April 21, 2021
Letters to the Editor of the L.A. Times: Better maternal mental health care could have saved Liliana Carrillo’s children
The tragic deaths of Liliana Carrillo’s three young children were entirely preventable. Each of her numerous interactions with Los Angeles County departments and agencies provided an opportunity to offer the mother help, treatment, and hope. Catastrophically, each and every opportunity was missed. As mental health professionals who have been teaching, training, and advocating for improved recognition and response to perinatal mental health disorders in Los Angeles County for over 15 years, we are heartbroken to see yet another family needlessly destroyed. We emphatically recommend that the Los Angeles County Board of Supervisors mandate in-depth training on perinatal mental health disorders for all agencies and employees of the county and provide resources to make robust perinatal mental health care realizable.
Postpartum psychosis – Ms. Carrillo’s presumed diagnosis –is an extremely rare and life-threatening medical emergency, occurring in only 0.1-0.2% of births. Only 4% of women who experience postpartum psychosis kill their children as a result of their delusions, and they often try to kill themselves afterward. The case of Andrea Yates first brought this issue to national attention in 2001; here in Los Angeles County, Carol Coronado killed her three children while in the throes of psychoses in 2014. Notably, postpartum psychosis is not interchangeable with, nor an extreme form of, postpartum depression – despite repeated misreporting in this article and in frequent media reports. Calling postpartum psychosis “depression” leads to even more stigma, as women who experience depression worry that they are “crazy” and that their children will be removed if they discuss their symptoms with anyone.
The term “perinatal mental health disorders” includes postpartum psychosis, but also the much more common diagnoses of depression, anxiety, obsessive compulsive disorders, post-traumatic stress disorders, bipolar disorders and chronic psychotic disorders that occur or worsen during pregnancy and/or the postpartum period. In fact, perinatal mental health disorders are the most common complication of childbirth. According to the 2016 Los Angeles Mommy and Baby Survey, 1 out of 4 new mothers in LA reported symptoms of depression during pregnancy and the postpartum period. The situation was even worse in households living below the federal poverty level, where rates are as high as 50%. The COVID-19 pandemic has exacerbated this already critical problem. Perinatal mental health disorders are treatable, and often preventable, through psychotherapy, medication management and/or social support.
We strongly recommend that the Board of Supervisors mandate comprehensive training on perinatal mental health disorders for all Los Angeles County employees and contracted agencies. Training should focus on signs and symptoms, how to detect red flags, and what to do in emergencies. Training should not be limited to mental health professionals only, as most individuals who are affected don’t seek immediate mental health care. They often, however, have numerous interactions with other county agencies. (Per the LA Times report, Ms. Carrillo never interacted with the Department of Mental Health; the Department of Children and Family Services and the Los Angeles Police Department were the only County agencies aware of her situation.) Almost all county agencies have some contact with young families, and there should be no restrictions on which county employees learn to detect and appropriately respond to perinatal mental health concerns.
We also recommend that the Board of Supervisors elevate perinatal mental health treatment as a health care priority by providing coordinated oversight and adequate funding for county agencies to develop and implement appropriate, high-quality, easily accessible and culturally appropriate care. This effort should cut across the siloes of county agencies to so that there is “no wrong door” for new mothers and young families to obtain needed help. Elevating treatment also means increasing acute care services, such as county-funded acute and stepdown care specifically for perinatal patients. In a safety net system as far-reaching, yet as fractured, as Los Angeles County, nothing short of a focused, well-funded, and prioritized effort is needed to address perinatal mental health disorders. We owe this to our county’s mothers, birthing people and families. The benefits would be tremendous.
Maternal Mental Health NOW
Elevate perinatal mental health treatment as a health care priority!