By admin 
The tragic case of Lindsay Clancy, the Duxbury, Massachusetts, mother accused of killing her three young children in January 2023, has become a flashpoint for a national conversation on the intersection of maternal mental health and the criminal justice system. As the case moves through the courts and captures the attention of the public, much of the discourse has focused on the perceived systemic failures of the American mental health infrastructure. Advocates and observers hope that the scrutiny surrounding this tragedy will finally catalyze a much-needed overhaul of how we approach perinatal and postpartum psychiatric care. However, as forensic and reproductive psychiatrists deeply embedded in this field, we believe there is a darker, unintended consequence looming on the horizon: the intense legal and public condemnation of Clancy’s medical providers could inadvertently decimate the already fragile network of clinicians willing to treat mothers with severe mental illness.
The reality of maternal mental health care in the United States is one of scarcity and immense pressure. While we agree that the current system is far from perfect, we are increasingly concerned that the fallout from the Clancy case will drive general psychiatrists and obstetricians away from treating high-risk patients. When medical decision-making is analyzed through the lens of a criminal trial and a subsequent civil lawsuit, the result is often "defensive medicine"—a practice where physicians prioritize liability avoidance over patient-centered care. In an ideal healthcare landscape, every mother experiencing psychiatric symptoms would have immediate access to a reproductive psychiatrist. These specialists possess advanced training in the complex interplay of hormones, pregnancy, and psychotropic medications. Yet, the reality is stark: there are only approximately 500 practicing reproductive psychiatrists in the entire United States to serve a population that sees nearly 3.6 million births annually.
Because of this massive specialist shortage, the burden of care falls primarily on general psychiatrists and OB-GYNs. These frontline providers are the backbone of perinatal mental health, but they do not have the luxury of a dedicated subspecialty focus. They must balance the risks of untreated mental illness against the potential side effects of medications, often while navigating a healthcare system that provides little time for the intensive monitoring these patients require. The Clancy case, which has seen the defense and the media scrutinize every telehealth visit and every medication adjustment, sends a chilling message to these providers. If a physician’s efforts to manage a complex, evolving psychiatric crisis can result in public vilification or career-ending litigation, many may simply choose to stop accepting "high-risk" maternal patients altogether.
The legal proceedings in the Clancy case have been particularly focused on the medical decision-making of the experts who treated her in the weeks leading up to the tragedy. The defense has alleged that Clancy was suffering from postpartum psychosis—a rare and severe medical emergency—and has criticized her treating clinicians for failing to recognize the gravity of her condition. Specifically, the defense has pointed to the use of telehealth, the frequency of medication changes, and the alleged missed diagnoses as evidence of substandard care. This line of argument creates a dangerous precedent. Telehealth, in particular, has been a lifeline for new mothers. For a woman struggling with postpartum depression or anxiety, the logistical hurdles of attending an in-person appointment—securing childcare, navigating transportation, and managing a newborn’s schedule—can be insurmountable. Virtual visits have significantly lowered the barrier to care, yet the public questioning of their validity in the Clancy case could lead clinicians to abandon this tool out of fear that it will be deemed "inherently inferior" in a courtroom.
The potential for a "chilling effect" is not merely theoretical. We have already begun to hear from psychiatric trainees and residents who express deep anxiety about their future practices. They see the Clancy case and wonder if the risk of treating a mother with intrusive thoughts or mood swings is worth the potential for a catastrophic legal outcome. If the next generation of doctors views maternal mental health as a "litigation minefield," the shortage of providers will only worsen, leaving thousands of mothers without any support at all. This is particularly concerning given that mental health conditions are among the leading causes of maternal mortality in the United States.
Beyond the risk of doctors abandoning the field, there is the equally troubling prospect of "over-correction" within the system. In a climate of fear, psychiatrists may become overly cautious, leading to the systemic overtreatment of symptoms. For example, many new mothers experience intrusive thoughts—distressing, unwanted images of harm coming to their baby—that are actually a common symptom of postpartum OCD or anxiety, not psychosis. These mothers do not typically pose a risk to their children and do not require hospitalization. However, a doctor practicing defensive medicine might see any mention of such thoughts as a liability risk and opt for immediate psychiatric hospitalization and a referral to Child Protective Services (CPS).
Such an approach is not only medically unnecessary in many cases but also deeply traumatizing. The forced separation of a mother and her infant can exacerbate depressive symptoms and disrupt the crucial bonding process. Even more dangerously, if mothers perceive that being honest about their symptoms will lead to the loss of their children or an involuntary hospital stay, they will stop reporting their symptoms altogether. When symptoms go underground, the risk of an unmonitored psychiatric crisis actually increases. The very system intended to prevent tragedy could, through its own rigidity and fear, create the conditions for one.
Postpartum psychosis is an exceptionally rare condition, occurring in approximately 1 to 2 out of every 1,000 deliveries. It is characterized by a loss of touch with reality, delusions, and hallucinations, and it is indeed a medical emergency that warrants immediate intervention and often hospitalization. However, the vast majority of perinatal mental health issues fall under the umbrella of Perinatal Mood and Anxiety Disorders (PMADs), which include depression, anxiety, and OCD. These conditions are highly treatable with the right combination of therapy and medication. The tragedy of the Clancy case should not be used to pathologize the entire experience of motherhood or to turn every struggling mother into a "high-risk" liability in the eyes of the medical community.
The best response to the Lindsay Clancy case is not to engender fear among physicians, but to provide robust awareness and education. We must empower all psychiatrists, not just specialists, with the tools to treat maternal mental illness effectively and confidently. To this end, we and dozens of our colleagues have worked to develop the National Curriculum in Reproductive Psychiatry (NCRP). This interactive, evidence-based curriculum is designed to bridge the gap between general psychiatry and subspecialty knowledge, ensuring that providers across the country have access to the latest research on medication safety and diagnostic accuracy during the perinatal period. Furthermore, we have led the creation of the American Academy of Psychiatry and the Law’s practice resource document on forensic reproductive psychiatry to help clinicians navigate the complex legal landscape of this field.
As the jury deliberates and the civil actions proceed, it is imperative that we do not lose sight of the broader healthcare ecosystem. If the legacy of the Clancy case is a world where doctors are too afraid to treat mothers, then we have failed as a society. We must advocate for a system that supports both the patient and the provider—one that prioritizes early intervention, reduces stigma, and recognizes that clinicians are often working under immense pressure with limited resources.
The alternative is a tragedy in itself: the creation of a healthcare environment defined by defensive medicine, where a mother reaching out for help is met with fear, avoidance, and abandonment. We cannot allow the quest for accountability in one case to destroy the very infrastructure that millions of women rely on for their health and the safety of their families. Education, specialized training, and a nuanced understanding of maternal mental health are the only ways forward. We must choose to build a system of care, not a system of fear.
