Re Jade Nelson, 2025 CanLII 33846

Re: Jade Nelson

ORB File No: 7461

Hearing held on: Friday, February 21, 2025

Place of hearing: Centre for Addiction and Mental Health, Toronto

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

Before:

Alternate Chairperson: Mr. M. Segal

Members: The Hon. B. Allen Dr. B. Bordoff Dr. J. Kis Mr. J. Cyr

Parties Appearing:

Accused: Jade Nelson Counsel: Mr. J. Wilton

The Person in charge of Hospital: Counsel: Ms. M. Warner

Attorney General of Ontario: Counsel: Ms. V. Culp

REASONS FOR DISPOSITION

(Dated April 14, 2025)

Introduction

1. On December 5, 2018 Ms. Jade Nelson was found not criminally responsible by reason of mental disorder on charges of attempted murder (x 4) and assault contrary to the Criminal Code.

2. Under s. 672.81(1) of the Criminal Code, a panel of the Ontario Review Board (the Board) was convened on February 21, 2025 at the Centre for Addiction and Mental Health (CAMH or the Hospital) to review Ms. Nelson's risk to public safety and the appropriate disposition under s. 672.54 of the Criminal Code.

3. Ms. Nelson's existing disposition dated March 18, 2024 orders that she be detained in a general forensic unit of CAMH in Toronto with provision for community living in an accommodation approved by the person in charge of the Hospital.

4. At the start of the hearing the parties provided the Board with their respective positions on disposition and significant risk. The Crown agreed with the Hospital’s position that Ms. Nelson remains a significant risk to the public and that the existing disposition should be maintained. The defence took the position that Ms. Nelson should receive a conditional discharge and requested the removal of the cannabis prohibition clause from the conditions.

5. The parties maintained their positions at the close of the evidence.

Disposition

6. For the reasons set out below the Board concludes, under s. 672.54 of the Criminal Code, that Ms. Nelson continues to pose a significant risk to public safety and that the necessary and appropriate disposition, that is the least onerous and the least restrictive to mitigate risk to public safety, is that she remain detained at CAMH on the same terms and conditions as the existing disposition.

Current Diagnoses

7. Ms. Nelson’s current diagnoses are schizophrenia and cannabis use disorder.

The Evidence

8. The Board has before it the Hospital Report dated February 11, 2025 which contains an account of Ms. Nelson’s personal and psychiatric background which needs not be repeated in detail here. The Board also has the oral evidence of Dr. Charles Choi, the author of the Hospital Report.

Index Offences

9. The circumstances of the index offence are described in the Hospital Report and are summarized as follows:

10. On July 3, 2018 the victims M. Ponnam-Palavanar, M. Thind, Pr. Kaur and Pa. Kaur were on a Bampton Transit bus in the area of Queen Street and McVean Road in the city of Brampton. At approximately 9:15 p.m. Ms. Nelson brandished a knife and started attacking people at random on the bus. The victims sustained the following injuries: M. Ponnam-Palavanar – stab wound to the back right shoulder, slash to the face and staples to reattach the left ear. M. Thind – stab wound to neck lacerating the thyroid. Pr. Kaur – stab wound to the right chest.

Criminal History

11. Records from the Toronto Police Service indicate that before the index offence, Ms. Nelson was charged with assault on September 11, 2017. Ms. Nelson initiated an altercation with a co-tenant at their residence over the co-tenant having installed a camera on the premises. Ms. Nelson punched the co-tenant in the face once. The camera was not in operation when the assault took place. However the assault was witnessed by another co-tenant. After being punched the co-tenant phoned 911 and was transported to the hospital for medical attention. Ms. Nelson was not there when officers later attended the residence. Early on September 12, 2017 the co-tenant returned home from the hospital. When she observed Ms. Nelson return to the residence she phoned 911 again. Ms. Nelson was located in the basement of the residence and arrested. She was transported to 31 Division where she was released on a recognizance.

Substance Use

12. Ms. Nelson stated that she began using cannabis in middle school. Initially she was smoking approximately one gram every “couple of days.” This increased after she left her father’s home at the age of 18 and she stated that in the subsequent years she was smoking one to two grams of cannabis per day. She indicated that she did not often drink alcohol.

Ms. Nelson’s Personal and Psychiatric History

Before the Current Reporting Year

Personal History

13. Ms. Nelson is 26 years of age. She was born in Jamaica and immigrated to Canada at age 4. She was the only child of unmarried parents. She has two younger maternal half-siblings and one older paternal step-brother. She was raised by her mother in Jamaica until age four when she moved to Canada to live with her father. Her mother remained in Jamaica. Ms. Nelson’s father is employed as a computer programmer at Rogers and resides in the North York area with his wife and stepson.

14. Ms. Nelson completed grade 10 and left school then went to work. She never returned to school. As for employment, Ms. Nelson stated that the longest she was ever employed at a job was for six months when she was age 16. She has worked in retail clothing, at a factory job and once at seasonal work at the CNE.

15. Ms. Nelson is not married or in a domestic relationship with a partner and has no dependants. She has had some casual relationships and a boyfriend off and on whom she recently learned has passed away.

Psychiatric History

16. Before the index offence Mr. Nelson had contact with several hospital psychiatric facilities.

17. The first incident reported of an encounter with a hospital for mental status concerns was at North York General Hospital on March 13, 2016 where she presented to the hospital voluntarily for a mental health evaluation and was later discharged. As she was leaving the hospital her father called the police as he believed that she was a danger to herself. When the police arrived Ms Nelson became aggressive and had to be restrained on the floor by multiple officers and a security guard. Ms. Nelson was subjected to physical restraints and administered an anti-psychotic medication injection. She eventually settled down with the medication. Her urine test was positive for cannabis and MDMA. She was held overnight for a psychiatric assessment which found she presented with significant oppositional behaviour with no evidence of delusions, hallucinations or thought form disorder.

18. On January 16, 2018 Ms. Nelson was brought by police to the emergency department of Humber River Regional Hospital (Humber River) after a manager at Pizza Pizza called 911. She was reportedly exhibiting “bizarre and unusual behavior”. She was observed “talking about God a lot” and spoke about “being punished by God for 300 years.” She settled down following the administration of an anti-psychotic injection. When assessed she was found to be irritable and difficult to communicate with. Ms. Nelson said she had not been taking any medications and freely admitted to taking half a gram of cannabis daily.

19. Ms. Nelson was admitted as an in-patient. She exhibited persecutory and bizarre delusions such as she believed the FBI was monitoring her and that there were bugs “everywhere,” including in her phone and that she was being recorded. There were also delusionary Christian religious themes in her interview with the psychiatric assessor. Ms. Nelson appeared to stabilize quickly during her admission and downplayed her delusionary assertions as being the result of just being a “conspiracy theorist”. She was discharged on January 19, 2018 without medications. Her discharge diagnosis was “Cannabis induced psychosis. R/O [rule-out] schizophrenia.”

20. Ms. Nelson was again admitted to Humber River on March 2, 2018 and released on March 6, 2018. She had been at a party at York University and had been drinking. She appeared more paranoid and was behaving more erratically than during her last admission in January 2018. She believed she was being monitored and said she had thrown away the cell phone her father gave her due to those concerns. Upon this admission to the hospital Ms. Nelson denied many of the delusionary assertions from her January 2018 attendance blaming her behaviour on smoking cannabis. She reported struggling with anxiety and coping by smoking cannabis.

21. Ms. Nelson denied believing that anyone was following or monitoring her, having a chip implanted in her head or hearing voices. She recalled reporting some of those things during her previous admission. But she attributed this to smoking “a lot of cannabis” at the time and getting into conspiracy theories on the internet. Ms. Nelson’s “acute confusional state” on admission was attributed to “alcohol intoxication and possibly cannabis use”.

22. Ms. Nelson was brought by police to Brampton Civic Hospital where she stayed voluntarily from April 5 to April 8, 2018. It is not clear why she was apprehended by the police, whether for behaving bizarrely in a store or for jaywalking. She presented with symptoms of paranoid delusions and poor insight and judgment. Ms. Nelson repeatedly stated that she was "going through issues and situations," but denied psychiatric symptoms or a history of psychiatric admissions. Ms. Nelson denied the use of substances but refused to undergo urine drug testing. She insisted on being discharged, became uncooperative and eventually had to be placed into physical restraints.

23. Oral anti-psychotic medication was initiated nightly for treatment. On April 6, 2018, Ms. Nelson remained disorganized, uncooperative, erratic and avoided verbal communication. She appeared to be responding to internal stimuli. The clinical impression was of an "acute psychotic episode," with a "known history of polysubstance use disorder (cannabis, ecstasy), [and] noncompliance with psychotropic medication". Ms. Nelson's clinical presentation appeared to improve quickly in the hospital.

24. On March 15, 2018 Ms. Nelson was brought to the CAMH emergency department by her legal aid worker. She had reportedly been staying at the York University campus library for a week. At the hospital she was unable to answer most questions and appeared guarded, “spaced out,” and internally preoccupied. While she denied all psychotic symptoms on questioning, her thought process was disorganized. Ms. Nelson was involuntarily admitted for further observation and administered anti-psychotic medication. She was irritable and uncooperative with assessments and appeared vague and guarded about her symptoms. She alternated between minimal communication and sudden emotional outbursts. Ms. Nelson’s mental status rapidly improved by March 18, 2018 and she was discharged from the hospital.

25. On July 2, 2018 the day before the index offence, the police brought her to Brampton Civic Hospital after she had been observed running into traffic and "picking grass." Upon being interviewed she stated that she had been trying to catch a bus and acknowledged that it was a poor choice to run into traffic. The records did not comment on her mental state and she was not referred for psychiatric assessment.

26. Following her arrest on July 3, 2018 for the index offence, Ms. Nelson was brought to Brampton Civic Hospital by police for treatment of a stab wound to her right thigh. The psychiatrist spoke to her only briefly before she was taken to jail and the doctor was therefore not able to form a diagnostic impression.

27. Following the index offence and before the current year Ms. Nelson was detained and treated at Vanier Centre for Women and followed by CAMH from July 2018 to November 2018. During this period she was also admitted to St. Joseph’s Health Centre and Oakville-Trafalgar Hospital.

28. Ms. Nelson's general presentation during this period was marked by poor engagement, bizarre behaviour, uncooperativeness and refusal to eat at times. On mental health assessments, she presented as irritable, demanding and threatening with evidence of paranoid thinking. It was in that context that she was admitted to St. Joseph's Health Centre and Oakville-Trafalgar Hospital. Ms. Nelson denied any previous contact with mental health services and denied ever seeing a psychiatrist or being admitted to the hospital. By September 12, 2018 Ms. Nelson's mental state was noted to be much improved. She was settled, cooperative and able to develop a good rapport. Her attention, concentration and eye contact were good. There is evidence however that from October to November 2018 she was inconsistent in complying with her medications.

29. From December 2018 to the present Ms. Nelson has remained in CAMH forensic services.

30. On admission to the Forensic Assessment and Triage Unit (FATU) at CAMH in December 2018 on a Warrant of Committal Ms. Nelson was actively psychotic at the time of admission, endorsing ideas of reference and auditory hallucinations. Overall she was agreeable to her medication but did have periods of medication noncompliance. With medication changes, Ms. Nelson's mental status and behaviour improved although she experienced transient episodes of auditory hallucinations. She tended to keep to herself and engage minimally with staff and other patients. She was amenable to interviews and she did not exhibit aggression, violence or inappropriate behaviours.

31. On February 14, 2019 Ms. Nelson was admitted to the Women’s Secure Forensic Unit (WSFU) at CAMH. Her behaviour was initially marked by not being forthcoming about her mental illness, evasiveness about the index offence, isolation in her room and responding to internal unseen stimuli when alone in her room. Her mental status improved as she began to admit experiencing auditory hallucinations.

32. The following factors reflect Ms. Nelson’s progress during the 2019/2020 reporting year: her engagement with the treatment team improved; she was deemed capable of making treatment decisions; she became more forthcoming in speaking about her mental illness and the index offence; she attended some programs on the unit; and she used escorted and accompanied passes on hospital grounds.

33. Ms. Nelson avoided meeting with her family including visits with her father and stepmother who raised her.

34. On April 29, 2020 Ms. Nelson was transferred from the WSFU to a general forensic unit. There were no critical incidents or breaches of her Board disposition; she utilized passes up to indirectly supervised passes on hospital grounds for rehabilitation activities, programming and accompanied outings in the community; there were no incidents of absconding from the Hospital or misuse of privileges; all of her random urine drug tests were negative; and there were no incidents of physical violence.

35. Ms. Nelson underwent several medication adjustments during this period. While she consistently denied any perceptual disturbances, staff continued to intermittently observe her appearing to respond to internal stimuli and continued to hold vague paranoid ideations. For instance she continued to believe a resident may be "getting encouragement" and she expressed concerns about the possibility of food tampering on the unit. Though she experienced residual paranoid symptoms Ms. Nelson was able to participate in treatment interventions. With her ongoing olanzapine administration, Ms. Nelson's mental status and behaviour gradually improved.

36. Ms. Nelson was concerned about the effect of olanzapine on her weight and her medication was adjusted to paliperidone in mid-October 2020 and olanzapine was gradually tapered. On November 16, 2020 Ms. Nelson was involved in a then uncharacteristic verbal altercation with a staff member. Ms. Nelson's mental state gradually improved over the following week and she appeared to respond well to the paliperidone.

37. During the reporting year 2021/2022 Ms. Nelson remained in a general forensic unit at CAMH. Again, overall Ms. Nelson had a positive reporting year. There were no breaches of her Board disposition; she utilized accompanied community outing passes for rehabilitation activities and programming; there were no incidents of absconding from the Hospital or misuse of privileges; her urine drug tests were negative for prohibited substances; and there were no incidents of physical violence.

38. Ms. Nelson disclosed sexual abuse in her teens perpetrated by her father. The clinical team provided support for her and prohibited all visits and phone contact with her father.

39. On the negative side during the 2021/2022 reporting year, Ms. Nelson’s insight into her major mental illness and risk factors for re-offending appeared superficial and she could not identify potential negative effects of cannabis use and rejected feedback about the potential detrimental effect on symptoms of psychosis. Ms. Nelson was also inconsistent in attending unit recreational groups including cooking, art, mindfulness and community meetings. She fluctuated in her levels of motivation and engagement.

40. Although Ms. Nelson's behaviour was controlled she continued to display residual positive paranoid symptoms. The treatment team continued to intermittently observe her appearing to respond to internal stimuli and Ms. Nelson continued with her concern about food tampering. Despite Ms. Nelson's resistance to changes in her anti-psychotic medication, with encouragement, she agreed to a switch from oral to long-acting intramuscular injections of paliperidone which began in September 2021. Ms. Nelson's behaviour improved over subsequent days with the switch to long-acting injections. There were no further changes to Ms. Nelson's medication during the year.

41. As noted, during the reporting year 2022/2023 Ms. Nelson remained an inpatient on the WGFU until August 15, 2022, when she was transferred to a general forensic unit. In general she had a good reporting period. She remained abstinent from drugs and alcohol, with no negative urine screens for that reporting period. There were no decompensation episodes and she remained compliant with her medications. Ms. Nelson advanced to Alternative Level of Care (ALC) status and transitioning to community housing became a priority.

42. However some concerns from the previous reporting year persisted.

43. While Ms. Nelson denied psychotic symptoms the staff could hear her talking to herself or shouting in her room occasionally. Ms. Nelson's insight did not seem robust despite her general compliance with medications and recommendations. She isolated herself from other patients, displayed little interest in unit activities and was reluctant to participate in activities and to go out on passes.

44. There was an episode of aggression in that reporting period on December 12, 2022. Ms. Nelson suddenly punched a co-patient who was uttering profanities in response to internal stimuli that were not directed specifically at Ms. Nelson. The altercation was violent enough that two nursing staff had to break up the fight.

45. When asked about requests to the Board concerning disposition conditions, Ms. Nelson asserted that she would like to be permitted to smoke cannabis and drink alcohol. She indicated that such substances "relax" her and that she wants to be able to "celebrate". She stated that substances have no impact on her mental illness and in fact, have helped her in the past to cope with anxiety.

46. The reporting year 2023/2024 was also in general a good year for Ms. Nelson.

47. There were no incidents of aggression or violence, substance use, medication non-adherence, pass misuse or absconding. Ms. Nelson was compliant with her psychiatric regimen. She continued to experience ongoing residual positive symptoms of psychosis and more prominent negative symptoms. Ms. Nelson denied perceptual disturbances; however she continued to be seen talking to herself in her room. Her ongoing treatment adherence made it possible for these experiences to not significantly impact her judgment or behaviour.

48. Ms. Nelson remained isolative and was not enthusiastic about engaging in unit programs and activities or using pass privileges. In March 2023 Ms. Nelson’s anti-depressant medication was increased to address those concerns but Ms. Nelson continued to be isolative. Her anti-depressant was again increased in July 2023 and by August 2023 Ms. Nelson appeared brighter overall. She reported feeling less depressed and more motivated to pursue rehabilitative goals and activities including using passes more frequently.

49. However in January 2024 Ms. Nelson exhibited a transient intensification of paranoid concerns about food tampering. She declined to be served food by a South Asian staff member. By early February 2024 Ms. Nelson’s paranoid concerns had abated somewhat in that she said she did not believe she was being targeted by Sri Lankans.

50. Ms. Nelson continued to attend one-on-one Forensic Consultation and Assessment Team (FORCAT) sessions with Dr. Tripp and actively participated in culturally adapted Cognitive Behavioural Therapy (CBT) and social activities on the unit. In October 2023 she was selected for intake into the Transitional Rehabilitation Housing Program 2 (TRHP-2), a supportive housing program that assists forensic clients prepare for independent housing in the community. Ms. Nelson was not accepted to the program, according to the clinical team, due to her ongoing functional deficits and inconsistent involvement in productive activities. The belief was that she would likely require more supportive housing possibly within a slower transitional mode.

51. By the end of the reporting year Ms. Nelson believed due to her medications that she was more able to cope with conflicts and would be able to withdraw if confronted instead of reacting with violence. Now, with age and maturity, Ms. Nelson also believed she was in a better place to consider the perspectives of others and would try to sympathize with the victims' concerns if confronted with similar circumstances.

The Current Reporting Period – March 2024 – February 2025

52. Ms. Nelson remained an inpatient in a general forensic unit during the current reporting year. There were no incidents of aggression or violence, substance use, medication non-adherence, pass misuses or abscondments. She was compliant with her psychiatric treatment regimen. Her mental status was stable but at the start of the period, her advancement remained slow with periods of stagnancy which state improved toward the latter part of the period. Ms. Nelson remains suitable for discharge when satisfactory accommodation becomes available. And in aid of enhancing her suitability the clinical team has encouraged her to increase her community activities and productive use of her time.

53. Ms. Nelson's engagement in productive activities also remained inconsistent and at times overall she languished during the first half of the reporting year. But to Ms. Nelson's credit, in August 2024 she began to attend the unit's weekly cooking group with good consistency and high participation. With the encouragement of her behavioural therapist, she began working in the unit's stamp store and also used off-unit passes, while not optimally, more frequently, a few times per week. From September 2024 she participated regularly in the unit's weekly recreational outings. Ms. Nelson also had more regular electronic contact with her mother during the latter half of the year and expressed a desire to eventually visit her mother in the USA.

54. Ms. Nelson continued her sessions with her individual therapist, Dr. Cripps, in FORCAT. However her engagement in those sessions was inconsistent and highly externally motivated by the team's facilitation and support. Despite having the required off-unit passes she preferred that Dr. Cripps either see her virtually or on the unit and for her to remain in bed for sessions on the unit. In aid of discharge preparation and community reintegration plan, Ms. Nelson has been encouraged to meet personally with Dr. Cripps in FORCAT rather than on the unit. As of February 2025 this had not yet occurred.

55. Regarding vocational and educational pursuits Ms. Nelson continued to intermittently identify various goals. However, notwithstanding the team's supportive efforts, she has failed to embrace activities outside of those facilitated on the unit.

56. Regarding the risk projected with a conditional discharge compared to a detention order the clinical team opined that, taking into account Ms. Nelson’s risk and protective factors, her risk of future violence would be low while subject to a detention order with community living. However should she be conditionally discharged her risk of future violence would be moderate-high.

57. The clinical team unanimously concludes that a detention order at the Forensic Service of CAMH with a provision for community living remains necessary and appropriate to manage Ms. Nelson’s risk to the public. The Hospital Report further points out:

[Ms. Nelson] remained a good candidate for housing, should suitable accommodations become available, though she benefitted from the bolstering of skills needed to live in accommodations more aligned with her expectations for independence. In the context of suitably supported accommodations while still subject to a detention order, Ms. Nelson's risk can be appropriately managed in the community. [at page 40].

Oral Evidence of Dr. Charles Choi

58. Dr. Choi, who is a resident psychiatrist who for two months has been working with Ms. Nelson, testified at the hearing. There have been no material updates since the date of the Hospital Report.

59. On discharge readiness, Dr. Choi pointed out that the clinical team is working with an occupational therapist and a behavioural therapist. In response to questions on the status of the housing search, Dr. Choi testified that currently there are no housing options suitable to Ms. Nelson's needs. He explained that the treatment team's rehabilitative objectives at this point are to encourage Ms. Nelson to participate more in programming, to engage more socially and to take her initiative since she continues at this time to rely on external prompting.

60. Dr. Choi spoke of the type of housing suitable to Ms. Nelson’s needs explaining that she requires a high level of structure and substantial support with her activities of daily living. She for example needs prompting to get out of bed and according to an occupational therapist assessment she took three hours to cook one meal. Housing would have to be in place before she is discharged to the community as homelessness has been a problem for her in the past. Dr. Choi opined that although Ms. Nelson is designated ALC she is not in a position to be discharged at this time because she requires further development in the skills in her activities of daily living.

61. On the issue of managing Ms. Nelson’s risk related to cannabis, referencing her past decompensation episodes involving cannabis use, Dr. Choi testified that the preferable housing option would have to engage significant support and supervision to minimize risk. Dr. Choi addressed the clinical team’s recommendation for an increase in Ms. Nelson's geographic boundary to the Greater Toronto Area and explained that the provision would expand housing opportunities for her.

62. Defence counsel raised a question about allowing a disposition that will permit Ms. Nelson to use cannabis. Counsel pointed out that she sees other co-patients using cannabis and he inquired as to whether Ms. Nelson could be allowed that privilege. Dr. Choi responded that cannabis use is not recommended because of Ms. Nelson's extensive history of violent and aggressive behaviour towards others after using cannabis, not the least of which was the unprovoked violent attack on the four unsuspecting victims during the index offence.

63. Dr. Choi was asked about the viability of a conditional discharge. He explained that the nature of Ms. Nelson’s instability, her tendency toward episodic delusional thought and violence when she is unwell, requires the ability for speedy intervention by the Hospital to admit her and retain her long enough to stabilize her mental status. On a conditional discharge under the auspices of the Mental Health Act a hospital may not be able to hold Ms. Nelson long enough to sufficiently treat her illness or respond speedily enough were Ms. Nelson to experience a crisis.

64. In support of the insufficiency of the Mental Health Act to address Ms. Nelson's needs at this point the Board referred to Ms. Nelson's numerous attendances at various hospitals in states of decompensation in 2018 before the index offence, the last such attendance being on July 2, 2018, the day before the index offence. The point of concern is that Ms. Nelson was released from hospitals only to return on each occasion shortly thereafter in crisis again, the most poignant occasion, of course, being her release from a hospital the day before the index offence. Ms. Nelson was unwell that day but did not meet the Mental Health Act criteria to be held in the hospital.

65. Dr. Choi testified the fear is that on a conditional discharge, Ms. Nelson would leave the care of the Hospital. Ms. Nelson's words at the hearing tend to confirm this. She voiced her discontent at not being granted a conditional discharge after seven years in the Hospital and made it clear she did not want to be in the Hospital. So the Board finds there is a real risk of Ms. Nelson not returning there if in crisis.

The Parties’ Positions

66. The Hospital and Crown maintained their joint position that Ms. Nelson continues to be a significant risk to the safety of the public and that the least onerous and least restrictive disposition, that is necessary and appropriate in the circumstances, is an order detaining Ms. Nelson on the existing conditions in a forensic unit at CAMH with privileges up to residing in approved accommodation. The defence maintained its position that the necessary and appropriate disposition is a conditional discharge with the cannabis prohibition removed as a condition.

The Board’s Conclusion

67. The Board unanimously accepts that Ms. Nelson remains a significant threat to public safety within the criteria outlined in Winko and as defined in s. 672.5401 of the Criminal Code. The Board considered the criteria, as set out in s. 672.54, namely, the paramount criterion of the safety of the public and Ms. Nelson’s community re-integration, her mental condition and her other needs and find that the necessary and appropriate disposition is an order detaining Ms. Nelson in a general forensic unit at CAMH with privileges up to residing in the community in an approved accommodation.

68. The Board arrives at its determination for the following reasons.

69. The evidence set out in the Hospital Report and Dr. Choi's testimony amply supports the Board's view that a detention order is necessary and appropriate to manage Ms. Nelson's risk. The fragility of Ms. Nelson's mental state when medication non-compliant and indulging in cannabis, combined with her deficits in activities of daily living and social engagement, we find render Ms. Nelson ill-prepared for transition to community housing. At this stage, consistent monitoring of her medication and substance use in a controlled environment is still required and she remains in need of the support and the prompting of the clinical team to promote her functionality.

70. The Board in the circumstances, for reasons given by the clinical team, accepts that the Mental Health Act system would be wholly inadequate to address Ms. Nelson’s needs if in the heat of a mental health crisis.

71. The Board is however pleased with the team’s rehabilitative objectives for Ms. Nelson going forward to prepare her for community living. In furtherance of this goal a behavioural therapist and occupational therapist have been retained to facilitate her progress toward more independence and a further assessment by FORCAT is pending.

72. The Board acknowledges the progress Ms. Nelson has made in being incident-free, medication-compliant and adherent to the cannabis prohibition over the past year and encourages her to keep up her progress to improve her life circumstances while hospitalized so in the near future she will be equipped to transition to community housing.

73. In keeping with the Criminal Code’s s. 672.5401 criteria, the clinical team's discharge plan promotes Ms. Nelson's integration into the community, addresses her mental health needs and fosters public safety given the Hospital's authority to approve housing that will manage Ms. Nelson's risk to the public.

74. In the result the Board concludes that Ms. Nelson remains a significant threat to public safety and that currently the necessary and appropriate disposition, which is the least onerous and the least restrictive to mitigate risk to public safety, is to detain her at CAMH with privileges up to living in the community in an approved accommodation.

DATED this 14^th day of April, 2025, at the City of Toronto, in the Toronto Region.

The Hon. B. Allen Legal Member

__________________

Office of the Registrar Ontario Review Board