When Help-Seeking Isn’t Enough

What the Lindsay Clancy Case Can Teach Us About Postpartum Mental Health and the Path Forward

Content caution note: This article discusses the deaths of children, suicide, and severe postpartum mental illness.

The deaths of Cora, Dawson, and Callan Clancy are first and foremost a devastating family tragedy. Their mother, Lindsay Clancy, was charged with killing the three children in their Massachusetts home in January 2023 and attempting to end her own life.

At trial, the central dispute was not whether Clancy killed her children, but whether she could be held legally responsible for her actions. Her defense argued that she was experiencing postpartum psychosis and lacked the capacity required for criminal responsibility. Prosecution experts disputed that account and argued that she remained able to understand her actions and distinguish right from wrong.

On September 4, 2026, the jury was unable to reach a unanimous verdict, and the judge declared a mistrial. That outcome did not establish that either side’s explanation was correct.

This article does not attempt to diagnose Clancy from a distance, determine her legal responsibility, or assign blame to an individual provider. A criminal trial and a clinical assessment ask different questions, and even extensive medical records cannot completely reconstruct someone’s mental state at one particular moment.

The case does, however, raise an important question:

What happens when someone repeatedly seeks help, but the people and systems caring for her do not recognize—or cannot agree on—how serious the situation has become?

Understanding postpartum psychosis

Postpartum psychosis is a rare but serious psychiatric condition that can occur after childbirth. It is estimated to affect approximately one or two people out of every 1,000 deliveries.

Symptoms may include hallucinations, delusions, severe confusion, paranoia, unusual beliefs, agitation, rapidly changing moods, and a loss of contact with reality. The condition can worsen quickly, so suspected postpartum psychosis is considered a psychiatric emergency requiring immediate medical attention.

Postpartum psychosis is not the same as postpartum depression, anxiety, or obsessive-compulsive disorder.

Some new mothers experience frightening, unwanted thoughts about harm coming to themselves or their babies. These intrusive thoughts can be deeply upsetting, but they do not automatically mean that someone wants to act on them. A person experiencing an intrusive thought may recognize that it is unreasonable, feel horrified by it, and take protective steps.

Psychosis involves a different type of experience. A person may hear voices, hold beliefs that feel completely true despite evidence to the contrary, or believe that a harmful act is necessary or protective.

Distinguishing between these experiences can be difficult, particularly when symptoms change over time. That is why careful assessment, repeated evaluation, and communication with family members and other providers can be so important.

Why serious risk can be difficult to recognize

Mental-health appointments capture only a limited period of time. Someone may appear calm and organized during an appointment while behaving very differently at home. Symptoms may fluctuate, and a seriously ill person may minimize what is happening because of shame, fear, confusion, or limited awareness of her condition.

A mother may also fear that disclosing frightening thoughts will result in hospitalization, judgment, or separation from her children. Clinicians should respond realistically and compassionately to that fear while remaining prepared to recommend additional protection when safety concerns increase.

When the level of risk changes, clinicians should consider whether the treatment plan must also change—even when the patient may not agree with the recommendation.

Screening questionnaires can help identify depression, anxiety, or suicidal thoughts, but they cannot tell the whole story. A reassuring answer during one appointment does not erase previously reported symptoms or changes noticed by family members.

Clinicians need to examine the pattern over time. Severe sleep loss, increasing agitation, unusual behavior, suicidal thinking, confusion, repeated crisis contacts, rapid medication changes, and reports that someone is “not herself” may become more meaningful when considered together. 

Mental illness deserves the same compassion as physical illness

When a mother has a serious physical illness that temporarily prevents her from caring safely for her children, people generally understand that she needs treatment and practical support. When postpartum psychosis affects a mother’s ability to care safely for them, her disclosure may instead be met with fear, shame, or judgment.

Both situations involve a medical condition interfering with a person’s ability to function. Acknowledging the need for help is not evidence of weakness or failure as a mother. It may be an act of insight, responsibility, and protection.

Postpartum psychosis is a psychiatric emergency, but it is also treatable. Stigma may make women afraid to disclose symptoms because they fear being labeled dangerous, separated from their children, or considered unfit mothers. That silence can delay lifesaving care.

A safer culture would allow a woman to say, “Something is seriously wrong,” knowing that she will be met with urgency, dignity, and compassion. Our society as a whole has begun to lower the stigma of mental health struggles, however, we have a long way to go. Mental-health conditions are not rare or limited to a small group of people.

Research suggests that nearly one in two American adults will meet the criteria for a diagnosable mental disorder at some point in life. Although experiences and levels of impairment vary widely, mental illness is a common part of human health and deserves the same seriousness, compassion, and access to treatment as physical illness. National Institute of Mental Health

Mental illness should not have to look physical before society accepts that it is “real”.

Women’s symptoms should not have to become catastrophic

The minimization of postpartum symptoms reflects a broader problem in women’s healthcare. Throughout their lives, women may experience significant physical and psychological changes related to menstruation, pregnancy, pregnancy loss, childbirth, infertility treatment, perimenopause, and menopause.

Too often, they are told that they are simply stressed, emotional, tired, or experiencing “normal hormones.” Symptoms may be minimized until they become disabling.

At the same time, hormones should not become a simple explanation for every concern. Mental health during reproductive transitions can be influenced by hormonal sensitivity, sleep disruption, medical conditions, psychiatric history, medication changes, trauma, relationships, caregiving demands, and social stress.

During perimenopause, for example, hormonal changes can coincide with changes in mood, anxiety, sleep, concentration, and emotional regulation. The American College of Obstetricians and Gynecologists reports that approximately four in ten women experience mood symptoms during perimenopause and that depression risk increases during the menopausal transition. See ACOG for more details.

The goal is not to blame everything on hormones. It is to stop treating reproductive changes as irrelevant.

Clinicians can help by routinely asking whether symptoms began or worsened during pregnancy, after childbirth, following a pregnancy loss, during menstrual-cycle changes, or around perimenopause. When the reproductive stage becomes part of an ordinary health history, women do not have to persuade every new provider that the information matters.

Medication requires coordination, not fear

Psychiatric medication can be lifesaving and should not be stigmatized. The lesson is not that medication is dangerous or should be avoided. It is that prescribing must be accompanied by careful assessment, monitoring, and communication.

Before treating depression or anxiety, clinicians may need to consider whether there is a history of bipolar-spectrum symptoms, mania, psychosis, previous postpartum episodes, or unusual reactions to antidepressants. ACOG

recommends screening for bipolar disorder before beginning medication for depression or anxiety when screening has not already occurred. ACOG

When several medications or prescribers are involved, someone should know:

• what has been started, stopped, or changed;

• why each medication was prescribed;

• how symptoms changed afterward;

• whether the clinicians involved know what the others are prescribing;

• who is responsible for responding if the patient’s condition worsens.

  
  

A patient experiencing a psychiatric crisis should not be expected to remember every medication, dose, date, and prescriber while acutely unwell.

Several countries, including Denmark and Finland, use nationwide systems that allow authorized healthcare professionals to access prescription information across settings. Similar coordination in the United States could benefit patients, providers, and families while requiring strong privacy protections.

Technology cannot diagnose a patient or replace professional judgment. It can help ensure that each clinician begins with the same essential information.

Someone must coordinate the care

A person experiencing a perinatal mental-health crisis may receive care from an obstetric clinician, therapist, primary-care provider, psychiatric prescriber, emergency department, hospital, crisis service, or telehealth provider.

Each professional may make a reasonable decision based on the information available during a single encounter. The risk is that no one sees the complete pattern over time.

Better care requires a clearly identified clinician or team responsible for coordinating high-risk cases. When a patient moves from one service to another (as escalated care had been handed off several times in the Clancy case) , the transition should establish:

• who is responsible for the next assessment;

• when that assessment will happen;

• who will monitor medication effects;

• which symptoms require immediate attention;

• what the family should do outside office hours;

• who will confirm that the patient is connected with the next service.

If in the Clancy case, providers would have connected on referrals, assessments, and treatment provided, the collaboration may have recognized the decline in functioning and need for a closer look into symptoms. The lack of connection among providers exists for multiple reasons. Over booked caseloads due to lack of funding, clients refusal to sign releases, lack of supportive involvement in clients lives, and clients withholding/forgetting treatment history. 

Giving someone a telephone number or telling her to “follow up” is not always enough.

When risk is elevated, the referring and receiving providers should communicate directly whenever possible. Responsibility should be actively transferred instead of being placed entirely on a patient or frightened family.

Effective coordination also requires manageable caseloads that give professionals enough time to communicate, follow up, and respond to changing risk.

Sleep is important clinical information

Sleep deprivation is often accepted as an unavoidable part of caring for a baby. Ordinary interrupted sleep is common, but profound or rapidly worsening sleep loss may be a warning sign of serious mood instability. See Postpartum Support

Clinicians should ask how many hours someone is actually sleeping, whether she feels tired, whether she can sleep when another person cares for the baby, and whether her behavior has changed. The postpartum period, like other times of significant hormonal change, can sometimes involve a progressive decline in functioning. After childbirth, rapid hormonal shifts may affect the biological systems involved in regulating mood and sleep. Sleep deprivation can then increase stress, intensify anxiety or panic, and interfere with concentration, judgment, and other cognitive abilities. Because hormonal changes, sleep disruption, psychological stress, medical factors, and individual vulnerabilities can interact in complex ways, the course and severity of postpartum symptoms may be difficult to predict.

Depending on the situation, a sleep-protection plan might include overnight assistance, changes in caregiving responsibilities, help with feeding, medication review, or more intensive treatment. Sleep alone does not explain severe mental illness. It should nevertheless be taken seriously rather than automatically dismissed as part of new parenthood.

More on sleep deprivation

Families need guidance, not sole responsibility

Family members often notice changes that are difficult to see during a short appointment. They may observe that someone is not sleeping, seems confused, has undergone a sudden personality change, or is expressing unusual fears or beliefs.

With the patient’s permission whenever possible, clinicians should listen to those observations and teach families which warning signs require urgent attention. Families should know whom to call, whether the patient can safely be left alone, and when waiting for the next appointment is no longer appropriate.

At the same time, family members cannot be expected to function as mental-health professionals. Telling a partner to “keep an eye on her” transfers enormous responsibility without necessarily providing the knowledge or resources needed to carry it safely.

Family participation should be one layer of support within a professional system—not a substitute for that system.

Better treatment options for mothers and babies

Hospitalization can save lives, but a general psychiatric unit may separate a mother from her baby and may not provide specialized support for postpartum medical needs, lactation, attachment, or infant care.

Specialized mother-baby psychiatric programs exist in several countries but remain limited in the United States. Expanding these programs could make it easier for families to accept necessary treatment while allowing professionals to consider the needs of both mother and infant. See Clinical overview

The period following discharge also requires careful attention. Leaving a hospital does not always mean that the danger has passed. Follow-up should be prompt and confirmed. Renewed insomnia, worsening agitation, missed appointments, difficulty obtaining medication, or concerns from family members should prompt outreach and reassessment.

Supporting the professionals who provide care

Mental-health professionals cannot safely manage complex perinatal emergencies through dedication alone. They need access to reproductive-psychiatry consultation, accurate medical records, reasonable caseloads, crisis resources, supervision, and clear after-hours procedures.

Asking for consultation should be viewed as responsible practice, not professional weakness. Reviewing difficult cases should focus on learning and prevention while maintaining appropriate accountability. Collaboration in the mental health field is vital to the care of clients along with the mental well-being of the clinician not feeling isolated and overwhelmed.

At 21 Reflections Professional Counseling, we pride our boutique practice as collaborative and not only within our office but within the mental health community. We see first hand the success in treatment when we utilize our collaborative approach with others involved in treating the client and those we may need to pull in for future care. 

Clinicians may sometimes be working with incomplete records, delayed communication from other providers, and uncertainty about a patient’s changing condition. These challenges make consultation and coordinated systems even more important.

Professionals should be able to say:

“I am worried. I am uncertain. I need help determining what level of care this patient requires.”

Healthcare organizations must give them the resources and support to act on that concern. Private practice professionals should rely on consultation as best practice when it comes to challenges in treatment. 

Moving forward together

The Lindsay Clancy case involved sharply conflicting interpretations of one woman’s mental condition and legal responsibility. People may reach different conclusions after hearing the evidence. Acknowledging that disagreement does not prevent us from considering the broader questions the case raises.

The lesson is not that mothers with mental illness are dangerous. The overwhelming majority are not. The lesson is also not that every frightening thought indicates psychosis or an intention to cause harm.

Serious postpartum illness can be difficult to recognize, can change rapidly, and may not fit neatly into a single appointment or diagnosis. Screening is useful, but it is not the same as safety. A referral is not necessarily a completed transfer of care. More appointments are not always the answer when someone requires a higher level of treatment.

No system can predict or prevent every tragedy. Patients may have symptoms that are difficult to identify, diagnoses may remain uncertain, and treatments that help one person may not help another.

That uncertainty is not a reason to stop improving.

The public can move forward by treating psychiatric illness with the same seriousness and compassion given to physical illness. Families can learn warning signs and seek urgent assistance when behavior changes dramatically. Clinicians can look beyond a single appointment, ask about reproductive stage and sleep, communicate across specialties, and request consultation early. Healthcare organizations can provide the staffing, technology, specialist access, and treatment options that make those actions possible.

Women should not have to reach a crisis before their symptoms are believed. Clinicians should not have to manage severe illness in isolation. Families should not have to coordinate an entire healthcare system while frightened and exhausted.

We often tell people to ask for help. Our responsibility as a society is to make sure that when they do, the system is prepared to listen, connect the pieces, and respond.

Someone must hold the whole story—but no one should have to hold it alone.

At 21 Reflections Professional Counseling, we consider the whole person and make safety assessment a central part of client care.

If this subject affects you personally or you are concerned about someone’s immediate safety, contact emergency services or call or text 988 in the United States. Postpartum Support International’s HelpLine is available at 1-800-944-4773 for support and referrals; it is not an emergency service.

• Lauren Brymer, LCPC (IL), CADC (IL), LPC (MS)