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What does the clean talk mod do for spam?

It works insanely well for my wiki, Wordpress or SMF installs?

Does it just check messages against a database?

Never heard of it before.

Appears to be a pay for service, which means they are part of the deep state that actually creates the spam, they don't want to stop it, they want moar

A quick look ... It appears to send the full post to the service to be checked.  So it would have to be some form of checks in place for the ip, email, password, name, other?  Honestly  I'm a tad leery of sending a users data to another site.

I just wondered if it was doing anything clever. It seems to work incredibly well.

They probably are ... but they are not giving away their secret sauce.  
1) send them the post, 2)magic happens, 3) get your result
May be good idea for an addon.

What about Turnstile from Cloudflare?
I've seen many websites using this solution?

I've seen that quite a lot as well. 

TBH I find it a bit intrusive, seems to take to long at times.  That said I'll see if I can add that to 2.0's list of captcha agents

Here ya go .... http://addons.elkarte.net/security/turnstile.html

Give it a try and let me know (I'll open an addon thread)