Re: Crystal L. Coniam
ORB File No: 8454
Hearing held on: Tuesday, April 29, 2025
Place of hearing: St. Joseph's Healthcare Hamilton, West 5th Campus
Pursuant to: Section 672.48(1) and 672.82(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. L. Banks
Members: Dr. R. Kunjukrishnan (by Zoom Video-conference)
Dr. G. Stones
Ms. N. Nathanson
Mr. A. Mete
Parties Appearing:
Accused: Crystal L. Coniam
Counsel: Ms. K. Edward
The person in charge of hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Mr. B. Adsett
REASONS FOR DISPOSITION
(Dated May 22, 2025)
Introduction:
On March 31, 2025 Crystal Coniam was found unfit to stand trial on Criminal Code charges of assault, assault (choking), mischief under $5000, break and enter, possession of a controlled substance (methamphetamine), fail to attend court and fail to comply.
The Court did not make a Disposition and referred Ms. Coniam to the Ontario Review Board (“ORB” or “the Board”).
On April 29, 2025 the Board convened a hearing pursuant to sections 672.48(1) and 672.82(1) of the Criminal Code. Ms. Conian was present at the hearing with her counsel, Ms. K. Edward.
Ms. Conian had initially been found unfit to stand trial on October 3, 2023. A sixty-day treatment order was issued and she returned to court on December 1, 2023, when she was again found unfit to stand trial. An initial ORB hearing was held on February 1, 2024 wherein a Detention Order was issued with privileges including entering the community accompanied by staff or approved person. An early hearing was convened on October 9, 2024. The Board found that Ms. Coniam was fit to stand trial and on October 18, 2024, the Board issued a Disposition pending Ms. Coniam’s return to court for a fitness hearing. Ms. Coniam’s fitness hearing was held on March 31, 2025. At that time, the Court found Ms. Conian unfit to stand trial. She returned to the ORB on April 29, 2025 pursuant to sections 672.48(1) and 672.82(1) of the Criminal Code.
The issues to be decided at this hearing were whether Ms. Coniam was fit to stand trial and, if not, the necessary and appropriate Disposition.
For the reasons set out below, the Board unanimously finds that Ms. Coniam is unfit to stand trial and the necessary and appropriate Disposition is that she be bound by the terms of a Detention Order within the Forensic Psychiatry Program at St. Joseph's Healthcare Hamilton (“St. Joseph’s” or the “hospital”), 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. Coniam remains unfit to stand trial and should be subject to a Detention Order within the Forensic Psychiatry Program at the hospital with privileges and prohibitions as set out in the Disposition Order of October 18, 2024, up to and including entering the community accompanied by staff or an approved person.
Counsel for the Attorney General supported the hospital's recommendation.
Ms. Edward submitted that her client does not agree with the hospital position and wants to go home. Beyond this, Ms. Edward did not provide a formal recommendation.
Outstanding Charges:
- The circumstances of the outstanding charges are set forth in detail in the Reasons for Disposition dated November 4, 2024 and can be summarized as follows:
On December 31, 2022 Ms. Coniam is alleged to have grabbed the manager of a Tim Horton’s franchise by the shirt and bit her. The manager pushed her away and Ms. Coniam choked her with one hand. Ms. Coniam was pushed out into the vestibule. She kicked the glass door causing it to shatter. She was charged with Assault, Assault (Choke) and Mischief under $5000.
It is alleged that on January 14th, 2023, the owner of a private apartment returned home to her previously locked apartment to find Ms. Coniam sleeping naked in her bed. The owner of the apartment did not know Ms. Coniam. Police investigation revealed that Ms. Coniam had the apartment owner’s property inside a backpack including pieces of jewellery, a calculator and a laptop charger. She also had three glass pipes containing white residue believed to be methamphetamine. Ms. Coniam was charged with break and enter and possession of a controlled substance under s. 4(1) of the Controlled Drugs and Substances Act.
It is alleged that Ms. Coniam failed to appear, as ordered. for Court on April 3, 2023 resulting in a charge of Failure to Attend Court contrary to s. 145(2)(b) of the Criminal Code.
It is alleged that on May 30th, 2023 Ms. Coniam was released from custody on a Release Order, a condition of which required her to report to the John Howard Society of Hamilton on Wednesday May 31st, 2023. Ms. Coniam failed to report on May 31st, 2023.
Personal and Psychiatric Background:
The Hospital Report outlines Ms. Coniam’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. Coniam is 44 years of age. Her current diagnoses are schizoaffective disorder, bipolar type, and stimulant use disorder (in remission in controlled environment). She is incapable to make psychiatric treatment decisions, and the Office of the Public Guardian and Trustee is her substitute decision maker. She is presently deemed capable regarding property and financial matters.
According to the Hospital Report, due to her mental status, Ms. Coniam “was unable to participate meaningfully in providing social history. Several attempts were made to contact family members but were unsuccessful. Therefore, little is known regarding Ms. Coniam’s social history.” (page 5, Hospital Report)
As set out in the Reasons for Disposition dated November 4 2024, at paragraph 11, Ms. Coniam
“has been employed in various customer service positions. She is presently supported by Ontario Disability Support Program (ODSP) benefits. Ms. Coniam has a history of substance use, including methamphetamine and crack cocaine, which has led to the loss of her housing and a breakdown of her relationships and the loss of her two children (13 and 20 years old), both of whom are said to be in the care of her father. Ms. Coniam has never engaged with addictions counselling, detoxification services or residential treatment nor has she ever engaged with outpatient mental health services.”
Prior to the outstanding charges, Ms. Coniam had no criminal record.
Since 2020, Ms. Coniam has had several emergency room presentations resulting
from substance misuse and in several cases exhibiting bizarre and erratic behavior.
- “Despite continued psychotropic medication optimization and adherence, Ms. Coniam’s presentation has been gradually deteriorating over the past four months. She presents with active symptoms of psychosis (constant commenting auditory hallucinations, persecutory and nihilistic delusional beliefs, and a disorganized thought process). It is unclear whether Ms. Coniam’s other symptoms (flat affect, avolition, amotivation, anhedonia, monotone) are negative symptoms from psychosis and/or symptoms of a clinical depressive episode.
Ms. Coniam’s decompensated mental state has impacted her fitness to stand trial. She has continued to be able to provide a rudimentary understanding of the main professionals in a courtroom and the available plea options to a defendant. However, she has been unable to apply this understanding to herself as she repeatedly denied having any current charges or need to attend court. Rather, Ms. Coniam has stated that she is being wrongfully detained in the hospital as her legal matters have been resolved and the Judge has communicated to her, through voices she hears in her head, that she has been released.
It is the unanimous opinion of the treatment team that Ms. Coniam poses a significant threat to the safety of the public. At this time, Ms. Coniam’s risk for violence is managed almost exclusively from external factors such as the warrant of committal and oversight of the forensic system. Besides these external factors, Ms. Coniam has few protective factors against violence; she has no contact with family and essentially no available personal supports, no stable housing, and no professional supports in the community. It is therefore the unanimous opinion of the clinical team that Ms. Coniam continues to pose a significant risk to the public. Given her ongoing risk to the public, it is my clinical opinion that a detention order is the most necessary and appropriate disposition at this time. A detention order is recommended for further treatment optimization, engagement in programming, and to work towards gradually reducing the risk of violence in less restricted settings.” (p. 22-23, Hospital Report)
Evidence at the Hearing
Dr. Duboff gave evidence. He has been Ms. Coniam’s attending psychiatrist since February 19, 2025. He adopted the Hospital Report.
Dr. Duboff stated that Ms. Coniam has had a challenging time under the ORB system. Previously, she had made some progress. Her medication was optimized and she became marginally fit for a period of time. However, more recently, she has become less well. Dr. Duboff described her illness as “treatment refractory”. He stated that Ms. Coniam has had multiple medication trials, including clozapine, with minimal results.
Dr. Duboff indicated Ms. Coniam has not been able to meet the fitness criteria for applying understanding of basic concepts to her own legal matters. As recently as the day of the ORB hearing, Ms. Coniam had been hearing voices telling her that her legal matters have been resolved. Dr. Duboff noted that Ms. Coniam cannot distinguish between voices she hears and reality and this is affecting her understanding of the need for treatment, her legal issues and why she is in hospital. She is exhibiting poor concentration, lethargy and lack of motivation. There had been a formal fitness assessment the day before the hearing and Dr. Duboff had assessed Ms. Coniam as unfit to stand trial.
Dr. Duboff stated that Ms. Coniam has experienced a shift backwards from her previous ability to appreciate her legal circumstances. Dr. Duboff is uncertain why this is so. Ms. Coniam’s situation was atypical in the sense that she had previously responded to clozapine and then subsequently stopped responding to it and was hearing voices again. As a result, the treatment team is now looking at causes such as depression or medical concerns. Dr. Duboff has communicated with the substitute decision maker about optimizing medication or potentially the use of electro-convulsive therapy which can be indicated for treatment refractory psychotic depression, which was identified as the most likely cause of most of Ms. Coniam’s current symptoms.
Ms. Coniam is currently being treated with four different medications, including two anti-psychotic medications. Blood tests confirm that there is no issue with adherence to medication.
Dr. Duboff noted that Ms. Coniam has poor insight, and that without the oversight of the Board, she risks returning to using substances (i.e. crystal methamphetamine). Should she relapse to substance use, she would be likely to suffer a further deterioration in her mental state and engage in criminal conduct.
No further evidence was called by the parties.
Submissions:
- The hospital maintained its initial position. Counsel for the Attorney General agreed with this position. No submissions were made by Ms. Edward.
Analysis and Conclusion:
The first issue for the Board to decide is whether Ms. Coniam remains unfit to stand trial.
The test for fitness to stand trial, as set out in R. v. Taylor, is one of limited cognitive capacity. This means that the person charged must be able to understand the nature and object of the proceedings and their possible consequences and be able to recount to counsel facts necessary to allow counsel to properly prepare a defence. This last point has been elaborated upon by the Court of Appeal in R. v. Morrissey, 2007 ONCA 770, at para. 29, wherein Blair J.A. stated:
“The ability to communicate with counsel in the context of a fitness inquiry speaks to the ability to seek and receive legal advice.”
At paragraph 36, the Court stated:
“An accused must be mentally fit to stand trial in order to ensure that the trial meets minimum standards of fairness and accords with principles of fundamental justice such as the right to be present at one's own trial and the right to make full answer and defence.[citations deleted] Meaningful presence and meaningful participation at the trial, therefore, are the touchstones of the inquiry into fitness.”
- The Court of Appeal addressed the fitness tests most recently in R. v. Bharwani, 2023 ONCA 203 at para. 167. The Court emphasized the need for meaningful participation in proceedings to be fit for trial including the ability to conduct a defence and to instruct counsel to do so.
“The accused must have the ability to make decisions. This involves the ability to understand available options, the ability to select from those options, the ability to understand the basic consequences arising from those options, and the ability to intelligibly communicate to either counsel or the court the decision arrived upon.”
Having considered the evidence presented at the hearing, the Board unanimously finds that Ms. Coniam continues to be unfit to stand trial. Currently, Ms. Coniam is unable to appreciate her legal situation in the sense that she has a fixed idea that the charges she is facing have resolved. She hears voices that tell her this. She believes a judge is telling her this through the voices. She is not able to appreciate why she is in hospital. She does not have a meaningful appreciation of the jeopardy she faces or an ability to make decisions. In these circumstances, she would be unable to conduct a defence, to instruct counsel or to meaningfully participate in her trial.
The second issue for the Board to decide is the necessary and appropriate Disposition. On the basis of the entire evidentiary record, including the oral testimony of Dr. Duboff, the Board finds that Ms. Coniam continues to present with significant symptoms of psychosis (hearing voices), poor insight, low motivation and a complete lack of appreciation of the reason for her hospitalization. The charges she is facing involve violence and serious criminal conduct. The Board agrees that Ms. Coniam continues to require a prolonged admission in order to safely manage her risk to the safety of the public.
The Board finds that the necessary and appropriate Disposition to safely manage Ms. Coniam’s risk of harm to others is that she be subject to a Detention Order with the same privileges and prohibitions as set out in the Disposition Order of October 18, 2024.
The Board has taken into account the factors as set out in s. 672.54 of the Criminal Code, including the need to protect the public from dangerous persons, Ms. Coniam’s mental condition, her reintegration into society and her other needs.
DATED this 22^nd^ day of May 2025, at the City of Toronto, in the Toronto Region.
Ms. N. Nathanson
Legal Member
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Office of the Registrar
Ontario Review Board