Maternal Mental Health In Crisis: What The Lindsay Clancy Case Teaches Us
The ongoing trial of Lindsay Clancy has brought the topic of maternal mental health to the national stage. Clancy is accused of killing her three children — Cora (5), Dawson (3), and Callan (8 months) — on January 24, 2023. She then attempted suicide and is now paralyzed from the waist down due to injuries she sustained from this incident.
From September 2022 to January 2023, Clancy actively sought treatment for her deteriorating mental health. She had appointments with experts in treating maternal mental health conditions; she went to the emergency room twice; she sought inpatient care at general and specialized psychiatric hospitals; she called a suicide hotline; and she was prescribed 13 medications over four months. According to her mother-in-law’s testimony, Clancy was “begging for help.”
Clancy was suffering from and actively seeking treatment for mental illness while in the trenches of early motherhood. She was navigating the complex mental health system — identifying mental health providers, making appointments, remembering to take medications and track side effects — while also managing the daily duties of parenting three young children and running a home. Her diary entries and conversations with friends and family show that she was sleep-deprived, anxious and overwhelmed, worried about returning to work, and experiencing intrusive thoughts about her children being harmed.
Clancy is white and well educated; she was married and worked in healthcare as a labor and delivery nurse; she lives in Massachusetts, a state widely considered a leader in implementing maternal mental health policies and programs. These factors make her less likely than women of color to fall through the cracks of our fragmented maternal healthcare system, and yet she did — leaving all of us with a collective pit in our stomachs as we reckon with just how broken the system is.
Sadly, this is not the first time such a crisis has caught the public’s attention. A similar event occurred in 2001, when Andrea Yates drowned all 5 of her children in a bathtub, and our nation learned about the deadly illness called postpartum psychosis. Yates was eventually found not guilty by reason of insanity, and she remains in a state mental health hospital. Both the Yates case in 2001 and the Clancy case today raise important questions: How could these tragedies happen? Why hasn’t the system changed in the last 25 years? How can we make sure this never happens again?
In the United States, mental health conditions are the most common complication of pregnancy and childbirth, affecting at least 1 in 5 pregnant or postpartum women. According to the U.S. Centers for Disease Control and Prevention, mental health conditions (including suicide and accidental overdose) are the leading cause of death for pregnant and postpartum women, accounting for 28% of pregnancy-related deaths.
These dismal statistics and these horrible tragedies call for a coordinated and comprehensive approach to addressing maternal mental health. We must do better, and we offer the following opportunities for action.
1: Integrate Maternal Mental Health Into Obstetric Care
All pregnant and postpartum parents should be educated about mental health conditions and provided resources for recovery. These individuals interact with a healthcare provider an average of 25 times during the two-year perinatal period — which includes pregnancy, delivery, and the first year of the baby’s life — offering many opportunities during standard, routine appointments for conversations about mental health.
Providers should not wait until a new parent is experiencing clinical anxiety or depression to offer assistance. Effective prevention means patients should have information and resources before they need them. However, healthcare providers often cite a lack of time to address maternal mental health and a lack of resources for those impacted. Addressing these concerns requires a multi-pronged approach.
First, providers need to have an easy way to raise awareness about maternal mental health conditions and share resources with their patients. Here is a simple script healthcare providers can use during short, routine appointments: “Mental health conditions are the most common complication of pregnancy and childbirth, impacting 1 in 5 pregnant or postpartum people. These conditions are not your fault, and they do not make you a bad person. I’m going to ask you each time I see you how you are doing. If you need help, you can reach out to me, and you can also contact the National Maternal Mental Health Hotline (1-833-TLC-MAMA) and Postpartum Support International at postpartum.net.”
Second, healthcare providers need more time to have meaningful conversations with their patients and to provide comprehensive, compassionate, patient-centered care. Routine obstetric appointments are usually just 10-15 minutes — not nearly enough time to address all the complex physical and mental health changes a pregnant person is experiencing. Our healthcare system must prioritize thorough, thoughtful care over patient volume and short-term savings.
Third, both providers and patients need easier access to mental health care. This can include embedding mental health care providers within obstetric practices, having real-time mental health consultation through psychiatry access programs, or making warm hand-offs to mental health providers within a hospital, health system, or community setting.
2: Educate Healthcare Providers About Maternal Mental Health
Education about maternal mental health is not standard or mandatory in medical school or nursing programs. Even psychiatrists are not universally trained to treat maternal mental health conditions. As a result, pregnant or postpartum patients who need mental health care or psychiatric medication can bounce from obstetrician to psychiatrist and back again.
Fortunately, there are many educational resources focused on maternal mental health. The National Curriculum in Reproductive Psychiatry offers several courses specifically for obstetric and psychiatric providers. Postpartum Support International hosts a variety of training opportunities, ranging from a free one-hour webinar to intensive 2-day programs. Maternal Mental Health Leadership Alliance maintains a database of over 200 trainings in maternal mental health and related topics, as well as a list of maternal and mental health conferences.
However, despite the many learning opportunities available, providers should not have to self-educate by choosing electives, joining affinity groups, or attending conferences. To achieve a scalable and long-term solution, maternal mental health education should be built into the systems that educate and support healthcare professionals. Medical, nursing, social work, and other health and mental health professional curricula should include foundational education on maternal mental health; professional organizations should require and offer continuing education on the topic; and hospitals, clinics, practices, and insurance companies should provide time and incentives for ongoing training.
3: Provide Postpartum Care Coordination
Giving birth is a major medical event, yet our healthcare system’s approach to postpartum care does not account for the full year of potential risk that follows pregnancy. Although more than one-third of pregnancy-related deaths occur between 6 weeks and a full year postpartum, current recommendations focus postpartum care primarily within the first 12 weeks — leaving a majority of the postpartum timeframe lacking standardized care.
A better approach would be for every patient to have a care coordinator who checks in regularly throughout the first year postpartum and supports the mental and physical health of mother and baby. Coordinators could identify concerns early and connect families to healthcare providers, therapists, support groups, doulas, lactation consultants, peer support specialists, home visiting programs, and other resources. Regular check-ins could also help new mothers feel more supported and less alone.
Care coordination is not new to obstetric care. For example, North Carolina Medicaid uses care managers to coordinate care for pregnant patients who are at risk for adverse birth and health outcomes, including gestational diabetes. Gestational diabetes affects less than 10% of pregnancies, yet virtually all pregnant patients are screened for it. Meanwhile, mental health conditions impact 20% of pregnant or postpartum patients, but maternal mental health screening rates remain strikingly low, ranging from 4% to 13% across Medicaid and commercial insurance plans. If we can screen and coordinate care for a condition affecting fewer than 10% of pregnancies, we can and should do the same for mental health conditions.
Hospital systems, insurers, and clinical practices should invest in year-long postpartum care coordination to help patients identify and address mental and physical health conditions earlier, connect patients to appropriate care and support, reduce preventable complications and costs, expand provider capacity, improve outcomes, and save lives.
4: Improve Protocols for Addressing Suicidal Thoughts
The Clancy case also raises important questions about how healthcare systems assess and respond when someone experiences suicidal thoughts. When Clancy called a suicide hotline, she was reportedly told she was not eligible for a higher level of care because she did not have a written suicide plan.
This tragedy should push all professional healthcare organizations to review, update, and reinforce protocols for addressing suicidal thoughts to ensure patients receive care until they are stable and are no longer experiencing acute suicidal thoughts. When a patient reports suicidal or self-harm thoughts, they should receive an immediate assessment of the severity and urgency of the risk, followed by care that matches their needs. Having a written suicide plan should not be the sole factor in determining the level of care someone receives.
5: Implement National Paid Family and Medical Leave
Maternal mental health is shaped not only by access to healthcare, but also by the conditions in which people recover and care for a new baby, which is why paid leave is so important. While Clancy was on leave from her job as a labor and delivery nurse during the postpartum period, sources have stated that she was feeling concerned about returning to work.
In the United States, approximately 1 in 4 mothers return to work within a few weeks of giving birth due to financial pressures and a lack of fully paid and accessible parental leave that gives parents enough time to recover and adjust during the postpartum period. The United States is the only wealthy country in the world without a national paid parental leave mandate. Even in states where paid family leave is considered robust, the program can be difficult to find, apply for, and use.
Research shows that when parents use paid parental leave for at least 2 to 3 months, their mental health is protected, postpartum depressive symptoms are reduced, psychological distress is lowered, and the financial and physical burdens of early childcare are lightened.
Congress has debated paid family leave for decades, with cost being a major roadblock. However, we are already paying a price: untreated maternal mental health conditions cost our nation $14 billion every year in healthcare costs and loss of productivity. This data is from 2017, so the cost today is likely even higher. Investing in paid parental leave could reduce and possibly prevent mental health conditions among new parents, promote positive mother-infant health outcomes, strengthen families and communities, and save dollars in downstream healthcare costs.
Congress should prioritize passing national paid family and medical leave so that new parents can recover from the physical and emotional demands of pregnancy, labor, and delivery, and adjust to life with a newborn. Organizations such as MomsRising, Chamber of Mothers, and A Better Balance advocate for paid leave, and individuals can contact A Better Balance’s free legal helpline to learn if they are eligible for parental leave where they live.
***
The Clancy case is a wake-up call for our country. We must invest in sustained, systemic change to ensure no other family suffers this kind of tragedy.
We call upon elected officials, healthcare leaders, insurers, and all who support new and expectant parents to make maternal mental health a priority. No parent should have to navigate a fragmented system alone, especially during a mental health crisis. Our nation’s mothers and babies are depending on us to do better.
Do you or someone you know need maternal mental health care? Call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA or contact Postpartum Support International at postpartum.net.
STAY IN TOUCH
