Re: Joanne Woods
ORB File No: 6114
Hearing held on: Thursday, February 6, 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: Ms. C. Finley Members: Dr. S. Lessard Dr. L. Leong Mr. P. Capelle Mr. A. Bouvier
Parties Appearing: Accused: Joanne Woods Counsel: Ms. A. Szigeti
The Person in charge of Hospital: Counsel: Ms. L. Senko
Attorney General of Ontario: Counsel: Mr. C. Coughlan
REASONS FOR DISPOSITION
(Dated April 3, 2025)
Introduction
On May 9, 2012, Joanne Woods was found not criminally responsible on account of mental disorder on charges of utter a threat to cause death or bodily harm and possession of weapon for dangerous purpose, all contrary to the Criminal Code of Canada (the "Criminal Code"). Ms. Woods is currently subject to a Disposition of the Ontario Review Board (the "Board") dated November 15, 2023, detaining her at the Forensic Service of the Centre for Addiction and Mental Health, Toronto (“CAMH”), with privileges up to living in the Greater Toronto Area in accommodation approved by the person in charge.
On February 6, 2025, a panel of the Ontario Review Board (the "ORB" or the "Board") convened a hearing pursuant to s. 672.81(1) of the Criminal Code of Canada. Ms. Woods was in attendance and was represented by her counsel, Ms. Szigeti.
Without Prejudice Position of the Parties
Ms. Senko, as indicated in the Hospital Report, advised that continuation of the current detention disposition was recommended. This was supported by Mr. Coughlan, on behalf of the Crown. Ms. Szigeti noted that an updated Hospital Report had not been provided and that documentation provided to her a half hour prior to the start of today’s hearing did not contain physician’s notes. Nonetheless, having met with Ms. Senko prior to the start of the hearing, she is tentatively prepared to support the hospital position based on the anticipated evidence.
Background and Index Offences
Ms. Woods' background is already covered in the Hospital Report and therefore need not be repeated. Briefly, she is almost 59 years old, no longer works and receives disability payments from her previous employer and the Canada Pension Plan. She is capable to manage her finances. As she is incapable to make her own treatment decisions, these are made by her daughter, Amber Woods-Smith.
Ms. Woods has had some contacts with the criminal justice system and extensive contacts with mental health services before the commission of the index offence. Many incidents that could have led to criminal charges were not processed through the court system, with some being handled through mental health services instead.
Ms. Woods has a very long psychiatric history as detailed in the hospital report. Her symptoms first appeared when she was about seventeen. Her first hospital stay was in 1998. The hospital report states on page 5:
there appear to be at least 25 documented inpatient admissions since 1998, the bulk of which were the result of a mental health apprehension following aggressive and/or bizarre behaviours in the community. The admissions were mostly short, involuntary, with Ms. Woods leaving against medical advice or back to the outpatient care of an Assertive Community Treatment Team. Mental health hospitalizations were generally complicated by the acute use of illicit substances and alcohol.
In 2002, police twice brought her to hospital following "strange and aggressive behavior." In 2004, she was diagnosed with schizoaffective disorder and was admitted under the Mental Health Act (MHA) because she was thinking about committing suicide. Discharge diagnoses included schizophrenia, paranoid subtype with somatic delusions.. Records from Toronto East General Hospital show 12 admissions between June 2005 and October 2007. These were usually brief stays after being brought in under the MHA for assessment. These assessments typically happened because she stopped taking medication, didn't follow her community treatment team's instructions, used substances (especially crack cocaine), or lost her housing.
In 2007, she was twice admitted to CAMH. Her diagnoses were "chronic paranoid schizophrenia and poly-substance abuse, especially crack cocaine." She was again hospitalized in 2008 and 2009.
Following the index offence, but before being found Not Criminally Responsible, she was admitted to the hospital twice. In July 2012, CAMH performed a risk assessment, which led to a recommendation for a Detention Order.
Ms. Woods also has a significant history of substance abuse, as noted on page 5 of the Hospital Report.
Ms. Woods has a longstanding and significant history of polysubstance abuse. Her substance use predominantly involved alcohol and cocaine. The use of alcohol and illicit substance was noted among her hospital discharge summaries to be either a precipitating factor for psychiatric admission or perpetuating factor for mental health deterioration. While she has denied attendance in relapse prevention programming, there is a brief notation in the report of Dr. Woodside regarding a possible contact at “The Donwoods Institute”.
Ms. Woods was abstinent from illicit substances while residing in the community from June of 2016, as corroborated by negative urine drug screens, until June 2018 when she restarted regular use of crack cocaine.”
The circumstances of the index offence are taken from last year’s Reasons for Disposition as follows:
“In December of 2010, the accused boarded a TTC bus. The driver noticed the accused sitting in the middle of the bus, mumbling and it was apparent that the accused was upset. The bus driver heard the accused yell “I’m going to kill someone”.
The driver looked in his rear view mirror and saw the accused looking through her bag. The driver stopped the bus and observed the accused still looking through her bag and heard her say “I have a knife”. The driver opened all doors and all the passengers exited the bus quickly.
The driver was now alone with the accused female. He observed her remove a shiny object with a black handle that appeared to be a knife. The female concealed the knife and ran off the bus. Police were called and the female was located a short distance away still in possession of the knife.”
Current Diagnoses
- Schizoaffective Disorder,
- Cocaine Use Disorder, severe,
- Alcohol Use Disorder, in sustained remission,
- Cluster B Personality Disorder Traits.
Evidence at Hearing
Dr. Meng gave evidence on behalf of the hospital. She noted that at the time of Ms. Woods’ last scheduled hearing in November 2024, there were reservations vis-à-vis the suitability of independent housing options for her. Since that time, Ms. Woods has done well and is currently mentally stable. Since October of 2024 her olanzapine dosage was increased to 30 milligrams daily. Further, there is room to increase the prescribed dosage of Epival as needed.
For the past month Ms. Woods has been trialed in returning to her residence on Lower Ossington Avenue, in the City of Toronto. This has occurred with the support of her daughter as well as the hospital. This return is anticipated in conjunction with the introduction of a long-acting depot antipsychotic medication pursuant to the terms of a detention disposition. On January 23, 2025 a meeting was held which included Dr. Chatterjee, Director of the Forensic Psychiatry Subspecialty Program, where it was again confirmed that the hospital supports Ms. Woods’ return to her previous community apartment. This will be a gradual return home for Ms. Woods as work is required to enable the apartment to be lived in. The team is working with Ms. Woods to assist with and augment her coping skills as well as her abstention from substances. If all goes well, it is projected that discharge will take place in the spring of 2025 with supports in place to address her stress levels in order to augment the likelihood of a successful transition. As at the date of this hearing, Ms. Woods is close to being “discharge ready” in that her level of anxiety associated with a return to the community has greatly diminished. The team is working towards making her comfortable in engaging with the community and not just returning to her apartment.
Dr. Meng emphasized that a detention disposition remains clinically essential because when Ms. Woods destabilizes rapid intervention is required. Historically, it has been difficult to locate Ms. Woods and return her to hospital when she has resumes substance use and elopes.
Dr. Meng opined that if Ms. Woods were to receive an absolute discharge she would discontinue her prescribed medications and threatening behaviours associated with her mental decompensation would rise to a level that constitute a serious risk of harm to members of the public. Dr. Meng advised that the treatment team have known Ms. Woods for a significant period of time although she herself has only known her since July when she became her treating psychiatrist. The entirety of the treatment team as well as Ms. Woods’ daughter are hopeful that she will maintain her stability going forward.
Questioned by Ms. Szigeti, Dr. Meng confirmed that her patient’s community apartment remains available to Ms. Woods’ and that her rent is up-to-date. Auto deposits for future rent payments are being explored but this has proven more complex as Ms. Woods is not in receipt of ODSP. The responsible social worker is addressing this issue. Ms. Woods’ income is derived from her pension income arising from a disability as well as the Canada Pension Plan.
Ms. Woods is not currently receiving a long-acting injectable antipsychotic but this will hopefully be implemented prior to discharge in addition to her oral medications. for added protection to her mental state.. Dr. Meng added that Ms. Woods’ daughter, who also acts as her mother’s Substitute Decision Maker (SDM) is supportive of this treatment plan. Ms. Woods’ physical health has recently declined, she has been started on puffers to address a diagnosis of COPD.
The goal is for Ms. Woods to spend the majority of her time at her apartment before being formally discharged. Ms. Woods’ prior difficulties when residing in that building included the tampering of locks and leaving fire doors ajar. These incidents are attributable to previous substance use. Overall, Ms. Woods’ engagement has improved. She has started to attend more activities on the unit as well as some community programming. The next step in her rehabilitation will involve transitioning her inpatient programming to outpatient programming.
Ms. Amber Woods-Smith was called to give evidence by Ms. Szigeti. She emphasized the importance that the parties and panel read and carefully consider the written statement she provided, entered as Exhibit 2. She testified that the apartment on Lower Ossington represents the longest and most stable housing that her mother has had and that its proximity to the resources of CAMH are essential to her mother’s mental wellness and to enable her community reintegration.
Closing Observations
Ms. Szigeti submitted that based on the evidence heard she is prepared to join in the hospital’s recommendation such that a joint position is in place. Ms. Szigeti noted the progress her client has made under the care of Dr. Meng and psychologist Dr. Cripps. She urged the panel to look at and reference Ms. Amber Woods-Smith’s letter. Ms. Szigeti added that her client has spent an enormous amount of time in hospital which has brought on a fear of returning to the community. While steps have been initiated over the past two years to transition Ms. Woods to housing far from the hospital, these measures were contrary to the wishes of her client. Although Ms. Woods does not agree that she continues to represent a significant threat this issue will not be contested by Ms. Szigeti at this time.
It was noted that Dr. Meng stated that Ms. Woods had done all the hard work to enable her to return to her apartment and that Dr. Cripps was in attendance as an additional show of support for Ms. Woods.
Ms. Senko adopted Dr. Meng’s testimony with regard to the ongoing presence of significant threat. She noted that there is a very clear plan for Ms. Woods to return to her apartment and that the patient is doing very well.
Mr. Coughlan emphasized in his submissions that on the written evidence Ms. Woods does continue to present a significant threat to public safety although her recent stability is to be commended. He noted that when she decompensates Ms. Woods can become aggressive and threatening as seen as recently as 2022.
Analysis and Decision
(a) Significant Threat
Ongoing significant threat to the safety of the public cannot be speculative. It must entail a real risk of serious physical or psychological harm arising from conduct that is both serious and criminal in nature.
In determining whether Ms. Woods continues to represent a significant threat to the safety of the public the Board has carefully analyzed the evidence as it relates to the Supreme Court of Canada decision in Winko, 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625.
The Board unanimously finds that Ms. Woods continues to pose a significant threat to the safety of the public. In arriving at this determination, the Board considered the similar position of the parties and accepted the uncontroverted evidence of Dr. Meng that Ms. Woods continues to pose a significant threat. The Board also relies on the Hospital Report and the most recent Clinical Risk Factors/Re-offence Scenario at page 57 of the Hospital Report, reproduced below for ease of reference:
The following criminogenic risk factors are important in the understanding of Mr. Woods’ current and future risk:
Criminogenic risk factors include: active symptoms of a major mental illness, non-compliance with medication, substance misuse, lack of adequate support system- personal and professional, unexpected stressors in life and coping strategies.
In risk assessment, one of the best predictors is a patient’s history of violence. Ms. Woods’ offence appears to have occurred when she was in a floridly psychotic state. She has a history of very poor compliance.
If Ms. Woods were to re-offend, this will likely transpire in the following way: absent treatment and supports (both professional and personal), increased substance use, psychosocial destabilizers will likely lead to non-compliance with medication, failure to cope, which will result in worsening of her mental state including an emergence of psychotic symptoms, which will then increase her risk of violence.
The Board therefore accepts that absent an ORB Disposition, Ms. Woods would likely become non-compliant with prescribed medications which would lead to decompensation, use of substances and the re-emergence of behaviours similar to those seen at the time of the index offences. We are satisfied that absent an ORB Disposition, it is likely that Ms. Woods will cause serious physical or psychological harm to members of the public and such conduct will likely be criminal in nature.
(b) Disposition
Flowing from the Board’s finding that Ms. Woods continues to pose a significant threat to the safety of the public it must shape a Disposition for the year ahead. Its paramount consideration in doing so must be the safety of the public while also considering Ms. Woods’s needs pursuant to s. 672.54 of the Criminal Code.
The necessary and appropriate disposition for Ms. Woods provides him as much freedom as possible without subjecting the community to a real risk of dangerous behaviour.
In considering Ms. Woods’ needs, the Board was attentive to the messaging from both Dr. Meng as well as Ms. Szigeti regarding the importance transitioning Ms. Woods from inpatient programming to outpatient programming as she prepares to return to her community residence, projected to occur in the Spring of 2025. These efforts are intended to combat the fears and anxiety that Ms. Woods may experience as she prepares to return to the apartment. A return to her apartment on Lower Ossington represents a major step in Ms. Woods societal reintegration.
Ms. Woods’ daughter’s testimony and correspondence emphasized that the aforementioned apartment is the longest and most stable housing her mother has had and that its proximity to the resources of CAMH are essential to her mother’s mental wellness. The requisite steps to augment the likelihood of a successful transition by the Spring of 2025 are ongoing and include gradually augmenting the amount of time she spends at apartment prior to a formal community discharge.
Ms. Woods’ has been hospitalized since her readmission to CAMH on December 23rd 2022. The panel foresees that the predictability of ongoing treatment compliance represents a key component in Ms. Woods’ successful reintegration and rehabilitation. The envisioned addition of a long acting antipsychotic prior to discharge will provide greater assurance of mental stability.
Ms. Amber Woods-Smith, the patient’s daughter and SDM is supportive of this treatment plan. Although she resides in the Caribbean, Ms. Amber Woods-Smith will be looked to for support in ensuring her mother’s long term acceptance of an intramuscular antipsychotic continues. This panel of the Board is optimistic that the treatment team, Ms. Amber Woods-Smith and Ms. Woods will work together collaboratively. We are hopeful that Ms. Woods will experience a successful discharge to the community and recognize the work done by the hospital in establishing the necessary framework to achieve this mutual objective.
Conclusion
Therefore, the Board unanimously determines that the necessary and appropriate Disposition required to manage the threat Ms. Woods poses to the safety of the public while still meeting her needs remains a Detention Disposition.
In making this Disposition, the Board carefully considered the positions and submissions of the parties and the evidence of Dr. Meng and is satisfied that this determination is both necessary and appropriate. The Board reviewed the provisions of s. 672.54 of the Criminal Code and carefully considered the need to protect the public from dangerous persons, Ms. Woods’s mental condition, her reintegration into society and other needs.
DATED this 3rd day of April, 2025, at the City of Toronto, in the Toronto Region.
Mr. P. Capelle Legal Member
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Office of the Registrar Ontario Review Board