ONTARIO COURT OF JUSTICE
Toronto
BETWEEN:
HIS MAJESTY THE KING
— AND —
SUZANNE KARANSUE
Before Justice Riun Shandler
Heard on February 20 and March 6, 2026
Ruling on Treatment Order Application released on March 13, 2026
J. Capozzi counsel for the Crown
F. Bernhardt counsel for the defendant Suzanne Karansue
I. Overview
1Ms Suzanne Karansue was found unfit to stand trial on February 20, 2026. The Crown applied for a treatment order which I ultimately granted on March 6, 2026, with reasons to follow. These are my Reasons for issuing a treatment order.
II. Background
2Ms Karansue has two informations before the court. She was charged with four mischief offences between January and February 2024, alleging that she made false allegations, such as calling 911 to state that: a dog walker was sexually assaulting dogs, her brother had been kidnapped, and that her neighbour was hanging people. Police investigation determined there was no basis for these complaints. Ms Karansue was charged again in September, 2025 with obstruct justice and assault peace officer where it is alleged she showed up at the scene of a motor vehicle accident, repeatedly refused to leave when directed by police officers and punched an officer in the face.
3Over the ensuing two years since her first set of charges, Ms Karansue appeared many times in Mental Health Court (“MHC”) in relation to these charges. She also missed many appearances. Jurists presiding in MHC noted concerns on multiple occasions, recording that Ms Karansue appeared acutely unwell, was rambling incoherently, acting disruptively and yelling at counsel.
4Ms Karansue was assessed twice for fitness and, while both opinions were that she was unfit, there were concerns that marijuana consumption may be affecting her mental state.
5On February 20, 2026, Ms Karansue presented in much the same fashion. She was disruptive, difficult to manage and repeatedly interrupted the proceedings to make irrelevant and, at times, bizarre comments. At the request of Mr. Bernhardt, I ordered a fitness assessment. Ms Karansue was assessed over the lunch hour, and a fitness hearing was held that same afternoon. Ms Karansue continued to be disruptive during the fitness hearing and left the courtroom at one point, however, she reattended within a short period of time.
6Dr. Maryana Kravtsenyuk testified that much of Ms Karansue’s responses to her questions were illogical and thought-disordered, with themes of pedophilia and paranoia, and perceptual disturbances such as voices. She testified that Ms Karansue appeared impulsive and unpredictable in a state of untreated psychosis. This evidence was consistent with Ms. Karansue’s presentation throughout the proceedings.
7I accepted the evidence of Dr. Kravtsenyuk that Ms Karansue was unfit to stand trial on the basis that she was suffering from a major mental illness – most likely acute untreated psychotic illness as well as substance use disorder (cannabis use) – and that her mental illness “seriously compromised” her ability to make and communicate reality-based decisions to defence counsel.
8After finding Ms Karansue unfit to stand trial, the Crown gave notice of their intention to bring an application for a treatment order. As the Crown was calling evidence on the treatment order application, Ms Karansue left the courtroom and, as it turns out, the courthouse. The evidence on the treatment order application was completed and counsel made submissions on the treatment order that included submissions as to whether a treatment order or a committal to the Ontario Review Board constituted the “least onerous and least restrictive” path to treatment. I issued a bench warrant for Ms Karansue and reserved my decision until she could be brought back before me. Counsel took the opportunity to file written submissions on the issue of whether a treatment order or a warrant of committal is the “least restrictive and least onerous” option.
9On March 6, 2026, Ms Karansue appeared before me with counsel. I deemed the bench warrant executed and issued a treatment order for Ms Karansue at the Centre for Addiction and Mental Health (CAMH) on or before April 16, 2026, the earliest available bed. Ms Karansue remains out of custody albeit she will have to step into custody prior to a bed becoming available at CAMH for the treatment order.
III. The Statutory Framework
10When an accused person has been found unfit to stand trial, the Criminal Code provides that the court can exercise an extraordinary power: ordering treatment over the consent of the accused. That power is subject to statutory safeguards set out in sections 672.58 through 672.62. The Supreme Court pronounced on these protections in R. v. Conception, stating:
The Code establishes a number of special protections that highlight the unusual nature of this power. As provided for in s. 672.59, the order may only be made if the court is satisfied on the basis of testimony from a medical practitioner that a specific treatment should be administered for the purpose of making the accused fit to stand trial. That testimony must fulfill the detailed criteria set out in s. 672.59(2), including that the treatment is the least restrictive and least intrusive that could be specified for the purpose and that the risk of harm to the accused is not disproportionate to its anticipated benefit. The accused has important procedural rights including notice, and the right to challenge the application and certain treatments including the performance of psychosurgery or electro-convulsive therapy are not permitted: ss. 672.6 and 672.61.
Second, by necessary implication, it authorizes medical personnel to carry out that treatment against the accused’s wishes. This is a remarkable provision, given that informed consent of the patient is generally the sine qua non of medical treatment. However, s. 672.62, by requiring consent of the hospital or the person responsible for the accused’s treatment, makes it clear that this provision does not oblige them to carry out the court’s disposition order without their consent. As the Court noted in Mazzei, doing so “would constitute interference with the authority and responsibility of hospital authorities to provide medical services to persons in their custody according to their view of what is appropriate and effective”: para. 34 (emphasis in original).1
IV. Analysis
11There is no issue that the power to make a treatment order is discretionary. At issue is the scope of that discretion and the factors that are properly considered when exercising that discretion.
12The defence argues that as part of the least onerous and least restrictive criteria, the court must consider alternatives, such as committal to the Ontario Review Board which provides for a person’s reintegration into the community and makes available options such as a “community treatment order” which permits ongoing community supervision, medication and psychiatric oversight are available.
13That submission, while notionally true, ignores the fact that the Review Board has no power to order treatment against the wishes of an accused. Section 672.55 is clear that the Board has no power to order that psychiatric or other treatment be carried out or that the accused submit to such treatment except and unless the accused consents and the Board consider the treatment “necessary and reasonable.”
14The courts, on the other hand, have been given this extraordinary power to order treatment notwithstanding the accused’s lack of consent in order to ensure that trials are not unduly delayed. As stated by our Court of Appeal:
The purpose of the treatment order regime in the Criminal Code is to restore an unfit accused’s fitness to stand trial as expeditiously as possible, thus enabling the trial process to proceed in a timely fashion and, in turn, enhancing both the accused’s fair trial and other Charter rights and society’s interest is seeing that criminal matters are disposed of on their merits. Experience shows that the majority of accused who are the subject of treatment orders suffer from a serious psychotic illness, such as schizophrenia, schizo-affective disorder, or bipolar disorder. Experience also shows they can often achieve a return to fitness for trial through the administration of anti-psychotic drug treatment for a period of 30-60 days: hence, the 60-day limit on a s. 672.58 order.2
15The point is that treatment orders are inherently onerous and extraordinarily restrictive. A treatment order impinges upon fundamental rights of the accused person. However, it does so for a narrow subset of individuals – those who are alleged to have committed a criminal offence, are unfit to stand trial and will be treatable within sixty days. Committal to the Review Board, with or without the civil treatment regime, will almost always be less onerous and less restrictive. If Parliament meant “least restrictive and least onerous” to be a comparison to treatment regimes outside of s. 672.59(2)(d), there would likely never be a treatment order under s. 672.58.
16I accept that a warrant of remand to the Review Board may be an appropriate solution for some individuals found unfit to stand trial but who remain out of custody and are relatively stable. Dr. Kravtsenyuk was cross-examined on this point and testified that successful out of custody treatment under the Review Board would require an individual who was insightful, cooperative, compliant and willing to engage in treatment. Ms Karansue is currently unable, and certainly unwilling, to engage in treatment. As Dr. Kravtsenyuk testified, “it would be quite challenging, if not impossible” to engage Ms Karansue with treatment given her degree of psychosis.
17I also accept that delays in accessing beds for a treatment order may justify other remedies. The Supreme Court left open the possibility of drafting an “immediate admission” as a Charter remedy, while noting that such remedies would be “exceedingly rare.”3 In R. v. Walker, Justice Code identified bed waits as a relevant consideration in determining whether to issue a treatment order. In that case, the Crown brought a certiorari application from a judge’s refusal to issue a treatment order as treatment under the criminal justice system – as compared to the civil mental health regime – was overly coercive. Justice Code provided this guidance when considering making a treatment order:
I am satisfied that s. 672.59 is not exhaustive of the considerations that may apply when deciding to make a s. 672.58 treatment order. Parliament specifically enumerated the most important considerations in s. 672.59 but it used the term "include", signifying that the list of s. 672.59 factors is not exclusive or exhaustive. Furthermore, s. 672.58 is an extraordinary power and Parliament could not predict every possible relevant consideration that might arise in a given case. It was important to maintain some residual discretion, given the coercive nature of this particular power and the real possibility of unforeseen circumstances. By way of analogy, see Baron v. Canada, 1993 154 (SCC), [1993] 1 S.C.R. 416, [1993] S.C.J. No. 6, 78 C.C.C. (3d) 510, at pp. 523-31 C.C.C., where Sopinka J. discussed a number of leading authorities concerning the importance of judicial discretion and explained why "a residual discretion is a constitutional requirement" in the law of search and seizure. [page293] In my view, similar considerations apply in the context of treatment orders.
Although some residual discretion exists under s. 672.58, it is not broad and unlimited. It is constrained by at least the following considerations:
first, the preconditions listed in s. 672.59 are the most important considerations and they make out a strong prima facie justification for a s. 672.58 treatment order. Where s. 672.59 has been satisfied, as in the present case, it means that the accused has been found unfit, the criminal process has been suspended, and the accused is treatable within 60 days by a method that is both proportionate and least restrictive. In these circumstances, it will be difficult to resist a treatment order;
second, any additional discretionary considerations must be consistent with the legislative context, that is, with the criminal law purpose of the surrounding Part XX.1 fitness provisions, as explained by the majority in Demers, supra [at para. 41], namely, to attain “the ongoing treatment or assessment of the accused in order for him or her to become fit for an eventual trial while preserving his or her maximum liberty and dignity”. Accordingly, if a treatment bed at a hospital is not available in a reasonable period of time, thus prolonging the detention of an unfit accused and unduly delaying resumption of the criminal trial process, this may be an unforeseen or unusual circumstance justifying a discretionary refusal to make a s. 672.58 order and making it preferable to exercise warrant of committal powers to a hospital, pursuant to s. 672.46(2);
third, any additional discretionary considerations must be consistent with the legislative purpose of s. 672.58 itself, as explained in Conception, supra, namely, involuntary treatment of an unfit accused without the accused’s consent but with the hospital’s consent, [at para. 33] “according to their [the treatment provider’s] view of what is appropriate and effective”, in order to avoid [at para. 126] “a potentially lengthy period of detention” for the unfit accused.4
18Bed availability was certainly an issue in this case. At the time that the Crown applied for the treatment order, a bed was not available at CAMH for some eight weeks. That said, the target date for a treatment order was the latest date that CAMH could accept Ms Karansue. As Dr. Kravtsenyuk testified, and as has been the experience of this judge who regularly sits in the Mental Health Court, individuals waiting for a bed on a pending treatment order are regularly admitted earlier than the initial date provided.
19The alternative route of a warrant of committal to the Ontario Review Board requires by statute that the Review Board hold a hearing within forty-five days or some six weeks. As noted, however, the Review Board, however, has no power to order treatment and it was Dr. Kravtsenyuk’s unchallenged opinion that without treatment, Ms Karansue would remain unfit to stand trial but that with treatment, she would likely be restored to a fit state within sixty days.
20Dr. Kravtsenyuk was cross-examined about the civil treatment regime under provincial legislation, and it was her evidence that the civil process would not result in Ms Karansue receiving treatment faster. Dr. Kravtsenyuk testified that a treatment order would result in Ms Karansue being returned to fitness in a timely manner whereas the civil treatment regime would be a prolonged process to intervene and treat someone who “lacks this degree of insight and is so uncooperative.”
21Dr. Kravtsenyuk testified that given Ms Karansue’s degree of psychosis, lack of insight and refusal to cooperate, she would have to undergo a capacity assessment and be found incapable of making treatment decisions and then her treatment would be decided by a substitute decision-maker. Ms Karansue could appeal that decision while refusing medication and it would not be possible to quantity how long this process could play out.5 Dr. Kravtsenyuk testified that there are individuals in this province who have appealed their findings of incapacity and have remained untreated while their appeals play out for up to two years.
22As noted by Justice Code in Walker, the civil treatment regime contains within it “a system of interlocutory appeals from a finding of incapacity, under the Health Care Consent Act, that gives rise to the potential for significant delays and that is arguably inconsistent with the legislative purpose of Part XX.1 of the Criminal Code.”6
23I accept Dr. Kravtsenyuk’s testimony that a treatment order is the most timely and effective means of restoring Ms Karansue to a fit state. Based on Ms Karansue’s level of acute unwellness, leaving the courtroom during the course of her fitness hearing, leaving the courthouse itself during the Crown’s application for a treatment order and remaining at large for some two weeks, I have no confidence that she would meaningfully engage with treatment providers under the civil treatment regime. That is, she would simply remain untreated and unfit while remaining under the jurisdiction of the Ontario Review Board with no certainty if the civil treatment regime would commence, and if it did start, what the outcome would be.
24Accordingly, I issued a treatment order.
Released: March 13, 2026
Signed: Justice Riun Shandler
Footnotes
- R. v. Conception, 2014 SCC 60 at paras. 32 – 33.
- Centre for Addiction and Mental Health v. Ontario, 2012 ONCA 342 at para. 33, affirmed R. v. Conception, 2014 SCC 60; R. v. Demers, 2004 SCC 46 at para. 41; R. v. Taylor (1992), 1992 7412 (ON CA), 77 C.C.C. (3d) 551 at para. 50.
- R. v. Conception, supra at para. 43.
- R. v. Walker, 2016 ONSC 2299 at paras. 55 – 56.
- R. v. Walker, supra at paras. 25 – 26.
- R. v. Walker, supra at paras. 36, 46