The Lindsay Clancy Trial and the Urgent Need to Take Postpartum Mental Health Seriously
The trial of Lindsay Clancy is unbearably tragic. Three children, Cora, Dawson, and Callan, lost their lives. Their mother, Lindsay Clancy, survived a suicide attempt that left her paralyzed. A husband and father lost his children and the family life he knew. An entire family has been destroyed.
Any conversation about this case must begin there. Talking about postpartum mental illness cannot and should not minimize the magnitude of these children's deaths or the suffering of the people who loved them.
At the same time, the Lindsay Clancy trial has brought desperately needed attention to postpartum depression, postpartum psychosis, and the ways our mental health and medical systems respond to mothers who are becoming psychiatrically unwell after childbirth. The legal question of Clancy's mental state and criminal responsibility belongs to the jury. Her defense has argued that she was experiencing postpartum psychosis, while prosecution experts have challenged that conclusion. We cannot diagnose a person we have never evaluated, nor should a criminal trial be reduced to a referendum on a psychiatric diagnosis.
But we can ask a different question: how do we build a system in which a new mother can become seriously psychiatrically ill without her, her children, and her family falling through the cracks?
Postpartum Depression and Psychosis Are Not Simply "The Baby Blues"
We have made progress in talking about postpartum depression. Most new parents are now at least somewhat familiar with the idea that depression and anxiety can occur after childbirth. But increased awareness has not always translated into a sophisticated understanding of what postpartum mental illness can look like, or into systems capable of responding when symptoms become severe.
Postpartum depression can include persistent sadness, hopelessness, intense anxiety, irritability, guilt, difficulty bonding with the baby, loss of pleasure, difficulty functioning, and thoughts of death or suicide. These symptoms are different from the temporary emotional fluctuations commonly called the "baby blues." They deserve assessment and treatment, not reassurance that exhaustion, hormones, and distress are simply part of becoming a mother. The pressure to seem fine is often intensified by the conflicting expectations placed on new parents, which makes honest disclosure harder rather than easier.
Postpartum psychosis is different. It is rare, affecting approximately 1 to 2 out of every 1,000 people who give birth, and it is a psychiatric emergency. A woman experiencing postpartum psychosis may develop hallucinations, delusions, paranoia, severe confusion, disorganized thinking, dramatic changes in mood or behavior, or an extreme disruption in sleep. She may begin making connections that do not make sense to the people around her or develop beliefs about herself, her baby, religion, danger, death, or the world that are not grounded in reality.
Crucially, someone experiencing psychosis may not understand that she is ill. That means we cannot build a maternal mental health system that depends entirely on a mother recognizing her own deterioration, accurately describing it, finding the right professional, making an appointment, and advocating for the level of care she needs.
Sometimes the very illness for which she needs help makes those tasks impossible.
When a New Mother Says Something Is Wrong, We Need to Listen
One of the most important lessons families and professionals can take from this national conversation is remarkably simple: when a new mother says she is not okay, take her seriously.
We should not assume that profound distress is inevitable because motherhood is difficult. We should not reassure someone out of seeking care. And we should not conclude that a woman cannot be seriously ill because she is still feeding her baby, caring for other children, going to work, exercising, smiling in photographs, or appearing composed during a brief appointment.
Mental illness does not always look like incapacitation.
We also need to listen to the people who know a new mother best. A partner may notice that she has barely slept for several nights. A parent may hear something frightening or unusual in a phone call. A sibling may notice that her thinking has become rigid, paranoid, confused, or simply unlike her. A friend may recognize that the person sending messages in the middle of the night does not sound like the person she knows. Those observations provide important clinical information.
Privacy and confidentiality are essential components of mental health treatment, but confidentiality should never be confused with refusing to listen to concerned family members. There may be limits on what a clinician can disclose to a spouse or parent without appropriate authorization. That does not mean the clinician cannot receive information from someone who is reporting a dramatic behavioral change or serious safety concern. This distinction becomes particularly important when treating illnesses that can impair insight.
We Need to Ask Better Questions
Screening for postpartum depression is important, and professional organizations including the American College of Obstetricians and Gynecologists (ACOG) recommend screening for depression and anxiety during pregnancy and the postpartum period. But handing a mother a questionnaire is not, by itself, adequate maternal mental health care.
Clinicians working with pregnant and postpartum patients need to think beyond depression. We need to ask about anxiety, suicidal thinking, psychotic symptoms, mania, previous episodes of psychiatric illness, family psychiatric history, medication changes, functioning, and sleep. Screening for bipolar disorder is particularly important because symptoms of bipolar disorder can emerge or worsen during the perinatal period, and treatment decisions can be affected significantly by an underlying bipolar disorder.
We also need to become comfortable asking questions that can feel frightening to ask. Are you hearing or seeing things that other people don't? Are you having thoughts that scare you? Do you believe someone or something is sending you messages? Do you believe your baby is in danger in a way that other people don't understand? Have you thought about dying? Have you thought about hurting yourself? Have you had thoughts about harming your baby or another child? How much are you actually sleeping? Does your partner think you are behaving differently?
Asking these questions does not put dangerous ideas into someone's mind. It gives an ill or frightened person an opportunity to tell us what is happening.
It is also important for clinicians to distinguish intrusive thoughts from psychosis. Unwanted, frightening thoughts about harm can occur in postpartum anxiety and obsessive-compulsive disorder, and a mother may be horrified by those thoughts and have no desire or intention to act on them. Psychotic beliefs and commands are different. Careful assessment matters because frightening thoughts do not all mean the same thing, and women should be able to disclose them without automatically fearing that someone will take away their baby. When intrusive thoughts are the primary concern, targeted strategies for calming anxious thinking are usually part of the treatment plan rather than a psychiatric emergency response.
Sleep Deserves Much More Attention Than It Gets
Sleep deprivation is often treated almost humorously as an unavoidable rite of passage for new parents. In maternal mental health care, however, sleep can be clinically significant.
There is an important difference between a mother who cannot sleep because her newborn wakes every two hours and a mother who cannot sleep even when someone else is caring for the baby. If a postpartum woman is sleeping very little and simultaneously becoming increasingly energized, agitated, confused, fearful, paranoid, or unusual in her thinking, that combination deserves immediate attention.
For women at increased risk of serious postpartum psychiatric illness, protecting sleep may need to be part of the treatment plan rather than simply a lifestyle recommendation. This is one of the many places where partners and extended family can play a meaningful role. Caring for a new mother sometimes means taking over a feeding, arranging overnight support, noticing changes that she cannot see herself, and insisting on an evaluation when something feels profoundly wrong. Extended family often carry more of this weight than gets acknowledged, and balancing the emotional and practical demands of caregiving deserves its own attention.
The Problem Is Not Simply That We Need More Screening
Perhaps the most important lesson is that screening without a functioning system behind it is not enough.
A postpartum mother may interact with an obstetrician, pediatrician, primary care physician, therapist, psychiatrist, emergency department, urgent care center, lactation consultant, and other health professionals. Yet these providers may know very little about what the others are seeing or doing. One professional may prescribe medication. Another may hear about suicidal thoughts. A family member may observe bizarre behavior at home. An emergency department may determine that the patient does not meet criteria for admission at one particular moment. Everyone may possess one piece of the picture while no one is responsible for putting the entire picture together.
That fragmentation is dangerous.
A mother can be screened without receiving timely treatment. She can receive treatment without adequate follow-up. Medications can be changed without sufficient monitoring. Family members can become increasingly frightened without knowing whom to call. And a woman whose judgment is being compromised by psychiatric illness can become the person expected to coordinate her own increasingly complicated care.
We would not design treatment for another life-threatening medical condition this way.
Maternal mental health care needs continuity. When symptoms are escalating, someone needs to know the whole story. Providers need to communicate with each other regularly. Families need clear instructions about warning signs and what constitutes an emergency. Psychiatric evaluation needs to be available quickly when psychosis, mania, suicidality, or severe deterioration is suspected. And when a patient transitions from one level of care to another, there needs to be meaningful follow-up rather than an assumption that someone else is handling it.
Families Should Be Part of the Safety Plan Before There Is a Crisis
During pregnancy or early in the postpartum period, clinicians can ask women whom they trust and who knows them well. Who would notice if you stopped seeming like yourself? Who should we contact if we become seriously concerned about you? If you have experienced depression, anxiety, mania, psychosis, or another significant psychiatric episode before, what did the beginning of that episode look like? What would you want your partner or family to do if you became too ill to recognize that you needed help?
These conversations are easier to have when someone is well.
Families also need straightforward education about what constitutes an emergency. Hallucinations, delusions, severe confusion, bizarre or paranoid beliefs, prolonged inability to sleep accompanied by unusual energy or agitation, suicidal intent, or thoughts of harming a child in the context of losing touch with reality require urgent psychiatric evaluation. In those situations, families should not worry about embarrassing someone, damaging the relationship, or "overreacting." Safety has to come first.
At the same time, we need to create a culture in which mothers can talk honestly about less acute symptoms without fearing judgment. If every disclosure of a frightening intrusive thought is treated as evidence that a mother is dangerous, women will understandably stop telling us what they are experiencing. Good maternal mental health care requires both vigilance and clinical sophistication.
Building that culture starts long before crisis. The early postpartum period is also when partners and extended family are laying down patterns of how the family will function under stress, and helping families build resilience together is part of what makes disclosure and support possible when it matters most.
What We Owe New Mothers and Their Families
The Lindsay Clancy case is not a story that should be reduced to whether one person is a monster or a victim. That framing is too simple for a tragedy of this magnitude.
Three children died. Their mother is permanently physically disabled. Their father has endured an unimaginable loss. Whatever the legal outcome of the trial, there is no verdict that can restore this family.
But tragedies should make us examine the systems surrounding them.
We need a maternal mental health system that identifies risk during pregnancy, screens repeatedly after childbirth, recognizes postpartum psychosis and mania as emergencies, takes dramatic sleep disturbance seriously, listens to family members, distinguishes intrusive thoughts from psychotic symptoms, provides rapid access to psychiatric care, coordinates treatment across providers, and follows women closely when symptoms or medications are changing.
Most importantly, we need to stop placing the burden of navigating that system entirely on mothers, particularly mothers who may be becoming too ill to recognize how much help they need.
Postpartum depression is treatable. Postpartum psychosis is treatable. Women can and do recover from serious perinatal mental illness.
But treatment only works when people can access it, when professionals recognize what they are seeing, and when the system responds with the urgency that the situation requires.
Caring for babies means caring for their mothers. And when a new mother is telling us, through her words, her behavior, or the observations of the people who love her, that something is seriously wrong, we have an obligation to listen.
How IMPACT Supports Perinatal Mental Health
At IMPACT Psychological Services, perinatal mental health is one of our clinical specialties. We work with pregnant and postpartum patients, their partners, and their families in individual therapy, couples therapy, and parent coaching, and we can help coordinate care with obstetric and psychiatric providers when a fuller team is needed. For new mothers who want the recognition of shared experience, our support group for new moms is a place to talk honestly with other women navigating the same season, and our clinicians also write and think about the emotional dimensions of the early postpartum period, including bonding with a new infant and finding peace in parenthood.
If you are pregnant, recently postpartum, or supporting someone who is, and something feels off, even if you cannot yet name it, reach out to our team. You do not need to wait until a situation becomes catastrophic, and you do not need to arrive with a diagnosis. We can help you figure out what you are looking at and what the next step should be.
If You Are Concerned About a New Mother
If a postpartum person appears to be losing touch with reality, experiencing hallucinations or delusions, becoming severely confused or agitated, expressing suicidal intent, or presenting an immediate risk of harm to herself or someone else, seek emergency medical care immediately.
In the United States, you can call or text 988 to reach the Suicide & Crisis Lifeline. The National Maternal Mental Health Hotline is available 24 hours a day by calling or texting 1-833-TLC-MAMA (1-833-852-6262). Most urban and suburban communities also have a mobile response team that families can connect with for immediate support. Often the best option is to go to a local psychiatric emergency room. When you arrive, family members should ask to speak privately with the evaluating providers and clearly describe what they have observed, including changes in behavior, sleep, thinking, beliefs, or statements that have raised concern. A person experiencing psychosis may not be able to accurately recognize or report the severity of their symptoms because of impaired insight, and they may also minimize or withhold symptoms out of fear, confusion, or concern about being judged.
If symptoms are concerning but not an immediate emergency, contact a qualified mental health professional, obstetric provider, or primary care provider for an evaluation. Families do not need to wait until a situation becomes catastrophic before asking for help.
At IMPACT, we are committed to supporting your mental health and well-being. Our experienced team of professionals are here to help you navigate life's challenges and achieve your goals. If you found this blog helpful and are interested in learning more about how we can assist you on your journey, please don't hesitate to reach out. Take the first step towards a healthier, happier you. Contact us today to schedule a consultation.
