In Re Lillian D. ( 2016 )


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  •                   IN THE COURT OF APPEALS OF TENNESSEE
    AT KNOXVILLE
    Assigned on Briefs June 2, 2016
    IN RE LILLIAN D.
    Appeal from the Juvenile Court for Knox County
    No. 143439     Timothy E. Irwin, Judge
    No. E2016-00111-COA-R3-PT-FILED-AUGUST 26, 2016
    This is a termination of parental rights case involving a two-year-old child, Lillian D.
    (“the Child”). On October 7, 2013, the Knox County Juvenile Court granted temporary
    legal custody of the Child to the Tennessee Department of Children’s Services (“DCS”).
    The Child was immediately placed in foster care, where she has remained since that date.
    DCS subsequently filed a petition to terminate the parental rights of the Child’s
    biological mother, Penelope D. (“Mother”), in the Knox County Juvenile Court on
    January 26, 2015.1 Following a bench trial, the trial court terminated Mother’s parental
    rights to the Child after determining by clear and convincing evidence that Mother was
    mentally incompetent to care for the Child and that the conditions that led to the removal
    of the Child from Mother’s custody still persisted. The trial court further found by clear
    and convincing evidence that terminating Mother’s parental rights was in the best interest
    of the Child. Mother has appealed. Discerning no error, we affirm.
    Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Juvenile Court
    Affirmed; Case Remanded
    THOMAS R. FRIERSON, II, J., delivered the opinion of the court, in which ANDY D.
    BENNETT, J., and J. STEVEN STAFFORD, P.J., W.S., joined.
    Mary L. Ward, Knoxville, Tennessee, for the appellant, Penelope D.2
    Herbert H. Slatery, III, Attorney General and Reporter, and Kathryn A. Baker, Assistant
    Attorney General, for the appellee, Tennessee Department of Children’s Services.
    1
    Termination of the biological father’s parental rights was sought by separate action.
    2
    We note that in its final order, the trial court listed “Vaneta A.” as a prior name for Mother. Inasmuch
    as the Child’s birth certificate and the trial court’s judgment refer to Mother as Penelope D., we will refer
    to Mother as Penelope D. or Mother for purposes of this Opinion.
    OPINION
    I. Factual and Procedural Background
    The Child was removed from the custody of Mother when she was only three days
    old due to Mother’s mental health condition, which compromised her ability to care for
    the Child. At the hospital following the Child’s birth, medical staff became concerned
    when Mother appeared to be suffering from delusions. Following a psychiatric
    consultation, hospital personnel concluded that Mother was suffering from delusions and,
    due to her condition, was not able to safely care for the Child. The Child was placed in
    foster care on October 7, 2013, by order of the Knox County Juvenile Court (“trial
    court”). The trial court adjudicated the Child as dependent and neglected on April 8,
    2014, “due to the mother’s mental health issues which create[d] an inability for the
    mother to provide appropriate care and supervision for the child.”
    Following the child’s removal, Mother told a DCS case manager, Kim Harvey,
    details of certain events in Mother’s past. Throughout her involvement with DCS,
    Mother had shared her story with other professionals, remaining fairly consistent but
    including some factual variations. Mother stated that she was born on a U.S. Navy ship
    in international waters to her parents, Katherine Gyorgyi and Alberto Delarosa.
    According to Mother, her mother was a naval surgeon and her father was an imperial in
    the Marines. After her father’s death, her mother was remarried to a man named Jack
    Gardner, who was a commander prince in the Navy. Mother further related that she had
    been hospitalized in Ireland as an infant due to Marfan Syndrome. She reported spending
    time in foster care as a child following the death of both parents. By Mother’s account,
    she had been kidnapped in Tennessee and taken to Florida at the age of five where she
    was adopted by a family named “Collinswood.”
    Mother further reported suffering a heart attack in the fifth grade and remaining in
    a coma until she was sixteen years old. As Mother explained, she was taken from foster
    care at sixteen years of age by a man named Arthur Howe, whom she married in order to
    be emancipated. She further reported giving birth to twenty-two children in addition to
    the Child, including Ellison who died at eight weeks due to a heart condition and three
    separate sets of septuplets with Mr. Howe. Mother explained that the last set of
    septuplets was born after Mr. Howe’s death in 2002 when she inseminated herself with a
    turkey baster. Mother said that the three sets of septuplets currently lived with a relative
    named Magdalena.3
    3
    Mother testified at trial that Magdelena was her cousin, but Ms. Harvey testified that Mother previously
    told her that Magdelena was her aunt.
    2
    Ms. Harvey testified that she searched and contacted multiple resources in an
    attempt to locate Mother’s family, including the Thomson Reuters CLEAR investigation
    database, local missing person programs, Tennessee Department of Vital Records,
    Knoxville Police Department, Knox County Sheriff’s Office, Tennessee Bureau of
    Investigation, the Federal Bureau of Investigation, U.S. Department of State, U.S.
    Department of Naval Services, and the U.S. Embassy in Ireland. According to Ms.
    Harvey, despite searching foster care records in Tennessee, Georgia, and Florida, she was
    unable to locate any records regarding Mother’s reported time in foster care. Ms. Harvey
    facilitated a voluntary national fingerprint search that produced one record pertaining to
    an arrest of Penelope D. occurring in Georgia, but no identifying information was
    available from that arrest record.
    Upon the Child’s placement into the custody of DCS, a permanency plan was
    developed for the Child on April 30, 2014, listing the alternate goals of “Return to
    Parent” or “Adoption.” The permanency plan required Mother to: (1) cooperate with
    DCS to obtain legal identifying documentation regarding Mother’s identity; (2) complete
    a full psychological evaluation and follow all treatment recommendations until released
    from treatment upon successful completion; (3) if prescribed, take medication as
    prescribed; (4) complete a parenting assessment; (5) demonstrate the ability to perform
    basic parenting skills during visits; (6) attend medication management appointments; (7)
    attend individual therapy to address her past trauma; (8) provide a safe, stable home for
    the Child; (9) maintain contact with DCS; and (10) notify DCS of any change in
    Mother’s circumstances. It is undisputed that Mother made efforts to comply with her
    permanency plan throughout her involvement with DCS.                Specifically, Mother
    participated in individual therapy, medication management, a full psychological
    evaluation, and a parenting assessment.4
    In March 2014, Mother underwent a psychological evaluation performed by a
    clinical psychologist, Dr. William A. McGillivray, Ph.D., ABPP. During this evaluation,
    Mother was diagnosed with Psychotic Disorder, not otherwise specified, with rule-out
    diagnoses of bipolar disorder and schizophrenia. Although Dr. McGillivray attempted to
    obtain information from Mother concerning her background, he was unable to do so. His
    evaluation described his interview with Mother as follows in relevant part:
    There is virtually no reliable information about [Mother] and the
    consistent parts of her story are implausible, including the circumstances of
    her birth, where she lived growing up, with whom she lived following the
    death of both parents one year after her birth, and on and on. Her
    4
    DCS pled substantial noncompliance with the permanency plan as a ground in the petition to terminate
    Mother’s parental rights. At trial, however, DCS conceded that Mother had substantially complied with
    the permanency plan, and DCS has not raised any issue on appeal with regard to that statutory ground.
    3
    explanation for the many gaps in her life history and the absence of any
    record of her life is also implausibly explained as being due to brain injury
    that has affected her memory and the loss of all documentation of her life
    by theft.
    ***
    As may be clear from the above, I do not believe I made any
    progress in gaining a better understanding of this woman’s life, life
    circumstances, or motivation for her bizarre recounting of her life.
    ***
    The tenacity of her delusions (unless she is lying) is remarkable as is
    her ability to mix seemingly factual information (albeit often inaccurate)
    with unbelievable claims. The fact that she has blocked every avenue[] to
    determine her identity does suggest that some conscious deceit is involved;
    but I believe any deceit coexists with genuine delusion.
    According to Dr. McGillivray, psychological testing revealed “evidence of a
    serious impairment to [Mother’s] ability to think logically and coherently.” Testing also
    showed that situation-related stress was placing higher demands on Mother than she had
    been accustomed to confronting. As a result, Dr. McGillivray determined that “[Mother]
    is at risk for becoming acutely upset and for functioning ineffectively in the decisions she
    makes and the courses of action she pursues.” Dr. McGillivray concluded that Mother
    may be indifferent to people and inattentive to what they are saying or doing. He
    maintained that Mother’s overly emotional and insufficiently deliberative approach
    “often compromises the effectiveness of [her] problem solving and the adequacy of [her]
    adjustment.” Dr. McGillivray concluded as follows:
    This is a difficult case. [Mother’s] delusions are certainly all
    encompassing, although there may also be an element of deception, given
    her presentation of self as sui generis, that is, without any connection to
    real past. At the same time, she appears able to function [o]n a daily basis
    and her reality testing is sufficient to manage her affairs in a limited
    manner. From the supervised visits, [Mother] appears able to attend to her
    child’s needs (again, for a limited period and limited possible needs she
    would need to meet under the circumstances).
    [Mother] is completely indifferent, la belle indifference in the old
    psychiatric literature, marking a kind of hysterical refusal to take what she
    4
    is saying seriously. . . . There is a kind of manic quality in her delusions as
    opposed to themes of world destruction and/or omnipotence in
    schizophrenic delusions. The possibility should be considered that she has
    Bipolar Disorder.
    To add to the mystery, [Mother’s] claim of multiple insults to her
    brain, once from a long-lasting coma, once from a severe automobile
    accident does suggest that her mental status may be connected to brain
    injury. The only evidence besides her own assertions is her significant
    difficulty noted on the WAIS and W-J in working with dispatch.
    What remains clear is that [Mother] clearly is mightily unstable in
    her living and financial circumstances and the mystery of her origins leads
    me to conclude she would not be very reliable in caring for her child at this
    time. I would recommend that she would need to have a longer track record
    of even modest stability before visits with her child be extended. Whether
    there can or should be more pressure on her to divulge her past or to allow
    an investigation by authorities such as the FBI is something DCS might
    consider if permissible.
    I will conclude that at this point [Mother] is almost totally
    unbelievable in her ideas, beliefs or intentions. Although seemingly able to
    function on a daily basis, albeit with significant help from social services, I
    have no sense that she would be able to form a relationship of trust, for
    example, with [Family Service Worker]. Perhaps in time “more shall be
    revealed” and the possibility of a more reliable relationship may develop.
    Mother’s parenting assessment was performed by Leigh Ann Goldstein, a licensed
    professional counselor, and René Stegall, M.S., Omni Community Health case manager
    for Mother. As Ms. Goldstein began the parenting assessment, Mother became agitated
    by questions regarding her family history when Ms. Goldstein was completing the
    genogram portion of the assessment. Mother suggested that because Ms. Goldstein did
    not believe her, she refused to work further with Ms. Goldstein. Ms. Stegall testified that
    she finished the genogram and the remaining parts of the assessment with Mother.
    Calling upon her master’s degree and thirty years of social work experience, Ms. Stegall
    related that Mother frequently became agitated when she was “being put on the spot” and
    would become further agitated if someone did not believe her or pointed out the
    inconsistencies in her story. Ms. Stegall recommended that Mother not be questioned
    during visits to prevent upsetting her with the Child present. Having observed Mother’s
    supervised visitation with the Child, Ms. Stegall testified that Mother was appropriate
    with the Child during these visits. At one visit supervised by Ms. Stegall, however,
    5
    Mother arrived in a “very agitated state.” According to Ms. Stegall, Mother indicated
    that the Child’s father was spreading rumors about her, and that she was previously
    “running from people in the downtown area of Knoxville” when “people were shouting,
    ‘whore’ and other things.” The assessment revealed that Mother remained agitated
    during the entire visit. Mother offered that she “‘was going to have to leave the state,
    find another place to live and go into hiding.’” Ms. Stegall recommended that Mother
    continue to maintain mental health services and be mentally healthy on a long-term basis
    before the Child’s return to Mother.
    Ms. Goldstein’s testimony included the importance to a healthy child of having a
    “mentally functional, non-delusional parent.” Ms. Goldstein holds a master’s degree in
    counseling from the University of Tennessee and is licensed as a professional counselor
    through the State of Tennessee. According to Ms. Goldstein, her career had focused on
    interactions between parents and children. During trial, Ms. Goldstein opined in
    pertinent part:
    [I]t’s extremely important to a child’s ability to have successful
    interchanges with [her] environment, that [she has] a parent who has the
    ability to be attuned to, anticipate, acknowledge and appropriately meet
    [her] emotional needs. When you have a parent that struggles with severe
    mental illness, those needs take precedence over the child, which places the
    child at risk.
    In Ms. Goldstein’s proffered opinion, it would be difficult for a child to establish a sense
    of reality if raised by a delusional parent because the child’s reality would shift according
    to the reality of the parent. Significantly, Ms. Goldstein differentiated between a child
    having a delusional caretaker and having occasional contact with a delusional relative.
    According to Ms. Goldstein, a child with a delusional caregiver would have to trust that
    caregiver to meet her needs. Conversely, a child having occasional contact with a
    delusional relative can obtain corrective information from a stable caregiver, which
    would not be harmful to the child.
    During trial, Mother again articulated a review of her life and background as
    Penelope D. Mother’s explanation was substantially consistent with the previous
    narratives she had provided throughout her involvement with DCS. During the first day
    of trial, DCS informed Mother that they had located her parents, Marsha S. and Brad S.
    (collectively, “Maternal Grandparents”), in Florida. DNA testing during the pendency of
    the case established that Maternal Grandparents were the biological grandparents of the
    Child. Mother, however, denied that they were her parents, insisting that her parents
    were deceased. Instead, Mother maintained that Maternal Grandparents were distant
    relatives from her mother’s side of the family. According to Mother, “[Maternal
    6
    Grandparents were] extremely abusive mentally and physically, and I don’t want them
    anywhere near my children because I think that it would be detrimental to their health.”
    Mother related that Maternal Grandparents lied to her about who her parents were and
    still refused to tell her the truth. When questioned as to why she did not like Marsha S.,
    Mother stated, “Because she made up false tales regarding what my childhood was . . . .
    She for a while pretended to be my mother and she’s not. She pretended to be my sister’s
    mother, and she’s not alive anymore. And she just generally makes things up.”
    Although insisting at trial that she was residing in an apartment located in a house,
    Mother did not present a lease. Notwithstanding Mother’s claim of employment, it was
    undisputed that Mother’s employment did not constitute a legal source of income due to
    her lack of proper identification and Social Security number. According to Mother, her
    lack of identification and birth records limited her options for employment.
    At trial, Brad S. identified himself as Mother’s biological father. Marsha S. also
    testified, acknowledging that she was Mother’s biological mother.                Maternal
    Grandparents testified that Mother’s name was in fact Vaneta A. and not Penelope D.
    They first discovered that Mother was using the name Penelope D. in 2007 or 2008.
    Regarding other family members, Maternal Grandparents explained that Mother had
    three brothers but not a sister. Although lacking a birth certificate for Mother, they
    presented Mother’s Social Security number and Florida driver’s license.5 When
    questioned, Maternal Grandparents, speaking as the only caretakers responsible for
    Mother’s care as a child, denied any kind of abuse or trauma to Mother or that Mother
    was ever placed in foster care as a child.
    DCS presented evidence demonstrating that Mother has two biological children
    residing in Florida: S.A., fourteen years of age, and C.A., eight years of age. Records
    from the respective child welfare agency in Florida reveal that S.A. was removed from
    the custody of Mother in 2005, when Mother was determined to be delusional and
    paranoid and verified indicators for threatened harm were found. Mother was homeless
    at the time. According to the Florida agency’s records, Mother took S.A. to various
    medical providers, claiming that someone had bitten S.A. on the vagina, but no medical
    evidence was present to support the claim. S.A. was later released to the custody of her
    father, where she remained according to Maternal Grandparents.
    5
    According to Maternal Grandparents, Mother had no birth certificate. They maintained that Mother was
    born at home and that the doctor did not submit the paperwork for a birth certificate. As explained by
    Brad S., they did not obtain birth certificates or social security numbers for Mother and her siblings in
    order to “protect them from Uncle Sam.” According to Brad S., Mother was enrolled in school without a
    birth certificate. Although Maternal Grandparents purportedly arranged for Mother to obtain a birth
    certificate, Mother would not cooperate because she refused to have her photograph taken. Marsha S.
    testified that she assumed Mother would follow through and obtain a birth certificate when needed.
    7
    Florida agency records also reflect that Mother and C.A. were found sleeping in a
    vehicle in front of an individual’s home. Mother appeared delusional at that time, and
    her statements were “inconsistent with reality.” The child welfare agency and law
    enforcement became involved, which resulted in C.A.’s release to her biological father.
    Although Maternal Grandparents assisted C.A.’s father in obtaining custody of C.A., they
    opined that this action resulted in their estrangement from Mother. Marsha S. testified
    that when Mother lost custody of C.A., “[Mother] broke.” At trial, when Mother was
    shown photographs of her children, she incorrectly identified them. When Mother was
    presented photographs of herself and her biological children, she claimed the pictures
    were either of her and one of her fictitious children, Rhiann, or of Mother’s fictitious
    sister and niece. Despite DNA testing and testimony by Maternal Grandparents, Mother
    continued to deny her identity and her family, including her two oldest children.
    In a letter received by DCS approximately three weeks before the second day of
    trial, Mother’s current therapist, Kimberly Rickerson, observed that Mother had made
    progress by beginning to take medication for bipolar disorder that had “assisted in
    creating some stability in [Mother’s] emotional state.”6 Ms. Rickerson also wrote that
    Mother continued to insist that Marsha S. was not her mother and maintain that she was a
    “victim of the system.” Ms. Rickerson informed Mother that DCS would need to observe
    signs of long-term stability from Mother prior to any reunification with the Child. Ms.
    Rickerson recommended a psychiatric evaluation to determine a “more appropriate
    medication combination” for Mother. Ms. Rickerson also stated that Mother was
    “emotionally fragile” and that a termination of her parental rights could cause Mother to
    suffer “severe depression.”
    A DCS case manager, Stephanie Grissom, testified at trial that as she had
    supervised visits between Mother and the Child, they were “some of the best visits [she
    has] supervised.” Although Ms. Grissom indicated that she was not concerned about the
    Child’s safety during those visits, she explained on cross-examination that she had safety
    concerns stemming from Mother’s mental health that prevented her from recommending
    unsupervised visitation. Stating that the Child was bonded to Mother through the
    supervised visits, Ms. Grissom opined that both Mother and the Child would be
    devastated if that relationship ceased. According to Ms. Grissom, however, the best
    long-term option for the Child was to be adopted by the foster parents, who desired to
    adopt her. As described by Ms. Grissom, the Child maintained a strong bond with the
    foster parents and had thrived since being in their home. Furthermore, the Child’s foster
    parents were open to allowing Mother to continue a relationship with the Child after an
    adoption. According to Ms. Grissom, Mother had complied with the permanency plan
    6
    Testimony established that Mother did not begin taking medication for her mental illness until April
    2015.
    8
    developed in the case but was still delusional, telling fantastic stories about her life that
    contradicted her actual identity. Ms. Grissom explained that she did not believe Mother
    would be able to parent the Child in the near future due to Mother’s significant mental
    illness.
    Following two days of trial conducted on July 20, 2015, and October 5, 2015, the
    trial court entered a final order on December 15, 2015, terminating Mother’s parental
    rights to the Child. The court found by clear and convincing evidence that (1) Mother
    was mentally incompetent and unable to care for the Child and (2) the conditions leading
    to the Child’s removal from the home still persisted. The trial court further found by
    clear and convincing evidence that termination of Mother’s parental rights was in the best
    interest of the Child. Mother timely appealed.
    II. Issues Presented
    Mother presents three issues for our review, which we have restated as follows:
    1.     Whether the trial court erred by terminating Mother’s parental rights
    based upon the statutory ground of mental incompetence.
    2.     Whether the trial court erred by terminating Mother’s parental rights
    based upon the statutory ground of persistence of conditions.
    3.     Whether the trial court erred in determining by clear and convincing
    evidence that the termination of Mother’s parental rights was in the
    best interest of the Child.
    III. Standard of Review
    In a termination of parental rights case, this Court has a duty to determine
    “whether the trial court’s findings, made under a clear and convincing standard, are
    supported by a preponderance of the evidence.” In re F.R.R., III, 
    193 S.W.3d 528
    , 530
    (Tenn. 2006). The trial court’s findings of fact are reviewed de novo upon the record,
    accompanied by a presumption of correctness unless the evidence preponderates against
    those findings. Tenn. R. App. P. 13(d); See In re Carrington H., 
    483 S.W.3d 507
    , 524
    (Tenn. 2016); In re F.R.R., 
    III, 193 S.W.3d at 530
    . Questions of law, however, are
    reviewed de novo with no presumption of correctness. See In re Carrington 
    H., 483 S.W.3d at 524
    (citing In re M.L.P., 
    281 S.W.3d 393
    (Tenn. 2009)). The trial court’s
    determinations regarding witness credibility are entitled to great weight on appeal and
    shall not be disturbed absent clear and convincing evidence to the contrary. See Jones v.
    Garrett, 
    92 S.W.3d 835
    , 838 (Tenn. 2002).
    9
    “Parents have a fundamental constitutional interest in the care and custody of their
    children under both the United States and Tennessee constitutions.” Keisling v. Keisling,
    
    92 S.W.3d 374
    , 378 (Tenn. 2002). It is well established, however, that “this right is not
    absolute and parental rights may be terminated if there is clear and convincing evidence
    justifying such termination under the applicable statute.” In re Drinnon, 
    776 S.W.2d 96
    ,
    97 (Tenn. Ct. App. 1988) (citing Santosky v. Kramer, 
    455 U.S. 745
    , 
    102 S. Ct. 1388
    , 
    71 L. Ed. 2d 599
    (1982)). As our Supreme Court has recently explained:
    The parental rights at stake are “far more precious than any property
    right.” 
    Santosky, 455 U.S. at 758-59
    . Termination of parental rights has
    the legal effect of reducing the parent to the role of a complete stranger and
    of severing forever all legal rights and obligations of the parent or guardian
    of the child.” Tenn. Code Ann. § 36-1-113(l)(1); see also 
    Santosky, 455 U.S. at 759
    (recognizing that a decison terminating parental rights is “final
    and irrevocable”). In light of the interests and consequences at stake,
    parents are constitutionally entitled to “fundamentally fair procedures” in
    termination proceedings. 
    Santosky, 455 U.S. at 754
    ; see also Lassiter v.
    Dep’t of Soc. Servs. of Durham Cnty, N.C., 
    452 U.S. 18
    , 27 (1981)
    (discussing the due process right of parents to fundamentally fair
    procedures).
    Among the constitutionally mandated “fundamentally fair
    procedures” is a heightened standard of proof—clear and convincing
    evidence. 
    Santosky, 455 U.S. at 769
    . This standard minimizes the risk of
    unnecessary or erroneous governmental interference with fundamental
    parental rights. Id.; In re Bernard T., 
    319 S.W.3d 586
    , 596 (Tenn. 2010).
    “Clear and convincing evidence enables the fact-finder to form a firm belief
    or conviction regarding the truth of the facts, and eliminates any serious or
    substantial doubt about the correctness of these factual findings.” In re
    Bernard 
    T. 319 S.W.3d at 596
    (citations omitted). The clear-and-
    convincing-evidence standard ensures that the facts are established as
    highly probable, rather than as simply more probable than not. In re
    Audrey S., 
    182 S.W.3d 838
    , 861 (Tenn. Ct. App. 2005); In re M.A.R., 
    183 S.W.3d 652
    , 660 (Tenn. Ct. App. 2005).
    ***
    In light of the heightened burden of proof in termination
    proceedings, however, the reviewing court must make its own
    determination as to whether the facts, either as found by the trial court or as
    10
    supported by a preponderance of the evidence, amount to clear and
    convincing evidence of the elements necessary to terminate parental rights.
    In re Bernard 
    T., 319 S.W.3d at 596-97
    .
    In re Carrington 
    H., 483 S.W.3d at 522-524
    . “[P]ersons seeking to terminate [parental]
    rights must prove all the elements of their case by clear and convincing evidence,”
    including statutory grounds and the best interest of the child. See In re Bernard T., 
    319 S.W.3d 586
    , 596 (Tenn. 2010).
    IV. Grounds for Termination of Parental Rights
    Tennessee Code Annotated § 36-1-113 (Supp. 2016) lists the statutory grounds for
    termination of parental rights, providing in relevant part as follows:
    (a)    The chancery and circuit courts shall have concurrent jurisdiction
    with the juvenile court to terminate parental or guardianship rights to
    a child in a separate proceeding, or as a part of the adoption
    proceeding by utilizing any grounds for termination of parental or
    guardianship rights permitted in this part or in title 37, chapter 1,
    part 1 and title 37, chapter 2, part 4.
    ***
    (c)    Termination of parental or guardianship rights must be based upon:
    (1)    A finding by the court by clear and convincing evidence that
    the grounds for termination of parental or guardianship rights
    have been established; and
    (2)    That termination of the parent’s or guardian’s rights is in the
    best interests of the child.
    The trial court determined that the evidence clearly and convincingly supported a
    finding of two statutory grounds to terminate Mother’s parental rights: (1) mental
    incompetence pursuant to Tennessee Code Annotated § 36-1-113(g)(8) and (2)
    persistence of conditions pursuant to Tennessee Code Annotated § 36-1-113(g)(3). Both
    termination grounds found by the trial court were based on Mother’s mental condition
    and how it inhibited her ability to care for the Child.
    In its final judgment, the trial court found the following facts relevant to the
    grounds established for termination of Mother’s parental rights:
    11
    I
    [The Child] was born out of wedlock to Penelope [D.] . . . in Knox
    County, Tennessee. . . . The temporary custody of this child was
    awarded to the State of Tennessee, Department of Children’s
    Services, on October 7, 2013, by order of the Juvenile Court of Knox
    County, Tennessee; she has been in foster care continuously since
    that date. An order finding the child dependent and neglected was
    issued by this Court following a hearing on April 8, 2014. The
    termination petition was filed against [Mother] on January 26, 2015.
    II
    1.    [The Child] was removed from her mother’s custody due to
    [Mother’s] mental health issues which create an inability for the
    mother to provide appropriate care and supervision for the child.
    When [the Child] was born, medical staff at the hospital became
    concerned about the mother’s mental health and whether she was
    well enough, from a mental health standpoint, to care for her
    newborn. The attending physician called for a psychiatric consult as
    the mother appeared to be significantly delusional. That consult
    concluded that the mother was actively suffering from one or more
    significant delusional disorders and that she could not safely care for
    the infant.
    ***
    8.    [Mother’s] delusions about her identity and her history have been
    essentially the same throughout her involvement with the
    Department of Children’s Services. So has her apparent interest in
    discovering the truth. . . .
    9.    One of the requirements on [Mother’s] permanency plan was that
    she complete a full psychological evaluation. That evaluation was
    done by Dr. William McGillivray in March 2014. [Mother] was
    diagnosed with Psychotic Disorder, NOS; R/o Bipolar Disorder,
    Schizophrenia. During the evaluation she gave evidence of a serious
    impairment in her ability to think logically and coherently. The
    evaluator recommended that she receive intervention focused on
    helping her improve the clarity of her thinking. He concluded:
    12
    This is a difficult case. Her delusions are
    certainly all encompassing, although there may also be
    an element of deception, given her presentation of self
    as sui generis, that is, without any connection to real
    past. . . .
    She is completely indifferent, la belle
    indifference in the old psychiatric literature, marking a
    kind of hysterical refusal to take what she is saying
    seriously. . . There is a kin[d] of manic quality in her
    delusions as opposed to themes of world destruction
    and/or omnipotence in schizophrenic delusions. The
    possibility should be considered that she has Bipolar
    Disorder.
    To add to the mystery, her claim of multiple
    insults to her brain, once from a long-lasting coma,
    once from a severe automobile accident does suggest
    that her mental status may be connected to brain
    injury. . .
    What remains clear is that she clearly is
    mightily unstable in her living and financial
    circumstances and the mystery of her origins leads me
    to conclude that she would not be very reliable in
    caring for her child at this time.[]
    10.   Other requirements of the permanency plan include that Respondent
    [p]articipate in individual therapy. [Mother] has received ongoing
    individual counseling at The Solution Source at the Department’s
    expense. She has been compliant with treatment to the extent that
    she has kept all her appointments but, as evidenced by her testimony
    during this trial, she has made no progress in addressing her
    delusions. She recognizes that she has issues to address, but she is
    unable or unwilling to address them. She has been compliant with
    medication management through Cherokee since April 2015. She
    was required to obtain appropriate housing. She was unable to
    qualify for public housing due to her lack of identification. She
    stayed with various individuals until she recently obtained an
    apartment in a house. She still has no lease and, thus, no stability
    though there is no reason to believe she cannot remain there
    13
    indefinitely. . . . [Mother] was also asked to complete a parenting
    assessment and to demonstrate parenting skills during visitation.
    The evidence was uncontroverted that [Mother] is a very loving
    mother, attentive to her child and prepared for visits. . . .
    11.   During a break on the first day of trial, [Mother] was advised that the
    Department of Children’s Services had finally been successful in
    identifying and locating her biological parents, Brad and Marsha S[.]
    Rather than being excited by the ultimate success of the
    Department’s extensive efforts, [Mother] became very upset. She
    testified that this was not good news and that “they’re not my
    parents. . . . My biological parents are deceased. . . .”
    12.   Brad S[.] testified by speakerphone from Florida on the first day of
    trial and then traveled to Knoxville to testify in person on the second
    day. Marsha S[.] did the same. They identified themselves as
    [Mother’s] biological parents. DNA testing conducted with [the
    Child] between the two days of trial confirmed this relationship.
    [Maternal Grandparents] stated that [Mother’s] actual name is
    Vaneta [A.], named after two of her great-grandmothers. She never
    had a sister. . . .
    13.   Vaneta (aka Penelope) was born . . . in South Bench, Indiana. The
    family moved to Florida in 1985 where they lived in several
    different cities based on [Brad S.’s] work, settling in Fort St. Lucie
    in 1995. Vaneta (aka Penelope) never lived with anybody else and
    was never in foster care. She was described as a happy little person
    until she became a teenager. A high school counselor suggested that
    she was a willful child and needed counseling but her parents did not
    agree. When she was 15 or 16, she ran away with a band that came
    to town and her parents retrieved her a couple months later from
    Paducah, Kentucky. They never knew what happened during that
    time but saw that their child had changed. . . .
    14.   [Mother’s] first child, [S.A.], was born in Florida [i]n . . . 2002.
    [S.A.] and [Mother] lived with [Maternal Grandparents] until [S.A.]
    was about 3. After an argument with [Marsha S.] over who was to
    care for [S.A.], [Mother] left with the toddler and went to a shelter.
    [S.A.] was removed from [Mother’s] custody a few weeks later by
    the Florida child welfare agency after [Mother] was found to be
    delusional and paranoid, including making various fictitious
    14
    allegations of abuse to the child. [S.A.] was eventually released
    from foster care to the custody of her father. [Mother’s] second
    child, [C.A.], was born in Florida [i]n . . . 2007. She was removed
    from [Mother’s] custody in March 2008 after they were found
    sleeping in a car in someone’s yard with no residence address and no
    means of support. [Mother] again appeared delusional. [C.A.] was
    immediately placed in the custody of her father . . . where she
    remains. It was about this time that [Mother] began using the name
    Penelope. [Mother] has not had ongoing contact with her parents
    since she lost [C.A.] They searched for her, but could not find her as
    she is an adult who did not want to be found.
    ***
    17.   Leigh Anne Goldst[ein], a licensed professional counselor,
    attempted to complete a parenting assessment with [Mother].
    During Ms. Goldst[ein]’s attempt to obtain family history and a
    genogram, [Mother] became agitated and refused to cooperate
    further with Ms. Goldst[ein]. That assessment was completed by
    René Stegall, another employee of Omni Community Health. The
    details of [Mother’s] history as related during this assessment vary
    from other stories, but the general outline is consistent with what she
    has told others and with her testimony during this trial. Ms.
    Goldst[ein]’s career has focused on interactions between parents and
    children. She testified as an expert witness to the importance of
    having a mentally functional, non-delusional parent. She stated that
    “it is extremely important to a child’s ability to have successful
    interchanges with their environment, that . . . they have a parent
    who has the ability to be attuned to, anticipate, acknowledge and
    appropriately meet their emotional needs. When you have a parent
    that struggles with severe mental illness, those needs take
    precedence over the child, which places the child at risk.” She
    agreed that it is difficult for a child to establish a sense of reality if
    being raised by a parent who is not in touch with reality. The child’s
    reality shifts according to whatever the reality of the parent is.
    ***
    19.   Upon these facts, the Court finds that the child has been removed by
    order of this Court for a period of six (6) months; that the conditions
    which led to her removal still persist; other conditions persist which
    15
    in all probability would cause the child to be subjected to further
    abuse and neglect and which, therefore, prevent the child’s return to
    the care of [Mother]; there is little likelihood that these conditions
    will be remedied at an early date so that this child can be returned to
    [Mother] in the near future; the continuation of the legal parent and
    child relationship greatly diminishes the child’s chances of early
    integration into a stable and permanent home.
    20.    The Court further finds that [Mother] is incompetent to adequately
    provide for the further care and supervision of the child because
    [Mother’s] mental condition is presently so impaired and is so likely
    to remain impaired that it is unlikely that [Mother] will be able to
    assume the care of and responsibility for the child in the near future.
    21.    This is not your everyday termination case. There is no villain here.
    [Mother] is certainly mentally ill. She is delusional. She has proven
    that through her own testimony. The Court cannot get past her
    testimony about her identity and history, her 22 fictitious children,
    and her two other real children. None of this is based in reality. Her
    refusal to accept her actual identity has cut her off from her family,
    including her two older children and her siblings, and has hampered
    her ability to provide for her own basic needs. According to all the
    witnesses, she is currently doing the best she’s done. But that best
    does not include any diminution of her mental illness. She recently
    found a place to live and she has supportive, sheltered employment.
    She provides excellent care for [the Child] under supervision. The
    Court, however, cannot trust her ability to meet even her own needs
    when given the added burden of a two-year-old. She lost two other
    children under similar circumstances in the past and she was not as
    sick then as she is now.
    22.    [The Child] needs stability. She needs to know what to expect every
    day, to know where she is going to lay her head at night. She must
    be able to develop a sense of her own identity in the context of
    loving adults who are in touch with reality and can provide that
    secure base for her.
    Having carefully reviewed the evidence and record in this action, we shall address
    each statutory ground in turn.
    16
    A. Mental Incompetence
    Mother contends that the trial court erred by terminating her parental rights based
    upon the statutory ground of mental incompetence. Tennessee Code Annotated § 36-1-
    113(g)(8) provides as a ground for termination:
    (8)(A) The chancery and circuit courts shall have jurisdiction in an
    adoption proceeding, and the chancery, circuit, and juvenile courts shall
    have jurisdiction in a separate, independent proceeding conducted prior to
    an adoption proceeding to determine if the parent or guardian is mentally
    incompetent to provide for the further care and supervision of the child, and
    to terminate that parent’s or guardian’s rights to the child;
    (B) The court may terminate the parental or guardianship rights of that
    person if it determines on the basis of clear and convincing evidence that:
    (i) The parent or guardian of the child is incompetent to adequately
    provide for the further care and supervision of the child because the
    parent’s or guardian’s mental condition is presently so impaired and
    is so likely to remain so that it is unlikely that the parent or guardian
    will be able to assume or resume the care of and responsibility for
    the child in the near future; and
    (ii) That termination of parental or guardian rights is in the best
    interest of the child;
    (C) In the circumstances described under subdivisions (8)(A) and (B), no
    willfulness in the failure of the parent or guardian to establish the parent’s
    or guardian’s ability to care for the child need be shown to establish that the
    parental or guardianship rights should be terminated.
    The General Assembly’s elimination of the requirement of willfulness from the statute
    “serves to protect children from harm caused by a parent who is incapable of safely
    caring for them.” See In re D.A.P., No. E2007-02567-COA-R3-PT, 
    2008 WL 2687569
    ,
    at *5 (Tenn. Ct. App July 9, 2008). If willfulness were required in order to terminate
    parental rights for mental incompetence, “an obvious result . . . is to condemn a child,
    whose parents are unfit to properly care for the child because of mental illness, to a life in
    serial foster homes without any possibility of a stable, permanent home.” See State,
    Dep’t of Human Servs. v. Smith, 
    785 S.W.2d 336
    , 338 (Tenn. 1990).
    17
    This Court has rejected the argument that the ground of mental incompetence is
    reserved only for parents who have “a condition for which ‘no amount of intervention can
    assist’” and instead has affirmed the termination of parental rights for mental disorders
    such as bipolar disorder, adjustment disorder with anxiety and depressed mood,
    dependent personality disorder, and schizophrenia disorder. See 
    id. at 337-39
    (affirming
    the termination of parental rights of a parent diagnosed with schizophrenic disorder on
    the basis of mental incompetence, although the acts of the mentally disabled parent were
    not willful); In re S.M.R., No. M2008-01221-COA-R3-PT, 
    2008 WL 4949236
    , at *6
    (Tenn. Ct. App. Nov. 18, 2008) (affirming a termination of parental rights on the
    statutory ground of mental incompetence when the parent was diagnosed with bipolar
    disorder and personality disorder, not otherwise specified); Dep’t of Children’s Servs. v.
    M.R.N., No. M2006-01705-COA-R3-PT, 
    2007 WL 120038
    , at *10 (Tenn. Ct. App. Jan.
    17, 2007) (affirming a termination of parental rights on the statutory ground of mental
    incompetence based on a diagnosis of adjustment disorder with anxiety and depressed
    mood, as well as dependent personality disorder). The parent’s mental condition,
    however, must impair the parent to an extent that he or she cannot adequately provide for
    the care and supervision of the child. See Tenn. Code Ann. § 36-1-113(g)(8)(B)(i).
    In the instant action, Mother has a long history of mental illness. In 2005 and
    2008, Mother lost custody of her two oldest children in Florida due to her mental
    condition and her inability to care for those children. Mother denied the existence of
    those two children at trial. In October 2013, the Child was removed from Mother’s
    custody due to Mother’s mental health issues, which interfered with her ability to care for
    the Child. Even upon the conclusion of trial, Mother continued to deny her real identity
    and parentage, despite a DNA test establishing that Maternal Grandparents were the
    biological grandparents of the Child. The evidence demonstrates that Mother’s delusions
    continued into a visit with the Child on at least one occasion when Mother appeared
    agitated and made statements that she was going to run away and go into hiding.
    In determining that Mother’s mental condition rendered her unable to care for the
    Child, the trial court relied heavily on Mother’s testimony at trial and her continued
    delusions concerning her identity. The evidence preponderates in favor of this
    determination. Despite efforts by Mother, the evidence demonstrated that her condition
    was unlikely to be remedied at any point in the near future to allow Mother to resume
    care and responsibility for the Child. As to this issue, Ms. Goldstein testified regarding
    the effect Mother’s delusions would have on the Child, opining that having a delusional
    parent would put the Child at risk. The trial court found that Mother was “compliant with
    treatment to the extent that she has kept all her appointments but, as evidenced by her
    testimony during this trial, she has made no progress in addressing her delusions.” As the
    trial court found, “[Mother’s] refusal to accept her actual identity has . . . hampered her
    18
    ability to provide for her own basic needs” and called into question Mother’s “ability to
    meet even her own needs when given the added burden of a two-year-old.”
    We acknowledge and commend Mother on her efforts in attempting to overcome
    her mental illness. Following a thorough review of the record, however, we conclude
    that the evidence does not preponderate against the trial court’s finding by clear and
    convincing evidence that Mother was incompetent to adequately provide for the care and
    supervision of the Child. Mother’s mental condition is presently and is likely to remain
    so impaired that it is unlikely Mother will be able to assume care of and responsibility for
    the Child in the near future. Therefore, we affirm the termination of Mother’s parental
    rights based on the statutory ground of mental incompetence.
    B. Persistence of Conditions
    Mother contends that the trial court erred in finding clear and convincing evidence
    of the ground of persistence of conditions in this case. Specifically, Mother argues that
    DCS presented no evidence to the court that Mother was unable to meet the needs of the
    Child. Mother also argues that she has made “substantial progress” during the pendency
    of this case. While we recognize that Mother has made efforts to remedy her mental
    condition by attending therapy and, more recently, beginning medication for her
    condition, we agree with the trial court that the conditions leading to removal still
    persisted at the time of trial.
    Tennessee Code Annotated § 36-1-113(g)(3) provides as an additional ground for
    termination of parental rights:
    The child has been removed from the home of the parent or guardian by
    order of a court for a period of six (6) months and:
    (A) The conditions that led to the child’s removal or other
    conditions that in all reasonable probability would cause the
    child to be subjected to further abuse or neglect and that,
    therefore, prevent the child’s safe return to the care of the
    parent or parents or the guardian or guardians, still persist;
    (B) There is little likelihood that these conditions will be
    remedied at an early date so that the child can be safely
    returned to the parent or parents or the guardian or guardians
    in the near future; and
    19
    (C) The continuation of the parent or guardian and child
    relationship greatly diminishes the child’s chances of early
    integration into a safe, stable and permanent home; . . .
    As the record reflects and the trial court found, the Child was removed from the
    custody of Mother on October 7, 2013, due to Mother’s mental health, resulting in
    Mother’s inability to care for the Child. The Child was adjudicated to be dependent and
    neglected on April 8, 2014, by the trial court due to Mother’s mental health issues and
    Mother’s inability to care for the Child. We have determined in this Opinion that the
    evidence preponderates in favor of the trial court’s finding that Mother’s delusions still
    persisted at the time of trial, rendering her mentally incompetent to care for the Child.
    This Court has previously determined that the ground of persistence of conditions
    can be based on a parent’s mental incapacity. See In re B.S.G., No. E2006-02314-COA-
    R3-PT, 
    2007 WL 1514958
    , at *7 (Tenn. Ct. App. May 24, 2007) (“A parent’s mental
    incapacity can provide a sufficient factual predicate for a finding that persistent
    unremedied conditions exist which prevent the safe return of the child or children to that
    parent’s care.”). In this case, despite efforts by both DCS personnel and Mother, the
    reason for removal of the Child from Mother’s care (Mother’s mental incapacity) still
    persisted at the time of trial. Additionally, the trial court found that it was unlikely this
    condition would be remedied at any point in the near future so that the Child could return
    to Mother’s custody. The court further found that continuation of the parent/child
    relationship between the Child and Mother greatly diminished the Child’s chances of
    early integration into a stable and permanent home.
    Following a thorough review of the record, we conclude that the evidence supports
    the trial court’s finding that DCS has proven the ground of persistence of conditions by
    clear and convincing evidence. While Mother had received medication and therapy at the
    behest of DCS case managers, her mental condition had not improved by the time of trial
    such that she was capable of safely caring for the Child. Furthermore, testimony
    demonstrated that Mother’s mental condition would be unlikely to improve in the near
    future so as to allow the Child to return to Mother’s custody. Continuation of the
    parent/child relationship would therefore greatly diminish the Child’s chances of
    integration into a safe and stable permanent home. The trial court properly terminated
    Mother’s parental rights based on clear and convincing evidence of this statutory ground.
    V. Best Interest of the Child
    When a parent has been found to be unfit by establishment of at least one statutory
    ground for termination of parental rights, as here, the interests of parent and child
    diverge, and the focus shifts to what is in the child’s best interest. In re Audrey S., 182
    
    20 S.W.3d 838
    , 877 (Tenn. Ct. App. 2005); see also In re Carrington 
    H., 483 S.W.3d at 507
    ,
    523 (Tenn. 2016) (“‘The best interests analysis is separate from and subsequent to the
    determination that there is clear and convincing evidence of grounds for termination.’”)
    (quoting In re Angela E., 
    303 S.W.3d 240
    , 254 (Tenn. 2010)). Tennessee Code
    Annotated § 36-1-113(i) (Supp. 2016) provides a list of factors the trial court is to
    consider when determining if termination of parental rights is in a child’s best interest.
    This list is not exhaustive, and the statute does not require the court to find the existence
    of every factor before concluding that termination is in a child’s best interest. See In re
    Carrington 
    H., 483 S.W.3d at 523
    ; In re Audrey 
    S., 182 S.W.3d at 878
    (“The relevancy
    and weight to be given each factor depends on the unique facts of each case.”).
    Furthermore, the best interest of a child must be determined from the child’s perspective
    and not the parent’s. White v. Moody, 
    171 S.W.3d 187
    , 194 (Tenn. Ct. App. 2004).
    Tennessee Code Annotated § 36-1-113(i) lists the following factors for
    consideration:
    (1)    Whether the parent or guardian has made such an adjustment of
    circumstance, conduct, or conditions as to make it safe and in the
    child’s best interest to be in the home of the parent or guardian;
    (2)    Whether the parent or guardian has failed to effect a lasting
    adjustment after reasonable efforts by available social services
    agencies for such duration of time that lasting adjustment does not
    reasonably appear possible;
    (3)    Whether the parent or guardian has maintained regular visitation or
    other contact with the child;
    (4)    Whether a meaningful relationship has otherwise been established
    between the parent or guardian and the child;
    (5)    The effect a change of caretakers and physical environment is likely
    to have on the child’s emotional, psychological and medical
    condition;
    (6)    Whether the parent or guardian, or other person residing with the
    parent or guardian, has shown brutality, physical, sexual, emotional
    or psychological abuse, or neglect toward the child, or another child
    or adult in the family or household;
    21
    (7)    Whether the physical environment of the parent’s or guardian’s
    home is healthy and safe, whether there is criminal activity in the
    home, or whether there is such use of alcohol, controlled substances
    or controlled substance analogues as may render the parent or
    guardian consistently unable to care for the child in a safe and stable
    manner;
    (8)    Whether the parent’s or guardian’s mental and/or emotional status
    would be detrimental to the child or prevent the parent or guardian
    from effectively providing safe and stable care and supervision for
    the child; or
    (9)    Whether the parent or guardian has paid child support consistent
    with the child support guidelines promulgated by the department
    pursuant to § 36-5-101.
    The trial court made the following findings of fact concerning the best interest
    analysis in relevant part:
    [The Child] is now described as a very smart, very happy child. She
    is bonded to her prospective adoptive family and excited to see them at the
    end of visits with her mother. They are providing her with that trusting,
    secure place where her emotional needs are being met and where she can
    develop with a clear sense of reality.
    ***
    [The Child] needs stability. She needs to know what to expect every
    day, to know where she is going to lay her head at night. She must be able
    to develop a sense of her own identity in the context of loving adults who
    are in touch with reality and can provide that secure base for her.
    [Mother] has not made such an adjustment of circumstance, conduct,
    or conditions as to make it safe and in the child’s best interest to be in her
    home despite reasonable efforts by available social services agencies for
    such duration of time that lasting adjustment does not reasonably appear
    possible. A change of caretakers and physical environment is likely to have
    a detrimental effect on the child’s emotional and psychological condition.
    Most significantly, [Mother’s] mental and/or emotional status would be
    detrimental to the child or prevent [Mother] from effectively providing safe
    and stable care and supervision for the child.
    22
    The Department of Children’s Services has made reasonable efforts
    toward achieving permanency for this child.
    It is, therefore, in the best interest of [the Child] and the public that
    all of [Mother’s] parental rights to this child be terminated and the complete
    custody, control, and full guardianship of the child be awarded to the State
    of Tennessee, Department of Children’s Services, with the right to place
    her for adoption and to consent to such adoption in loco parentis.
    (Emphasis and paragraph numbering omitted.)
    This Court addressed a similar situation in State of Tennessee, Dep’t of Children's
    Servs. v. Oliver, No. M2007-00844-COA-R3-PT, 
    2007 WL 4553036
    (Tenn. Ct. App.
    Dec. 26, 2007). In Oliver, this Court acknowledged that the parents had not actively
    abused the children and that they made substantial efforts to complete the requested
    classes, visit the children regularly, and maintain a relationship with the children. 
    Id. at *9.
    Despite those efforts, this Court affirmed the trial court’s finding that the parents in
    that case were unable mentally to care for the children and were unlikely to improve to a
    point where they would be capable of caring for the children. 
    Id. In affirming
    the trial
    court’s best interest finding, this Court reasoned as follows:
    At this stage in the analysis . . . we must focus on the best interests of [the
    children]. We have observed:
    [T]he statutes on termination of parental rights are established
    not only to protect a child from a parent who actively abuses
    him, but also to avoid the harm visited upon a child by
    spending years in the uncertainty of foster care because his
    biological parents are unwilling or unable to care for him
    properly, and yet will not voluntarily relinquish their parental
    rights so that the child will be available for adoption and a
    permanent home. Such parents may recognize that they are
    unable to shoulder the responsibility of caring for the child,
    but wish for a relationship with the child that does not require
    caring for the child’s needs. The statutory scheme enacted
    evidences recognition by the Legislature that, unless the
    parental rights of such a parent can be terminated, a
    substantial number of children will spend their childhood in
    foster care, with no possibility of a permanent home.
    23
    In re Marr, No. M2001-02890-COA-R3-CV, 
    2003 WL 152640
    , at *10
    (Tenn. Ct. App. Jan. 23, 2003), judgment vacated for lack of standing, 
    127 S.W.3d 737
    (Tenn. 2004). We emphasized that the best interests of the
    child “must be evaluated in light of the statutory purpose of determining
    whether the child would be able to safely live with the parents.” The Marr
    court quoted Tenn. Dep’t of Children’s Services v. D.G.B., No. E2001-
    02426-COA-R3-JV, 2002 Tenn. App. LEXIS 647, 
    2002 WL 31014838
    (Tenn. Ct. App. Sept. 10, 2002), as follows:
    In the instant case, the trial court found – and the evidence
    does not preponderate to the contrary – that “an early return
    to the care of their parents” was not possible. . . . This it
    seems to us is the key to this issue. The legislative intent is
    not simply to establish a “meaningful relationship” between a
    child and his or her parents; it is to return the child to the care
    of his parents.
    D.G.B., 2002 Tenn. App. LEXIS 647, at *26-27, 
    2002 WL 31014838
    quoted in Marr, 
    2003 WL 152640
    , at *11. We then discussed the impact
    [on] the child of continuing the parent/child relationship with a parent who,
    through no fault of the parent, cannot care for the child:
    [T]he focus of the termination statute is on whether the child
    can safely live with the parent and have his, that is, the
    child’s, day-to-day needs met. Some of the grounds, such as
    abuse of the child, are reasons for which the parent can be
    faulted.     Other reasons, such as a parent’s mental
    incompetence, are reasons for which the parent cannot be
    faulted, but the result nonetheless is that the child cannot
    safely live with the parent in such a way that the child’s needs
    will be met. . . . For a child who is in foster care, failing to
    terminate the . . . parent’s parental rights means that the child
    will spend his childhood in foster care, with no permanent
    home.
    Marr, 
    2003 WL 152640
    , at *12 (internal citations omitted). Thus, we
    cannot ignore the legislative intent behind the termination statutes. Clearly,
    the legislature intended for the focus to be on achieving a permanent, safe
    home for children coming into the care of the State. In this case,
    continuation of the children’s relationship with Mother and Father would
    prevent their adoption and mean that they would spend their childhood in
    24
    foster care, with no permanent home. That is substantial harm indeed.
    Therefore, we affirm the trial court’s finding that termination of the
    parental rights of Mother and Father is in the best interests of [the children].
    Oliver, 
    2007 WL 4553036
    , at *9-10.
    In the case at bar, the trial court found that Mother was mentally incompetent such
    that she was unable to safely care for the Child. Mother suffered from delusions and was
    still unwilling or unable to accept her identity or her family at the conclusion of trial,
    despite DNA evidence proving a biological relationship between the Child and Maternal
    Grandparents. Expert testimony and a psychological evaluation of Mother’s mental state
    indicated that Mother’s mental illness would have a detrimental effect on the Child.
    Mother had made efforts to improve her mental condition, but her delusions persisted at
    the time of trial and were clear from her testimony. The trial court relied significantly on
    Mother’s testimony, which evinced that her delusions still persisted.
    In making its decision, the trial court found that the Child was bonded to her foster
    parents, who wished to adopt her, and that she was in a “trusting, secure place where her
    emotional needs [were] being met and where she [could] develop with a clear sense of
    reality.” Following our thorough review of the record, we conclude that the evidence
    does not preponderate against the trial court’s finding by clear and convincing evidence
    that termination of Mother’s parental rights was in the Child’s best interest.
    VI. Conclusion
    For the foregoing reasons, we affirm the trial court’s judgment terminating
    Mother’s parental rights to the Child. This case is remanded to the trial court, pursuant to
    applicable law, for enforcement of the trial court’s judgment and collection of costs
    assessed below. Costs on appeal are assessed to the appellant, Penelope D.
    _________________________________
    THOMAS R. FRIERSON, II, JUDGE
    25