The Lindsay Clancy trial has ended without a verdict.

After nearly six weeks of evidence and seven days of jury deliberations, the jury was unable to reach a unanimous decision about whether Lindsay Clancy should be held criminally responsible for the deaths of her three children, Cora, Dawson and Callan. The judge declared a mistrial.

Nothing can undo the devastating loss of those three children. Their deaths were an appalling tragedy. But the collapse of this trial should not bring the conversation about what happened to Lindsay, or about postnatal psychosis, to an end. It should make us ask some much more difficult questions: did those involved understand the illness Lindsay was experiencing well enough, and did they do enough to look beyond controlling her symptoms to understand what might have been contributing to them?

Postnatal psychosis

This matters not just for this case, but for millions of women around the world who experience poor mental health during pregnancy or after childbirth.

Postnatal psychosis is rare, affecting around one to two women in every 1,000 after childbirth, but it is a serious psychiatric emergency. It can develop rapidly and involve hallucinations, delusions, paranoia, mania, severe confusion and a profound disturbance in a woman’s perception of reality. Most of these women with postnatal psychosis are looked after by psychiatrists who usually have little or no training about hormones.

It can be triggered by the dramatic reduction in hormone levels that occurs after having a baby, yet this is far too often still ignored by doctors, especially by psychiatrists and obstetricians.

Beyond symptom control

As doctors, we are responsible for making diagnoses and treating patients or signposting them to the most appropriate treatment. When a treatment fails, we should not simply keep doing more of the same: we should ask whether we have missed an alternative diagnosis, another contributing factor or if the patient needs a different treatment.

This is particularly important when we are treating women whose mental health changes dramatically around major hormonal changes.

Pregnancy and childbirth involve enormous biological changes. During pregnancy, levels of estradiol and progesterone rise substantially before falling rapidly following childbirth. For some women, these changes can have a profound and negative effects on their mental health.

It has been known for many decades that some women are extremely sensitive to hormonal fluctuations. It is something we hear about daily at Newson Clinic. I consult with women who have premenstrual dysphoric disorder (PMDD), whose symptoms can become so severe that they experience suicidal thoughts, women whose mental health deteriorates dramatically in perimenopause and menopause, and women struggling with postnatal depression or who have experienced postnatal psychosis.

All these women usually improve when I prescribe them the right dose and type of hormone treatment, especially with bioidentical progesterone. Many women who feel that they can no longer cope with life regain a sense of themselves when the hormonal factors contributing to their symptoms are recognised and appropriately treated with bioidentical hormone treatments (HRT).

These experiences are a reminder that we cannot separate women’s mental health from hormones.

Hormones: not just about periods and hot flushes

For too long, doctors have talked about women’s hormones through a reproductive lens: periods, fertility, pregnancy and symptoms such as hot flushes and night sweats.

But hormones are not confined to the reproductive organs. Estradiol, progesterone and testosterone have important functions throughout the body, including in the brain. They can influence mood, sleep, cognition, anxiety and emotional wellbeing. Changes in hormone levels can have a profound effect on how women think, feel and function.

This is why I find it frustrating that the conversation about women’s hormones is still so often reduced to physical symptoms. Hot flushes and night sweats matter, but they are only part of the picture.

If we want to understand women’s mental health properly, we cannot ignore what is happening hormonally in the brain.

Hormone treatment

The idea that hormones may have a role in severe mental illness following childbirth is not new. More than half a century ago, pioneering physician Dr Katharina Dalton recognised a relationship between hormonal changes and severe psychiatric symptoms in some women after childbirth. She treated women with progesterone and reported significant improvements.

I have spoken to women with postnatal psychosis in the past who were treated by Dr Dalton who describe remarkable improvements in their mental health following progesterone treatment.

Some women also benefit from estradiol and testosterone.

Yet this is too often ignored and this ignorance is harming women. Bioidentical hormones are both effective and safe.

Mental health

Pregnancy and childbirth involve enormous changes to a woman’s body. Among the most dramatic are changes in hormone levels. During pregnancy, levels of estradiol and progesterone rise substantially. After the baby is born, they fall rapidly and for some women, the days and weeks following childbirth, when hormone levels are at their lowest, can be associated with serious mental illness, including postnatal psychosis.

Did they look at the whole picture?

The trial heard extensive evidence about Lindsay’s deteriorating mental health, severe insomnia and the numerous psychiatric medications she was prescribed.

Her treatment included antidepressants, sedatives, mood stabilisers and antipsychotic medication. I am not suggesting that psychiatric medication has no place in treating postnatal psychosis. It can be essential, particularly when a woman is acutely unwell.

But treating a woman who has become severely mentally unwell after childbirth should mean looking at the whole picture.

During the trial, the court heard evidence from a defence expert that Lindsay had not undergone blood testing to assess her postnatal hormone levels.

It raises an important question: when a woman develops profound psychiatric symptoms following childbirth, why isn’t her hormonal health routinely part of the conversation and treatment?

It’s 2026. Millions of women experience mental-health problems, yet hormonal health is still too often considered separately from mental health.

Learn from this tragedy

This case should be used to ask whether all women with severe postnatal mental illness are being prescribed hormone treatments, and if not then why not?

When hormones change, the brain changes.

We need to look at the whole woman, and ensure doctors are better equipped to recognise and understand the effects of hormones and hormone treatments for women with postnatal psychosis to try and prevent another tragedy of this magnitude.

The trial has collapsed. The conversation must not.

Three children died in an unimaginable tragedy, and their mother experienced severe mental illness. We need to learn from this: was Lindsay’s illness recognised early enough, was she given the most appropriate treatment, were hormone treatments considered, especially when she deteriorated, and how much were hormonal factors part of the wider clinical picture?

The collapse of this trial should not be the end of the story. We should instead use this moment to demand better education about hormones and better access to hormone treatments for women experiencing severe mental illness after childbirth.

When treatments fail, we need to ask why. And when hormonal factors are likely to be part of the picture, we need to consider why hormone treatments are not part of the treatment.

We need to do better, because the future health and lives of more people depend on it.

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