In Good Health: The Matter Of Maternal Mental Health Care

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0:30The Lindsay Clancy murder trial captured public attention for weeks. Prosecutors charged Clancy with murdering her three children. They say she then attempted suicide and that her injuries left her paralyzed from the waist down. Clancy's lawyers say she was experiencing postpartum psychosis and should not be held criminally responsible. prosecutors say she planned the deaths. After seven days of deliberation, the jury remained deadlocked and the case ended in a mistrial. The story has sparked conversations about maternal mental health, raising questions about gaps in postpartum care. About one in five expecting or postpartum women in the U.S.

1:09experience mental health disorders. And according to a 2025 study, overall maternal mental health has dramatically dropped in the past seven years, with only 25 % of moms reporting excellent mental health. I'm Jen White. You're listening to the 1A Podcast. What do we know about maternal mental health care? Where are the gaps in our knowledge? And how can our systems be bolstered to help those who need it most after giving birth? That and more after this short break. Stay with us.

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2:17And if you want to dive deeper into your favorite podcasts and enjoy perks like bonus episodes, archive access, and more, check out NPR+. Find out more and support the shows you love at plus.npr.org. Let's jump in with Caroline Polisi. She's a legal contributor at CBS News and a criminal defense attorney. Caroline, welcome to the program. Thanks for having me, Jen. And Dr. Firla Berhink, Director of Mount Sinai's Women's Mental Health Center in New York and a professor of psychiatry. Dr. Berhink, thanks for joining us today. Yes, thanks for having me. And a quick note that we will be discussing murder, thoughts of suicide.

2:58So if you are experiencing a mental health crisis or thinking of harming yourself, the 988 Suicide and Crisis Lifeline is available 24-7 by phone and text. Now, first off, an important note about the Lindsay Clancy case. Her attorneys don't dispute that she killed her children. At issue is whether or not she should be held criminally responsible for doing so. Clancy's defense argued that her medical team failed her even after Clancy reached out for help. Here's Clancy's lawyer, Kevin Reddington, cross-examining her psychiatrist, Dr. Jennifer Taft. Did she call suicide at that point? I was not aware that she did.

3:34Did you ever ask her? I don't think I specifically asked that question. Did you ask her anything to be around the bush? Maybe you asked her anything about suicide hotlines? I don't think I asked her about suicide hotlines. Would it surprise you to know that she called suicide hotline in that time frame, not once, but twice, and was turned away? You guys want your front lines, aren't you? Caroline, we heard from a couple of people from Clancy's medical team during the trial. What picture was Reddington trying to paint here and how effective was it? Yeah, I mean, Reddington went really hard against all of the mental health care providers that Lindsay saw leading up to the horrific deaths, including, we heard there, Dr.

4:21Jennifer Tufts, who was really a newly minted psychiatrist, a prescriber. She went to a few different prescribers. She also saw nurse practitioners, you know, mental health social workers. And one of the themes of the prosecution's case was that she was doctor shopping, that she, you know, was, would quit the regimens of medicine if she didn't like them. And Reddington pushed back really hard on that, basically saying that all of these providers sort of passed the buck and, you know, weren't there for her. I mean, she checked herself into a mental facility for days. You know, she was begging for help.

5:04I mean, that's a direct quote from Lindsay Clancy's mother-in-law, which was some of the most powerful testimony. But, you know, Reddington really wanted to paint a picture that this was not just, you know, out of the blue, that for months she was begging for help and she didn't get the help that she really desperately deserved. One of the questions in the trial is whether Clancy had postpartum psychosis. And Dr. Berhink, how do you define that condition? What are some of the key traits? Postpartum psychosis is a severe mental illness with symptoms within three months after delivery. And that can be mania or raising thoughts, having ideas that are grandiose, psychosis, losing reality or seeing or hearing things that are not there, or depression with psychotic features, meaning that you're so low and so depressed that you lose reality, that you feel it's better to die.

6:00And the onset of these severe symptoms occur within three months after delivery. How many people does this affect? One in a thousand. So it affects many women in the U.S. and also worldwide. and there is not enough attention for this disorder and for the fact that women are unfortunately after delivery at higher risk than at other times for severe mental illness, psychosis, mania or depression with psychotic features. We'll talk more about some of the causes. But Caroline, what did the defense and prosecution say about this diagnosis in the case? Yeah, you know, it's really interesting because I always like to note from a legal perspective that the mental illness diagnosis and the test, the criminal law test for not criminally responsible by mental disease or defect are in fact different.

7:00There's a really slim overlap if you look at a Venn diagram between the panoply of mental health illnesses versus what state of mind is required for what we're going to call a not guilty by reason of insanity verdict is actually quite small. If the law allowed for non-criminal responsibility just because of mental illness, we would have a very different criminal justice system. But basically, the legal test is whether or not Lindsay Clancy was able to appreciate the difference between right or wrong and whether or not she could conform her conduct to the law. So that's a pretty favorable defense definition.

7:41And I just note, legally, in the Commonwealth of Massachusetts, it's actually not on the defense to prove that state of mind. It's on the prosecution to disprove it. And so this whole issue of was it postpartum psychosis or was it just severe depression with an altruistic suicide or altruistic filicide, which is when you kill your children under the mistaken belief that it's sort of a better path, that was at issue. And we're sort of using the was it postpartum psychosis as a fill-in for the legal standard. Well, let's go to our voicemail box. We got this message from Lynn in Florida. There is no way that a mom in any decent or rational state of mind would do that.

8:30And it's awful. This whole trial is awful. She's very unwell and nobody in their right mind would do that. I don't know why there's even this discussion at this point. Caroline, as you've been covering this case, what have you noticed about public opinion and how people are talking about it? Oh my goodness. People are severely divided. They come down really hard one way or the other. I think it's really hit a nerve, especially amongst mothers in this country. But I think it's worth noting that, again, this did end up in a mistrial and the prosecution has to decide how it's going to move forward, whether or not they're going to recharge at first degree murder.

9:12And we've now heard from four jurors. The breakdown was 11 to 1, 11 for not guilty by reason of insanity, meaning they weren't sure that the prosecution proved its case beyond a reasonable doubt. And I think that that speaks volumes when the district attorney, Tim Cruz, is going to think about moving forward with re-prosecuting this case because clearly the defense put a strong argument up. And for that 12th juror? Have we heard from them yet? No, we have not. They're remaining anonymous, which is his absolute right. People are so invested in this case that I don't blame him for remaining anonymous.

9:57The issue really is there, Jen, did he apply the facts to the law as the judge instructed, which is how our criminal justice system is supposed to work and how you take an oath as a juror to do? Or did he engage in a form of what we would call sort of reverse jury nullification, which is, well, I'm not listening to the law. I see, I understand, I actually have reasonable doubt, but the crime was so heinous in my mind that I'm just gonna, I'm not gonna follow the law. And that's improper. And that's what Reddington argued. That's why he argued that that juror should be removed, replaced with an alternate juror that ultimately didn't happen and a mistrial was declared.

10:37Dr. Bergenke, as someone who specializes in postpartum mental health and psychosis, I'm curious to hear your reaction, not just to the case, but really the conversations around it. I really understand that people are so shocked, and I understand also both sides. She had severe mental illness, but I also understand the other side as the feeling like, how could that be? This is so horrible. Something must be wrong with her or she must be an evil person also. Otherwise, it's impossible that it happens. And I think it's up to us to explain that that can happen so that it can happen to everyone. Unfortunately, we know that it's quite random.

11:25It happens to all kinds of women. It doesn't matter what kind of personality you have or what kind of background you have. It's just a matter of bad luck. And I think that is really a scary realization for people that, you know, severe mental illness, including psychosis or depression with psychotic feature can hit you. Caroline, really briefly, what are you watching for next? As you said, this case ended in a mistrial. Right. Well, obviously, we're just waiting to see what the DA does, whether they might cut a deal, charge a second degree, or come to some sort of plea agreement that does not involve a second trial.

12:04That's Caroline Polisi. She's a legal contributor at CBS News and a criminal defense attorney. Caroline, thanks for speaking with us. Thank you for having me. Dr. Fierla Berink, director of Mount Sinai's Women's Mental Health Center, is staying with us. Coming up, mental health conditions are the most common complication of pregnancy and childbirth. Why do our medical systems still fall short? That's just ahead.

12:30I haven't seen my son since 2012. This is Deborah Tice. The disappearance of her son, Austin, is one of the biggest missing person cases in the world. What do you want from me? I should solve the mystery. I know that my son is somewhere alive. Listen to Where Is Austin Tice from NPR's Embedded and BBC Radio 4 on the NPR app or wherever you get your podcasts. On NPR's Wildcard podcast, musician Sarah Bareilles on being a crier. My mom is a big crier too, and she loves to take credit for my crying. Mom, my crying is mine. Watch or listen to that wildcard conversation on the NPR app, YouTube, or wherever you get your podcasts.

13:19This message comes from the Conservation Fund, protecting at-risk land before it's lost. The forests, farmland, open spaces, and places that wildlife call home. They believe conservation shouldn't be a choice between protecting nature and supporting people. It should advance both in harmony. With over 9 million acres protected across all 50 states, the Conservation Fund secures the irreplaceable lands people love. Learn more at conservationfund.org. Let's get back to postpartum mental illness and the gaps in care for new mothers by adding a new voice to the conversation. Joy Burkhardt is the chief executive for the Policy Center for Maternal Mental Health.

14:00That's a nonprofit policy and research think tank pushing for change in our healthcare systems to better address maternal and mental healthcare. Joy, welcome to 1A. Hi, Jen. Thanks for having me. We're also hearing from you. Stevie in Indiana shared this story. After I had my son, I completely went, I mean, off the wall. Like I was just so depressed. I was so quick to anger. I had no, absolutely no patience, which is so important to have with the baby. And no one really warned me about that. I did luckily, thank God, my doctor was able to diagnose me actually with ADHD and also help me get on some antidepressants and anti-anxiety.

14:42But, you know, there's certain medicines you can't even take when you're breastfeeding, if that's what you're able to do. And it was just crazy. It's a lot. And I just hope we're able to figure it out and do better. Thanks for that message. We also heard from another of you who emails, I have so many thoughts on the Lindsay Clancy trial. I have so much empathy. Probably the only silver lining is the awareness raising about postpartum depression and postpartum psychosis. This is a very real thing. I experienced it so severely that I was truly afraid for the safety of my kids. Please understand that I absolutely loved my babies, but how was I supposed to get help?

15:17I thought I'd surely go to jail for merely confessing my thoughts. And a note that if you are experiencing a mental health crisis or you're thinking of harming yourself, the 988 Suicide and Crisis Lifeline is available 24-7 by phone and text. The National Maternal Mental Health Hotline is also available 24-7. You can text, call, or chat at 1-833-TLC-MAMA. MA. Joy, you're on the ground in the courtroom for the Clancy trial. You also had people reach out to you as this case was playing out who also experienced some form of postpartum mental health illness. What did you hear from those people? Well, of course, much of the field, the providers and patients and survivors have been sitting at the edge of their seats watching this trial, as the world has as well.

16:09And first, everyone is devastated about the loss of these children and survivors and those in the throes of a maternal mental health disorder right now really worried, could that have been me? And so they really see and saw themselves in Lindsay Clancy. But those who have experienced a disorder, even if it wasn't postpartum psychosis, really, I think we're worried about how the system could potentially fail her twice, not catching these disorders in the healthcare system, but also legally holding her accountable for the system failing her. Dr. Berhink, you mentioned some of the conditions that can emerge in that postpartum period.

16:53Do we understand why some of these conditions develop? We know that the major changes after childbirth, the drop in hormones, the changes in the immune system, likely play a role in triggering severe mental illness after delivery. And for all other mental health disorders such as depression or anxiety or OCD, it's good to know that these happen, you know, a lot at other times as well in women in their fertile ages, regardless whether they're pregnant or postpartum or, you know, so that there is not an enormous peak after delivery. However, it is a sensitive period because there is sleep loss. It's a major, you know, change in role and a lot is happening.

17:43So it's good that people, you know, know how to detect it and especially also know how to treat it because it's not that difficult to treat postpartum mental health disorders. Are there people who are more vulnerable to mental health illness after birth? If you have had a mental health disorder in the past, that is the biggest risk factor for having a difficult time after delivery as well. But it's good to know with regards to treatment that everything that works at other times also works in this particular period. So as I said, if anything, then postpartum depression and postpartum anxiety often has better treatment response than at other times.

18:31So I really want to give this message out as well, which is an additional reason for women who are not well to speak out and say that they're not well or they're down or anxious. And that very first step is already helpful and not having to pretend as if everything is fine. Well, we're thankful that so many of you are sharing your stories with us. When I had my babies both times, which was back 54, 56 years ago, I had serious postpartum depression. I was just, I was real happy when they were born and then this came over me. Luckily, we got someone to come and help me. And also my doctor prescribed Ritalin, which I was on for a month, which really helped me.

19:23I just dropped my first child, my only child, off at college. But 18 years ago when he was born, I had really severe postpartum OCD and depression. And I think it was really misunderstood at the time. I had a very hard time getting the help I needed, and the OCD aspect of what I experienced made it really, really difficult to actually get treatment. Lucy in Oklahoma, Amber in Portland, Oregon, thanks for those messages. According to a 2019 study, at least one in five women experienced some type of peripartum mental health disorder, and that makes mental health issues the most common complication of pregnancy and childbirth.

20:08And yet, Joy, we've heard from so many of our listeners just in the lead up to the show about how difficult it was to talk about it or to find places where they felt safe sharing their story and their struggles. And so how much of this conversation is also about tackling the stigma around mental health disorders in that postpartum period? It's a really important question. And I think there's certainly been growing awareness about mental health challenges in general during COVID, adolescent mental health, girls' mental health, even menopause now. So we're making a lot of progress on talking about mental health as a society.

20:51But the system still is not working as it should in detecting mental health problems, even outside of the perinatal period in primary care, for example. I do want to share that one of the things that we feel is critical is that that system worked to combat stigma and, of course, support diagnosis and treatment. If your provider is not talking about this just as you did, Jen, as the number one complication of pregnancy and childbirth, we're here to help you. We screen everyone because we know it's the most common complication. Then, of course, we are only perpetuating stigma. I'm happy to tell you a little bit about the clinical practice guidelines that came out to that end in 2023 from the American College of Obstetricians and Gynecologists.

21:40They were the very first clinical practice guidelines issued in America, and they were issued after the Clancy killings, unfortunately. So there are now guidelines and really root this work, which we think is appropriate, in obstetric care. So OBGYNs and midwives and those care teams should start to detect these disorders and talk about them and normalize them. Starting in pregnancy, given new onset, can happen in pregnancy as common, in pregnancy as in the postpartum period. And of course, women can enter pregnancy with untreated, undiagnosed mental health conditions as well. That takes us to this email from one of you.

22:21I had my first child in 1990 and had no family around to help with a new baby. My baby cried day and night, and I got so close to shaking him one day that it scared me, and I just left him and took the baby monitor and went to my neighbor's house. I was only 22 years old, and no one had told me anything about the possibility of postpartum depression, signs to look for, or resources to reach out for if needed. I hope to God things have changed. Joy, what kinds of resources are now available to most new mothers? Well, we've got more work to do. We actually believe that support groups for parents, just generally, how to cope with the stressors, how to cope with crying babies.

23:03There are groups and support around those tactics, but just general parenting support should be available to all patients, we believe. There are other services, programs like mothers and babies that support stress mitigation and even can prevent these disorders from getting worse. It's all about systematizing and scaling the availability of those programs, making sure that providers who are trained in these programs can be found, that support groups are reimbursed by the health insurance companies, for example. So we know a lot about what works. It's just about access and making sure that these programs are available and reimbursed through our health delivery system.

23:50When it comes to that access question, how much does the availability of resources depend on where you live or your income level? Well, I mean, let's be clear here that maternal mental health sits in our healthcare system, and I say in quotes, right? air quotes here around system, because we don't really have much of a healthcare system at all, I would argue. In America, it's really fragmented and it's really about providers and institutions, facilities that need to earn revenue, right? So to your question, Jen, if a business cannot earn revenue in a particular area, either because there aren't enough patient base or reimbursement is low through Medicaid, for example, and that's the primary base of patient's insurance, then we have a problem.

24:45So it does really matter where a patient lives, whether or not they will have access to maternal health care, mental health care, or hospital care, labor and delivery, birth facility support. So zip code and income and insurance coverage does matter whether we like it or not. It's fundamental that we get to the root of those challenges so we can support maternal mental health. One of you emailed, I had severe postpartum depression after the birth of my daughter. I had to beg my OBGYN to see me. I was desperate. I had no family around for support. It was very difficult and unexpected, and it is something our culture ignores.

25:25Dr. Bairhink, I'm curious about the societal pressures and around motherhood, the expectations of motherhood, what mothers are perhaps told their experience should be, and how they may bump up against the experience they're actually having. Yes, the expectations in society are very high. So there is more openness for mental health problems in general, in younger women, in older women. But in particularly during this period, people have the association with a pregnant woman or a new mother and a baby. That evokes very positive feelings, right? And it's just then more difficult to imagine that when there is a healthy baby, that a mother can have quite severe mental health problems.

26:23So I think that is a major problem. So the more people speak out, and I've seen that changing in the last decades, that also more people in the public area are speaking out, that helps a lot. But also on a local level, if people just share their experiences and how it really is, because that is what all our patients say, that is what all mothers say who struggle with these problems. I felt alone. I felt that I was the only one. So I think that's huge. If we just acknowledge that this is, you know, for everyone, a very challenging time, that it's, you know, that it's characterized by sleep loss.

27:06And many women have all kind of mood swings and it is hard. And for some women, that means that they get more mental health problems. And I think if we acknowledge that, that makes a huge difference. Well, it makes me wonder, Dr. Berghink, about the effectiveness of the diagnostic tools that are used to screen for postpartum mental health issues. Do you think they're sufficient? Yes, they are sufficient. As I said before, it's not that difficult. The real change is if you ask someone, if I ask you, how are you? You're going to say good, right? Really, whether you're good or not. So it's really the translation from asking, how are you?

27:49And instead, asking, are you depressed? Do you have depressive thoughts? Are you anxious? And in addition, there is a very simple screening instrument which only takes five minutes, a self-infill questionnaire. It's called the EPDS. You can type it into Google and you get a calculator. And that has then very simple questions. It's translated in 30 languages. And then you know if someone has depressive or anxiety symptoms. And so it's not that difficult at all, either using that questionnaire or literally asking, how is your mood? Do you feel depressed? Do you feel anxious? Joy, I'm curious to hear your thoughts about not just the diagnostic tools, but perhaps the time doctors have to spend with new mothers, with new parents, to really perhaps take some time to suss out whether or not they're doing okay.

28:54That is such a critical and important question that obstetric providers and others, Mental health providers tend to have more time the way the coding structure works to provide services. But obstetric providers like midwives and OBGYNs, even family practice providers, less time from a reimbursement standpoint. They have to fill in these very specific code structures. And so that really is an important question. We are actually seeing that some of these codes, one of the codes will be sunsetting soon. that provides obstetric providers one flat rate for all the care that they provide. And instead, now we'll have an opportunity to bill for more services and get paid for more services.