Ontario Review Board
Re: Ellen Fergadiotis
ORB File No: 1294
Hearing held on: Tuesday, October 7, 2025
Place of Hearing: Centre for Addiction and Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. L. Banks
Members: Dr. L. Cappe
Dr. C. Rose
Hon. C. Nelson
Mr. J. Cyr
Parties Appearing:
Accused: Ellen Fergadiotis
Counsel: Ms. M. Perez
The person in charge of hospital: Counsel: Ms. S. Rosales-Zelaya
Attorney General of Ontario: Counsel: Mr. D. Brandes
REASONS FOR DISPOSITION
(Dated October 30, 2025)
Reasons of the Majority
(Dr. L. Cappe, Mr. J. Cyr, Hon. C. Nelson)
Introduction:
On April 19, 1991, Ellen Fergadiotis was found not guilty by reason of insanity (“NGRI”) on two counts of attempted murder contrary to the Criminal Code of Canada. (the “Criminal Code”). Since that time, she has remained subject to Dispositions, initially of the Lieutenant Governor’s Board of Review and subsequently of the Ontario Review Board (the “ORB” or the “Board”), and most recently, a Disposition of the ORB dated October 2, 2024, which detains her at a General Forensic Unit of the Centre for Addiction and Mental Health (“CAMH” or the “hospital”). This Disposition provides her with a variety of privileges up to and including the privilege of living in the community in accommodation approved by the person in charge.
On October 7, 2025, a panel of the ORB convened to hold a hearing to conduct an annual review of Ms. Fergadiotis’ existing Disposition pursuant to section 672.81(1) of the Criminal Code. Ms. Fergadiotis was present at the hearing and was represented by her counsel, Ms. Perez.
The issues to be considered at this hearing are whether Ms. Fergadiotis is a significant threat to public safety as now defined in s. 672.5401 of the Criminal Code and, if she is found to be a significant risk to the community, the determination of the necessary and appropriate Disposition in the circumstances bearing in mind the factors enunciated in s. 672.54 of the Criminal Code.
For the reasons set out below, the Board has unanimously concluded that Ms. Fergadiotis continues to pose a significant threat to public safety. The majority of the Board finds that the necessary and appropriate Disposition in the circumstances is that she be detained on a General Forensic unit at CAMH on the terms and conditions as are set forth in her existing Disposition.
Index Offences:
- The circumstances giving rise to the index offences are extracted from last year’s ORB Reasons for Disposition dated October 21, 2024, as follows:
“On January 9, 1990, in the morning, Ms. Fergadiotis returned home after having been
away the night before and, a few minutes later left the residence again to go to the
hardware store, where she purchased an axe. Shortly after this, she returned to her home
and attacked her mother, who was sitting on the couch in the living room. She struck her
mother several times with the axe, twice on her head and once across her right hand. The
mother’s screams brought her husband to her assistance. As he attempted to grab the axe, the patient struck her father across the head, as well as several times on various parts of his body. The mother was able to disarm her daughter and call the police. As a result of the attack, Mrs. Fergadiotis was treated for lacerations to her head, as well as to her hand and arm. She received about 14 stitches on her head, and stayed in the hospital overnight. Mr. Fergadiotis received cuts to the centre-top of his forehead, his chin, and lacerations to his left arm and other parts of his body, also requiring a few stitches to his head.
Two weeks prior to this attack, Ms. Fergadiotis had been threatening to kill her parents
and, as a result, her mother took steps to hide all of the kitchen knives in the apartment.
During her initial interview in SOTU following the index offence, Ms. Fergadiotis stated
that she bought the axe because she was hearing voices from the furniture which told her
that she and her family were in danger. She felt that she needed to splatter blood over the
furniture to protect her family from this danger. She described that, for months, she had
a feeling of fright and fear, under the influence of the furniture.”
Background and Personal History:
Ms. Fergadiotis’ personal background, mental health history, criminal history, and her course in the hospital subsequent to her arrest and NGRI finding are set out in considerable detail in the Hospital Report dated September 26, 2025 (the “Hospital Report”) which was entered as an Exhibit at the hearing and need not be repeated here. We have also relied extensively on last year’s ORB Reasons for Disposition in this regard. Briefly stated, Ms. Fergadiotis was 65 years old on the hearing date. She has never been married and has no children. She has a younger sister who acts as her Substitute Decision Maker (“SDM”). Her mother passed away several years ago.
Ms. Fergadiotis left school in Grade 9 as she found the schoolwork too difficult. In the 1980s, she obtained a hairdressing license but was unable to find work as a hairdresser. She has no significant employment history and has been supported by ODSP since the onset of her psychiatric illness.
Criminal History:
- Prior to the index offences, Ms. Fergadiotis had no involvement in the criminal justice
system.
Psychiatric History:
Ms. Fergadiotis has a lengthy history of psychiatric contacts and admissions, having first been admitted to the Scarborough General Hospital at the age of 16. From 1982 to 1989, she had numerous admissions to various psychiatric facilities, as well as numerous assessments in emergency departments, generally as a result of her unpredictable and violent behaviour involving both self-harm and harm to others. Her diagnosis was most commonly Schizophrenia.
Ms. Fergadiotis also has a long history of non-compliance with medication and follow-up care. She has no history of alcohol and/or illicit substance use but has smoked tobacco for several years.
There have been incidents of aggression and assaultive behaviour during Ms. Fergadiotis’ time under the ORB. In October 2008, she hit a co-resident with a clipboard, and in October 2010, she was charged with assault after throwing a cup of coffee at a housing staff member. This charge was ultimately withdrawn.
Ms. Fergadiotis was arrested in January 2015 after an incident where she allegedly chased a co-resident with a knife and made threatening comments. She was under the jurisdiction of the ORB in relation to this offence until the charges were withdrawn in July 2018.
Since the NGRI finding, Ms. Fergadiotis has been detained at CAMH with some periods of hospitalization and some periods of community living. She was discharged to her current accommodation on June 11, 2018 and has remained in the community since that time with no hospital readmissions.
Current Diagnosis:
- Ms. Fergadiotis’ current diagnosis is Schizoaffective Disorder, Bipolar type.
Positions of the Parties:
At the commencement of the hearing, the parties were canvassed as to their without prejudice recommendations to the Board. Counsel for the hospital submitted that Ms. Fergadiotis continues to represent a significant threat to public safety. The hospital recommended that her existing Detention Order Disposition remain unamended.
Counsel for the Attorney General supported the hospital’s recommendation.
Counsel for Ms. Fergadiotis indicated that her client was requested a Conditional Discharge Disposition with terms to include: residency condition, consent to treatment, weapons prohibition, and reporting requirement. The issue of significant threat was conceded for the purpose of the hearing.
All parties maintained their respective initial recommendations to the Board in closing submissions.
Evidence at the Hearing:
Dr. I. Swayze, Ms. Fergadiotis’ treating psychiatrist, testified at the hearing to supplement the information contained in Exhibits entered into evidence at the hearing. Dr. Swayze advised that he assumed care of Ms. Fergadiotis in November 2023. He reported that there were no material updates to the Hospital Report.
Overall, Dr. Swayze commented that Ms. Fergadiotis had had another good year in review albeit in the context of her experience of treatment-resistant psychosis. She remained compliant with her prescribed medications, she did not require any hospital readmissions, and she did not present as a behavioural or management problem at her residence. Ms. Fergadiotis most often adheres to the rules and expectations of her residence and the clinical team.
In the community, Ms. Fergadiotis is seen by the Forensic Outpatient Service (“FOS”) staff at least biweekly as mandated by her ORB Disposition; however, the frequency of these meetings is set in response to Ms. Fergadiotis’ fluctuating mental status.
Dr. Swayze testified that Ms. Fergadiotis continues to reside in her semi-independent bachelor apartment at St. Anne’s Place which is a facility managed by LOFT community housing services. This housing is designated as “high support” and staff are on-site 24/7 to oversee medication supervision, meal preparation, laundry, housekeeping assistance, and escorts to appointments, etc. As well, there is a mental health professional on-site at all times.
The Hospital Report indicates that Ms. Fergadiotis’ family doctor attends at her residence on an as needed basis, and she is also supported by her podiatrist, who makes monthly visits to her residence. Ms. Fergadiotis has been complaining of chronic knee pain and she has been diagnosed with degenerative osteoarthritis. She is being treated with medication and has recently commenced physiotherapy, accompanied by FOS staff.
Ms. Fergadiotis is seen by Dr. Swayze in person at the FOS clinic once a month. Her FOS case manager connects with her at least once every two weeks, alternating between home and clinic visits.
Dr. Swayze stated that Ms. Fergadiotis most consistently expresses satisfaction with her residence but at times, she comments that she would like to move. She is aware that any change in her residence would require the prior approval of the hospital. According to Dr. Swayze, her high support housing is one of the pivotal cornerstones in her effective risk management. There were a few incidents over the past year when Ms. Fergadiotis smoked in her room in contravention of housing rules and Dr. Swayze commented that should she continue to do so, she could jeopardize her residence and be evicted.
When Ms. Fergadiotis turned 65 in April 2025, her financial support transitioned from ODSP to Old Age Security pension, Canada Pension Plan and Guaranteed Income Supplement. She remains not capable to manage her finances and the Office of the Public Guardian and Trustee acts as substitute decision maker (“SDM”).
Ms. Fergadiotis continues to be assessed as incapable to consent to treatment and her sister acts as her SDM. She remains compliant with her medications which include daily oral doses of an antipsychotic medication, clozapine, and a mood stabilizer, lithium. In addition, she receives a long-acting injection of another antipsychotic medication, zuclopenthixol decanoate, every two weeks. These medications are administered under close staff supervision. Ms. Fergadiotis attends monthly for clozapine blood work. Her levels for clozapine and lithium remain therapeutic. Under supervision, she has been adherent to her prescribed medications.
Dr. Swayze testified that despite compliance with her medications, Ms. Fergadiotis continues to present at her baseline with significant ongoing symptoms of her illness including: transitory hallucinations, mood instability, thought disorder and disorganization, and grandiose delusions of a paranoid and/or somatic nature. When ill, the symptoms of her psychosis become intensified, particularly her hallucinations and paranoia. The doctor testified that her decompensations are typically accompanied by periods of increased irritability and angry affect. However, when probed, she denies self-harm, aggressive or elopement ideation, plan or intent. She denies hallucinations and has not been observed to be responding to internal stimuli.
The Hospital Report indicated that with ongoing aggressive treatment, Ms. Fergadiotis’ mood instability and psychosis have attenuated somewhat over the year and she is generally more behaviourally settled. However, the doctor noted that given the chronic nature of her symptoms, she is vulnerable to acute decompensations which occur with no apparent triggers. The doctor stated that the episodic deteriorations in her mental state are entirely unpredictable. Dr. Swayze reported that this pattern has been the case for over the past decade.
Notwithstanding some improvement, Dr. Swayze testified that Ms. Fergadiotis continues to present with affective and behavioural instability, with pronounced lability (e.g., sudden onset of distress, anxiety, irritability, poor distress tolerance). She also exhibits thought disturbances. Her ability to cope with stressful circumstances remains challenging, and she requires significant staff support and direction. The Hospital Report indicates that during periods of intensified symptoms of her illness, “…FOPS staff increase their vigilance in monitoring Ms. Fergadiotis’ mental status and behaviour (in concert with housing staff in monitoring Ms. Avenue’s mental condition, status and behaviour in concert with housing staff).”
As was the case in the preceeding reporting year, Dr. Swayze stated that the treatment team would like to begin the process of transferring Ms. Fergadiotis’ care to a civil treatment team. In the past, Ms. Fergadiotis has indicated she will not cooperate in this process, fearing that she would no longer be under the care of her current case worker. Ms. Fergadiotis appeared unable to tolerate a discussion in this regard without putting herself at risk of a significant deterioration due to her experience of heightened stressors. However, Dr. Swayze stated that more recently, over the past two months, Ms. Fergadiotis stated that she will consider a transition of her care to a civil treatment team, in order to allow her to progress towards full community reintegration and the grant of an Absolute Discharge.
Dr. Swayze testified that the clinical team is pursuing whether or not Ms. Fergadiotis’ care can be transitioned to the CAMH Flexible Assertive Community Treatment (“FACT”) team. He commented that there are concerns about her age (given that she recently turned 65); however, discussions are ensuing. Dr. Swayze commented that Ms. Fergadiotis requires a level of care that cannot be met by the CAMH Geriatric Outpatient Service.
In the doctor’s opinion, given the fragility in Ms. Fergadiotis’ mental state, any potential transfer of Ms. Fergadiotis’ care to a new treatment team is likely to be highly stressful to her. That stressor may be significant enough to result in a deterioration of her mental state. In Dr. Swayze’s opinion, the transfer of her care to the FACT (or any other civil) team should occur while Ms. Fergadiotis remains under a Detention Order so that if she suffers a deterioration in her mental state, she can be rapidly readmitted to the hospital under a Warrant of Committal, without delay and at any early juncture. Dr. Swayze commented that if Ms. Fergadiotis was subject to a Conditional Discharge Disposition and she suffered a decompensation, then she would have to meet criteria under Box A or B of the Mental Health Act (“MHA”) before she could be involuntarily detained in hospital. Further, he commented that in that scenario, her ongoing detention could only be maintained if she continued to satisfy MHA criteria or if she were to consent to a voluntary readmission. Otherwise, her readmission to hospital would not guarantee a prolonged hospital readmission. Dr. Swayze stated that he did not think that Ms. Fergadiotis would be likely to consent to a voluntary admission if decompensated.
In addition, Dr. Swayze indicated that Ms. Fergadiotis has established a strong therapeutic alliance with her outpatient treatment team and is somewhat anxious about losing this relationship should she transition to any other treatment team, whether it be FACT or any other civil treatment team.
In response to questions from a panel member, Dr. Swayze confirmed that any initiation of the transfer of Ms. Fergadiotis’ care to the FACT or any other civil treatment team would occur in the context of the ongoing supervisory role of the FOPS. He stated that during any transition period, he expected that the FOPS team would in fact have increased contact with Ms. Fergadiotis to assist her in managing the transition.
Dr. Swayze stated that it will be necessary to assess whether or not the services of the FACT (or any other civil) team will be sufficient to manage Ms. Fergadiotis’ needs.
In response to a series of questions posed by Ms. Perez, Dr. Swayze acknowledged that over the past several years, Ms. Fergadiotis has been able to manage several significant stressors without resulting in an acute decompensation or necessitating hospital readmissions. Ms. Perez suggested to the doctor that such stressors might include: Ms. Fergadiotis’ transition from hospital to community living in 2018, her change in housing in 2019 to move to her current residence, the death of her mother in 2022, and multiple FOPS and housing staff changes. Dr. Swayze commented that these changes were “one-offs” as opposed to long-term changes which he stated would be the case on a transfer of Ms. Fergadiotis’ care to a civil team.
When addressing the issue of significant threat, Dr. Swayze stated that Ms. Fergadiotis suffers from a highly treatment refractory major mental illness with ongoing fluctuating symptoms. Her illness “waxes and wanes” and, although she had a good year with no readmissions to hospital or significant incidents, she continues to present with significant and ongoing psychotic symptoms, including, delusional thought content and notable disorganization of thought. She has a history of experiencing rapid decompensations which has led to violence ranging from aggressive verbal and physical altercations to serious assault with use of a weapon, as in her index offences.
In addition, Dr. Swayze noted that, as has been the case for many years, Ms. Fergadiotis has very little insight into her illness, the impact of medication on her illness or the connection between her illness and her aggressivity. She is unable to recognize early warning signs of decompensation. She rejects her diagnosis of Schizoaffective Disorder and is unable to identify any of the symptoms of her illness. She maintains her actions at the time of the commission of the index offences and other acts of violence had no relationship to her illness. Despite ongoing psychoeducation, her insight has not improved.
Ms. Fergadiotis continues to present as a fairly socially isolated individual and does not have a peer group or social supports beyond her sister and her housing residence staff. She is not involved in programming or pursuing educational or vocational opportunities. She spends most of her time at her residence watching TV, listening to music or reading. On occasion, she participates in activities offered by FOS or her residence. Ms. Fergadiotis has sporadic telephone contact with her sister, which requires oversight from the FOPS team.
According to the Hospital Report, Ms. Fergadiotis’ overall risk assessment profile suggests an ongoing risk of violence, albeit her risk is currently well-controlled under the terms of the Detention Order with the intensive supports she receives at her residence and from the forensic outpatient services team. In Dr. Swayze’s opinion, absent those supports, her risk would be unmanageable in the community.
The doctor added that if Ms. Fergadiotis were no longer under the ORB’s jurisdiction, it would be highly likely that she would cease to be fully adherent to her prescribed medications and would be likely to suffer a decompensation in her mental state which in turn would put her at heightened risk of engaging in criminal behaviours.
Dr. Swayze acknowledged that Ms. Fergadiotis has successfully remained in the community since June 2018, without re-admission. Notwithstanding, he advised that the clinical team recommended a continuation of the current Detention Order. In the team’s assessment, Ms. Fergadiotis’ relative stability in the community is reliant on the high level of staff supervision and structure provided at her current residence.
When asked if Ms. Fergadiotis could be safely managed on a Conditional Discharge Disposition, Dr. Swayze responded in the negative. The treatment team requires the ongoing authority to approve Ms. Fergadiotis’ accommodation in the community. The Hospital Report indicates that Ms. Fergadiotis is on a fairly complicated medication regime which is fully supervised by her housing providers. The doctor reinforced his view that Ms. Fergadiotis requires the intensive supports that she currently receives at her residence. In addition to medication administration, housing staff assist her daily with her emotional management and coping skills. They also assist in limiting her exposure to destabilizers and in providing her with a supportive environment, all of which assists in managing her underlying disorganization and instability.
In the doctor’s opinion, it remains absolutely imperative that the hospital have oversight with regard to her community placement to ensure that her housing provides her with the necessary level of structure, support, supervision and monitoring, including staff supervision for medication administration. Dr. Swayze stated that the cornerstone of Ms. Fergadiotis’ stability in the community is that her current housing provides supervision with medication and frequent mental health check-ins, as well as allowing her access to a mental health professional who is on-site 24/7.
The doctor testified that even if a proposed Conditional Discharge Disposition were to include a residency clause stipulating that she remains at her current supervised home, that would be insufficient to safely manage her risk.
Dr. Swayze stated that Ms. Fergadiotis has been unable to sustain prolonged psychiatric stability and the hospital continues to require the authority of a Detention Order to expeditiously readmit her to hospital were she to decompensate in the community. The MHA would be insufficient to safely manage her risk to public safety as it would not allow for her readmission to hospital for admission unless she satisfied criteria for certification. The doctor stated that Ms. Fergadiotis presents as chronically thought disordered with significant mood lability and ongoing psychosis and, in such a state, her cooperation with a voluntary readmission would be uncertain. Further, the doctor noted that she is prone to rapid decompensation within days, with a corresponding acute heightening of her risk of violent physical aggression.
In response to questions posed by Ms. Perez, Dr. Swayze acknowledged that over the years, there have been several incidents when Ms. Fergadiotis agreed to voluntary readmissions; however, he reiterated that he would not expect that going forward she would consent to a voluntary readmission. He stated that Ms. Fergadiotis has recently commented that she would prefer to not be followed by any mental health professionals.
In concluding, Dr. Swayze’s opinion, Ms. Fergadiotis’ mental state remains too unstable at the present time for the team to be confident that she can be safely managed in the community under a Conditional Discharge Disposition particularly because she has not yet been transitioned to a new civil treatment team.
No further evidence was called by the parties.
Analysis and Conclusions:
After considering all the evidence presented and the submissions of the parties, the Board members unanimously find that Ms. Fergadiotis poses a significant threat to the safety of the public. The panel accepts the evidence of Dr. Swayze and the Hospital Report in this regard. We note that Ms. Fergadiotis suffers from a major mental illness, Schizoaffective Disorder. She has experienced several decompensations in the past, related to medication non-compliance. Over the past reporting year, in March and April 2024, despite ongoing medication compliance, Ms. Fergadiotis exhibited a deterioration in her mental state and re-emergence of symptoms, including heightened paranoia, delusions, and auditory hallucinations. This episode is reflective of “…the unstable, waxing and waning, nature of her treatment resistant illness.”
Ms. Fergadiotis has a history of experiencing rapid decompensations and her history of violence ranges from aggressive verbal and physical altercations, to serious assault with use of a weapon, as in her index offences. The Hospital Report indicates that her aggression has been exacerbated by her personality characteristics, including affective dysregulation, high impulsivity and intense emotional responses. Unfortunately, Ms. Fergadiotis’ insight across all domains remains critically underdeveloped.
The expert evidence indicates that absent the oversight of the forensic system, Ms. Fergadiotis would in all likelihood become non-compliant with her prescribed medication which, in turn, would be extremely likely to lead to a decompensation of her mental state and a resultant re-emergence of criminal behaviours.
In coming to our decision that Ms. Fergadiotis continues to pose a significant threat to public safety, the panel carefully considered the decision of the Supreme Court in Winko v. British Columbia. In that case, the Court identified a significant risk as a "real risk of physical or psychological harm to members of the public that is serious in the sense of going beyond the merely trivial or annoying. The conduct giving rise to the harm must be criminal in nature". In Winko, the Supreme Court also outlined that in coming to a conclusion on the issue of significant threat, a Review Board should closely examine a range of evidence including: the circumstances of the original offence, the past and expected course of the accused's circumstances and treatment, the present state of the NCR accused's medical condition, the NCR accused's own plans for the future, the support services existing for the NCR accused in the community and, perhaps most importantly, the recommendations provided by experts who have examined the NCR accused. According to Dr. Swayze’s testimony, Ms. Fergadiotis’ clinical team unanimously agree that she continues to represent a significant threat to public safety.
The Board considered whether Ms. Fergadiotis could be safely managed under a less restrictive Conditional Discharge Disposition. In the opinion of the majority of the Board, she cannot. In the majority’s opinion, it remains imperative that the hospital retain the authority to approve her community housing to ensure that it provides her with the requisite degree of structure, support, supervision and monitoring to effectively manage her risk.
The evidence before the Board indicates that including a residence condition in a Conditional Discharge Disposition would still require the hospital to rely on Ms. Fergadiotis meeting criteria for readmission under the MHA in order to have her readmitted. Ms. Fergadiotis is prone to acute and rapid decompensations (even at times when she is compliant with her medications and substance free). The provisions of the MHA would not afford the hospital with the authority to intervene at an early juncture to effect Ms. Fergadiotis’ immediate readmission to safely manage her risk to members of the public should she present with subtle signs of a decompensation in her mental state. Further, Dr. Swayze’s evidence indicated that he was not confident that, if requested, Ms. Fergadiotis would voluntarily return to a hospital for readmission or that she would remain detained in hospital voluntarily if recommended by her treatment team.
The majority of the panel agree with the expert indicating that at this juncture, Ms. Fergadiotis presents with significant fragility in her mental state and is far too unwell to be safely managed in the community under a Conditional Discharge Disposition.
Further, the majority agrees with the hospital’s assertion that it is critical that the transfer of Ms. Fergadiotis’ care to the FACT or any other civil treatment team occur while she is subject to a Detention Order Disposition. This is necessary as it is anticipated that such a transition will be extremely stressful to Ms. Fergadiotis and may result in a mental state decompensation. In that likely scenario, the expert evidence indicates that the authority of a Detention Order will enable the hospital to promptly and, at an early juncture, readmit Ms. Fergadiotis and allow the hospital to detain her there for as long as is necessary to return her to mental status stability.
Given the strong therapeutic relationship Ms. Fergadiotis currently has with her treatment team and her anxiety associated with losing this alliance if and when her care is transferred to a civil-based treatment team makes it somewhat more challenging for Ms. Fergadiotis to make a successful transition and further increases the probability of an unsuccessful transition due to decompensation.
Accordingly, the Board finds that the necessary and appropriate Disposition is that Ms. Fergadiotis be detained on a General Forensic unit at CAMH on the same terms and conditions as are set forth in her existing Disposition.
Reasons of the Minority
(Ms. L. Banks and Dr. C. Rose)
In our assessment, Ms. Fergadiotis has demonstrated that she is now an appropriate candidate for a discharge on conditions. We note that since her discharge to the community in 2018, Ms. Fergadiotis has not required any readmissions to hospital nor has she incurred any additional criminal charges.
The index offences were extremely serious and could have had lethal consequences but they occurred approximately 35 years ago when she was 29 years old. She is now 65 years old and has been compliant with her prescribed medications for years. She has successfully resided in the community since 2018 and has not presented as a significant management challenge.
We accept the doctor’s evidence that Ms. Fergadiotis success is in large part due to the high-support housing she resides in. We also note that if subject to a Conditional Discharge Disposition with a residency clause mandating that she reside at that same residence, Ms. Fergadiotis will continue to receive those vital supports that assist her in managing so well.
We also note that despite ongoing adherence with her prescribed treatment, Ms. Fergadiotis continues to experience residual symptoms of psychosis and episodic exacerbations in her treatment-resistant illness that are unpredictable. We accept the expert evidence that significant stressors can also negatively impact her fragile mental state. However, we are also cognizant of the fact that over the years while residing in the community, and being confronted with a myriad of significant stressors as set forth in part in paragraph 37 above, Ms. Fergadiotis’ risk to public safety has not become elevated to the point that she required hospital readmission, nor has she acted out with significant aggression.
As outlined in the Hospital Report, Ms. Fergadiotis has experienced several periods of increased psychotic symptoms. In response, the hospital has increased the frequency of her reporting requirements, when needed. In the minority’s view, the evidence indicates that temporary increases in her reporting have been sufficient to manage her periods of decompensation. We also note that Ms. Fergadiotis resides in high-support housing where staff are able to closely monitor her mental state and, when appropriate, notify the FOPS of any changes in her presentation.
The minority finds it speculative to assume that Ms. Fergadiotis would be likely to experience a significant deterioration in her mental status if transitioned to the FACT or other civil treatment team over the upcoming reporting year. The evidence indicated that if accepted to a civil service, the transition process would still require ongoing involvement and supervision from her current FOPS team. In fact, the evidence of Dr. Swayze indicated that to support Ms. Fergadiotis through the transition process, the FOPS team would in fact have increased contact with her to assist her in managing any stressors. It is not clear to the minority why that process could not be implemented safely if Ms. Fergadiotis were subject to a Conditional Discharge Disposition. It is also unclear I why past risk management strategies, such as increasing the frequency of her reporting would be insufficient to manage her risk, as Ms. Fergadiotis has demonstrated the ability to stabilize in the community on numerous occasions since her discharge in 2018, when appropriate risk management measures are implemented.
Finally, in our assessment, the provisions of the MHA would be sufficient to effect Ms. Fergadiotis’ return to the hospital for psychiatric assessment, and, if warranted, admission under either Box A or B of the MHA. She would be able to be detained in hospital as long as she satisfied the criteria under the MHA. We note as well that Ms. Fergadiotis has agreed to voluntary readmissions to the hospital at the request of her treatment team on many occasions in the past, despite her preference to avoid hospitalization. We also note that Ms. Fergadiotis has complied with all requirements, including discrete periods of increased reporting, without incident. The evidence before us also indicates that this compliance has occurred in the context of periods of decompensation and despite her preference for less frequent reporting.
In the event that Ms. Fergadiotis was not amenable to the treatment team’s request for a prolonged hospital admission, then the treatment team could call for an early ORB hearing to request a Detention Order Disposition.
The minority recognizes that a Detention Order Disposition allows the hospital to act swiftly, and if necessary, even proactively, to return a patient to the hospital from community living. However, the efficiency of the hospital to effect a patient’s readmission is not the appropriate test to be applied. Rather, the Board is tasked with crafting the least restrictive and least onerous Disposition which is necessary and appropriate bearing in mind the paramount concern for public safety. In our assessment, a Conditional Discharge Disposition on terms recommended by Ms. Perez is both necessary and appropriate, as well as least onerous and least restrictive bearing in mind the paramount concern for public safety. It allows her to continue to progress towards full community reintegration.
In reaching our decisions, the Board considered public safety, Ms. Fergadiotis’ mental condition, her reintegration into society and her other needs.
DATED this 30^th^ day of October, 2025, at the City of Toronto, in the Toronto Region.
Ms. L. Banks
Alternate Chairperson
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Office of the Registrar
Ontario Review Board