(If you know someone or are personally dealing with postpartum mental health issues, know that you are not alone. Reach out to the NIMHANS Perinatal Mental Health Helpline – 8105711277.)A case in the US has the world watching with rapt attention. Lindsay Clancy, a 36-year-old woman from Massachusetts, strangled her three young children in 2023.Her defence said it was postpartum psychosis, while the prosecution argued she knew what she was doing. Twelve jurors sat with the same evidence for days. Unfortunately, unlike the movie 12 Angry Men, there was no Henry Fonda to talk them into agreement. After several days of deadlock, the judge declared a mistrial. Miles away in a drawing room in Mumbai, my friends had already reached a verdict, one which was swift and unanimous. “We can’t take refuge in a condition that isn’t even recognised by the psychiatry bible—the Diagnostic and Statistical Manual (DSM).”I let the verdict sit with me for a while, then began my research on the condition, letting the case rest with the jury.'No One Tells You...': New Moms in Kashmir on Battling Postpartum DepressionUnderstanding the Postpartum Body, Before the DiagnosisA woman’s body goes through extreme hormonal and immune shifts after childbirth. Estrogen and progesterone, the hormones that support pregnancy and mood, rise slowly for nine months and then suddenly crash post-childbirth. It’s one of the fastest hormonal falls the human body endures. These changes almost invariably cause "baby blues" characterised by mood swings, tearfulness, and irritability that resolve within days to a couple of weeks.It’s estimated that one in six women go through postpartum depression, a persistent mood disorder marked by sadness, exhaustion, guilt, and loss of interest that doesn’t lift on its own, along with difficulty bonding with the baby. Estimates also point to one in a thousand women going through postpartum psychosis, where they lose touch with reality. This could look like disorganised thinking, seeing or hearing things that aren’t there, false beliefs, or extreme suspicion of people around her.The risk is highest within 12 weeks of childbirth and leaving it untreated carries a rare yet real risk of suicide or infanticide.Both conditions are treatable, yet families often dismiss them as nothing more than "baby blues". An elder woman in the family may brush off the symptoms as normal, something she says she went through herself.The Right to Breastfeed Means Little Without a Place For Mothers to Do ItThe DSM DebateSo were my friends right? Not quite. Postpartum psychosis is a recognised clinical condition, but it doesn’t appear as a separate diagnosis in the DSM yet. What experts can’t agree on is where it belongs. The DSM sorts mental illnesses into groups, a bit like chapters in a book, and this condition doesn’t neatly fit into any of the existing ones. I spoke to Dr Kersi Chavda, a senior psychiatrist at Hinduja Hospital, on what it means for diagnosing and treating patients while the condition still isn’t in the DSM. “It doesn’t matter if it’s not added to the DSM yet,” Dr Chavda said, adding: “There’s enough research to prove we know this is a condition that needs immediate psychiatric care.”Postpartum psychosis is a recognised condition, but without a clear, distinct place in the diagnostic manual, training and awareness gaps follow. These likely play a part in why many women are still misdiagnosed.The Risk FactorWho is more at risk of postpartum psychosis? Those with a family history of mental health disorders, and a personal history of mental illness. Dr Chavda flagged another issue affecting maternal mental health. “Women with pre-existing conditions often pause their psychiatric medication during pregnancy or after childbirth, fearing it will harm the baby. It has been proven that continuing psychiatric medicines under proper guidance is safer for the health of both mother and child than abruptly stopping them,” he said.Dr Sudeshna Ray, associate director of gynaecology at Jaslok Hospital, Mumbai, added, “In some cases, doctors do recommend a brief pause, which is called a ‘drug holiday’ during the first 12 weeks of pregnancy, when fetal organ development is most active, but only for women who are doing well and can safely tolerate it. This is always done in consultation with the treating psychiatrist and never decided alone. For everyone else, continuing treatment under medical supervision remains safer than stopping out of fear.”As the gynaecologist is often the first point of contact, her advice to fellow gynaecologists is direct:“Always explicitly ask about mental health history. Look for subtle signs and never miss an opportunity to psychoeducate the family, because it’s a narrow window.”Beyond regular engagement, she also makes it a point to psychoeducate the mother and family on the second day after delivery.‘Breast Not the Best?’: A Mom’s Nursing Journey From Breastfeeding to FormulaWhat Comes NextResearch shows the ideal treatment setting is a specialised mother-infant unit in a psychiatric facility. When I called over a dozen mental health facilities offering inpatient admission across four major metros in India, most had never heard of the concept. A few offered to informally accommodate mother and baby in a larger room, though I couldn’t establish whether that followed any formal protocol. Most simply treated the mother’s condition as they would any other patient; the infant wasn’t part of the admission at all. After the sixth call, I stopped being surprised. Two facilities in the country came up cleanly in both primary and secondary research as offering these specialised units—NIMHANS, the central government institute based in Bengaluru, and Shadithya Hospital, a private facility in Chennai. Between them, they have a combined capacity of 12 beds. England, with a population roughly one-twentieth of India’s, has around 20 specialised mother-and-baby psychiatric units with over 150 beds. I wonder if, without a formal DSM entry, there’s simply no mandate forcing facilities to plan for optimum care.As I think about the failures stacked at every level, I keep coming back to one question. What are the odds of a woman in this condition actually reaching remission in India? I believe that even for an urban, educated, privileged woman, it takes a near perfect stroke of luck. Lucky that those around her recognise something is wrong and seek help instead of reassurances. Lucky that there’s a psychiatrist close enough to where she lives, one who knows better than to go strictly by the manual and can diagnose it. Lucky, if it comes to that, that a bed is available at all, and lucky that all of this happens fast enough to matter. And if this is what it takes for a woman with every advantage, I don’t know what it takes for a woman with none. What still gives me hope is that NIMHANS’s own published research on its mother-baby unit found that most mothers showed significant improvement by the time of discharge. I wonder who is to blame if a woman doesn’t have that stroke of luck and commits an act in a moment when she is out of touch with reality. I hope that in a Viksit Bharat, it doesn’t have to come to luck at all.(Atika Lamba is an ex-banker, now consults organisations in the mental health space, and is also a practising coach. She is an alumna of IIM Kozhikode and TISS. This is an opinion piece and the views expressed are the author's own. The Quint does not endorse or is responsible for them.)