TULSA, Okla. — The door frame that Cathy Carter leans against is all that separates her from the fate suffered by her great aunt in the 1930's.

Carter has been diagnosed with anxiety and agoraphobia, and she believes her ancestor suffered similarly or worse. For her great aunt, that meant being hauled away to a California insane asylum, as they were called at the time — a trip that did nothing to ease her condition or help her life.

Carter, still leaning in her doorway, pauses in telling the family story. For her, the outcome has been different.

More than 600 miles southeast of Colorado Springs, in the boom-or-bust oil town of Tulsa, exists an effort to tackle mental illness not just with therapists or pharmaceuticals, but with four walls and a roof.

Spearheaded by the Tulsa-centered Mental Health Association of Oklahoma and backed by tens of millions of dollars from wealthy, oil-made philanthropists, the initiative provides hundreds of housing units to people battling mental health and substance abuse problems — often both. Hundreds more units have been set aside by the nonprofit for affordable housing as a preventative measure to keep people from descending into homelessness and in need of even more acute mental health care.

Mental health logo

For Carter, that means an apartment. Her apartment. No psychiatric hospital visits needed.

“Here, we’re accepted,” she says.

The Tulsa program is earning a growing reputation for addressing mental health's many tendrils — even among some nonprofit leaders in Colorado Springs. And it centers on a hard truth for any community seeking to finally tackle mental illness: Making meaningful headway is impossible without addressing the societal factors that play into a person’s well-being.

So often, housing ranks at the top of that list.

“It’s the deal maker or the deal breaker,” said Mike Brose, the nonprofit’s CEO, over dinner at a downtown diner. “It’s all the difference in the world. If you don’t have a place to live, you can’t get anywhere.”

And it’s not like Brose’s nonprofit is starting from a place of privilege.

The Sooner state has one of the worst mental health care systems in the nation, ranking 41st in Mental Health America’s most recent report.

Chief among those concerns for social service providers is the fact that Oklahoma has yet to expand Medicaid benefits to impoverished and low-income adults without children. It was a key benefit of the Affordable Care Act that the state’s Republican leaders eschewed in a show of defiance against President Barack Obama’s signature health law.

Tulsa and Oklahoma City also routinely rank disproportionately high in evictions, meaning more people are at risk of homelessness, and in turn, at higher risk for new or exacerbated mental illnesses brought on by living on the streets.

In the face of those obstacles, mental health advocates in Tulsa got creative.

Unable to woo more clinicians to the area or single-handedly shift the state’s prevailing political winds, they focused on the fundamentals — the social determinants of health. Issues like crime, employment and access to healthy foods can play an outsized role in a person’s overall well-being, according to the federal Substance Abuse and Mental Health Services Administration.

And housing ranks among the most important of those factors.

It’s a fact that Carter, 67, knows all too well.

She leans away from her doorway, shuffling unsteadily back to her wheelchair, and invites visitors in for a tour. The linoleum flooring looks like paneled wood, the kitchen is quaint, there are two bedrooms in the back. Two cats — one white behemoth named Snowball and a nimble tabby named Jack — lay on cushions in her living room. Her old service dog rests nearby. 

At the moment, her walls are white and empty — she’s only lived in this apartment for a week, because her last unit flooded in a storm. But she’s been a tenant of the Mental Health Association of Oklahoma for six years.

She still struggles with agoraphobia — a condition that can cause her to feel overwhelmed when she’s overstimulated, such as when she leaves her house. And she still grapples with anxiety — a particular problem, given that she also suffers from a rare neurological disorder that becomes exacerbated when her stress spins out of control.

But backward as it may sound, having a place to live has helped keep her from becoming isolated from the rest of the world.

“There are other people around who maybe have the same disorder," says Carter, her voice soft and calm. “If I have panic or problems with agoraphobia, I know I’m not the only one.

“They’re not going to freak out if I'm freaking out, with panic or the agoraphobia. That’s not going to bother them."

A resurgent downtown

The nonprofit owns and manages about two dozen apartment complexes all across Tulsa, a sprawling city bisected by the Arkansas River. Those buildings contain 1,435 units — about three times the number possessed by Colorado Springs’ largest nonprofit provider of affordable housing. That's despite Tulsa’s population being slightly smaller.

There are streets lined by Art Deco architecture. Downtown is brimming with reinvestment, including a Woody Guthrie museum, new restaurants and a minor league baseball stadium. A downtown arena hosts national concert tours, and a nearby theater recently captured dates from a touring production of "Hamilton." A Bob Dylan museum is on the drawing board.  

Just a short walk from all of it is the Altamont Apartments — a 1930s-era brick building purchased by the nonprofit to use as affordable housing, complete with a quiet gazebo in back and an interior that recently underwent millions of dollars in renovations.

And there is the newly constructed Yale Apartments, tucked beside Interstate 244 east of downtown, home to dozens of formerly homeless people.

Each of the units comes with a caseworker who to seeks to connect tenants to whatever health care is needed and available, as well as job and food assistance.

The reason is simple, says Greg Shinn, the nonprofit’s chief housing officer.

“The bottom line is that when people are on the street, or in a homeless shelter, they could not stabilize and go into recovery mode to be successful," he said. "They’re in survival mode."

Shinn himself became a believer in the early 2000s. After spending years running a homeless shelter in downtown New York City, he heard about the Tulsa nonprofit's plan to provide housing.

Immediately, he thought: “Well, that’s the solution.”

“Let’s give them choice of where to live, if you can do that,” Shinn said. “And then that empowers them to choose where they want to live to get out of their homeless situation. And then to offer them flexible services they feel they need to recover. And then that’ll give them a head start on recovery in the housing where they could be successful.”

Most importantly, he says, once people are housed, they don't often return to the streets. 

Through the end of August, 82 percent of the people with mental illnesses who have received apartments from the nonprofit remain there. It's a retention rate that has remained relatively steady for years, and one the nonprofit proudly boasts as proof of its success.

Housing as key to recovery

The concept stems from the Housing First ethos. And it is rooted in a growing pile of research on the social determinants of health.

For decades, researchers have grown increasingly confident that a person’s health — both physical and behavioral — is swayed by far more than doctors or therapists. Myriad triggers can push a person’s well-being for better or worse — including crime, racial discrimination and poverty, according to the federal Substance Abuse and Mental Health Services Administration.

The connection is simple, says Vickie M. Mays, a professor of psychology and health policy and management at the University of California, Los Angeles. Those issues all cause toxic stress — otherwise known as the hormone cortisol — to build up inside a person, deteriorating their health and causing a cascade of mental health problems.

Often, housing ranks at or near the top of those social determinants, Mays said. Without it, how can anyone kick an addiction? And how can anyone maintain their hygiene well enough to find or keep a job?

"So if you want to know how to enhance people's well being, to motivate them, you need to think about housing as a very significant social determinant,” Mays said. "And to think about building our houses in ways in which — while they’re affordable — at the same time, they really allow some communities to be able to thrive.”

In Colorado, the situation is no different.

A recent report by the Colorado Health Institute warned of a connection between the state’s rising housing costs and the negative health outcomes that may result.

Housing costs across the state increased by 77% over the last decade as newcomers have flocked to the state, causing the Front Range two swell with new houses and prices in scenic mountain towns to skyrocket. Meanwhile, wages have inched up a mere 4.5% in that same time, the report found.

More than a quarter of the state’s households are now cost burdened, meaning more than a third of their income goes to housing costs. It’s a problem that’s even worse for minorities.

"One of the big connections between housing instability and mental health is around chronic stress,” said Sarah Barnes, manager of special policy initiatives for the Colorado Children’s Campaign, which is helping lead a group that's using the report to help spur policy solutions.

Shinn, the Tulsa nonprofit’s housing leader, says he sees the benefits of housing day in, and day out.

More affordable housing means fewer people living paycheck to paycheck and strapped for cash, reducing the generational cycles of poverty that often cause traumas that lead to poor mental health, he said.

And fewer evictions mean children can change schools less, meaning a better education and eventually better jobs, lower incarceration rates and fewer tax dollars spent on emergency room visits and lockups.

“This leads to sustainable neighborhoods and higher quality of life for everybody else,” Shinn said. “The housing needs being met in the community has a direct impact on the overall mental health of the community. “You can connect the dots all day long. Some of them are direct, some of them are indirect. But every community in the country needs more affordable housing. 

'When I wanted to live'

Alyssa Orcutt knows that reality all too well.

Black tattoos crisscross Orcutt’s arms and back — etchings of a past she chooses not to forget.

There’s the four-leafed clover with the words “But for the grace of God” — a throwback to the moment she got sober in 2014, on St. Patrick’s Day.

And there’s a picture of lady justice, her scales resting even to represent the vast criminal record she accumulated while homeless and on the streets of Tulsa that she's since overcome.

“It takes a lot of courage to live the life I lived,” Orcutt said.

Her life is a case study in the mental toll that homelessness can take — and the power of housing to heal those invisible scars. 

She descended into homelessness when her abusive husband went to prison — leaving her with nothing, because the house and car were in his name. A man groped her the first time she visited a homeless shelter, so she never went back. Instead, for two and a half years, she camped at a local park.

“I just gave up all hope and I turned to street drugs to help cope with the pain of what you go through on the streets,” Orcutt said. “Because it’s very violent; there’s a lot of violence that happens when you're living outside.”

“You can’t focus on mental health when you’re just trying to survive the day,” Orcutt added. “I just wanted to make it to midnight to live another day. When I wanted to live."

She racked up a slew of charges, ranging from what she calls “survival crimes” for stealing food and clothes to violent felonies. But a prison diversion program helped her finally get sober, she said.

Then came years of therapy to unpack the tangled web of mental illness that became exacerbated on the streets. 

"I lived 24 years without anxiety and depression and PTSD," she said. "And after two and a half years on the streets, now I have these diagnoses.”

She's an example of the Mental Health Association's culture of inclusivity. She's now a case manager for the nonprofit's Denver House — a day center for some of the most mentally ill people living on the streets of Tulsa. About 60 percent of her fellow employees at the association also have diagnosed mental illnesses. More than one-third of the employees have a history of addiction. And a quarter experienced homelessness.

A key step in Orcutt's journey: An apartment provided to her and her two children.

The benevolent landlords

Some people in Colorado Springs have taken notice.

Three years ago, several local nonprofit leaders visited Tulsa and toured the nonprofit’s program.

They saw first-hand the Tulsa nonprofit's strategy: Purchase and refurbish declining or dilapidated apartment complexes and motels across the city. Then, rent them at affordable rates — often to people suffering from mental illness.

The reason for relying on existing buildings was simple: Keep costs relatively low while maintaining the city’s affordable housing stock, said Brose, the nonprofit’s CEO.

Under the nonprofit’s auspices, the buildings won’t get razed to make way for a new development, or flipped by developers seeking to gentrify an area and raise rents.

“At some point, you’ve got to not only create more affordable housing, but preserve affordable housing,” Brose said. “A lot of our properties — we only have one new construction — they’re all existing apartment complexes that we purchased and own.”

“They’re not fancy,” he said. "But we certainly want them to be safe and affordable and to be decent.”

And, Brose adds, they’re often available to people who wouldn’t be accepted anywhere else — people with histories of evictions, drug use and homelessness.

“We refer to ourselves as benevolent landlords,” Brose said. “Sometimes people fail in our housing. But as a benevolent landlord, we'll give them repeated chances to come back.”

A year later, Brose himself visited Colorado Springs and spoke at a conference hosted by the Pikes Peak Continuum of Care, which is focused on addressing homelessness.

The Tulsa nonprofit made an impression.

“They understand that homelessness and health are so intricately related,” said Shawna Kemppainen, who went on the trip as executive director of The Place, a youth homeless shelter in downtown Colorado Springs formerly known as Urban Peak. “It’s really interesting that it’s the largest mental health association there in the state that's actually doing homeless housing, and is very productive with it.”

Chris Garvin, deputy executive director for the El Paso County Department of Human Services, agreed.

“It was pretty impressive in that they were able to garner community support,” Garvin said. “And the fact they would buy maybe a defunct apartment building, or an apartment building that was pretty riddled with crime or drugs. And they were able to go in there and — I don’t want to say gentrify it — but they brought it up a notch. And it kind of improved the neighborhood.”

Brose's visit to Colorado Springs helped lead Tulsa’s fire department to adopt a Colorado Springs program called CARES. It’s a partnership of the Colorado Springs Fire Department, AspenPointe and other agencies.

Its goal is to create a team to act as a special service to people who are known as “super utilizers” — people who call 9-1-1 at a disproportionate rate, using it more as a medical service than an emergency line and tying up resources while jacking up health-care costs in the region.

Now, some wonder whether Colorado Springs could learn a lesson or two from Tulsa.

For his part, Greg Shinn, the Tulsa nonprofit's chief housing officer, called the organization's model “inherently transferrable." And he urged for local leaders also to consider tax increases, arguing such investments could pay off in spades.

“Any locality can do it — it’s a nonpartisan issue,” Shinn said. “Nobody wants to waste money locking up people who are homeless that could be in housing. Nobody wants to waste money with law enforcement emergency runs or emergency hospitalizations that could be avoided if these people were in housing with the services that they need.

“Let’s stop throwing away money.”

A belief in 'doing what's right'

Several Colorado Springs nonprofit leaders who saw the Tulsa program first-hand a few years ago said one factor stands above the rest in limiting Colorado Springs from taking a similar approach: Funding.

The presence of multiple well-heeled philanthropists in Tulsa — and those donors’ penchant for giving substantial sums of money to the social service sector — is what separates that city from others.

Most of the Mental Health Association of Oklahoma's units were purchased over the last 10 years, after the nonprofit raised $65.5 million.

Three-quarters of those donations came from private donors. And nearly half — $30 million — came from a single philanthropic organization: The Anne and Henry Zarrow Foundation.

Henry Zarrow was the son of a Jewish immigrant who fled to the U.S. escaping the Russian pogroms, according to accounts in the Tulsa World. He started his first company at the age of 22 and became a powerful player in the oil and gas industry — then gave away much of his wealth at the behest of his wife, Anne Zarrow.

Homelessness and mental health have been top priorities for them, as well as for Henry’s brother, Jack Zarrow.

Only Jack Zarrow's widow, Maxine, remains alive. But the Zarrows' philanthropy lives on in the foundations established in their names.“Both families are really social justice-minded,” said Nancy Curry, program officer for the Zarrow Family Foundations. “And really kind of believe in doing what’s right.”

Stand in downtown Tulsa and it’s hard not to spot a building influenced by Zarrow or another deep-pocketed philanthropist, billionaire oilman and banker George Kaiser.

Named a Tulsan of the Year in December by the city's hometown newspaper, the Tulsa World, Kaiser has given $4 billion to his community foundation. He's helped bankroll myriad projects in the city's up-and-coming downtown. And while he typically turns down interview requests — including one recently by The Gazette — he occasionally writes opinion pieces for the World, including a recent pitch for Oklahoma to expand Medicaid coverage.

Without that kind of philanthropic investment, replicating anything similar is a long-shot, say Colorado Springs nonprofit leaders. For example, Springs Rescue Mission here in the Pikes Peak region has struggled for years just to raise the final $2.25 million needed to complete its first-of-a-kind campus on downtown’s southern edge.

Colorado Springs' white-hot housing market also makes replicating Tulsa's model difficult.

Greccio Housing, the leading affordable housing nonprofit in Colorado Springs, said acquiring properties has become far more difficult than in past years.

Until a few years ago, it relied almost exclusively on acquiring existing apartment complexes to stock its housing inventory. The vast majority of the nearly two dozen properties managed by Greccio were purchased and refurbished, much like in Tulsa.

But as Colorado Springs’ housing market heated up in recent years, that calculus changed.

Complexes that sold for $50,000 or $60,000 a door now routinely go for well more than $100,000 a unit, said Lee Patke, Greccio’s executive director.

There also are fewer apartment complexes for sale, and ones that do hit the market are quickly bought up by private-sector investors, who can move more quickly without needing as much due diligence as the nonprofit Greccio.

“It’s not that we don’t have the resources in town,” Patke said. “It’s that the environment is not the same — from the available inventory to the competition with investors. All of that plays a role.

“It’s not that we don’t have the capacity for those that are interested. The dynamics have changed. And that’s just not the most effective way to get projects done right now.”

Shinn, with the Tulsa nonprofit, still says there are opportunities.

“I know we all believe we can do it,” Shinn said. “And it’s not a political issue. That’s not a Republican or Democrat issue. It’s not a conservative or a liberal issue. It’s a humanitarian issue. And it’s an economic issue.

Rebuilding the destroyed

Orcutt desperately wants more cities to take notice. She points to the man walking by her side on a sweltering August afternoon as the reason why.

Together, they stroll down a cobblestone courtyard of an apartment complex that’s been renovated and set aside for mostly people suffering from mental illnesses. For him, it means apartment shopping for the first time in seven years.

She points out the nearby amenities, a shopping center, a Sonic drive-in, a grocery store. Other tenants sit outside their front doors, soaking in the day.

“Yeah, it’s pretty nice,” says the man, Lamar Linton, 37.

Almost the entire time, his hands hardly leave his armpits, crossed in front of his chest. He’s not one to open up quickly — or to many people, at all. After seven years spent living on the streets, trust doesn’t come easily.

He stopped walking, ready to make a decision.

“I think it’s something I could restart and have a new beginning,” Linton said. “I could start to rebuild something I destroyed: My life.”

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