There’s no way to know for sure why a 20-year-old shot and killed 20 children and six teachers at Sandy Hook Elementary School before taking his own life last week, but what has been reported thus far has prompted questions about access to mental health services in the state.

At a Capitol press conference Monday, Gov. Dannel P. Malloy said the state’s mental health landscape will be something the legislature should explore in the wake of the shootings.

“Mental illness has long been delegated to a different discussion than physical health,” Malloy said. “It is a distinction that I think in many ways has not served our country well.”

He said there’s also the assumption that mental illness can’t be cured, when in many instances that is not the case.

But access to mental health services is seldom easy.

State Healthcare Advocate Victoria Veltri, who helps Connecticut residents battle their health insurance companies on a daily basis, said there are two issues hindering access to care for those who seek it — there are too few providers who offer care and there are too few providers even accepting private insurance.

“Psychiatrists, in general, many of them do not take private insurance,” Veltri told the Colin McEnroe Show on Monday. “Psychologists — it’s the same sort of thing.”

So it’s about the financial structure, not just the deinstitutionalization movement that started about 50 years ago, Veltri said. She said there’s also a financial incentive to deny care or to simply not provide care, which only goes further to stigmatize the disease.

“We really have a system that is fractured,“ Veltri said.

Heather Gates, president of Community Health Resources, said in a phone interview that individuals and families rely on state services because they have no other options.

The state moved to a community-based delivery method in favor of group homes over large institutions, but many insurance plans — including Medicaid — still don’t cover in-home care despite the efficacy of those programs.

In October, Veltri hosted a public hearing on the issue of access to mental health and substance abuse treatment.

Dr. Laura Saunders, a child psychologist at the Institute of Living, told the panel that there are absolutely no private insurance plans in the state that cover in-home psychiatric services. She said the only carrier that covers in-home psychiatric care is the state’s Medicaid program, called HUSKY.

The only thing she can recommend as a provider is a higher level of care than is medically necessary for a child.

“If you have commercial insurance, we have to automatically divert someone to get voluntary services,“ Saunders said. “The lack of access is very, very unfair to these families with commercial insurance.”

In order to access in-home services, families have to get a referral from the Department of Children and Families Voluntary Services division.

While HUSKY does cover some in-home services for children, adults on Medicaid can only receive in-office treatment. But access to those types of services also is dwindling because Medicaid reimbursement rates remain flat.

“It’s harder and harder to recruit psychiatrists to provide services,” Gates said. “That’s directly related to the rates.”

The problem will only get worse in 2014 when the Affordable Care Act requires that everyone purchases insurance, and the demand for services increases, she said.

State funding for nonprofit community providers like Gates’ organization, which serves 11,000 individuals, have not received an increase in state funding for decades. Up until late Monday, it was unclear as to whether budget deficit negotiations would lead the General Assembly to take away the 1 percent cost-of-living increase it provided to those organizations when it adopted the current budget in June.

“That would be devastating to individuals and families,” Gates said.

By late Monday, lawmakers said the 1 percent cost-of-living increase was no longer part of the deficit mitigation package they plan to adopt Wednesday.

However, details were not available Monday regarding cuts to mental health services offered through the alphabet soup of state agencies that are facing spending cuts. Malloy used his executive authority to cut about $7.7 million from the Department of Mental Health and Addition Services, and proposed cutting about $1.76 million more through the deficit mitigation effort.

The Department of Developmental Services and the Department of Social Services, which also provide some services in this area, were slated for millions of dollars in cuts amounting to about 2.57 percent to 2.65 percent of their budgets.

But lawmakers like Rep. Toni Walker, D-New Haven, said Monday that they were mindful of cuts to those areas.

“We’re trying to protect them,” Walker said. “Because those areas really need more resources, especially in light of what we’ve seen.”