Ontario Review Board
Re: Marlene Roest
ORB File No: 6542
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. R. Sheppard Dr. M. Kalia Ms. J. Greenwood1 Mr. J. Cyr
Parties Appearing:
Accused: Marlene Roest Counsel: Ms. L. Shafran
Person in charge of hospital: Counsel: Ms. A. Marshall
Attorney-General of Ontario: Counsel: Ms. N. MacDonald
REASONS FOR DISPOSITION
(Dated March 10, 2025)
Introduction
On September 5, 2014, Marlene Roest was found not criminally responsible on account of mental disorder (NCR) on charges of threatening death (x2), charges of criminal harassment (x2), and charges of failing to comply with court order (x2), all contrary to the Criminal Code.
Ms. Roest is currently subject to the terms and conditions of a Disposition of the Ontario Review Board (“ORB”) dated December 5, 2023, detaining her at the Forensic Program of the Ontario Shores Centre for Mental Health Sciences (“Ontario Shores” or “the Hospital”) with certain privileges including to live in the community in supervised accommodation approved by the person in charge.
On January 29, 2025, a panel of the Board convened to review the Disposition in accordance with the requirements of s. 672.81(1) of the Criminal Code. Ms. L. Shafran, counsel for Ms. Roest, attended the hearing, as did Ms. Roest. Ms. Roest’s mother and sister also attended the hearing. A Hospital Report dated November 18, 2024, a Victim Impact Statement dated October 31, 2024, and an Addendum to the Hospital Report dated January 24, 2025, were filed as Exhibits 1, 2 and 3 respectively, at the hearing.
Ms. Shafran submitted there were certain portions of the Victim Impact Statement that were not admissible under the Criminal Code. In this regard, all parties agreed that the panel could exercise its proper discretion in considering only the relevant and admissible portions of the Victim Impact Statement.
The issue to be determined is whether Ms. Roest continues to represent a significant threat to the safety of the public, as defined in section 672.5401 of the Criminal Code, and if so, the necessary and appropriate Disposition to manage that risk, having regard to the criteria set out in s. 672.54 of the Criminal Code.
Initial Position of the Parties
At the outset of the hearing, the parties were canvassed as to their initial recommendation to the Board.
Ms. Marshall, on behalf of the Hospital, submitted that Ms. Roest continued to be a significant threat to the safety of the public and recommended no change to the existing Detention Disposition.
Ms. MacDonald, on behalf of the Attorney General of Ontario, supported the recommendation of the Hospital.
Ms. Shafran, on behalf of Ms. Roest, conceded the issue of significant threat and agreed with the Hospital’s recommendation.
Index Offence
- The circumstances of the index offences are taken from last year’s Reasons as follows:
“The accused dated the victim’s brother when they were in high school about 30 years ago; the victim’s brother then moved out of the province and has not had contact with the accused for over 30 years. The accused has attended the victim’s home for the past 15 years, leaving cards at the house for the victim’s brother.
The accused left a Christmas card at the victim’s home dated December 1, 2013. It is addressed to the victim’s brother and says, “From Marlene Roest”, part of the note reads, “don’t come to Toronto you will be killed, I mean it. Phone Ingrid Pfaff and Mike Pfaff (your brother and sister) to sell the house and move to where you are in Vancouver. I worry about their safety”. This is the first card with a threatening message the victim received. On another letter dated April 20, 2014, again addressed to the victim’s brother, saying “From: Marlene Roest”, part of the message reads “I’ll burn down your house Ingrid Pfaff and Mike Pfaff if I can’t see your brother Mark Pfaff. I’ll cut your heads off (Mike Pfaff and Ingrid Pfaff and Mark Pfaff). In a letter dated April 27, 2014, addressed to the victim’s brother saying, “love always Marlene Roest”, part of the message reads “I might have your head cut off and your body dissected. In an Easter card that isn’t dated, the card says, “love Marlene”, part of the card reads, “If I don’t see you tonight, I’ll burn down your house…”.
When the victim received the card on December 1, 2013, she contacted the accused mother, who asked the victim to send her a copy of the card so she could make the accused counselors aware of the situation. The cards stopped until April 6, 2014. The victim contacted police on April 6, 2014, to report the threatening cards from the victim. On that date, the victim saw the accused at her address leaving a card. After reading the card, the victim contacted the police. Officers spoke with Marlene on the telephone and cautioned her about leaving these threatening cards with the victim. Since that time, 4 more threatening cards have been left at the home, which has caused the victim to become very fearful of her safety. On Monday April 28, 2014, the accused was arrested and charged with Uttering Threats against the victim. The accused was released on Bail on May 1, 2014.
On May 3, 2014, the victim, Ingrid Pfaff was inside her home in the city of Toronto. At approximately 1 p.m., she heard the lid of her metal mailbox lift open and then slam shut. By the time the victim opened her door she could not see anyone in the area. When she checked the mailbox, she found a single envelope addressed “To Mark (care of Ingrid Pfaff and Mike Pfaff)”. Inside the envelope was a birthday card. The message written inside stated; “Hi! Mark Pfaff from Marlene Roest. Now listen, I love you and miss you! Mark I miss you and if we don’t meet I’ll have to put you on the cross. Love Always from me to you”. Upon reading the contents of the card, the victim immediately called the police. On Sunday May 4, 2014, officers attended at her boyfriend’s address and located her. She was placed under arrest, advised of her rights to counsel and transported to 42 Division where she was investigated and held for a show cause hearing.
On May 23, 2014, the victim was at her home in the city of Toronto. The accused approached the victim and said, “I know I am not supposed to talk to you but here it’s a nice one”, then handed the victim a card. The card was addressed to Mark Pfaff which Is Ingrid’s brother and care of Ingrid and Mike Pfaff. The card read “Hey babe, how’s it going. It was love at first sight, eh Mark. How could you forget that great party I had for you? Remember that nite-you held me so tight and when you put your penis inside remember how great that felt. Do it gently from the front – you know the vagina. I need to see you – or otherwise I will blow your head off. Remember you’re the King of the world and I’m the Queen. See ya. From: Marlene Roest. When the victim saw the accused, she immediately called police.”
Personal Background/Psychiatric History
Ms. Roest’s personal background and psychiatric history are comprehensively reviewed in the Hospital Report filed as an exhibit at the hearing.
Briefly, Ms. Roest is 64 years of age. She was born in Toronto and is the second eldest in a sibling of four. Her two brothers are engineers, and she is closest to her one sister, a pharmacist. She attended the University of Toronto but never finished her first year of classes. She lived at home with her parents until her 20s and has worked in different jobs, including a travel agency. After her father’s stroke, her mother was unable to care for both her spouse and daughter, and Ms. Roest moved to a group home.
Ms. Roest has a history of significant substance use using cannabis and crack cocaine regularly. She has had two serious relationships in her adult life. One of these partners had significant substance use issues, and Ms. Roest engaged in prostitution to procure drugs for both their use.
Her first psychiatric hospital admission was in 1991 with three more in 2003. She reported hearing voices in her 40s claiming she was "Queen of the World". During states of acute psychosis, Ms. Roest experienced grandiose and erotomanic delusions, ideas of reference, impulsive and reckless behavior, and extreme disinhibition. Behaviors of concern included physical intimidation (lunging), sexually explicit/vulgar language/demands, disrobing (which began in 1990), and threats of physical violence.
Ms. Roest was managed on an outpatient basis with the assistance of an Assertive Community Treatment Team (ACTT) from 1999 to the date of the index offences. There were concerns relating to substance use and symptoms of auditory hallucinations, disorganization and delusions. At the time of the index offences, Ms. Roest was living independently in a boarding house in Toronto. She was under the care of her ACT team for psychiatric treatment, receiving both daily oral medication and intramuscular antipsychotic medication.
In May 2014, Ms. Roest's mother raised concerns about her worsening hallucinations, delusional thoughts and aspirations related to a past relationship involving the victim of the index offence. She also had a pattern of disrobing and announcing that she was the “Queen of the World”. Importantly, Ms. Roest had not adhered to her medication regimen for approximately a week prior to the index offences and was using illicit substances, including crack cocaine.
On September 5, 2014, Ms. Roest was found to be NCR on multiple utter threats, criminal harassment and failing to comply with court orders.
Ms. Roest has had several elopements from hospital. In March 2015, she absconded twice, used drugs, and dropped off letters at the residence of the victim’s sister, in contravention of the terms of her Disposition. In June 2016, she eloped and left a threatening letter for the victims of the index offence. Ms. Roest has written letters to the victims which were intercepted by the hospital.
Ms. Roest is supported financially through the Ontario Disability Support Program (ODSP). Her finances were managed by the Public Guardian and Trustee. Ms. Roest was deemed incapable of consenting to treatment and her sister, Ms. Hyland, was her substitute decision maker (SDM).
Current Diagnosis
- Ms. Roest’s current diagnoses are Schizoaffective Disorder, Bipolar Type, Dependent Personality Disorder, Histrionic Personality Disorder, Amphetamine-type Substance Use Disorder, severe, in sustained remission, Cocaine Use Disorder, severe, in sustained remission.
Evidence at the Hearing
The Hospital’s evidence was presented through the oral testimony of Dr. B. Chuong to supplement the Hospital Report, filed as an exhibit at the hearing.
Dr. Chuong advised that she has been Ms. Roest’s treating psychiatrist since January 2020. Ms. Roest remained in the Forensic Community Rehabilitation Unit (FCRU), a general forensic unit, for the duration of the reporting year. She had no episodes of aggression, her urine drug screens were negative, and she was fully compliant with her medication regimen.
Although Ms. Roest's mental status remained stable, Dr. Chuong noted that symptoms of her illness persist, such as erotomanic delusions and disinhibition. These symptoms cause her to remove her clothing and make inappropriate statements. The doctor explained that the intensity of the symptoms varies depending on Ms. Roest's stress level. Dr. Chuong indicated that some symptoms were managed through non-pharmacological interventions, such as behavioral therapy and support from members of the treatment team.
During the reporting year, she had a few episodes of experiencing auditory hallucinations where she reported hearing “Eddie’s (previous boyfriend who was deceased) and Mark’s (the victim of the index offence) voices, although her focus on the latter had diminished over the reporting year. Ms. Roest mentioned these voices more often during instances of inappropriate behavior, such as her disrobing on the unit, and attributed these actions to her auditory hallucinations.
While Ms. Roest did not require medication changes, she did require more monitoring and redirection by unit staff. She remained on clozapine, an antipsychotic medication. Ms. Roest was seen in consultation through the Medication Assessment Program for Schizophrenia (MAPS) at the Centre for Addiction and Mental Health (CAMH) for a second opinion on clozapine. The MAPS team opined that clozapine remained the optimal treatment for Ms. Roest.
Ms. Roest’s insight regarding her mental illness was superficial. While she acknowledged her diagnosis and was adherent to her treatment, she showed limited appreciation for the need for such treatment. Her insight into her substance use was also limited.
Ms. Roest utilized her accompanied privileges on hospital grounds and in the community with staff and her approved person(s) without issue or concern. Due to her elopement risk, a graduated privilege program was initiated on June 17, 2024, with rewards for completing each indirectly supervised privilege appropriately. The program was suspended after Ms. Roest’s unauthorized leave of absence on July 5, 2024. She was using her indirectly supervised privileges on hospital grounds and did not return to the unit at the expected time. Ms. Roest was located walking by Lakeridge Health (Whitby site) towards the shopping plaza. Dr. Chuong assessed it as a temporary lapse of impulse control rather than psychotically-driven behavior. Consequently, Ms. Roest’s privileges were suspended and reinstated on October 21, 2024. Since then, there has been a modification to the plan and Ms. Roest has utilized 30 indirectly supervised privileges without incident or any attempt at elopement.
The treatment team suggested a long-term care (LTC) home for Ms. Roest upon discharge next year. Due to the elopement risk, Dr. Chuong discussed increasing her indirectly supervised privileges on hospital grounds to manage this concern.
Dr. Chuong noted that Ms. Roest did not contact the victim or his family in the past year, with the last attempt in 2020. The doctor confirmed that upon discharge, the treatment team will inform the community facility of the risk of contact. In this regard, the Crown advised that the victims have always been proactive in notifying the police.
The doctor explained that a geriatric unit in hospital was not suitable for Ms. Roest. Typically, such units are targeted for long admission and are primarily for individuals who have dementia with symptoms specifically related to dementia. The doctor stated that a geriatric unit would not provide Ms. Roest with the same activities and privileges found in an LTC facility.
Dr. Choung mentioned that a 30-60 day stay in a geriatric unit before moving to an LTC facility would not be suitable for Ms. Roest due to potential destabilization and increased stress symptoms. The treatment team hopes to find suitable accommodation within a year, although discharge within that period is unlikely.
Dr. Chuong was asked by a Board member whether histrionic and dependent personality disorders remain prominent aspects of Ms. Roest’s personality profile. Dr. Chuong stated that while dependent personality disorder is still evident, histrionic traits are not as prominent. When questioned about whether Ms. Roest had undergone formal cognitive and neuropsychological testing, Dr. Chuong confirmed that she had not. Dr. Chuong agreed that such testing could help clarify specific functional limitations and guide tailored interventions. Although a neuropsychologist is not available on-site to perform a comprehensive assessment, Dr. Chuong stated that the team could consider conducting a cognitive screening within the next year.
Dr. Chuong advised that Ms. Roest has been very active in programming and worked part-time in hospital at the Fashion Boutique. She remained in close contact with her family, who were very supportive. Her approved persons were her mother, her sister, and her mother’s care provider. The family remained in frequent contact with the treatment team and collaborated with them with respect to Ms. Roest’s care.
Dr. Chuong advised that Ms. Roest remains a significant risk to the safety of the public and adopted her assessment of risk and risk factors contained in the Hospital Report. The doctor emphasized that the hospital needed to approve any supervised accommodation upon her discharge from hospital. The doctor agreed that there remains a risk for elopement and that any placement in the community would need to have the appropriate support and supervision to manage this risk. In this regard, the doctor advised there were devices such as a “wander guard” that sounded an alarm upon any attempt to leave the facility. The doctor advised that the MHA would not be sufficient to manage Ms. Roest’s risk on a Conditional Discharge Disposition.
No further evidence was presented at the hearing.
Final Submissions of the Parties
Ms. Marshall, on behalf of the Hospital, maintained her initial position that Ms. Roest remained a significant threat to the safety of the public and that the existing Detention Disposition should remain in place. She submitted that Ms. Roest had a good year, and the treatment team looks forward to working with her and her family towards appropriate discharge options in the coming year. She noted that with respect to future testing, the Hospital will make their best efforts in the coming year.
Ms. MacDonald, on behalf of the Attorney General of Ontario, adopted the hospital’s submissions. The proposed continuation of the Detention Disposition is the most appropriate considering public safety. She submitted that the Board should consider the relevant and admissible portions of the Victim Impact Statement relating to the effect on the victims. She further submitted that when Ms. Roest is discharged to the appropriate LTC facility, certain safeguards are put in place to address any attempt to contact the victims.
Ms. Shafran, on behalf of Ms. Roest, submitted that it is a joint submission, and that the threshold of significant threat to the safety of the public has been met. She submitted that Ms. Roest has had an excellent year and has remained substance free, which was a contributing factor for the index offences. Ms. Shafran submitted that the team has worked well with Ms. Roest and her family in moving towards the goal of a discharge to an appropriate facility. Ms. Shafran submitted that Ms. Roest’s last attempt to contact the victims was in 2020, her focus on the victims has recently decreased and while there have been subsequent elopements, there has not been any attempt to contact the victims.
Conclusion and Disposition
Having considered all the evidence presented at the hearing, the Board finds that Ms. Roest continues to pose a significant threat to the safety of the public as set out in s. 672.5401 of the Criminal Code. We make this finding based on the evidence of Dr. Chuong and the evidence contained in the Hospital Report, filed as an exhibit at the hearing, notwithstanding the joint position on significant threat of the parties.
Ms. Roest’s index offences consist of several unwanted contacts with the victim(s). She has a long-standing major mental illness together with personality disorders, and a history of substance use, all of which contributed to the index offences. She continues to experience symptoms of her illness, primarily in the form of eroto-manic delusions and disinhibition, which cause her to remove her clothing, hear voices from time to time, make inappropriate flirtatious statements, and require ongoing redirection. In this regard, neuropsychological testing, and/or cognitive screening may provide insights into Ms. Roest's ongoing inappropriate behavior.
Due to her multiple diagnoses, persistent delusions (even at her baseline) and impulsive behavior, Ms. Roest remains a significant risk to the safety of the public. She requires ongoing support and supervision if discharged to community living. Fully supported and supervised accommodation, such as an LTC facility, is currently the most suitable option to manage this risk.
Notably, Ms. Roest’s elopement risk remains a concern of the treatment team. In this regard, the treatment team has been vigilant in developing a graduated privilege program to assist with the management of her indirect privileges and ongoing risk for elopement. Although Ms. Roest has not attempted to contact the victim(s) for some time, the Board is mindful of her history of doing so and the resulting significant psychological impact on them. In this regard, should Ms. Roest be discharged to supported accommodation, it will be important for the staff to be made fully aware of the terms of her Disposition and the potential risk for elopement and/or victim contact.
To her credit, Ms. Roest has been compliant with her medication, remained substance free, and has had no aggressive episodes over the reporting year. She has completed several programs in hospital and enjoys the full and ongoing support of her family, most notably her mother and sister.
Although not advanced by the parties, we find that a Conditional Discharge Disposition has no air of reality. The hospital needs to approve any community accommodation to manage the ongoing risk, particularly given her ongoing symptoms and risk for elopement. In this regard, the MHA would not suffice to manage her risk in the community.
For the reasons set out above, we came to the unanimous conclusion that Ms. Roest remains a significant threat to the safety of public and that the most appropriate and necessary Disposition was the continuation of the existing Detention Disposition on the same terms and conditions.
In reaching our decision, the Board has considered the safety of the public, Mr. Roest’s mental condition, his reintegration into society, and his other needs.
DATED this 10^th^ day of March 2025, at the City of Toronto, in the Toronto Region.
Mr. C. Flanagan Legal Member
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Office of the Registrar Ontario Review Board