Ontario Review Board
Re: Rebecca L. Dieter (a.k.a. Rebecca M. Daly)
ORB File No: 7869
Hearing held on: Wednesday, March 5, 2025
Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Mr. J. Weinstein Members: Dr. R.D. Chandrasena Dr. B. Sheppard Ms. K. Tomaszewski Ms. C. Plyley
Parties Appearing: Accused: Ms. Rebecca L. Dieter (a.k.a. Rebecca M. Daly) Counsel: Mr. S.F. Gehl
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. D. Rows
REASONS FOR DISPOSITION
(Dated April 14, 2025)
Introduction
[1]. On April 1, 2021, Rebecca Dieter, whose preferred name (which shall be used in the remainder of these Reasons)) is "Rebecca Daly", was found not criminally responsible on account of mental disorder ("NCR") on a charge of second-degree murder, contrary to the Criminal Code of Canada (the "Criminal Code").
[2]. Ms. Daly is currently subject to a disposition of the Ontario Review Board (the "Board") dated May 24, 2024, detaining her at the Southwest Centre for Forensic Mental Health Care, St. Joseph's Health Care London (hereinafter referred to as the "Hospital"). The Disposition included privileges up to and including passes for up to 72 hours in Southwestern and Southern Ontario with an approved person or indirectly supervised, passes for up to one week for up to eight times per year in Southwestern and Southern Ontario with an approved person with an itinerary approved by the person in charge, and the ability to live in Southwestern Ontario in accommodation approved by the person in charge. The Disposition did not include an 'abstain' clause.
[3]. On March 5, 2025, a panel of the Ontario Review Board convened to review Ms. Daly's current disposition pursuant to s. 672.81(1) of the Criminal Code. Ms. Daly was present for her hearing and was represented by counsel throughout the proceedings. A hospital report dated January 16, 2025, was entered as Exhibit 1 (the "Hospital Report").
[4]. Ms. Daly's mother attended the hearing in support of Ms. Daly.
[5]. The issues to be determined are whether Ms. Daly continues to represent a significant threat to the safety of the public, and if so, the necessary and appropriate disposition to manage that risk having regard to the criteria set out in s. 672.54 of the Criminal Code.
[6]. For the reasons set out below and based on the evidence and opinions before us, the Board concludes that Ms. Daly continues to represent a significant threat to the safety of the public. The Board finds that a Conditional Discharge is the necessary and appropriate Order on the terms set out in our formal Disposition having regard to the safety of the public, which is the paramount concern, and also having regard to Ms. Daly's mental health and other needs.
Current Psychiatric Diagnoses
[7]. Ms. Daly's current diagnoses are schizoaffective disorder, bipolar type; and cannabis use disorder in sustained remission.
Index Offence
[8]. The circumstances of the index offence have been set out in detail in the Hospital Report. The following is a concise and accurate summary excerpted from last year's Board Reasons for Disposition:
On August 9, 2020, during a major psychotic incident, Ms. Daly stabbed her infant son multiple times causing his death. Ms. Daly has a history of struggles with mental health (since at least February 2012) with multiple hospitalizations. At the time of her arrest, she was highly psychotic, experiencing command auditory hallucinations commanding her to sacrifice her child.
Background Information
[9]. The Hospital Report contains detailed information regarding Ms. Daly's history, background and psychiatric history, the entirety of which need not be repeated here in detail. The following background information is excerpted from last year's Board Reasons for Disposition:
In her late teen years, Ms. Dieter's psychiatric difficulties became more overt. She recalled 3 psychiatric hospitalizations for psychosis, episodes which generally occurred in the context of substance use and/or medication nonadherence.
Ms. Dieter was admitted to Grand River Hospital on February 22, 2012 (at age 18). She went to hospital on the advice of her pastor, and was placed on a Form 1 in the emergency department (ED).
Ms. Dieter was again admitted to Grand River Hospital on September 21, 2014 (at age 20). She was brought to the ED by police, accompanied by her grandmother. She was discharged on October 30, 2014, with the diagnosis of Bipolar Disorder with psychosis.
Ms. Dieter was admitted to the North York General Hospital Psychiatry service between January 11 and 15, 2018 as a voluntary patient (she was 23). She was brought to the ED by a boyfriend and a roommate. She was psychotic, with grandiose, persecutory, and religious ideas ... she had been consuming excessive quantities of cannabis. ... She declined to stay in hospital any longer despite advice. ... Her discharge diagnosis was rule out marijuana-induced psychotic disorder, rule out Bipolar Disorder, and rule out Schizophrenia.
Cannabis use induced or exacerbated her mental health difficulties during previous hospital contacts. Notably, however, there was no evidence of cannabis use proximal to the material time. Her urine drug screen in hospital on August 9, 2020, was negative for substances of abuse.
Ms. Dieter occasionally followed up with outpatient psychiatric services after hospital admissions. She generally fell away from treatment as she felt better. For the 2 or so years prior to her pregnancy, Ms. Dieter did not have any outpatient psychiatric care (she had been getting her antipsychotic prescription from her father's family physician).
She ultimately stopped taking medications (she believed on the advice of a pharmacist) shortly after learning she was pregnant.
Ms. Dieter did not have a criminal record.
Position of the Parties
[10]. At the commencement of the hearing, counsel for the Hospital submitted that Ms. Daly continues to represent a significant threat to the safety of the public and that she should be subject to a conditional discharge as recommended in the Hospital Report, and with the addition of a requirement to submit samples for drug and alcohol testing. The Hospital took the position that it was not necessary to include an 'abstain' clause (particularly with respect to alcohol) or include any travel restrictions.
[11]. Counsel for the Attorney-General adopted the Hospital's position but proposed adding a prohibition on driving after any consumption of alcohol.
[12]. Counsel for Ms. Daly agreed with the Hospital's position and indicated that if the Hospital requested an abstain clause Ms. Daly would not oppose it. Counsel reserved his position with respect to a prohibition on driving after any consumption of alcohol.
Course Since Last Disposition
[13]. The following excerpts from the Hospital Report summarize Ms. Daly's course since the last Disposition. On the whole, Ms. Daly had a very positive year:
Ms. Daly has developed insight into the index offence inclusive of contributory factors. From this she maintains being steadfast in her abstinence except from alcohol & remains committed to her long-acting injectable medication.
Ms. Daly continues to demonstrate good insight into her illness. She can identify her diagnoses, and early signs of relapse. She demonstrates meta-cognition with her ongoing discernment of her thoughts & contacting clinical staff as required for further debriefing.
Ms. Daly appears to have developed insight into treatment. She maintains commitment to medication and will seek treatment teams' assistance if system level issues present in obtaining medication (i.e. difficulty billing.) She remains curious regarding the lowest effective dose of medication she requires to maintain her wellness. She agrees with decreasing medication being slow and cautious. Due to her residing with her mom and stepdad, Ms. Daly agrees herself being cautious and in frequent contact with the treatment team, it is believed any lapses in mental health can be identified quickly.
Ms. Daly does not believe there is a scenario where she is a risk of violence to others. If she needed to identify a risk-enhancing element, it would be if she were to use cannabis again.
Over the course of the reporting period, Ms. Daly continued to voice residual delusion beliefs that all her problems were rooted in moving her hands in negative ways, such as "scratching."
Throughout the reporting period, Ms. Daly continued to present with some worries and anxiety which contribute to a temporary decrease in her mood. Examples of these worries included sudden feelings of concern of what others think about her, analyzing her thoughts, and a concern about what was being charted as she believes there have been mistruths previously stated in her annual hospital report to the Ontario Review Board. She also stated that at times, she experienced a lower mood and difficulty experiencing joy.
Throughout the reporting period, Ms. Daly voiced placing unnecessary pressure on herself to find structure and daily activities to engage in... The Outreach team believes that this example lends itself more to anxiety than to paranoia, as Ms. Daly continued to express fear of mental health decompensation which correlated to her analyzing her thoughts.
Ms. Daly reported that sources of stress over the year included her ongoing romantic relationship, uncertainty of employment, her finances, medication (perceiving that she was on a high number of pills & fatigued) and wanting to live differently (more exercise, healthier eating). She continued to utilize adaptive coping strategies such as journaling, talking to peers or family, and reaching out to her Outreach team through email, text message or telephone.
Ms. Daly's employment at Mission Thrift store continued to be stable throughout the year. Her employer became aware of her index offence and struggles with mental illness, and despite this, has been a good support. He spoke highly of Ms. Daly's performance at work, and work ethic and reported that he advised Ms. Daly to come to him and or take the time she needs if she feels distressed and triggered by anything that happens at work. She works approximately 16 hours per week, over three days, divided between different departments, cash register, pricing, and sorting. When not at work, she reported that she enjoyed activities such as journaling, walking, exercising, soccer, utilizing a music app for music creation, spending time at the library, shopping, and spending time with family.
Ms. Daly's mother... reported to the Outreach team that Ms. Daly remained vulnerable, suggestable, and presented with impulsive behaviour. Ms. Daly also identified difficulty setting and maintaining boundaries with peers. She continued to struggle with articulating a clear sense of self and remained highly impacted by the opinions of peers. She continued to have ongoing deliberation related to if she was living or behaving consistent with God's biblical direction, resulting in her decisions and opinions often changing rapidly.
With education on the potential risk for relapse of her Bipolar symptoms, it was agreed to begin titrating her Olanzapine down by 5 mg (from 20mg to 15mg) and was reassessed every eight weeks. Ms. Daly is knowledgeable about the medication that she is prescribed and will directly reach out to the outreach team with any functional issues securing her medication. A further reduction took place on November 20, 2024, from 15mg to 10mg.
Ms. Daly remained steadfast that she will not use cannabis as she cannot risk the impact this could have on her mental health. She reported drinking alcohol regularly, at times to intoxication (up to 8 drinks.) When asked, she stated that she was not concerned about the potential for alcohol to become an addiction. Her mother... also expressed agreement that Ms. Daly's alcohol consumption remained within reasonable limits. [Her mother]has cautioned Ms. Daly and the treatment team that Ms. Daly has had alcohol addiction in the past.
[14]. Ms. Daly's self-report about her alcohol use is set out at page 113 of the Hospital Report. Of concern to the Board are entries dated July 14, 2024: "two to three beers, and two to three rums, out with friends at a bar, then drove home"; and "September 26, 2024: denied her drinking to be problematic and mom agreed, however mom noted that her drinking had the potential to be problematic. she stated that when drinking she tends to drink more than she had planned to".
[15]. Ms. Daly ended a romantic relationship in January 2025.
Evidence at the Hearing
[16]. The Board had available to it the evidence and documents forming the Record, the Exhibit, and oral evidence from Dr. Ajay Prakash, Ms. Daly's attending psychiatrist.
[17]. Dr. Prakash testified that Ms. Daly has never been diagnosed with alcohol use disorder, despite the comment included in the Hospital Report and attributed to Ms. Daly's mother. It is clear from previous Hospital Reports that after the high school years Ms. Daly's use of alcohol appears to have moderated. She drinks on average two drinks per week. She stopped drinking when she learned she was pregnant. She denies experiencing alcohol withdrawal or blackouts. Her substance use is not related to the index offence, which occurred when she was untreated. Historically, cannabis use has contributed to psychosis, but there is no relationship between alcohol use, psychosis and bipolar disorder.
[18]. The abstain clause was removed from Ms. Daly's Disposition in 2024 to assess her ability to remain abstinent, particularly from cannabis. Ms. Daly's symptoms did not worsen as a result of alcohol use over the reporting period, and her mother says she has minimal concerns about her alcohol use this year. The details about her use of alcohol were included in the Hospital Report because it was 'worth noting'.
[19]. The Hospital is not recommending that Ms. Daly be required to abstain from alcohol because at this time the treatment team has no concern that alcohol use will increase the risk of violence. Ms. Daly has no prior criminal record. The index offence occurred in specific circumstances when Ms. Daly was untreated. She is now treated with a long-acting injection. Her medications have been optimized as of this point in time, and she is compliant with her treatment.
[20]. In Dr. Prakash's opinion, including an abstain clause could have a negative impact on Ms. Daly's ability to move to an absolute discharge in the upcoming year(s), with the risk that the Board would require a recent period of time without an abstain clause prior to an absolute discharge.
[21]. Dr. Prakash did not think it is necessary to include a 'consent to treatment' clause in the Disposition because Ms. Daly is compliant with treatment. Although there is some pre-forensic history of non-adherence, that is not currently an issue.
[22]. Ms. Daly reaches out frequently to the treatment team and relies strongly on the team for support to deal with day-to-day stressors. The treatment team 'debriefs' Ms. Daly on a weekly basis, which provides a high level of supervision.
[23]. Ms. Daly's personality structure makes her highly vulnerable to peer influences and suggestions. Historically, substance use has been connected to the influence of her romantic partners. She does not currently have a romantic partner.
[24]. Ms. Daly has recently connected with FACTT (Flexible Assertive Community Treatment Team). She completed her intake interview on February 20, 2025, and has been accepted by them. Of note, one of the primary care workers on the FACTT is an addictions specialist.
[25]. Ms. Daly is at the top of the list for Thresholds Homes and Supports housing, however Dr. Prakash did not know whether Ms. Daly will want to move away from home or will decide to stay with her mother and stepfather.
[26]. Dr. Prakash did not see the need for any addictions programming at this time but felt certain that Ms. Daly would be likely to agree to any recommendations of the treatment team. Because of her personality structure, Dr. Prakash expressed concern that spending time at a residential program with others with more severe addictions could be risk-enhancing for Ms. Daly.
[27]. Because the treatment team visits Ms. Daly weekly and she contacts the team frequently, the Hospital recommends reducing reporting requirements to a minimum of two times per month.
[28]. Dr. Prakash testified that Ms. Daly's risk to the public because of alcohol use is no greater than the risk posed by any other member of the public. Ms. Daly does not intend to drink and drive. That incident was a "one off".
[29]. No additional evidence was called.
Closing Submissions
[30]. Counsel for the Hospital maintained their initial position and submitted that the Hospital had no objections to a driving prohibition, but if one was included, an abstain clause was not necessary. Counsel for the Attorney-General adopted the Hospital's position and left the question of a driving restriction to the Board. Counsel for Ms. Daly maintained his initial position, and took the position that Ms. Daly opposed a driving restriction.
Analysis and Conclusion
[31]. In Winko the Supreme Court outlined that, in coming to the conclusion on the issue of significant risk, a Review Board should closely examine a range of evidence, including: the circumstances of the original offence; the past and expected course of the accused's treatment; the present state of the NCR accused's medical condition; the NCR accused's own plans for the future; the support existing for the NCR accused in the community; and most importantly, the recommendations provided by experts who examined the NCR accused. In coming to our conclusion in this matter, the Board relies on the expert evidence of Dr. Prakash in addition to the documentary evidence before us.
[32]. The Board notes that the index offence was very serious, and relies on the evidence excerpted from the clinical assessment of risk, and reoffence scenario, contained in the Hospital Report:
Ms. Daly has a major mental illness, a schizoaffective disorder. Although her symptoms have been well managed, she continued to present residual symptoms, specifically religious preoccupations and increased anxiety.
Absent the current level of support that Ms. Daly receives from the Outreach team it is unknown how she would manage the stressors of daily life independently. She has continued to voice the idea of living on her own with less supports. As a result, she may come across negative peer influences that would potentially influence her impulsiveness, leading to increased [risk of] substance [use]. She did not utilize her personal supports to their full extent; who are currently providing oversight. While she cooperated with the Outreach team and does not think they are necessary; she valued the support she receives... but lacks insight into the intensity they provide.
[33]. The Board accepts the joint submission of the parties and finds that Ms. Daly continues to pose a significant risk to the safety of the public.
[34]. The parties presented a joint submission that the necessary and appropriate disposition is a conditional discharge. The Board accepts this joint submission of the parties.
[35]. Ms. Daly is open and honest with the treatment team, respects authority and is motivated to please the authority figures in her life, including the treatment team. She followed the prohibition on alcohol use as found in her previous dispositions.
[36]. Her insight across all spheres has improved over the past year. She is compliant with medications and has tolerated medication adjustments well with no destabilization. She is treated with long-acting injections, which decrease the likelihood of non-adherence. She dealt with a romantic relationship, and the ending of that relationship well, albeit with significant support from the treatment team.
[37]. There have been no emergencies or hospital admissions over the past year. She has not used cannabis. She has used alcohol, but this has not affected her mental stability, and she has decreased its use since the Hospital Report was prepared.
[38]. Ms. Daly has been accepted by the FACTT and will be transitioning to their care over the next year.
[39]. Ms. Daly has a stable home with her mother and stepfather and will have the option to move to Thresholds housing.
[40]. Dr. Prakash does not believe that a Warrant of Committal is necessary to return Ms. Daly to the Hospital, and the Hospital does not need the ability to approve housing. There is no evidence to suggest that Ms. Daly would choose to live in a home that would be detrimental to her mental health.
[41]. All parties agree that a requirement for testing be included in the Disposition, to enable the team to monitor Ms. Daly's abstinence as she transitions to greater independence. The Board agrees that this is necessary to reduce the risk and protect the safety of the public.
[42]. Much evidence was directed to the question of whether an abstain clause or a driving restriction dealing with alcohol should be included in the Disposition.
[43]. After carefully considering the evidence, the Board concluded that it was not necessary to include either of these clauses in the Disposition to protect the safety of the public.
[44]. Dr. Prakash provided clear testimony that Ms. Daly does not have a diagnosis of alcohol use disorder; that she presents no greater risk to the public from the use of alcohol than any member of the general public; that she has reduced her use of alcohol in response to the Hospital Report; that there is no connection between the use of alcohol and the index offence or between the use of alcohol and her mental disorder or cannabis use. In short, the evidence does not support the conclusion that the use of alcohol by Ms. Daly increases her risk to the safety of the public.
[45]. In making the disposition the Board took into consideration all the evidence and submissions, and the criteria set forth in s.672.54, the paramount consideration being the safety of the public, the mental condition of Ms. Daly, her reintegration into society and other needs of the accused.
[46]. Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board concludes that Ms. Daly remains a significant threat to the safety of the public and that the necessary and appropriate Disposition is a conditional discharge upon the terms set out in our formal Disposition.
[47]. The Board congratulates Ms. Daly on a very successful year in the community and wishes her every success as she transitions to the care of FACTT.
DATED this 14th day of April 2025, at the City of Toronto, in the Region of Toronto.
Ms. K. Tomaszewski Legal Member
Office of the Registrar Ontario Review Board