Ontario Review Board
Re: Tara Moore
ORB File No: 6942
Hearing held on: Tuesday, May 13, 2025
Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. M. D. Segal
Members: Dr. R. Chandrasena Dr. S. Wiseman Mr. E. Siebenmorgen Ms. R. Chopra
Parties Appearing:
Accused: Tara Moore
Counsel: Ms. C. Whillier
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. D. Rows
REASONS FOR DISPOSITION
(Dated June 9, 2025)
Introduction
1. On April 19, 2016, Tara Moore was found not criminally responsible on account of mental disorder (NCR) on a charge of aggravated assault, contrary to the Criminal Code. Ms. Moore was most recently subject to a Disposition of the Ontario Review Board (“ORB” or “the Board”) dated May 22, 2024 pursuant to which she was ordered discharged on conditions, including that she reside at a named long term care home in Sarnia, Ontario and that she take recommended psychiatric treatment, pursuant to s. 672.55 of the Criminal Code.
2. On Tuesday, May 13, 2025, a panel of the Board convened in person at Southwest Centre for Forensic Mental Health (“Southwest Centre” or “the Hospital”) to conduct a review of Ms. Moore’s Disposition and to make a new Disposition pursuant to section 672.81 (1) of the Criminal Code. Ms. Moore was present and represented by her counsel, Ms. Whillier. The issues to be determined at the hearing were whether Ms. Moore 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 that was also the least onerous and least restrictive taking into account the factors set out in 672.54 of the Criminal Code.
Positions of the Parties
3. At the commencement of the hearing the parties were requested to provide their initial and “without prejudice” positions with respect to the issues before the Board. The parties jointly submitted that Ms. Moore no longer represented a significant threat to the safety of the public and that, accordingly, she was entitled to an Absolute Discharge. The parties maintained their positions at the conclusion of the evidence.
Evidence at the Hearing
4. The evidence at the hearing consisted of the Hospital Report dated March 13, 2025, an Update to that Report dated May 3, 2025, and the oral evidence of Dr. Arun Prakash, Ms. Moore’s attending psychiatrist at the Hospital.
Findings
5. The Board accepted the parties’ joint recommendation and found, independently on the evidence, that Ms. Moore can no longer be said to represent a significant threat to the safety of the public. She was granted an Absolute Discharge at the conclusion of the hearing. She was advised that Reasons for the Board’s finding would be provided at a later date. These are those Reasons.
Index Offence
6. The synopsis of the circumstances surrounding the index offence is contained within the Hospital Report. In brief terms, as of the date of the offence (June 20, 2015) Ms. Moore and her boyfriend, Steven Williams, had been in an on-and-off relationship for several years. On June 20, 2015, the couple were at their residence in Sarnia for most of the afternoon and evening. Throughout the evening, Ms. Moore was observed by Mr. Williams to have a large kitchen knife in her possession and appeared to have been displaying signs of paranoid behaviour. This caused him concern for both his wellbeing as well as that of Ms. Moore.
7. At approximately 11:15 p.m., Mr. Williams found Ms. Moore hiding in a bathroom near the rear of the residence. He questioned her as to why she was acting in that manner, at which time she left the bathroom and exited the residence through a rear door, into the backyard. Mr. Williams followed Ms. Moore into the yard and continued his efforts to ensure Ms. Moore’s wellbeing. At this time, Ms. Moore turned towards Mr. Williams and began swinging her arm towards him while holding the kitchen knife. She struck Mr. Williams four or five times in his left shoulder, chest, and neck area, causing two stab wounds that punctured his skin. Mr. Williams was able to flee the area and summon help. Ms. Moore fled the area on foot.
8. Mr. Williams was transported to hospital where he was treated for his injuries, which consisted of two stab wounds that required stitches. One wound was in the area of his left shoulder and the other was on the left side of his neck, close to several blood vessels.
Diagnoses
9. Ms. Moore’s psychiatric diagnoses are as follows:
(i) schizoaffective disorder;
(ii) substance use disorder; and
(iii) borderline personality disorder.
Background Information
10. Ms. Moore’s personal history, psychiatric background and course under the Board’s jurisdiction are extensively detailed in the Hospital Report. As the Report was entered as an Exhibit and forms part of the evidence, its contents need not be summarized to any great extent in these Reasons. In summary, Ms. Moore is now 49 years of age and is currently living in a long-term care facility in Sarnia. As will be seen, she has come a very long way during the nine years that she has been subject to the Board’s jurisdiction and under the care of her inpatient and outpatient teams at the Hospital.
11. Ms. Moore’s earlier life can fairly be characterized as chaotic. Records indicate that she had a very difficult childhood which included abuse and neglect. She spent a significant amount of time in foster care and had Children's Aid involvement. She also exhibited significantly problematic behaviors in school and did not complete high school. Her parents were separated. There is a family history of alcohol and drug abuse. Reports indicate that all family members, except her mother, have been in jail and she has a brother who has been diagnosed with Schizophrenia.
12. Ms. Moore has an extensive criminal and psychiatric history, both beginning in 1999. Her convictions include aggravated assault, assault of police, threats to cause bodily harm, forcible confinement, carrying a concealed weapon, theft under, intoxication in a public place, mischief and many failures to comply with conditions of undertakings and probation. With respect to her mental health, Ms. Moore has received various diagnoses including dysthymic disorder, substance abuse disorder, personality disorder and substance-induced psychosis. She has been mostly noncompliant with medications on leaving hospital in the past and, prior to her NCR finding, regularly failed to follow up with psychiatric care. She also had a history of homelessness.
Brief Summary of Course Under the Board’s Jurisdiction
13. Ms. Moore was actively symptomatic, including extreme paranoia, during her assessment prior to her initial ORB hearing. After being placed on a Detention Order, she began to show significant improvement in the spring of 2017 and by 2018, her symptoms, complicated by her personality issues, persisted but were less intense and her reactivity declined. Nevertheless, her symptoms impacted all facets of her functioning, including social awareness, judgment, executive functioning, decision making, and independent living skills. At times, she became angry rapidly without major precipitants but subsequently settled quickly. She remained highly impulsive in her behaviours and her actions.
14. Ms. Moore experienced a regression into more intense paranoia, anger and reactivity later in 2018, after she was declined a community living placement (staff at the home determined that she could not manage the placement due to her inability to implement a routine and structure into her day). Her mental status continued to deteriorate despite adjustments to her medication. Her paranoia in relation to hospital staff continued to intensify and at one point in early 2019, MS. Moore threatened to punch her attending psychiatrist in the face. Angry outbursts continued throughout 2019 but were contained through staff intervention.
15. Ms. Moore has multiple physical health issues as well as her mental health challenges. She has historically overestimated her ability to live independently in the community. In 2020, her treatment team suggested that an opportunity to live within a transitional apartment (located within the Hospital facility) could alert Ms. Moore to the significant challenges of living with her complex conditions in an independent setting. She lived for a month in that setting before being returned to her regular hospital unit. There were barriers to finding appropriate community accommodation for Ms. Moore due to her physical limitations and COVID-19 restrictions. In 2021 she was offered a place to live with an old high school friend in the community of Sarnia. She was returned to the Hospital within two months as she was unable to manage her daily living tasks and required much more care and attention than her friend could provide.
16. Ms. Moore attempted to live in a group home setting in October of 2021; however, this placement was unsuccessful due to Ms. Moore’s medical needs; she required more nursing intervention than the home could provide. She was found to be eligible for long-term care living and placed on waitlists. She had reconnected with her daughter and expressed a desire to live with her; however, this was determined not to be feasible at that time. Ms. Moore continued to express an unrealistic view of her own capacity to live independently.
17. Ms. Moore was discharged to a long-term care home in London in June of 2022. She struggled with the rules and routine of the home, and the Hospital’s Forensic Outreach Team had great difficulty establishing a therapeutic relationship with her. Ms. Moore expressed dissatisfaction with living in the home, as she wanted to have her own room and felt that she was too young to be in such a facility. Her overall dissatisfaction with living in long-term care was identified as a significant stressor.
18. Ms. Moore continued to remain abstinent of substances following her discharge to the long-term care home, as she had throughout her inpatient stay at the Hospital. Her insight into her mental illness, need for medication, and associated risk remained poor. Her treatment team noted that absent medication supervision, she would not likely remain adherent to her treatment.
19. Ms. Moore received a Conditional Discharge Disposition in April of 2023. In November of that year, she moved to Sumac Lodge, a long-term care home in Sarnia. She continued to live at Sumac Lodge as of the hearing date. Her May 22, 2024 Conditional Discharge Disposition reflects this change in her residence. Ms. Moore’s substance use abstention clause was removed by her 2023 Disposition. It was reported that she consumed cannabis and alcohol but no decompensation in her mental state was observed by either the treatment team or the Sumac Lodge staff.
20. Ms. Moore adjusted well to her living situation at Sumac Lodge, though she struggled at times with rule adherence, including the facility’s rules around smoking. Only two incidents of interpersonal aggression were observed: one consisting of threatening another resident over cigarettes, and an incident in the dining room when she threw a box of tissues at another resident. Staff at the facility were able to manage situations as they arose. Over time, staff have gained a better understanding of how to support and redirect Ms. Moore.
21. Ms. Moore has an aunt in the Sarnia area who has been supportive of her. She visited Ms. Moore when she lived in the London long-term care home and has seen her much more frequently since she moved to Sumac Lodge. They are reportedly in almost daily telephone contact and the aunt has expressed interest in helping with Ms. Moore’s medical needs.
22. In December of 2023, Ms. Moore was referred to the Sarnia Assertive Community Treatment (ACT) team. She was accepted into their caseload under the psychiatric care of Dr. Michael Koval. She first met Dr. Koval in April of 2024 and expressed a positive attitude toward working with him and the Canadian Mental Health Association (CMHA) team. In December of 2024, during a review of her capacity to consent to psychiatric treatment, Ms. Moore stated that she would continue to take her psychiatric medication. At the same time, the purpose of a Community Treatment Order (CTO) was explained to her. She was agreeable to a CTO being initiated, and this was completed.
23. Ms. Moore reportedly has verbalized that she is “stressed out” over living in long-term care, stating that she does not need to live there as she is much younger than the typical residents. She seemed reassured concerning this upon being advised that other community partners may be able to support a future move out of long-term care (LTC).
24. Ms. Moore’s insight into her ability to care for herself and to manage her care remains poor. Her aunt (Barbara), the LTC staff and CMHA are anticipated to be able to replicate the level of support that she requires.
25. The HCR-20 (v.3) risk assessment tool was completed for Ms. Moore and the assessment is reproduced in the Hospital Report. Her overall risk of violence is assessed as being low in the context of an Absolute Discharge.
Evidence of Dr. Arun Prakash
26. Dr. Prakash gave evidence to supplement the evidence in the Hospital Report, which he adopted. He had been Ms. Moore’s treating psychiatrist since before she was discharged to the community in 2022. Dr. Prakash noted that Ms. Moore has not required readmission to the Hospital since her discharge.
27. Dr. Prakash stated that Ms. Moore has developed good social contacts since returning to the Sarnia community, has taken several trips into the community, and is well-supported by her aunt. There have been no reported problems in the community. Aside from some moderate consumption of cannabis and alcohol since her abstinence clause was removed from her Disposition, Ms. Moore has been essentially abstinent from substances for almost ten years.
28. Dr. Prakash testified that Ms. Moore expressed willingness to stay at Sumac Lodge as long as necessary, although she would prefer not to be in LTC care. He reiterated a note in the Hospital Report to the effect that CMHA would be able to connect Ms. Moore, in the future, with other housing opportunities. Dr. Prakash also advised the panel of an unfortunate recent event, stating the Ms. Moore’s roommate just passed away on the day prior to the hearing. Ms. Moore is managing this event with the support of LTC staff.
29. Dr. Prakash advised the panel that Ms. Moore’s CTO was renewed, and that the treatment plan names Sumac Lodge. In addition, Ms. Moore has seen Dr. Koval for several appointments, the most recent of which was on May 1. Their next appointment is scheduled for July 16. He is a psychiatrist for both the ACT team, operated out of the local hospital in Sarnia (Bluewater Health), and for CMHA. According to Dr. Prakash, Dr. Koval is both supportive of the recommendation for an Absolute Discharge and willing to continue to help manage Ms. Moore post-discharge. Ms. Moore has had visits from the ACT team and the CMHA, although both agencies have taken a less active role as Ms. Moore is in LTC care.
30. Dr. Prakash testified that Dr. Koval is familiar with forensic patients and the forensic system. If Ms. Moore were to, hypothetically, revoke her consent to the CTO, the LTC home would notify Dr. Koval. In addition, the doctor at the LTC home would be in a position to trigger the mechanisms under the Mental Health Act.
31. Ms. Moore’s psychiatric medications are administered and supervised by LTC staff, as are her numerous medications for her various physical/medical health issues. In terms of additional professional support, Ms. Moore has her family doctor, who helps manage her back pain. In addition, she is seen weekly by a general practitioner at Sumac Lodge.
32. In response to questions from a panel member, Dr. Prakash advised that Sumac Lodge has a recreational therapist, an occupational therapist, and a behavioural therapist who are available to support Ms. Moore. She participates in outings and has at least weekly contact with her aunt. Ms. Moore at this point interjected to state that her aunt takes her to the YMCA for swimming and for her cardio work.
33. No further evidence was led following Dr. Prakash’s testimony.
Analysis and Conclusions
34. Having considered the evidence in its entirety, the panel found that it can no longer be said that there is a real and substantial likelihood that she would commit a criminal act that would result in serious physical or psychological harm to another person. It is, of course, true that she suffers from a major mental disorder as a well as a borderline personality disorder. Adherence to antipsychotic medication continues to be the mainstay to the relative stability of her mental condition. While she continues to exhibit residual symptoms and occasional impulsive behaviour, she resides in a long-term care home whose staff have been able to support and redirect her when necessary.
35. Although Ms. Moore expresses limited insight into her mental illness and need for medication to stabilize that illness, she nevertheless has been determined to be capable of consenting to psychiatric treatment. Since coming under the ORB’s jurisdiction, she has been adherent to her medication, despite questioning its helpfulness, and has expressed her intention to remain compliant if her doctor tells her that she needs her medication. She has, over the past reporting year, transitioned well to the care of the Sarnia ACT team, and has, on the evidence, a good relationship with Dr. Koval, who serves as something of a “functional hub” to coordinate Ms. Moore’s mental health care with the ACT team and with the CMHA in Sarnia.
36. Ms. Moore enjoys the solid support of her aunt, who lives in the Sarnia area. She also lives in Sarnia and takes part in outings into that community. This is not without its risks, of course, as Ms. Moore was raised in Sarnia and lived most of her adult life there, including a very chaotic period from 1999 to the time of the index offence in 2015. To her credit, however, Ms. Moore has avoided social settings that would reintroduce her to the world of substance use that contributed to the self-destructive trajectory of her earlier life.
37. In addition to these supports, Ms. Moore is subject to a Community Treatment Order (CTO), which provides some measure of external assurance that she will continue to adhere to her treatment and receive professional support.
38. Finally, Ms. Moore lives in a long-term care facility whose staff have come to understand how to support her, including administering and supervising her psychiatric and other medications. Stable housing is critical for her. On the evidence, Ms. Moore is not able to live independently, either financially or from the standpoint of managing her own care needs. While she expresses a degree of discontent about her current living situation and a desire to live independently, this is known to those who currently support her. While in theory there is a possibility of Ms. Moore becoming disengaged from her antipsychotic medication and potentially homeless again, with the result that she could become psychotic and act out in the community in a harmful fashion, in the panel’s opinion such a possibility is too remote to constitute a substantial likelihood.
39. Accordingly, the panel found that the evidence falls short of the threshold required to ground a finding that Ms. Moore represents a significant threat to the safety of the public, and she therefore was entitled to be absolutely discharged from the Board’s jurisdiction.
40. In closing, the panel wishes Ms. Moore the best of success as she continues the positive trajectory that has been her journey over the last number of years.
DATED this 9th day of June 2025, at the City of Toronto, in the Toronto Region.
Eric Siebenmorgen
Legal Member
Office of the Registrar
Ontario Review Board