Whatever happens next in the murder case against Lindsay Clancy after a Massachusetts jury failed on Friday to reach a verdict, it is certain that she will remain institutionalized for many months, if not years.
Even if she is not ultimately convicted, medical and legal experts have said that her future will be one of confinement.
Ms. Clancy does not deny strangling her three children with exercise bands in 2023. Her symptoms of postpartum psychosis in the months before she killed them were at the center of her defense. Her lawyers argued that she was not legally responsible for the deaths.
That view apparently persuaded most of the jury members in the monthlong trial. Notes from the jury suggested that 11 of the 12 jurors seemed ready to acquit Ms. Clancy. But one lone juror declined to join the rest, even after apparently expressing doubts about her guilt.
A similar debate has captivated and divided the American public for weeks. At its core is a fundamental disagreement about how Ms. Clancy should spend the rest of her life. Should she be labeled a criminal and imprisoned? Or should she be regarded as a victim of a sort, who should be provided treatment? In neither case would she go free. But to what end should her confinement serve?
Michelle Oberman, a law professor at Santa Clara University who studies legal issues around pregnancy and motherhood, said it felt like a “watershed moment” that most jurors seemed inclined to support the idea that Ms. Clancy should be helped, not punished.
Eleven of 12 jurors apparently agreed, she said, that “postpartum mental illness is real, and that postpartum psychosis can cause someone to do something they’d never otherwise do.”
The murder charges against Ms. Clancy remain intact after the mistrial, and will keep her locked up in a local psychiatric hospital for now, while the state decides whether to try her again, according to her lawyer, Kevin Reddington.
In remarks after the judge declared the mistrial, Mr. Reddington said that Ms. Clancy would be returning to Tewksbury Hospital, where she was held during the trial. It is a state-run psychiatric facility about an hour’s drive from where Ms. Clancy was tried in Plymouth, Mass.
The judge set a Sept. 29 status hearing in the case.
Timothy Cruz, the Plymouth County district attorney, did not immediately pledge to retry Ms. Clancy, saying on Friday that the decision would come later. But he strenuously defended his decision to charge her with first-degree murder and said the case was about seeking justice for her three dead children.
The forceful tone of his remarks signaled that he was not likely to walk away from seeking accountability for Ms. Clancy, though it is possible the case could end with a negotiated plea bargain that forgoes the need for another lengthy and gut-wrenching trial.
Mr. Cruz dismissed the suggestion that the case was about mental health issues after the mistrial was announced on Friday, saying the trial was “about getting justice for those three little babies.”
If Ms. Clancy is ultimately found not responsible for the crimes, experts say she may be sent to a high-security forensic psychiatric hospital — a center to treat people who have stood criminal trial — for long-term mental health care.
Several psychiatrists said that for many women, symptoms of postpartum psychosis are treated and resolved within a year. But even if she is found not guilty because of that diagnosis, Ms. Clancy will most likely be treated for other ongoing issues, such as suicidal thoughts and a potential diagnosis of bipolar disorder, which can be a risk factor for postpartum psychosis.
Dr. Katrina Furey, a reproductive psychiatrist, has treated patients with postpartum psychosis for about a decade. She said treatment could be conducted through a combination of drugs, and sometimes with electroconvulsive therapy, in which electricity is used to trigger a short seizure that can help “reset the brain.”
The treatment has a bad reputation from Hollywood movies, Dr. Furey said, but is routine and often effective.
“The end game of treatment is for mom to feel like her normal self again,” she added.
“Many of these women have no significant past psychiatric history, and then get very ill very quickly,” said Dr. Nicole H. Cirino, a psychiatrist who serves on the Postpartum Psychosis Task Force at Postpartum Support International, a nonprofit.
She continued: “Reconciling that and thinking about how to move forward, particularly if they have legal involvement, is really something that is quite complicated and takes some time.”
Patients often work with a team of psychiatrists, psychologists, social workers, nurses, peer advisers and other therapists while they’re hospitalized, said Dr. Susan Hatters-Friedman, a forensic and reproductive psychiatrist at Case Western Reserve University and the former president of the American Academy of Psychiatry and the Law.
The goal of forensic hospitalization is not just to manage patients’ mental illness, but also to prepare them to heal and possibly return to society.
The treatment plan for patients like Ms. Clancy very likely also includes helping them cope with the killings of their children. Ms. Clancy “grieves the loss of those three children,” her lawyer, Mr. Reddington, said on Friday.
In many states, including Massachusetts, people who are found not guilty by reason of insanity often spend more time hospitalized than they would have in prison, said Dr. Renée Sorrentino, a forensic psychiatrist who is licensed in Massachusetts.
In Massachusetts, she said, Ms. Clancy would be reviewed for discharge on an annual basis. Doctors could recommend that she be discharged from the hospital if they believed that her symptoms had improved and if they determined that she was not a danger to others.
The Plymouth County District Attorney’s Office would then be notified. If it disagreed with the medical team’s assessment, it could obtain its own experts or argue in court that Ms. Clancy should remain hospitalized. A judge would then decide whether she could be released, Dr. Sorrentino said.
“Humane mental health treatment is really important for her, and for us to think about as a society,” said Dr. Nirmaljit Dhami, the medical director of an inpatient psychiatric ward in California focused on perinatal mental health and preventive care.
In 2012, Deanna Laney, a Texas woman who was found not guilty by reason of insanity for killing two of her children and seriously injuring a third in 2003, was released from a psychiatric hospital after treatment. Several conditions were placed on her release.
An Illinois woman, Paula Sims, was granted parole in 2021, after serving 30 years in prison for killing her infant daughter. Her lawyer said that the decision to grant her parole was a recognition that “postpartum psychosis is real.”
Some women, however — like Andrea Yates, a Texas woman who in 2006 was found not guilty by reason of insanity in the killings of her five children — choose to waive their right to a review and remain hospitalized instead.
