Re: Trisha M. Wall, 2025 CanLII 23495

Ontario Review Board

Re: Trisha M. Wall

ORB File No: 5240

Hearing held on: Tuesday, February 11, 2025

Place of hearing: Brockville Mental Health Centre by Zoom videoconference

Pursuant to: Section 672.81(2.1) of the Criminal Code

Before:

Alternate Chairperson: Ms. L. Banks Members: Dr. R. Kunjukrishnan Dr. G. Stones Ms. K. Tomaszewski Mr. A. Mete

Parties Appearing:

Accused: Trisha M. Wall Counsel: Mr. P. Lewandowski

The person in charge of hospital: Representative: Dr. J. Gray

Attorney General of Ontario: Counsel: Ms. C. Breault

REASONS FOR DECISION

(Dated March 17, 2025)

Introduction

1. On December 15, 2008, the accused, Trisha Wall, was found not criminally responsible (“NCR”) on a charge of mischief contrary to the Criminal Code of Canada. Ms. Wall is currently subject to a Disposition of the Ontario Review Board (the “Board”) dated December 18th, 2024, which discharges her on certain terms and conditions.

2. On January 8, 2025, the Brockville Mental Health Centre (“BMHC” or the “hospital”) advised the Board that:

Ms. Wall was admitted to the hospital on December 27, 2024, following admission at the general hospital due to ongoing concerns of homicidal ideation. Ms. Wall did not meet the threshold to be formed under the Mental Health Act on admission so she was here voluntarily.

We have thus far been unable to discharge Ms. Wall back into her community accommodation due to ongoing safety concerns therefore Ms. Wall was issued a Form 3 under the MHA on December 31, 2024 and remains in-hospital to date.

3. On January 9, 2024, the Board advised the hospital that it would proceed to schedule an ROL hearing pursuant to section 672.81(2.1) of the Code.

4. On February 11, 2025, a panel of the ORB convened a hearing via Zoom videoconference at the hospital to conduct a review of the period of increased restrictions on Ms. Wall’s liberty during her involuntary detention in hospital, which commenced on December 31, 2024, and continues to the date of the hearing, pursuant to s. 672.81(2.1) of the Criminal Code.

5. Ms. Wall’s counsel, Mr. Lewandowski, indicated that he had spoken with her prior to the hearing, and that she had provided instructions enabling him to proceed in her absence. As a result, Ms. Wall’s presence was excused pursuant to s. 672.5(10) of the Criminal Code.

6. The issue the Board considered was whether the restriction on Ms. Wall’s liberties during the involuntary admission to hospital which commenced on December 31, 2024, and continued to the date of the hearing (the “ROL”), was necessary and appropriate as well as the least restrictive and least onerous intervention available to the hospital, both initially and throughout its duration.

7. For the reasons which follow, the Board found that there was a significant restriction on the liberties of Ms. Wall during the ROL and that this was necessary and appropriate as well as the least restrictive and least onerous in the circumstances, both initially and throughout its duration to the date of the hearing.

Position of the Parties

8. At the outset of the hearing, the parties were canvassed as to their recommendations to the Board. Dr. Gray submitted on behalf of the hospital that the restriction of Ms. Wall’s liberty during the ROL was necessary and appropriate and the least onerous and least restrictive decision available to the hospital in the circumstances, both at the commencement of the ROL and continuing to the date of the hearing. The doctor advised that the existing Conditional Discharge Disposition remained necessary and appropriate.

9. Counsel for the Attorney General declined to make a recommendation until she heard Dr. Gray’s evidence.

10. Counsel for Ms. Wall adopted the hospital’s recommendations.

Index Offence

11. The circumstances giving rise to the index offence are abstracted from the Board’s latest Reasons for Disposition as follows:

“The police occurrence report states that Ms. Wall called 911 repeatedly on and around November 14, 2008, complaining of voices telling her to kill her mother, and seeking assistance. She was reportedly taken to the Civic hospital where she was offered admission with a 1:1 sitter. However, when she refused, she was released. Once home, she continued to call 911 and returned again to the hospital but was not admitted. When she continued to make further calls, she was arrested and charged with mischief due to abuse of the 911 system. The police reported that she was "happy to be arrested" so that she would not hurt anyone.”

Ms. Wall stated that she made the 911 calls because she was hearing voices and was concerned that she would act on them.

12. Ms. Wall’s current diagnoses are:

• Schizoaffective Disorder
• Borderline Personality Disorder
• ADHD, by history
• PTSD, by history
• Opioid Use Disorder - in sustained remission

Personal Background

13. As the Hospital Report dated October 28, 2024 (the “Hospital Report”) was made an Exhibit in this hearing, it is not necessary to reproduce the information contained therein; however, we note the following updated information from the Board’s most recent Reasons for Disposition, dated January 20, 2025:

• Ms. Wall’s admissions to hospital in the past were characterized by a pattern of conflict, absent direct aggression towards others, followed by her request for admission on a voluntary basis as a form of temporary respite. After admission, she generally stabilized within a week.
• Ms. Wall has had a good year and was not readmitted to hospital during the reporting year. She has now been living in the community longer than she has in her adult life. She lives independently in an apartment with a forensic subsidy. Her apartment is within walking distance of the hospital, and her partner, although she has her own apartment, is very frequently with Ms. Wall. Ms. Wall is not involved in volunteer work or paid employment, but spends time with her dogs, shopping, watching movies, and having dinner with her partner’s grandmother. Ms. Wall has been using cannabis, which she reports is provided to her by her partner in limited amounts, for pain control for her knee.
• Ms. Wall is adherent to her medication and did not disclose psychotic or mood symptoms until shortly after knee replacement surgery on October 1, 2024. Over the two days that she was hospitalized, she did not receive her dose of Clozapine, and her dose needed to be re-titrated on her return.
• Dr. Gray testified that Ms. Wall continues to report auditory hallucinations at times, including approximately three weeks before the hearing. Dr. Gray stated that he “pressured her to stop” using marijuana, she said she would, and she did not do so. He is unsure of the reason for the voices and whether Ms. Wall’s cannabis use is a contributor but opined that the stress before her annual hearing may have contributed. He stated that the reports of voices have not affected Ms. Wall’s clinical status, but she has reported them.
• Ms. Wall reports using small amounts of cannabis at a time (provided by her partner for pain control for her knee), but there is a cumulative effect to cannabis use over time.
• Ms. Wall is participating in a group for managing powerful emotions in order to help her to manage her stress more effectively.

14. The prohibition on using cannabis was removed from the most recent Disposition, for the purpose of enabling Ms. Wall to show insight by following clinical direction to refrain from using cannabis. This is in preparation for an eventual absolute discharge.

Evidence at the Hearing

15. Dr. Gray gave evidence on behalf of the hospital. He provided the following timeline of events leading to the ROL:

• The Board’s most recent Disposition was received on December 18, 2024.
• Dr. Gray continued to see Ms. Wall as an outpatient, and on December 23, 2024, noted no change in her mental status. She seemed “well”.
• Dr. Gray was scheduled to see Ms. Wall on a weekly basis because of an “uptick” in voices telling Ms. Wall to harm her partner. The next scheduled appointment was on December 30, 2024.
• On December 24, 2024, Ms. Wall was seen by the outpatient nurse, who noted no change in Ms. Wall’s mental state. The nurse noticed no “red flags”, but recorded that Ms. Wall was planning to go to her partner’s mother’s house for Christmas, although she was not looking forward to this visit.
• On December 26, 2024, Ms. Wall called the inpatient unit of the hospital (B3), reporting more anxiety and “feeling off”. Ms. Wall was encouraged to use her coping strategies, and to go to the hospital or call 911 if things got much worse.
• Later on, that same day, on December 26, 2024, Ms. Wall experienced a stronger and more intense voice urging her to harm her partner. She took a knife and walked into the room, close to where her partner was sleeping. This event was self-reported and not witnessed by her partner.
• Ms. Wall was frightened by her actions and called a support worker. 911 was called (either by Ms. Wall or the worker – Dr. Gray was not clear about this.) Ms. Wall was taken to the general hospital, where it was decided to take her to the Forensic Treatment Unit.
• Ms. Wall was admitted as a voluntary patient on December 27, 2024.
• On December 30, 2024, Dr. Gray spoke with Ms. Wall, who recounted these events to him. At that time, Ms. Wall was feeling better and wanted to go home. Dr. Gray attempted to speak to Ms. Wall’s partner to find out if she would feel safe if Ms. Wall returned home. Dr. Gray was unable to reach her as she was at her mother’s house where there was poor cellphone reception. Ms. Wall told Dr. Gray that she did not want Dr. Gray to call her partner, as she expected that Dr. Gray would tell her partner that Ms. Wall should not use cannabis.
• On December 31, 2024, Ms. Wall was made an involuntary patient under the Mental Health Act. Dr. Gray indicated that he made the decision to detain Ms. Wall in hospital involuntarily for several reasons: the seriousness of the threat to Ms. Wall’s partner’s safety; Ms. Wall’s desire to return home; Dr. Gray’s inability to contact Ms. Wall’s partner to consult with her prior to Ms. Wall’s return home; and Ms. Wall’s expressed desire to continue using cannabis.
• While Ms. Wall was in the hospital, the voice increased in frequency, character and intensity. Ms. Wall began to say that she did not trust her partner.
• Because of this increase in symptoms, Dr. Gray decided to change Ms. Wall’s medications to be more conducive to treating OCD, given the possibility that the voice could be an obsessive thought.
• Dr. Gray reported that the voice is much quieter now and is not telling Ms. Wall to harm her partner. The medication will still be optimized over the course of the next month, but this does not need to be done while Ms. Wall is in hospital.
• Ms. Wall’s Certificate of Involuntary Admission was renewed and will expire on February 12, 2025. Dr. Gray indicated that he did not intend to renew the Certificate on February 12, 2025, and Ms. Wall will remain in hospital as a voluntary patient.
• Ms. Wall’s partner has been speaking with Ms. Wall daily and anticipates no danger if Ms. Wall returns home.

16. Dr. Gray testified that he plans a gradual discharge from hospital for Ms. Wall. She will start with day passes and then weekend passes so that he can be confident that Ms. Wall will not pose any harm to her partner. Her return home will be dependent on Dr. Gray being able to call the partner on a daily basis.

17. Dr. Gray indicated that he needs to hold a patient conference with Leeds and Grenville Mental Health prior to finalizing this plan, because this organization will be sending a worker into the home to ensure that Ms. Wall’s partner is safe.

18. Dr. Gray was asked whether he would recommend a detention order. He responded that he was not recommending a detention order for two reasons. First, Ms. Wall’s risk was manageable under the Mental Health Act. She reached out for help and came to the hospital voluntarily. This is her normal pattern. Second, a person with borderline personality disorder has a tendency to fear abandonment by the team, and a detention order at this point could possibly delay Ms. Wall’s ability to become independent.

19. In Dr. Gray’s opinion, adding a cannabis prohibition to her Disposition “would not accomplish much”. He would not be able to use the Mental Health Act to admit her to hospital voluntarily for cannabis use, and she is forthcoming about her use of cannabis.

20. Dr. Gray stated that he had discussed with both Ms. Wall and her partner about not living together, for the partner’s safety. Neither agreed with this suggestion. A no contact provision in the Disposition would be of no effect.

21. When asked whether Ms. Wall’s decompensation was the result of cannabis use, Dr. Gray stated that he had several theories about what increases the frequency, character and intensity of the voice: the cumulative effect of cannabis use (although she uses only 1-2 puffs per night); the October 2, 2024, setback when Ms. Wall had a knee replacement the hospital did not have clozapine and she was without it for 3 days and had to be titrated up from 25mg daily to 200mg daily; and/or underlying stressors including potentially, OCD type obsessive thoughts.

22. Dr. Gray has a good relationship with Ms. Wall, and to her credit, she is generally forthcoming about her cannabis use and her symptoms.

23. No further evidence was called by the parties.

Analysis and Decision

24. The analytical framework established by Campbell (Re), 2018 ONCA 140 requires the Board to consider the liberty norm and the liberty status of an accused on a restriction. The liberty norm and liberty status for each restriction must be examined to determine the significance of the increase (if any) on the restriction of an accused’s liberty caused by the restriction. In determining the liberty norm of an accused at the outset of each period of restriction, the Board must “take a contextual approach, one that considers the individual’s pattern of liberty in the recent past.” ((Re) Campbell, ibid at para. 66). The liberty she/he was actually experiencing (rather than what she/he was entitled to) at the time of the increase is what the Board is to consider, and that “liberty must be of sufficient duration to have become, objectively speaking, the NCR accused’s norm” ((Re) Campbell, supra at para. 65).

25. Pursuant to the decision of (Re) Campbell, the Board agrees that a restriction of liberty had taken place. Ms. Wall had been living in the community under a conditional discharge and was restricted by involuntary admission in the hospital.

26. The Board finds that the restrictions of liberty imposed on Ms. Wall during the ROL represented the least onerous and least restrictive interventions in the circumstances, and that these continued to the date of the hearing. We find the restriction of Ms. Wall’s liberty throughout this time frame was warranted and necessary for public safety.

27. The threat to the physical safety of Ms. Wall’s partner was serious. Upon speaking to Dr. Gray on December 30, 2024, Ms. Wall wished to return home, and did not initially wish Dr. Gray to call her partner (the potential victim). Ms. Wall’s delusions were directed toward her partner. Ms. Wall deteriorated while she was in the hospital, which required a renewal of her involuntary status.

28. The Board accepted Dr. Gray’s recommendations that no changes be made to Ms. Wall’s Disposition. The provisions of the Mental Health Act are sufficient to manage Ms. Wall’s risk to the public, and there will be no practical mitigation of this risk by imposing a prohibition on the use of cannabis, or a no-contact provision for her partner. The Board also considered that a weapons prohibition (for household items as opposed to firearms) would be impracticable and unenforceable.

29. Dr. Gray has a plan to safely supervise and re-integrate Ms. Wall into living in the community.

30. In reaching our Decision, the Board carefully considered public safety, Ms. Wall’s mental condition, her integration into society, and her other needs.

31. The Board wishes Ms. Wall all the best with her transition back to living in the community.

DATED this 17th day of March, 2025, at the City of Toronto, in the Region of Toronto.

Ms. K. Tomaszewski Legal Member

__________________ Office of the Registrar Ontario Review Board