Earlier this year, Joy Burkhard, a 42-year-old mother of two who splits her time between her family, her job as a quality control insurance agent, and volunteering with the Junior League of Los Angeles, walked into the Superior Court building in Compton, California, prepared to support Carol Coronado, a woman she'd never met. Just two months earlier, Coronado had been found guilty of brutally murdering her own children in the bedroom of her home in south Los Angeles County.
Burkhard had been following the case for weeks, but Coronado's sentencing was her first opportunity to speak in court. Describing the scene to Broadly over the phone, she spoke with a tone of firm conviction and warm concern. There were three strollers set up outside as a vigil for Coronado's three daughters, "as a way to show our support," Burkhard explained, "but also to acknowledge the loss."
In May 2014, Coronado took the lives of three-month-old Xenia, 16-month-old Yazmine, and two-year-old Sophia. She slit their throats with kitchen knives, stabbed two of her daughters in the heart, and beat the third in the head with a claw hammer. When her husband, Rudy, and her mother, Julie Piercey, found Coronado in the bedroom, she was laying naked on the bed next to the bodies of her children, covered in blood. She had tried to stab herself in the heart, but punctured a lung instead.
"What's so obvious about this case is that no one disputed that she was psychotic," Burkhard says. "No one disputed it."
During the trial, Diana Lynn Barnes, an expert on perinatal mood disorders who interviewed Coronado and reviewed her police and psychiatric reports, confirmed what three other psychiatrists also testified in court: They all believe Coronado was suffering from a psychotic episode brought on by a combination of factors ranging from childhood sexual trauma to the stress that followed the birth of her third child.
In her testimony, Barnes told the court how Coronado began hearing voices directing her behavior after she was molested by a relative at gunpoint when she was only five years old. Barnes also explained how Coronado endured gang rape as an adolescent and was raped again while serving with the California Conservation Corps. Barnes described how the voices Coronado heard would return with each childbirth, to the point where she believed she was having spiritual and out-of-body experiences. After her third daughter, Xenia, was born, Coronado rarely slept, which only made the voices worse.
Despite these symptoms, her OB-GYN, Dr. David Speiser, believed Coronado was fine when she came in for her post-delivery check-up six weeks after Xenia was born. As Speiser told the court, Coronado showed no signs of postpartum depression or psychosis during her visit. "She was very happy," the Daily Breeze reported Speiser telling the prosecutor. "She gave me a picture of her baby."
One's eagerness to share baby pictures, however, is not necessarily equivalent to a thorough psychiatric evaluation.
As Executive Director of 2020 Mom, a volunteer advocacy group raising awareness of maternal mental health issues, Burkhard hoped her group's presence—and the stroller tableau outside—would help convince Superior Court Judge Ricardo Ocampo to spare Coronado a life sentence without parole and instead see that she be sent to a mental health institution for appropriate care.
A cold wind kept people moving quickly past the scene outside the courthouse, but the media eventually picked up the visuals. Once inside the courtroom, Rudy Coronado asked Burkhard why she and her supporters hadn't shown up earlier. "That's when," Burkhard says, "I felt this, like, punch in the stomach. Like we should have been here all along, and the media's been following the case."
"You know, here we all are in our world, as advocates," Burkhard continues, "trying to get the media to come to other events and hear what we have to say when all along, they are showing up, and we're not here at these cases when we should be."
During the sentencing hearing, Burkhard stood up to tell Judge Ocampo how common mental health disorders are among new mothers and how 20 percent of women will suffer from a condition like postpartum depression or postpartum psychosis—a more rare and serious condition that can cause new mothers to have extreme mood swings, hallucinations, and delusions normally associated with a psychotic break.
Burkhard told the judge how women are not being routinely screened or treated for these complications. "We can't fail her twice," Burkhard said in court. "We failed her family. Our healthcare system failed her." Afterwards, Ocampo read the three life sentences, calling the murders "vicious, sophisticated, and with vulnerable victims who trusted her."
"My big takeaway," Burkhard says, "is this: I have to be at these cases. And I have to know them and be willing to speak up much earlier. It could have made a difference perhaps."
In November 2015, Judge Ocampo found Coronado guilty of three counts of murder, siding with the prosecution's argument that she had plotted the killings with the clear intention of hurting her husband. During the trial, Rudy Coronado admitted he had threatened to divorce his wife and that he believed he could get in trouble for bringing the three girls to his work where he sold auto parts at a swap meet. On the witness stand, Rudy testified that he didn't help care for the children because, as the Daily Breeze reported, he was raised "to believe that women should care for daughters to 'avoid legal issues' with little girls."
But Rudy Coronado also testified that his wife was a "very good mother" and that she "didn't act the way Carol act[ed]" in the days leading up to the murders. When his wife pled not guilty to the murder charges, her attorney Stephen Allen told reporters that Rudy Coronado supported his wife "100 percent and just wants to be there for her every step of the way." When Carol Coronado was sentenced, Rudy wept outside the courtroom, telling reporters he had forgiven her.
According to Allen, Carol Coronado has no memory of the afternoon in question and had no malicious intent. "We all believed she was in temporary insanity when it happened, suffering from postpartum psychosis," Allen says. "She was a good mom. She would have never done this. She has no memory of it."
For Burkhard, Coronado's case was both heartbreaking and eye-opening in how it revealed the judicial system's lingering misconceptions about postpartum psychosis and mental health in general. As a member of the Junior Leagues of California State Public Affairs Committee, Burkhard helped bring a mental health awareness bill before the state senate in 2011 after hearing the story of Jenny Bankston, a young mother who killed her seven-week-old son with a handgun she had purchased that same day before turning the weapon on herself. The bill would have required hospitals to provide information to new parents about the signs, symptoms, and risk factors of postpartum depression, but it was effectively neutered by California's statewide budget crisis. The bill morphed into a resolution declaring the month of May as Maternal Mental Health Awareness Month, but it led Burkhard to form 2020 Mom as a volunteer advocacy group.
Burkhard's interest in these issues is personal. After the birth of her own son, she suffered from what she now believes was an undiagnosed case of postpartum anxiety and mild depression. "I can say this with confidence now," Burkhard says. "And my husband was a huge support for me. Had he not been taking the night shift for so long, I think I really could have slipped into a really dark depression. Or who knows what else? It's hard to know."
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"Us advocates," Burkhard explains, "we haven't thought about our role in the courtroom." While the public's view of mental health issues maybe be shifting, the courts are lagging behind. "I think everyone's recognizing that the attention [Coronado's] case got nationally, even just through social media and our networks, that everyone is sort of recognizing how absurd the outcome of this case was. And also recognizing, in a way, why the judge ruled the way he did."
According to the DSM-V, which updated its standard definition of postpartum psychosis in 2014, women suffering from the condition often experience specific feelings that their child is possessed. Or they may experience auditory hallucinations—voices commanding them to kill their baby. The weight of postpartum psychosis, which affects one to two out of every 1,000 women in the first 12 months after childbirth, is such that a mother may feel the only way to protect her newborn child is to take its life entirely. Women are most at risk for postpartum psychosis if they have experienced postpartum mood episodes in the past or have a history of depressive or bipolar disorders, as Coronado does.
According to Burkhard, there's a reluctance among OB-GYNs and pediatricians to screen new mothers for serious mental health issues. "It really boils down to the fact that OB-GYNs and other primary care docs, including pediatricians, are still afraid of mental health," Burkhard says. "Most OBs will say they had an hour of mental health in medical school, and fellowships don't typically cover mental health either."
While a lack of mental health training is obviously a problem, there's an even larger one looming, Burkhard says. "Our big problem with mental health generally—not unique to this issue—is that there's a shortage of therapists, and particularly of psychiatrists." So when a pediatrician is faced with a mother showing signs of something more serious than the "baby blues," he is not only ill-equipped to treat her, but the community at large may also lack the resources to get her proper treatment. "That's the big elephant in the room," Burkhard says, "this referral pathway: Who can I lean on?"
In the case of Carol Coronado, the series of failures that ultimately ended in tragedy began at the hospital level. "It definitely started with the doctors," Allen explains. "She was seen by a couple of different ones, but they didn't take any real approach other than asking her simple questions [about whether] she was alright. She's had mental illness when she was a child. The fact that someone's saying she's alright isn't really sufficient."
Even those closest to Coronado failed to act when they started seeing signs that something might be wrong. "Her own husband saw things that were wrong with her," Allen says, "but he didn't know what to look for or know what to do. He kind of left her alone."
"The mom [Julie Piercey]—she saw things wrong, too, and didn't do anything. It started from the doctors, goes all the way to the family. The community in general, everyone who knew her. I think a lot of people, unfortunately, let her down in a time of need because they didn't know what to do."
Something as simple as a community support network could have saved the lives of these children, Burkhard insists. Coronado asked Piercey to come over on the day of the killings, but her mother couldn't make it because she was a bus driver who couldn't get off work until after 5 PM. "If there had been a crisis nursery, which we think every community should have, perhaps she could have dropped her babies off and even slept," Burkhard says.
Her own husband saw things that were wrong with her, but he didn't know what to look for or know what to do.
While a shift in screening methods and resources for those suffering from mental health issues may have prevented the crime entirely, the court ultimately failed Coronado as well. Even though both sides agreed Coronado experienced a psychotic episode, under California law Judge Ocampo was bound to consider a two-pronged test to determine her sanity. A report from the Public Law Research Institute at UC Hastings explains the test: "The first prong requires a defendant to understand the nature and quality of his act. The second prong requires the defendant to be able to distinguish between right and wrong. A defendant who cannot satisfy both of these prongs is statutorily insane."
Because Coronado locked the door after the killings, Judge Ocampo reasoned that she knew what she had done was wrong. But there's likely another explanation, Burkhard says a week after Coronado's sentencing. "It's hard to know because we weren't in her head, but psychotic people can imagine that there's, like, a demon outside of the door, for example." Coronado had been hearing voices nearly all her life, but a judge sentenced her to life in prison because she locked the door before she attempted to end it.
Coronado's case is unfortunately not the first time an American court has failed a mother suffering from postpartum psychosis. In 2001, Andrea Yates confessed to drowning her five children in the bathtub. Yates was convicted of capital murder and nearly sentenced to death based on false testimony by a psychiatrist. The prosecution argued that Yates had the intent to kill and knew it was wrong based on a Law and Order episode she had allegedly watched. The episode depicted a mother who killed her children but was acquitted with an insanity defense. The psychiatrist who testified against Yates was a consultant on the show and was brought into to court to discuss the episode.
Yates was sentenced to life in prison before an appeal overturned the verdict and sent her to a mental health facility where her roommate was Dena Schlosser—who had suffered from postpartum psychosis when she killed her own infant daughter in 2004.
"And actually," Allen says "Carol was housed with two other individuals charged with the same crime—and I don't know how old their kids were—but it's happening, and it can't go unnoticed. There has to be some kind of connection."
After an appellate court found Andrea Yates not guilty by reason of insanity in 2006, her attorney George Parnham and Texas state representative Jessica Farrar wrote legislation that would have decriminalized infanticide in cases where postpartum psychosis could be proven. The bill would have brought Texas up to date with similar laws that have been in place in the UK for over half a century. "It's something every civilized country has on its books," Parnham told the Dallas Morning News in 2009. "The only thing that will change public attitude is education about postpartum issues."
The legislation would have been the first of its kind in the United States, but it was controversial in Texas, where it eventually died before it could get through the state legislature. After the Coronado case, Burkhard sees a more compassionate way forward.
"I feel like we should start simpler in California," Burkhard says, by advocating for mental health first aid training for members of our judicial system—the public defenders and prosecutors that often find themselves on either side of cases like these. Had Ocampo been more familiar or well-versed in mental health issues, Burkhard speculates the outcome could have been different in this case. "I think, had this judge had some of that training," Burkhard says, "he might have known that psychosis waxes and wanes. Or that maybe she came out of it in a moment and locked the door. Or that she was still delusional."
For now, however, Allen has filed an appeal he hopes will lead to a new trial for Coronado. Burkhard, for her part, has vowed to show her support. "I will be at the appeal personally. I will make sure I'm there."
With Burkhard, 2020 Mom, and other activists for maternal mental health on board, the goal is ultimately to have Coronado placed in a mental hospital, as Andrea Yates and Dena Schlosser were in Texas. But even with an ideal outcome, the fact remains that the current healthcare and legal systems will continue to fail new mothers and their children if they do not recognize the reality of maternal mental health issues.
"It's unfortunate that it takes something like this to even have that be acknowledged," Allen concludes, "but we're trying to use it make positive change."