The Lindsay Clancy case has brought postpartum mental health back into the national spotlight and raised difficult questions about how women access care during pregnancy and after childbirth.
One issue gaining attention is whether counseling practices should be expected to provide childcare while parents attend therapy.
The concern behind that question is legitimate. For many mothers, lack of childcare is a real barrier to receiving treatment. But acknowledging that barrier does not automatically mean every outpatient mental health practice can-or should-be expected to operate a childcare program.
The larger conversation needs to include postpartum mental illness, access to psychiatric care, insurance reimbursement, the economics of mental health practices, confidentiality, and the responsibilities of the healthcare system as a whole.
Postpartum Mental Health Is More Than Postpartum Depression
Postpartum depression may be the condition people recognize most often, but perinatal mental health encompasses a much broader range of concerns.
Women may experience depression, anxiety, intrusive thoughts, obsessive-compulsive symptoms, trauma associated with pregnancy or delivery, panic symptoms, sleep disruption, mood instability, or worsening of a preexisting mental health condition.
Postpartum psychosis is much rarer, but it is also far more serious and requires urgent psychiatric attention.
One important lesson from highly publicized cases involving postpartum mental illness should not be that mothers experiencing postpartum depression or anxiety are dangerous. Most are not.
Instead, these cases should remind us how important it is for women to have access to qualified professionals who can recognize symptoms, determine the appropriate level of care, coordinate treatment, and intervene when symptoms become more severe.
Childcare Really Is a Barrier to Mental Health Treatment
It is easy to tell someone, “You need to go to therapy.”
Actually getting to therapy may be much more complicated.
A mother may be caring for an infant and two older children. She may be working. Her spouse may also be working. Family members may live hours away. Childcare may cost nearly as much as the therapy appointment itself.
These are legitimate barriers.
Mental health practices should think creatively about accessibility. Telehealth can be extremely helpful. Flexible scheduling can help some families. In certain situations, having a young infant in a session may be clinically appropriate.
However, there is a significant difference between accommodating families when possible and requiring a counseling practice to supervise children while a parent attends therapy.
Why Can’t Children Simply Sit in the Therapy Session?
Sometimes they can.
Sometimes it is clinically inappropriate.
A newborn sleeping beside a mother is very different from an 8-, 12-, or 15-year-old sitting in a room while a parent discusses trauma, marital problems, sexual concerns, substance use, suicidal thoughts, parenting struggles, resentment, abuse, or other deeply personal subjects.
Therapy depends on privacy and the client’s ability to speak freely.
A therapist may determine that an older child should not remain in the room because the content of the session could be harmful or developmentally inappropriate for the child to hear.
That is not a therapist being insensitive to the parent’s situation.
It may be good clinical judgment.
Likewise, leaving children unattended in a waiting room presets another problem. Receptionists, billers, office managers, and other clinicians are not automatically childcare providers simply because children are present in the building.
Who is responsible if a child gets injured, leaves the office, experiences a medical emergency, disrupts another client’s appointment, or overhears confidential information?
Those are real concerns.
Mental Health Practices Already Operate on Extremely Tight Margins
Another part of this conversation rarely receives enough attention.
Mental health professionals often have master’s or doctoral degrees, years of supervised training, professional licensure requirements, continuing education obligations, and substantial clinical responsibility.
Yet behavioral health providers are frequently reimbursed at relatively low rates compared with many other healthcare professionals with similar levels of education and training.
For insurance-based practices, the reimbursement received for a therapy appointment does not simply become the therapist’s income.
That payment has to help cover therapist compensation, payroll taxes, employee benefits, supervision, rent, utilities, billing staff, scheduling staff, electronic health record systems, credentialing, malpractice insurance, business insurance, compliance, technology, continuing education, and other operating expenses.
Mental health billing can also be unusually complicated.
A patient’s medical insurance may be administered through one company while behavioral health benefits are handled through a separate mental health carve-out.
Another patient may have an Employee Assistance Program, or EAP, requiring separate authorization and billing.
Others have primary and secondary insurance.
A practice may submit a claim to a primary insurer, wait for processing, receive the explanation of benefits, send the remaining balance to a secondary insurer, respond to requests for information, and then wait weeks or months-sometimes to receive only a few additional dollars.
Every one of those steps requires employee time.
- Someone verifies benefits.
- Someone obtains authorization.
- Someone submits the claim.
- Someone follows up on denials.
- Someone corrects errors.
- Someone appeals improperly processed claims.
- Someone posts the payment.
That administrative work is rarely reimbursed separately.
So Who Should Pay for Childcare?
If we agree that childcare is an important barrier to maternal mental healthcare, then childcare solutions are absolutely worth discussing.
But why should the financial responsibility automatically fall on the counseling practice?
A mental health office offering childcare would potentially need additional employees, background checks, dedicated space, liability coverage, safety policies, age-specific procedures, training, and possibly additional regulatory compliance.
Insurance companies are not typically adding additional reimbursement to a psychotherapy claim because a client needs childcare.
That raises an important question:
If society believes childcare is necessary to improve access to postpartum mental healthcare, shouldn’t society help fund it?
Perhaps insurance companies could provide childcare benefits for perinatal behavioral health appointments.
Perhaps employers could expand dependent-care benefits.
Perhaps states could create childcare vouchers connected to maternal mental health treatment.
Perhaps larger health systems could include childcare within specialized perinatal mental health programs.
Those solutions address the actual problem without expecting small outpatient practices to continually absorb another unreimbursed expense.
We generally do not expect a cardiology practice, dentist, OB-GYN, or physical therapy office to provide childcare during appointments.
Mental health professionals should not automatically be held to a different standard.
Expanding Postpartum and Perinatal Mental Health Care in Alabama
At Integrative Health Services, we believe mothers should have access to appropriate mental health treatment before symptoms reach a crisis point.
We provide counseling services for individuals experiencing postpartum and perinatal concerns, including anxiety, depression, adjustment to motherhood, intrusive thoughts, trauma, relationship changes, and other emotional challenges surrounding pregnancy and childbirth.
Beginning September 9, 2026, we are also expanding our services with the addition of our new psychiatric nurse practitioner.
She will provide psychiatric evaluation and medication management and will treat postpartum and perinatal mental health concerns, allowing clients who need both counseling and medication support to receive more coordinated care.
Integrative Health Services serves clients through our locations in Pelham, Gardendale, and Alabaster/Calera, with telehealth options available across
Alabama when clinically appropriate.
We Need Better Support-Not Just More Expectations
Mothers deserve better access to mental healthcare.
Therapists should work to reduce unnecessary barriers whenever possible.
But we cannot solve an underfunded behavioral health system by continually asking mental health professionals and small practices to absorb additional costs.
The bigger questions are how we improve screening, psychiatric access, insurance reimbursement, coordination of care, childcare resources, and early intervention.
A mother saying, “I am not okay,” should be able to find meaningful help.
And the solution requires participation from therapists, psychiatric providers, physicians, insurance companies, employers, policymakers, families, and communities.
Postpartum mental health is everyone’s concern.
Making the therapist’s office responsible for every barrier a family encounters is not the same thing as building a better system.
Finding Postpartum and Perinatal Therapy Near You in Alabama
If pregnancy or motherhood does not feel the way you expected, you are not failing-and you do not have to minimize what you are experiencing. Anxiety that will not quiet down. Intrusive thoughts that frighten you. Feeling disconnected, overwhelmed, panicked, deeply sad, or unlike yourself. These experiences deserve compassionate attention, even if you are still getting through the day and caring for everyone around you. Integrative Health Services offers postpartum and perinatal mental health counseling for women navigating anxiety, depression, intrusive thoughts, birth trauma, relationship changes, adjustment to motherhood, and other emotional challenges.
- Connect with IHS in Pelham, Gardendale, or the Alabaster/Calera area, or ask about telehealth across Alabama when clinically appropriate.
- Read more IHS blogs about postpartum mental health, anxiety, medication management, relationships, and adjusting to major life changes.
- Explore your care options. Our team can help you identify an appropriate provider and appointment option.
Additional Therapy Options Available in Pelham, Alabaster/Calera, Gardendale, and Surrounding Areas
Integrative Health Services offers comprehensive mental health counseling for children, teens, adults, couples, and families throughout Alabaster, Pelham, Calera, and Gardendale. Our clinicians provide anxiety therapy, depression counseling, trauma therapy, EMDR therapy and Brainspotting. Our team also offers play therapy, LGBTQIA+-affirming therapy, marital and premarital counseling, and medication management.
