Understanding Postpartum Psychosis: When Postpartum Mental Health Becomes an Emergency
POSTPARTUM MENTAL HEALTH SERIES • PART 1
The Lindsay Clancy Trial has gained national attention and has brought light to postpartum psychosis and the difficult, painful, and impossible to ignore conversation surrounding maternal mental health in our country.
At the center of the trial is a question about severe postpartum mental illness. I am less interested in relitigating the details of what happened than in asking that much bigger question:
How do we prevent a postpartum mother from ever becoming so psychiatrically unwell that a crisis reaches this point?
Because whether individual treatments, appointments, medications, family support, or professional interventions were present in this particular case, the outcome tells us something important: it was not enough.
And that is what we - as a nation - need to examine.
Do families recognize what postpartum psychosis can actually look like?
Do partners understand when sleeplessness, paranoia, confusion, unusual beliefs, or dramatic behavioral changes require emergency intervention?
Do mothers feel comfortable enough to disclose terrifying thoughts without becoming too afraid or ashamed to keep talking?
Do providers have enough time, training, and access to perinatal mental-health care to catch the signs early?
What happens after a mother asks for help?
And when a mother’s ability to recognize their own illness begins to disappear, who is responsible for noticing that the situation has become an emergency?
Lindsay Clancy is not the first mother whose name has become associated with tragedy and severe postpartum mental illness. And unless we improve how we recognize and respond to postpartum psychiatric emergencies, she will not be the last.
We cannot keep watching these tragedies happen to ask what could have been done differently after it is too late.
We need to create a safety net that recognizes postpartum mental illness early, responds appropriately as symptoms escalate, and protects families from slipping through the cracks.
And that begins with understanding what postpartum mental illness actually looks like.
Postpartum Depression and Postpartum Psychosis Are Not the Same Thing
These terms get used interchangeably in conversations about maternal mental health, but they are very different conditions.
Postpartum depression can involve persistent sadness, hopelessness, guilt, loss of interest or pleasure, difficulty bonding with baby, significant anxiety or despair, and thoughts of death or self-harm.
Postpartum anxiety may involve racing thoughts, persistent or overwhelming worry, panic, physical symptoms of anxiety, or frightening intrusive thoughts.
An important distinction to remember:
Having an unwanted intrusive thought is not the same thing as wanting to act on that thought.
A mother may experience a frightening or unwanted thought about something happening to their baby but immediately be able to recognize that thought as inconsistent with what they actually want.
Postpartum psychosis is different.
What Is Postpartum Psychosis?
Postpartum psychosis, often abbreviated as PPP, is one of the most severe psychiatric conditions associated with childbirth.
It is uncommon, occurring in approximately 1-2 out of every 1,000 births. But uncommon does not mean unimportant.
PPP can cause someone to lose touch with reality. Symptoms can include:
Hallucinations - seeing and hearing things that aren’t there
Delusions or strongly held beliefs that aren’t based in reality
Paranoia
Severe confusion
Disorganized thinking or behavior
Manic episodes or extreme changes in mood
Severe insomnia
Thoughts of suicide or harming onesself or others
These symptoms can change quickly, which is one reason recognizing PPP can be difficult.
Postpartum psychosis is a psychiatric emergency.
A person experiencing Psychosis may not recognize that what they are experiencing isn’t real. That means we need to adjust our expectations around postpartum mental-health.
We Cannot Put the Entire Responsibility on the Mother
Our postpartum mental-health messaging says: “Reach out if you're struggling.” Reaching out absolutely matters. But it cannot be our entire safety system.
Someone experiencing postpartum depression or anxiety may recognize, “Something is wrong. I need help.”
Someone experiencing postpartum psychosis may genuinely believe the things they are seeing, hearing, fearing, or believing.
How can we expect the person losing touch with reality to be responsible for recognizing that they've lost touch with reality?
That's why partners, families, friends, doulas, healthcare providers, and mental-health professionals all have roles to play.
We need to know the warning signs before we're standing in the middle of an emergency.
Postpartum Psychosis Has to Be Taken Seriously
The truth is, most people who experience postpartum psychosis do not harm their babies.
People experiencing mental illness should not be treated as inherently dangerous, and discussing PPP should never become another reason for postpartum parents to be afraid of admitting that they're struggling.
But we also cannot minimize the severity of this condition.
Research has found an increased risk of both suicide and infant harm among people experiencing postpartum psychosis. Estimates of infanticide among PPP cases are generally in the low single digits.
Those events are rare.
But when we're talking about preventable deaths, rare is not the same thing as acceptable.
Families Need to Know the Signs, Too
We spend enormous amounts of time preparing families for pregnancy and birth.
We teach partners how to time contractions. We tell families how much postpartum bleeding is too much. We teach them how to recognize signs that a newborn isn't getting enough milk. We tell them when a fever warrants a call to the pediatrician.
Postpartum mental health deserves that same preparation.
Partners and other support people should know what mental-health warning signs look like.
Sometimes the person experiencing the crisis is the least capable person in the room of recognizing that something is wrong.
That's why postpartum mental-health education cannot simply be:
"Tell someone if you're struggling."
The people surrounding postpartum families need education, too.
Asking for Help Has to Lead Somewhere
Screening matters. But screening isn't treatment. Recognizing symptoms isn't enough if appropriate care isn't accessible.
And telling someone to reach out if things get worse isn't enough if their ability to recognize that they need help disappears as their illness progresses.
A functioning safety net requires more than one person or one appointment.
It requires education.
Accessible treatment.
Communication between providers.
Partners and families who understand warning signs.
Professionals who recognize when symptoms are escalating.
And clear pathways for getting someone to a higher level of care when they need it.
Before You Bring Baby Home
Postpartum preparation shouldn't only include diapers, feeding plans, freezer meals, and a car seat.
Families should talk about mental health, too.
Who knows you well enough to notice when something isn't right?
Who can you call when you're struggling?
Does your partner know the difference between postpartum exhaustion and warning signs requiring professional attention?
What symptoms mean we should call the provider?
And what symptoms mean we need emergency help now?
These conversations can feel uncomfortable.
But they are so important. Have them anyway.
Because protecting postpartum families means caring for the whole person—not just their physical recovery and their baby.
Maternal mental health is maternal healthcare.
Free Maternal Mental Health Resource
Maternal Mental Health: Know the Signs & Know When to Get Help
Download my free printable maternal mental health guide for information about postpartum depression, anxiety, intrusive thoughts, postpartum psychosis, warning signs, and where to find support.
→ Download the Free Maternal Mental Health Guide
Consider printing a copy and sharing it with your partner or another person in your postpartum support system.
If You or Someone You Love Needs Help
If you suspect someone is experiencing postpartum psychosis, treat it as a medical emergency. Do not leave the person experiencing psychosis alone with the baby while emergency care is being arranged.
National Maternal Mental Health Hotline
Free, confidential support available 24/7 for pregnant and postpartum people.
Call or text 1-833-TLC-MAMA (1-833-852-6262)
Postpartum Support International (PSI)
Education, peer support, provider directories, support groups, and specialized postpartum psychosis resources.
PSI HelpLine: 1-800-944-4773
988 Suicide & Crisis Lifeline
Call or text 988 for an immediate mental-health or suicide crisis.
Oregon Health Authority — Perinatal Mental Health
Learn about perinatal mental-health conditions and warning signs, find Oregon county mental-health and crisis services, connect with 211info, and find help accessing care through the Oregon Health Plan.
If there is an immediate danger to the postpartum person, baby, or anyone else, call 911 or go to the nearest emergency department.
Sources & Further Reading
American College of Obstetricians and Gynecologists (ACOG) — Perinatal Mental Health Conditions
Postpartum Support International — Postpartum Psychosis & Perinatal Mental Health
U.S. Health Resources & Services Administration — National Maternal Mental Health Hotline
Oregon Health Authority — Perinatal Mental Health
Toor R, et al. Postpartum Psychosis: A Preventable Psychiatric Emergency. 2024.
Friedman SH, Reed E, Ross NE. Postpartum Psychosis. 2023.
This article is for educational purposes and is not a substitute for medical or mental-health care.