Lindsay Clancy & the state of Postpartum Support

Lindsay Clancy’s case highlights the inequities and shortcomings of our mental healthcare system specifically, and our health insurance system at large. These shortcomings fall into two broad categories: 1. Changes in health insurance coverage that have dwindled access and treatment timelines down to a nub and 2. Shortfalls in the continuity of care due to hectic schedules, lack of reimbursement for communication, and the absence of functional wrap-around services. The end result of these repeated failures is just this: an outcome so terrible and chaotic that it seems like everyone is to blame. This is what systemic collapse looks like.

I have known many folks who have needed access to inpatient psychiatric care but have waited in emergency rooms for 24 hours or more without receiving a spot in an inpatient facility. I also know that aftercare planning for a hospitalization is predicated on the availability of aftercare services. Psychiatric appointments, which used to be the length of a therapy session, now reimburse for drastically truncated time periods. Lindsay Clancy’s appointment with her psychiatrists were each around 17 minutes long. When I entered the field in 2003 there were wrap-around services for children and teens that included inpatient hospitals, day treatment programs, home-based therapy, psychiatry, and peer mentoring. Inpatient hospitalizations could be as long as six weeks depending on the case. Now I find that partial hospital programs are few and expensive, hospitalizations are routinely 2-3 days, and waitlists for psychiatrists are over six months long. 

The feeling of this experience for the person in the midst of a psychiatric crisis (while also being in the midst of parenting three children under the age of six) is unfathomable. Lindsay Clancy did her due diligence by asking for help over and over, seeking multiple avenues of receiving help, and checking herself into an inpatient facility. But the shortness of time allotted to her and to her providers to gather history, titrate down off of meds that weren’t working, and keep her safe long enough to stabilize her, was a hard stop to every effort she made.

This is, of course, because our mental health system is run by health insurance companies that are run with the priority of gaining profit. Over the last twenty years we have seen access to care dwindle, reimbursement rates for care dwindle, loopholes in which providers are not paid expand, copays expand, deductibles expand, and as a result, increasingly we find that high quality mental health programs for teens, adults, and postpartum moms do not take insurance at all. They offer superbills, which means that the patient pays full price, gets a bill, and submits it to the insurance company, which will then either pay or not pay and will certainly cause time and cognitive frustration on the part of whomever gets the joy of having to make that call and track that money. I can tell you from experience, that enough of that and you will need another round of therapy.

I am curious about the experiences of my fellow therapists who have been practicing for the past 20-30 years: how have you seen the landscape change? What have you noticed about in-patient hospitalizations, outpatient partial hospitalizations, access and communication with other members of your treatment teams, as well as access to mental health talk therapy, or involvement with a psychiatrist who is able to follow care closely? How have your rates changed over time and what is your experience with health insurance companies? 

I am incensed that the Lindsay Clancy trial centers on the narrow focus of whether Lindsay Clancy knowingly murdered her children or if her treatment team failed her when we already know that everyone failed her. We also failed her psychiatrists by not reimbursing for more than 15 minute med management sessions, and those who work for inpatient mental facilities by dwindling reimbursement for psychiatric inpatient stays down from several weeks to several days; and we continue to fail every single mother and family by systematically ignoring the experiences of women and the issues present in women’s perinatal healthcare due to our patriarchal, profit driven, dismissal of the health experience of perinatal people. 

Postpartum depression is not even in the DSM, let alone the constellation of disorders which also occur in tandem with child rearing. These include, but are not limited to, postpartum depression, postpartum anxiety, postpartum OCD, postpartum psychosis, and postpartum bipolar disorder. One in five women and one in ten men suffer from some form of perinatal mental health challenge.

What is truly needed in order to create a wrap-around program for postpartum families is a team of psychiatrists, a team of lactation consultants, a team of mental health professionals and a team of grandmas and grandpas. Plus, several support groups. The truth of the matter is that Lindsay Clancy needed better access to stable mental health support, yes, better history taken, better communication among her providers and a longer inpatient stay in which her meds and sleep were stabilized, and her bipolar and psychotic symptoms fully addressed. She also needed her kids completely cared for while she received this care. Finally, she would have benefited from therapy or counseling, and timely support from other mothers in the form of a support group (which are being offered, free of cost, through Postpartum Support International).

Does this sound like a lot of investment? Maybe it is, but the entire US mental health services and treatment market amounted to around $118 billion dollars (data from 2024), roughly 12% of what we spent on AI last year.

Please contact Postpartum Support International for much needed free support groups, resources and training: Postpartum Support International - PSI ]