Re Edward St. Louis, 2025 CanLII 31425

Ontario Review Board

Re: Edward St. Louis

ORB File No: 6447

Hearing held on: Tuesday February 11, 2025

Place of Hearing: Royal Ottawa Mental Health Centre

Pursuant to: Section 672.81(1) of the Criminal Code

Before:

Alternate Chairperson: Mr. P. Capelle

Members: Dr. G. Glancy

Dr. G. Boulais

Mr. P. Hageraats

Mr. A. Bernardo

Parties Appearing:

Accused: Edward St. Louis

Counsel: Ms. M. Munsterman

Person in charge of hospital: Representative: Dr. M. Strike

Attorney-General of Ontario: Counsel: Ms. M. Dufort

REASONS FOR DISPOSITION

(Dated April 9, 2025)

Introduction

1. On December 3, 2013, Mr. Edward St. Louis appeared in Court on a charge of attempt to commit murder, contrary to the Criminal Code of Canada.

2. The Court was presented with psychiatric evidence establishing that Mr. St. Louis was suffering from a severe mental disorder when he committed the offence. Based on that evidence, the Court found that Mr. St. Louis was not criminally responsible on account of mental disorder (NCR).

3. Mr. St. Louis is currently subject to a disposition of the Ontario Review Board (ORB or “the Board”) dated February 23, 2024, by which he was discharged on conditions. Mr. St. Louis was required to reside at the Mon Chez Nous group home residence in Casselman, Ontario. He was also ordered to have no contact with the victim of the index offence, his mother, unless with her written revokable consent. The remaining conditions included a prohibition from consuming alcohol or drugs.

4. On February 11, 2025, the Board convened at the Royal Ottawa Mental Health Centre (ROMHC or “the hospital”) to conduct an annual review. Mr. St. Louis attended and was represented by counsel, Ms. M. Munsterman. Also present was the hospital social worker, Mr. Richard Robins. Mr. Robins has been working with Mr. St. Louis for several years.

5. The Board received direct testimony from the attending psychiatrist, Dr. Melanie Strike, along with documentary evidence, the hospital report dated January 27, 2025.

6. The issues to be considered by the Board are whether Mr. St. Louis presents a significant risk to the safety of the public, and if so, to determine the necessary and appropriate disposition.

Positions of the Parties

7. The Board was presented with a joint submission by all three parties, namely that Mr. St. Louis continues to present a significant threat to safety of the public. The parties further agreed that to manage the level of threat, Mr. St. Louis should continue to be discharged, under much the same terms and conditions as before.

8. For the reasons set out below, the Board adopted the joint submission, subject to a few minor changes, arrived at with the consent of the parties.

Current Psychiatric Diagnoses

• Schizophrenia, Multiple Episodes, currently in full remission

• Cannabis and Alcohol Use Disorder, in sustained remission

• Border Intellectual Functioning

9. Mr. St. Louis is treated with psychiatric medications, including the following:

• Clozapine 50 mg in the morning and 237.5 mg at bedtime (antipsychotic)

• Epival 500 mg orally twice daily (mood stabilizer)

• Paliperidone Trinza 350 mg intramuscular every 10 weeks (antipsychotic)

• Quetiapine 50 mg daily as needed for anxiety

• Lorazepam 2 mg daily as needed for anxiety

• Clonidine 0.05 mg at bedtime (for drooling)

• Atropine 1-2 drops under the tongue at bedtime (for drooling)

Index Offence

10. The circumstances are described in the hospital report and in last year’s Reasons for Disposition, dated March 28, 2024. In summary:

On September 13, 2013, Mr. St. Louis’ mother, Dorothy Maw, provided an audiotaped statement to police investigators at approximately 12:00. She mentioned that she lived with her son, Edward St. Louis.

She got up that morning at around 7:00 a.m. and he was standing in the kitchen. She asked him if he wanted coffee. For some reason, she felt nervous. She offered him a cup of coffee and he accepted. There was not much conversation between them, according to her.

She was still in the kitchen and was putting dishes in the dishwasher when he suddenly came at her with a knife that he’d got from the kitchen drawer. He pushed her to the other side of table then to the floor. He then stabbed her in the neck. He said, “I’m going to kill you right now,” a few times.

She pleaded with him not to kill her. He was holding her down with one hand around the neck area and was stabbing her with the knife in his other hand. He was kneeling down and straddling over the top of her while doing this. He was motioning around with the knife around her neck. She was holding onto the knife as she was trying to keep it away from her neck to protect herself from him and pleading with him. Ms. Mau reported that Mr. St. Louis had so much anger and he was so violent that he was capable of killing her.

Personal History

11. Mr. St. Louis is now 49. He was born and raised in Pembroke, Ontario. In 1991, when he was 5, his father died in a drowning accident. Mr. St. Louis did not complete Grade 8. The school had placed him in a special education stream. In 1992, at age 16, he was moved to an Ottawa Group Home after an earlier assault against his mother.

12. Mr. St. Louis and his mother are close. They speak daily by phone. Mr. St. Louis visits Ms. Maw in Pembroke at least twice a year. She is in her sixties, or even older. A few years ago, she moved from her home to a retirement residence. The social worker, Mr. Robins, plays a key role in organizing and facilitating visits. Mr. Robins drives Mr. St. Louis from Casselman to Pembroke. Mr. St. Louis is dropped off at his mother’s to spend a large portion of the day with her. This leaves Mr. Robins free to see other Pembroke clients elsewhere in town. Later, in the same day, Mr. Robins collects Mr. St. Louis for the drive back to Casselman. This arrangement has worked well for all concerned over the last years.

Criminal History

13. Mr. St. Louis has no previous criminal record.

Psychiatric History

14. In 1982, when he was 6, Mr. St. Louis was admitted to child psychiatry at the ROMHC. He had acted out at school and in the home. A neuropsychological assessment revealed he had cognitive issues, either because of mild retardation or borderline intellectual functioning. Previous medical records indicate that his mother was also affected by an intellectual developmental delay.

15. For the last two years, Mr. St. Louis has not needed to be involuntarily admitted to hospital. On March 21, 2024, he reached out on his own, seeking psychiatric help. Mr. St. Louis had been non-adherent to some of his medications. It was on his insistence that he was admitted to the Queensway-Carleton Hospital. Once there, he made a rapid recovery after Clozapine oral medication was carefully restarted. When he returned to the group home on April 2, 2024, the staff were given clearer instructions about the need to properly supervise medication adherence.

16. Mr. St. Louis has long wanted to relocate to Pembroke, to a different group home. This would permit him to be closer to his mother and to visit more frequently. The ROMHC treatment team has applied on his behalf to the Pembroke Assertive Community Treatment Team (ACT Team) and to their 24-hour supportive residence in Pembroke.

17. Mr. St. Louis has regular case management visits from Mr. Robins at the Casselman group home. Mr. Robins provides active help for Mr. St. Louis’ attendance at his required hospital appointments. Mr. Robins is Mr. St. Louis’ primary support in the community, offering him supportive counselling and ongoing psychoeducation. Mr. Robins continues to describe their interactions as very polite and friendly.

18. The attending psychiatrist, Dr. Strike, confirms that Mr. St. Louis remains free of alcohol and other substances, including cannabis. Mr. St. Louis has maintained complete abstinence since he first came under the ORB in 2013. Mr. St. Louis is highly motivated to avoid peers who use substances.

19. Dr. Strike reports that Mr. St. Louis continues to struggle with anxiety and fatigue. He attributes this to his oral medication, Clozapine. For the last few years, they have worked on reducing the dosage. A year ago, it was down to 105mg daily. A more recent adjustment saw the medication administered twice daily, once in the morning, at a lower level, and later, at bedtime, with a higher dose.

20. At the last annual review held in February 2024, Mr. St. Louis was quite upset about his living situation. He wanted permission to live on his own in Pembroke. After Dr. Strike and Mr. Robins provided supportive therapy, his affect returned to a more normal state. Mr. St. Louis was not experiencing hallucinations and could demonstrate logical thinking.

Current Violence Risk Assessment

21. Dr. Strike made recent use of the HCR-20-v3 structured clinical judgement tool. Having regard to the numerated factors, including the historical, clinical, and dynamic risk items, Dr. Strike concluded that Mr. St. Louis’ condition continues to present a significant risk to the safety of the public.

22. That said, she and Mr. Robins are of the opinion that should Mr. St. Louis’ mental state decline, voluntary admissions and tools available under the Mental Health Act are adequate to bring Mr. St. Louis to the hospital quickly and to keep him there for a sufficient length of time. The treatment team was able to do so in March and April 2024, just as they were able to do earlier, in the Spring-Summer of 2022. On each of these occasions, there was no difficulty bringing Mr. St. Louis into care as an inpatient.

Evidence at the Hearing

23. Dr. Melanie Strike, Forensic Psychiatrist with the ROMHC, is the author of the hospital report filed in evidence. She provided further explanations to the parties and responded to questions.

24. Counsel inquired about the patient’s long-term sobriety following the NCR finding and whether Mr. St. Louis is internally motivated to abstain. Dr. Strike explained, it is hard to say whether Mr. St. Louis’ sobriety is motivated internally or by the Board’s formal requirement. Dr. Strike added that Mr. St. Louis has clearly declared how “he’s done with that lifestyle”. Moreover, Mr. St. Louis always cooperates when he is asked to voluntarily provide samples for random urine drug screens. At no time has he shown any hesitation or resistance to doing so. This is even after the Board earlier saw fit to drop the formal requirement that he submit samples.

25. Mr. St. Louis’ psychiatric condition is treated with oral Clozapine. This requires taking blood samples to monitor the level of medication in his system. On occasion, Mr. St. Louis will vent to the team about having to undergo such testing. However, Mr. St. Louis consistently goes along with the monthly procedure.

26. Dr. Strike was asked whether the same blood samples obtained for Clozapine monitoring could also be analyzed to screen for alcohol and THC (cannabis). She confirmed it is possible to do so.

27. Counsel asked about Mr. St. Louis’ application to live in Pembroke under supervision of the local ACT Team. The application has been submitted to Pembroke Carefor and to the ACT Team. In the hope that Mr. St. Louis is accepted, the ROMHC forensic team will stay involved in a shared care model with both Pembroke agencies. Mr. Robins would continue his involvement, visiting Mr. St. Louis in Pembroke, while liaising with the involved mental agencies there.

28. Dr. Strike advised that the timelines for transfer to Pembroke are not short. The waitlist could possibly be as long as two years. If a bed becomes available earlier, they will schedule an early ORB hearing to seek a change to the residence condition set out in the disposition.

29. Returning to the subject of substance use, Dr. Strike explained that Mr. St. Louis shows good insight into the negative effects substances will have on his mental health. She believes that a formal substance prohibition is no longer needed. While such a disposition term may be appropriate, it is, in her view, no longer necessary. The requirement to abstain causes Mr. St. Louis no difficulty at all.

30. Dr. Strike advised that when Mr. St. Louis visits his mother in Pembroke, things go well. In 2024, they had four visits in all. Ms. Maw has never expressed any concerns about her son’s conduct, nor has the staff at her supervised retirement residence. In every respect, it appears that their interaction is positive and helpful.

31. Dr. Strike noted, Mr. St. Louis has been showing interest in reconnecting with other family members in the Pembroke area. The treatment team has no concerns at all about the possibility that Mr. St. Louis might try to contact previous negative peer associates in his hometown.

32. Apart from the one concern arising in the Spring of 2024 - when Mr. St. Louis was found to be checking his oral medication - group home staff members at Mon Chez Nous have not reported any management concerns. Dr. Strike confirmed, the staff have now been properly educated about the need to carefully monitor Mr. St. Louis’ administration of oral medications. Dr. Strike added, Mr. St. Louis has some insight into his need for medication and how his mental stability can be adversely affected when he does not take it appropriately.

33. The parties presented no further evidence.

Submissions of the Parties

34. All three parties reaffirmed their joint submission, recommending that Mr. St. Louis be subject to a conditional discharge, much as before. Dr. Strike commended Mr. St. Louis for another excellent year and for his many years of continuous abstinence, together with his extended collaboration with the treatment team.

35. Dr. Strike further acknowledged Mr. St. Louis’ frustration at having to live far from his mother and family.

36. In final comments to the Board, Dr. Strike recommended that condition 1(c) of the disposition be removed (the requirement to abstain from alcohol or drugs). In its place, she suggested a condition requiring the patient to submit random samples of urine or breath, to determine whether any alcohol or drug use might resume.

37. On behalf of the Attorney-General, Ms. Dufort agreed with the hospital’s recommendations. Counsel acknowledged that Mr. St. Louis is frustrated at times by having to remain in Casselman. However, he has never taken any active steps to leave his assigned group home.

38. Ms. Dufort asked the Board to consider term 1(e) - which limits contact with his mother, the victim of the index offence. At this point, it is no more than a “relic condition”. In Ms. Dufort’s submission, while the condition can be considered appropriate, it would assist Mr. St. Louis’ further transition into the community to have it removed. Counsel recognized that Mr. St. Louis and his mother have achieved a positive relationship, both with each other and with the treatment team.

39. Speaking for her client, Ms. Munsterman observed that, at a practical level, Mr. St. Louis is “not capable” of moving himself to Pembroke from Casselman. Without the treatment team’s help, he is not sufficiently organized. Counsel advised that Mr. St. Louis is quite motivated to continue working with the hospital and the other agencies on his plan to relocate.

Conclusions and Disposition

40. Based on the evidence, and supported by the appropriate joint submission, the Board agrees that Mr. Edward St. Louis’ condition does come within the ambit of significant risk to the public. This is due to the serious nature of the index offence, the history of past aggression and instability, the clinical diagnosis and the most recent overall risk assessment.

41. Mr. St. Louis still needs ongoing psychiatric care and community-based supervision. To his credit, he has done well, notwithstanding the difficulties and frustrations which he experiences. It is to his further credit that he has stayed the course and remained open in spirit to the involvement and assistance being offered, both by Mr. Robins and by Dr. Strike.

42. The Board agrees with the recommendations of counsel and the hospital that a conditional discharge is the necessary and appropriate disposition, representing the least onerous and least restrictive measure. For reasons well explained by Dr. Strike, Mr. St. Louis no longer needs to be governed by a strict term of “forced abstinence”. The hospital can promote his reintegration, while keeping an eye on things, by having Mr. St. Louis provide random samples, testing for any future potential alcohol or drug consumption.

43. Similarly, given the positive healthier mother-son relationship which has been seen for many years, the Board does not consider it necessary to formally limit their contact. Condition 1(e) is therefore removed. We are also satisfied that adequate measures of safety have been established, having regard to the involvement of Mr. Robins and to the fact that Ms. Maw resides in a supervised residence.

44. For these reasons, and considering the primary factor, the safety of the public, while balancing Mr. St. Louis’ mental condition, his reintegration and other needs, Mr. St. Louis is discharged, subject to conditions. Terms and conditions are set out in the accompanying disposition.

45. We thank Dr. Strike and Mr. Robins for their assistance. We also appreciate the helpful approach taken by both counsel. We wish Mr. St. Louis well for the next twelve months.

DATED this 9^th^ day of April 2025, at the City of Toronto, in the Toronto Region.

Mr. P. Hageraats

Legal Member

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Office of the Registrar

Ontario Review Board