Eleven days after the Lindsay Clancy mistrial, Governor Healey stood in Beth Israel Deaconess Medical Center and proposed spending $2.25 million on maternal mental health. The money would expand two programs that already exist. It would not change a single line of Massachusetts criminal law, and it is not meant to. But it is the first official response to a case that turned on postpartum psychosis, and it is worth understanding precisely what it does, because the gap between what the proposal reaches and what the Clancy case exposed is the whole story.
One juror’s reaction captured it. Paula Devlin, 65, one of the eleven who voted that Clancy was not criminally responsible, told Boston 25 through tears: “I thought maybe, if we got to talk about this 10 years from now, there might be some kind of change. I just can’t believe people have listened and are willing to really look at postpartum.” She added: “It just seems like if she had gotten the right help that she needed, those three children would still be here.”
This piece explains what postpartum psychosis is, what the Governor actually proposed, how Massachusetts criminal law currently treats a postpartum mental illness, why Massachusetts has no postpartum defense and Illinois does, and what would have to change for the law to catch up with the policy.
What the Governor proposed
Three things, announced Tuesday and described by the Governor’s office to WBUR and NBC10 Boston.
First, $2 million to expand Welcome Family, a Department of Public Health program that sends a maternal and child health nurse to a family’s home once, free, within the first weeks after a birth. The program currently reaches about 3,000 births a year. Massachusetts has roughly 68,000 births a year. The additional money is intended to make the visit available to every parent. In 2025 the program conducted 1,620 postpartum depression screenings, of which 208 were positive, and referred those parents to services.
Second, $250,000 to expand the Department of Mental Health’s Massachusetts Child Psychiatry Access Program for Moms, known as MCPAP for Moms, which supports the obstetricians, pediatricians and primary care doctors who are usually the first to see a struggling parent. The Governor’s office says the expansion would let the program track postpartum psychosis data specifically and build a clinical education team for mental health providers.
Third, and without any appropriation, the Department of Public Health plans to update its regulations to improve screening for mood and anxiety disorders during and after pregnancy.
Both funding requests go into a supplemental budget filing, which means the Legislature has to pass them. Neither is law yet.
What postpartum psychosis is, and why it is different
Postpartum depression and postpartum psychosis are not the same condition, and the distinction matters legally. Postpartum depression is common, affecting roughly one in eight people who give birth. Postpartum psychosis is rare, occurring in something on the order of one to two births per thousand, and it is a psychiatric emergency. It involves a break with reality: delusions, hallucinations, or a disordered belief system, typically with a rapid onset in the days or weeks after delivery.
The legal significance is that a break with reality is the kind of impairment Massachusetts criminal law recognizes. Depression, however severe, ordinarily is not. A defendant who knew what she was doing and knew it was wrong is criminally responsible no matter how much she was suffering. That line, not the severity of the illness, is where cases are won and lost. We explain the standard in what not guilty by reason of insanity actually means in Massachusetts.
How Massachusetts law handles it now
Through a defense written in 1967 that says nothing about childbirth. Under the McHoul standard, a defendant is not criminally responsible if, as a result of mental disease or defect, she lacked substantial capacity either to appreciate the wrongfulness of her conduct or to conform her conduct to the requirements of the law. Postpartum psychosis enters a Massachusetts courtroom as one possible source of a mental disease or defect. It has no special status, no presumption, and no separate instruction.
That is what the Clancy jury was asked to apply, and Devlin’s account of the deliberations describes it exactly: “We had to look at the evidence, and the evidence said she was in a psychotic break. In Massachusetts, that’s a reason to be not responsible.”
Once the defendant raises the issue, the Commonwealth must prove criminal responsibility beyond a reasonable doubt, the same standard as every other element. That is a defendant-friendly allocation compared with most states. It is also why these cases are fought with competing expert witnesses rather than over the law.
Why Illinois has something Massachusetts does not
Illinois is the only state with a statute that makes postpartum mental illness a mitigating factor at sentencing. Public Act 100-0574, effective June 1, 2018, allows a court to consider an undiagnosed or untreated postpartum depression or postpartum psychosis when imposing sentence, and it allows a woman already convicted to seek a new sentencing hearing if qualified medical evidence of the condition was never presented at her trial or sentencing. A companion provision added in 2019 extends that route to forcible felonies.
What the Illinois law does not do is create a defense. A defendant in Illinois still has to meet the insanity standard to be acquitted. The statute operates after conviction, on the sentence.
Massachusetts has no equivalent. A Massachusetts jury either finds a defendant not criminally responsible, in which case she is committed to a secure psychiatric facility for what is frequently longer than a prison term would have been, or it convicts, in which case murder in the first degree carries a mandatory life sentence without parole and the judge has no discretion to consider postpartum illness or anything else. There is no middle. The all-or-nothing structure is a large part of why these trials are so bitterly fought, and why a hung jury is a plausible outcome.
England has had an Infanticide Act since 1922, most recently in its 1938 form, which reduces what would be murder to a lesser offense where a mother’s mental balance was disturbed by the effects of birth or lactation. Massachusetts has never adopted anything like it, and the Governor’s proposal does not propose one.
What the proposal reaches, and what it does not
It reaches detection. A universal home visit and a better-supported network of front-line doctors are aimed at finding the parent in trouble before a crisis, and the 2025 figures, 1,620 screenings producing 208 positives, show the mechanism working at small scale. Expanding it to 68,000 births is a genuine change in the state’s posture toward maternal mental health.
It does not reach treatment capacity. A positive screen produces a referral, and a referral is only as good as the appointment at the end of it. Massachusetts has a shortage of psychiatric beds and of outpatient mental health providers, and neither $2 million nor $250,000 changes that. A screening program that identifies more people than the system can treat converts a detection problem into a waiting list.
It does not reach the specific illness at issue in the Clancy case. Postpartum psychosis has an onset measured in days and a trajectory measured in hours. A one-time home visit in the first weeks may catch it, and the MCPAP expansion’s promise to start tracking postpartum psychosis data suggests the state does not currently know how often it occurs here. But a screening questionnaire is designed for depression and anxiety, and a woman in a psychotic break is frequently not able to report it.
And it does not touch the criminal law at all. Nothing in the proposal would change how the next case is charged, defended or sentenced.
What would
Three things a Legislature could do, none of which has been filed.
A sentencing provision on the Illinois model, allowing a judge to consider postpartum illness at sentencing and permitting resentencing where the evidence was never presented. In Massachusetts this would have limited reach, because the mandatory life sentence for murder in the first degree would have to be amended for it to matter in the cases that draw attention.
A lesser included offense, on the English model, giving a jury a middle verdict between conviction of murder and acquittal by reason of insanity. This is the change that would most directly address the all-or-nothing problem, and it is also the most controversial, because it necessarily means a shorter period of confinement for someone who killed a child.
A mandatory screening requirement in statute rather than regulation, with a treatment guarantee attached. The Department of Public Health’s regulatory update is the administration doing what it can without the Legislature. A statute could require both the screen and the appointment.
Devlin, the juror, put the policy question in the only terms that matter to her: “If something good and positive can come of all this sadness, then that is justice for those children.” Whether the Legislature funds a supplemental budget in the fall is the first test of that.
Common questions
What is postpartum psychosis?
A rare psychiatric emergency, occurring in roughly one to two births per thousand, involving a break with reality through delusions or hallucinations, usually with rapid onset in the days or weeks after delivery. It is distinct from postpartum depression, which is far more common and does not involve loss of contact with reality.
Is postpartum psychosis a defense to murder in Massachusetts?
Not on its own. It can supply the mental disease or defect element of the insanity defense under the McHoul standard, which asks whether the defendant lacked substantial capacity to appreciate wrongfulness or conform her conduct to the law. Once raised, the Commonwealth must disprove it beyond a reasonable doubt.
What did Governor Healey propose?
$2 million to expand the Welcome Family home nurse visit program from about 3,000 births a year toward all 68,000, $250,000 to expand MCPAP for Moms, and a Department of Public Health regulatory update on screening. The funding requires legislative approval in a supplemental budget.
Does any state treat postpartum illness specially in criminal law?
Illinois, under Public Act 100-0574 (2018), allows postpartum depression or psychosis as a mitigating factor at sentencing and permits resentencing where the evidence was never presented. It is not a defense. No such law exists in Massachusetts.
Would this proposal have changed the Clancy case?
Nothing in it changes criminal law, charging or sentencing. Its effect is on detection and referral before a crisis.
Proposal details and figures from the Governor’s office as reported by WBUR and NBC10 Boston, September 15, 2026. Juror Paula Devlin’s remarks from Boston 25 News, September 15. Illinois Public Act 100-0574 and its 2019 companion as described by the Policy Center for Maternal Mental Health and NBC Chicago; the Illinois session law text was not retrieved. Prevalence figures for postpartum depression and psychosis are the ranges generally reported in the clinical literature and are approximate. The McHoul standard is set out in our September 9 explainer. This is general information about Massachusetts law, not legal or medical advice. If you are struggling after a birth, the national Maternal Mental Health Hotline is 1-833-852-6262 and the Suicide and Crisis Lifeline is 988.