The recent shooting that killed 26 people and wounded more than 20 others Sunday at a church in Sutherland Springs, Texas, led to calls for prayers and condolences that have become commonplace after such tragic acts.
It also led to calls to address mental illness by the commander in chief himself.
"I think that mental health is your problem here," President Donald Trump said the day after the shooting. "We have a lot of mental health problems in our country, as do other countries."
Patient advocates rebuked Trump's claim, saying that kind of rhetoric cements mental illness as the root cause of such acts and that only perpetuates the stigma surrounding the disease.
"Most people with mental health concerns are never violent," said Paul Gionfriddo, president and CEO of Mental Health America, in a written statement. "That said, it is true that the mental health system in this country—the system on which the victims of this horrifying assault will now rely—is broken."
Less than half of the more than 43 million U.S. adults who experience a mental illness every year receive treatment, according to the U.S. Substance Abuse and Mental Health Services Administration.
Advocates appreciate the raised awareness in the aftermath of such incidents. Sometimes, mass shootings have helped direct more federal funding to healthcare.
Last year, President Barack Obama requested Congress fund $500 million for mental health reform as part of executive actions aimed at curbing gun violence.
In the days following the 2015 mass shooting in San Bernardino, Calif., that killed 14 people, House Speaker Paul Ryan called for mental health reform that echoed similar calls by lawmakers in the aftermath of 2012's Sandy Hook shooting that killed 26.
But "it's an uncomfortable position to be in," said Ron Honberg, director of policy and legal affairs for the National Alliance on Mental Illness. "I think it's very natural for people when something this horrific and senseless happens to say, 'nobody who's emotionally stable would do something like this.' "
In reality, people with severe mental illness account for 3% to 5% of all violent acts while being 10 times more likely than the general population to be victims of violence themselves, according to HHS.
"We should not stigmatize mental health," said Antonio Puente, a professor of psychology at the University of North Carolina at Wilmington and president of the American Psychological Association. "This is something that is much more complicated, much more prevalent and less violent than we often make it out to be."
Patient advocates say they're not confident the shooting that killed nearly 60 people in Las Vegas or the recent Texas shooting will result in added support for healthcare.
In one of his first acts as president, Trump signed a bill to roll back an Obama-era regulation that made it harder for people with mental illnesses to purchase a gun.
Trump's 2018 proposed budget includes a 26% cut below 2017 appropriations in community development block grants to states for mental health services such as outpatient treatment, rehabilitation, crisis stabilization and case management.
Last month, Trump signed an executive order to end federal cost-sharing subsidy payments to insurers to cover deductibles and co-pays for some 7 million low-income Americans.
More recently Trump has called for Republican lawmakers to include a provision within their current tax reform bill to repeal the Affordable Care Act's individual mandate, which would result in fewer Americans buying insurance and is expected to lead to higher insurance premiums.
Puente said such efforts to limit funding coupled with calls to address mental healthcare in the aftermath of such tragedies is especially disappointing.
"Not only is the concept of mental illness being stigmatized but it's also being unfunded," Puente said. "We're getting the worst of both worlds."
