What the Lindsay Clancy Case Reminds Us About Maternal Mental Health
The Lindsay Clancy case is difficult to talk about. Not only because of the devastating loss of three young lives but because it has brought a much wider conversation about maternal mental health into the public eye.
Clancy is currently on trial in the United States for the deaths of her three children in January 2023. Her defence has argued that she was experiencing severe mental illness, including postpartum psychosis, while prosecutors dispute this. The trial is ongoing and it is important that we do not try to draw clinical conclusions about her diagnosis or what happened from the outside.
But there is something important that we can take from the conversation surrounding the case.
Maternal mental health needs to be taken seriously long before a crisis occurs.
Motherhood can be emotionally complicated
There is often an expectation that having a baby should be one of the happiest times in a woman's life and while it can be, it can also bring enormous emotional, physical and psychological demands. Sleep changes, hormonal shifts, recovery from pregnancy and birth, feeding difficulties, a crying baby, changes in relationships, financial pressures, a loss of independence and the enormous responsibility of suddenly being responsible for another person. Alongside all of this, there can be an unspoken expectation that a mother should simply cope. Many women do, until they don't.
Maternal mental health difficulties can include depression, anxiety, obsessive thoughts, trauma, panic, adjustment difficulties and, in more severe cases, bipolar disorder or psychosis. These conditions are not a reflection of how much a woman loves her baby, nor are they evidence that she is a "bad mother". They are mental health conditions that require recognition and treatment.
Perinatal mental health conditions are also much more common than postpartum psychosis. Depression and anxiety can affect a significant proportion of women during pregnancy and the postpartum period, yet they often remain under-recognised or untreated.
Not every struggling mother looks like she is struggling
This is perhaps one of the most important things to understand. A woman can be functioning remarkably well while experiencing significant psychological distress. She may be getting the baby dressed, attending appointments, responding to messages and appearing completely capable from the outside. She may even be telling herself that she has no reason to be struggling. This is particularly relevant for women who are used to being high functioning, independent and capable. They can become very good at carrying on while quietly feeling overwhelmed.
Sometimes distress looks like crying and withdrawal.
Sometimes it looks like anxiety, irritability or constant checking.
Sometimes it looks like not sleeping even when the opportunity is there.
Sometimes it looks like intrusive thoughts that are frightening and difficult to talk about.
And sometimes, particularly in more severe mental illness, there can be a significant change in a person's perception of reality.
This is why simply asking a mother, "Are you coping?" is not always enough. We need to be willing to ask more specific questions about mood, anxiety, sleep, intrusive thoughts, functioning and changes in behaviour.
Postpartum psychosis is different
The conversation around the Clancy case has understandably brought postpartum psychosis into focus.
Postpartum psychosis is very different from the more common "baby blues" or postpartum depression. It is a psychiatric emergency and can involve confusion, severe insomnia, paranoia, hallucinations, delusions and a loss of contact with reality. It usually develops rapidly, often within the first few weeks following birth. It is uncommon but its seriousness means that it is important for mothers, partners, families and healthcare professionals to know what to look out for.
One of the challenges is that a person experiencing psychosis may not recognise that they are becoming unwell. Often, the people around them notice that something has changed before the mother herself does. This is why maternal mental health cannot be treated as something that belongs solely to the mother. Partners, family members and healthcare providers all have a role to play.
A significant change in behaviour, extreme or prolonged sleep deprivation, confusion, paranoia, unusual beliefs, hallucinations or thoughts about harming herself or her baby should never simply be put down to the stress of having a newborn. Immediate professional assessment is needed.
We need to move beyond crisis intervention
One of the biggest lessons from cases like this is not simply that we need to recognise severe mental illness. We need to become better at recognising distress much earlier. Maternal mental health should not only be addressed when a woman reaches breaking point. It should form part of routine pregnancy and postpartum care. The American College of Obstetricians and Gynecologists recommends screening for depression and anxiety during pregnancy and postpartum, with systems in place to ensure that women who screen positive receive appropriate assessment, treatment and follow-up. That matters because a screening questionnaire is only the beginning.
A woman might score highly on a questionnaire, but what matters clinically is understanding what is happening underneath that score. How long has she felt this way? How is she sleeping? Is she functioning? Is she frightened by her own thoughts? Does she feel connected to her baby? Does she feel like herself? Does her partner or family notice a change? These conversations can identify difficulties before they become overwhelming.
We also need to make it easier for mothers to ask for help
There is still a tremendous amount of shame around struggling with motherhood. Women can worry that admitting they are not coping will make people question their ability to mother. They may fear being judged, losing control of decisions about their baby, or simply being seen as ungrateful. So they minimise.
"I'm just tired."
"Everyone feels like this."
"It will get better when the baby sleeps."
"I should be coping."
Sometimes it does get better but sometimes it doesn't. Asking for help should not require a woman to first reach a point where her distress is impossible to hide. We need to create an environment where a mother can say, "I'm not feeling like myself," without feeling that she has failed. We need healthcare professionals to take those words seriously.
Maternal mental health is family health
Looking after a mother is not separate from looking after her baby. A mother's mental health affects her ability to rest, connect, function and navigate the demands of early parenthood. It also affects partners, relationships and the wider family system. This is why maternal mental health deserves to be treated as part of healthcare, rather than as an optional extra once the physical aspects of pregnancy and birth have been addressed.
The Clancy case is an extreme and deeply tragic example. Most women experiencing postpartum depression, anxiety or other perinatal mental health difficulties will never harm their children. It is important not to create fear around mental illness or motherhood by suggesting otherwise. What we should take from this case is something much simpler. Maternal mental health matters.
It matters when a mother is mildly anxious.
It matters when she is struggling to adjust.
It matters when she cannot sleep.
It matters when she feels persistently low or overwhelmed.
It matters when she is frightened by intrusive thoughts.
And it matters urgently when there are signs of severe mental illness or a loss of contact with reality.
We do not need to wait for a crisis before we start paying attention. Sometimes the most important intervention is simply noticing that something has changed, asking the right questions and helping a mother access support early. Caring for a mother is also part of caring for the family she is trying so hard to hold together.