The trial of Lindsay Clancy, a mother accused of triple murder in January 2023, has ignited a broader discussion about how a mother actively seeking help for her mental health can end with a suicide attempt and the deaths of her children.

In a previous story, I spoke with Dr. Patricia De Marco Centeno, a board-certified consultation-liaison and reproductive psychiatrist, about the lexicon around mental health diagnoses related to pregnancy. Here, we discuss how a system designed to offer support can still fail the mothers who need it most.

The ‘Hidden Mental Health System’

"The vast majority of patients with mental health conditions never actually see a psychiatrist at all," Centeno says. Emergency physicians, obstetricians, pediatricians, hospitalists, midwives and lactation consultants are usually the ones in the room when warning signs appear instead — "the hidden mental health system," as she calls it.

Part of that gap is a genuine shortage of psychiatrists in the workforce; part of it is that many practicing psychiatrists have opted out of the insurance and reimbursement systems most hospitals rely on. Either way, the result is the same. Many hospitals lean on psychiatric evaluation teams — therapists or social workers whose only job is determining whether a patient meets the legal bar for involuntary commitment, not diagnosing or treating anything.

“A cleared risk assessment can get mistaken for a cleared diagnosis,” she shares — and a mother gets sent home who shouldn’t have been. Centeno values these multidisciplinary teams, especially in a system with a physician shortage — but the structure is no fair substitute for a board-certified........

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