Bexar County recently committed more than $30 million to expand local mental health services, and federal dollars may further boost those efforts, if the U.S. Senate’s bipartisan gun violence measure — a response to the Uvalde school shooting — ever gets to a vote.

But while people on the front lines of mental health treatment and advocacy applaud the increased focus on the need for mental health care, they worry that too often discussion of events like the Uvalde shooting ties people with mental health problems to violent behavior.

More mental health care access may reduce suicides by firearm, but likely won’t reduce gun homicides or mass shootings, they say. Meanwhile, continually lumping mental illness together with violence is not only inaccurate, it can also lead to further stigmatization, which in turn may lead some people to avoid seeking care.

Amy Joyce-Ponder, an education and outreach specialist for the San Antonio chapter of the National Alliance on Mental Health, said it could make people think, “‘I don’t want to get services because then people will think … I’m going to be a mass murderer.’

“It’s not out of the realm of possibility that someone with a mental health condition can do something terrible of mass proportions,” she continued. “But there were other things involved that allowed this whole thing to play out. … societal conditions.”

Salvador Ramos, the 18-year-old Uvalde gunman who killed 19 children and two teachers, appears to have had a tumultuous home life, but he had no record of mental health diagnosis or treatment.

While Democrats have again largely set their sights on gun control as a response to mass shootings, Republicans continue to point to the need for additional school security and greater access to mental health care. The resulting bipartisan measure, not yet written into legislative text, is a compromise that includes those elements, although it may ultimately be watered down.

U.S. Rep. Tony Gonzales, a Republican who represents Uvalde and parts of San Antonio who has voted against gun control measures in the past, wrote in a recent commentary that he believes the bill should include “more on mental health.”

But the “vast majority” of gun violence is not attributable to mental illness, wrote the American Psychiatric Association in a June 1 statement. “Rhetoric that argues otherwise will further stigmatize and interfere with people accessing needed treatment without addressing the root causes of firearm violence.”

Just 8% of people who carry out mass shootings had a history of lifetime psychotic symptoms, according to a 2021 analysis of 1,315 mass murders. A 2016 study found that people with serious mental illness commit about 3% of violent crimes. Meanwhile, nearly one out of every five adults live with a mental illness.

People with mental illness are actually more likely to be victims of violence, said Eric Estrada, executive director of Form Communities and San Antonio Clubhouse, a volunteer center for people living with mental health issues.

Estrada said he has held off on making public comments about Uvalde in an effort to avoid conflating the shooting with mental health.

He recalled meeting a woman who was experiencing a crisis at a recent mental health fair just days after the Uvalde shooting whose experience, he said, illustrates how the stigma around mental health can harm individuals.

The woman told him that she was sitting in a hospital, for an issue unrelated to her mental health, on the day of the shooting.

“She’s hearing people say that people with mental health conditions need to be caged up because that way, they don’t do bad things,” he said. The discussion made her feel isolated and alone, fearful of asking for help.

Estrada acknowledged that people who commit acts of extreme violence “aren’t doing well,” and said that’s why communities must focus on the upstream causes of mental illness, before they become crises.

“The goal here is that people feel connected to the world and feel valued and feel like they’re part of something — because not being isolated is an important part of being healthy.”

Loopholes and hindsight

In 2019, Texas established a $290 million youth mental health program, which has since treated 6,000 students “including those at high risk for hurting themselves or others,” the Texas Tribune reported. But that program hadn’t yet been deployed in Uvalde.

It’s unclear if such a program would have steered Ramos away from Robb Elementary School or led to a mental health diagnosis or detention, which could have disqualified him from purchasing two AR platform rifles from a federally licensed dealer when he turned 18. (An existing legal loophole would have allowed him to purchase them from a private seller at a gun show, however, even if he had a disqualifying history.)

Maybe mental health intervention could have prevented the tragedy, but “hindsight is always 2020,” said Melissa Tijerina, vice president of child behavioral health at the Center for Health Care Services. “In general, I think we want to create environments — at home, in community, in schools — where children know who they can go to for help, where they have those trusted adults around them.”

The Sand Tray room at the Children's Bereavement Center of South Texas features tactile objects for clients to play with. The Center offers mental health services for individuals between three and 24 who may be struggling following a traumatic event.
The Sand Tray room at the Children’s Bereavement Center of South Texas features tactile objects for clients to play with. The Center offers mental health services for young people ages 3 to 24 who may be struggling following a traumatic event. Credit: Bria Woods / San Antonio Report

When feelings of anger or depression become a mental health diagnosis is a bit of a gray area because it’s specific to each individual, she said.

“Lots of people experience mental illness in different ways, but there’s a difference between having a mental illness and acting out violently,” Tijerina said. “Violence is a behavior and it’s not necessarily behavior that’s consistent with everyone who has a mental illness.”

Tijerina said she hopes families and officials will have more healthy conversations about mental health in public spaces and inside homes.

“If you thought your child had a broken arm or you thought they had sprained their [ankle], you would not put a pause on going to the doctor,” Tijerina said. “This is just another one of those things that kids need advocates for. Because there is help, you can get treatment, you can be better. … I just encourage people not to be afraid to ask for help, because treatment absolutely works. And it is life-changing — particularly for children.”

Even as they raise concerns about conflating violence and mental illness, local advocates agree that the recent additional funding for mental health care access is welcome and desperately needed.

Of the roughly $30 million Bexar County approved earlier this month, $16.3 million will go to expand an existing mental health collaborative to all school districts in Bexar County over the next four years, while $14.8 million will enhance or create mental health and violence prevention programs.

The money comes from the county’s federal coronavirus pandemic relief grants. The City of San Antonio is slated to spend $26 million of its American Rescue Plan Act funds on various mental health initiatives.

“We hope that the people affected [by the Uvalde shooting] are able to access the services,” Joyce-Ponder said. “And then hopefully we can continue to fight the stigma.”

If you or someone you know needs mental health support, there are several local and national resources, including:

Senior Reporter Iris Dimmick covers public policy pertaining to social issues, ranging from affordable housing and economic disparity to policing reform and mental health. Contact her at