The woman in the jail cell clearly thought she was cradling a baby in her arms, though she was holding nothing more than air. Jane Doe had been arrested a few hours earlier and charged with killing her 4-year-old and 18-month-old children. She seemed oblivious to her surroundings, and well on her way to a psychotic episode. She ignored anyone who tried to communicate with her – no verbal response and no eye contact. She repeated the same phrase over and over, indicating that she would soon "be her with babies” – the ones she had been accused of killing.

Jail staff, rightly so, took that as an indication of her determination to commit suicide. The jail utilized its telepsychiatry service and had her in front of a psychiatric advanced practice nurse in a matter of minutes. In front of the monitor, she became somewhat coherent and spoke to the APN.

"I thought another baby would fix our problems,” she said. "I was wrong. He didn’t want me anymore.”

She then said her husband had been having an affair for nearly two years. He recently told her he didn’t love her anymore and planned to leave her for the other woman. He accused her of being unstable since the second child was born, and indicated he planned to seek full custody of both of their children. She had no family in the area, and felt nobody could help her sort through her options. She couldn’t bear the thought of having her kids taken from her. Due to her state of mind, she determined the only way to prevent this was to send them "to live with God,” she said.

The psychiatric advanced practice nurse diagnosed her with severe post-partum depression (PPD), which had gone untreated since the birth of her second child 18 months ago. The psychiatric advanced practice nurse deemed Jane to be unstable and instructed the jail staff to have her admitted into a psychiatric facility immediately. The jail’s round-the-clock access to a specialist made it possible to make the evaluation without delay and have her directly admitted to a psychiatric forensic facility. There was no extended period of supervision during a lengthy Emergency Department wait. Jane Doe remained at the forensic psychiatric facility for several weeks, until she was cleared and returned to the jail to stand trial for her crimes.