Re: Daniel Ballok
ORB File No: 5278
Hearing held on: Thursday, February 20, 2025
Place of hearing: St. Joseph’s Healthcare Hamilton West 5th Campus, Hamilton
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. L. Maunder Members: Dr. S. Simpson Dr. M. Kalia Mr. R. Bigelow Mr. S. Doherty
Parties Appearing:
Accused: Ms. D. Ballok Counsel for the Accused: Mr. A. Rai Counsel for the Person in charge of Hospital: Mr. S. O’Brien Counsel for the Attorney General of Ontario: Ms. J. McKenzie
REASONS FOR DISPOSITION
(Dated: April 2, 2025)
Introduction
On June 15, 2009, Daniel (Dani) Ballok was found not criminally responsible on Criminal Code charges of assault and fail to comply with probation. At the time of the hearing, Ms. Ballok1 was detained at St. Joseph’s Healthcare Hamilton (SJHH) with privileges up to living in the community in supervised accommodation approved by the person in charge. On February 20, 2025, the Board convened a hearing to conduct an annual review of Ms. Ballok’s disposition.
The Hospital and the Attorney General requested that the Board maintain the detention order on the same terms and conditions as last year. Ms. Ballok asked for a conditional discharge. She was willing to agree to a term that she take her medications and to the inclusion of a Young clause.
For the reasons set out below, the panel agreed that the evidence established Ms. Ballok remains a significant threat, and we concluded that a detention order was the necessary and appropriate disposition.
The Index Offences
In June 2008, Daniel Ballok (who presented as a man at the time, and will be referred to as he in this section of the Reasons only) went to an apartment and asked the female occupant if she would give him some food. She allowed him in but he began to act “strange” and she asked him to leave. She repeated her request. Daniel Ballok became upset. He punched her in the face then grabbed her by the neck and pushed her towards the glass table in front of her. Once she was on the floor, he kicked her on the side. She then managed to leave the apartment and when the police arrived, they found Daniel Ballok hiding in a bedroom.
Daniel Ballok was on probation at the time. Although the Hospital Report doesn’t say, we assume he was in breach of the term to be of good behaviour and keep the peace.
Background / Context
Ms. Ballok is a 46-year-old single transgender woman and father of two adult children. She is diagnosed with schizophrenia, cocaine use disorder, alcohol use disorder, antisocial personality disorder and, at least by history, gender dysphoria.
Ms. Ballok began to have outbursts of anger and oppositional behaviour while still in public school. In high school, she began to use cannabis and other substances. She stole her mother’s car. She was described as impulsive and lacking remorse. Her mother first observed signs of delusions and bizarre behaviour when Ms. Ballok was in her late teens.
Ms. Ballok had a lengthy relationship with a woman that started in her early teens. They had two children together – the first born when she was 16 years old. By the time she was 21 years old they had separated. The children lived with their mother for a time but were then cared for by Ms. Ballok’s parents. Ms. Ballok also lived with a woman for two years when she was in her late twenties. The relationship ended when she was charged with domestic assault.
Ms. Ballok has a criminal record that includes dangerous driving, failing to comply, obstruct peace officer, drug possession and three assaults. The last of these convictions were registered a week before the index offences.
When Ms. Ballok was 25 years old, she had her first psychiatric admission to hospital and within a year was admitted three more times. She was paranoid, experiencing auditory hallucinations and was physically aggressive. She improved with treatment but did not remain compliant with treatment when discharged from hospital.
Ms. Ballok went two and a half years without an admission. She was living with her common law partner at the time. Between the end of the relationship sometime in 2007 and the index offences in 2008, Ms. Ballok stopped taking her long-acting injectable antipsychotic medication, was homeless for a time, and increased her use of cocaine. She had two more psychiatric admissions due to psychosis (both related to cocaine use and withdrawal), as well as two psychiatric admissions for assessments of fitness to stand trial. After her arrest for the index offences, it took several months for her to become fit to stand trial.
Under the jurisdiction of the Board, Ms. Ballok’s mental state was stabilized before she moved into transitional housing in the community in 2010. Between then and 2022, Ms. Ballok lived in the community but had frequent readmissions to hospital, some lengthy, due to decompensation in her mental status. Cocaine use was usually the cause of her decompensation, but she was also, occasionally, not fully compliant with medications. She came close to being evicted from her housing twice.
During a hospitalization in 2022, the team decided that Ms. Ballok was no longer suitable for transitional housing – after twelve years, she had not progressed to more independent housing. Ms. Ballok has stayed in hospital since then, awaiting a bed in high support housing.
Ms. Ballok has continued to use cocaine in hospital and her mental state has worsened in response. In 2023, she failed to return from a pass into the community and was returned to the hospital by police the next morning.
Ms. Ballok typically avoids taking responsibility for her actions – she denies substance use (and other behaviours) and blames others. She frequently alleges that others are responsible for secretly giving her drugs.
Ms. Ballok had a long history of gender dysphoria. She has described “phases” as far back as childhood (dressing as a female at play and being rejected for it). From the beginning of her time under the Board, she was offered services related to transitioning and met with some physicians she was referred to but she demonstrated significant ambivalence about proceeding. Since her return to hospital in 2022, Ms. Ballok has been undergoing hormone therapy.
Ms. Ballok’s father and brother have died while she has been under the jurisdiction of the Board. Her primary support, other than professional forensic services, is her mother. Unfortunately, the relationship has been somewhat complicated by the fact that Ms. Ballok’s mother is also the primary support for Ms. Ballok’s adult children with whom she has a challenging relationship.
The Current Year
Dr. Yuri Alatishe, Ms. Ballok’s attending psychiatrist since 2012, testified and adopted the Hospital Report.
Dr. Alatishe testified that overall Ms. Ballok had a good year – she was medication compliant, she was not aggressive or violent, and when she wasn’t using substances she was pleasant and calm. Her mental state was stable, if fragile.
Ms. Ballok continued along her process of transitioning. She was treated with hormone therapy.
Ms. Ballok used cocaine on at least three occasions during the year – she tested positive in February/March, October, and December. She became irritable, paranoid, and expressed some bizarre thoughts. After initially denying use in February, Ms. Ballok did admit using although attributed it to finding cocaine on hospital property. In October, she blamed new cigarettes she had smoked. She implicated a former patient in trying to sabotage her but later claimed that Dr. Alatishe had forced her to use. She also claimed not to have used cocaine in ten years (despite having admitted use seven months earlier).
Ms. Ballok attended a substance use treatment program most of the year but her insight remains poor. Her substance use is interfering with her progress and she expresses significant frustration with the length of time she has been under the jurisdiction of the Board and the restrictions she is subject to.
Dr. Alatishe expressed cautious optimism that this coming year might see Ms. Ballok have more success with abstinence – he noted that there was a period of seven months (March to October) this year where Ms. Ballok did not use and hoped that she might begin to string together longer periods of abstinence.
Ms. Ballok’s mother remains her primary support. Over the year, Ms. Ballok’s relationship with her daughters seemed to improve for a time. In December, her daughters moved out of her mother’s home – it appears one of them has been charged with assaulting Ms. Ballok’s mother.
Dani Ballok’s Evidence
Ms. Ballok testified. She said that if granted a conditional discharge, she would remain at the hospital voluntarily while she looked for a job, with the goal to be to find an apartment that she could afford.
Ms. Ballok was asked about her use of cocaine during the year. She testified that all three occasions were attributable to her daughter lacing her drink or otherwise surreptitiously giving her cocaine.
Significant Threat
- The panel accepted the evidence from the hospital that Ms. Ballok remains a significant threat to the safety of the public. Although Ms. Ballok has not been violent or physically aggressive in many years, the risk that she would become so without the oversight of the Board is genuine and more than speculative. Substance use is what drives the risk. Given her history, including consistent use of cocaine (even within the structure of the hospital), we were certain that Ms. Ballok would use substances (cocaine and alcohol). Without oversight, her use of substances would progress – she would use greater quantities and more frequently. Rather than irritability and paranoia, seen this year with her periodic use in hospital, Ms. Ballok would decompensate precipitously. She would become more paranoid and psychotic, leading to physical aggression. She would be a real risk of causing someone serious physical harm.
Necessary and Appropriate Disposition
The panel agreed with the hospital and the Attorney General that the necessary and appropriate disposition remained a detention order with the privilege of living in the community in approved accommodation. We were convinced on the evidence that the hospital needs to be able to approve Ms. Ballok’s housing and needs a detention order to bring her back to hospital and keep her until she has stabilized, in the event she decompensates. Dr. Alatishe’s opinion in this regard was amply supported by Ms. Ballok’s history, including the current year. Ms. Ballok’s substance use, cocaine in particular, has a predictable and quick negative impact on her mental state. She continues to relapse despite ongoing treatment and she fails to take responsibility. It was clear to us that Ms. Ballok needs supportive housing so that her mental condition can be monitored, and she can be pulled back to hospital before her mental condition becomes dangerous.
We rejected the notion that a treatment clause and a Young clause, along with the availability of an early hearing should the hospital ask for it, would adequately protect public safety. The treatment clause will not address the primary risk of decompensation – cocaine use. The Young clause would allow an assessment but would not allow the hospital to keep Ms. Ballok in hospital while she was stabilized. She is capable and would likely not meet the criteria under Box A to be made an involuntary patient. She would be unlikely to stay voluntarily either – she has a history of absconding and is quite frustrated with the restrictions the hospital puts on her.
DATED this 2nd day of April 2025, at the City of Toronto, in the Toronto Region.
Leslie Maunder Alternate Chairperson
Office of the Registrar Ontario Review Board