Otty Sanchez got two weeks in a state mental hospital after she was found wandering around a drug store last year, shopping for an imaginary trip to China.
She got a few hours in an emergency room, then a ride home, in July as a new mom hearing dark voices.
Three-week-old Scott Wesley Buchholz-Sanchez was dead six days later, decapitated and missing fingers and toes, while police say his mother wailed about how the devil made her do it. A judge ruled Thursday that a jury will decide whether Sanchez is mentally competent to stand trial after Sanchez's attorney said her mental condition is worsening.
"In addition to her psychotic condition, her schizophrenic condition and her postpartum psychotic condition, she may also be affected by post-traumatic stress disorder," Ed Camara, Sanchez's attorney, told the court.
Sanchez, 33, is charged with capital murder in the death of her son. His father said Sanchez should "burn in hell" and deserves the death penalty for dismembering their only child. He watched quietly as Sanchez shuffled into court with her head down, wearing glasses and her black hair cropped short.
Two psychiatric evaluations concluded Sanchez was competent to stand trial, but Camara said he received a medical report Tuesday that was more bleak. A date was not immediately set for a jury to settle the issue.
The autopsy report spells out the attack in nauseating detail: mutilated genitals, the head nearly decapitated and the skin flayed. Authorities said Sanchez ate parts of her son, including the brain, and medical examiners found apparent bite marks across the body.
Sanchez's sister made the horrifying discovery before sunrise, and Otty can be heard screaming, "I didn't mean to do it! He told me to!" while her sister pleads for an ambulance in a desperate 911 call. Sanchez later wailed to her sister that she thought everyone was dead.
Bexar County prosecutor Yvonne Gonzalez has said her office would seek the death penalty on the legal presumption that Sanchez was sane. Although prosecutors were still gathering medical records, she said there were signs Sanchez had been "functioning quite well," including holding down a job for several years.
"We're not really sure she had a long history of mental illness," Gonzalez said earlier in the week.
Scott Buccholz, the baby's father and a self-described schizophrenic, insisted that Sanchez had appeared fine and gave no hint of a severe mental illness.
An estimated one in 1,000 women are afflicted with postpartum psychosis. Unlike postpartum depression, which occurs in as many as one in five new mothers, women with postpartum psychosis can suffer dangerous delusions and desires to hurt their child.
The same illness tormented Andrea Yates, the suburban Houston mother who drowned her five children in a bathtub in 2001, and Dena Schlosser, another Texas mother who cut off her baby's arms in 2004, according to the women's attorneys.
Doctors say the risk of developing postpartum psychosis is 50 percent or higher for women with schizophrenia who are not taking medication. Camara says Sanchez fits the bill: although Sanchez was prescribed the antidepressant citalopram after giving birth, she only took it once _ the day before her son was killed. Such drugs take weeks to begin working.
It was one of a handful of times that Sanchez appeared to try reining in her mental illness.
She wound up shuffling around an Austin drug store for eight hours last summer, Camara said, only after going to the city with a friend who said an acupuncturist there could help her mental problems.
A week before the killing, Camara said an ambulance rushed Sanchez to a hospital from a counseling center where she had made an appointment because she was feeling depressed and having hallucinations.
Advocates say resources for indigent women with mental disorders are sparse in Texas, which is ranked 49th in per capita mental health expenditures, according to the National Alliance on Mental Illness.
At the Center for Health Care Services in San Antonio, where Camara said Sanchez was referred for outpatient treatment, about 2,000 more people are served each year than the state pays for, CHCS President Leon Evans said.
State mental hospitals are no less overwhelmed.
"My job here is to get people out, bottom line," said Dr. David Gonzalez, a psychiatrist at the San Antonio State Hospital. "They have hired me to treat people so I can get them out of the hospital. I'm here to keep people out."
Recently, Camara said, music coming from a jailhouse speaker triggered Sanchez into a flashback of the night her son died. The hallucinations returned, Camara said, and Sanchez called over a guard for help.
A jailer handed Sanchez some more medication. She calmed down.
"If only that had been available to her that evening," Camara said.
(This version CORRECTS that Sanchez was in hospital for two weeks.)