Lindsay Clancy Case Could Deter

Intense legal and public scrutiny of the Lindsay Clancy case could make psychiatrists more reluctant to treat mothers with mental illness. Forensic and reproductive psychiatrists Renee M. Sorrentino and Susan Hatters Friedman warn this is a dangerous unintended consequence of the focus on alleged systemic failures, according to an opinion piece in STAT News.

They argue that the criminal case, a related civil action, and extensive media coverage have concentrated on the alleged failures of the clinicians who saw Clancy before she killed her three children. This raises the possibility that physicians will see treating a new mother's psychiatric disorder as a high liability risk. As a result, they may avoid high-risk maternal patients, making it even harder for mothers who need psychiatric treatment to obtain it. The authors note that trainees have already expressed concerns to them about their future practices.

The Reality of Provider Access

In an ideal world, all mothers would have easy access to reproductive psychiatrists. The reality is that only about 500 reproductive psychiatrists are practicing in the United States. Consequently, general psychiatrists and OB-GYNs are often the frontline providers for perinatal mental illnesses. While trained to assess and treat these disorders, they lack a dedicated focus on them.

Reproductive psychiatrists have more experience because of their subspecialty training. They devote their clinical work to such mothers and are often consulted on diagnoses or medication safety during the perinatal and postpartum period.

Risks of Defensive Medicine

The spotlight on medical decision-making in the Clancy case could create significant barriers to care. The defense has criticized aspects of Clancy's care, suggesting missed diagnoses, the inferiority of telehealth visits, and inappropriate medication changes. The authors report being asked if the public will now view virtual visits as inappropriate for maternal mental health treatment.

That would be a problem. Many mothers who struggle to attend in-person appointments find virtual visits much more accessible.

Beyond general psychiatrists avoiding treatment, the larger criticism could result in more cautious, systemic treatment. This might include increased hospitalization for any mother reporting psychiatric symptoms. Intrusive thoughts and depressive symptoms are not uncommon in the perinatal period and usually do not require hospitalization. Psychiatrists may now err on the side of caution by overtreating with unneeded hospitalization and potentially inappropriate referrals to child protective services. Paradoxically, this could make mothers less likely to report symptoms and get the treatment that reduces their risk.

A Proposed Path Forward

The best response to the Clancy case, the authors argue, should be to provide awareness and education rather than engender fear. To that end, dozens of reproductive psychiatrists worked to create the National Curriculum in Reproductive Psychiatry, an interactive curriculum to teach mental health professionals. The two authors also led the creation of the American Academy of Psychiatry and the Law's practice resource document on forensic reproductive psychiatry.

The alternative is to create an environment where a mother seeking psychiatric treatment is met with fear, avoidance, and abandonment by a healthcare system practicing defensive medicine.