Court of Appeal for Ontario

Date: 2025-07-07
Docket: COA-24-CR-1041
Panel: Miller, Zarnett and Madsen JJ.A.

In the Matter of: Amy Smith Cox
An Appeal under Part XX.1 of the Code

Appearances:
Michael Davies, for the appellant
Adrianna Mills, for the respondent Attorney General of Ontario
Paige Miltenburg, for the respondent The Person in Charge of Brockville Mental Health Centre

Heard: April 9, 2025

On appeal from the disposition of the Ontario Review Board dated August 30, 2024, with reasons dated September 25, 2024.

Reasons for Decision

Overview

[1] The appellant, Amy Smith Cox, was charged with two counts of assaulting a police officer, one count of uttering threats to cause death or bodily harm, and one count of failure to comply with a release order. On March 21, 2023, the appellant was found not criminally responsible due to mental disorder for the index offences.

[2] The appellant appeals a detention order dated August 30, 2024, which found that she continued to pose a significant threat of serious harm to the public, and imposed a no-contact provision with her father, Steven Cox. The appellant currently remains in detention at the Secure Forensic Unit of the Brockville Mental Health Centre. The appellant appeals both the finding that she poses a risk to the public and the no-contact provision.

[3] For the reasons below, we dismiss the appeal of the finding that the appellant remains a significant threat, but allow in part the appeal of the no-contact provision.

Factual Background

[4] On October 8, 2021, police attended the appellant’s residence in response to a 911 call she had made, threatening to kill herself. While the police were en route, she advised she had an axe and would kill the attending police officers. When the officers arrived, she threatened them with an axe. Her father subsequently arrived and urged her to run from the police. After several hours, the appellant was apprehended with the use of a taser. Mr. Cox was charged with obstruction. Months later, on April 3, 2022, the appellant again called 911 and, when the police attended, sprayed an officer with a fire extinguisher. These are the index offences for which the appellant has been found NCR.

[5] The appellant has been diagnosed with schizophrenia, alcohol and cannabis use disorder (in remission in a controlled environment).

[6] The Crown requested a no-contact provision at the first review hearing on August 15, 2023. However, Dr. Jonathan Gray, a member of the treatment team, testified that although he would not support such a provision at that time, he would consider limiting or prohibiting the appellant’s contact with her father if he proved to be a negative influence. The Crown withdrew its request and the Board decided that the appellant’s re-engagement with her father would “remain at the discretion of the treatment team.” The Board also noted in its reasons that the appellant’s father had historically been a substance enabler and that there had been a previous application to remove him as the appellant’s substitute decision-maker.

[7] On July 22, 2024, the Consent and Capacity Board removed Mr. Cox as substitute decision maker for the appellant because they found he had not been acting in her best interests.

[8] In the disposition under review, the Board included a condition that precluded the appellant from having any contact with her father. The Board found the appellant’s father to have had a negative influence on the appellant’s mental health over the past year and that he was the “most significant” obstacle to the treatment of her schizophrenia.

The Significant Threat Finding

[9] On appeal, the appellant argues that the Board came to the conclusion that she continues to pose a significant threat of serious harm to the public without genuinely engaging in the analysis required to reach such a conclusion. Counsel for the appellant argues that the Board appears to have leapt from the fact that the appellant suffers from mental illness to the conclusion that she is a significant threat of serious harm.

[10] Although we agree with the appellant that the Board’s assessment of risk appears conclusory when read in isolation, the reasons when read as a whole amply justify the conclusion. The Board accepted the evidence of Dr. Gray that her condition was essentially unchanged since the time of her admission, when she was found to pose a significant risk of serious harm to the public. She was refusing antipsychotic medication to treat the symptoms of her schizophrenia, she lacked insight into her mental health issues, and she was likely to resume substance abuse – which exacerbates the schizophrenia – if discharged. Her behaviour on the ward had been violent and anti-social, including destruction of property and manifestations of paranoia towards staff. Dr. Gray found a connection between her refusal to take medication and the re-emergence of the behaviours that were occurring at the time of the index offences. He characterized her risk for future violence as moderate to high.

[11] It was evident from the Board’s reasons that it accepted this evidence, and that the only available conclusion to be drawn was that the appellant remained a significant risk of serious harm. Although it would have been preferable for the Board to have explained its reasoning directly, its train of thought was nevertheless both visible from the reasons taken as a whole, and reasonable. We would not interfere with it.

The No-Contact Provision

[12] We have concerns about the breadth of the no-contact provision.

[13] The rationale for the no-contact provision is not that it is in the appellant’s best interests, but that it is necessary for the protection of the public. After treating the appellant over the prior year, the treatment team had come to the opinion that Mr. Cox was, as the Crown had previously argued, a barrier to the effective treatment of the appellant’s schizophrenia. The treatment team believes that Mr. Cox may also suffer from psychosis. He denies that the appellant suffers from schizophrenia and encourages her not to take medication and to distrust the treatment team. The treatment team has observed that the appellant manifests dysregulation and distress after phone calls with her father, even when those are supervised.

[14] The Board accepted that interactions with Mr. Cox had been both detrimental to the mental health of the appellant and contributed to the threat she posed to the public.

[15] We do not disagree with the reasonableness of that finding. However, given the fundamental nature of the parent-child relationship – even where a child is an adult – we agree with the appellant that it was incumbent on the Board to at least consider whether a less intrusive order could achieve the same ends. The scope of the existing order is total – it would not permit so much as the appellant giving or receiving a birthday card. The evidence, however, went no further than documenting that there was a problem with Mr. Cox: (1) frustrating the efforts of the treatment team to treat the appellant’s illness and help her to develop insight; and (2) causing the appellant great distress through phone calls. There would seem to be some scope for interactions – perhaps in writing and moderated – that would allow for some ability to maintain contact while not undermining therapeutic objectives.

[16] We would replace the blanket no-contact provision with a provision that made contact subject to the discretion of the treatment team, as had previously been in place. This would allow an opportunity for the appellant to communicate with her father in forms and in degrees that the treatment team believes not to be therapeutically counterproductive. Such a provision would allow the treatment team to increase or decrease access to communication as therapeutically indicated.

Disposition

[17] The appeal of the finding that the appellant remains a significant threat of serious harm to the public is dismissed. The appeal of the no-contact provision is allowed, and the provision is varied to allow for contact with the appellant’s father, to the extent permitted by the treatment team.

“B.W. Miller J.A.”
“B. Zarnett J.A.”
“L. Madsen J.A.”