Re: Thi M. Luu
ORB File No: 6839
Hearing held on: Friday, January 10, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. C. Fraser
Members: Dr. W. Johnston Dr. T. Stirpe Ms. A. La Viola
Parties Appearing:
Accused: Thi M. Luu Counsel: Mr. J. Halberstadt
The Person in Charge of Hospital: Counsel: Ms. L. Senko
Attorney General of Ontario: Counsel: Mr. M. Feindel
REASONS FOR DISPOSITION
(Dated February 20, 2025)
Overview
On October 5, 2015, Thi M. Luu was found not criminally responsible (NCR) on the Criminal Code charge of abduction of a person under 14 years of age.
Ms. Luu is currently subject to a disposition of the Ontario Review Board (the Board) dated January 31, 2024, which detains her at the Forensic Service of the Centre for Addiction and Mental Health (CAMH or the hospital) with the outer limit privilege to live in the community in accommodation approved by the person in charge.
On January 10, 2025, this panel of the Board convened a hearing at CAMH for the annual review of Ms. Luu’s disposition pursuant to s. 672.81(1) of the Criminal Code. Ms. Luu was present at the hearing and represented by counsel, Mr. Halberstadt. The public member of the panel was unavailable (for the day) due to unforeseen circumstances and all parties agreed that we could proceed as a four member panel. We did not foresee an issue with a divided panel in our deliberations.
A Vietnamese interpreter was ordered for Ms. Luu but was not required. Ms. Luu has a good command of the English language. Her counsel advised the Board that he communicates with her in English, and an interpreter was not necessary. Ms. Luu also confirmed this.
The issues for the Board to decide at the hearing were first whether Ms. Luu remains a significant threat to the safety of the public and, if so, what is the necessary and appropriate disposition for the coming year based on a consideration of the factors in s. 672.54 of the Criminal Code.
At the outset of the hearing, the parties were asked for their initial positions. Hospital counsel recommended continuation of the current detention order on the same terms and conditions. Crown counsel supported the hospital position, as did counsel for Ms. Luu. In the result, the Board was presented with a joint recommendation by the parties. Significant threat to the safety of the public was not contested.
For the reasons which follow, the Board finds Ms. Luu is a significant threat to the safety the public and the necessary and appropriate disposition for the coming year is the one jointly recommended by the parties, a continuation of the current detention order on the same terms and conditions.
Index Offence
- The circumstances of the index offence are excerpted from last year's Board Reasons dated February 26, 2024, at paragraph 9, as follows:
“On September 23, 2010, Thi Luu was charged with one count of abduction of a person under the age of 14, after she grabbed the hand of a 3-year-old boy who was walking with his mother at the Toronto Eaton Centre. Ms. Luu told the child to “come” and pulled him away from his mother. The mother grabbed the child’s other arm and demanded that Ms. Luu let go of her child, which she did.”
Background and Course Since Last Hearing
The hospital report dated December 10, 2024, (exhibit 1) contains considerable detail regarding Ms. Luu’s personal background and psychiatric history. The details need not be repeated in these Reasons. Some relevant information will be highlighted.
Ms. Luu is 49 years of age. She has current diagnoses of schizophrenia and substance use disorders, in remission in a controlled environment. Ms. Luu is treatment incapable for psychiatric decisions and the Public Guardian and Trustee is her substitute decision maker. She can manage her financial affairs. Ms. Luu has been under the jurisdiction of the Board for approximately nine years.
There was a long delay between the commission of the index offence and the NCR finding. Over the course of approximately five years, Ms. Luu made numerous appearances in court and at times was found fit to stand trial and then almost immediately thereafter found unfit to stand trial. She has been an inpatient at CAMH since the NCR finding in October 2015.
Ms. Luu was born in Vietnam and came to Canada in 1993. She is now a Canadian citizen. During her early life she experienced many traumatic events, including the reality of life as a child during the war in Vietnam. She also witnessed domestic violence and was subjected to emotional abuse and possibly physical abuse from a family member.
After graduating from high school, Ms. Luu attended Ryerson University. She developed symptoms of psychosis in 2000, which interfered with her efforts at higher education. She left school that same year.
Ms. Luu’s first psychiatric admission was in 2003 for a reported suicide attempt after she developed paranoid symptoms. Thereafter, she had several psychiatric admissions and contacts prior to the index offence. Collateral reports indicate that Ms. Luu’s psychiatric problems were exacerbated by her extensive substance use, including ecstasy, cannabis, cocaine and amphetamines.
Ms. Luu was convicted of criminal harassment and assault in February 2009. The conduct leading to the charges occurred during a period when Ms. Luu was clearly unwell. She attended a class at her former high school and advised a former teacher that she was attracted to her. Ms. Luu initially refused to leave the class when asked to do so, and then she returned to the school several times despite being advised not to. When confronted by the school principal and security officers, Ms. Luu wrapped her arms around the teacher’s waist. The police were called, and Ms. Luu was arrested. Shortly after, Ms. Luu was admitted to hospital following a relapse of her chronic schizophrenia illness. Notes from that admission indicate that she had been noncompliant with her medication in the community.
After being found NCR in October 2015, Ms. Luu initially resided on a secure forensic unit at CAMH. Over the years, depending on her mental stability and behaviour, she has resided on both general and secure forensic units at the hospital. At the time of last year's hearing, she was residing on the Women's General Forensic Unit (WGFU) under the care of Dr. Ray. At that time, Dr. Ray reported that during the prior reporting year, all of Ms. Luu’s urine screens were negative for illicit substances, there were no absconding incidents and Ms. Luu did not demonstrate any violence or aggression. Ms. Luu was also reported to have developed a good therapeutic rapport with many members of her treatment team and although she had only partial insight into her mental illness, she was medication compliant.
In June 2023, there was a vacancy in TRHP-2 (transitional housing) located on the campus of CAMH. Ms. Luu received an offer for this residence. She declined it after visiting the location as it would have required her to live with male co-residents. Her history of trauma made this untenable for her.
In late August 2023, Ms. Luu went AWOL while she was on an indirectly supervised pass in the community. She returned to the unit three days later. She presented as tired and disorganized. Ms. Luu said her decision to leave while on a pass was impulsive. She endorsed hearing the voice of her mother, making her feel anxious. Her mother had passed away a month prior.
In October 2024, Ms. Luu was designated as Alternate Level of Care (ALC) to facilitate discharge planning. This is the last stage prior to discharge, and it signifies clinical readiness for community reintegration.
On November 11, 2024, Ms. Luu was transferred from WGFU (women only) to the Forensic General Unit A (FGUA), under the care of Dr. Meng. She accepted the transfer well and did not express any distress about moving to a mixed gender unit.
As in previous years, Ms. Luu’s mental state fluctuated during the reporting period. When on the unit, she typically isolated herself in her room and engaged only briefly and selectively with staff. The prominent feature of her presentation was guardedness. She could also be dismissive. These two features of her personality made comprehensive assessments of her mental status challenging.
Ms. Luu had a few incidents of writing numbers on her arms and when asked what they meant, she refused to say. She occasionally expressed paranoia regarding the forensic system and Dr. Ray (no longer her treating doctor). Of note, Ms. Luu’s mental status and engagement with staff noticeably improved when she accompanied staff into the community.
Ms. Luu’s understanding of her schizophrenia illness remained very limited over the reporting year. She repeatedly claimed she did not have a mental illness and believed she had been cured of schizophrenia. She did not think she required treatment with antipsychotic medication and expressed the desire to discontinue psychiatric follow-up on discharge. Despite this strongly held view, Ms. Luu was medication compliant. She continued to be unable to provide consent for psychiatric treatment.
Evidence at the Hearing
Dr. Dupré, Ms. Luu’s current treating psychiatrist, gave the evidence for the hospital at the hearing. The doctor authored the hospital report, and it was adopted in her evidence. The doctor’s oral testimony was brief.
The doctor had two updates. The first is that Ms. Luu has progressed to level 7 privileges which is indirectly supervised passes into the community for rehabilitation activities. She has been exercising these privileges for the past two months with no concerns.
The other update was regarding housing. Ms. Luu had applied to Margaret House, an all-women residence in the city. Regrettably, Ms. Luu’s application was not successful. This housing is highly sought after, and it is difficult to be placed there.
Dr. Dupré said that they will do an occupational therapy assessment to see if there is a potential for Ms. Luu to reside in more independent accommodation. This would potentially permit an earlier discharge to community living as it opens up more housing options. It is unclear when a bed may become available again at Margaret House.
Counsel for Ms. Luu asked the doctor about what changed with Ms. Luu in the past year regarding Ms. Luu's willingness to be discharged to community living as in the past she was content to remain in the hospital. Dr. Dupré said it is difficult to say, however overall Ms. Luu’s internal state is better, and she has participated in more structured programs in the past year such as dialectical behaviour therapy.
It was confirmed in questions by Dr. Dupré that family involvement has been a positive source of support for Ms. Luu in the past year from her brother and sister-in-law who frequently visit Ms. Luu.
No further evidence was called at the hearing.
In final submissions, the parties maintained their original positions from the outset.
Analysis and Conclusion
The Board finds Ms. Luu is a significant threat to the safety of the public based on s. 672.5401 of the Criminal Code, and Winko, and its related authorities.
The Board notes the parties did not contest a finding of significant threat to the safety of the public. Despite this, the Board makes its own finding of significant threat based on the expert evidence of Dr. Dupré, as supplemented by the hospital report.
Ms. Luu suffers from a treatment resistant schizophrenia and substance use disorders (in remission). Her substance use in the past included cannabis, cocaine and ecstasy. To her credit, Ms. Luu has consistently tested negative for illicit substance use for quite some time.
According to the hospital report the current risk assessment deems Ms. Luu as a low risk for any future violence and a low risk for imminent violence in the context of a detention order with community living in approved accommodation.
The Board notes that Ms. Luu’s index offence (abduction of a child) occurred when she was in a floridly psychotic state. If Ms. Luu were to re-offend it would likely occur because of medication noncompliance and a falling away from supports (both professional and personal). If Ms. Luu was not medication compliant, she would show a worsening of her mental state including an emergence of psychotic symptoms which would then increase her risk of violence. It is also likely that she would turn to substance use to help her cope and substance use would exacerbate her psychotic symptoms and further increase her risk of violence.
In all the circumstances, the Board is satisfied that Ms. Luu is a significant threat to the safety of the public.
The necessary and appropriate disposition for the coming year is the one jointly recommended by the parties which is a continuation of the current detention order on the same terms and conditions. Of note, Ms. Luu is designated ALC and placement in the community appears imminent. She is exercising privilege levels close to the maximum and there is enough leeway in her current disposition to ensure that her liberties are maximized commensurate with public safety. The Board is hopeful that Ms. Luu can be placed in the community in the very near future.
The parties did not request consideration for a conditional discharge and the Board notes that there is a clear need for the hospital to approve housing for Ms. Luu given her constellation of risk factors and the authority to approve accommodation can only be assured on a detention order and not a conditional discharge. See Runnalls (Re) 2012 ONCA 295 at paragraph 12.
The Board further finds that there is a need to intervene promptly and return Ms. Luu to hospital for admission, treatment and stabilization if she decompensated. Reliance on the Mental Health Act alone would not be sufficient to manage her risk. This is the opinion of Dr. Dupré, and the Board agrees.
The Board notes that at the time of the index offence, Ms. Luu was floridly psychotic and trying to take a child away from her mother at the Eaton Centre. Had the mother not intervened, it is difficult to know what the consequences would have been. If Ms. Luu decompensates the Board reasonably concludes that the same level of violence could occur.
Historically, Ms. Luu has been ambivalent about community living and a detention order will ensure that if the transition to the community does not go as planned, the hospital will have the authority to return Ms. Luu to the hospital for placement at alternate accommodation. There will be stressors for Ms. Luu when she transitions to the community, and it is uncertain how she will respond to her new surroundings. The Board agrees with the doctor that Ms. Luu will require structure, support and supervision in her new housing, at least initially. The authority to return her to the hospital is a critical risk management factor in the Board’s view. Hence, the detention disposition remains necessary and appropriate.
The Board wishes Ms. Luu well in the coming year. The transition to community living will be significant for Ms. Luu as she has yet to experience this during her long tenure under the Board. We are confident the transition will go well and that she will be engaged with the treatment team.
In arriving at our decision on the appropriate disposition, the Board has considered the paramount factor of the safety of the public, Ms. Luu’s community reintegration, her mental condition and her other needs, all as required by s. 672.54 of the Criminal Code.
A disposition will issue accordingly.
DATED this 20th day of February 2025, at the City of Toronto, in the Toronto Region.
Mr. C. Fraser Alternate Chairperson
__________________ Office of the Registrar Ontario Review Board