Re: Suzanne Schafer
ORB File No: 8440
Hearing held on: Friday, March 28, 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. M. Labrosse Members: Dr. P. Prendergast Dr. L.O. Lightfoot Ms. L. Banks Mr. A. Bouvier
Parties Appearing:
Accused: Suzanne Schafer Amicus Curiae: Ms. C. Whillier
The person in charge of hospital: Counsel: Ms. J. Szabo
Attorney General of Ontario: Counsel: Mr. C. Waite
REASONS FOR DISPOSITION
(Dated May 14, 2025)
Introduction
On October 24, 2023, Suzanne Schafer was found not criminally responsible on account of mental disorder on a charge of aggravated assault, contrary to the Criminal Code of Canada.
Ms. Schafer is currently subject to an Ontario Review Board Disposition dated April 8, 2024, which detains her at the Forensic Service of the Centre for Addiction and Mental Health, Toronto, and includes permission to live in the community in accommodation approved by the person in charge.
On March 28, 2025, the Ontario Review Board (“ORB”) convened a hearing at the Centre for Addiction and Mental Health, Toronto, hereinafter referred to as “CAMH” and/or the hospital, to conduct the annual review of Ms. Schafer’s Disposition pursuant to s. 672.81(1) of the Criminal Code. Ms. Schafer was present for the hearing and was not represented by counsel. Ms. Carla Whillier was appointed by the Board to act as Amicus Curiae for the hearing. The Hospital Report dated March 5, 2025, was entered as Exhibit 1 for the hearing.
The issues for the hearing are whether Ms. Schafer continues to pose a significant threat to the safety of the public and, if so, to determine the necessary and appropriate Disposition having regard to the factors enunciated at s. 672.54 of the Criminal Code.
For the reasons set out below, the Board finds that Ms. Schafer continues to pose a significant threat to the safety of the public and that a detention order continues to be the necessary and appropriate Disposition albeit with a reduced reporting requirement of not less than once every four weeks.
Index Offences
- The circumstances of the index offences are extracted from last year's Reasons for Disposition, as follows:
“Ms. Schafer and her mother, Mrs. Schafer, have lived together in the parental home for many years, in an uncommonly close parent-child relationship. On the evening of November 9, 2021, they followed their longstanding routine, in which Ms. Schafer read to her mother, and then they went to sleep in their shared bed. At about 4:35 a.m. that night, now November 10th, her mother woke up to Ms. Schafer screaming incoherently and striking her repeatedly on the head with items including a patio brick, bottle, and radio. Her mother yelled at her to stop, and she began throwing items around the room and pushed her mother to the floor. Her mother lost consciousness briefly, and then told Ms. Schafer to call the police. Ms. Schafer asked, “Where am I?”, and her mother told her she was upstairs, and instructed her to go downstairs and call an ambulance.
Ms. Schafer called 911. On the call, she was screaming unintelligibly and then suddenly stopped responding. The 911 dispatcher called back, and again she was screaming, and saying “I did something terrible”, “I don’t know what happened”, and “help”. She again stopped responding, walked away from the phone, and was heard screaming at a distance.
When police arrived at 4:51 a.m. Ms. Schafer was on the sidewalk outside the house, pacing and stumbling, covered in blood, and acting in a bizarre way, screaming incoherently and randomly moving her arms. She said that she hit her mother with a bottle, heard voices telling her to do so, did not know what was going on, and that she had head pain and wanted to sleep. She was arrested, and when paramedics arrived, was sedated and taken by ambulance to Credit Valley Hospital.
In the emergency department, she was cold and shaking, seemed more calm and aware, not expressing a lot of emotion but still randomly moving both arms. She reported that she had had trouble falling asleep that night, then awoke some time after 4 a.m., went downstairs to the washroom and to get a drink, and on her way back upstairs, heard voices saying “hit” repeatedly, and started to hit her mother and could not control herself. The voices were louder than her mother screaming for her to stop.
Ms. Schafer’s mother had been found sitting in a pool of blood, with several gaping wounds on her head, and been taken by ambulance to the same hospital for immediate medical attention. She had sustained blunt force trauma to her head, which required many staples, and many stitches across her forehead, to mend.”
Background History
Ms. Schafer’s personal, legal, and psychiatric history are set out in detail in the Hospital Report. Briefly summarized, Ms. Schafer is currently 57 years of age and is the only child of parents who were born in Germany and came to Canada, where she was born. Her mother worked as a homemaker, and her father as an engineer.
The family moved to Mississauga when she was a teenager, in the early 1980’s. In high school, she did very well academically and took part in extra-curricular activities. She went to University of Toronto, Mississauga (‘UTM’), on a scholarship that she maintained each year. She completed a B.A. with a specialization in languages; followed by an M.A. in German art and literature, while beginning as a Teacher’s Assistant. She started a doctoral degree in German literature in 1991.
Unexpectedly, her father died in August 1992. He was at home, having recently returned from working in Indonesia, when he fell from a ladder, suffering a head injury. Ms. Schafer tried to resuscitate him, sadly to no avail. She has said that, when her father died, she lost any aspirations she had, found it difficult to concentrate, and not much gave her pleasure, but that her mood and concentration improved after a few years.
A later assessment at Credit Valley Hospital described Ms. Schafer as having had a period of depression lasting five years, following her father's death. She has said that her mother took his death very hard. She committed herself to her mother’s care and well-being, to an unusually exceptional degree. She had no other relatives, friends, close colleagues, or supports for herself. She initially started keeping her mother company at night, and they established a routine of sharing the bed in her mother’s bedroom.
Ms. Schafer returned to her TA work in September 1992. She did not do well that year in her doctoral work, and ultimately left the PhD program, later declining an offer to return to it.
Ms. Schafer has described a deterioration in her mental state at the end of the summer of 2021, with a fixation on a perceived failure in her work and significant rumination. She began to feel unwell on or about October 15, 2021, with nausea, sleeplessness, loss of concentration, and worrying.
On November 8, 2021, two days before the index offence, she made a bleach mixture and brought it to work, planning to drink it and die. She did not drink it, and later described having found herself with the bleach, not knowing why and not remembering contemplating suicide.
The next day, Ms. Schafer recalled having a typical day, including taking an afternoon bus into town to give a tutoring lesson. In the early hours of November 10th, she had only a blurry, fragmented memory of standing by her mother’s side of the bed holding the bottle, a loud voice saying “hit her”, screaming uncontrollably, and uncontrollably hitting her mother. She recalled her mother being on the floor, then it going quiet all of a sudden, her mother telling her to call 911, being unable to speak coherently on the call, and not knowing what was going on.
Ms. Schafer’s current diagnoses include major depression with psychotic symptoms (in remission) and schizoid personality traits.
Evidence at the Hearing
The hospital's evidence was presented through its report and through the oral testimony of Dr. J. Dupré, who has been Ms. Schafer’s attending psychiatrist since August 2024.
Dr. Dupré adopted the contents of the Hospital Report and advised that there were no material updates to provide since the completion of the report.
At the commencement of the reporting year, Ms. Schafer was followed in EFOPS (Extended Forensic Outpatient Services) by Dr. Benassi and her caseworker, Ms. Dam. In April of 2024 the EFOPS team met with Ms. Schafer and her mother at the family home. Ms. Schafer's mother expressed a desire to have her daughter returned to the residence and indicated that she understood that there could be a risk of future mental health decompensation. Mrs. Schafer accepted these risks and felt the benefits of living together with her daughter outweighed them. Accordingly, the hospital approved Ms. Schafer’s return to her mother's residence which occurred on May 17, 2024. The EFOPS team again met with Mrs. Schafer in the fall of 2024 to conduct an additional home visit where Mrs. Schafer indicated that she had no concerns about her daughter living at home with her since May of 2024.
Ms. Schafer has continued to report weekly to her EFOPS case manager and sees Dr. Dupré once per month. She has been compliant with all of her reporting requirements and there have been no readmissions to hospital or emergency department visits in the past year.
Ms. Schafer is currently not treated with any medication. She is capable of consenting to psychiatric treatment. In addition to receiving Ms. Shafer’s self-reports, the hospital has monitored her mental state and there has been no evidence of any depressive or psychotic symptoms throughout the reporting year.
Ms. Schafer expresses shame surrounding the index offence and the stigma associated with criminalization and her tenure under the ORB. She has displayed an anxious affect when discussing these issues. According to Dr. Dupré, she has also evidenced some symptoms consistent with post-traumatic stress, including avoidance of external reminders, negative mood such as guilt and shame, and disrupted sleep. Dr. Dupré advised that she has provided psychoeducation to Ms. Schafer about antidepressant medication, sleeping aids, and Prazosin, a medication used in the treatment of PTSD for night-time hyperarousal and nightmares. Ms. Schafer has continued to decline medication and prefers to continue to monitor her symptoms. She has indicated that she would be open to medication if it was a strong recommendation of the team or if it would be helpful to secure a conditional discharge.
With respect to her insight, Ms. Schafer has applied herself conscientiously over the past year to understand her psychiatric diagnosis and has done much reading. She has stated that she accepts the diagnosis of depression. Ms. Schafer continues to hold the belief that her symptoms were related to having received a COVID-19 vaccine that she received, although she acknowledges that her psychiatrists have not agreed with that.
Ms. Schafer briefly took antidepressant medication and noticed no decrease in her mood once these were stopped. She discontinued the antidepressant medication, complaining of brain fog which was an intolerable side effect for her given her work as a university lecturer. Ms. Schafer also had a brief trial of antipsychotic medication which also caused her side effects. Dr. Dupré described Ms. Schafer’s psychosis as being “ultra-brief”, the symptoms of which went away before antipsychotic medication was started. Dr. Dupré is not convinced that it would be helpful at this point to start a prophylactic course of antipsychotic medication.
Ms. Schafer is currently engaged and participating in two modalities of treatment for her major depressive disorder including psychological 1:1 counseling with Dr. Pynoo, which she has been doing since December of 2024. She is also involved in behavioural activation therapy for which she has been described as very enthusiastically engaged in social activities at the hospital.
Dr. Dupré confirmed that she and Ms. Schafer continued to talk about the possible benefits of antidepressant medication. Dr. Dupré acknowledges that it is Ms. Schafer’s choice. There are currently no symptoms of depression observed in Ms. Schafer. The hospital will raise the issue of medication once again should there be a recurrence of symptoms.
For the coming year, Ms. Schafer will continue to work with Dr. Pynoo on understanding her diagnosis and increasing her coping skills and ability to deal with stress. It is expected that Ms. Schafer will continue to come to the hospital to attend the behavioural and social activation programming that she has enjoyed over the past year. According to Dr. Dupré, Ms. Schafer is very internally motivated to continue with this programming.
In response to questions posed to her by counsel for the Attorney General, Mr. Waite, Dr. Dupré confirmed that the services and programming available to Ms. Schafer would not meaningfully change under a conditional discharge.
The hospital is recommending the maintenance of a detention order with a reduced reporting frequency of not less than once every four weeks. Dr. Dupré explained that the reduction in reporting will be done very slowly and most likely only towards the outer envelope of the reporting year.
Despite Ms. Schafer's cooperation and adherence to her Disposition, including reporting to the hospital as required and the fact that she has not experienced any sort of relapse, the hospital believes that a conditional discharge may not be adequate to address the rapidity of the onset of psychosis that Ms. Schafer experienced at the time of the index offences. How Ms. Schafer would respond to any further symptoms remains unknown. In addition, the person who is at primary risk is Ms. Schafer's mother with whom she now lives once again.
It is reported that Ms. Schafer and her mother no longer share a bed; however, Dr. Dupré is of the opinion that as they have resumed living together a detention order is required to manage the ongoing risk given that Mrs. Schafer is at primary risk of harm. Additionally, a detention order would allow the hospital to continue to approve accommodation such that if it was felt that there was any heightened risk to Ms. Schafer’s mother, the hospital could withdraw the approval of current accommodation.
Dr. Dupré confirmed that counselling is available for Ms. Schafer's mother, but this has not happened yet. When the team met with Ms. Schafer's mother to discuss the issue of risk, Mrs. Schafer indicated that she was aware of the risk but wanted her daughter to move back to the house. The treatment team believes that though Mrs. Schafer states that she fully appreciates the risk, she may be minimizing it to some extent. As a result of discussions with the treatment team, Mrs. Schafer was able to identify changes in her daughter’s sleep pattern brought about by stressors in her life such as when she underwent a change of psychiatrist. Dr. Dupré acknowledges that though Mrs. Schafer’s level of insight may not be high, the risk to her is currently being managed with ongoing supervision.
In response to a question posed to her by Ms. Schafer, Dr. Dupré acknowledged that Ms. Schafer has formed good therapeutic alliances with the treatment team and that those relationships are founded on trust and very good engagement on the part of Ms. Schafer.
In response to questions posed to her by Amicus, Ms. Whillier, Dr. Dupré indicated that she does not know how Ms. Schafer would respond if there was a request by the treatment team that she attend at the hospital. If she becomes symptomatic and unwell, it is unclear what kind of insight she would maintain in the face of increased symptomology. Dr. Dupré acknowledged that Ms. Schafer is asking for a greater frequency of reporting than the hospital is requesting and that she believes that Ms. Schafer will continue to report. Dr. Dupré was not able to confirm whether the change in sleeping arrangements at the house was because of the hospital’s request or whether this was decided by Ms. Schafer herself.
In response to questions posed to her by members for the panel, Dr. Dupré responded as follows:
a) Though Ms. Schafer does not have any previous diagnosis of depression, Dr. Dupré is of the view that she most likely was experiencing an episode of depression after the death of her father when she was attending university. Ms. Schafer experienced low mood and anhedonia and according to Dr. Dupré this was most likely an episode of depression. Given that Ms. Schafer has experienced episodic depression, it increases the likelihood for further depressive episodes in the future. Dr. Dupré confirmed that when the team had met with Mrs. Schafer to discuss the possibility of further symptoms of depression, they were taking a trauma-informed approach to this as the team is mindful of what the family has gone through both in relation to the death of Ms. Schafer’s father and the index offence.
b) The team does not believe that a conditional discharge with a Young provision would be adequate to ensure that Ms. Schafer can be admitted to hospital in the event of a further episode of psychotic depression. Only the detention order would enable the hospital to act swiftly and to admit Ms. Schafer if necessary.
c) Dr. Dupré acknowledged that the hospital remains cautious as Ms. Schafer has not been involved with the forensic system for very long. She acknowledged that there have been no negative events in the past year; however, given the severity of the episode at the time of the index offence and the fact that it is still in the relative near past, the hospital believes that a conditional discharge is premature.
d) Ms. Schafer's continued engagement in psychological therapy with an emphasis on developing a better ability to recognize symptoms will be important to maintain her progress over the course of the next year.
e) Dr. Dupré confirmed that she does not believe that Ms. Schafer’s mother would respond to counseling or be amenable to it. Dr. Dupré confirmed that Ms. Schafer's mother remains the primary person at risk in the event of a further episode of psychosis. Given the rapidity of the onset of the psychotic episode, the hospital believes that the risk remains greatest for somebody who is living with Ms. Schafer.
f) Dr. Dupré acknowledged that Ms. Schafer is a very pro-social person with no history of violence.
g) Ms. Schafer remains involved with EFOPS, the Extended Forensic Outpatient Services, which provides closer supervision and additionally, provides the benefit of a case manager that can go out to meet with Ms. Schafer in her community of Mississauga.
- In response questions arising by Mr. Waite from the Panel’s questions, Dr. Dupré confirmed that there have been no noted depressive symptoms over the course of the past year and that the treatment team continues to monitor that through observations, clinical interview and psychometric testing. If Ms. Schafer was to start demonstrating depressive symptoms there would likely be a corresponding decreased participation in hospital programming and at that time the hospital would likely recommend the start of antidepressant medication.
Evidence of Suzanne Schafer
Ms. Schafer testified at her hearing and indicated that she had debated whether just to accept the recommendations of the hospital for the maintenance of a detention order.
Ms. Shafer went into detail to illustrate what she has done over the course of the past year to deal with her situation. She completed the RAP program offered to her by the hospital which targets stress and how to cope with stress. She did that program over two months between May to July 2024 during which she learned about triggers and early warning signs and how to deal with emotional distress.
Ms. Schafer stated that it caused her great stress when she was told that she would have to switch psychiatrists. In addition to having to recount the index offence, she was concerned that her new psychiatrist might not agree that she should be living with her mother or might push her to try to take medication.
Ms. Schafer explained that she has been very careful about monitoring her own mental status and does self-check-ins on a regular basis. She explained that at one point she had started journaling her self- check-ins but has since stopped doing that and has continued to simply do it without writing it down.
Ms. Schafer stated that she has had some very stressful periods over the course of the past year including having to care for her mother after cataract surgery which included having to come into her room at night. Ms. Schafer explained that she started to wake her mother up before she enters the room by playing the radio. She also explained that she had been coping with the stress of her teaching position and exams and having to take her mother to the hospital for another health-related event. Ms. Schafer explained that she has gone through all of this while being under the supervision of CAMH. She feels that she has developed some good coping strategies, particularly in the two years and three months after the index offence, before the NCR verdict, where she was living on her own in a hotel. Ms. Schafer did not have contact with her mother between November 2021 and May 2022 due to her bail conditions. She also accused of fraud when transferring money from one account to another. She feels that she was able to cope adequately with all of these stressors.
Ms. Schafer stated that she has had 15 sessions of psychological counseling and that she accepted this willingly when it was offered to her. In counseling she has covered the issues of stigma around the ORB disposition, how to make new connections, how to find new friends and what to reveal to those people about her situation in order to create lasting relationships. They have discussed her diagnosis in depth, problems with emotional regulation, mindfulness and relationships with people outside of the home, such as with neighbours.
Ms. Schafer also talked about rebuilding the relationship with her mother and that though they did talk about things initially, her mother does not want to talk about it again. Ms. Schafer stated that in her family emotions were rarely discussed. Her parents were war children, and their focus is on living in the present rather than dwelling on the past.
Ms. Schafer also believes that her mother is willing to take the risk of living with her as it is worse to be apart. Ms. Schafer stated that she has been living in the home for 316 days without incident.
Regarding the concerns that she may not come into hospital if she was ill, Ms. Schafer stated that she now knows the hospital and knows her symptoms. She believes that there would be little risk that she would not come to the hospital as she would not want to jeopardize her situation.
In response to a question posed by a panel member, Ms. Schafer stated that following the death of her father, neither she nor her mother had any counseling or therapy and that the family doctor was not helpful and simply offered medication.
No other evidence was presented.
Submissions of the Parties
The hospital submits that Ms. Schafer continues to pose a significant threat to the safety of the public and that a detention order with a reduced reporting frequency to not less than once every four weeks is the necessary and appropriate disposition.
Counsel for the Attorney General, Ms. Szabo, indicated her support of the hospital recommendation, while acknowledging the remarkable steps that Ms. Schafer has taken in the past year.
Ms. Schafer stated that she understands the hospital’s recommendation, and the request to maintain the ability to remove her from the home if she became ill again. Ms. Schafer’s main goal is to remain in the family home with her mother and she is doing everything that she can to reduce her risk.
Analysis and Disposition
- Having considered all of the evidence presented at the hearing, and the submissions of the parties, the Board finds that Ms. Schafer continues to meet the threshold of significant threat to the safety of the public as set out in s. 672.5401 of the Criminal Code of Canada and as further defined in Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625. This was not contested at the hearing. The basis for that finding is well summarized at pages 30-31of the Hospital Report under the heading Re-offence Scenario and Assessment of Significant Threat as follow:
“Ms. Schaffer is a 57-year-old single woman with no previous violent offences and no past history of diagnosed major mental disorder, but likely she had previous undiagnosed depression. Prior to the index offence, she was living at home with her mother in the family home where they had resided together for more than 40 years. Ms. Schafer and her mother have an atypically close and codependent relationship with few outside interests and no external sources of personal support. Prior to the index offence, they spent almost all their free time with one another and shared a bed to sleep. Ms. Schafer reported the sudden violent death of her father as having shaped her adult life, accounting for her lack of friends or other relationships. It is likely, however, that her schizoid personality traits both shaped the way she responded to the trauma and how she subsequently interfaced with the outside world.
Regarding risk factors, her history of major depression with psychosis, stress and coping, and living situation are the primary risk factors. Regarding protective factors, her intelligence, her work, her positive attitude toward authority, her willingness to comply with treatment or obligations made of her, and her pro-social life goals are significant.
There is no evidence that Ms. Schafer presents a risk to the public at large; the only foreseeable victim is her mother. Ms. Schafer loves her mother dearly and values her ability to remain living with her highly. The index offense was entirely out of character and occurred in the context of what appeared to be a depressive episode associated with brief psychosis.
According to R. v. Winko, a ‘significant threat to the safety of the public’ means a real risk of physical or psychological harm to members of the public that is serious in the sense of going beyond the merely trivial or annoying. The conduct giving rise to the harm must be criminal in nature. Further, it is noted that evidence to determine whether an individual is a significant threat to the safety of the public can include the past and expected course of the NCR accused’s treatment, if any, the present state of the NCR accused’s medical condition, the NCR accused’s own plans for the future, the support services existing for the NCR accused in the community, as well as other items.
Absent the ORB, Ms. Schafer would live without supervision or other personal support. She would not develop any further insight or coping skills regarding her personality structure. She would not be removed from her mother’s home after showing signs of decompensation of her mental state. Without any professional or social support, and because of the age and vulnerability of her mother, as well as her mother’s lack of understanding or awareness of her daughter’s mental illness, her mother would not be able to recognize or to summons help for her daughter should her mental health deteriorate. Therefore, Ms. Ingrid Schafer would be at risk of significant harm should her daughter experience a further depressive episode with psychosis. For that reason, it is our opinion that Ms. Schafer represents a significant threat to public safety from a psychiatric perspective based on the factors noted above. »
Shortly after her Initial Hearing before the ORB, Ms. Schafer was permitted to return to the family home following a meeting between Ms. Schafer, her mother and members of the treatment team. This was the ardent wish of both Ms. Schafer and her mother, and so far, things appear to be going well. Ms. Schafer has insight into the fact that her mother would be at risk, were she to experience another episode of psychosis.
Ms. Schafer has meaningfully engaged in psychosocial treatment in the past year since being under an ORB Disposition, in an effort to better understand her diagnosis and to participate in recreational and social programming at the hospital. Psychological counselling was started recently in December 2024 and Ms. Schafer meets regularly with the hospital psychologist, Dr. Pynoo. The goal of this therapy is to assist Ms. Schafer in discussing and better identifying her inner mental state and to provide her with tools to cognitively understand what happened and be better prepared to cope with future stressors.
While she has clearly engaged in her rehabilitation, Ms. Schafer remains untreated. After a brief trial of antidepressant medication and anti-psychotic medication, both of which caused intolerable side-effects for her, Ms. Schafer, who is capable of consenting to treatment, has opted not to take medication.
The rapidity of the onset of psychosis at the time of the index offences is very concerning. It remains unknown whether Ms. Schafer would maintain insight if she were to become rapidly unwell again and whether she would cooperate with a request for admission. At this time, the hospital believes that a detention order is necessary to manage the risk in the event of another rapid and extreme episode of psychosis to effect swift readmission to hospital. In addition, if there are signs that Ms. Schafer is becoming unwell, the hospital may have to reconsider whether the family home can remain an approved accommodation, given that Ms. Schafer’s mother is the person at risk. For these reasons, we agree with the hospital that a conditional discharge is premature.
We commend Ms. Schafer for the efforts undertaken by her in the past year. We encourage her to maintain that level of engagement and continue working on better understanding her mental health and symptom management through continued psychological counselling and other hospital programming.
Having considered the four factors set out in s. 672.54 of the Criminal Code, namely the protection of the public which is the paramount consideration, the mental condition of the accused, her reintegration into society and her other needs, the Board finds that the current detention order, on the same terms and conditions, but with a reduction in the reporting frequency to not less than once every four weeks, remains the necessary and appropriate, least onerous and least restrictive Disposition in all of the circumstances.
DATED this 14th day of May, 2025, at the City of Toronto, in the Region of Toronto.
Ms. M. Labrosse Alternate Chairperson
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Office of the Registrar Ontario Review Board