DAYTON, Ohio _ The Dayton gunman had three mental health counseling receipts on his person when he died, according to preliminary autopsy results.
The Dayton Daily News examined the results, which typically include photographs of items found in a person's wallet or pocket.
The bloodied receipts were for April 5, June 10 and another date that couldn't be read. They were for $50 payments. Two were marked for mental health counseling, the other for mental health services.
Mental health has been a major topic of debate after the mass shooting, even though most wide-scale studies of mass shooters repeatedly show that mental health illnesses aren't the main cause of the tragedies.
Connor Betts, 24, was responsible for the shooting deaths of nine people when he opened fire shortly after 1 a.m. Aug. 4. in the city's Oregon District. Dayton police shot him at least two dozen times and killed him.
The autopsies were detailed Thursday by Montgomery County Coroner Dr. Kent Harshbarger, who was joined in a city hall press conference with Dayton Police Chief Richard Biehl.
Biehl previously said the shooter had received treatment, but wasn't aware of any diagnosed mental illnesses.
Multiple people who knew the shooter have told the Dayton Daily News that Betts had told them he had several mental illnesses, including depression and possible bipolar disorder.
Additionally, the shooter had cocaine, alcohol and Xanax in his body, the results say.
Ohio Gov. Mike DeWine focused on mental illnesses last week in his response to the Oregon District shooting. Among other proposals, he called for increased access to inpatient psychiatric care, "wrap-around services," early intervention training, online mental health services for students, training on risk factors, and red-flag legislation to keep guns out of the hands of the mentally ill.
But research has shown the behavioral factors that lead some to commit heinous acts of mass violence are more nuanced and complex than a label of mental illness.
Studies of mass shooters in the U.S. have found that about 25% have a diagnosed mental illness, which is a slightly higher rate than the percentage of people in the general population _ 18%.
Betts had a history of threatening women who he felt had wronged him. Multiple witnesses said he was disciplined in high school for creating a "hit list" of girls he wanted to rape and kill. His band performed a genre of music that focuses on violent imagery including raping and killing women.
Following the Dayton shooting, the American Psychiatric Association said people with mental illness are far more likely to be victims of violent crime than perpetrators of violence.
"Rhetoric that argues otherwise will further stigmatize and interfere with people accessing needed treatment. Individuals can also be emboldened to act violently by the public discourse and divisive rhetoric," the association said.
