Re: Sarah J. Pickering
ORB File No: 7697
Hearing held on: Wednesday, January 29, 2025
Place of hearing: Ontario Shores Centre for Mental Health Sciences
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. C. Flanagan
Members: Dr. B. Sheppard
Dr. M. Kalia
Ms. J. Greenwood
Mr. J. Cyr
Parties Appearing:
Accused: Sarah J. Pickering
Counsel: Ms. J. Boissonneault
The person in charge of hospital: Counsel: Ms. A. Marshall
Attorney General of Ontario: Counsel: Ms. N. MacDonald
REASONS FOR DISPOSITION
(Dated February 25, 2025)
Introduction
On February 13, 2020, Sarah Pickering was found not criminally responsible (NCR) on account of mental disorder in respect of two counts of assault with a weapon and one count of possession of a weapon for a purpose dangerous to the public peace, all contrary to the Criminal Code. She is subject to a Disposition of the Ontario Review Board (“Board” or “ORB”) dated December 6th, 2023. Pursuant to that Disposition, Ms. Pickering is discharged conditionally, able to live on her own in the community within the catchment area of Ontario Shores, and to report to hospital not less than every two weeks.
On January 29th, 2025, the Board convened in person at Ontario Shores to review Ms. Pickering’s Disposition and make a new Disposition pursuant to s. 672.81(1) of the Criminal Code, in accordance with the provisions of s. 672.54. Ms. Pickering attended the hearing and was represented by her counsel, Ms. J. Boissonneault. Ms. Marshall represented the Hospital and Ms. N. MacDonald represented the Attorney General.
The issues at the hearing were whether Ms. Pickering represents a significant threat to the safety of the public within the meaning of s. 672.5401 of the Criminal Code, and if so, what is the necessary and appropriate Disposition having regard to the evidence, considering the factors in s. 672.54.
At the outset of the hearing, when asked for their initial and tentative positions, the Hospital confirmed that it was seeking a continuation of the current Disposition, a Conditional Discharge. Counsel for the Attorney General did not take an initial position.
Counsel on behalf of Ms. Pickering joined in the hospital’s recommendation for the continuation of the current Disposition, the Conditional Discharge, and proposed an amendment to one of Ms. Pickering’s conditions. Counsel submitted that condition (1)(f) of Ms. Pickering’s Conditional Discharge Disposition should be amended to provide that in addition to being permitted to travel accompanied by one or more of her parents, that she also be permitted to travel accompanied by her brother, Aidan Pickering.
The evidence at the hearing consisted of the viva voce testimony of, Dr. D. Pallandi, Ms. Pickering’s attending psychiatrist. In addition, the Hospital Report dated November 4th, 2024 was filed as an Exhibit.
At the conclusion of its deliberations, the panel concluded that Ms. Pickering continues to represent a significant threat to the safety of the public. The panel further found that in the circumstances, the least onerous and least restrictive Disposition is a Conditional Discharge. The panel found that no changes to the current Disposition were necessary or appropriate. The panel’s Reasons for our conclusions are outlined below.
Index Offence:
- The circumstances giving rise to the index offences are taken from the most recent Reasons for Disposition, dated February 23, 2023. They are reproduced as follows:
"On Wednesday, June 12, 2019, at 50 Winter Court, Whitby, at approximately 0042 hours, the accused, Ms. Sarah June Pickering, did commit the offence of Assault with a Weapon x2 and Possession of a Weapon for a Dangerous Person, contrary to the Criminal Code of Canada. She attempted to stab her mother, Debora Pickering, while she laid in her bed, with a large kitchen knife. The commotion awoke her father, Glen Pickering, who followed her to the stairs guarding himself with a four-foot rifle case using it as a barrier. At that time, Ms. Pickering lunged forward around the case and stabbed Mr. Pickering on the left side of his torso. Mr. Pickering followed her to the front door where Ms. Sarah June Pickering again charged him where she threw a knife at him and stabbed him again in the left torso."
Background Information
The details of Ms. Pickering’s family background, early life, educational and work history, and emotional/mental health challenges predating the index offences are contained in the Hospital Reports. As these documents both constitute evidence at the hearing, it is unnecessary to repeat these details in these Reasons. Some information is highlighted below for the purpose of providing context for understanding Ms. Pickering’s current diagnoses and the panel’s conclusions. The panel, however, has considered all the evidence before it.
The November 4th, 2024 Hospital Report lists Ms. Pickering’s current diagnoses as follows:
Schizophrenia
Posttraumatic stress disorder
Personal history (past) of spouse/partner violence, sexual
Borderline Personality traits
Ms. Pickering was 27 at the hearing date. She had been conditionally discharged the previous year and was living in the community. She gave birth to her child and had moved out from her parents home to several different accommodations. Her living arrangements, and future accommodations, were uncertain.
The background regarding Ms. Pickering’s mental health and other issues are well outlined in last year’s reasons. She has struggled with a number of interpersonal difficulties in relationships and with her peers, partners, and parents. Her parents have remained a steady source of support for Ms. Pickering.
Course Since the Index Offence:
Ms. Pickering’s symptoms were well treated during her first year at Ontario Shores after the NCR verdict, though she retained the belief that her father had sexually abused her when she was little. She reported symptoms of post-traumatic stress disorder from the abuse she endured over the years, causing her to feel stressed and sad. She reported having bad dreams or nightmares regarding being sexually abused.
Ms. Pickering was consistently found capable of consenting to treatment and discharged herself from the hospital despite presenting with active symptoms and refusing medication. Her symptoms abated after the NCR verdict, and she actively engaged in psychoeducational and structured recreational programs. She attended weekly CBT-p sessions and was open to discussing her past delusional beliefs. She spent the entirety of the 2021-2022 reporting period on the FCRU (a general forensic unit) and did not engage in aggressive behavior. She maintained a close relationship with her family and was discharged to their home in May 2022.
Following discharge, she continued to engage in weekly individual CBT-p and received trauma therapy. She was re-admitted to the hospital twice at her own request due to increased delusional content and suicidal ideation. She resumed the use of cannabis, which she believed helped decrease her anxiety and suicidal thinking. She also spoke with her psychiatrist about increasing her Lithium dosage. In January 2023, she returned to college to complete her Baking Diploma.
Course Since the Last Hearing (November 24, 2023 - November 4th, 2024):
The hospital report details Ms. Pickering’s progress over the last reporting year. In January 2024, Ms. Pickering delivered a healthy baby boy.
Ms. Pickering was supported in the community by her FOS clinician twice weekly and had additional visits when coping with stress. She also had visits with her therapist weekly and saw her psychiatrist once per month. Ms. Pickering also had DSO financial support through the passport funding program, and support from two personal support workers for four hours per day each weekday. After Ms. Pickering’s baby was born, she also had support from the public health nurse bi-weekly, and weekly visits from a home volunteer as part of the Health Babies Healthy Mom’s Program. Ms. Pickering terminated this support from Public Health in August 2024.
With respect to medication, Ms. Pickering was being treated with medications, which included: Aripiprazole, Zoloft, Lithium, and Ativan. The Aripiprazole was discontinued on October 10th, 2024 as it was ineffective. The Zoloft and Lithium were discontinued out of caution during the pregnancy and were restarted in February and April 2024, respectively. The treatment team had some concerns about medication compliance given that Ms. Pickering had not picked up the medication from her pharmacy.
The team was also aware that Ms. Pickering was using marijuana occasionally to reduce stress; she had been granted medicinal marijuana use. Daily use was not an amount supported by her treatment team. In October 2024, Ms. Pickering reported to her psychiatrist that she had not used marijuana for three days and requested a PRN instead to assist her in coping with stress.
On October 31st, 2024, Ms. Pickering had a meeting with her FOS clinician and disclosed she had not been medication compliant for some weeks, that she had stopped taking her oral medications because she did not like the way they made her feel, and identified that her continued drinking was concerning and requested a referral to the concurrent disorders program.
The hospital report indicated that initially Mr. Pickering had a good alliance with her team; she was transparent and aligned with her treatment plan. However, as the year progressed and stressors and substance abuse persisted, her judgement was negatively impacted. Ms. Pickering went on to engage in behaviour and make choices that presented difficulties for her and led to some decompensation. Specifically, she chose to live in a polyamorous relationship, she reached out to several ex-partners who had sexually abused her in the past, fuelling discord with her then current partner, and began no-showing for her appointment with her treatment team. After this time, she became less engaged and less transparent and forthcoming with her team. She did not disclose she had unilaterally stopped taking her medication and was minimizing the amount of alcohol she was consuming. One notable example of the lack of transparency is outlined in the hospital report, in April 2024, when Ms. Pickering disclosed feeling suicidal to a CAS worker, but had not disclosed those feelings to her psychiatrist, whom she had met with that same day.
The hospital report highlights a few concerns of the treatment team, one around Ms. Pickering’s choices involving interpersonal relationships; she had reached out to the mother of a former boyfriend in British Columbia with a view to obtaining his address. This former partner had been charged with an alleged sexual assault on her years earlier. This partner had no desire to establish contact with Ms. Pickering.
On October 5th, 2024, Ms. Pickering attended the Waterloo Airport with her infant son, in an attempt to purchase a ticket to British Columbia. She was eventually brought into hospital and admitted on a Form 1. She remained in hospital for three nights but declined a longer voluntary stay. Ms. Pickering’s mother was awarded interim custody of her child for a period of six months following this incident.
The incident in October 2024, was the most serious of several notable incidents over the year. Ms. Pickering reported in February 2024, that she felt that her mother was withholding her child from her. She also reported flashbacks of prior abuse of being trafficked. In March 2024, she reported symptoms of depression and requested Zoloft be prescribed. Ms. Pickering also reported alleged physical and sexual abuse by her partner. She reported the behaviour to police and CAS. Further, during the same month, she reported being sexually assaulted by her mother and not just her father. She reported wanting to “formally press charges of sexual assault against both her parents.” In August 2024, following an argument with her partner, Ms. Pickering asked her mother to care for her son while she stayed in a women’s shelter for abused women, and went to police to have her partner charged with an alleged sexual assault. There are a number of other incidents described in the hospital report involving abuse allegations.
Ms. Pickering also continued to experience residual symptoms of her illness, including auditory hallucinations, anxiety, low mood, impulsivity, intrusive thoughts, and passive suicidal ideations. She denied any serious suicidality or plan. A medication review has been scheduled to review her medications.
The hospital report indicated that at the time of writing, Ms. Pickering was homeless, having given up a DSO-supported apartment that she had been living in with a female friend. She temporarily returned to her parents home, and eventually found an apartment in Oshawa.
Evidence at the Hearing:
Dr. Pallandi testified that he adopted the contents of the hospital report, and that there were, in fact, some significant updates since the writing of the report in November 2024.
Dr. Pallandi gave evidence that Ms. Pickering had been living temporarily in a motel for some period of time before Christmas, and that after Christmas at the end of December, Ms. Pickering abruptly moved to Pickton, Ontario. This was a random place, a house, and she was living there with her intimate partner. However, she had recently had an argument with her partner, and he was charged with mischief as a result. Given that situation, he would not be permitted to return to the home, and Ms. Pickering would not be able to afford that housing on her own. Dr. Pallandi’s evidence was that as of February 1st, 2025, Ms. Pickering would be homeless.
Dr. Pallandi referred to Ms. Pickering’s circumstances as dynamic and changing. The team had hoped that Ms. Pickering could achieve some longer-term stability, and that could be achieved by staying in one place and working with her team to find suitable housing or accommodation.
The team had been working with Ms. Pickering to manage her, despite her move, which was not canvassed or discussed with her team prior. They have been managing her by using virtual conferencing through the hospital’s OTN system, and that she was continuing to receive her injectable medication.
Dr. Pallandi’s evidence was that Ms. Pickering does reach out for help when she needs it, adding “she is good about that part.” She maintains contact with her treatment team and enjoys that contact.
When asked by Ms. Marshall, Dr. Pallandi indicated he believed Ms. Pickering would return to hospital if asked. When asked about medication, Dr. Pallandi explained that Ms. Pickering had some issues with medication compliance. She had stopped taking some of her medications including Lithium and Zoloft as she did not like the effects. The team is working with Ms. Pickering to optimize the medication to help her feel better and also encourage compliance. Dr. Pallandi felt that the current medication was working quite well, despite some residual symptoms.
With respect to the use of cannabis, there had been a point during the year where Ms. Pickering was using quite heavily, but that has decreased and overall, she presents as more stable, alert, engaged and more positive.
Dr. Pallandi was asked about the change in the wording of condition (1)(f) to allow Ms. Pickering to travel with her brother, and his evidence was clear that he did not know about this proposed change in advance of the hearing. He did not know Ms. Pickering’s brother, nor did he have any information about whether he would be a suitable travel companion.
There was also evidence that Ms. Pickering had disclosed to Ms. Young, a member of her clinical team, that she had been feeling angry towards her parents, anger that was presenting in a “fashion that was familiar to her around the time of the index offence.” Dr. Pallandi indicated he himself did not have an opportunity to speak to Ms. Pickering about this anger, but that this could impact any potential travel plans until the team had more information. Dr. Pallandi indicated that they needed more information about Ms. Pickering’s mental state to assess what was going on and how her parents were feeling about her current situation.
Dr. Pallandi was asked about why he felt the team could continue to manage Ms. Pickering on a Conditional Discharge, and his evidence was despite the issues over the last year, “we really haven’t seen any increased level of risk” and “we have been able to manage.” Dr. Pallandi was firm in his evidence that a Conditional Discharge remains appropriate and that a Detention Order would be negative and could impact Ms. Pickering’s autonomy and reintegration into the community. However, Ms. Pickering is not yet ready for an Absolute Discharge. She requires the support of the team and an improvement in her mental state to not pose a significant threat to the safety of the public.
Dr. Pallandi was questioned at length by Counsel for the Attorney General, Ms. MacDonald, about Ms. Pickering’s lack of transparency. Dr. Pallandi confirmed that Picton, Ontario is within the Ontario Shores catchment area, albeit just within the boundary.
He was also asked about Ms. Pickering’s use of cannabis and alcohol, and whether this increases her risk. Dr. Pallandi indicated her urine screens did not test positive for either substance but agreed that alcohol is metabolized faster.
Ms. MacDonald also asked about Ms. Pickering’s changes to her housing and clarified that she gave up her DSO supported apartment, moved to a motel, then to an apartment in a house, then to her parents briefly, then to Picton. Dr. Pallandi was asked about the circumstances that led to the charge of Ms. Pickering’s partner. The circumstances were unclear to Dr. Pallandi, but it involved an argument, and Ms. Pickering’s partner damaged her property, possibly headphones, and was charged with mischief.
When asked by Ms. MacDonald about risk factors, Dr. Pallandi advised it had been a highly stressful year, Ms. Pickering was a new mother, had ongoing discord with her mother, and housing instability. Dr. Pallandi gave evidence that despite this instability, she has not had any increased risk, no inappropriate conduct, and no acts of violence. Although she has been less engaged with her team, she has remained appropriate in her attitude towards the team. Dr. Pallandi indicated that despite Ms. Pickering being underhoused that the team would work with her to ensure she had support, up to and including readmitting her to hospital if necessary.
Regarding the travel condition, Dr. Pallandi was asked by Ms. MacDonald and confirmed that he did not know Ms. Pickering’s brother and did not know what he knew about her mental health. Her brother is not an approved person; only her mother is an approved person. Dr. Pallandi was unsure if he had previously been made aware of Ms. Pickering’s travel plans.
Lastly, Dr. Pallandi indicated that he is not aware if Ms. Pickering’s parents are aware of Ms. Pickering’s reported increased anger towards her parents, that she recently disclosed to her clinician. This is something that the team needs to explore and requires “more clarity.”
Ms. Boissonneault questioned Dr. Pallandi on behalf of Ms. Pickering. She clarified Dr. Pallandi’s evidence that Ms. Pickering would return to hospital if asked, and that at the times she was requested to return to hospital, she did so. He further clarified through defence questions that despite those readmissions, Ms. Pickering was not viewed as having increased risk as she was compliant with medication, specifically her long-acting injectable, which forms a critical part of her risk management. Dr. Pallandi was clear that Ms. Pickering has never expressed a desire to stop her injectable medication.
Dr. Pallandi explained that Ms. Pickering is now taking Seroquel to assist her with her mood and that is assisting her after having discontinued the lithium. Ms. Pickering has her cannabis use under control, and is attending therapy with Ms. Young, and is communicative about her distress. She is doing a good job of communicating with the team and seeking support when she needs them. With respect to housing, Ms. Pickering maintains her DSO funding and supports regardless of where she is living. Lastly, when asked about the travel condition by defence, Dr. Pallandi indicated that he did not know about the travel plans or whether being accompanied by her brother was appropriate.
The panel asked Dr. Pallandi questions. In particular, he was asked to clarify some of his answers around the incident in October, and why Ms. Pickering was at the airport with her child, and whether the team had any forewarning. Dr. Pallandi indicated that it came out of the blue but did not appear to be motivated by delusional thinking. Her risk continued to be viewed as manageable.
The panel asked about Ms. Pickering’s unstable housing situation, and Dr. Pallandi confirmed that if she is without housing, she would be asked to come back to hospital and admitting her back to hospital was an option. If she did not agree to come back to hospital, the hospital could request an early review of Ms. Pickering’s Disposition.
The process for international travel was also clarified with Dr. Pallandi who explained that at present, the hospital must approve Ms. Pickering’s travel itinerary and that there would be a process for that, before it is approved, including the hospital knowing who is travelling with her. This process involves input from Dr. Pallandi, from the forensic program manager, and from the person in charge of the hospital.
No further evidence was led at the conclusion of Dr. Pallandi’s testimony.
Submissions of Counsel:
At the conclusion of the evidence, the hospital and defence maintained their position of no change to the current Disposition. Ms. Boissonneault advocated that an additional party, namely, Ms. Pickering’s brother, Aidan Pickering, be added as a party to condition (1)(f) of the travel condition to allow Ms. Pickering to travel accompanied by her brother. Hospital and Defence Counsel both submitted that despite difficulties this past year, Ms. Pickering’s risk was manageable, and a Conditional Discharge was in her best interest and the least onerous, least restrictive Disposition.
Ms. MacDonald advocated for the panel to impose a Detention Order with community living to better manage Ms. Pickering. Ms. MacDonald’s submissions were that Ms. Pickering is not being adequately managed on a Conditional Discharge and as such her risk to the safety of the public is too high. A Detention Order would allow the hospital to approve her residence and monitor her movements. The incident involving Ms. Pickering’s infant son, and attending the airport, was troubling and there was insufficient oversight of her whereabouts. Further, Ms. MacDonald highlighted that it is concerning that Ms. Pickering has increased anger and has expressed a desire to kill her own father. The submission of the Attorney General was that Ms. Pickering’s parents are at risk of harm.
Analysis and Conclusions:
The panel finds, first, that Ms. Pickering continues to represent a significant threat to the safety of the public. This threshold question was not in dispute at the hearing.
Ms. Pickering suffers from schizophrenia and her mental condition is exacerbated by a history of alleged trauma and abuse by past partners and her parents. Ms. Pickering had a difficult year, but to her credit, her treatment team remained supportive of her and felt she could be adequately managed on a Conditional Discharge.
However, Ms. Pickering’s level of instability and lack of engagement with her team was troubling. At different times during the year, she discontinued medications without consulting with her team. She used cannabis and alcohol despite those substances increasing her risk and she advised her team she was overwhelmed with support. She did not disclose suicidal ideation with her psychiatrist but disclosed it to a CAS worker.
Most troubling is the anger Ms. Pickering has towards her parents; she has made allegations of abuse against her parents, and the hospital report indicated her anger towards her mother for not protecting her and now having custody of her son. This change in the family dynamic will no doubt present new challenges to the treatment team to manage and for Ms. Pickering to work towards developing insight around. All these stressors and changes affect her risk. However, to date, she has remained stable, which favours her remaining on a Conditional Discharge.
The panel is satisfied that Ms. Pickering will return to hospital if asked and will continue taking her medication. It is the hope of this panel that the team can work together with Ms. Pickering to optimize her medication and assist her with appropriate stable housing, hopefully closer to Ontario Shores, to assist her reintegration into the community. It seems that these two issues, if resolved, would set Ms. Pickering up for success in the coming year. We hope she continues to work with Ms. Young and her team to maintain a strong therapeutic alliance.
The panel is satisfied, on the evidence, that a continuation of the current order is the least onerous and least restrictive Disposition. As Ms. Boissonneault reminded us in her closing submissions, the NCR accused is entitled to the utmost liberty that is compatible with her circumstances, bearing in mind the “twin goals” of Part XX.1 of the Criminal Code. In this case, the evidence indicates that Ms. Pickering’s risk to the community can continue to be managed effectively under the terms of a Conditional Discharge.
If any of the issues outlined above, including the issues with her parents become unmanageable, leading the Hospital to conclude that Ms. Pickering’s risk cannot effectively be managed under the terms of a Conditional Discharge, the Hospital can request an early review of this Disposition at any time, pursuant to s. 672.81 (2) of the Criminal Code.
Lastly, the panel considered Ms. Pickering’s request to add her brother as a party to condition (1)(f) allowing her to be accompanied by her brother for the purposes of travel. There was no evidence before the panel that this was appropriate. The only evidence the panel received was that her brother is twenty-two years old. No other information was known, and this formed an insufficient basis for the panel to properly consider a change to this condition. Given the current circumstances involving Ms. Pickering’s parents, and her feelings towards them, and given that no travel plans had been approved by the hospital, the panel did not find it was appropriate to change this condition. Should the parties wish to revisit this condition, and there is an evidentiary basis for the change, the parties can request an early review.
For all the above reasons, the panel concluded that the least onerous and least restrictive Disposition, and thus the necessary and appropriate one considering the factors in s. 672.54 of the Criminal Code, is a Conditional Discharge.
DATED this 25th day of February, 2025, at the City of Toronto, in the Toronto Region.
Ms. J. Greenwood
Legal Member
Office of the Registrar
Ontario Review Board