The gun control debate is fraught. Mental health experts don't want their cause dragged in
Mental health is on a long list of factors conservatives have focused on in the wake of the Uvalde shooting
Mental health experts worry about being used. More specifically, that the cause they've dedicated themselves to might be used as a smokescreen, a diversion tactic, a shiny red ball of distraction.
Texas Gov. Greg Abbott repeatedly raised the spectre of mental health at a news conference about the recent massacre of schoolchildren in his state.
And former president Donald Trump also focused on mental health in part of his speech Friday as the National Rifle Association (NRA) kicked off its annual convention in Houston.
Gun control? Abbott brushed off the idea it might help reduce mass shootings, saying 18-year-olds in Texas have had access to long guns for decades.
Abbott instead highlighted worsening mental health: "We as a state and society need to do a better job with mental health."
That puts mental illness on a long list of factors conservative commentators have focused on after the school shooting in Uvalde — one that also includes taller school fences; fewer doors; arming teachers; deploying armed veterans at schools; handing out bulletproof blankets; restoring Judeo-Christian values; and the general goal of reversing societal moral rot.
People who work in mental health are happy to talk about their field and how to make things better. But in the wake of Abbott's remarks, several expressed unease about having it used to stifle the gun control conversation.
That includes one mental health adviser to the Texas government who says basic comparative statistics discredit the idea that mental illness is a key driver of U.S. mass shootings.
What global comparisons show from several different studies are small differences in reported rates of mental illness between developed countries.
What is not small is the difference in homicide rates: The U.S. rate is multiple times higher than Canada, which itself has a higher rate than most developed countries.
"You cannot ascribe the difference to mental illness. You just cannot," said Stephen Strakowski, a psychiatrist and professor at the University of Texas at Austin who's helping Texas redesign its care-delivery model in many of the state's counties.
"All you do is look at the data. All countries have the same rates of mental illness. What they differ in is how they manage firearms."
A colleague at the University of Texas shared her own reticence about discussing mental health in a context where it could be used to distract from the gun control debate.
"It just feels like jousting with straw men. I don't think this is a real concern of our governor," said Sarah Kate Bearman, a professor who specializes in empirically supported practices for underserved youth.
"It's remarkable how quickly [mental illness is] used as a scapegoat for gun violence. Texas has more guns per capita than any other state. America has more guns per capita than any other country. And we are unparalleled on gun violence. The outlier there is not mental health problems — it's access to guns."
50th out of 50
With that being said, what exactly is Texas doing about mental health care? The state's long-term track record is dismal, with some new efforts at improvement.
Texas ranked dead last among all 50 U.S. states in providing mental health services, according to a 2022 study by Mental Health America, a mental health advocacy non-profit.
Just last month, Abbott cut $210 million US for the state department that oversees mental health.
The money was redirected to what he calls Operation Lone Star: a state project to control unlawful migration at the Mexican border.
The deficiencies in Texas's mental health system were laid out in an investigative series by The Houston Chronicle that found a system plagued by low staffing levels, violent assaults and uninvestigated deaths.
It begins with an elderly couple discovering their son has died in an underfunded facility and struggling to get information about his death. Another man whose son died after drifting in and out of the system said: "They just run [the mentally ill] through just like a cattle chute."
But there's another side to the story.
Texas has made recent attempts to turn a corner on this front, and Strakowski is part of it in numerous counties, where he's leading an ambitious project.
The state is spending hundreds of millions of dollars to build what he calls state-of-the-art hospitals in several different cities to provide psychiatric care.
One just-completed facility in Austin has a café, gym, art room, an outdoor basketball court and walking trails.
"They have [tried], actually," Strakowski said of the state government.
"Texas has made real investments in mental health. I think [Abbott] can say that and it's factually correct.… Does that mean Texas leads in mental health care? Absolutely not."
A big reason Texas is ranked last by Mental Health America is a lack of access to care through health insurance.
Texas has the highest rate of uninsured residents of any state, at 18 per cent — double the national average. People with mental illness have an uninsured rate of 21.5 per cent in Texas, nearly six times greater than Massachusetts's rate of 3.8 per cent.
And why its uninsured rate is so low falls directly at the feet of decisions made by state politicians, including Abbott.
Medicaid expansion rejected
The way the U.S. health system works in a nutshell is about two-thirds of people with insurance get it from private companies, and about one-third get it through a pair of public programs: one for seniors (Medicare) and one federal-state program for poorer Americans (Medicaid).
But just under 10 per cent of Americans have no health coverage.
It happens that Texas is one of a few conservative-leaning states to refuse a federal offer that would have expanded health care for low-income people.
The health-reform law signed by then-president Barack Obama extended Medicaid to cover more people, up to 133 per cent of the poverty line. Here was Washington's offer: $9 to a state government for every $1 the state puts up in order to extend the Medicaid program.
Because of this Medicaid expansion under the so-called Obamacare laws, 21 million Americans gained health coverage this year.
About 1.2 million to 1.4 million Texans would have gained health coverage under this law, including mental health coverage. But 12 states have refused to participate — and Texas is one of them.
Bearman says there are gaps throughout the mental health system, including staff shortages, wait-lists for care, poor quality of care in some cases, and discrepancies in the way physical and mental health get insured.
"Of course we need better mental health treatment," Bearman said.
But she says that still shouldn't make this conversation part of the wrenching national debate over guns.
"Both things can be true," she said.
"Texas has failed to provide adequate mental health support. And mental illness in this scenario is also a red herring that becomes a talking point only when these tragedies unfold, in an effort to keep us distracted from the focus on common-sense gun legislation."