Hours after a white gunman walked into a Walmart on August 3 and killed Hispanic shoppers in El Paso, Texas, Governor Greg Abbott addressed a room full of reporters in the border city and expressed grief and support for the community.

In light of the high-profile mass shootings that continue to erupt across the country — three of which occurred in Texas in the last two years — he was asked what he planned to do.

Abbott, a Republican, hesitated, then spoke at length about how the state Legislature reacted to the 2018 high school shooting in Santa Fe, eventually focusing on what he said was the most agreed-upon need: addressing mental health issues.

“Bottom line is mental health is a large contributor to any type of violence or shooting violence, and the state of Texas this past session passed a lot of legislation and provided funding for the state to better address that challenge,” he concluded, referring to bills aimed at improving children’s mental health care.

Behind him, U.S. Representative Veronica Escobar, a Democrat from El Paso, visibly stiffened, shaking her head slightly as Abbott connected mental illness to what appears to be an act of domestic terrorism fueled by a white supremacy ideology that killed 22 people and injured more than two dozen more in her district.

The next day, before a vigil in downtown El Paso for the victims, she put into words what had been apparent on her face.

“I would also call on those who use mental illness as an excuse to please stop. Please stop,” Escobar said, to light applause from those beginning to arrive for the service. “It further stigmatizes those who truly suffer from mental illness, and the fact of the matter is people with mental illness are far more likely to be victims of violent crime, not perpetrators.”

“This tragedy is not in vain if we can finally have a reckoning in this country as to what is really going on,” she added.

Abbott’s focus on mental illness is a common reaction among Republican lawmakers immediately after mass shootings, often mirroring public sentiment. But such focus comes at the dismay of mental health experts and Democrats, who argue that automatically pinning such horrors on mental illness is a way to avoid talking about issues surrounding gun violence and the rising prominence of white supremacy in the United States. In reality, the intersection between mental health and mass shootings is complicated.

In 2013, a Gallup poll found that 48 percent of Americans blamed the mental health system for failing to identify potential perpetrators of gun violence, that belief trumping other causes like drug abuse or easy access to guns. In a similar CBS poll from 2017, 68 percent thought better mental health screenings could prevent gun violence. And many high-profile shootings that seemed to tie in with mental health issues have further cemented the connection into the minds of Americans and their elected officials — perhaps most notably with the Sandy Hook shooting, in which the gunman killed 20 elementary school children and six staff members.

But research on mass killings and serious mental illness doesn’t usually back this connection.

A 2015 study of about 230 mass homicides since 1913 found that only 22 percent of the killers could be considered mentally ill, defined as exhibiting psychosis. Examining only the killings from this millennium, the author, a forensic psychiatrist, considered 32 percent of the killers mentally ill. A 2016 study found only 15 percent of mass killers had a psychotic disorder and 11 percent had paranoid schizophrenia. But more recent government reports indicate higher levels — a U.S. Secret Service report of 27 mass attacks in 2018 found that 44 percent of attackers had been treated for or diagnosed with a mental illness.

The rates of mental illness among mass murderers in recent studies doesn’t surprise Greg Hansch, the executive director of the Texas branch of the National Alliance on Mental Illness. He doesn’t discount that mental illness is sometimes a factor in large-scale attacks, but argues that it is not the sole cause and is often used as a scapegoat for gun violence.

“We shouldn’t immediately jump to blaming mental illness, because one, it’s impossible to make that determination without having facts to back that up and two, there are often other causative, aggravating factors that need to be explored,he said. “Certainly, in the case of El Paso, it seems like it was a hate crime.”

There has been no information released regarding the mental health of the gunman in Saturday’s massacre. But the 21-year-old suspect allegedly published a racist manifesto before the shooting, describing the attack as a “response to the Hispanic invasion of Texas.”

Still, Abbott and Republicans nationwide one again pointed to mental illness immediately after the back-to-back shootings in El Paso and Dayton, Ohio. And President Trump told reporters on Sunday that “these are people who are very, very seriously mentally ill.” In a White House address the next day, he said the country must reform its mental health policy “to better identify mentally disturbed individuals who may commit acts of violence.”

“Mental illness and hatred pulls the trigger, not the gun,” he said.

The fact that hatred motivated the El Paso gunman isn’t being debated in the wake of the shooting. And Texas Democrats say that zeroing in on mental illness allows Republicans to ignore gun safety measures and racism.

“Let’s use our collective voice to keep the focus where it should be – that’s on the dual problem of lax gun laws and the white nationalist views that have been fueled by President Trump,” wrote State Representative Chris Turner, the leader of the Texas House Democratic Caucus, in a memo to his colleagues. “We should not allow Republicans to try and change the topic to mental health, video games, prayer in school or anything else.”

Right after the Sante Fe high school shooting, which killed 10 people and left moe than a dozen wounded, Abbott brought together students, school officials, law enforcement, mental health experts, and advocates on both sides of the gun debate to propose legislation aimed at preventing future school shootings. He also created committees to study the issue while lawmakers were not in session to come up with proposals for the 2019 Legislature.

At the time, mental health experts cautioned Texas policymakers against using mental illness as a panacea for addressing shootings. A Senate committee assembled an army of experts to testify, and later released a 2018 report that said mental health professionals were warning that potentially flawed logic was being considered in the debate.

Dr. Andy Keller, CEO of the Meadows Mental Health Policy Institute, told senators that mental illness alone is “not a risk factor for violent acts” and that there is “no reason to believe focusing solely on this population will prevent future events,” according to the report. Another expert, Dr. Jeff Temple, the director of behavioral health and research at the University of Texas Medical Branch, testified that “mental illness is not a driving factor of violence,” adding that those suffering are “more likely to hurt themselves or be hurt by someone else than to harm another individual.”

As the 2019 state legislative session began in January, mental health concerns and school-hardening measures, like increasing police presence and installing metal detectors, were still the top priorities for Republican lawmakers, who hold majorities in both the state House and Senate. By the time lawmakers went home in late May, the Legislature had passed sweeping legislation aimed at improving mental health care for students, arming more school employees and hardening schools.

Bills tied to gun control efforts went nowhere. Gun restrictions were loosened in some ways, like forbidding landlords to prohibit tenants or guests from carrying firearms.

“Nobody wants to talk about gun violence prevention measures. Nobody wants to talk about the fact that we need to do something … about the increasing racism in this country,” state Senator José Rodríguez of El Paso, a Democrat, said before the Sunday vigil and silent march. “On the other hand, I want to tell you that there were a whole slew of bills that were championed by the state leadership … that now allow, for example, guns in your churches, that allow more guns on campuses.”

Abbott told reporters on Saturday that it was too soon to talk about politics.

In Ohio, just two days after the Dayton mass shooting, the Republican governor proposed a red flag law that would allow authorities to remove guns from people whom a court deems dangerous. Trump has called for a similar policy at the federal level. Such a proposal fell flat at the feet of Texas Lieutenant Governor Dan Patrick after the Santa Fe shooting.

In the wake of El Paso, Abbott said that the gunman didn’t appear to exhibit any red flags, but announced there would be a new set of roundtable discussions this month to consider the issue.

El Pasoans at Sunday’s vigil showed they are ready for change. Filling the streets in the evening after their city was attacked, they held handmade signs depicting their pain, and also their frustration with the politics surrounding such tragedies that were now all too real for them.

Marching in silence with hundreds of grieving people downtown, one woman held up a sign written in bold, red marker: “Racism is not mental illness.”

Alexa Ura contributed reporting.

Disclosure: The University of Texas Medical Branch has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations, and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.