The Lindsay Clancy case has shone a spotlight on maternal mental healthcare.
Ms. Clancy, a former labor and delivery nurse, pleaded not guilty to three counts of first-degree murder in the deaths of her three children, The New York Times reported Aug. 27. She faces life in prison without parole if convicted, or, if found not guilty by reason of insanity, likely commitment to a secure psychiatric facility. Jurors began deliberating after weeks of testimony from medical professionals, family members and forensic psychiatrists. The fifth day of deliberation ended with no verdict, NBC News reported Sept. 2.
As the trial in Plymouth, Mass., continues to unfold, the country’s maternal mental health grade sits at a C in 2026, according to the Policy Center for Maternal Mental Health, with mothers reporting worse mental health than previously. Meanwhile, hospitals have closed 21 maternity units in 2026 alone, thinning an already strained safety net.
More broadly, maternal health services are seeing closures across systems — and if health systems can’t sustain the physical infrastructure of maternal care, it raises the question of how they can be expected to support behavioral health needs as well. Becker’s has tracked 21 maternity service closures in 2026 to date, following 29 in 2025, as hospitals cite financial pressure, staffing shortages and falling birth rates.
“The Lindsay Clancy case tragically illustrates this systemic breakdown across the ‘care cascade’: detection failure; severe illness is missed; the screening paradox; follow-up failures,” said Robert Trestman, MD, PhD, chair of psychiatry and behavioral medicine at Carilion Clinic and Virginia Tech Carilion School of Medicine in Roanoke.
Perinatal mental illness is common, detectable and treatable, he said, yet most affected women fall through the gaps between screening, diagnosis, referral and adequate treatment. The most severe outcomes are largely preventable.
Perinatal depression and anxiety affect roughly 12% to 20% of women, Dr. Trestman said, and depression goes undiagnosed in about two-thirds of cases and untreated in about half despite universal screening recommendations. Those figures track with the Policy Center’s fact sheet, which names maternal mental health conditions the leading complication of childbirth, affecting 20% of U.S. women.
Postpartum psychosis is a rare condition, according to Cleveland Clinic’s website, affecting between 0.089 and 2.6 out of every 1,000 births. In the U.S., it occurs between 320 and 9,400 births each year.
The Policy Center’s 2026 state report cards show the country’s overall grade edging up only slightly, from a C-minus in 2025 to a C in 2026. The report also showed no state failed outright for the first time since 2023, though none earned an A. The U.S. earned an F overall on a new “parental support” domain measuring paid leave and childcare access.
Dr. Trestman noted that most women aren’t monitored through the recommended 12 months postpartum. Among those hospitalized for postpartum psychosis or mood disorder, nearly one-third are readmitted within six months, he said.
“Screening, even when conducted, is still not treatment,” Dr. Trestman said. “When identified, fewer than 1 in 4 of those screening positive receive treatment, driven by a host of barriers including limited clinician training, absent protocols, thin referral networks, insurance gaps or complete absence, fragmentation between obstetrics and psychiatry, patient barriers — stigma, custody fears and medication concerns.”
Death by suicide and by overdose cause 22.7% of pregnancy-related deaths, and review committees deem 100% of these preventable, Dr. Trestman said. He points to integrated, collaborative-care programs like Massachusetts’ MCPAP for Moms as a model for closing the gap. The free, statewide program helps medical providers care for the mental health and substance use needs of pregnant and postpartum individuals.
The case is also raising questions about clinical practice itself. Breanna Urena, a psychiatric-mental health nurse practitioner for the Nashville, Tenn.-based Mental Health Cooperative, said the case should prompt providers to reevaluate how they diagnose, treat and respond to severe perinatal mental illnesses.
Maternal mental health conditions are far broader and more nuanced than postpartum depression alone, Ms. Urena said — a reality of which mothers and their support systems are often unaware. Each condition warrants its own clinical assessment and treatment plan rather than reliance on single screening tools like the Patient Health Questionnaire-9 or the Edinburgh Postnatal Depression Scale, she said.
That uncertainty is already playing out among providers. According to a Sept. 2 report in The New York Times, Postpartum Support International, which offers medical provider consultations with reproductive health psychiatrists, has received more questions about postpartum psychosis and diagnosing different perinatal mental illness. Providers are also fielding more questions and addressing anxiety from patients and their families.
The Times also reported that a University of North Carolina-run resource center is seeing more calls from social workers, physicians and nurses who work with pregnant and postpartum women, seeking guidance on distinguishing psychosis from more common maternal mental illness. Some community providers, according to the report, are referring patients to specialist clinics. They no longer feel comfortable managing conditions such as perinatal obsessive-compulsive disorder or perinative anxiety.
“Pregnancy and childbirth often garner enormous medical attention, but postpartum psychiatric care, as in the case of Lindsay Clancy, is often fragmented,” Ms. Urena said. “This case should prompt us to reevaluate how we diagnose, treat, and respond to severe perinatal mental illnesses.”
National data is showing the decline in mothers’ self-reported mental health, too. A 2025 JAMA Internal Medicine study found that mothers reporting “excellent” mental health fell from 38.4% in 2016 to 25.8% in 2023, while “fair” or “poor” ratings rose from 5.5% to 8.5%, based on survey data from more than 198,000 mothers.
Ms. Urena said maternal mental health conditions are the most common complication of childbirth in the U.S., yet remain frequently overlooked during the perinatal period. She called for closer collaboration between psychiatric providers and the mother’s whole care team.
“My hope is that this case urges providers not to retreat from complicated perinatal cases,” Ms. Urena said. “But rather to broaden their knowledge and comfort in supporting women during this vulnerable period.”
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