Re: Allen Marcel
ORB File No: 4003
Hearing held on: Monday, March 3, 2025
Place of Hearing: Providence Care Hospital, Kingston
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Mr. J. Hanbidge Members: Mr. E. Siebenmorgen Dr. J. Watts Dr. J. Cheston Mr. R. Rainboth
Parties Appearing: Accused: Allen Marcell Counsel: Mr. M. Rodé Person in charge of hospital: Representative Ms. T. Tom Attorney-General of Ontario: Counsel: Ms. J. Ferguson
REASONS FOR DISPOSITION
(Dated May 5, 2025)
Introduction
On June 23, 2004, Allen Marcel was found not criminally responsible on account of mental disorder (“NCR”) on a charge of assault with a weapon, contrary to the Criminal Code of Canada (“Criminal Code”).
Mr. Marcel is currently subject to a Disposition of the Ontario Review Board (the “Board” or “ORB”) dated April 25, 2024. The Disposition ordered that he be detained at the Secure Forensic Unit of the Providence Care Hospital (“PCH”) in Kingston, with privileges up to and including to live in the community in accommodation approved by the person in charge.
On Monday, March 3, 2025, a panel of the Board convened for an in-person hearing at PCH to conduct a review of Mr. Marcel’s Disposition. Mr. Marcel was in attendance and was represented by legal counsel, Mr. Michael Rodé.
The issues to be determined at the hearing were whether Mr. Marcel continued to represent a significant threat to the safety of the public as defined in section 672.5401 of the Criminal Code, and, if so, what was the necessary and appropriate Disposition which was also the least restrictive and least onerous taking into account the factors set out in section 672.54 of the Criminal Code.
Position of the Parties:
At the commencement of the hearing the parties were requested to provide their initial without prejudice positions with respect to the issues before the Board.
Ms. Tina Tom appeared for PCH. She advised of the Hospital position that Mr. Marcel remains a significant threat to public safety, and if the Board so finds, the necessary and appropriate Disposition is a continuation of a Detention Order with the same conditions as were contained in last year’s Disposition, save and except for one amendment – to paragraph #1 – to delete the words “the Secure Forensic Unit of”, so that it now states: “detained at Providence Care Hospital, Kingston.”.
Both Ms. Jennifer Ferguson, appearing for the Attorney-General, and Mr. Rodé, appearing for Mr. Marcel, supported the Hospital’s position in respect of Mr. Marcel’s continued significant threat to public safety, as well as the recommended Disposition.
Findings:
- For the Reasons that follow, the panel found that the threshold for significant threat is met, and that the necessary and appropriate Disposition is a continuation of the current Disposition, namely, a Detention Order within PCH, with the same conditions and privileges as were contained in last year’s Disposition, save and except for one amendment – to paragraph #1 – delete the words “the Secure Forensic Unit of”, so that it now states: “detained at Providence Care Hospital, Kingston.”.
Index Offence:
- The details giving rise to the index offence are extracted from the most recent Reasons for Disposition, dated June 10, 2024, as follows:
"On the 19th day of February 2004, shortly after 1:00 p.m., the victim (Gary Olmstead) was walking on Fitzgerald Street in the village of Maynooth. The victim told police he saw the accused (Allen Marcel) walking towards him on Fitzgerald Street, and the accused had his hands in his pockets at that time. The victim knows the accused as a friend, and asked the accused if he was going to the food bank, as it was about to close. The accused did not respond to the victim's questions. The accused reached out with his left arm and pulled the victim into his chest. The victim believed that the accused was giving him a hug, until he felt a burning pain in his neck. He pulled away and saw the accused holding a metal object in his right hand that the victim was not able to identify. The victim yelled at the accused asking him what he was doing, and the accused just smiled. The victim departed the scene, and had a friend look at his neck, and discovered that he had been stabbed. The victim returned to his home, and eventually went to a neighbour's house, who in turn drove the victim to his doctor's office. The victim's doctor arranged to have the victim attend the local hospital, where he received stitches for an approximately 1.5 cm wound on his neck.
Police were contacted by the hospital. Officers attended the residence of the accused on the 19th day of February 2004 and arrested him. At the time of arrest, the accused had on his person two knives, a round metal file with a sharpened point, a pill bottle filled with 0.22 & 0.38 calibre ammunition, as well as a key with blood on it... "
Current Diagnosis:
- Mr. Marcel’s current diagnoses are Schizophrenia, Alcohol and Cannabis Use Disorder(s) in Remission, and Antisocial Personality Disorder by History.
Background:
The Hospital Report dated February 10, 2025, (entered as an Exhibit at the hearing) provides a considerable amount of information concerning Mr. Marcel, his personal history, his criminal and mental health histories, details of the index offence, his course in hospital, then in the community, and then re-admission to hospital subsequent to the date of the NCR finding. As the Hospital Report was made an Exhibit in this hearing it is not necessary to reproduce all of the information contained in it in these Reasons, except as highlighted hereafter.
Briefly, Mr. Marcel is now a 53-year-old man. Mr. Marcel was born in Georgetown, Ontario, the eldest of two boys, and has never been married. It is reported that he was diagnosed as suffering from a learning disability as a child and did poorly in school prior to the onset of his illness at age 15. He required residential care and was aggressive to others and damaged property during those placements. Mr. Marcel moved from town to town after leaving school in 1991, working short-term construction labourer jobs.
As an adult Mr. Marcel was convicted of multiple offences between 1991 and 2000. His charges include assaults, assault with intent to resist arrest, theft, break and enter, and several convictions of failing to comply with court probation orders. He reportedly collected welfare and grew and sold marijuana to supplement his income while unemployed. He moved to the Bancroft area in 2001 to be closer to his mother.
At the age of 25, Mr. Marcel began to experience auditory hallucinations. He had two admissions to the inpatient unit at Homewood in Guelph, including a five-day admission in 1996, and a 43- day admission in 2000. Both arose from aggressive and suicidal behaviour and were involuntary, with a diagnosis of schizophrenia.
Following the NCR verdict, Mr. Marcel was transferred from the Quinte Detention Centre to Waypoint Mental Health Centre. In 2007 he was transferred to PCH in Kingston. Mr. Marcel has returned to hospital on several occasions since his first transition to the community. The last occasion was in December 2020, when he exhibited threatening and belligerent behavior to staff at his structured community residence (TRHP). In 2022, following a hearing, the Board changed his Conditional Discharge Disposition to a Detention Disposition, the second time in his history.
As for Mr. Marcel’s course from January 2024 to January 2025, the Hospital Report summarizes this as follows:
“Over the reporting period, Mr. Marcel was relatively psychiatrically stable, returning to his usual low-grade paranoia with occasional mild mood lability. He had no periods of seclusion or restraint and scored approximately five times on the Aggressive Incidents Scale (AIS), a scale that quantifies aggressive events from least (1) to most (9). His highest score was a 3 recorded in October 2024, a pattern of aggression indicative of verbal outbursts only. The overall decrease in aggression compared to 2023 was attributed to a series of medication adjustments in or around late 2023/early 2024. As such, Mr. Marcel’s psychiatric medications were largely unchanged over the reporting period, and he remained medication compliant.
Despite the plan to discharge Mr. Marcel back to the structured community residence, TRHP [Transitional Rehabilitation Housing Program, a 24/7 supervised housing facility in the community], after a sinus surgery in September 20224, Mr. Marcel continued to have difficulties with his medical health, including but not limited to incontinence, chronic pain, and hyponatremia. He continued to have falls, including one in December 2024 that led to an emergency department visit. He also had difficulties with ambulation despite more engagement with physical therapy. In general, Mr. Marcel showed a progressive decline in functioning that led to a reconsideration for his discharge into the community.
In summary, while Mr. Marcel had no significant periods of psychiatric decompensation, AWOL attempts, or concern for substance use over the reporting period, he was ultimately deemed too medically compromised to be discharged back to his structured housing residence. He did adhere to his privileges and continued to be involved with various groups and community outings.”
The Hospital Report noted that Mr. Marcel continues to represent a significant threat to the safety of the public. Several factors are listed which include his major mental disorder (with symptoms of delusions of paranoia and auditory hallucinations), history of violent attitudes, substance use, and antisocial personality disorder; these factors predisposed Mr. Marcel to the index offence and other instances of violent behaviour which have resulted in previous hospital admissions, including the current one.
There has been relatively minimal change in Mr. Marcel’s shorter-term risk of violence over the past year, relative to prior recent years. He continues to struggle with frustration tolerance, verbal aggression (and on one occasion, physical aggression), and at times, paranoia.
Medication adjustments several months ago have had a positive effect on Mr. Marcel’s overall mental stability; however, he has not engaged in formal programming or psychosocial interventions to improve his insight, symptoms of psychosis, emotion regulation, and problem solving.
According to the Hospital Report, Mr. Marcel’s risk for violent reoffending in the shorter term is considered at least moderate with his current level of support and supervision. His risk however is less clear within a less secure setting. It is possible that this level of risk could be maintained through a gradual transition to live in another psychiatric unit at PCH or into the community.
At present, Mr. Marcel’s discharge is limited primarily by his medical issues. Notwithstanding the above, it will remain important to hospitalize Mr. Marcel with any significant psychiatric decompensation and/or aggression. This is based not only on his variable hospital course since 2020, but also Mr. Marcel’s repeated history of moving from inpatient to outpatient level of care over the years.
In the absence of an ORB disposition, Mr. Marcel’s risk would likely be high. Accordingly, the Hospital is recommending no changes to Mr. Marcel’s ORB Disposition in the upcoming reporting period, save and except to delete his requirement to be detained within the Secure Forensic Unit of PCH but rather at PCH, with efforts for placement outside of the forensic inpatient unit continuing.
Oral Testimony at the Hearing:
The Hospital’s evidence was also presented through the oral testimony of Dr. Selhi to supplement the evidence contained in the Hospital Report. Dr. Selhi has been Mr. Marcel’s treating psychiatrist since July 2022.
Dr. Selhi testified that she adopted those portions of the Hospital Report for which she made a personal contribution, including the conclusion that Mr. Marcel continues to represent a significant risk to the safety of the public. The factors applicable to Mr. Marcel’s significant risk included his major mental illness diagnoses with ongoing low-grade paranoia that causes Mr. Marcel to become frustrated. Also considered was Mr. Marcel’s noted significant violent outbursts that occurred in previous years which required seclusion, as well as Mr. Marcel’s significant criminal record and a history of substance use. Mr. Marcel also presents with limited insight but has good judgment as he agrees to take his prescribed medication.
As for Mr. Marcel’s future insight capabilities, Dr. Selhi noted that Mr. Marcel had not participated in individual or group therapies to develop insight. He was not likely to improve his insight. Dr. Selhi testified that Mr. Marcel’s psychotic symptoms appear stable at present primarily due to Mr. Marcel being optimally medicated and his current placement at the PCH setting.
Plans to move Mr. Marcel to a community placement at the Transitional Rehabilitation Housing Program (“THRP”), a 24/7 supervised housing facility in the community, during the past year following some sinus surgery did not materialize. Although Mr. Marcel presented as psychiatrically stable, he is too medically compromised to leave hospital. In particular, Dr. Selhi noted that Mr. Marcel has been physically declining over the years; he has gait difficulties and is subject to falling, despite previous physical therapy interventions. Accordingly, it was Dr. Selhi’s opinion that Mr. Marcel was more suited to a transfer to another unit within PCH. For this reason, the Hospital & Dr. Selhi were requesting an amendment to the current Disposition so that in paragraph #1: delete the words “the Secure Forensic Unit of” and replace with: “detained at Providence Care Hospital, Kingston.”.
Dr. Selhi indicated that currently PCH has two adult mental health units. One of the units was described as having a more stimulating and active environment (and which includes dual diagnosis and drug abuse patients), while the other is thought to be a more settled environment. Dr. Selhi noted that Mr. Marcel would be more suited to the latter setting where he would have his own room. If acceptable to the other unit, Dr. Selhi hoped to effect Mr. Marcel’s transfer within the next 3 to 4 months.
In response to questions posed by Crown counsel, it was noted that the Hospital Report indicated that Mr. Marcel’s lack of insight served as a clinical factor contributing to his risk for violence. Dr. Selhi testified that Mr. Marcel had some insight into his mental illness diagnosis. According to Dr. Selhi, Mr. Marcel sees it as Bipolar disorder rather than Schizophrenia, but his understanding varies. However, Mr. Marcel demonstrates less awareness of his behaviour’s impact on others when he becomes upset and frustrated. Although to his credit, Mr. Marcel exhibits some self-control; he usually gets up and leaves the situation before further issues arise.
In response to questioning by Mr. Rodé, Mr. Marcel’s counsel, Dr. Selhi confirmed that Mr. Marcel was awaiting needed knee surgery. He has had 2 referrals to date, but his appointment has yet to be confirmed. Dr. Selhi also noted that Mr. Marcel was disinclined to have the surgery until such time as he has a future placement in the community. In the interim, Mr. Marcel preferred to stay in hospital using whatever alternatives are available to help with fall prevention.
In response to questioning by panel members, Dr. Selhi testified that, as for Mr. Marcel’s current risk for violence, Mr. Marcel was perceived as psychiatrically stable with his Schizophrenia diagnosis primarily considered to be in remission, although he exhibited some low-grade paranoia and frustration on some occasions. Dr. Selhi added that Mr. Marcel’s antisocial personality traits were not that prevalent. However, Dr. Selhi referenced that Mr. Marcel’s mental illness was less stable in 2023, with Mr. Marcel exhibiting far more psychotic symptoms, particularly paranoia, coupled with outbursts of aggression requiring Mr. Marcel’s seclusion.
Dr. Selhi further testified that Mr. Marcel presented as quite mentally stable at present. He communicates in a linear manner. He has fewer delusional comments when conversing with staff. He uses provocative language when frustrated. There has been no physical aggression exhibited by Mr. Marcel. His mental illness continues to remain stable on his current medication regimen; his is optimally treated at this point for his psychiatric condition. However, Mr. Marcel’s main barrier is due to the fact that he is medically/physically compromised, a condition suffered by Mr. Marcel for many years and is getting worse. Accordingly, for this reason Mr. Marcel’s discharge to a community placement (including to TRHP) is not an option at present.
The Hospital Report noted that, in 2012, Mr. Marcel rejected participation in group therapies to assist with Mr. Marcel gaining insight into his diagnosed mental illness. Dr. Selhi testified that, since then, with Mr. Marcel being asked many times whether he would participate, Mr. Marcel declined indicating that he was not interested in that type of programming.
Dr. Selhi testified that Mr. Marcel’s mental illness condition is quite sensitive to his prescribed medication regimen. According to Dr. Selhi, Mr. Marcel’s difficulties in 2023 related to a medication issue. With medication changes, and Mr. Marcel’s compliance, Mr. Marcel is now doing much better.
When questioned about the risk of Mr. Marcel stopping his prescribed medication regimen should there be a change in Mr. Marcel’s current living arrangements, Dr. Selhi testified it was unlikely there would be any significant change should Mr. Marcel be transferred to another unit in PCH. However, Dr. Selhi cautioned that if Mr. Marcel were to move into the broader community setting, with the added concern that he would consume substances, risk to public safety would be a concern. Dr. Selhi added that any future plan to discharge Mr. Marcel to the community would entail his placement at TRHP where his medication regimen would be administered by staff, but such a move is not contemplated at present due to Mr. Marcel’s medical/physical concerns, as well as Mr. Marcel’s personal concerns about moving into the community without successful knee surgery and physical stability issues being addressed.
Transferring Mr. Marcel to another PCH unit is a necessary first step in order to test Mr. Marcel’s future risk to public safety. Dr. Selhi observed that Mr. Marcel had previously been granted Conditional Discharge Dispositions on two occasions in the past by the Board, but did not do very well, with Mr. Marcel exhibiting aggressive outbursts and being physically assaultive towards security staff. When symptomatic, Dr. Selhi noted that it is quite significant for Mr. Marcel. According to Dr. Selhi, a step-down approach is required for Mr. Marcel’s rehabilitation progress.
Although Mr. Marcel has declined the use of psycho-social interventions, it is hoped that by him moving to a different unit in PCH, Mr. Marcel will become more involved as compared to his current isolated existence in the quiet setting of the forensic unit of PCH.
When questioned about the logic of Mr. Marcel’s current medication regimen that includes substantial doses of both oral and injectable forms of Invega Sustenna, as well as an older form of antipsychotic medication, namely, Risperidone, Dr. Selhi testified that she did not typically change a patient’s medication regimen when she commenced overseeing their psychiatric care. Dr. Selhi added that she was not the physician who originally decided to implement Mr. Marcel’s medication regimen but noted that she was disinclined to alter it as it seems to be effective for Mr. Marcel, and Mr. Marcel accepts it.
It was noted by a panel member that, while Mr. Marcel’s physical limitations are significant and an overriding factor, the current global risk assessment report information provided in the Hospital Report fails to address Mr. Marcel’s physical limitations at all. It was further noted that this aspect of risk assessment needed to be better articulated in any future Hospital Report.
It was further observed that the current Hospital Report lacks a proper summary of Mr. Marcel’s gestalt. As a further example, it was noted that the Hospital Report references Mr. Marcel’s 2021 risk assessment report but lacks citing details, including, for example, information concerning the most serious conduct touching upon Mr. Marcel’s risk of violence. There appeared to be limited details of Mr. Marcel’s most significant aggressive event from July 2023. The circumstances were briefly noted at page 53 of the current Hospital Report from an earlier reporting period, as follows:
“Mr. Marcel’s most significant aggressive event over the reporting period occurred in July 2023, where he had a brief, two-day seclusion after an altercation with nursing staff. During this episode, he made death threats, resisted a security escorted walk to the observation suite, and hit/spit on several security personnel. He also scored a 7 on the AIS (violent assault – antecedents identifiable), and was declared a code white, signifying a high degree of violence risk.”
As for Mr. Marcel’s history of unsuccessfully abiding by the terms of two previously issued Conditional Discharge Dispositions of the Board, Dr. Selhi was uncertain whether the certification provisions of the Mental Health Act (“MHA”) would be sufficient to return Mr. Marcel to hospital as needed, as history noted that he would require quick and urgent rehospitalization if he suffered decompensation in the community. As an example, the staff at TRHP, Mr. Marcel’s previous community placement, indicated that they would not accept Mr. Marcel back to their home without the provisions of a Detention Order in place for Mr. Marcel. Therefore, the hospital required the ability to bring Mr. Marcel back into hospital quickly under a Detention Disposition.
Given Mr. Marcel’s capacity to become quite violent in his current state, it was suggested that a more fulsome and up-to-date risk assessment should be contemplated to be conducted by Dr. Selhi and Mr. Marcel’s treatment team.
In response, Dr. Selhi noted that she has not completed her own overall risk assessment of Mr. Marcel but agreed that, if and when Mr. Marcel achieves stability at hospital and is ready for community living, a further assessment was needed. Dr. Selhi wished to see how Mr. Marcel manages himself outside the forensic unit at PCH. However, in support of her current opinion concerning Mr. Marcel’s risk of violence, Dr. Selhi referenced the circumstances of the index offence. [Note, however, that the summary provided concerning the index offence does not detail what instrument was used to commit the stabbing, namely, either a set of keys (upon which blood was located) or some other device]. Clearly, any future Hospital Report needs to include this detailed information concerning Mr. Marcel’s risk for violence.
When asked whether Mr. Marcel was currently able to carry out acts of aggression given his physical limitations, Dr. Selhi answered in the affirmative, opining that Mr. Marcel meets the threshold for being a significant threat to public safety, and that the necessary and appropriate Disposition is a continuation of a Detention Order.
In re-examination by Ms. Tom, counsel for PCH, Dr. Selhi testified that it is important that the Hospital be able to approve Mr. Marcel’s eventual accommodation in the community, given that PCH would like to ensure there is less risk to public safety by having Mr. Marcel reside in a structured residential program as compared to any unsupervised independent living arrangement. Mr. Marcel requires a step-down process for reintegration into the community, with approved accommodation in a structured environment will ensure Mr. marcel receives his prescribed medications to ensure his ongoing stabilization, addressing his many medical/physical problems, monitor any potential use of substances, and assist with future risk assessments.
No further evidence was presented at the hearing by the parties.
Conclusion and Disposition
Having considered all the evidence presented at the hearing, the Board finds that Mr. Marcel continues to pose a significant threat to the safety of the public as set out in s. 672.5401 of the Criminal Code. We make this finding based on the evidence of Dr. Selhi and the evidence contained in the Hospital Report, independently of the joint submission on significant threat from the parties.
Mr. Marcel is a 53-year-old man diagnosed with schizophrenia, alcohol and cannabis use disorders (in sustained remission), and antisocial personality disorder. He has a history of assaultive behaviour, both in hospital and in the community, and the index offence involved the use of a weapon. All these factors contribute to his significant risk to the safety of the community.
Mr. Marcel has continued to struggle with frustration tolerance, verbal aggression, and at times, paranoia. Although typically mild and self-limited, as noted from July 2023, Mr. Marcel’s unpredictable behavior led to a significant episode of aggression and a brief seclusion. Changes to his medication regimen have shown some improvement in his mental health condition.
Mr. Marcel has limited insight and has not engaged in any formal psychosocial interventions to improve his insight, symptoms of psychosis, or emotion regulation, The evidence is clear that Mr. Marcel requires optimized pharmacological treatment, ongoing clinical support, and supervision to prevent the recurrence of inappropriate and aggressive behaviour and the potential relapse in his mental state, as seen on past occasions. In this regard, we accept the risk assessment noted in the Hospital Report which indicates that in the absence of an ORB Disposition, Mr. Marcel’s risk would likely be high.
To his credit, Mr. Marcel has shown improvement in his behaviour over the past several months. His medication has been changed, yielding a positive effect on his overall mental stability and there have been less frequent and less intense events occurring, with no significant aggressive outbursts. Subject to Mr. Marcel having his medical/physical issues addressed (including contemplated knee surgery), it is hoped that Mr. Marcel can be initially transitioned to another unit at PCH as the first phase of step-down towards community reintegration. Thereafter, should Mr. Marcel continue his positive trajectory, it may be that he can return to his previous structured community residence at TRHP.
Although not advanced by the parties, we find that a Conditional Discharge Disposition nevertheless has no air of reality. Given his risk factors and past behaviour, Mr. Marcel requires supervised accommodation, approved by the hospital. The Hospital also requires the ability to bring Mr. Marcel back into hospital quickly under a Detention Disposition to prevent any escalation of aggressive behaviour, most notably as historically noted to TRHP housing staff, should he begin to decompensate. As such, the specific requirements under the MHA would not suffice to manage the risk.
For the reasons set out above, and most notably the high risk of Mr. Marcel’s impulsiveness and acting out aggressively and causing significant harm, we came to the unanimous conclusion that the most appropriate and necessary Disposition is the continuation of the existing Disposition, namely, a Detention Order within PCH, with the same conditions and privileges as were contained in last year’s Disposition, save and except for one amendment – to paragraph #1 – to delete the words “the Secure Forensic Unit of”, so that it now states: “detained at Providence Care Hospital, Kingston.”. This amendment will permit the hospital in its discretion, based on the advice of Dr. Selhi and the treatment team, to transfer Mr. Marcel to a non-forensic unit at PCH as the first phase of a step-down approach to Mr. Marcel’s rehabilitation taking into account the risk to public safety.
As noted earlier in these Reasons, the Board adds that, given Mr. Marcel's capacity to become quite violent in his current state, a more fulsome and up-to-date risk assessment should be contemplated, to be conducted by Dr. Selhi and Mr. Marcel's treatment team.
The Board wishes Mr. Marcel every success concerning his recovery in the upcoming year. By hopefully being able to address his medical/physical needs, and by demonstrating appropriate behaviour, as well as following the advice and direction of Dr. Selhi and the treatment team, and being compliant with his medication regimen, Mr. Marcel can look forward to the prospect of undergoing the step-down process of transferring to a non-forensic unit at PCH, followed, hopefully, with securing a placement at the TRHP facility in the community.
In making this Disposition, the Board carefully considered the joint position of the parties, the evidence of Dr. Selhi, and the contents of the Hospital Report entered as an exhibit at the hearing and was satisfied that this determination is both necessary and appropriate. The Board reviewed the provisions of sections 672.54 and 672.5401 of the Criminal Code and carefully considered the need to protect the public from dangerous persons (with the public's safety being the Board's paramount consideration), Mr. Marcel’s mental condition and his reintegration into society and other needs.
DATED this 5th day of May 2025, at the City of Toronto, in the Toronto Region.
Mr. John Hanbidge Alternate Chairperson
Office of the Registrar
Ontario Review Board