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A psychiatrist with decades of experience treating perinatal depression and anxiety says the adversarial legal system is not well equipped to deal with cases involving mental illness, like that of Lauren Dickason.
The former GP did not deny killing her daughters, six-year-old Liané and her 2-year-old twins Maya and Karla, at their Timaru home in September 2021, but pleaded not guilty to murder, saying she was severely ill with postpartum depression.
Associate professor Mark Huthwaite, who works at the Regional Specialist Maternal Mental Health Service in Wellington, said lawyers needed "black and white definitions", but mental illness was all shades of grey.
"Unfortunately in psychiatry, there are fewer definitive answers."
Psychosis could overlap with anxiety and depression and fixed beliefs that had no basis in reality, he said.
"But in court, there's a defence and there's a prosecution, it's oppositional, it's adversarial.
"For me in this kind of process, one of the worst ingredients is adversity."
Other countries had different models for dealing with such cases, he noted.
In his native South Africa - also Lauren Dickason's homeland - a judge conducts the trial with the help of expert advisors.
As a young psychiatrist, Huthwaite was an expert advisor to South Africa's Truth and Reconciliation Commission into Apartheid, led by Archbishop Desmond Tutu.
"We heard horrific things, absolutely the worst things humans can do to each other. Yet it was the collective that held us, that was the strength in it.
"And I would say in this process in court, for example, if we had used Māori tīkanga here, actually we would have started each session with a cleansing, a karakia, a holding and we would have finished each session like that.
"That was how the Truth and Reconciliation Commission did it as well."
It did not really matter whether someone had religious beliefs or not, in his view.
"It's the drawing together and the 'holding in mind' that actually counts.
"In Zulu, the word for this is 'ubuntu' or 'the humanity of others', which is the kind of like the real meaning of aroha - which doesn't mean just 'love' the way we flip it around. It really means that deep ingrained sense of the respect and dignity of others. And for me, that should be at the core when we talk about this case, this tragedy."
'We don't normalise it enough'
Sarah Urquhart started spiralling into anxiety and depression while she was pregnant with her first baby 16 years ago.
Sarah Urquhart. Photo: Supplied
The shame and stigma of feeling like "a bad mother" kept many women from seeking help, she said.
"People were too scared to actually say what they were going through for fear of being judged. So if you said too much, people would look at you like 'what do you mean you're anxious and depressed and not enjoying your baby?'."
She went on to do post-graduate research on the subject, and has worked with support organisations and Post Natal Anxiety and Depression Aotearoa.
Even so, she struggled again after the birth of her youngest child just before the pandemic.
"I got incredibly anxious about who was around my child, who had been vaccinated and who hadn't, all the handwashing. It just fed into that hyper-vigilance and I could feel myself falling back into that pattern.
"If I struggled to get help and I know who to ask and where to go for help, it's almost too hard for people who don't work in that sphere. We don't talk about it enough, we don't normalise it enough."
She feared Covid and lockdowns had left many young parents without support.
"My worry is that some of these people who had their first child in lockdown are now having a second baby, and they think what they went through is normal, that it's just the way it is and they have to put up with it.
"The standard line I heard was: 'Oh everybody feels like this, it will pass'. And I got to the point where I thought: 'If everyone feels like this, I just have to suck it up'."
She said there was a lack of understanding - even among medical professionals - about what perinatal anxiety and depression actually looked like and how long it could persist, and that created a lot of barriers.
"We live in such a high-achieving society that people are keeping it quiet, rather than looking for that support.
"It took me several goes at speaking out before I found someone who took me seriously.
"My message is: don't be disheartened if someone rubbishes what you're saying or gives you that blanket statement: 'It's like this for everybody'.
"No, keep pushing."
So-called "intrusive thoughts" were not uncommon.
One study of depressed mothers with children under three found 41 percent have thoughts of harming them - but few acted on those thoughts.
Huthwaite said the Dickason case had been emotionally triggering for some clients.
"I'm seeing the identification with it, in other words, 'My goodness, I could do that, it could have been me. What if I got to that point?' which is an incredibly frightening thought for anyone, let alone any prospective mother or mother of a newborn or someone who is struggling at the moment.
"The impact is significant."
Lauren Dickason was caught "in a perfect storm", he said.
She had reportedly stopped her antidepressants, only just arrived in a new place after 14 days in managed isolation with three small children ... on top of two years of pre-emigration stress in a country riven with civil unrest and power blackouts and a decade-long struggle with infertility.
"As an immigrant, you feel completely alone. I remember that feeling myself - you want to come, you think you're prepared, but you have left your place of safety (even if it's not actually safe) and everyone and everything you know. Then there was the MIQ system, which was inherently adversarial, and we know that people become acutely unwell in holding cells where they feel detached from the place they are.
"All this at a time when we were trying to be kind."
"If we could go back in time and prevent it, I would say to Te Whatu Ora, you are bringing in staff, where is your package of care? How are you holding these people in mind and building this into your system?"
Parenting was not meant to be done alone, and previous generations and other cultures understood this, he said.
"There was always 'an angel in the nursery' - a midwife, a friend, a neighbour - if a mother was struggling, you had all these people there to hold children and mother in mind and that's how people got through."
Recovery was certainly possible, even after years, he said.
"I recently saw a woman who was struggling with her 13-year-old, oppositional defiance etc. Then we found she actually had untreated post-natal depression and we worked on that, and it's transformed their relationship."
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