In page after page of the photo album, Karen Lee Batts poses in the house where she grew up. Beautiful, in late 1970s dresses, she smiles on the arm of her high school boyfriends.

Teenage dating can be painful and mortifying, but Batts relished it. She was outgoing, a junior varsity cheerleader and a contender for Grant High School's Rose Festival court.

There are childhood photos of Karen and older brother Alan standing in front of the Mercedes their dad brought back from his Army tour in Germany and Karen sitting on her mother's lap even though she was too big by that point. Those give way to photos of high school dances and shenanigans, then pages of academic honors and the nose-bleed section tickets to a Portland Trail Blazers game where Karen received a scholarship.

Elizabeth Batts is thankful she asked her daughter to return the photo album once Karen started moving from one apartment to another. It's one of a string of prescient moments, like when Batts bought her daughter a cemetery plot in 2001.

Karen Lee Batts, 52, will be buried there Wednesday. She died of hypothermia last weekend, isolated from the two people who spent their lives trying to care for her and keep her from dying the way she did.

Homeless people in Oregon rarely die of exposure, but this winter's long stretch of freezing temperatures is the most severe in about 20 years. The city has scrambled to deal with the challenges the cold and snow have posed to people living on the streets.

Three men also succumbed to hypothermia in the last two weeks -- making the winter's tally equal to the past five years of exposure deaths combined.

Batts is at the center of a paradox that plagues families and social service providers -- she reached the point when she was least able to make good decisions about her health and safety even as others were ready to help.

In many ways, Batts is typical of the mounting homeless crisis in Portland. More than half of the homeless population suffers from mental illness, according to most estimates from outreach workers and county data. At the downtown Operation Nightwatch shelter where people can get hot meals and fellowship, Executive Director Gary Davis said he sees many people like Batts shun shelters because they fear other people.

Her mental health qualified her for disability benefits, but also drove her away from her support system, which left her without the wherewithal to seek out help on her own.

"It's hard enough for ordinary people to comply with that model, but when you're on the streets and alone what do you do?" Davis said.

Batts is also part of a rising trend of women, older people and African Americans ending up unsheltered, which Multnomah County officials say makes people even more vulnerable to abuse.

She had been homeless since October, when she was evicted from low-income housing after months of erratic behavior. She suffered from schizophrenia and sometimes abused drugs and alcohol, leading to her refusing help from her family, social service organizations and Portland police.

The contradiction haunts Elizabeth Batts.

"Every which way we tried to turn, no one can help us," she said. "I don't know what families are supposed to do when the decision is up to a person who can't make a rational decision."

From Rose Festival Court to homelessness

Alan and Karen Batts were born on the same day, one year apart, at a U.S. Army base in Germany. They moved often until settling in Northeast Portland in 1970.

Alan and Karen relied on each other for support during the moves and when their father was away for long periods. Alan took his role as older brother seriously. He helped his sister with her homework and walking her to Hollyrood Elementary School. When they got older, he took her dancing at teen clubs downtown.

He was quiet and reserved and Karen was vibrant and loud, filling the house with the funk of her Earth, Wind and Fire records and the rattle of her sewing machine. She made some of the clothes she wore during her Rose Festival princess bid (to this day, her mom says she was robbed).

But she also suffered from an early age with mental illness. Her mom noticed early on that Karen was anorexic and bulimic. She showed what were likely early signs of schizophrenia, but they weren't pronounced until her 30s.

By then, Karen had tried college. She did a year of pre-dentistry studies at Fisk University in Tennessee before moving home and attending Portland State and Portland Community College on and off for about two years.

She never finished, partly due to working part time to pay her way and partly due to her slowly deteriorating mental state.

She bounced between about a dozen jobs and homes. In the early 1990s, she was working at Standard Insurance when she called her mother to tell her she was hearing voices from the sprinkler system in her apartment building. On the phone, she kept saying she thought her coworkers were listening in to their conversation.

Days later, on a light rail ride to Fred Meyer, Karen told her mom that the other riders were staring.

"I told her no, that is silly," Elizabeth Batts said. "I didn't know she was in a paranoid state at the time. I didn't know what was going on."

Karen Batts died of hypothermia outside in Portland 30 Gallery: Karen Batts died of hypothermia outside in Portland

When Alan Batts returned in 1992 from 11 years in the Air Force, his sister had changed. He assumed much of the responsibility of taking care of his sister. His mother's health was starting to fail and his father died in 1999.

As she got older, Karen Batts' life was increasingly interrupted by trips to hospital emergency rooms, rehabilitation centers and psychiatric units. He urged her to see counselors, sometimes missing work to go with her, but she always eventually dropped out.

In 1995, she likely spent her first time on the streets. Her family doesn't know where she was during those months. She disappeared. Her brother plastered fliers with Karen's face and his contact information on telephone poles and church bulletin boards around town. Eventually, she called him out of the blue.

He helped her get another apartment, which she was evicted from a year later. Public records show she owed a downtown Portland apartment building $512. She showed up to court and she and her family paid down what was owed.

Mental illness creates a paradox

When Karen Batts was on her medication, her family saw her thrive. She could take care of herself, she was more dependable on visits and calls. After a stint in the Lloyd District branch of the Oregon State Hospital, she lived in a halfway house before moving seven years ago to Oak Apartments, where her mother and brother thought she was doing the best she had in years.

They took her to movies and to dinner. They visited relatives in Seattle and went to the Oregon coast because she loved the beach.

She was mostly a model tenant at Oak Apartments. Cari Hilsabeck, a former security guard there, said they talked several times a week, sometimes about serious topics, sometimes just gossip. At the time, Hilsabeck said, Karen was quiet but laughed easily.

But she started to withdraw over the years. Visitors needed a resident to allow them in the front door and Karen stopped buzzing up her older brother. She would call home from her landline in her apartment, then would hang up after a few minutes when Alan or their mother asked how she was doing.

"We didn't know what was going on in that apartment," Alan said. "She wasn't going to say everything about what she was going through."

Her medication also made her gain weight, which triggered her old anorexia and bulimia.

Elizabeth Batts would take her to dinner and Karen would say she was stuffed after a few bites, excusing herself to go to the bathroom shortly after.

As far as Alan can tell, she went off her medication in December 2015. He encouraged her to get a refill and see a psychologist but couldn't force her.

"We're her family, but we can't do anything at all," he said. "We don't know who to talk to and who to call, we're just grasping at straws."

"We were trying to tell anyone who would listen that she needed help."

At least once, Alan Batts called Portland police after his sister refused to let him up to her apartment. He hadn't heard from her in a long time and was worried. The police officer visited her for a mental health check, but she would talk only through the closed door to her apartment. The officer said that she didn't seem like a danger to herself or anyone else, so he couldn't do anything.

Elizabeth and Alan Batts grappled with their helplessness and guilt. They couldn't make Karen move home and couldn't dedicate all their time to her. Alan works full time and takes care of his mother, whose health problems made her unable to do much for Karen outside of emotional support.

"You have to manage her paranoia and your own sanity," Alan said. "I couldn't go up the stairs and knock on her door, so I walked away."

According to building owner, nonprofit Northwest Housing Alternatives, Karen also refused help from an on-site staff member who wanted to connect her with mental health services. Executive Director Martha McLennan said staff and social service workers talked with her dozens of times when they received reports of her damaging property, threatening other tenants and breaking building rules.

"The point in time somebody might most need those services, they might be least able to reach out and obtain those services," McLennan said.

One of the last times Alan Batts saw his sister, more than a year ago, she insisted on meeting him across the street from her building and refused a hug. He trailed slightly behind her as she walked to the MAX Green Line with her fingers in her ears.

He assumed she was blocking out the street noises and maybe the voices in her head, too. She was too distracted to carry a conversation. While waiting for the train, she bought a cup of hot water -- no tea, no coffee -- and then simply walked away.

Evicted, alone and in a mental health crisis

Karen didn't pay August or September rent, and in October, she was evicted for $338 of missed rent. The Multnomah County Sheriff's Office let her grab some clothes and personal belongings before locking her out.

Her phone had been shut off by then and her family had no way to find her. Police and court records detail the last months of Karen Batts' life.

On Nov. 3, she was standing barefoot and covered in bruises at the intersection of West Burnside and Broadway streets. Someone had called police, saying that a woman was in traffic.

Karen was drinking from portable hand sanitizer bottles, telling police that she was doing it to keep her mouth clean.

She said she didn't know where she lived or where her family lived and didn't believe that the police were who they said they were. The officers drove to Legacy Good Samaritan Hospital and placed her on a mental health hold.

At some point, she was released and seems to have returned to the streets.

In early December, Karen called Alan's phone a couple times. He missed the calls, but still has the voicemails.

Karen, in a distant voice, said she wanted to celebrate Christmas at home -- largely still looking the way it has for 46 years, with the hanging seashell decoration Karen bought her mom on her only trip to Florida and the free-standing stereo she was photographed in front of as a teenager.

She always liked Christmases with her family, she said, and planned to get a cellphone in a few days. She would call again when she got it, she said. But she never did.

The next time Batts showed up in court records was Dec. 27 when she was ticketed $175 and kicked off a TriMet MAX Yellow Line train for sleeping over four seats. She told the officers that she hadn't paid her fare because she fell asleep.

She listed her address as the Bud Clark Commons, a day center for homeless people where they can receive mail, store their belongings and hang out for the day.

Then, on the night of Jan. 7, when temperatures dipped into the low 20s, a parking lot attendant found Batts on her back on the second floor of the garage, police said. She had started undressing, which could be attributed to the late stages of hypothermia, and was still breathing.

A private security officer called 911 at 2:04 p.m. Medics arrived at 2:09 p.m. Portland Fire Bureau members arrived at 2:11 p.m. to find Batts dead.

What you can do

If you need help:

Call 211. There might be a wait, but stay on the line. Someone will answer. They can direct you to the nearest warming shelter and arrange for a car to come pick you up. No one will be turned away. There's a list of warming centers at 211info.org.

Use public buildings, such as libraries and community centers, to get warm during that day.

If you want to help:

Donate new or lightly used clean clothing and supplies -- hats, coats, gloves, socks, men’s and women’s underwear, tents, sleeping bags, blankets and tarps. Go to 211info.org/donations to find out where you can drop off items or donate money.

Call 911: If you see someone outside who appears to be in danger or is in the midst of a medical crisis.

Call 211 or the Portland police non-emergency line: If you're concerned about someone who might need help. The non-emergency line is 503-823-3333.

-- Molly Harbarger

mharbarger@oregonian.com 503-294-5923 @MollyHarbarger