As jurors weigh whether Lindsay Clancy should be held criminally responsible for killing her three young children, maternal mental health experts and advocates are raising a different question: How can Massachusetts improve care for mothers and prevent another tragedy?
The 32-year-old Duxbury resident is accused of strangling her children — a 5-year-old, a 3-year old and an 8-month-old — in the basement of her family’s home in January 2023 and is charged with three counts of first-degree murder.
Attorneys in the case made their closing arguments on Thursday. Both sides agreed that Clancy killed her children, but they differed on whether she was in a state of mind where she could be held criminally responsible for her actions.
Prosecutors claimed she acted intentionally and bears full responsibility for their deaths. The defense argued she shouldn’t be held criminally responsible because she had postpartum psychosis, a severe mental illness linked to the stress, sleep deprivation and hormonal changes that follow childbirth.
Last week, hundreds of women began gathering outside of the Plymouth Superior Court to show support for Clancy and others who suffer from postpartum mood and anxiety disorders. Many of them wore pink shirts emblazoned with phrases such as “Believe” and “She Needed Help.”
“Women are being dismissed, neglected and ignored when we speak up,” one of Clancy’s supporters told the Associated Press. “We’re scared because nobody takes us seriously.”
Clancy’s case has also sparked outrage and heated debate online, with critics arguing that such a grievous case demands accountability.
“The feminist left is entirely predicated on the idea that women cannot be held accountable for anything,” said far-right political commentator Steven Crowder in one of countless YouTube videos debating the trial.
For advocates and experts working in maternal mental health in Massachusetts, the case marks a wakeup call: a clear example of where resources available to new mothers fall short and a potential inflection point in how the state treats the mental health of women after giving birth.
Postpartum psychosis: Dangerous but treatable
Postpartum psychosis is extremely rare, occurring in roughly one in 1,000 individuals, but carries a significant risk of infanticide and suicide — 4% and 5%, respectively — according to Dr. Uruj Kamal Haider, a perinatal psychiatrist and expert on postpartum psychosis.
“It’s potentially lethal but highly treatable,” Haider said.
The treatment for postpartum psychosis generally involves immediate hospitalization and medication. According to Haider, most diagnosed women end up having entirely normal lives with their families after treatment.
The illness is characterized by delusions, hallucinations, disorganization and confusion that can disconnect patients from reality.
In Clancy’s case, the defense said she heard a persistent, commanding voice that told her to kill her children and herself, and that she was not acting with calculated, rational intent.
Haider wouldn’t comment on the case specifically but said that patients experiencing postpartum psychosis, broadly, are not aware of their actions and cannot be considered responsible for what they do during a psychotic episode.
“We tend to ask, ‘How could a mom do this?’” Haider said. “But we have to understand ... this is not a personality pathology or a flaw of the character. What’s missed is these moms are truly doing it from their own reality, not from the reality that you and I see.”
The exact reason that postpartum psychosis causes a person to disconnect from reality isn’t fully understood, but Haider said the illness often happens when somebody has a preexisting condition, such as bipolar disorder, insomnia or anxiety.
Medical experts also believe that perinatal hormonal changes play a role in the illness.
“In the postpartum period, there’s that sudden withdrawal of estrogen and progesterone,” Haider said. “So that hormonal crash is thought to affect some people who are more vulnerable compared to other women.”
Catching cases before a tragedy
In addition to working with perinatal patients herself, Haider is the medical director of a statewide initiative called the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. The program helps connect clinicians who don’t have a broad knowledge of postpartum illnesses with expert psychiatrists.
Haider said that programs like MCPAP for Moms can play a crucial role in preventing the escalation of severe postpartum illnesses, including psychosis, by helping providers identify early symptoms before a patient experiences red-flag symptoms, such as considering harming themselves or their children.
She calls these early symptoms “pink flags.”
“Those are characterized by paranoia, hypervigilance, maybe subtle onset of confusion and maybe some early onset mood changes or racing thoughts,” Haider said. “If we detect these early enough, that’s really where lives can be saved.”
The problem, however, is that not enough providers are aware of these pink flags, according to Dr. John Straus, a pediatrician and MCPAP for Moms’ founding director.
“It’s not just professionals,” Straus said. “It’s the whole village that takes care of mom and her baby. It’s the partner. It’s the pediatrician that they go to. It’s the nanny. It’s the doula. It’s anybody that the mom is interacting with who may hear some of these pink flags. So there’s a whole educational process that needs to happen here to help call for help.
One potential barrier to that education is that the American Psychiatric Association does not currently recognize postpartum psychosis as a distinct diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which experts say hinders targeted research and standardized treatment protocols.
”The emphasis needs to be shifted to the fact that it clinically exists, because we know that it does,” Haider said. “The majority of women who experience postpartum psychosis go on to recover and have fully functional and healthy lives with their families. And I think that’s what the conversation really needs to be around — not whether this exists.”
A survivor’s story of recovery
Kriti Lodha, a Newton resident, experienced postpartum psychosis after the birth of her daughter five years ago.
“I always dreamed of being a mom,” Lodha said. “But I wasn’t sure if pregnancy would be in the cards for me because of a history of hormonal issues.”
Lodha said she and her husband were thrilled when they learned that she was pregnant during the COVID-19 pandemic. At the time, she said she had no history of mental illness and that her pregnancy went pretty smoothly.
But a traumatic 46-hour labor and postpartum sleep deprivation — compounded by her newborn’s feeding struggles and an abrupt switch to formula — triggered mania and, ultimately, a psychotic break.
“This was truly a break from reality,” she said. “Nothing I thought or did was in my control. I was living between multiple realities.”
According to Lodha, her psychosis waxed and waned; at times, she felt on top of the world and was entirely lucid, while at other moments, she “had no sense of what was real and what was not.”
Lodha said she knew something was wrong and that she became convinced that she had postpartum depression. She began writing profusely and posted often on social media about how she was trying to improve her condition. People seeing the posts, she said, would likely assume that while Lodha had the “baby blues,” she had things under control and was seeking the necessary help.
The day that Lodha’s illness reached a crisis point began entirely normal. In the morning, she showered, cooked a meal and took her daughter to the pediatrician. But that evening, she called 911, convinced that her husband was having a panic attack and that they were unfit parents.
“People who look at this from a distance probably say, ‘How could your husband not have seen this sooner?’” she said. “But sometimes this hides in plain sight.”
Lodha was hospitalized and separated from her partner and baby for weeks. She saw several doctors and was eventually diagnosed with postpartum psychosis, an illness she had never heard of before.
She recovered through roughly a year of hospitalization, medication, talk therapy and strong familial support. But Lodha said she carried private shame.
“I went back to work and only a handful of people knew about my story,” she said.
Eventually, she turned her experience into advocacy work with Postpartum Support International, the world’s largest perinatal mental health nonprofit. The organization pushes for earlier recognition of warning signs and better access to specialized perinatal mental health care.
Lodha said while it’s difficult to share her story, she does it to send a message that no parent should feel alone or need a crisis to ask for help.
“This is a medical emergency, but it’s temporary and treatable,” she said. “We have the collective power, wisdom and urgency to make sure that we prevent any other tragedy from happening.”
Expanding resources and awareness in Massachusetts
While awareness and treatment of postpartum mood and anxiety disorders has increased significantly in recent years, experts and advocates are in agreement that major gaps exist, especially when it comes to rare but severe illnesses like postpartum psychosis.
“In Massachusetts, we have a strong network and providers and programs, but less than a real safety net,” said Jessie Colbert, executive director of the Mind the Gap Coalition, a group that advocates for maternal mental health legislation on Beacon Hill.
Mind the Gap helped lobby for universal postpartum mental health screenings across the commonwealth and state Medicaid coverage for those screenings. The group is now backing legislation that would require mental health evaluations for new moms charged with crimes.
Under the measure, a mom who is diagnosed with a condition like postpartum psychosis could go into mental health treatment rather than the case proceeding in court.
Opponents, especially in light of the Clancy case, have argued the measure would let people who’ve committed serious crimes bypass the criminal justice system. But Colbert said cases involving severe maternal mental health issues should not be about accountability.
“This is not an illness where there is a deterrent factor,” she said. “This is something that nobody wants to have happen. I think we are much better served by focusing on treatment, focusing on understanding what this illness is, what the warning signs are, how we can look out for families and make sure to treat this as a medical emergency and get folks to care as soon as possible.”
Colbert’s coalition has also helped push for more funding for community-based groups across Massachusetts helping increase access to postpartum care. That includes Monumental Beginnings, a doula service using state grant money to fund at-home visits for new moms on Cape Cod, Martha’s Vineyard, & Nantucket.
“Our work is really to lessen the load at home to make their day to day life with the new baby a little bit easier, and also to provide support and companionship while they heal,” said Krista Sullivan, a doula and owner of Monumental Beginnings. “We’re also there also to get a gauge on the emotional wellness of the mom postpartum.”
While doulas are not able to diagnose perinatal mood and anxiety disorders, Sullivan said home-visitors are well equipped to assess what is normal and whether patients need to be referred to professional help.
Monumental Beginnings, she said, regularly sees new moms in need of medical intervention, and the rapport that doulas build with families can help forge a sense of trust, making medical referrals easier.
In Western Mass, another nonprofit, It Takes A Village, is working to increase access to care in rural communities by providing free at-home visits for new mothers.
“We don’t often think about Massachusetts being rural, but basically everything left or west of the 91 corridor is Berkshire Hills, where there’s a lack of services for families,” said executive director Lisa Goding.
Before working for the organization, Goding was a survivor of postpartum depression and experienced severe intrusive thoughts about harming her children. She said it’s been challenging watching the Lindsay Clancy trial, where defense attorneys have argued she wasn’t properly diagnosed and was put on a series of medications that left her worse off.
“I was referred to different specialists, too,” she said. “We tried medication. It didn’t work. Then we tried another. At one point I think I was on five different medications. I was almost incapacitated by the medications.”
Goding said she received a visit from a volunteer from It Takes A Village that was “life-changing.” She ultimately recovered, switched careers and made it her mission to spread awareness about maternal mental health and help increase access to resources.
While the Clancy trial has been difficult for Goding, she said, regardless of how the jury rules, the case has helped shine a light on an illness that too often hides in the darkness.
“This case underscores the gaps that we have in our systems,” she said.
