Renee Sorrentino and Susan Hatters Friedman, both forensic psychiatrists with leadership roles in the American Academy of Psychiatry and the Law, discuss concerns arising from the Lindsay Clancy criminal trial. The case, now with a jury, centers on the mother who killed her three children and has drawn sustained media and legal attention to the clinical care she received beforehand. That attention has emphasized alleged failures by multiple clinicians who evaluated and treated Clancy prior to the deaths.
The public and legal scrutiny has focused on aspects of clinical decision-making, including whether treating clinicians missed diagnoses, the role and adequacy of telehealth visits, and whether medication changes were appropriate. The authors warn that this scrutiny, and the associated civil and criminal actions, could have ripple effects beyond the immediate case.
The authors note a significant workforce limitation: only about 500 reproductive psychiatrists practice in the United States. Because of this scarcity, general psychiatrists and obstetrician–gynecologists commonly serve as frontline providers for perinatal mental illnesses. While those clinicians are trained to assess and treat mood disorders, anxiety, obsessive-compulsive disorder, and the rarer but acute postpartum psychosis, they do not necessarily have the focused subspecialty training that reproductive psychiatrists possess.
Reproductive psychiatrists commonly serve in consultative roles, advising general psychiatrists about diagnosis and, importantly, about medication safety during pregnancy and the postpartum period. Given the limited number of specialists, generalists provide much of the day-to-day care for pregnant and postpartum patients.
Sorrentino and Friedman express concern that the intense legal and media focus could lead clinicians to view treatment of new mothers as unusually high risk for legal liability. That perception might prompt general psychiatrists to avoid treating mothers with psychiatric disorders, particularly patients perceived as higher risk. The authors report anecdotal feedback from trainees who have expressed apprehension about working with perinatal patients because of the case.
If clinicians become more reluctant to treat maternal mental illness, access will worsen for patients who already face long waits and limited specialist availability. The authors underscore that reducing clinician willingness to engage with perinatal patients would be an adverse outcome of the current public discussion.
Beyond clinicians declining to treat mothers, the authors describe other possible systemic shifts toward defensive medicine. One anticipated change is a lower threshold for hospitalization: symptoms that commonly occur in the perinatal period, such as intrusive thoughts and depressive symptoms, often do not require inpatient care, but heightened caution might lead to more admissions and, in some cases, separation of mothers from their infants.
The authors also warn of an increased likelihood of inappropriate referrals to child protective services driven by fear of legal consequences. Such responses could paradoxically make mothers less likely to disclose symptoms or seek help, undermining prevention and treatment efforts that would reduce risk.
The Clancy case has highlighted debate about the adequacy of telehealth for maternal mental health. Defense arguments have labeled virtual visits as inherently inferior in some respects. The authors caution that devaluing telehealth would erect a barrier for many mothers who rely on remote visits to access care — for instance, those who cannot easily travel with an infant or multiple children in inclement weather or on public transportation.
Given that telehealth has expanded access for perinatal patients, limiting or stigmatizing virtual care in response to a high-profile case could substantially reduce practical access to psychiatric evaluation and ongoing treatment.
Sorrentino and Friedman argue that the appropriate response to the Clancy case is not avoidance or defensive practice but improved education and awareness for clinicians who treat perinatal patients. They note that dozens of reproductive psychiatrists have contributed to the development of the National Curriculum in Reproductive Psychiatry, an interactive training resource intended to teach mental health professionals about reproductive psychiatry.
The authors also note their involvement in producing a practice resource on forensic reproductive psychiatry through the American Academy of Psychiatry and the Law. These and similar educational efforts aim to close knowledge gaps and support clinicians who care for pregnant and postpartum patients, particularly when complex diagnostic or medication-safety questions arise.
The authors conclude that the harmful alternative to education and improved systems is an environment shaped by fear: clinicians avoiding maternal patients, defaulting to overtreatment or hospitalization, and possibly increasing separations or child-protective referrals. That environment would make mothers less likely to seek care and would worsen access to appropriate treatment. Their recommended emphasis is on expanding training, consultation, and resources for clinicians who provide care for perinatal mental illness rather than promoting defensive medicine driven by liability concerns.
Renee M. Sorrentino, M.D., and Susan Hatters Friedman, M.D., are forensic and reproductive psychiatrists and have held leadership positions in the American Academy of Psychiatry and the Law. The article reflects their clinical and forensic perspective on the implications of the Clancy case for maternal mental health care.