Mientras tanto, en febrero, ocho demócratas del Senado, incluido John Hickenlooper de Colorado, votaron a favor de que continúa bloqueando a los inmigrantes documentados e indocumentados que pagan impuestos utilizando ITIN (un número de identificación individual del contribuyente que otorga el IRS) para que no reciban alivio económico.

Casi (incluidos unos ) tienen un número de ITIN y pagan impuestos, según el American Immigration Council, una organización de defensa con sede en Washington, D.C.

En Colorado, pagaron aproximadamente en impuestos federales y $156.5 millones en impuestos estatales y locales en 2018. Según el , los contribuyentes de ITIN en todo el país pagan más de $9 mil millones en impuestos anuales sobre las colillas de pago.

El Migration Policy Institute, un grupo de expertos sin fines de lucro en Washington, DC, informó en enero que cuyos ingresos alcanzan el umbral para la ayuda de covid no pueden acceder a ella, y tampoco pueden solicitar programas federales que brinden asistencia en forma de dinero y alimentos.

Agregó que las personas indocumentadas representan más de la mitad de los trabajadores en las industrias más afectadas, como empacadoras de carne, restaurantes, atención médica y el cuidado infantil.

La organización sin fines de lucro de Colorado que le brindó a Ana asistencia para el alquiler, llamada , recibió solicitudes de 300 familias para obtener ayuda para pagar sus rentas. El grupo solo pudo ayudar a 51 de ellos, dijo Julissa Soto, directora de programas estatales.

Soto, quien fue indocumentada, dijo que sabe de al menos 30 familias indocumentadas que no tienen hogar debido a la pandemia en el condado de El Paso, que incluye Colorado Springs. Dijo que se siente frustrada por la falta de acción de los líderes políticos de Colorado para abordar el problema.

“Mi comunidad se muere de hambre y es desalojada, y esto se debe a que somos indocumentados y no existimos”, dijo. “Nadie quiere hablar de la comunidad indocumentada”.

No está claro cuántas personas que viven ilegalmente en todo el país han sido desalojadas durante la pandemia. Una razón de la incertidumbre es porque a menudo se van en el momento en que un propietario amenaza con echarlos para evitar ir a la corte y correr el riesgo de deportación, dicen explican defensores.

Como resultado, los propietarios a menudo pueden desalojar a las personas indocumentadas sin siquiera presentarse oficialmente en un tribunal civil y sin seguir las reglas estatales y federales, por lo que no hay ningún formulario que rastrear.

“En lugar de ir a la corte y hacer valer sus derechos, simplemente se mudan”, dijo Zach Neumann, fundador del de Colorado. “A menudo lo hacen de una manera que es realmente perjudicial para sus familias y sus vidas”.

El arrendador de Ana la desalojó al final de su contrato. Dijo que su casero amenazó con llamar a la policía, por lo que se fue lo más rápido posible. El breve período de tiempo establecido por el propietario no se ajustó a la ley de Colorado, que permite a los inquilinos 10 días para apelar un desalojo en la corte o dejar la propiedad después de la notificación oficial.

La empresa que gerencia la vivienda tiene un número de teléfono que está fuera de servicio.

Aunque el paquete de ayuda de emergencia para la pandemia propuesto por Biden menciona garantizar el acceso a las vacunas para todos “independientemente del estatus migratorio”, no se incluye una declaración similar para los $30 mil millones propuestos en asistencia para alquiler, electricidad y agua.

y la desarrollaron programas de pago para residentes indocumentados. Pero, a pesar de tener una población indocumentada de casi 200,000, lo que representa cerca del 3% de la población del estado en 2016, Colorado no tiene un programa de ayuda financiera para esta comunidad.

Ana y sus hijos ahora duermen en la casa de una amiga, en el suelo de una habitación sin muebles. Recientemente encontró un trabajo de limpieza que paga $300 a la semana. No es mucho, pero está agradecida después de nueve meses de buscar trabajo. Todavía le aterroriza perder a sus hijos si los trabajadores de servicios sociales descubren que la familia no tiene hogar.

“Esto no es vivir. Es solo sobrevivir. Seamos claros. Esto es solo sobrevivir y quiero vivir. Quiero una casa para mis hijos”, dijo.

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For the next three weeks, the family fought the illness in isolation — Ana clutching the top of door frames to catch her breath — while friends and neighbors left food on the porch of their home in Colorado Springs, Colorado. Ana and her children never took tests to confirm they caught the coronavirus, but the pressure in her lungs, the fever, the headache and the loss of smell and taste convinced her it couldn’t be anything else.

“It was horrible,” said Ana, a Colorado resident for more than two decades who requested her last name not be used because of her immigration status. “We had to lay on the floor to breathe.”

Nearly a year later, the effects of the virus go far beyond nagging shortness of breath for Ana. She lost her job cleaning houses when she got sick last March, so she couldn’t pay rent. A local nonprofit’s cash assistance funded by some federal covid relief helped her catch up in the fall, but she still had no work and fell behind on rent again. Her landlord finally threw the family out of their home at the beginning of January with 30 hours’ notice, she said.

Ana is one the nearly 11 million undocumented immigrants living in the U.S. without legal permission, who are particularly vulnerable to the economic fallout wrought by the pandemic and have no direct access to the billions of dollars in federal pandemic relief over the past year. An estimated 4 in 5 of them work essential jobs that put them at high risk to catch the covid virus. They are also more likely to suffer the economic consequences, even with protections in place — such as the Centers for Disease Control and Prevention’s eviction moratorium, — because they fear that reaching out for help or reporting landlords could lead to deportation or detention.

President Joe Biden’s inauguration brought some encouraging news, as he’s said he wants to for many of the nation’s undocumented immigrants. they should be able to be vaccinated against covid without worrying that they will be arrested and deported.

Even though the covid vaccines are available to everyone no matter their citizenship, a distrust of government and law enforcement in the immigrant community and a lack of culturally competent vaccination information and even misinformation have made some undocumented immigrants reluctant to come forward early in the vaccination rollout.

Even if Biden makes good on his pledge of equitable access to a vaccine, unauthorized U.S. residents continue to have no direct access to billions of dollars in federal pandemic relief. The issue was brought up again on March 6 when Republican Sen. Ted Cruz claimed Biden’s new $1.9 trillion aid package would send stimulus checks . Democratic Sen. Dick Durbin in the measure that passed the Senate. The House was set to take up the Senate’s changes on Tuesday.

Advocacy groups have argued for “inclusive” aid packages that provide direct aid to as many immigrants as possible no matter citizenship status, and while a few states set up aid for the undocumented, it’s not nearly enough, according to Marielena Hincapié, executive director of the National Immigration Law Center.

“Immigration status shouldn’t be the gatekeeper to any of these programs. It really ultimately is about need and ensuring that families have the economic stability, to not only survive, but to get through this pandemic that all of us are impacted by,” Hincapié says. “Eighty percent of undocumented immigrants are working as essential workers. We are relying on them, and yet are denying their families this basic support that everyone else is getting.”

Couples with mixed immigration status — in which only one partner is a U.S. citizen — were also blocked from aid until December. They can now apply for stimulus payments retroactively but will still receive less than couples who are U.S. citizens. Though the change made millions more families eligible for some aid, couples in which both partners are undocumented immigrants also have not received stimulus payments for their children even if their children were born in the U.S. and are citizens. A group of families after it excluded children in the first COVID-19 aid package known as the CARES Act. The Department of Justice under the Biden administration has continued to defend the policy and has asked a federal judge to dismiss the lawsuit. A decision is pending.

Meanwhile, in February, eight Senate Democrats, including John Hickenlooper of Colorado, that continues to block both documented and undocumented immigrants who pay taxes using ITINs (individual taxpayer identification numbers) from receiving direct relief. (A Social Security number is a requirement for federal pandemic aid, which means immigrants who pay taxes with ITINs can’t qualify.) After getting blowback for his vote from Colorado’s immigration rights community and a from the Colorado ACLU accused the senator of breaking campaign promises to stand with immigrants, Hickenlooper met with community members and released a to a local news station: “I recognize how this vote has distorted that important fact and fed dangerous and damaging narratives about the undocumented community. … I remain committed to working together to finally achieve a comprehensive fix for our broken immigration system, including a pathway to citizenship.”

Hincapié calls the vote “morally unconscionable.” “The pandemic has shown how interdependent we are and that this is a time in our nation to make sure we’re taking care of everyone. It’s the only way we’re going to get out of this,” she said. “There is no recovery without including immigrants.”

Nearly half of the nearly living illegally in the United States (including some in Colorado) pay taxes, according to the American Immigration Council, a Washington, D.C.-based advocacy organization. In Colorado, they paid an estimated in federal taxes and $156.5 million in state and local taxes in 2018. According to the , ITIN filers nationwide pay over $9 billion in annual payroll taxes.

The Migration Policy Institute, a nonprofit think tank in Washington, D.C., in January that 9.3 million unauthorized immigrants whose income meets the threshold for covid aid are blocked from accessing it, and also can’t apply for federal programs that provide cash and food assistance. It reported that undocumented people represent more than half of the workers in the hardest-hit industries, such as meatpacking, the restaurant business, health care and child care.

The Colorado nonprofit that provided Ana with rental assistance, , received applications from 300 families for rental help. The group could assist only 51 of them, said Julissa Soto, the group’s director of statewide programs. Soto, who used to be undocumented herself, said she knows of at least 30 undocumented families that are homeless because of the pandemic in El Paso County, which includes Colorado Springs. She said she is frustrated by a lack of action by Colorado’s political leaders to address the problem.

“My community is starving and getting evicted, and this is because we are undocumented and we don’t exist,” she said. “No one wants to talk about the undocumented community.”

It’s unclear how many people living illegally across the nation have been evicted during the pandemic. One reason for the uncertainty is because they often leave the moment a landlord threatens to kick them out to avoid going to eviction court and risking deportation, immigration advocates say. As a result, landlords can often evict undocumented people without ever officially filing in civil court and without following the state and federal rules, so there is no paper trail to track.

“Rather than go to court and assert their rights, they just move out,” said Zach Neumann, founder of the . “They often do so in a way that’s really disruptive to their families and their lives.”

Ana’s landlord evicted her at the end of her lease exploiting a loophole in the federal eviction moratorium that allows evictions when leases expire. She said her landlord threatened to call the police, so she left as quickly as possible. The short time frame her landlord set does not follow Colorado law, which allows tenants 10 days to appeal an eviction in court or leave the property after official notice is given.

A phone number listed for the landlord, AB Property Management, was disconnected, and multiple attempts to contact the owners of Ana’s past rental property were unsuccessful.

Though President Joe Biden’s proposed emergency pandemic aid package mentions ensuring vaccine access to Americans “regardless of their immigration status,” there is no similar statement included for the $30 billion proposed in rental and critical energy and water assistance, or extended unemployment benefits or individual stimulus checks..

and developed payment programs for undocumented residents. But despite having an undocumented population of almost 200,000 — accounting for about 3% of the state’s population in 2016 — Colorado has no financial aid program to address that community.

Ana and her children are now sleeping on the floor in a friend’s unfurnished spare room. She recently found a cleaning job that pays $300 a week. It’s not much, but she’s thankful to have it after nine months of looking for work. She’s still terrified of losing her kids if social-service workers find out the family is homeless.

“This is not living. This is just surviving. Let’s be clear. This is just surviving, and I want to live. I want a house for my kids,” she said.

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Known as “street medics,” these unorthodox teams of nursing students, veterinarians, doctors, trauma surgeons, security guards, ski patrollers, nurses, wilderness EMTs and off-the-clock ambulance workers poured water — not milk — into the eyes of tear-gassed protesters. They stanched bleeding wounds and plucked disoriented teenagers from clouds of gas, entering dangerous corners where on-duty emergency health responders may fear to go.

Many are medical professionals who see parallels between the front lines of COVID-19, where they confront stark racial imbalances among those stricken by the coronavirus, and what they see as racialized police brutality.

So donning cloth masks to protect against the virus — plus helmets, makeshift shields and other gear to guard against rubber bullets, projectiles and tear gas — the volunteer medics organized themselves into a web of first responders to care for people on the streets. They showed up early, set up first-aid stations, established transportation networks and covered their arms, helmets and backpacks with crosses made of red duct tape, to signify that they were medics. Some stayed late into the night past curfews until every protester had left.

Iris Butler, a 21-year-old certified nursing assistant who works in a nursing home, decided to offer her skills after seeing a man injured by a rubber bullet on her first night at the Denver protests. She showed up as a medic every night thereafter. She didn’t see it as a choice.

“I am working full time and basically being at the protest after getting straight off of work,” said Butler, who is black. That’s tiring, she added, but so is being a black woman in America.

After going out as a medic on her own, she soon met other volunteers. Together they used text-message chains to organize their efforts. One night, she responded to a man who had been shot with a rubber bullet in the chest; she said his torso had turned blue and purple from the impact. She also provided aid after a shooting near the protest left someone in critical condition.

“It’s hard, but bills need to be paid and justice needs to be served,” she said.

The street medic movement traces its roots, in part, to the 1960s protests, as well as the American Indian Movement and the Black Panther Party. offers a 20-hour training course that prepares them to treat patients in conflicts with police and large crowds; a four-hour session is offered to medical professionals as “bridge” training.

Since the coronavirus pandemic began, the Denver Action Medic Network has added new training guidelines: Don’t go to protests if sick or in contact with those who are infected; wear a mask; give people lots of space and use hand sanitizer. Jordan Garcia, a 39-year-old medic for over 20 years who works with the network of veteran street medics, said they also warn medics about the increased risk of transmission due to protesters coughing from tear gas, and urge them to get tested for the virus after the protests.

The number of volunteer medics swelled after George Floyd’s May 25 killing in Minneapolis. In Denver alone, at least 40 people reached out to the Denver Action Medic Network for training.

On June 3, Dr. , an associate professor of medicine at the University of California-San Francisco and the co-founder of the Do No Harm Coalition, which runs street medic training in the Bay Area, hosted a national webinar attended by over 3,000 medical professionals to provide the bridge training to be a street medic. In her online bio, Marya describes the coalition as “an organization of over 450 health workers committed to structural change” in addressing health problems.

“When we see suffering, that’s where we go,” Marya said. “And right now that suffering is happening on the streets.”

In the recent Denver protests, street medics responded to major head, face and eye injuries among protesters from what are sometimes described as “” or “less-than-lethal” bullets shot at protesters, along with stun grenade canisters that either hit them or exploded in their faces.

Garcia, who by day works for an immigrant rights nonprofit, said that these weapons are .

“We’re seeing police use these less-lethal weapons in lethal ways, and that is pretty upsetting,” Garcia said about the recent protests.

Denver police Chief Paul Pazen , including banning chokeholds and requiring SWAT teams to turn on their body cameras. Last week, a to stop Denver police from using tear gas and other less-than-lethal weapons in response to a class action lawsuit, in which a medic stated he was shot multiple times by police with pepper balls while treating patients. (Last week in North Carolina police were recorded .)

Denver street medic Kevin Connell, a 30-year-old emergency room nurse, said he was hit with pepper balls in the back of his medic vest — which was clearly marked by red crosses — while treating a patient. He showed up to the Denver protests every night he did not have to work, he said, wearing a Kevlar medic vest, protective goggles and a homemade gas mask fashioned from a water bottle. As a member of the Denver Action Medic Network, Connell also served at the Standing Rock protests in North Dakota in a dispute over the building of the Dakota Access Pipeline.

“I mean, as bad as it sounds, it was only tear gas, pepper balls and rubber bullets that were being fired on us,” Connell said of his recent experience in Denver. “When I was at Standing Rock, they were using high-powered water hoses even when it was, like, freezing cold. … So I think the police here had a little bit more restraint.”

Still, first-time street medic Aj Mossman, a 31-year-old Denver emergency medical technician studying for nursing school, was shocked to be tear-gassed and struck in the back of the leg with a flash grenade while treating a protester on May 30. Mossman still has a large leg bruise.

The following night, Mossman, who uses the pronoun they, brought more protective gear, but said they are still having difficulty processing what felt like a war zone.

“I thought I understood what my black friends went through. I thought I understood what the black community went through,” said Mossman, who is white. “But I had absolutely no idea how violent the police were and how little they cared about who they hurt.”

For Butler, serving as a medic with others from various walks of life was inspiring. “They’re also out there to protect black and brown bodies. And that’s amazing,” she said. “That’s just a beautiful sight.”

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Toole County quickly became the state’s hot spot for COVID-19 deaths, with more than four times the infection rate of all other counties and the most recorded deaths in the state. COVID deaths through Tuesday have occurred here.

But another danger loomed: What if it got into the prison, less than 4 miles away from the hospital and assisted living facility? The county was nearly overwhelmed as it was. Across rural America, prisons and jails sit in places like Toole County that have minimal intensive care unit beds and ventilators and few additional medical resources. Many hospitals there were strained before the pandemic.

This rural, 5,000-person county tucked under the Canadian border might not have seemed like a breeding ground for the contagion. It is a primarily agricultural community almost twice as large as Rhode Island situated in the Great Plains under a big Montana sky. Some areas of the county don’t have cellphone coverage, much less internet, and winters are cold enough that people plug in their cars not because they are electric but because they must heat the engines to keep them from freezing.

“When you look at the per capita infection rate in the county and deaths, unfortunately, in our community, it’s very, very staggering,” said William Kiefer, CEO of the Marias Medical Center, which is affiliated with the assisted living facility. “And the impact is clearly similar to what’s happening in some of the urban areas that have been hit really hard.”

The two original cases of COVID-19 at the assisted living facility exposed 63 staffers at the center and the affiliated hospital. Thirteen tested positive, and one was hospitalized. All of them recovered. It took a monumental effort by the entire county to keep the hospital from shuttering.

At the worst point, Kiefer and his CFO were the only original staff members not quarantined and able to work. The Montana National Guard helped wash laundry, former employees came out of retirement to fill in, nurses worked as many as five different roles for weeks on end, and quarantined staff coordinated administrative work from sunup to sundown while isolating from their families.

But, through it all, the dreaded coronavirus hasn’t yet crept into the site of one of the community’s largest employers, the prison. It holds almost 15% of the county’s total population with a 712-bed facility for both federal and state inmates.

Almost 70% of the nation’s more than 1,100 prisons are located , according to 2017 research by , an associate professor in sociology at the University of Wisconsin-Madison. A building boom occurred from 1980 through 1999 as struggling towns eyed prisons as economic salvations.

But in many of those same communities, rural hospitals that would be tasked to care for inmates during a pandemic have since struggled, with in the past decade.

“It’s going to be a nightmare because rural communities are so disadvantaged,” Eason said. “We’re going to see a lot of people in prison contract and die of COVID.”

It is not just the inmates behind bars, but also the people in the surrounding community, many of whom work at the facilities, who would be at risk. The employees leaving prisons and jails daily could spread the virus to inmates on the inside and community members on the outside. Already such rural communities on average have sicker and older populations than the rest of the country, even before considering the added risk of close-quartered prisons and jails.

“What is at stake is, in some way, always what’s been at stake,” said Jessica Pishko, the senior legal adviser at the , a nonprofit focused on the justice system. “The most vulnerable are already the ones who are the most impacted.”

The Justice Collaborative released a finding that 12% of people held in jails are in counties without intensive care unit beds. In Montana, the report said, over a third of jail detainees are in counties without them. And Toole County has none. Jails, which hold people pretrial, often have a higher rate of turnover of inmates moving in and out of the facility than prisons, increasing the chance of spreading the disease. Still, prisons have similar difficulties with COVID-19 prevention inside facilities.

Of course, not all people infected with the coronavirus end up in need of intensive care, but even a small number of serious cases in a small jail or prison could overwhelm limited resources.

“You can’t just airlift 10 people to another hospital,” Pishko said.

The Marias Medical Center has two ventilators and added a six-bed COVID-19 isolation tent behind the hospital. It has two regular staff nurses. But, like many rural hospitals, it is designed to stabilize patients and then transfer them to other, bigger hospitals, if needed. Those are some 80 and 160 miles away.

COVID-19 has only magnified the existing resource problems of the medical center.

“We almost got pushed to the limit where we didn’t have sufficient staff to maintain our emergency room open, and that would be catastrophic to a community,” Kiefer said.

In normal times, the facility saw about five of the prison’s inmates a month in the emergency room. Now, amid the pandemic, officials from the medical center and county have been coordinating with the company that runs Crossroads to form plans in case a new wave of COVID-19 compromises the facility. Ryan Gustin, a spokesperson for CoreCivic, which runs Crossroads, said they are all sharing information to “strengthen our collective response.”

The also helped the private prison distribute educational materials, such as newsletters detailing information about the virus and prevention. As of Monday, no inmates had tested positive in Montana state-run facilities and three staff had tested positive.

Even so, Toole County Health Department interim director Blair Tomsheck wrote in an email that “any outbreak has the potential to overwhelm our medical resources.”

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“Jito, ven a casa”, le dice siempre, usando una forma cariñosa de llamarlo en español. Aunque puede tener cama y comida, su hijo, Matt Vinnola, rara vez regresa a casa. Si lo hace, es temporal. Las calles son más fáciles para él. Su propio hogar puede ser demasiado pacífico.

Pero las mismas calles que a Vinnola le ofrecen confort también son inseguras para un hombre que lucha contra dos demonios: el consumo de drogas y la esquizofrenia paranoide crónica.

La policía y los tribunales penales a menudo intervienen antes que Vinnola reciba tratamiento o atención. Desde su primer diagnóstico de enfermedad mental grave en 2014, Vinnola ha estado sumando una lista de cargos, desde delitos menores hasta casos graves como entrar en una propiedad privada u otros relacionados con drogas. En los últimos cuatro años, Vinnola ha sido acusado en cuatro tribunales distintos de Colorado y arrestado varias veces casi cada mes, ya sea por nuevos delitos o por órdenes de arresto por no comparecer ante un tribunal.

Pero pronto, podría encontrarse en las calles con profesionales de salud mental en lugar de policías. Denver es una de al menos ocho ciudades que está considerando implementar un programa de Eugene, en Oregon, llamado Crisis Assistance Helping Out On The Streets (CAHOOTS) que busca despenalizar y mejorar el tratamiento de las personas con enfermedades mentales graves, al tiempo que ahorrar dinero a la ciudad. El programa CAHOOTS, que ya lleva 30 años, desvía las llamadas al 911 no violentas, a menudo relacionadas con la salud mental, a un médico y a un profesional especializado en lugar de a las fuerzas del orden.

La policía de Denver y proveedores de servicios comunitarios visitaron Eugene en mayo, para seguir a los equipos de CAHOOTS. Los funcionarios de Denver dijeron que están considerando el modelo como una opción para ir más allá de su programa actual de corresponsabilidad que envía a profesionales de la salud mental en aproximadamente seis llamadas al 911 por día.

Más de 8 millones de personas luchan con la esquizofrenia o el trastorno bipolar en Estados Unidos, y se estima que el 40% de los diagnosticados con esquizofrenia no reciben tratamiento, según el , una organización sin fines de lucro centrada en la salud mental. Las personas con esas enfermedades a menudo pierden la capacidad de darse cuenta de sus déficits, creando un obstáculo para acceder a la atención y asistir a citas médicas o judiciales.

Los delitos de bajo nivel pueden hacer que las personas con paranoia, alucinaciones o con capacidad de comunicación reducida, como Vinnola, terminen en el sistema penal. Se estima que 383,000 personas con enfermedades mentales graves están tras las rejas en todo el país, según el Treatment Advocacy Center, mientras que solo una décima parte de ese número está en psiquiátricos estatales.

Repensando la seguridad

Desde la publicación en 2018 de un artículo de sobre CAHOOTS, funcionarios de Los Ángeles y Oakland, en California; Nueva York; Vancouver, en Washington y Portland, en Oregon, entre otros, han llamado a sus organizadores.

Cuando responden a una llamada derivada del 911, el equipo de CAHOOTS de Eugene se presenta vestidos con botas, jeans y camisas, y sin oficiales de policía.

“Esa diferencia en los uniformes puede ayudar a las personas a bajar la guardia y estar abiertos a aceptar la ayuda que se les ofrece”, dijo Tim Black, coordinador de operaciones de CAHOOTS, en Eugene.

Para las personas con antecedentes de arrestos volátiles, a menudo por crisis de salud mental, esto podría hacer que el tratamiento sea más accesible, menos traumático y más seguro. Según el Treatment Advocacy Center, una de cada 4 muertes por tiroteos policiales involucra a personas con enfermedades mentales.

Vinnie Cervantes, director organizador de la Denver Alliance for Street Health Response, cree que usar médicos y profesionales de salud mental como socorristas significa tratar a las personas con dignidad.

“Hay muchos oficiales fantásticos, como personas, pero tienen sus roles para hacer cumplir un sistema que ha sido violento, que ha sido racista, que ha sido deshumanizante”, dijo Cervantes.

Van der Laak dijo que cree que su hijo estaría más dispuesto a aceptar un tratamiento si la policía no fuera parte de la intervención en sus crisis de salud mental. Le preocupa que sus respuestas lentas a las órdenes y la dificultad para responder a los policías se perciban como un desafío y se conviertan en un arresto, o algo peor.

Hablando por su hijo

Después que el hijo de Van der Laak fuera diagnosticado con esquizofrenia paranoide en 2014, su mirada cotidiana cambió de los rascacielos de la ciudad y el cielo azul de Colorado a las personas que vivían en las calles de Denver. Es difícil para ella fingir que no existen. Eso significaría que su hijo no existe.

No entiende cómo hace la gente: caminan junto a su hijo como si fuera un árbol, o nada, incluso cuando tiene los pies descalzos ensangrentados, la ropa rasgada y la cara visiblemente deshidratada, todos signos visibles de que Vinnola está luchando su batalla interna contra la esquizofrenia.

“Su cerebro simplemente no funciona como el tuyo y el mío”, dijo.

La madre de Vinnola dijo que su hijo no es un peligro para nadie más que para él mismo, pero muchas personas asocian la enfermedad mental con la violencia. Según el Departamento de Salud y Servicios Humanos (HHS), las personas con enfermedades mentales graves tienen más de que la población en general.

Vinnola aceptó ser entrevistado para este artículo, pero no pudo responder preguntas durante más de unos minutos. Sus respuestas fueron fragmentadas y cortas. Luchó por entender las preguntas. Van der Laak dijo que responde de la misma manera en una corte.

Van der Laak se considera la defensora y la voz de su hijo. Asiste a sus citas en la corte, llevando documentos legales y médicos en una carpeta. Puede que él no se presente, pero ella no perderá la oportunidad de hablar en contra de un sistema judicial que considera incapaz de responsabilizarse del tratamiento de su hijo.

“Es crítico que esté allí. Porque si no estoy, lo engañarán y terminará en la cárcel por largos períodos de tiempo”, dijo. “Y no es donde necesita estar”.

El doctor Sasha Rai, director de salud del comportamiento en la cárcel del condado de Denver, dijo que una persona en una crisis de salud mental debe estar en un lugar más terapéutico que la cárcel para recibir tratamiento. Para Rai, los mayores obstáculos para cuidar a las personas que trata en la cárcel son la falta de una vivienda estable y el estigma de las enfermedades mentales.

“Si estuviera enfermo de cáncer, no lo meterían en la cárcel por 84 días hasta que encuentren un lugar para que lo atiendan”, agregó Van der Laak, refiriéndose a cuando su hijo pasó más de dos meses tras las rejas en 2017 esperando una de las 455 camas en el hospital de salud mental del estado después de ser arrestado por violar su libertad condicional.

Una pesada carga

El Departamento de Policía de Eugene utiliza a su personal de CAHOOTS para más que llamadas de salud mental. Informan sobre muertes en la ciudad, reparten botellas de agua y calcetines a las personas que viven en las calles, y reciben referencias médicas de la comunidad fuera del horario de atención. El personal ofrece esos servicios a la ciudad por la mitad del costo de un oficial de policía.

A nivel nacional, los policías cargan con la responsabilidad de responder a los problemas de salud mental. En 2017, las agencias del orden gastaron $918 millones en el transporte de personas con enfermedades mentales graves, según una encuesta de 2019 del Treatment Advocacy Center. También estimó que los oficiales pasan el 21% de su tiempo respondiendo y transfiriendo a personas por problemas de salud mental.

“Nuestros oficiales de policía hacen lo mejor que pueden, pero no son profesionales de salud mental”, dijo Ron Tinseth, teniente de la policía de Eugene.

En 2017, Eugene derivó el 17% de un estimado de 130,000 llamadas a sus equipos CAHOOTS. Esto liberó a los agentes de policía de responder a emergencias de alto nivel.

Al igual que muchos departamentos de policía, Denver siente la presión de los problemas de salud mental. Según el departamento, de julio de 2018 a julio de 2019, recibieron 15.915 llamadas relacionadas con la salud mental, casi un aumento del 9% de su promedio anual durante tres años.

Para promulgar un programa como CAHOOTS, el Departamento de Policía de Denver tendría que resolver detalles como el seguro para cubrir a los socorristas y las asociaciones con organizaciones locales sin fines de lucro que ofrecen servicios como refugios de sobriedad, atención médica y consejería sobre adicciones.

Lisa Raville, directora ejecutiva del Harm Reduction Action Center de Denver, una organización sin fines de lucro enfocada en ayudar a usuarios de drogas, afirma que el poder de un programa CAHOOTS radica en sus relaciones con la comunidad y la capacidad de los socorristas de simplemente preguntar: “¿Cómo puedo apoyarte hoy?”.

“Y luego puedes hacerlo. Quizás pueda ser posible. Quizás esta persona pueda encontrar algún tipo de seguridad”, dijo. “Todos merecemos eso”.

Hasta entonces, cuando el hijo de Van der Laak está en la calle, ella usa Facebook y a sus vecinos para seguirle la pista. Les da a empleados de las tiendas cerca de las calles en dónde su hijo elige vivir su número de teléfono, con la esperanza de que la llamen a ella para recoger a su hijo durante una crisis y no al 911.

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“’Jito, come home,” she always tells him, using a Spanish endearment. There he can have a bed and food, but her son, Matt Vinnola, rarely returns home. If he does, it is temporary. The streets are easier for him. Home can be too peaceful.

But the same streets that give Vinnola comfort are also unsafe for a man battling dual demons of drug use and chronic paranoid schizophrenia.

Police and criminal courts often intervene before Vinnola gets treatment or care. Since his first diagnosis of severe mental illness in 2014, Vinnola has collected a litany of charges from misdemeanors to felony trespassing and drug offenses. Over the past four years, Vinnola has been charged in four separate Colorado courts and arrested multiple times almost every month either for new offenses or on warrants for failing to appear in court.

But soon, he might encounter mental health professionals on the street instead of cops. Denver is one of at least eight cities considering an Oregon program called Crisis Assistance Helping Out On The Streets to decriminalize and improve the treatment of people with severe mental illness — while saving the city money. The 30-year-old CAHOOTS program diverts nonviolent, often mental health-related 911 calls to a medic and a mental health professional instead of law enforcement.

Denver police and community service providers visited Eugene, Ore., in May to shadow CAHOOTS teams. Denver police officials said they are considering the model as an option to push beyond their existing co-responder program that sends mental health professionals on about six 911 calls a day.

Over 8 million people struggle with schizophrenia or bipolar disorder in America, and an estimated 40% of people diagnosed with schizophrenia go untreated, according to the , a nonprofit focused on mental health. Individuals with those illnesses often lose the ability to realize their deficits, creating a roadblock in accessing care and attending medical or court appointments.

Low-level offenses can land those with paranoia, hallucinations or a reduced ability to communicate, like Vinnola, in the criminal justice system. An estimated 383,000 people with severe mental illness are behind bars nationwide, according to the Treatment Advocacy Center, while only a tenth of that number are in state hospitals.

The Push To Rethink Safety

Since the 2018 publication of a about CAHOOTS, calls have poured into its organizers from officials in Los Angeles; Oakland, Calif.; New York; Vancouver, Wash.; and Portland, Ore., among others.

The Eugene CAHOOTS team shows up in work boots, jeans and T-shirts — and without police officers — in response to 911 calls diverted to the program.

“That difference in uniforms can assist folks with letting their guard down and being open to accepting the help that is being offered,” said Tim Black, the Eugene CAHOOTS’ operations coordinator.

For people with a history of volatile arrests often while in mental health crisis, this could make treatment more accessible, less traumatic and safer. One in 4 deaths from police shootings represent people with mental illness, according to the Treatment Advocacy Center.

Vinnie Cervantes, the organizing director for Denver Alliance for Street Health Response, believes using medics and mental health professionals as response teams means treating people with dignity.

“There are plenty of fantastic officers, as people, but they have their roles enforcing a system that has been violent, that has been racist, that has been dehumanizing,” Cervantes said.

Van der Laak said she thinks her son would be more willing to accept treatment if police were not part of the intervention in his mental health crises. She worries that his delayed responses to commands and difficulty answering cops will be perceived as defiance and escalate into an arrest — or worse.

Giving Voice To Her Son

After van der Laak’s son was diagnosed with paranoid schizophrenia in 2014, her everyday gaze shifted from the city skyscrapers and Colorado blue sky to the people living on Denver’s streets. It’s hard for her to pretend they don’t exist. That would mean her son doesn’t exist.

She doesn’t understand how people do it — walk by her son as if he’s just a tree, or nothing, even when his bare feet are bloody, his clothes torn and his face visibly dehydrated, all visible signs of Vinnola fighting his internal battle with schizophrenia.

“His brain just doesn’t work like yours and mine,” she said.

Vinnola’s mother said her son is not a danger to anyone other than himself, but many people associate mental illness with violence. People with severe mental illness are more than than the general population, according to the U.S. Department of Health and Human Services.

Vinnola agreed to be interviewed for this article but was unable to answer questions for more than a few minutes. His answers were fragmented and short. He struggled to understand the questions. Van der Laak said he answers the same way in the courtroom.

Van der Laak is outspoken for her son, calling herself his advocate and voice. She attends his court dates, toting legal and medical paperwork in a thick manila folder. He might not attend, but she won’t miss a chance to speak up against a justice system she sees as incapable of being responsible for her son’s treatment.

“It’s critical that I’m there. Because if I am not, they will railroad him and he will end up in jail for long periods of time,” she said. “And that’s not where he needs to be.”

Dr. Sasha Rai, director of behavioral health at the Denver County Jail, said a person in a mental health crisis needs to be in a more therapeutic place for treatment than jail. To him, the biggest obstacles to care for the people he treats in jail are a lack of stable housing and the stigma of mental illness.

“If you were sick with cancer, they’re not going to stick you in jail for 84 days until they find a place to get you care,” van der Laak added, referring to when her son spent over two months in jail in 2017 awaiting one of the 455 beds in the state’s mental health hospital after being arrested for violating probation.

A Burden Lifted

The Eugene Police Department uses its CAHOOTS staff for more than mental health calls. They deliver death notices across the city, hand out water bottles and socks to people living on the streets, and take after-hours community medical referrals. The staff offers those services to the city for half the cost of a police officer.

Nationally, police officers carry the brunt of responding to mental health issues. In 2017, law enforcement agencies spent $918 million transporting people with severe mental illness, according to a 2019 survey from the Treatment Advocacy Center. It also estimated that officers spend 21% of their time responding to and transferring people for mental health issues.

“Our police officers try the best they can, but they are not mental health professionals,” said Eugene Police Lt. Ron Tinseth.

In 2017, Eugene diverted 17% of an estimated 130,000 calls to its CAHOOTS teams. This freed up Eugene police officers to respond to higher-level emergencies.

Like many police departments, Denver is feeling the pressure of mental health issues. From July 2018 to July 2019, the department said, it received 15,915 mental health-related calls, almost a 9% increase from its annual average over three years.

To enact a program like CAHOOTS, the Denver Police Department would have to iron out details such as insurance to cover responders and partnerships with local nonprofits that offer services like sobering-up shelters, medical care and substance-abuse counseling.

Lisa Raville, executive director of Denver’s Harm Reduction Action Center, a Denver nonprofit focused on helping those who use drugs, asserts that the power of a CAHOOTS program lies in its community relationships and the ability of first responders to simply ask, “How can I support you today?”

“And then you can do it. Maybe it can be possible. Maybe this person can find some sort of safety,” she said. “We all deserve that.”

Until then, when van der Laak’s son is on the streets, she uses Facebook and her neighbors to keep track of him. She gives store clerks near the streets he chooses to live on her phone number in the hope they will call her to pick up her son during a crisis, not 911.

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