Lindsay Clancy: When The Courtroom And Mental Health System Collide

Twelve jurors in Massachusetts are confronting a question that reaches beyond the fate of Lindsay Clancy: What does justice require when the person who committed an unspeakable act may also have been overtaken by a profoundly disordered mind?

There is no dispute that Clancy killed her three young children, or that she had experienced serious psychiatric symptoms and repeatedly sought help.  The prosecution contends that she acted deliberately. Her defense argues that postpartum psychosis destroyed her ability to appreciate or control her actions.

That conflict exposes a problem much larger than one criminal trial. Our legal system asks whether Clancy was a victim or a perpetrator when the painful answer may be that, in some circumstances, a person can be both. Yet, severe mental illness does not excuse violence. And, accountability should not require us to pretend that every human act originates in a rational mind.

Under Massachusetts law, it would appear that mental illness alone does not eliminate criminal responsibility. A defendant is not criminally responsible if she lacked the substantial capacity to appreciate the wrongfulness of her conduct or conform to the law. While the standard may appear straightforward, applying it is far harder.

The larger question is why the complete picture of a person’s deterioration is so often assembled only after tragedy occurs. We have seen versions of this problem after suicides, school shootings and other acts of violence. A family member notices troubling behavior, but ignores it. A doctor prescribes medication but does not monitor the situation. A counselor hears something disturbing but does not report it. Police encounter someone in crisis but the individual is released. Each may possess one piece of the puzzle, but too often no one sees the entire picture.

Before violence occurs, civil-commitment laws generally require evidence of immediate or near-term danger. Those protections are essential. Most people with mental illness are not violent, and diagnosis alone should never cost someone her liberty. Yet these standards can leave families and professionals watching a person deteriorate while being told that meaningful intervention is unavailable. If tragedy follows, the criminal system examines those same warning signs and asks whether the person was nevertheless rational enough to punish.

A person may therefore be considered not dangerous enough for intervention on Monday but sufficiently responsible for the harshest punishment on Tuesday. That is the gap reform must address. The answer is not simply to make involuntary commitment easier or sacrifice civil liberties in the name of prevention. There is considerable territory between doing nothing and involuntary hospitalization.

States should explore carefully limited procedures permitting earlier evaluation when multiple documented warning signs demonstrate serious deterioration, with medical evidence, appointed counsel, prompt judicial review and strict time limits. Better coordination among physicians, hospitals, mental-health professionals, law enforcement and families is equally important.

This cannot be solved by Washington alone. Criminal law, civil commitment and mental-health treatment remain substantially state responsibilities. But the federal government can encourage innovation. There is precedent for such an approach. When the nation struggled with an ineffective child-support enforcement system, federal funding incentives and national requirements pushed states to strengthen their programs while leaving much of the implementation to the states.