Re: Steven Sparling
ORB File No: 7239
Hearing Held On: Monday, January 6, 2025
Place of Hearing: Centre for Addiction and Mental Health
Pursuant To: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. C. Fraser
Members: Dr. B. Sheppard Dr. T. Stirpe Ms. A. La Viola Ms. R. Chopra
Parties Appearing:
Accused: Steven Sparling Counsel: Mr. B. Vincents
Person in charge of Hospital: Representative: Ms. L. Senko
Attorney-General of Ontario: Counsel: Mr. M. Feindel (via Zoom)
REASONS FOR DISPOSITION
(Dated February 14, 2025)
OVERVIEW
- On October 6, 2017, Steven Sparling was found not criminally responsible on account of mental disorder on a charge of arson – reckless disregard for human life, contrary to the Criminal Code. Mx. Sparling’s1 last annual review was conducted on December 15, 2023. They are currently subject to a disposition of the Ontario Review Board dated December 28, 2023, detaining them at the Centre for Addiction and Mental Health. The disposition permits Mx. Sparling community living in the Greater Toronto Area in supervised accommodations, approved by the person in charge.
ISSUES
On January 6, 2025, the Board convened at CAMH for a mandatory review hearing of the disposition further to s. 672.81(1) of the Criminal Code. The issue before the Board was to determine whether Mx. Sparling continues to pose a significant threat to the safety of the public and, if so, to determine the necessary and appropriate disposition for them consistent with the factors set out in s. 672.54 of the Criminal Code. Mx. Sparling attended the hearing in person, along with their Counsel, Mr. Vincents.
The Hospital asked the Board to conclude that Mx. Sparling continues to represent a significant threat to the safety of the public, and a Detention Order remains necessary, as already set out in the current disposition. Counsel for the Attorney General agreed with the Hospital’s recommendation. Counsel, Mr. Vincents, advocated that Mx. Sparling is entitled to an Absolute Discharge, or in the alternative, should the Board find that the test for ‘significant threat’ has been met, then a Conditional Discharge would be the most appropriate outcome.
FINDINGS
- After reviewing the evidence, the Board concluded that Mx. Sparling continues to represent a significant threat to the safety of the public. Although it may be appropriate to begin initial steps for them to live in the community in the future, they have been assessed as a high-risk of committing grave harm to the public, and to themselves, and they continue to require the current level of supervision and treatment. There are serious concerns about their progress in the recovery process and their level of understanding and limited insight that they suffer from treatment resistant Schizophrenia. Their treatment plan includes the appropriate level of monitoring and supervision, which is still necessary at this time. For the reasons that follow in more detail below, the Board also concluded that the continuation of a Detention Order is both necessary and warranted at this time.
PERSONAL BACKGROUND
The Hospital Report dated December 27, 2024, was entered as an exhibit at the hearing. The following background information, including the events surrounding the 2015 index offence, has been taken from the Report, summarized here as follows.
On May 20, 2015, Collingwood emergency responders attended to a structure fire at a local group home, where Mx. Sparling lived on the second floor. Mx. Sparling had attempted suicide by cutting their wrists and, when that failed, they ignited the bed sheets despite knowing other residents were in the house. They had barricaded themselves in a room, preventing others from helping. Another resident suffered severe smoke inhalation, resulting in several months of hospitalization. The fire caused nearly $300,000 in property damage. Mx. Sparling sustained second and third degree burns requiring two and a half months in Sunnybrook Hospital's burn unit and a year at St. Joseph’s Rehabilitation Hospital, for multiple skin grafts.
Mx. Sparling is 58 years old, born in Collingwood, Ontario and is the second youngest of five children. Their youngest sister (their primary source of support) advised that their father and mother passed away in 2012 and 2016, respectively, and that Mx. Sparling struggled to cope with both deaths.
Mx. Sparling left high school in order to obtain employment. They had been a good student and eventually enrolled at the Collingwood Learning Centre where they successfully attained a high school diploma. They attended George Brown College, focusing on Culinary Arts. After the completion of an apprenticeship at Westin Harbour Castle, Toronto, they earned their certification as a Red Seal Chef. Mx. Sparling worked at several different restaurants in Toronto and Collingwood but has long been unemployed due to their mental health difficulties.
Mx. Sparling had only been involved in two romantic relationships, with the last one being in their early twenties. Mx. Sparling has never been married, nor did they cohabitate with either of the girlfriends. Mx. Sparling had one serious romantic relationship that ended when the girlfriend went to university, and Mx. Sparling became ill. Records indicate that Mx. Sparling was confused about their sexuality as early as 1993.
Mx. Sparling does not have a criminal record and has never been charged with a criminal offence.
PSYCHIATRIC BACKGROUND
The psychiatric background information is contained in the Hospital Report. The following is a summary of the psychiatric hospital admissions before and after the court finding that Mx. Sparling was not criminally responsible of the index offence.
Mx. Sparling had multiple psychiatric admissions to hospital before the index offence. Records show that they were hospitalized in 1998 and 1999, receiving a diagnosis of psychosis, possibly due to Chronic Paranoid Schizophrenia or drug use, and traits of Dependency Inadequacy in the latter year at Penetanguishene.
There is a significant gap in the hospital records until 2009, during which time it appears they were receiving outpatient care. In 2010, they were admitted to Penetanguishene again and discharged with a diagnosis of Schizophrenia. In 2014, they visited an emergency room claiming they had suffered a sexual assault. They mentioned adhering to prescribed medications but had not seen a psychiatrist in four years and used marijuana daily, considering it their ‘medication’.
Following the injuries sustained in the fire related to the index offence, Mx. Sparling was treated in hospital. After discharge, they resumed consultations with a community psychiatrist but had multiple hospital admissions in 2016 due to psychiatric decompensations.
In 2017, Mx. Sparling was evaluated for criminal responsibility. After the finding of ‘not criminally responsible’, they initially resided in the community subject to a Conditional Discharge disposition while followed by the Waypoint outpatient forensic team.
In May 2018, they began to exhibit breakthrough symptoms of psychosis, and their reporting condition increased to not less than every week. It was subsequently discovered that they had been non-compliant with their oral antipsychotic medication. On December 10, 2018, the Board convened an early hearing at the request of the outpatient team. They were issued a new Detention Order disposition, and police brought them to Waypoint for admission later in the day. They remained at Waypoint until their transfer to CAMH on July 13, 2021.
In 2023, Mx. Sparling’s clinical year was described as relatively stable, but stagnant. There were no significant rule violations or management concerns. They were abstinent from substances, and there were no absconding incidents. Mx. Sparling continued to exhibit treatment-resistant psychotic symptoms, with limited engagement, declining all efforts to engage in therapeutic programming or activities. When Dr. Meng was away from the hospital, they refused to meet with the replacement psychiatrist for a significant period. Mx. Sparling’s insight into their illness remains very poor.
Mx. Sparling’s current psychiatric diagnoses are Schizophrenia (with treatment refractory positive and negative symptoms), and Cannabis Use Disorder (in sustained remission, in a controlled environment). Mx. Sparling has been found not capable of making decisions about their medical treatment, but they are capable of managing their finances independently. Their substitute decision maker has been appointed by the Office of the Public Guardian and Trustee. They are financially supported by the Ontario Disability Support Program.
EVIDENCE AT THE HEARING
Mx. Sparling’s course in hospital is detailed in the Hospital Report and their attending psychiatrist remains Dr. H. Meng. The information in the Report is summarized here, along with updated information provided at the hearing.
Dr. Meng gave evidence regarding Mx. Sparling’s clinical course this reporting year. She acknowledged her long-standing role in Mx. Sparling's care, stating that she has been their most responsible physician for quite some time. Dr. Meng pointed out that it is important to remain mindful of communication styles, especially considering Mx. Sparling's history of disengagement following past challenging hearings. She noted that last year's in-person hearing had been a more positive experience for Mx. Sparling, reporting that they had felt ‘humiliated’, but they managed to recover relatively quickly afterwards.
Dr. Meng then shifted the focus to the Hospital Report and provided her insights on her clinical opinion. She stated that for the most part, the concerns and findings from the previous year still applied to Mx. Sparling this year, but there were positive aspects of Mx. Sparling's progress to highlight. Dr. Meng indicated that Mx. Sparling's mental state and belief system remains relevant, with associated distress fluctuating in intensity. However, she noted that the treatment team has learned to predict and manage these fluctuations more effectively, enabling quicker stabilization and therapeutic engagement.
The doctor highlighted the change from a bi-weekly to a four-weekly injection of intramuscular, long-acting antipsychotic, which was noted as crucial in reducing complications related to adherence. The treatment team acknowledged the potential challenges that may arise regarding Mx. Sparling’s appearance, particularly in the hospital setting, and anticipated that transitioning to the community would present additional challenges due to less control. However, the reduction in injection frequency was seen as a protective measure against potential issues.
Attention was then directed to Mx. Sparling’s access to ‘indirectly supervised’ community passes, which they had not utilized very much throughout the year. Although there had been a period of increased activity during the summer, this had since decreased. Concerns were raised regarding Mx. Sparling’s physical health, safety in the community, and financial stability, which collectively contributed to their reluctance to use the passes. The team noted that if Mx. Sparling were to engage more vigorously with these passes, it would be a positive sign of their readiness for future community discharge.
Dr. Meng emphasized that utilizing the passes could help assess Mx. Sparling’s stability and enhance their comfort level within the community, ultimately building resilience in facing potential stressors. However, the ongoing challenge remains that exposure to the community could lead to increased episodes of instability. Only with adequate support and supervised housing could Mx. Sparling be considered for discharge in the future.
However, finding suitable housing remains a challenge, particularly for individuals requiring a high level of support. Mx. Sparling’s ability to live in the community is contingent upon finding appropriate housing. Despite fluctuating symptoms characterized by paranoia and physical distress, they have not engaged in any physical aggression, indicating some ability to manage distress with adequate support.
Dr. Meng commended Mx. Sparling for their improved engagement over the past year. The doctor reflected on how previously, the treatment team could count on one hand the number of days Mx. Sparling would actively engage. This year, however, Mx. Sparling worked collaboratively with the team on numerous occasions. Dr. Meng emphasized the importance of a collaborative approach to Mx. Sparling's care, acknowledging that while there are still moments of distrust, Mx. Sparling's proactive communication with care providers has been commendable.
SUBMISSIONS
The Hospital reiterated that its initial position remained unchanged, emphasizing that Mx. Sparling remains a ‘significant threat’ and current the Detention Order is required to protect the public. Counsel commended Mx. Sparling’s collaboration with the treatment team, noting that the team is working towards their discharge into appropriate accommodations. Counsel stressed the importance of trialing Mx. Sparling in the community under supervision to facilitate a successful transition. Counsel for the Attorney General agreed with the Hospital’s submissions.
Counsel, Mr. Vincents contended that the most appropriate disposition for Mx. Sparling would be an Absolute Discharge, or alternatively, a Conditional Discharge, highlighting that no serious problems have been reported during their treatment, including no incidents of violence or medication non-compliance. He pointed out improvements in Mx. Sparling’s condition due to the current long-acting injectable medication, asserting that they could be well managed in the community with appropriate follow-up, reflecting on Mx. Sparling’s consistent adherence to treatment and scheduled meetings.
ANALYSIS AND CONCLUSION
(a) Significant Threat
Where there is a risk of serious physical or psychological harm to members of the public resulting from conduct that is criminal in nature but not necessarily violent, the Board must find that the threshold for ‘significant threat’ has been met. The issue of whether Mx. Sparling continues to pose a significant threat to the safety of the public was contested at the hearing, and accordingly we have considered the issue.
Based on the testimony of Dr. Meng and the relevant contents of the Hospital Report, we find that Mx. Sparling remains a significant threat to the safety of the public, and accordingly, they are not entitled to be discharged absolutely. Several factors convince us that the threshold for ‘significant threat’ has been met. Mx. Sparling has a complex psychiatric profile where their primary diagnosis of Schizophrenia appears to be treatment resistant. Recent risk assessments also point out that Mx. Sparling’s risk for violent recidivism remains in the relatively high range, and this must be balanced with the paramount consideration – public safety, which in our view, warrants the continuation of their Detention Order. The evidence was clear, and cogent, and we agree that although they generally comply with their medication administration, and they generally engage with the treatment team, there are serious and ongoing concerns regarding their mental status and their limited insight. We find that although Mx. Sparling appears to be compliant with the injectable antipsychotic, and they may have acquired some insight into their mental illness, this must be taken together with the fact that they are not capable of making treatment decisions. But for the consent of their substitute decision maker, their past psychiatric history indicates that they were consistently non-adherent to their prescribed psychiatric medications, and there is a likelihood that they will discontinue their medication if not monitored with the necessary level of oversight moving forward.
We accept Dr. Meng’s evidence, and we confirm that Mx. Sparling’s trajectory under the Board began with a Conditional Discharge, which was later followed by a Detention Order due to medication noncompliance and disengagement from the treatment team. We appreciate that despite the setback, their current mental state has shown some stability, however the same underlying beliefs and ways of thinking still persists. Initially, anxiety and stress was more prominent than overt psychotic symptoms, but since then, their symptoms have become more pronounced. The medication noncompliance has been somewhat mitigated by the type of medication currently being administered, but this must be understood along with the fact that substitute consent must be given for Mx. Sparling to achieve this level of compliance, which allows for treatment even if they were to refuse the injectable form of antipsychotic. Even when they become ready for approved and supervised community living, a high-level of clinical support in the community will be essential, as there is a risk of increased resistance to treatment outside the hospital environment. Familiar staff members play a crucial role in medication administration, to assist in managing their needs. Also, the importance of appropriate supportive housing in order to help Mx. Sparling achieve a feeling that they are safe, which speaks to their specific needs and their ongoing recovery and rehabilitation processes, requires a certain amount of future planning.
We note that Mx. Sparling has been assessed as having a treatment resistant mental disorder, marked by psychotic and mood symptoms, including a salient paranoid belief system. This is particularly concerning considering the violent nature of the index offence, with particular disregard for the other residents of the group home, and their own life, which was driven by untreated psychotic episodes. There is still a high probability that they will become violent again, especially if their positive and negative psychotic symptoms worsen. Over the reporting year, they have shown more engagement with activities, and there have been no incidents of aggression or violations during this period. However, their entrenched delusional system remains a real concern, and while the current medication administration is the best available option, they require high level supports with clinical staff to assist during distressing moments. This introduces another layer of instability, creating a vulnerable period which will necessitate continued support and supervision. We find that continued oversight under the Board will be vital to their overall recovery process, especially in light of the recent resurgence of psychotic symptoms – with increased paranoid and persecutory intensity, which highlights the need for continued close monitoring and supervision to ensure both their safety and that of the public.
(b) Necessary and Appropriate
The plan of care in place for Mx. Sparling appears to be adequate, however we see that it is still in progress. Their current disposition appropriately addresses their current level of threat to the safety of others and to themselves, given that they are subject to the level of supervision provided by their treatment team and the forensic psychiatry services at CAMH. Their psychiatric treatment and care involves the necessary level of supervision, evaluation, and adjustment to manage their risk level. Without the forensic treatment team, and their interventions and support, their recovery path would most certainly decline. A Conditional Discharge has absolutely no air of reality at this time because of the lengthy history of mental illness and the severity of their substance use, the serious nature of the index offence, and the limited recovery progress they have made over the years, notwithstanding the length of time they have been in the psychiatric system. Although it may be appropriate to begin initial steps for them to live in the community in the future, they have been assessed as a high-risk of committing grave harm to the public, and they continue to require the necessary level of supervision and treatment, which is provided by a Detention Order. Community living without supervision is not appropriate for Mx. Sparling at this time because their treatment relies on the clinical expertise and supervision that they are currently being provided with. This plan is in place because of the numerous readmissions to hospital, the ongoing psychotic symptoms intensified by a concrete paranoid belief system. This presents a significant treatment challenge at this point in time, and there remains a serious risk of grave harm occurring to the public should Mx. Sparling be discharged back into the community without a high level of supervision.
Regarding the appropriate community housing for Mx. Sparling in the future, there was some uncertainty expressed about when suitable supervised accommodations would be available, and individual-based advocacy efforts are necessary in Mx. Sparling’s case. Discussions with Mx. Sparling about their future plans have occurred, including their desire to travel to Israel. As much as we encourage them to realize, and work towards their desire to travel to Isreal, we believe that they would likely achieve that privilege level by demonstrating increased mental wellness and recovery gains through the use of ‘indirectly supervised’ passes, which are presently available to them, but which they do not avail themselves of. However, we also appreciate that their understanding of what they can achieve in relation to a public safety perspective is still developing.
The forensic treatment team is key in helping Mx. Sparling achieve mental stability, and we find given all the circumstances, that they could not be managed without the current level of assistance and supervision. It remains to be seen if they are able to make more progress moving forward and achieve more stability with the medication and treatment plan in the upcoming year. We conclude on the evidence before us that the most necessary and appropriate outcome for Mx. Sparling is to continue their recovery process under the supervision and authority of the Ontario Review Board, in accordance with their current Detention Order.
DATED this 14th day of February, 2025 at the City of Toronto, in the Toronto Region.
Ms. A. La Viola Legal Member
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Office of the Registrar Ontario Review Board