Diana Lynn Barnes, Psy.D (President, PSI 2002-2004)
George Parnham (Defense Counsel, Andrea Yates)
There are more psychiatric admissions around the child-bearing years than at any other time in the female life cycle.
Each year, as many as 800,000 women will experience some form of postpartum mood disorder that will disrupt their relationship with their infants, their partners, family members and friends.
Severe maternal depression carries with it the characteristic features of impaired judgment, thought distortions and emotional detachment that increases a woman’s risk for child neglect, abuse and even fatal injury to her child.
POSTPARTUM SUPPORT INTERNATIONAL BELIEVES:
Prevention is only possible through awareness. The channels for communicating and organizing information, knowledge and support are the family, the law and the community.
THE FAMILY
A woman’s reproductive history has a direct bearing on her mental health postpartum and her relationship with her children, particularly her infant.
In addition to live births, reproductive events also include miscarriages, abortions, stillbirths, ectopic pregnancies and any other fetal or infant loss.
In many cases, the origins of a woman’s depression or psychosis are tied to these reproductive events that occurred long before the actual legal offense that brings her to trial.
Even in cases where there is no live birth, the undue stress of a reproductive event along with the physiological changes and psychological impact precipitated by the event can have a lethal impact on a woman’s behavior in relationship to her children.
POSTPARTUM SUPPORT INTERNATIONAL BELIEVES:
Family members must familiarize themselves with the symptoms of mood disorder and the range of ways in which perinatal mood disorders present themselves.
Family members must pay attention to the new mother’s behavior during pregnancy as well as during the first year postpartum. Her behavior provides clues as to the state of her mental health and the risk to herself and/or her children for self-injury or harm.
THE LAW
Current law permits individual states to construct their own unique standards that determine how the actions of the mentally ill mother are governed. The M’Naghten standard (commonly referred to as the “right from wrong” test) provides the basis for most state insanity provisions, although the language varies considerably from state to state. (Note: Four states Kansas, Idaho, Utah and Montana have no insanity standards).
Other societies have incorporated into their legal structure the defense of infanticide. This defense is available to a mother who harms her child within 12 months of the child’s birth and who suffers from postpartum illness.
The international community of medical science acknowledges the reality of perinatal mood disorders as gender and biologically based illnesses that occur around pregnancy and birth.
POSTPARTUM SUPPORT INTERNATIONAL BELIEVES:
A competent presentation of women’s mental health issues to judges and juries engaged in the criminal justice system is critical. In some, the actions of the mother must be legally viewed through her eyes and her mental state at the time of the act.
Only clinicians trained in postpartum issues are able to explain to a jury in understandable terms through an equally educated defense counsel the reality of postpartum illness and the thought process of the suffering mother.
Only a women’s reproductive mental health specialist with a foundation in postpartum illness should be permitted to render an opinion as to whether or not the mother on trial appreciates the nature and quality of the act she was committing or “knew” her conduct was wrong.
The appointment of an expert specifically trained in women’s reproductive mental health is essential to the defense in terms of fitting together the relevant pieces of a woman’s reproductive and mental health history in order to determine any connections between her state of mind and the events surrounding the harm to her child.
THE COMMUNITY
The community consists of all those who are directly or indirectly involved in the care of women and their families. This includes - obstetricians, pediatricians, psychiatrists, psychologists, marriage and family therapists, social workers, doulas, midwives, lactation consultants, childbirth educators, labor and delivery staff, hospital personnel , defense counsel, public defenders, and district attorneys, among others.
POSTPARTUM SUPPORT INTERNATIONAL BELIEVES:
Women must be routinely screened during pregnancy and the first year postpartum.
Those women who are identified as at risk must be monitored throughout their pregnancy and into the first year postpartum.
The community has a responsibility to provide appropriate resources and referrals to knowledgable health care providers so that they may receive appropriate treatment.
The community has a responsibility to educate and inform itself about the most current assessment and treatment practices for perinatal mood disorders.