Re: Melissa Revill
ORB File No: 8755
Hearing held on: Tuesday, April 29, 2025
Place of hearing: St. Joseph's Healthcare Hamilton, West 5th Campus
Pursuant to: Section 672.47(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. L. Banks
Members: Dr. R. Kunjukrishnan (by Zoom Video-conference)
Dr. Dr. G. Stones
Ms. N. Nathanson
Mr. A. Mete
Parties Appearing:
Accused: Melissa Revill
Counsel: Mr. A. Confente
The person in charge of hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Mr. B. Adsett
REASONS FOR DISPOSITION
(Dated May 9, 2025)
Introduction:
On March 24, 2025, Ms. M. Revill was found not criminally responsible on account of mental disorder (“NCR”) on a charge of break and enter and utter threats, contrary to the Criminal Code of Canada (the “Criminal Code”), in relation to incidents that occurred on and December 23, 2024, respectively. On finding Ms. Revill NCR, the Court did not make a Disposition but referred the matter to the Ontario Review Board (“ORB” or the “Board”) for an initial hearing.
On April 29, 2025, a panel of the ORB convened a hearing to make a Disposition as required pursuant to s.672.47(1) of the Criminal Code. Ms. Revill was present at the hearing with his counsel, Mr. Confente. Ms. Revill was also supported at the hearing by her mother.
The issues to be decided at this hearing are whether Ms. Revill meets the test of posing a significant risk to the safety of the public and, if so, a decision as to the necessary and appropriate Disposition to be made in the circumstances, including conditions to be attached to that Disposition, bearing in mind the four factors set out in s. 672.54 of the Criminal Code.
For the reasons set out below, the Board unanimously finds that Ms. Revill represents a significant threat to the safety of the public. The Board finds that the necessary and appropriate Disposition is that she be bound by the terms of a Detention Order Disposition within the Forensic Psychiatry Program at St. Joseph's Healthcare Hamilton (“St. Joseph’s or the “hospital”), all as set forth at the conclusion of these Reasons.
Positions of the Parties:
At the commencement of the hearing, all parties were canvassed as to their initial recommendations to the Board. Counsel for the hospital submitted that Ms. Revill represents a significant threat to public safety and that she should be ordered detained within the Forensic Psychiatry Program at the hospital with privileges extending as outlined at the conclusion of the Hospital Report; however, the hospital, in consultation with the other parties to the hearing, recommended the removal of the prohibition on Ms. Revill’s use of incendiary devices.
Counsel for the Attorney General supported the hospital's recommendation regarding significant threat and the proposed Disposition.
Mr. Confente submitted that his client concedes the issue of significant threat for the purposes of this hearing and joins in the hospital’s recommendation.
All parties maintained their joint recommendations to the Board in closing submissions.
Index Offences:
- The circumstances of the index offences are set forth in detail in the Hospital Report to the ORB dated April 23, 2025 (the “Hospital Report”) and may be summarized as follows:
“On September 19, 2024, Police were dispatched to a ‘Suspicious Person’ call at 1 Mayfair Place, City of Hamilton. The homeowner was not home but a family friend, William PRANGLEY, who parks in their driveway and walks to McMaster University for classes, observed a woman in the backyard of the property and called his mother Kate PRANGLEY. Kate reported the incident to Police and PRANGLEY continued on his way to class.
As Police arrived on scene, another call was dispatched to Officers for an ‘Open Signal Alarm’ at 1 Mayfair Place. The homeowner, Paul SIMON, reported that his front door was open and he could see someone inside the house on his home security camera. SIMON said he was up north and no one should be there.
Police entered the residence through the open door and announced their presence. Police heard a voice coming from the enclosed backyard through a broken window in the living room. Police informed the female located that she was under arrest and cuffed her without incident. She was read her rights to counsel and caution. She did want a lawyer at that time and said that she understood the police caution. The female verbally identified herself as Melissa, she had no surname and added that she was the Queen. Police informed Melissa that she would be charged with obstruct if she did not provide her name. Melissa did not care but did provide her date of birth and Police were able to locate a Melissa REVILL in Niche with matching tattoos and DOB.
McMaster Special Constables had attended the scene as well as they had seen Police lights and Special Constable MANCUSO assisted in the search prior to placing REVILL in the back of the police vehicle.
Police entered the residence again to clear the house and to ensure no one else was inside. Nothing appeared taken and only the window was broken. Kate PRANGLEY arrived on scene and advised that she would secure the house for the night until Paul SIMON arrived home. Police spoke with SIMON who confirmed that he was supportive of charges and was satisfied with Kate staying on scene to secure the premise. SIMON
also confirmed that he did not know REVILL and did not give her permission for her or anyone else to be in his house.
Police transported REVILL to Station 10 custody and while enroute, REVILL stated that she no longer wished to contact a lawyer. REVILL also told Police that she bought that house and that she broke the window because the front door was locked. REVILL also claimed that she tried to turn off the alarm but did not know how. REVILL has multiple mental health occurrences on file with the Hamilton Police Service; no outstanding charges.
On December 23rd 2024, the Hamilton Police responded to a Dollarama located at 90 Main Street in the Town of Dundas within the City of Hamilton to investigate a threatening.
Police learned that at approximately 5:15 pm, the victim observed a transient female who was later identified as the accused concealing items in her jacket. The victim approached the accused and instructed her to return the items to the shelf to which the accused then threw the items and charged toward the exit door. Before exiting the door, the accused smacked the handicap door button and shouted at the victim "the next time I see you I will smash your head in" (Utter Threats to Cause Death/Bodily Harm).
The victim claimed that the accused has made similar threats in the past and has caused prior disturbances at this specific Dollarama. In addition to this, the victim was aware that the same female has pulled knives out on Tim Horton's staff who worked in the same area. The victim claimed to be in genuine fear for her safety. At approximately 7:53 pm, Police located then accused behind a Metro Grocery store on Kerr Street in the Town of Dundas.
As a result of this investigation, Police formed the grounds to arrest the accused for Uttering Threat to Cause Bodily Harm and opposed the accused bail due the Victim's safety and 524 procedural arrest reasons.”
Personal Background:
The Hospital Report outlines Ms. Revill’s history and background and need not be repeated here in detail as this document was entered as an Exhibit at the hearing. Briefly summarized, Ms. Revill was born in Hamilton in 1977. Her parents separated shortly after her birth and thereafter, she had only sporadic contact with her father.
Ms. Revill’s mother reported that Ms. Revill had been sexually assaulted by her father at age 15 but health records indicated this had occurred when she was 12 years old. Ms. Revill dropped out of school after grade 9 and spent much time at home. As a teenager, she presented for psychiatric care for suicidal ideation and depression. Health records indicated that Ms. Revill received counselling as a teenager following the assault. Ms. Revill’s father was charged following the sexual assault of his daughter and other family members.
Ms. Revill began experimenting with cannabis, alcohol, ecstasy, speed, LSD, and hashish during her teenage years. She also experimented with prescription opiates. Over the last 13 years, Ms. Revill has regularly used crystal methamphetamine with brief periods of abstinence.
In recent years, Ms. Revill had been regularly using crack cocaine and alcohol. Her use of substances has resulted in multiple interactions with mobile crisis services and hospital emergency rooms contacts related to substance-induced psychosis, acute intoxication, and aggressive behaviours in the community. Ms. Revill had attended addictions counselling and withdrawal management centres on several occasions but she has never attended a residential treatment facility.
Ms. Revill has three children, all sons. She was involved in a long-term relationship with the father of her two eldest sons; however, he was abusive and she left the relationship after the birth of their second son.
Ms. Revill married in 2002 and had her third son. Her second husband was also abusive towards her and he abused substances. The Children’s Aid Society became involved with the family and Ms. Revill’s two older children were placed in the care of their father and her mother assumed care of her youngest son. Ms. Revill regained custody of her youngest son in 2007 after she left her husband.
In 2008, Ms. Revill became involved in another relationship with a man named Jason. Their relationship was tumultuous and they both regularly used crystal methamphetamine. She remained in this relationship until 2024. Ms. Revill’s mother assumed care of her youngest grandson until 2015 when he was transferred back to his father’s care.
In approximately 2022, Ms. Revill briefly moved to New Brunswick to reside with her mother in an attempt to remain abstinent from substances. At that time, Ms. Revill was described as psychiatrically stable and compliant with her long-acting injectable (“LAI”) antipsychotic medication. She returned to Ontario after five weeks and returned to crystal methamphetamine and crack-cocaine use.
At the time of the index offences, Ms. Revill had recently lost her independent housing and had not been compliant with her LAI of antipsychotic medications since approximately 2022. She was homeless and was financially supported by Ontario Disability Support Program.
Criminal History:
- The Hospital Report cites police information that in 2019 Ms. Revill was convicted of fraud under $5,000, identity theft, and procures to make an identity document. She received a suspended sentence and 3 years-probation.
Psychiatric History:
The Hospital Report indicates that Ms. Revill has an extensive history of psychiatric contacts and fairly brief admissions, commencing in 1994. Reference should be made to pages 6 to 22 of the Hospital Report for detailed particulars surrounding these admissions over the years.
Recurring themes related to many of these psychiatric contacts and admissions relate to Ms. Revill’s experience of depression, suicidality, illicit substance use, medication non-compliance, medication overdoses, stressors related to her volatile relationships, and symptoms of her major mental illness.
At times, she has been brought to hospital by police and has been involuntarily detained under the Mental Health Act (“MHA”). On many other occasions, she has requested in-patient admissions.
Her pattern in the community historically has included her relapsing to substance use and/or non-compliance with prescribed medications.
Prior to the index offences, Ms. Revill was “evicted from her apartment for ongoing interactions with police and crisis services subsequent to aggressive behaviour, substance abuse, psychotic symptoms, and altercations with co-tenants. Health records indicated mobile crisis services attended Ms. Revill’s residence on 13 separate occasions in 2024 for escalating behaviour at her apartment.” (p. 22 Hospital Report)
Current Diagnoses:
- Ms. Revill’s current diagnoses are:
Bipolar 1 Disorder, current manic episode, with
psychotic features;
Stimulant Use Disorder (crystal methamphetamine),
by history; and
Alcohol Use Disorder, by history.
Evidence at the Hearing:
Dr. O. Lee, a PGY6 psychiatric resident working under the supervision of Dr. Duboff, testified at the hearing to supplement the documentary evidence available to the Board. Dr. Lee stated that she was involved in Ms. Revill’s risk assessment and has been involved in her care since her admission to the hospital on February 3, 2025.
Dr. Lee testified that when Ms. Revill was admitted to the hospital for the purposes of a court ordered NCR assessment, she was quite unwell. She was detained on the Forensic Assessment Unit (“FAU”) where she exhibited labile affect. Her mood fluctuated between tearful and agitated. As well, she expressed delusional content about having numerous children and them being abducted. She also expressed grandiosity believing she was royalty and that she owned multiple dwellings. The Hospital Report also indicated that early on in her admission she was expressing persecutory and paranoid delusions. The doctor described Ms. Reville’s thought process as disorganized and tangential and noted that her speech was pressured.
The Hospital Report indicated in reference to the early days of her NCR assessment admission, “Ms. Revill appears to have no awareness she experiences mental illness and adamantly denies any need for mental health support despite the charges she is facing.”
Initially, Ms. Revill was somewhat reclusive to her room and guarded in her interactions with staff, albeit she continued to express delusional content. Over time, she accepted a mild sedative medication to assist her with sleep. Dr. Lee testified that following the introduction of this medication, Ms. Revill’s thoughts and speech slowed down to the point that she was able to meaningfully engage with team members. Her delusional beliefs had become considerably attenuated and she was better able to tolerate her delusions being challenged.
In most interactions with staff, Ms. Revill was polite and cooperative with staff; however, she was noted to have periods of irritability and agitation, particularly in regard to her legal situation and her on-going hospitalization. There were instances where Ms. Revill presented with irritability and agitation with co-patients and there was one incident during a bingo program in which she was involved in a verbal altercation with a co-patient. Extra staff were called to assist in de-escalating Ms. Revill and she was able to be directed to her room to settle.
Dr. Lee stated that Ms. Revill has been assessed as capable to consent to psychiatric treatment and she is treated with a daily oral dose of a mood stabilizing medication, Lamotrigine. She was started on Lamotrigine on April 16, 2025 and the dose of same will continue to be titrated upwards until it is at a therapeutic and optimal dose. She is currently at a dose of 50 mg daily. Dr. Lee testified that this medication must be titrated up slowly. In the past, Ms. Revill was treated at 125 mg daily. Dr. Lee stated that it is possible that Ms. Revill’s treatment with this medication will require augmentation for optimum symptom management. To date, Ms. Revill has not experienced any adverse reaction to the Lamotrigine but the team will stay alert to the emergence of any concerning side effects.
In terms of her current level of insight, Ms. Revill is able to recognize that she suffers from Bi-Polar Disorder and that medication is important to treat her illness. She is able to appreciate that her conduct at the time of the index offences was driven by the fact that she was experiencing a manic episode. She is now better able to understand that her conduct may have been perceived as threatening to others.
In addition to her medication, Dr. Lee testified that another important aspect of Ms. Revill’s treatment will be for Ms. Revill to engage in therapeutic programming to address her substance use challenges. To date, Ms. Revill has not presented with any drug-seeking behaviours. The doctor advised that Ms. Revill is currently involved with the Capacity Building Team to provide her with some background information regarding Concurrent Disorders Programming available at the hospital.
When asked about Ms. Revill’s insight into her substance abuse challenges, Dr. Lee stated that Ms. Revill recognises that substance use has impacted her life; however, she expresses superficial insight into the negative impact of her substance use on her mental illness.
Ms. Revill is noted to be cooperative with the team but she has intermittently become argumentative with co-patients. In response to a question posed by a panel member, Dr. Lee stated that once transferred from the FAU, Ms. Revill will likely be granted privileges on a graduated and step-wise basis.
The Risk Assessment prepared by Dr. Peter Sheridan and contained in the Hospital Report indicates that, “Overall, using the HCR-20 V3, Ms. Revill’s risk for violence is considered moderately low while on a Detention Order disposition and high if granted an Absolute Discharge by the ORB.”
Risk factors relevant to Ms. Revill identified in the Hospital Report and endorsed by Dr. Lee include:
- her ongoing active symptoms of a manic episode (namely, psychosis and affective lability);
- her pharmacological treatment has not yet been optimized;
- her history of non-adherence to prescribed medications;
- her history of falling away from professional psychiatric follow-up services when in the community;
- her significant history of trauma for which Ms. Revill has not received treatment;
- her significant history of substance use, which has historically exacerbated the symptoms of her major mental illness; and
- her under-developed insight across all domains, particularly regarding, the nexus between her substance use and the exacerbation of the symptoms of her illness, and the potential serious consequence of a relapse into a manic episode.
Protective factors for Ms. Revill include: (i) the more recent improvement in her mental state secondary to adherence with a mild sedative (Clonazepam) to assist with her sleep as well as the introduction of mood-stabilizing medication; and (ii) the external oversight of the ORB.
Ms. Revill is supported by her family, including her mother, aunt, older brother, and younger sister. The Hospital Report indicates that her family remains supportive and have attended her court dates over the course of the assessment period.
Dr. Lee stated that Ms. Revill is in the early stages of her tenure under the Board and it is not necessary or appropriate to add a community living privilege at this juncture as its inclusion may be a barrier to her engagement with her care providers. If the hospital finds that Ms. Revill has progressed to the point that a community privilege would be appropriate, then Dr. Lee testified that the hospital would request an early hearing to recommend it be included in her Disposition.
Dr. Lee stated that following the issuance of the Board’s initial Disposition, Ms. Revill will be transferred from the FAU to another unit and she will be assigned a different treating psychiatrist.
In response to a series of questions posed by a panel member, Dr. Lee advised that a Detention Order is the necessary and appropriate Disposition at the current time as Ms. Revill requires a prolonged period of time as an in-patient in order to:
- optimize her medications;
- stabilize her mental state;
- engage her in therapeutic programming, including substance abuse programming, as well as other modalities and programs to improve her insight across all domains (including potentially, CBT for psychosis, and mood regulation);
- interrupt her access to alcohol and other substances of abuse;
- closely monitor and support her; and
- allow her to demonstrate her ability to exercise increasingly liberal privileges while remaining abstinent of substances of abuse, and medication compliant.
According to Dr. Lee, absent forensic oversight, Ms. Revill would be likely to discontinue adhering to her prescribed medication, and relapse to illicit substance use. Over time, the doctor stated that Ms. Revill would be very likely to experience an exacerbation in the symptoms of her illness which would result in elevation of her risk to members of the public.
No further evidence was called by the parties.
Analysis and Conclusions:
- The Board unanimously finds that Ms. Revill poses a significant threat to the safety of the public. In coming to this conclusion, the Board notes the salient risk factors highlighted in the expert evidence of Dr. Lee and in the Hospital Report. Ms. Revill suffers from
Bipolar 1 Disorder with psychotic features. As well, she has a longstanding and recent history of Stimulant Use Disorder (crystal methamphetamine), and Alcohol Use Disorder.
When ill, she has presented with a variety of psychotic symptoms, including delusional beliefs and auditory hallucinations, agitation, disorganized thought and behaviour, and paranoia. She continues to present with clear evidence of active psychotic symptoms of a paranoid nature and she is not yet optimally treated. Her risk profile is further elevated due to her underdeveloped insight into her mental illness, the need for medication, the impact of alcohol and illicit substances on her mental state, and her risk profile.
The panel notes Ms. Revill’s history of non-adherence to psychotropic medication when living in the community which has led to a deterioration in her mental status, with or without substance relapse, resulting in symptoms of psychosis.
This panel finds there is a foreseeable and substantial risk that Ms. Revill would be likely to commit a serious criminal offence, if discharged absolutely. If not under the Board’s jurisdiction, she would be likely to stop her psychiatric medication and suffer a rapid deterioration into an acute psychotic state. In combination with her ongoing alcohol and/or substance use, she would be at high risk to become impulsive and acting out violently. The Board had no difficulty in concluding that Ms. Revill presently poses a significant threat to the safety of the public.
This panel finds that a Detention Order is both necessary and appropriate to safely manage Ms. Revill’s risk to public safety. These are early days in Ms. Revill’s tenure under the ORB’s jurisdiction. Presently, she requires the structured environment of a hospital admission where she can be closely supervised and monitored. We accept the hospital’s evidence that the external structure and oversight provided by an inpatient admission has been an integral part of the improvements in her mental status achieved over the course of her admission. Ms. Revill’s continued detention in hospital will allow the treatment team to work closely with Ms. Revill to support her success in all of the areas identified in paragraph 41 above.
Further, when Ms. Revill is ready for discharge to the community, the hospital will require the authority to approve appropriate and forensically supported housing for Ms. Revill. As well, a Detention Order grants the hospital the ability to address any potential mental status deterioration when she is living in the community and it provides the hospital with an efficient mechanism to expeditiously return her for readmission should she become unwell. Accordingly, the Board accepts the joint recommendation of the parties that Ms. Revill’s risk to the public can only be managed by a Detention Order at the present time. A Conditional Discharge would not provide the hospital with the risk management tools necessary to protect public safety.
Accordingly, we accept Dr. Lee’s evidence that the necessary and appropriate Disposition to safely manage Ms. Revill’s risk is that she be detained in the Forensic Psychiatry Program at the hospital subject to the following privileges, terms and conditions:
- to attend within or outside of the hospital for necessary medical, dental, legal or compassionate purposes;
- hospital and grounds passes, escorted by staff, accompanied by staff or an approved person, or indirectly supervised;
- passes into the community of Southern Ontario escorted by staff, accompanied by staff or an approved person, or indirectly supervised;
- passes to enter the community of Southern Ontario, escorted by staff, accompanied by staff or an approved person, or indirectly supervised;
- she refrain from having in her possession any firearm, ammunition, or other offensive weapons, or being in the company of any person possessing a firearm other than a peace officer;
- she abstain from alcohol, drugs, or any other intoxicant; and
- she submit samples of her urine and/or breath to the person in charge of the hospital or his/her designate as requested by the hospital for the purpose of analyzing whether she has ingested alcohol, drugs or any other intoxicant.
- In making this Disposition, the Board has reviewed the provisions of s. 672.54 of the Criminal Code and has carefully considered the need to protect the public from dangerous persons, Ms. Revill’s mental condition, her reintegration into society and her other needs.
DATED this 9^th^ day of May 2025, at the City of Toronto, in the Toronto Region.
Ms. L. Banks
Alternate Chairperson
_________________________________
Office of the Registrar
Ontario Review Board