A woman with schizophrenia once heard a friend describe how her relative had forced their schizophrenic son to undergo a vasectomy. The comment struck her as controlling, even harmful. She thought: Maybe I shouldn’t be a mother.
She had spent over a decade managing her condition through medication, despite past overdoses and a psychotic episode that included driving on a freeway ramp in a dissociative state. The last thing she remembered was her hands on the steering wheel as she accelerated up a freeway on-ramp. Still, she and her husband decided to try for a pregnancy, attending prenatal appointments at a university-affiliated medical center. The care she received was exceptional. Most women with severe mental illnesses—including schizophrenia, bipolar disorder, or psychosis—encounter treatment gaps long before conception.
In the U.S., 13% of pregnant women are prescribed SSRIs, but 80% of those prescriptions come from OB-GYNs rather than psychiatrists, according to Maria Muzik, director of the University of Michigan’s Perinatal and Reproductive Psychiatry Clinic. Yet only 6% to 8% of women with peripartum depression receive proper psychiatric care. Suicide and homicide have now surpassed childbirth complications as the leading causes of maternal death. The healthcare system fails women at every stage.
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Postpartum psychosis: A deadly gap in care
Lindsay Clancy’s case illustrates the consequences. Her husband, Patrick, later told 60 Minutes that he did not recognize the risks of postpartum psychosis until it was almost too late. He said he understood anxiety and depression, but he didn’t know how to manage a postpartum illness. Clancy’s story is extreme, but it reflects a larger reality: more than 100,000 women with severe mental illnesses give birth annually in the U.S., yet their care remains disjointed.
Insurance barriers, rural psychiatric service shortages, and brief hospital stays, averaging five to seven days, leave women exposed to preventable risks. In Michigan alone, Muzik estimates there are only six to ten reproductive psychiatrists for the entire state. The shortage forces clinicians to depend on resources like the University of Michigan’s MC3 hotline, where Muzik offers real-time guidance to primary care providers. Yet this approach cannot replace specialized care. Relying on general practitioners to manage complex mental health conditions over the phone is no different from asking them to diagnose leukemia without proper training.
Fake specialists and unchecked risks
Lauren Osborne, vice chair of clinical research at Weill Cornell Medicine, highlights another critical issue: anyone can call themselves a reproductive psychiatrist without formal credentials. She said that women with severe mental illnesses often seek out providers they assume are qualified; but aren’t. Critical details get overlooked, and the results can be devastating.
The lack of standardized training compounds the problem. The American Board of Psychiatry and Neurology requires 25 fellowship programs with 50 trainees to establish a formal subspecialty in reproductive psychiatry. Currently, only 18 programs exist, nearly all with a single trainee, and none follow a consistent curriculum. Osborne describes the gap as a crisis, noting that in one incident, she ran away from the group home where she had been institutionalized, eating Benadryl tablets like M&Ms and knocking them back with Budweiser, then drove in a blackout.
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Without structured pathways, women like the writer, who ultimately decided against pregnancy after years of consideration, face impossible decisions. Her mother’s words during a miscarriage grief session stayed with her: “Meggie, you’re allowed to choose your health.” The message was clear: she had the right to prioritize her well-being. For others, however, the system offers no such clarity.
Certification push to fix broken system
Efforts to address these gaps are underway. Muzik and Osborne co-founded the North American Board of Reproductive Psychiatry, a nonprofit aiming to create a board certification exam. If approved, it could standardize training and expand fellowship opportunities. Osborne estimates the process will take 15 to 20 years before the field reaches full capacity. Until then, women with severe mental illnesses depend on fragmented care, hotlines, and the discretion of individual providers.
The writer’s own history, including multiple overdoses, a psychotic break, and a near-fatal dissociative episode while driving, left her questioning her ability to parent. During one episode, she became convinced a hospital patient was a Vatican assassin, her repetition of the word “tray” code for “prey.” Another time, she packed her cats into carriers, believing her grandmother intended to harm them, and attempted to cross the Blue Water Bridge from Michigan into Ontario without a passport. These experiences reflect the unpredictable nature of psychosis, a condition that distorts reality in ways most people cannot grasp.
