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 three young children in the Reseda neighborhood of Los Angeles in April 2021 have ignited a fierce debate regarding the adequacy of the county’s social safety net and its ability to identify and treat perinatal mental health disorders. Liliana Carrillo, the 30-year-old mother of the victims, was arrested and charged with the murders of her three children: 3-year-old Joanna, 2-year-old Terry, and 6-month-old Sierra. In the wake of this catastrophe, mental health advocates and professionals are pointing to a series of systemic failures that allowed a documented domestic and psychological crisis to escalate into a triple homicide.

Advocates from the organization Maternal Mental Health NOW have issued a public call to action, arguing that the deaths were "entirely preventable." They contend that every interaction Carrillo had with Los Angeles County departments represented a missed opportunity for intervention. As the legal proceedings move forward, the focus has shifted toward the Los Angeles County Board of Supervisors and the urgent need for mandated training and resource allocation to prevent similar tragedies.

The Reseda Tragedy: A Chronology of Systemic Failure

The events leading up to the morning of April 10, 2021, when the children’s grandmother discovered their bodies, reveal a timeline of escalating concern and legal friction. For months, the children’s father, Erik Denton, had been engaged in a harrowing custody battle with Carrillo. Court documents and police records indicate that Denton had repeatedly sought help from various authorities, expressing grave concerns about Carrillo’s deteriorating mental health and the safety of their children.

In March 2021, just weeks before the killings, Denton filed for temporary emergency custody. In his petitions, he described Carrillo as suffering from severe delusions and paranoia, alleging that she believed he was involved in a pedophile ring and that the children were in imminent danger from external forces. Despite these "red flags," the legal and social service systems failed to consolidate this information into a decisive mental health intervention.

According to reports, the Los Angeles Police Department (LAPD) and the Department of Children and Family Services (DCFS) were both aware of the family’s situation. However, there was a critical lack of communication between these agencies and the Department of Mental Health (DMH). Carrillo never received a formal psychiatric evaluation through county-mandated channels during this period. The disconnect between law enforcement, child welfare, and mental health services created a "fractured" environment where Carrillo’s symptoms were treated as a custody dispute rather than a medical emergency.

Understanding Postpartum Psychosis vs. Postpartum Depression

A central point of contention for mental health professionals is the public and institutional misunderstanding of perinatal disorders. Experts believe Carrillo was suffering from postpartum psychosis, a condition that is often incorrectly conflated with postpartum depression in media reports and general discourse.

Postpartum psychosis is an extremely rare and life-threatening medical emergency, occurring in only 0.1% to 0.2% of births. Unlike postpartum depression, which involves feelings of sadness, exhaustion, and anxiety, psychosis is characterized by a total break from reality. Symptoms include hallucinations, delusions, and severe cognitive impairment. Statistically, only 4% of women experiencing postpartum psychosis commit infanticide, and these acts are often followed by attempted suicide.

Advocates emphasize that calling postpartum psychosis "depression" is not merely a semantic error; it is a dangerous miscategorization that fuels social stigma. When the media or officials use these terms interchangeably, women suffering from standard postpartum depression may fear seeking help, worried that they will be labeled as "crazy" or "dangerous" and face the removal of their children. The case of Liliana Carrillo echoes previous high-profile tragedies, such as the 2001 Andrea Yates case in Texas and the 2014 Carol Coronado case in Los Angeles, both of which involved mothers in the throes of psychotic delusions.

Supporting Data: The Scope of Perinatal Mental Health in Los Angeles

The crisis of maternal mental health is not limited to rare psychotic breaks. Perinatal mental health disorders (PMHD) are the most common complication of childbirth in the United States. In Los Angeles County, the scale of the problem is significant. Data from the 2016 Los Angeles Mommy and Baby (LAMB) Survey indicates that one out of every four new mothers in the county reported symptoms of depression during pregnancy or the postpartum period.

The prevalence of these disorders is deeply influenced by socioeconomic factors. Among households living below the federal poverty level, the rate of reported depressive symptoms rises to as high as 50%. The COVID-19 pandemic served to exacerbate these issues, as social isolation, financial instability, and reduced access to healthcare facilities left many new parents without a support system.

Despite the high prevalence, PMHDs are highly treatable and often preventable. Interventions such as psychotherapy, medication management, and robust social support networks have proven effective. However, the current "safety net" in Los Angeles is often described as "siloed," meaning that a mother might interact with a nutritionist or a social worker who lacks the specific training to identify the early warning signs of a mental health crisis.

Official Responses and Calls for Mandated Reform

In response to the Carrillo case, Maternal Mental Health NOW and other advocacy groups have presented a list of recommendations to the Los Angeles County Board of Supervisors. The primary recommendation is a mandate for in-depth training on perinatal mental health disorders for all county employees and contracted agencies.

This training, experts argue, should not be limited to mental health professionals. Because many struggling mothers do not immediately seek out a psychiatrist, they are more likely to interact with employees of the LAPD, the DCFS, or public health clinics. The goal is to ensure that every "door" a mother walks through is the "right door" for receiving help. Training would focus on:

• Identifying clinical signs and symptoms of PMHD.
• Detecting "red flags" in behavior and speech.
• Establishing protocols for emergency mental health referrals.
• Reducing the stigma associated with maternal mental health struggles.

Furthermore, there is a push for the Board of Supervisors to elevate perinatal mental health to a top-tier healthcare priority. This would involve providing coordinated oversight and dedicated funding to develop high-quality, culturally appropriate care that is easily accessible to all residents, regardless of income level.

Broader Impact and the Path Forward

The Liliana Carrillo case serves as a grim reminder of the costs of administrative and clinical oversight. The broader impact of these failures is felt not only by the immediate family but by the entire community, as it erodes trust in the institutions designed to protect the vulnerable.

From a public health perspective, the failure to address maternal mental health has long-term implications for child development and societal stability. Children of mothers with untreated PMHD are at a higher risk for developmental delays and emotional challenges. By neglecting the mother’s mental state, the system inherently fails the child.

Analysis suggests that Los Angeles County requires a "no wrong door" policy. This means creating an integrated system where a report of concern from a father or a relative—as was the case with Erik Denton—is met with a multidisciplinary response team rather than a bureaucratic hand-off between departments.

The legal system must also evolve to better handle cases where mental health is a primary factor. In the Carrillo case, the civil court system handling the custody battle and the criminal justice system functioned in isolation. Advocates argue that specialized "mental health courts" or more robust integration of psychiatric experts in family law could provide the necessary nuance to identify when a parent poses a risk to themselves or their children due to a medical condition.

As Los Angeles County reflects on the loss of Joanna, Terry, and Sierra, the consensus among experts is clear: the tools to prevent such tragedies already exist, but they must be funded, coordinated, and mandated. The benefits of a well-funded, prioritized effort to address perinatal mental health would be tremendous, potentially saving lives and ensuring that the "safety net" finally lives up to its name. The county owes it to its mothers, birthing people, and families to ensure that the missed opportunities of the Carrillo case are never repeated.