Psychiatrists warn Clancy case may deter

Forensic and reproductive psychiatrists Renee M. Sorrentino and Susan Hatters Friedman warn that the Lindsay Clancy case could have a dangerous unintended consequence. They argue that intense legal and media scrutiny may make psychiatrists more reluctant to treat mothers with mental illness, worsening access to care.

Writing in STAT News, the two psychiatrists express concern that the focus on alleged clinical failures could heighten liability fears. General psychiatrists and OB-GYNs, who are often frontline providers, might avoid high-risk maternal patients as a result.

The risk of defensive medicine

The criminal case, a related civil action, and extensive media coverage have all focused on the clinicians Lindsay Clancy saw before she killed her three children. This spotlight raises the possibility that physicians will see treating new mothers as a high-liability risk.

Already, the authors report that trainees have expressed concerns about their future practices. If psychiatrists become more cautious, mothers needing treatment will find it even harder to obtain.

The reality of provider access

In an ideal world, all mothers would have easy access to reproductive psychiatrists. The reality is different. Only about 500 reproductive psychiatrists practice in the United States.

This shortage means general psychiatrists and OB-GYNs frequently serve as frontline providers. While trained to assess and treat perinatal disorders, they lack the dedicated focus of a subspecialist.

Reproductive psychiatrists have subspecialty training and devote their clinical work to such mothers. They are often consulted on diagnosis or, more commonly, for advice on medication safety during the perinatal and postpartum period.

Potential barriers to care

The defense in the Clancy case has criticized aspects of the care, suggesting missed diagnoses and inappropriate medication changes. The competence of the treating mental health experts has been questioned.

The authors note they have been approached by colleagues asking if the public will now view virtual visits as inappropriate for maternal mental health treatment. This perception would be a significant barrier.

Many mothers who struggle to attend in-person appointments find virtual visits much more accessible. Telehealth can be crucial for those facing logistical challenges like transportation with a newborn.

Beyond reluctance to treat, the authors fear systemic overreaction. Increased hospitalization for any mother reporting psychiatric symptoms is a risk. Intrusive thoughts and depressive symptoms are not uncommon in the perinatal period and usually do not require hospitalization.

Psychiatrists following the case may err on the side of caution. This could lead to unneeded hospitalization, possible separation from infants, and inappropriate referrals to child protective services. Paradoxically, it might make mothers less likely to report symptoms and get risk-reducing treatment.

Advocating for education over fear

The best response, according to the authors, is to provide awareness and education rather than engender fear. Dozens of reproductive psychiatrists worked to create the National Curriculum in Reproductive Psychiatry, an interactive teaching tool for mental health professionals.

Sorrentino and Friedman also led the creation of the American Academy of Psychiatry and the Law’s practice resource document on forensic reproductive psychiatry. The alternative, they warn, is an environment where a mother seeking help is met with fear, avoidance, and abandonment by a defensive healthcare system.