Ontario Review Board
Re: Alverna Lawrence
ORB File No: 7952
Hearing held on: Monday, March 10, 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. S. Clapp
Members: Dr. R. Sheppard Dr. S. Lessard Mr. D. Sandor Mr. J. Cyr
Parties Appearing:
Accused: Alverna Lawrence Counsel: Mr. A.J. Grant-Nicholson
The person in charge of hospital: Representative: Dr. R. McMaster
Attorney General of Ontario: Counsel: Mr. J. Rinaldi
REASONS FOR DISPOSITION
(Dated April 30, 2025)
Introduction:
On September 29, 2021, Alverna Lawrence was found not criminally responsible on account of mental disorder (“NCR”) on charges of weapons dangerous, and assault with a weapon, contrary to the Criminal Code. She is currently subject to a Disposition of the Ontario Review Board (“ORB” or the “Board”) dated March 19, 2024, whereby she is discharged from the Centre for Addiction and Mental Health (“CAMH” or the “hospital”) subject to a number of conditions, including that she report to the hospital not less than once per month, and agree to take medication on her consent.
On March 10, 2025, a panel of the Board convened at CAMH to conduct Ms. Lawrence’s annual review pursuant to section 672.81(1) of the Criminal Code. Ms. Lawrence attended the hearing and was represented by counsel.
The Hospital Report dated February 9, 2025, was marked as Exhibit 1. In addition to the documentary evidence, Ms. Lawrence’s attending psychiatrist, Dr. R. McMaster, gave evidence.
The issues to be decided at the hearing were whether Ms. Lawrence continues to meet the test of posing a significant threat to the safety of the public and if so, what is the necessary and appropriate Disposition, bearing in mind the four factors in section 672.54 of the Criminal Code.
Position of the Parties:
- All parties were asked for their initial without prejudice positions at the outset of the hearing. Dr. McMaster represented the hospital, and recommended a continuation of the existing Conditional Discharge, but with the removal of the consent to treatment condition. Mr. Rinaldi supported the hospital’s position on behalf of the Attorney General. Mr. Grant-Nicholson conceded the issue of significant threat and stated that it was a joint submission.
Findings:
- For the reasons that follow, the panel found that Ms. Lawrence continues to pose a significant threat to the safety of the public, and that the necessary and appropriate Disposition is a continuation of the existing Conditional Discharge, with removal of the consent to treatment condition.
Index Offences:
The circumstances of the index offences are outlined in the Hospital Report (at pages 9-10). They can be summarized as follows. On July 21, 2020, Ms. Lawrence was observed by a witness brandishing a large kitchen knife and chasing numerous people in the street with the blade exposed. Ms. Lawrence approached one person stating, “I’m going to get you” while swinging the knife towards them.
When asked about the index offences, Ms. Lawrence consistently stated that she acted in self defence in the face of sexual harassment.
Background:
Ms. Lawrence’s personal background and history are set out in detail in the Hospital Report and will not be repeated here. Briefly summarized, Ms. Lawrence is a 63-year-old divorced woman who came to Canada from Jamaica as a young girl. She has one son from whom she is estranged. She was raised by her mother (her father passed away) and has two younger brothers.
Ms. Lawrence completed high school and graduated from nursing in 1989. She worked as a nurse for nine years and then went back to university and obtained a degree in religious education. She subsequently founded at least two religiously themed businesses, but they were not successful due to financial difficulties. Ms. Lawrence has been unemployed since 2012 and is financially supported by the Ontario Disability Support Program.
Criminal History:
- The Hospital Report referred to Ms. Lawrence’s CPIC Report which shows that she was convicted of assault causing bodily harm, assault with a weapon, and mischief under $5000 (x2) in January 2017. The assault involved Ms. Lawrence throwing a toxic substance at a young child in a movie theatre. After two assessments, Ms. Lawrence was found to be criminally responsible and she received a custodial sentence of four days (with credit for the equivalent of 21 months pre-sentence custody) and a weapons prohibition.
Psychiatric History:
The Hospital Report includes Ms. Lawrence’s detailed psychiatric history commencing in 2010, when she exhibited “inappropriate, bizarre, and delusional behaviour” while she was working as a nurse. She was diagnosed with Psychosis Not Otherwise Specified and was prescribed Olanzapine. Ms. Lawrence was next assessed in 2016 as a result of the criminal charges referred to above. She was diagnosed with a psychotic disorder and was noted to decline treatment.
While at the Vanier Centre for Women following the commission of the index offences, Ms. Lawrence presented as hypertalkative and elevated, she was writing on the walls of her cell, appeared religiously preoccupied, and had significant paranoid ideation that police officers and correctional officers were targeting her. She denied that she had any mental health problems and was not treated. She was admitted to hospital from jail on at least two occasions due to concerns of poor self-care, violent behaviour, threats to others, and risk of impairment to self. Ms. Lawrence remained unwell during the assessments of criminal responsibility and often refused to be assessed.
Following the NCR finding, Ms. Lawrence was found incapable to consent to treatment in October 2021 and the Public Guardian and Trustee became her substitute decision-maker. Ms. Lawrence’s mental condition improved significantly with treatment. Although her insight remained poor and she was reluctant to discuss the index offences, she engaged with the clinical team, was cooperative with care, and was active in programming. Ms. Lawrence was transitioned to a longer-acting injectable antipsychotic medication (Trinza) in March 2022, and she returned to her church by November 2022. An occupational therapy assessment completed at that time showed that Ms. Lawrence would require supports while living in the community initially.
Ms. Lawrence was discharged to CMHA TRHP2 (Transitional Rehabilitation Housing Program 2) housing on October 23, 2023. This is a 24-hour supervised high-support program that provides on-site medication monitoring, curfew, case management, and programming. Ms. Lawrence had a very good year and worked well with the treatment team following this move. She engaged in groups, was independent with her activities of daily living, and went to church on the TTC on her own.
Ms. Lawrence’s insight into her illness and the need for medication improved, and she was found capable of consenting to treatment in February 2024. Since moving to TRHP2, Ms. Lawrence independently attended for her long-acting injection at the Forensic Outpatient Service (“FOPS”) and did not require any prompts or reminders. Ms. Lawrence received a Conditional Discharge last year.
The Hospital Report stated that Ms. Lawrence’s diagnosis is Schizophrenia, although a diagnosis of Schizoaffective Disorder remains on the differential. She has never had issues with substance use.
Evidence at the Hearing:
The Hospital Report stated that Ms. Lawrence had a very good reporting year. She continued to independently manage her activities of daily living, her instrumental activities of daily living, and attendance at FOPS for her injection. Although some fluctuation in her energy levels was noticed, her mental status remained stable. Ms. Lawrence is described in the Hospital Report as being cooperative, intelligent, caring, and involved in prosocial activities. She volunteers with the Patient and Family Council at CAMH, attends FOPS outings and events, and co-founded a Bible Study group at TRHP2. She was also able to connect with a family doctor in the community.
Ms. Lawrence remained at TRHP2 housing due to a lack of availability of more independent housing options. The Hospital Report stated that staff believe Ms. Lawrence has the skills to live independently, and she was on track to apply for Forensic Supporting Housing. Unfortunately, referrals for that housing are currently closed, so she is now considering moving to TRHP1 housing which has less support than TRHP2.
The Hospital Report stated the following about Ms. Lawrence’s insight (at page 19):
“Insight into mental illness as well as index offence has changed over the reporting year. In February 2024, Ms. Lawrence did not agree with the events of the IO as described in the report, and only “agreed somewhat” with diagnosis of schizophrenia. Over the year, Ms. Lawrence has had productive conversations with her psychiatrist about her major mental illness, and index offence, and she participated in a WRAP program. Ms. Lawrence now believes she has schizophrenia, and that if she stopped medications, symptoms could re-occur. She says medication help her thinking be “appropriate.” She still cannot fully recall the events of the offence, but is accepting that she “wasn’t well” at the time, and therefore not thinking or acting appropriately.”
The Final Risk Judgment in the Hospital Report stated that Ms. Lawrence’s risk of future violence would be low in the context of a Conditional Discharge, but it would be elevated if she received an Absolute Discharge. There are still concerns that Ms. Lawrence tends to withdraw and isolate herself, and she has few community supports at this stage.
The Hospital Report includes the following under “Team Review of Recommendation” (at page 25):
“It is the unanimous opinion of the clinical team that a conditional discharge, is the necessary and appropriate disposition. Ms. Lawrence is on a three-month injection and has demonstrated stability in her mental health and behaviour. She has agreed to stay at THRP2 until appropriate independent housing is found. Given her prosocial behaviour, the team is of the opinion that she will continue to work with the team to achieve her goal of more independent housing. Should she receive an absolute discharge, there is concern by the team that she would fall away from supports, would [not] be underhoused / possibly experience homelessness, which would be a significant stressor for her leading to psychotic decompensation. In this context, her risk would be elevated. The team plans on working with her to obtain more permanent housing this upcoming year, and hopefully transition her to non-forensic supports.”
The treatment team also recommended removal of the consent to treatment condition given that Ms. Lawrence has agreed to continue with her antipsychotic medication.
Dr. McMaster reiterated that Ms. Lawrence had a good year. He testified that she has become more self-sufficient, has more fulsome insight into her mental illness and the need for medication, as well as its relationship to the index offences. He stated that Ms. Lawrence is committed to her wellness.
Dr. McMaster testified that they are gradually reintegrating Ms. Lawrence into the community. They have applied for TRHP1 housing (which is the next step down in supportive housing and off of hospital grounds), and it is hoped that Ms. Lawrence may be able to move there in the next few months. Following that, it is hoped that she will obtain permanent independent supportive housing when it becomes available. Dr. McMaster testified that housing is central to Ms. Lawrence’s stability, and the treatment team will continue to work with her on this. The team will also work to transition Ms. Lawrence to a non-forensic treatment team in the community.
When asked whether Ms. Lawrence continues to meet the threshold for significant threat, Dr. McMaster stated yes, and pointed to Ms. Lawrence’s psychotic illness which led to significant decompensation in the past. Without the significant supports of her treatment team and housing, Dr. McMaster stated that Ms. Lawrence was likely to experience stress, potential homelessness, and medication noncompliance. This would result in incidents that are psychotically driven, as happened in the past.
Dr. McMaster was also asked about the team’s recommendation to remove the consent to treatment condition. Dr. McMaster testified that Ms. Lawrence’s motivation to take medication is now more internal than external, and removal of the condition will allow Ms. Lawrence an opportunity to demonstrate that.
Analysis and Conclusion:
Based on the Hospital Report and the evidence of Dr. McMaster, the panel found that Ms. Lawrence continues to represent a significant threat to the safety of the public. Ms. Lawrence experienced psychotic symptoms which largely went untreated for many years. Once diagnosed with a psychotic illness, she frequently refused to engage in assessment or treatment, and engaged in behaviours that led to criminal charges. Her symptoms included disorganization in thought form, persecutory and grandiose delusions, and misinterpretation of surroundings which led her to act out irrationally in response to perceived threats. While Ms. Lawrence has progressed well under the ORB, she still has some important transitions to make with respect to her reintegration into the community. In the absence of the oversight and significant supports of the ORB, the panel accepted the evidence that Ms. Lawrence was likely to relapse in response to stressors and potential loss of housing, which would likely result in harm to members of the public, as happened in the past.
The panel accepted the joint submission that a continuation of the existing Conditional Discharge Disposition, with the removal of the consent to treatment condition was the necessary and appropriate Disposition, as well as the least onerous and least restrictive Disposition for Ms. Lawrence at this time. The panel was of the opinion that Ms. Lawrence’s housing is crucial to her recovery and the mitigation of risk to the public. It is anticipated that Ms. Lawrence will be undergoing a housing transition in the coming year, and she continues to work on developing supports in the community. The treatment team needs to continue to support Ms. Lawrence with these important and potentially stressful transitions going forward.
Finally, the removal of the consent to treatment condition represents a loosening of conditions for Ms. Lawrence. Ms. Lawrence’s insight has improved slowly over the last couple of years, and she was found capable of consenting to treatment just over one year ago. The removal of the consent to treatment condition will provide Ms. Lawrence with an opportunity to demonstrate that she is committed to being compliant with medication in the absence of a requirement stipulated by the ORB.
Ms. Lawrence has progressed well under the ORB, with improvement in her insight and functioning, and a clear commitment to her recovery and well-being. She is encouraged to continue her pattern of working with the treatment team as she progresses with the next steps in her reintegration into the community.
DATED this 30th day of April 2025, at the City of Toronto, in the Toronto Region.
Ms. S. Clapp
Alternate Chairperson
Office of the Registrar
Ontario Review Board