The trial of Lindsay Clancy has dominated international headlines since the end of July. Outside of the media storm, this tragic case raises policy issues important to maternal mental health in Northern Ireland.  

Clancy, a former labour and delivery nurse, is accused of killing her three children Cora, Dawson, and Callan, on January 24 2023, and subsequently attempting suicide, which left her paralysed below the sternum. 

Her defence argues that she was suffering from severe postpartum mental illness, including psychosis, at the time of the killings. The prosecution maintains that she is criminally responsible for her actions. 

The trial raises questions society are profoundly uncomfortable with, and struggle to find concrete answers for.

Although it is an incredibly divisive and difficult trial to follow, I have followed it with interest as, two days after the birth of my daughter in February 2023 I was sectioned to a general psychiatric ward with suspected postpartum psychosis.

What is postpartum psychosis?

Postpartum psychosis is a serious mental illness and a medical emergency which usually occurs shortly after the birth of a baby, although it can manifest later. It is characterised by hallucinations, delusions, mania, and confusion amongst other serious symptoms. There can be a danger of imminent harm to the mother and the child if it is not treated in a timely and appropriate way by expert professionals. People who experience postpartum psychosis may not realise that they are ill. Often their partner, family, or friends have to help them to seek treatment.

It is not merely 'the baby blues', ‘new mum anxiety’, or 'a hormonal blip'. It is a serious psychiatric illness that usually requires immediate hospitalisation. It is indiscriminate in who it affects. I had no previous mental health issues, I had a relatively straight forward birth, and a willing support network of friends, family, and church. My only risk factor, which saw me go straight from the postnatal ward to the general psychiatric ward, was having a baby. 

I am conscious of the cacophony of voices commenting on the Clancy trial and have asked myself what good can come of another one adding to the noise. However, if we as a society do not use this as an opportunity to educate ourselves and others on maternal mental health and to examine how we can best meet the needs of new mothers and their babies then we have failed. Utterly. 

What is needed for new mums and their families?

Whilst I cannot claim to be a psychiatrist, a midwife, or a mental health worker I know what it is like to be a mother who is unable to trust her own thoughts, to not recognise herself, and it is terrifying. There are some fundamental requirements to ensuring mothers and their babies get the right help, in the right place, at the right time.

●        Timely and expert diagnosis - maternal mental illness is acute, sudden onset, and it can affect those with no previous psychiatric issues. This can make it hard to anticipate, detect, and diagnose with variances between the symptoms, severity, and treatment required for a wide spectrum of issues. During my time on the general psychiatric ward I was diagnosed with adjustment, panic, and depressive disorder. A multi-issue disorder, requiring a variety of interventions including continual observation, talking and group therapies, and medications. Too often postpartum issues are diminished, dismissed, misdiagnosed, or missed entirely. With up to 1 in 4 new mums experiencing some form of perinatal mental health condition we need to get serious about how we assess, diagnose, and treat new mothers in this crucial early window.

●        Clear referral pathways and joint working - It’s a well-worn trope that the health service must work better together. In the case of maternal mental health, it is crucial and potentially lifesaving. I was ‘lucky’ in a sense that my symptoms manifested so shortly after birth in a hospital where I was surrounded by multiple different specialists who could make swift, real-time decisions. With so many interventions so shortly after birth, and so few in the months that follow, it is imperative that all professionals are familiar with a patient's full presentation history, know the appropriate referral pathways and patient interventions are recorded and shared.

●        Mother and Baby Units (MBUs) - These specialist, multi-disciplinary units provide supervised and co-ordinated expert care where mums can be treated whilst they remain with their baby. The previous Health Minister committed to ensuring the delivery of such a unit by 2029 at the latest. They are not a perfect solution, but evidence suggests that there are much improved outcomes for both mother and baby when they are treated in an MBU. And whilst it may seem crude, there is also a cost saving element. Research indicates mothers in MBUs generally feel more satisfied with their treatment, recover more quickly, and fathers, difficult as it might be, can continue to work whilst the mother and baby are admitted.  

●        Education - The Clancy trial has the world asking questions about maternal mental illness, treatment, support, and the state of the medical institutions. However these questions must be met with evidence based, expert informed, and accessible education to help challenge misinformation and identify when someone needs help. It should extend beyond those delivering postpartum care in the first few days. For example pharmacists, health visitors, GPs, and practice nurses will engage with new mums and babies up to the first year following birth. These are prime opportunities to educate and intervene to support new mums and their families. 

What happens next?

At the time of writing the Clancy case has been officially declared a mistrial. Whatever the next steps, I hope that those involved in the case have wisdom, understanding, and compassion, and those commenting on the case have more of the same.

Whatever the outcome, my hope is that policymakers become better informed about the challenges and will consider how we can translate informed thinking into practical on the ground support.

●        Where to find help

●        Where to learn more about PPP and where to learn more about maternal mental health

●        I will be speaking at the upcoming event celebrating specialist perinatal mental health services on Friday 2 October. Register to attend and support.

Laura Orr, writing in a personal capacity as a lived experience campaigner with Action on Postpartum Psychosis. Laura is Regional Public Affairs Officer with Dogs Trust, Chair of the Northern Ireland Companion Animal Welfare Group, Vice Chair of Breastival, and Board member of Acacia Path. Mum of one, living on the North Coast. Member of Portstewart Baptist Church. When not working or mumming can be found walking hills and attempting pilates.