The second day in the latest court challenge to Indiana’s near-total abortion ban focused on the law’s explicit exclusion of mental health in its definition of a “serious health risk.”

The plaintiffs argue one of the law’s few exceptions is “unconstitutionally narrow” — and could harm pregnant Hoosiers.

Testimony Thursday expanded discussion on abortion access for patients with serious health risks due to “psychological or emotional conditions.”

Dr. Leena Mittal is an instructor and a psychiatrist who directs reproductive psychiatric services at a Harvard University teaching hospital. She also serves on the Massachusetts maternal mortality review committee and was an expert on behalf of the plaintiffs.

Mittal testified that pregnancy can cause or worsen serious mental health conditions. While Mittal said an abortion is not a treatment for mental health, she believes it is a part of the full scope of mental health care patients should have access to for serious health risks.

She said terminating a pregnancy can be an option to address an underlying or exasperating factor impacting a patient’s mental health, similar to how treating physical conditions, like a pain disorder, can have an affect on patients mental health.

READ MORE: First day of trial to challenge Indiana’s abortion law focuses on ‘health or life’ exception

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Dr. Aaron Kheriaty is a psychiatrist and directs a bioethics program at the conservative-leaning Ethics and Public Policy Center. He was an expert for the state’s defense.

Kheriaty testified a “subset” of people who receive abortions can experience emotional distress afterward, and he has not encountered a patient who needed abortion care to address serious mental health risks. He alleged the risks of serious mental health symptoms or conditions are higher following an abortion compared to a pregnancy.

The American Psychological Association said a significant number of large longitudinal and international studies disagree with that claim and suggests abortion does not increase mental health risks.

Both experts also discussed the concerns around medications that can pose a risk to the development of a fetus, known as teratogenic medications. There are a variety of medications used to treat mental health conditions that fall into this category.

Kheriaty said he typically avoids prescribing these medications to patients of “child-bearing age” that can get pregnant to limit risk. For patients who are already on these medications, he said it is common to make adjustments during pregnancy based on physiological changes and find other ways to manage the condition.

Mittal testified treatment plans and decisions are developed through a conversation with the patient’s whole treatment team and some patients have no other medication that works for them.

When she sees a patient who is taking a teratogenic medication who wants to be pregnant, it can take a lot of time and effort to develop a safe plan to transition treatments.

For patients without the time to plan, stopping medication abruptly can cause a severe or intense recurrence of a mental health condition Mittal said. She said there’s a risk of harmful outcomes even if a patient gradually stops taking medication for a mental health condition.

Planned Parenthood Great Northwest, Hawai‘i, Alaska, Indiana, Kentucky; All-Options; and an Indianapolis-based OB-GYN brought the lawsuit.

The trial is set to conclude Friday.

Abigail is our health reporter. Contact them at aruhman@wboi.org.