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Published Online:https://doi.org/10.1176/ps.49.5.650

Many parents with severe and chronic mental illness lose custody of their children due to child abuse or neglect. These children may linger in foster care for long periods of time until decisions about custody are made. Recent proposals to shorten the time that children remain in the foster care system include the use of categories of abuse to guide decisions about custody. One proposal has been to "fast-track" cases involving parents with long-standing mental disorders by automatically terminating parental rights. This approach assumes that a severe and chronic mental disorder is incompatible with safe parenting. This report describes three cases of mentally ill mothers who lost custody of their children after they killed someone. The mothers were nonetheless found to be at low risk for future child maltreatment and violence according to evaluation with two current methodologies, Parenting Risk Assessment and Risk of Violence Assessment. The cases question the assumption that mental illness is incompatible with safe parenting and underscore the fact that evaluation of the parenting competency of mentally ill parents is rarely clear-cut.