Mothers Shouldn’t Have to Be Heard on Trial

What the Lindsay Clancy case is forcing us to confront about maternal mental health care

There are moments when a case becomes bigger than the courtroom.

The Lindsay Clancy trial is one of those moments.

This is an extraordinarily tragic case involving the deaths of three children and a mother who survived a suicide attempt and is now facing trial. The defense argues that severe postpartum mental illness, including postpartum psychosis, played a role in what happened; prosecutors dispute that explanation and argue that she is criminally responsible. The trial is ongoing, and the legal questions ultimately belong to the court.

But for those of us working in maternal mental health, there is another conversation we cannot afford to ignore.

What happens when a mother says she isn't okay—and the system doesn't know how to respond?

How many times does a mother have to ask for help?

Mothers are often expected to advocate for themselves while they are simultaneously exhausted, recovering physically, navigating hormonal and emotional changes, caring for an infant, managing a household, and trying to convince everyone around them that they are still functioning.

They may say:

"I'm not sleeping."

"I don't feel like myself."

"My anxiety is getting worse."

"I'm scared."

"Something is wrong."

"I need help."

And sometimes the response is:

You're a new mom. You're tired. That's normal.

But what happens when it isn't normal?

What happens when symptoms are escalating?

What happens when sleep deprivation becomes severe?

What happens when intrusive thoughts become frightening?

What happens when depression, anxiety, agitation, paranoia, mania, or psychosis enters the picture?

That is when we need a system capable of recognizing the difference between ordinary postpartum adjustment and a psychiatric emergency.

The testimony in the Clancy case has raised questions about fragmented care, medication management, access to records, diagnostic disagreements, and whether important warning signs were adequately recognized or communicated. One defense expert recently described the medical records as sparse and questioned whether additional medical evaluation was warranted. Other treating clinicians testified that they did not observe psychosis during their encounters with Clancy.

Those conflicting accounts are precisely why this conversation matters.

Mothers shouldn't have to become their own case managers.

One of the most frustrating realities in maternal healthcare is that mothers are frequently expected to coordinate their own care.

Find the therapist.

Find the psychiatrist.

Call the OB.

Call the pediatrician.

Ask for the referral.

Explain your symptoms again.

Explain your medication list again.

Tell another provider what the last provider said.

Repeat your history.

Ask whether anyone has communicated with the other members of your treatment team.

And do all of this while you're exhausted.

This is not a sustainable healthcare model.

The Clancy trial has brought renewed attention to the consequences that can arise when mental health care is fragmented and when providers may not have access to a complete picture of a patient's treatment. Testimony has included discussion of providers not having complete records and limited communication among clinicians involved in Clancy's care.

We need to learn from that.

Not through blame.

Through better systems.

Postpartum mental illness deserves serious attention.

Postpartum depression and anxiety are increasingly recognized, but severe conditions such as postpartum psychosis remain less understood and can develop rapidly.

Experts discussing the Clancy case have emphasized that postpartum psychosis can involve symptoms such as hallucinations, delusions, confusion, severe sleep disruption, and dramatic changes in mood or behavior. It requires urgent evaluation and can require a much higher level of care than routine outpatient therapy.

This matters because not every postpartum mental health concern belongs in an outpatient therapy office.

Sometimes a mother needs:

• Psychiatric evaluation

• Medication management

• Emergency assessment

• Intensive outpatient treatment

• Partial hospitalization

• Inpatient psychiatric care

• Coordinated medical and psychiatric treatment

• Immediate safety planning

• Family involvement and support

And clinicians need to know when to say:

"This is beyond what I can safely manage alone."

Referral is not failure.

Referral is good clinical care.

We have to stop confusing functioning with wellness.

One of the most dangerous assumptions we can make about mothers is:

"But she looks fine."

A mother can get her children dressed.

She can make dinner.

She can answer texts.

She can attend appointments.

She can smile for pictures.

She can go to the grocery store.

She can appear completely functional while experiencing profound psychological distress.

The Clancy trial has included testimony describing severe mental health symptoms alongside periods in which she appeared outwardly functional. That disconnect is an important reminder that presentation does not always tell the whole story.

We have to ask deeper questions.

Not simply:

"How are you?"

But:

"How are you really sleeping?"

"Are you feeling safe?"

"Are you having thoughts that frighten you?"

"Are you experiencing anything that feels disconnected from reality?"

"Do you feel like you can safely care for yourself and your baby?"

"What has changed?"

And then we have to actually listen to the answers.

Mothers deserve coordinated care.

A mother shouldn't have to be the person connecting every provider in her care.

We need systems where:

OB/GYN + therapist + psychiatrist + primary care + pediatric care + family supports

can communicate appropriately when clinically indicated and with appropriate consent and privacy protections.

We need better education about perinatal mental health.

We need clinicians who understand that postpartum psychiatric illness can look different from the mental health presentations they see outside the perinatal period.

We need clear pathways for escalation.

We need access to higher levels of care.

We need providers who know their scope.

And we need mothers to be believed when they say:

"Something is wrong."

This isn't about blaming one person.

There is a temptation when a tragedy happens to look backward and ask:

Who missed it?

But hindsight is powerful.

The more productive question is:

How can we build systems that make it harder for someone to fall through the cracks?

The Clancy trial is still unfolding. There are competing accounts, expert opinions, and legal arguments that have not been resolved. We should be careful not to turn courtroom testimony into a definitive clinical conclusion about what happened.

But we can still listen to what this case is bringing to the surface.

We can ask better questions.

We can improve training.

We can strengthen referral pathways.

We can communicate more effectively.

We can document carefully.

We can reassess when symptoms change.

We can recognize when a mother needs a higher level of care.

And we can stop treating maternal mental health as something secondary to physical healthcare.

And to the mothers reading this…

If you've ever sat in a doctor's office thinking:

"Why won't anyone listen to me?"

If you've ever asked for a referral and had to ask again.

If you've ever been told you're just tired.

If you've ever questioned your own experience because someone minimized it.

If you've ever felt like you had to prove that you were struggling enough to deserve help—

I want you to know this:

You are allowed to ask questions.

You are allowed to ask for another opinion.

You are allowed to ask what your treatment options are.

You are allowed to ask for a referral.

You are allowed to tell your provider that something has changed.

You are allowed to bring someone with you.

You are allowed to advocate for yourself.

You are not difficult because you want to be heard.

And you shouldn't have to reach a breaking point—or sit in a courtroom—for someone to finally listen.

Mothers deserve to be heard before there is a crisis.

They deserve to be heard when they're whispering.

When they're exhausted.

When they're scared.

When they're saying, "I don't feel like myself."

We need better systems.
We need better access.
We need better coordination.
And most importantly, we need to listen.

Because mothers shouldn't have to be heard on trial.

Montana Therapy for Moms
Maternal mental health support for the seasons of motherhood that don't always get talked about.

If you or someone you know is experiencing severe postpartum mental health symptoms, seek urgent professional evaluation. Postpartum psychosis is a psychiatric emergency and should not be managed through routine outpatient support alone.