Massachusetts Murder Trial Spotlights Failures of Health Care System in Treating New Mothers

Lindsay Clancy does not dispute that she strangled her three young children — Cora, 5; Dawson, 3; and Callan, 8 months — with exercise bands inside the family’s home on January 24, 2023, then cut her wrists and neck and jumped from a second-floor window in an apparent suicide attempt that she survived.Tragically, Ms. Clancy is not the only mother whose mind has turned on her this way, and the numbers behind that fact are getting harder to ignore. What a Plymouth County jury must now decide, three weeks into her murder trial at Plymouth Superior Court, is whether she was too consumed by postpartum psychosis to understand what she was doing and why, in case after case, doctors keep missing it until it is too late.The BackstoryPostpartum psychosis is a rare but severe psychiatric emergency, historically estimated to strike one to two out of every 1,000 new mothers, marked by hallucinations, delusions and a break from reality that can develop within days of childbirth. That is a different, far more dangerous condition than postpartum depression, which is common, affecting as many as one in seven new mothers, and typically presents as persistent sadness or anxiety rather than a loss of touch with reality.A national analysis of more than 12.3 million U.S. deliveries between 2016 and 2019 found that hospital readmissions for postpartum psychosis within 60 days of giving birth rose significantly over those four years, even as overall diagnosis rates stayed under 2 per 1,000 births.Yet, some clinicians warn the numbers on psychosis undercount what they are actually seeing.A perinatal psychiatrist who directs the Massachusetts Child Psychiatry Access Program, Dr. Uruj Kamal Haider, wrote in a recent essay that during one eight-week stretch, 6 percent of her postpartum patients met the criteria for a psychotic disorder, a rate she called “almost six times higher than rates published in the medical literature.”Roughly half of women who develop the illness, Dr. Haider noted, have no prior psychiatric history at all.Whether that reflects a true rise in cases or simply sharper detection is still debated. What is not in dispute is how often the illness goes unrecognized until a family is already in crisis.Testimony this month has centered on the roughly 30 prescriptions for more than a dozen psychiatric medications Ms. Clancy received from at least six providers in the four months before the deaths — a fragmented paper trail that has become the trial’s central exhibit.Her primary psychiatrist, Dr. Jennifer Tufts, spent two days on the stand facing cross-examination over the medications she testified to prescribing, telling jurors she wrote close to half of Ms. Clancy’s prescriptions even though she had never before treated a case of postpartum psychosis and did not observe signs of it herself.A psychiatric nurse practitioner at South Shore Health, Rebecca Jollotta, testified this week that Ms. Clancy repeatedly asked to change her medications, complaining of insomnia and intrusive thoughts. She told the court she had had no concerns that Ms. Clancy had postpartum psychosis.Nineteen days before the killings, doctors sent Ms. Clancy home after five days at McLean Hospital. The psychiatrist who treated her there testified she never once saw signs of psychosis and had judged Ms. Clancy a low-level risk.Under cross-examination, Ms. Jollotta acknowledged that Ms. Clancy’s denial of feeling tired despite going without sleep was itself a warning sign doctors watch for.“It’s a symptom of mania that we look for,” she confirmed.Ms. Clancy’s case is not the outlier it might seem. It’s a sharper version of something that keeps playing out in courtrooms across the country, where the same illness slips past one provider after another before anyone catches it.Take Krista Brunecz. The West Virginia mother was found not guilty by reason of insanity after fatally stabbing her 3-month-old daughter in December 2022. She’d seen a doctor just the day before and walked out with a prescription for depression and anxiety — while, her family says, she was hearing voices and hadn’t slept in days. Nobody diagnosed it as postpartum psychosis until after her daughter was dead.Only one state, Illinois, has a law allowing undiagnosed or untreated postpartum psychosis to serve as a mitigating factor at sentencing, meaning in nearly every other state, a missed diagnosis offers a mother no legal shelter at all. That is what has drawn psychiatrists, researchers and advocates to watch the Clancy trial so closely. A conviction would affirm that even a woman drowning in documented psychiatric symptoms can still be held fully responsible for killing her children; a finding of not guilty by reason of insanity would mark one of the most closely watched tests yet of whether the American legal system is capable of treating postpartum psychosis as the medical emergency doctors say it is, rather than as a crime.Either outcome is likely to shape how prosecutors, judges and legislators in other states handle the next mother who walks into an emergency room saying she can no longer trust her own mind.The Prescription CascadeSo many providers participated in Ms. Clancy’s care, yet not one flagged postpartum psychosis. That, specialists say, is exactly why her case is worth studying. Hand a patient off from doctor to doctor, and the diagnosis gets harder to pin down, not easier — especially with an illness that can look completely different from one hour to the next.“It certainly can for any psychiatric condition, when you see someone who was started on a psychiatric medication a couple of weeks ago, you don’t know how they presented a couple of weeks ago and if what they are presenting with now is a side effect or a core symptom of their mental illness,” a professor and vice chair of research in psychiatry and neurobehavioral sciences at the University of Virginia, Jennifer Payne, tells The New York Sun.Dr. Payne, who is also developing a blood test meant to predict which pregnant women face high risk of postpartum depression, says the illness typically presents through three overlapping symptom clusters: mood swings ranging from mania to depression or a mix of both; hallucinations or delusions; and a delirium-like disorganization that causes the illness to wax and wane.A mother can appear gravely ill one hour and largely composed the next, she explains, which means the timing of an evaluation can make or break an accurate diagnosis. Women experiencing it, Dr. Payne explains, often describe the confusion simply as “brain fog” or difficulty “getting it together,” a presentation subtle enough that it can slip past a clinician looking for more obvious mania or psychosis.Experts Divided on a DiagnosisExperts do not unanimously agree on whether Ms. Clancy’s symptoms add up to a textbook case of postpartum psychosis. They do agree on this: Once the illness takes hold, it can spiral fast.“Postpartum psychosis tends to come on much more quickly than other mental illnesses, and often presents fulminantly,” a professor of psychiatry, reproductive biology and pediatrics at Case Western Reserve University, Susan Hatters Friedman, tells the Sun. She contrasts it with schizophrenia, a more familiar form of psychosis whose onset typically unfolds over months rather than days.Dr. Hatters Friedman notes that the terror of experiencing such symptoms as a new mother, combined with the stigma attached to any postpartum mental health struggle and a fear that admitting to symptoms could cost a mother custody of her baby, creates powerful incentives for women to hide what they are going through rather than report it.Women who survive one episode, research shows, face a significantly elevated risk of recurrence in future pregnancies without close monitoring and preventive treatment.An adverse reaction to antidepressants prescribed by multiple providers should, by this account, actually make a diagnosis easier to reach rather than harder, since it is a telltale sign the that underlying illness is bipolar-related.“Lithium is a very effective treatment; 98 percent of patients get completely better,” a professor in the department of psychiatry at the Icahn School of Medicine at Mount Sinai, Veerle Bergink, tells the Sun. She notes that electroconvulsive therapy also works well and that almost all patients improve within weeks.The capacity to deliver that care, however, barely exists in America, Dr. Bergink stresses.“The US system does not support women with severe mental illness postpartum,” she says, noting there are only a handful of day treatment programs nationwide and no facilities where a mother and her baby can stay together overnight during psychiatric care, unlike in Britain, Australia, Western Europe and India.Britain runs roughly 21 dedicated mother-baby psychiatric units for about 600,000 births a year. America has five inpatient perinatal psychiatric units total — none of which let a baby stay overnight with its mother — leaving 45 states without a single specialized bed, according to the national directory kept by Postpartum Support International.Why the Numbers Appear to be RisingWhether America is actually seeing more cases of postpartum psychosis, or simply hearing about more of them, depends on whom you ask.“Some of it is visibility. Cases like Lindsay’s get national attention now in a way they didn’t a decade ago, and that makes it feel like a new phenomenon when it isn’t,” the founder and chief executive of the advocacy group Moms First, Reshma Saujani, tells the Sun.She points out that the underlying incidence rate, which affects roughly 7,000 American women a year, about half of whom have no prior psychiatric history at all, has held fairly steady. What has changed, she argues, is the pressure surrounding it.“Mothers are doing this with no paid leave, no affordable childcare, and no support system to fall back on, and that isolation and financial strain make an already dangerous condition even harder to catch early,” Ms. Saujani says.Dr. Payne points to other unaddressed issues.“I think there are two big gaps. One in the US medical system, and that is education regarding psychiatric illness during the peripartum time period. We can do a much better job of educating both psychiatrists and OB-GYNs on how to manage psychiatric illnesses during the peripartum,” she says.The second gap, Dr. Payne continues, is scientific. In simple terms, doctors still don’t know enough about what causes postpartum psychosis in the body to catch it with a test or treat it before it turns into a crisis.“We need more research that is aimed at discovering the underlying biological vulnerabilities to psychiatric illness to move psychiatric towards precision medicine,” Dr. Payne says.A System With Too Few SafeguardsAccording to Ms. Saujani, the gap in postpartum follow-up care extends well beyond hospitals and specialty psychiatric units.The standard screening tool used in many hospitals dates to 1987, she observes, and is administered only about 30 percent of the time. It is followed by little more than a six-week checkup lasting roughly half an hour, leaving new mothers largely unmonitored in between.“Screening is treated as a box to check, not a relationship to build,” she continues.Ms. Saujani also points to the absence of guaranteed paid family leave as the single policy change she believes would matter most, giving mothers “the time and stability to get diagnosed and treated” instead of returning to work while still unraveling.“Every other wealthy nation treats this as non-negotiable,” she adds. “We don’t, and mothers are paying for that gap with their lives and their children’s lives.”

Massachusetts Murder Trial Spotlights Failures of Health Care System in Treating New Mothers

Massachusetts Murder Trial Spotlights Failures of Health Care System in Treating New Mothers

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