Will politicians who blame mass shootings on mental illness expand Medicaid?

“If you care about mental health, expand Medicaid.”

So said Beto O’Rourke, the Democratic candidate for Texas governor, in a Tweeter last week it went viral. O’Rourke was reacting to the events of the past few weeks which included a mass shooting at a grocery store in Buffalo, New Yorkwhich left 10 black people dead at the hands of a white supremacist, and a mass shooting at a predominantly Latino elementary school in Uvalde, Texaswhich left 19 students and two teachers dead in the third deadliest school shooting in US history.

The tragedies could have been avoided with tougher gun laws, but Republican politicians resisted calls for gun reform, even as mass shootings and threats continued to occur almost daily. Instead, the GOP elected elected officials like Texas Governor Greg Abbott – which O’Rourke notably called for hypocrisy in the days following the Uvalde shooting – blamed recent mass shootings on mental illness.

“We as a state, we as a society need to do a better job of mental health,” Abbott said after the Uvalde shooting. “Anyone who shoots someone else has a mental health issue, period.”

Yet Abbott refused to champion measures that would improve access to mental health care for Texans, like expanding Medicaid. To date, the state’s Republican-controlled legislature has refused to expand the joint federal-state health care program for low-income people under the Affordable Care Act, as well as 11 other states, a total of eight of them in the South. The Republican-controlled North Carolina State Senate recently passed a bill to expand Medicaid in the state, but State House Speaker Tim Moore (R) said there was little appetite for Medicaid expansion in his chamber.

As it stands, Texas is the state with the most largest coverage gap. An estimated 771,000 residents are not eligible for Medicaid but also ineligible for premium subsidies to offset the cost of private coverage, making it difficult for them to access mental health care. Across the country, most those who fall within the coverage gap live in the South, and 60% are people of color.

Medicaid is the nation’s top payer for mental health and addictions care, covering more than one in four adults with serious mental health issues, according to the National Alliance on Mental Illness. In states that have expanded the program, people are more likely to have access to care and are less likely to skip medications due to cost. Additionally, research has found a link between Medicaid expansion and falling suicide rates; suicide turned out to be a strong predictor of mass shootings.

However, mental health advocates are concerned about politicians’ efforts to link mass shootings to mental illness. This week, 60 national organizations, including the American Psychiatric Association and the National Alliance on Mental Illness released a statement condemning “false and harmful attempts” to link gun violence to mental illness:

Attempts to link mental illness to mass shootings are a distraction that inflicts enormous damage by diverting attention from solutions that might actually prevent such occurrences. It perpetuates a false narrative that promotes stigma and discrimination against the millions of Americans living with mental health issues who are more likely to be victims of violence than perpetrators. In fact, people with mental illness represent a very small part of gun violence. While mental health issues are common in countries around the world, the United States is the only country where mass shootings have become commonplace. In fact, guns are now the leading cause of death among children and adolescents in the United States. It’s no coincidence that the United States is also unique in making guns widely available with few restrictions.

Gun violence is a public health crisis, and the trauma and fear caused by mass shootings significantly worsen the mental health of Americans. A large majority of adults in the United States feel the stress associated with mass shootings, and one-third of American adults say fear of mass shootings keeps them from going to certain places and events. Additionally, research has shown that victims and members of affected communities experience increased symptoms of post-traumatic stress, depression, and other signs of psychological problems. Other studies have found that after previous mass shootings, young people felt less safe and more fearful. These findings, many of which are not surprising, make it all the more important to take urgent action to prevent these shootings, especially in light of the current youth mental health crisis in our country.

While the organizations say they welcome continued bipartisan efforts to improve the nation’s mental health and addictions systems, they note that the gun violence epidemic is compelling policymakers to promote gun safety.

But increasing access to mental health care through Medicaid expansion would undoubtedly help mass shooting survivors and broader communities traumatized by such events. It would also help reduce racial disparities in who can access care related to these shootings. While more than 97% of mass murderers are male, blacks are overrepresented, representing just over 13% of the US population but 21% of mass shooters. white people make up 76% of the American population and 52% mass shooterswhile Latinos compensate 18% of the US population and 8% of mass shooters. However, three-quarters of mass shooting victims – defined as those with at least four injuries or deaths – are blackmeaning that black communities in the South and across the country bear a disproportionately heavy traumatic burden related to these shootings.

As mental health advocate David Kendrick Jr. Noted in the aftermath of the Buffalo Grocery Massacre, survivors of the mass shootings suffer mental injuries resembling those of war survivors. And people who survived previous atrocities like the Charleston church massacre have been re-traumatized by the recent shootings and may also need treatment which may be difficult to access; Caroline from the south is also among the states where lawmakers have refused to expand Medicaid.

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