Re Camilla Shapiro, 2025 CanLII 23529

Re: Camilla Shapiro

ORB File No: 8635

Hearing held on: Tuesday, January 28, 2025

Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto

Pursuant to: Section 672.47(1) of the Criminal Code

Before: Alternate Chairperson: Ms. C. Finley Members: Dr. G.A. Chaimowitz Dr. K. Hand Mr. J. Goldenberg Mr. S. Duffy

Parties Appearing:

Accused: Camilla Shapiro Counsel: Ms. M. Addie

The person in charge of hospital: Counsel: Ms. L. Senko

Attorney General of Ontario: Counsel: Mr. M. Feindel

REASONS FOR DISPOSITION

(Dated March 20, 2025)

Introduction

1. On September 23, 2024, Camilla Shapiro was found not criminally responsible on charges of assault and assault causing bodily harm, contrary to the Criminal Code of Canada. The Court declined to make a disposition and remitted the matter for a hearing before the Ontario Review Board (ORB/the Board). She remained incarcerated until her admission to the Centre for Addiction and Mental Health (CAMH/the hospital) Forensic Assessment and Treatment Unit (FATU) on October 21, 2024. She was transferred to the Women’s Secure Forensic Unit (WSFU) on November 11, 2024, and then to the Women’s General Forensic Unit (WGFU) on November 15, 2024.

2. On January 28, 2025, the Board convened for an initial hearing pursuant to s. 672.81(1) of the Criminal Code to determine whether Ms. Shapiro continues to represent a significant threat to the safety of the public, and if so, the necessary and appropriate disposition. Ms. Shapiro was present and represented by Ms. Addie.

3. At the outset of the proceedings the parties were canvassed as to their initial positions on the issues to be determined by the Board. Ms. Senko, on behalf of the hospital, submitted that Ms. Shapiro continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition is an order detaining Ms. Shapiro on the General Forensic Unit at CAMH with discretionary privileges up to and including the ability to reside in supervised accommodation approved by the hospital. Mr. Feindel, on behalf of the Ministry of the Attorney General, and Ms. Addie agreed with the hospital’s positions. Miss Addie specifically conceded that Ms. Shapiro continues to represent a significant threat to the safety of the public. Thus, a joint submission was presented to the panel.

Findings

4. For the reasons that follow, the panel finds that Ms. Shapiro continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition is a Detention Order with the terms and conditions as recommended by the parties.

The Evidence

5. The evidence at the hearing consisted of the Agreed Statement of Fact for the two index offences (ex. 1), the Hospital Report dated January 6, 2025 (ex. 2), and the viva voce evidence of Dr. Dupré, Ms. Shapiro’s treating psychiatrist.

The Index Offences

6. On March 23, 2024, Ms. Shapiro was in downtown Toronto. She approached the victim who was unknown to her and slapped her across the face. The victim fell to the ground, scraping her knee. Ms. Shapiro was arrested at the scene.

7. On May 7, 2024, Ms. Shapiro was at Trinity Square where she engaged in a verbal altercation with the victim. When the victim threw her coffee in Ms. Shapiro’s face, Ms. Shapiro responded by forcefully shoving the victim to the ground and then pushed the victim’s head into the ground with both hands. A witness separated the two women. The victim sustained an injury to her mouth, some lost teeth and an injury to her fingers on her left hand.

Background Information

8. The Hospital Report provides only limited background information for Ms. Shapiro. Much of the information comes from Ms. Shapiro herself and she has been noted to be an unreliable historian. Basic facts, such as her immigration status in Canada, are yet unknown to the team. While there are available medical records dating back to 2021, these are all comprised, based as they are on Ms. Shapiro’s self-reporting. Additionally, obtaining medical records is complicated by Ms. Shapiro having used a variety of different names. Ms. Shapiro declined to provide consent to allow the hospital to access medical records in the United States.

9. There is no reliable information on Ms. Shapiro’s parents, siblings, or her experiences in childhood. There are no available sources of collateral information. Ms. Shapiro identified as a straight woman though she acknowledged being born with a penis and expressed interest in its surgical removal. According to medical records, Ms. Shapiro has been mostly without a fixed address since 2021, including staying in several shelters and sleeping outdoors.

10. Ms. Shapiro has declined to provide consent for the release of medical records from the United States, where she reported previously receiving psychiatric care. The first known engagement with psychiatric services in Ontario was in October 2021. Ms. Shapiro was brought to the emergency department of the Credit Valley Hospital by police. She reported previously being diagnosed with bipolar disorder, schizophrenia, anxiety, and post-traumatic stress disorder (PTSD), and reported having many prior psychiatric admissions to hospital and eight prior suicide attempts. She was admitted to the psychiatric unit for diagnostic clarification. The discharge diagnosis was borderline personality disorder. No medications were prescribed.

11. A month later, Ms. Shapiro presented at the emergency department of CAMH. She endorsed experiencing significant trauma; however, she would not elaborate further. She reported that she had escaped from a cult in Indiana, USA, where she grew up. She further endorsed that people from the cult were coming to harm her. However, no objective evidence of psychosis was observed throughout her admission.

12. Over the following two years, Ms. Shapiro presented to multiple hospital emergency departments. According to hospital records, she did not appear to be experiencing psychotic symptoms. It was believed that she was seeking admission and she was discharged back to the community.

13. In May 2022, Ms. Shapiro was found unfit to stand trial and was admitted to CAMH pursuant to a Treatment Order. Upon admission, Ms. Shapiro presented as grandiose, hyper-talkative, and disorganized. She exhibited flight of ideas, was distractible, and unable to participate meaningfully in assessment due to her mental condition. She became agitated, verbally aggressive, and threatening to staff and was placed in seclusion. She was treated with the antipsychotic medication olanzapine. This was the first of three similar admissions to CAMH between May 2022 and January 2023.¹

Course Since NCR Finding

14. Since her admission to CAMH, Ms. Shapiro has been generally cooperative and polite with staff. She has participated in recreational programming on the unit. There have been no instances of violence or aggression necessitating locked seclusion.

15. Ms. Shapiro evidences a primary psychotic illness, either schizophrenia or schizoaffective disorder. Although compliant with medication, Ms. Shapiro exhibits ongoing symptoms of psychosis including auditory hallucinations, a disorganized thought process, and grandiose delusions about her wealth, employment, and family situation. She also was noted by staff to be responding to internal stimuli.

16. Ms. Shapiro also evidences symptoms of borderline personality disorder, including affective lability, problems with anger and irritability, recurrent self-harm, suicidality, impulsivity, and possibly identity disturbance. More information is required to confirm this diagnosis.

17. Ms. Shapiro’s insight into the benefits of medication is superficial. She does not believe that there would be any difference in her mental state were she to stop the medication. She does not believe that her failure to comply with medication is related to her risk of violence. She has yet to engage in psychotherapeutic programming.

18. The Hospital Report includes the following composite assessment of risk, at p. 28:

Since Ms. Shapiro's involvement with mental health services in 2021, she has presented numerous times in a psychotic state, following medication non-adherence, exposure to stressors, and unstable housing. Her mental state has resulted in frequent emergency department visits across the city and resulted in criminal charges. When unwell, she experiences hallucinations, delusions (paranoid and grandiose), disorganized thoughts and behaviours, suicidal ideation, impulsivity, aggression, and irritability. During such periods of decompensation, she has been assaultive towards others, including during the above-index offences. Acts of violence and behavioural dyscontrol can be anticipated when she is experiencing active psychotic symptoms of her mental illness, likely in the context of non-compliance with medication use, exposure to stressors, and housing instability. Ms. Shapiro has continued to exhibit psychotic symptoms despite compliance with antipsychotic medication.

19. Dr. Dupré testified before the Board. She reported that Ms. Shapiro has remained adherent to her medication but has been hesitant to agree to a recommended increase in the dosage. Ms. Shapiro typically denies experiencing psychotic symptoms, notwithstanding observations by staff.

20. Dr. Dupré indicated that the plan for the next year is to build the therapeutic alliance between the treatment team and Ms. Shapiro. Further, efforts will be made to obtain collateral information relating to Ms. Shapiro’s background and personal history. Ms. Shapiro will be able to participate in therapeutic programming and, assuming appropriate behaviour, receive progressive privilege passes. Dr. Dupré anticipates a positive trajectory for Ms. Shapiro, including possible discharge to appropriate accommodations that would include medication supervision.

21. All parties maintained the joint submission.

Analysis and Conclusion

22. The panel has carefully considered the Hospital Report and the evidence of Dr. Dupré and unanimously finds that Ms. Shapiro continues to represent a significant threat to the safety of the public. Her risk flows from her diagnosis of either schizophrenia or schizoaffective disorder. Even when adherent to treatment, Ms. Shapiro continues to experience active psychotic symptoms. When not taking medication, Ms. Shapiro has a history of impulsivity and aggression as demonstrated in the two index offences.

23. Having found that Ms. Shapiro continues to represent a significant threat to the safety of the public, the panel must consider the necessary and appropriate disposition taking into consideration the criteria set out in s. 672.54 of the Criminal Code, which includes the need to protect the public from dangerous persons, the mental condition of the accused, the integration of the accused into society and the other needs of the accused.

24. The panel is also in agreement with the joint submission that the necessary and appropriate disposition is a detention order. Ms. Shapiro has just begun receiving treatment and support for her major mental illness. Her medication has yet to be optimized and her diagnosis clarified. In addition, further information relating to Ms. Shapiro’s background will assist the treatment team in supporting her progress and ultimate reintegration into the community.

25. Accordingly, the panel orders that the necessary and appropriate disposition is a detention order on a general forensic unit with privileges up to and including the ability to reside in supervised accommodation. Further the panel orders that Ms. Shapiro abstain from the non-medicinal use of alcohol or drugs or any other intoxicant; submit samples of her urine and/or breath to the person in charge of the facility; refrain from having in her possession any firearm, ammunition, or other offensive weapons; and, when living in the community, report not less than once a week.

DATED this 20th day of March, 2025, at the City of Toronto, in the Toronto Region.

Ms. C. Finley Alternate Chairperson

Office of the Registrar Ontario Review Board

Footnotes

1. 1Ms. Shapiro’s local criminal record listed four mischief charges and two assault charges, withdrawn on October 11, 2023. In April 2024, Ms. Shapiro was arrested after an argument at her shelter, where she got into a verbal dispute with a staff member and allegedly struck and broke a window. She was charged with Mischief Under $5,000 and taken to a local hospital for assessment.