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\t\t\t\t Many women with a history of mental illness get pregnant; others who were previously healthy experience symptoms for the first time while pregnant. Thirteen percent of all pregnant women use selective serotonin reuptake inhibitor antidepressants (SSRIs), according to Maria Muzik, a psychiatry and obstetrics and gynecology professor at the University of Michigan and the director of its Perinatal and Reproductive Psychiatry Clinic<\/a>. Eighty percent of them obtain their prescription from an OB-GYN rather than a psychiatrist, she told me. And, though the experience of severe mental illness and motherhood remain almost invisible in popular discussion, more than 100,000 women<\/a> with severe mental illnesses have children every year in the United States. Most women with serious mental health conditions<\/a> like schizophrenia and bipolar disorder are mothers.<\/p>\n These women often experience gaps in care like Clancy\u2019s. Average inpatient psychiatric hospitalization stays are five to seven days<\/a>. Many outpatient psychiatrists and therapists don\u2019t take insurance. When they do, copays can be a significant barrier. Vast areas of the country, particularly rural regions, are deserts for psychiatric care and reproductive psychiatric care. Muzik estimated there might currently be six to 10 practicing reproductive psychiatrists in the entire state of Michigan. Only\u00a06% to 8%<\/a>\u00a0of women with peripartum depression receive adequate psychiatric treatment, and suicide and homicide combined are the leading cause of maternal mortality<\/a> in the United States.<\/p>\n After deciding to start a family, my husband and I sought prenatal counseling on the safety of my medication regimen in pregnancy and my potential for relapse at a university medical center. But this potentially lifesaving prenatal care remains out of reach for many women with serious mental illness, 20% of whom are uninsured<\/a>.<\/p>\n To fill the gap in reproductive psychiatric treatment, practitioners are developing a workaround \u2014 maternal mental health consultation hotlines like UMass Chan Medical School\u2019s Lifeline for Moms<\/a> or the University of Michigan\u2019s MC3<\/a>, with a phone line Muzik staffs every Friday. These hotlines are a critically important innovation, allowing primary care physicians, nurse practitioners, and OB-GYNs to receive real-time guidance from specialists, improving clinician confidence.<\/p>\n But they have become a substitute for the specialized workforce the country has never built. Imagine asking primary care physicians to manage leukemia over the phone because oncologists were so scarce \u2014 we\u2019d recognize there was a problem.<\/p>\n Even more damagingly, women often receive care from practitioners who declare they are specialists but have no real reproductive psychiatry training, according to Lauren Osborne, the vice chair of clinical research in the Department of Obstetrics and Gynecology at Weill Cornell Medicine. \u201cAnybody can hang out a shingle and say, \u2018I\u2019m a reproductive psychiatrist,\u2019 and there\u2019s nothing to say that somebody is or is not,\u201d she said. \u201cPeople who have more severe versions of these [mental health] disorders, who are seeking out help and expertise, find somebody they think is qualified, and that person isn\u2019t, and things get missed, and there can be tragic consequences.\u201d<\/p>\n \t\t\t \t\t\t\t\t\tI\u2019m a reproductive psychiatrist. The Lindsay Clancy trial will cause terrible damage to my field<\/a><\/p>\n Training in reproductive psychiatry is inconsistent, with expertise remaining concentrated at universities. Despite the complexity of treating psychiatric illness during pregnancy and the severe need, the United States still has no formal reproductive psychiatry subspecialty or standardized national training pathway. The American Board of Psychiatry and Neurology requires that a general psychiatry subspecialty reach a certain number of fellowships and trainees in those fellowships to be formally approved, Osborne told me.\u00a0At least 25 fellowships with 50 trainees enrolled\u00a0are needed; 18\u00a0programs, nearly all of which have a single trainee and\u00a0all of which differ, currently exist\u00a0in reproductive psychiatry.\u00a0<\/p>\n \u00a0\u201cIt\u2019s probably 15 or 20 years, even as quickly as the specialty is growing, before we could reach that [threshold], and maybe even longer because there\u2019s no money to support these fellowships,\u201d Osborne said.<\/p>\n If they become pregnant, women who experience psychosis often have little support. And psychosis is a uniquely traumatizing condition. My husband and I sometimes laugh about my delusions: how, during my psychotic break, I believed a fellow psychiatric patient with religious delusions was a Vatican assassin, hunting me down, her repetition of the word \u201ctray\u201d code for \u201cprey.\u201d How I thought my grandmother plotted to kill my cats, so I packed them in their carriers, put them in the backseat, and attempted to cross the Blue Water Bridge from Michigan into Ontario without a passport.<\/p>\n These stories are funny \u2014 and not. People experiencing such devastating delusions deserve humane, quality care. With such care, we are capable of leading rich, fulfilling lives \u2014<\/p>\n And even being good parents.<\/p>\n A solution is taking shape to the maternal mental health care crisis. Realizing they can\u2019t wait 20 years or longer, Muzik, Osborne, and other leading clinicians and advocates have founded a nonprofit organization that is working to establish its own board certification exam. Many other specialties, including obesity and breastfeeding medicine, have followed a similar path to certification, Osborne told me.<\/p>\n This nonprofit, the\u00a0North American Board of Reproductive Psychiatry<\/a>, is beginning to establish a set of standards. For instance, to be eligible to sit for the exam, a clinician will have had to complete a fellowship in reproductive psychiatry\u00a0or consult-liaison psychiatry,\u00a0or have substantial clinical practice and some continuing medical education, according to Osborne.<\/p>\n \u201cWe\u2019re hoping eventually that money earned from that exam can then be fed back in to form more fellowships,\u201d she said. \u201cWe would eventually love to see this be something where, to be a qualified reproductive psychiatrist to sit for that exam, you have to have done [a] fellowship, but we need a pathway to increase the numbers of fellowships. Our approach was to tackle the board certification first and use that as a path to then create more fellowships.\u201d<\/p>\n Osborne also directs the National Curriculum in Reproductive Psychiatry<\/a>, what amounts to a fellowship-length education for reproductive psychiatry. Osborne estimates that most of the fellows from the currently established reproductive psychiatry fellowships are now training in it, along with many fellows from the related consult-liaison specialty,\u00a0an important step to regulating this care in the United States.<\/p>\n The North American Board of Reproductive Psychiatry is actively fundraising to mount the first exam and publicizing its work.<\/p>\n The reproductive needs of women with serious mental illness deserve to be considered, our right to make decisions for ourselves honored. Clinicians should be working to support us, not fumbling incompetently or making paternalistic determinations. With proper support, we can make informed reproductive choices.<\/p>\n \t\t\t![\"\"\/](\"https:\/\/www.statnews.com\/wp-content\/themes\/stat\/images\/home\/statplus.svg\")
\n\t\t\t\tSTAT Plus: Lindsay Clancy case exposes dangers of fragmented U.S. health system, experts say<\/a><\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/09\/AP26231616995533-768x432.jpg\")
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