Nearly a fourth (22%) of the participants within a research sample of 148 individuals with serious mental illness reported the death of a loved one as a significant loss, and two thirds of these deaths involved the loss of one or both parents. The key determinant of the severity and duration of grief in response to the death of a parent was whether or not there were extenuating circumstances that complicated the death event, such as co-residence with the deceased at the time of death or a lack of regular social contact with anyone other than the deceased. In all instances of severe or prolonged grief, there was no preparation for the parental death, either through preparatory counseling or practical plans for funeral arrangements, financial repercussions, life-style changes, or residential relocation. Mental health agencies serving people with serious mental illness should begin to incorporate financial and emotional preparation for parental deaths and bereavement counseling as essential services.The population of people with serious disabilities is growing older. As within the general population, a large "baby-boomer" generation of disabled adults is now entering its fifth decade and facing the multiple life complications characteristic of middle age, inclusive of parental death, divorce, children's growth into adolescence, anxiety about financial security, and agerelated health problems. When combined with a severe disability, such normal midlife concerns can become traumatic, and at times tragic. Concurrent and multiple losses make it difficult to cope with everyday problems or to sustain employment and meaningful life activities, and they can contribute to prolonged grief following the death of a loved one (Rando, 1993 The most universal and inevitable loss experience of middle age is the death of a parent. Death of any close other is associated with a variety of physical and mental disorders, including suicidal ideation and depression (Finley-Jones & Brown, 1981;Prigerson et al., 1997Prigerson et al., , 1999. Individuals who must deal with the death of a loved one in combination with pre-existing psychiatric disability are especially vulnerable to severe depression and depression-related physical illnesses (Mazure, Bruce, Maciejewski, & Jacobs, 2000;Surtees & Wainwright, 1999). Results of recent research studies underscore the vulnerability of people with serious mental illness to prolonged, severe grief. While a study of grief within a sample of physically disabled and nondisabled adults reported that only 11% had severe grief lasting 10 months or longer after the death of a loved one (Avison & Turner, 1988), a study of psychiatric outpatients reported that nearly a third experienced intense grief lasting an average of 10 years (Piper, Ogrodniczuk, Azim, & Weideman, 2001).Over and above the emotional experience of severe grief, the loss of a parent or another relative on whom the mentally ill bereaved was financially or functionally dependent may set in motion a cascade of negative events that may ...