Re: Amy Knight, 2025 CanLII 56023

Ontario Review Board

Re: Amy Knight

ORB File No: 7979

Hearing held on: Thursday, May 15, 2025

Place of Hearing: Southwest Centre for Forensic Mental Health, 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. M. McKinnon

Parties Appearing: Accused: Amy Knight Counsel: Mr. R. Cunningham The person in charge of hospital: Counsel: Ms. J. Zamprogna Attorney General of Ontario: Counsel: Ms. K. Dalrymple

REASONS FOR DISPOSITION (Dated June 13, 2025)

Introduction

1On December 3, 2021, Amy Knight, now 35 years old, was found not criminally responsible on account of mental disorder (NCR) on two charges of mischief not exceeding $5,000.00, contrary to the Criminal Code. Ms. Knight was most recently subject to a Disposition of the Ontario Review Board (“ORB” or “the Board”) dated February 8, 2024, pursuant to which she was ordered detained at the Southwest Centre for Forensic Mental Health (“Southwest Centre” or “the Hospital”) subject to various conditions, including community living in approved accommodation. She has been living in the community since August, 2023 and since May, 2024, has been living in a market rent apartment in St. Thomas.

2On Thursday, May 15, 2025, a panel of the Board convened in person at the Hospital to conduct a review of Ms. Knight’s Disposition and to make a new Disposition pursuant to section 672.81 (1) of the Criminal Code. Ms. Knight was present and represented by her counsel. Ms. Knight’s father was also in attendance. The issues to be determined at the hearing were whether Ms. Knight 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

3At the start of the hearing, the parties were asked to provide their initial and “without prejudice” positions with respect to the issues. Counsel for the Hospital and counsel for the Attorney General submitted that Ms. Knight continued to represent a significant threat to the safety of the public and that the necessary and appropriate Disposition was a Detention Order on largely the same terms and conditions, except that the substance use abstention clause could be removed and the minimum reporting period reduced to once monthly. Counsel for Ms. Knight submitted that she no longer represented a significant threat and was thus entitled to an Absolute Discharge.

4During the presentation of evidence, in response to some questions by Ms. Knight’s counsel, counsel for the Hospital advised that it would also be appropriate to expand Ms. Knight’s privileges by providing for passes for up to two weeks into Southwestern Ontario, indirectly supervised.

5The parties essentially maintained their positions at the conclusion of the evidence, although counsel for Ms. Knight proposed, in the alternative, a Conditional Discharge Disposition. He proposed that pursuant to such a Disposition, his client was agreeable to maintaining a substance use abstention requirement and would agree to the inclusion of a “consent to treatment” clause pursuant to s.672.55 of the Criminal Code. He submitted that a monthly reporting requirement would be sufficient.

Evidence at the Hearing

6The panel received extensive documentary and oral evidence. The documentary evidence consisted of:

1. the Hospital Report, dated December 19, 2024;
2. an update to the Report, dated January 20, 2025;
3. a further update to the Report, dated April 29, 2025;
4. three notes from Dr. Anyaegbuna of Bluewater Health in Sarnia, dated respectively January 12, 2020, February 16, 2020, and February 21, 2020;
5. an undated letter from the Addiction Resource Centre;
6. a file closure note from Family and Children’s Services of St. Thomas and Elgin, dated March 13, 2025;
7. an email from Vincent Alway (Ms. Knight’s father), dated May 6, 2025; and
8. a progress note from Dr. N. Mokhber, dated March 5, 2025.

The oral evidence consisted of testimony from: Dr. Ajay Prakash (Ms. Knight’s attending psychiatrist from the time of her discharge to the Forensic Outreach service until January of 2025); Dr. N. Mokhber (Ms. Knight’s current attending psychiatrist); and Ms. Knight.

Findings

7The panel found that Ms. Knight continues to represent a significant threat to the safety of the public, though this finding must not be misconstrued as reflecting negatively upon her commitment to her wellness. The panel deliberated at some length as to the type of Disposition that, at this stage, represents the least restrictive measure for the management of her risk. We found that the necessary and appropriate Disposition is a Conditional Discharge. Our Reasons for these conclusions are below, following a review of important parts of the evidence.

Index Offences

8The circumstances of the index offences are excerpted from last year’s Reasons, dated February 28, 2024, in the form of the following police synopsis:

“The accused in this matter, Amy KNIGHT born March 20, 1990, currently resides at 305-911 Wellington Street in the City of Sarnia. As of January 2020, KNIGHT has been causing significant problems with staff and other tenants of 911 Wellington Street as well as caused excessive damage to the building.

As of the date of this report, KNIGHT has generated 23 calls of service to attend 911 Wellington Street in regards to her behaviour.

On February 15, 2020, at 12:38 p.m., Sarnia Police Service dispatch received a 911 call to attend 911 Wellington Street in the City of Sarnia as KNIGHT was out of control and kicking doors within the building.

Constable Sean VANVLYMEN #208 and Constable Karl BROWN #204 attended on scene and, upon arrival, Constable VANVLYMEN #208 spoke with the superintendent, [redacted]. She stated that KNIGHT had kicked in the door of unit 311, which was the apartment of a male party who is bedridden with cerebral palsy.

Constable VANVLYMEN #208 attended unit 311 and observed the door handle to be broken off the outside of the door, lying on the ground. Constable VANVLYMEN #208 entered the residence to check on the wellbeing of the male party, who identified himself as Steven CURRIE. He was extremely upset and hysterical. CURRIE was unable to catch his breath due to the fact that someone had kicked in his door and he had not been able to move or call for help.

Constable VANVLYMEN #208 then made his way to unit 305 and observed KNIGHT’s door to be open with KNIGHT inside screaming “help her, he killed her”.

A short time later, Constable VANVLYMEN #208 apprehended KNIGHT under the Mental Health Act. KNIGHT was transported to Bluewater Health to see the crisis team.

Constable VANVLYMEN #208 later received information from Bluewater Health staff that KNIGHT was being held on a 72 hour Form.

Upon further investigation, Constable VANVLYMEN #208 learned that KNIGHT had caused damage to the building two previous times, which needed to be fixed by a locksmith; resulting in an expense of $367.25.

It was also determined that on January 11, 2020, KNIGHT had been observed pulling the fire alarm on video surveillance.

As of January 2020, management of 911 Wellington Street has received ongoing complaints from tenants fearing for their safety as well as letters had been received by March of Dimes office and staff complaining of verbal abuse, intimidation, harassment, and aggressive behaviour towards their workers as well as tenants in wheelchairs from KNIGHT.

It is Constable VANVLYMEN #208’s opinion that if KNIGHT continues to reside at 911Wellington Street she is going to seriously injure or kill another person based on her previous unpredictable and violent behaviour. The other tenants that reside in the building under the care of the March of Dimes are particularly vulnerable due to their disabilities.

Given the fact that KNIGHT is currently being held at Bluewater Health, a warrant for her arrest is being requested so that she can be brought into custody upon her release."

Diagnoses

9Ms. Moore’s psychiatric diagnoses are as follows:

(i) schizophrenia; (ii) methamphetamine use disorder, in remission; (iii) cannabis use disorder, in remission; and (iv) antisocial personality traits.

As is developed further below, Ms. Knight now questions her schizophrenia diagnosis.

Background Information

10Ms. Knight’s personal and criminal history, psychiatric background, and course under the Board’s jurisdiction are detailed in the Hospital Report, the updates to that Report, the notes of Dr. Anyaegbuna (who assessed her during brief hospital admissions prior to and immediately following the index offences in 2020), and the note from the Addictions Resource Centre. The panel has considered this information. While these materials are in evidence and their contents need not be extensively reviewed, features of this history are highlighted below. Additional references to the evidence appear in the “Analysis” portion of these Reasons.

11At the outset, we note that para. 15 of last year’s Reasons refers to Ms. Knight’s report of being of Metis background, with her mother having been born on Manitoulin Island. The Hospital Report (p. 14) states that information from the Children’s Aid Society (CAS) and from Ms. Knight’s father suggests otherwise. On the available evidence, the panel cannot resolve this.

12Ms. Knight has a significant substance use history. She reported that both parents have had issues with substances and that all but one of her siblings use cannabis. Ms. Knight said she began to use cannabis around 12 to 13 years of age. She continued to smoke cannabis in high school, together with episodic use of ecstasy. There is more, however, described below following a brief relationship history.

13Ms. Knight reported having six children with five different partners. Her eldest children were born in May 2008 and January of 2010 when Ms. Knight was 18 and 19 years old, respectively. They have reportedly lived with their paternal grandmother since 2022 pursuant to a kinship agreement through the CAS. A third child was born in 2013 and is reportedly in her father’s care. Ms. Knight’s fourth child, A., was born in 2017. Her father is reportedly a member of the Aamjiwnaang First Nation. A. was the subject of CAS intervention due to her father’s incarceration, was living with Ms. Knight’s father in Sarnia until recently, and as Ms. Knight testified at this hearing, now is transitioning to live with her in St. Thomas.

14A fifth child, Bronx, was born in 2018. The father died before the child’s birth, and Bronx lives with the father’s sister, Ms. Kazuk. Ms. Knight is reportedly subject to an order prohibiting her from contacting Ms. Kazuk and has been charged with failing to comply with this order.

15Ms. Knight’s youngest child is Xavier, who was born in April of 2021. The father, Chris Pelkie, is Ms. Knight’s partner and approved person. Mr. Pelkie reportedly has full custody of Xavier.

16Ms. Knight reportedly (Hospital Report, p. 18) has a history of harassing those who have custody of her children, enlisting the assistance of peers to threaten harm, and threatening to go to the schools where her children are enrolled as a means of having contact with them. There is a history of CAS workers needing to contact the police due to her aggression.

17Ms. Knight reported that in 2014, when she was 24 years of age, she began using crystal methamphetamine to help her "cope" following a breakdown of a long-term relationship. She said that the drug had helped to "stabilize" her "emotional roller coaster" and stop her crying. She admitted to having abused the substance "on and off" for much of the seven years leading up to the index offences. Nevertheless, Ms. Knight stated that she had been "clean lots of the time" and at the point of admission at the Southwest Centre, did not consider her use of the substance to have been excessive as she had still been able to go to work and raise her family.

18Ms. Knight has a significant criminal record commencing in September 2014, the same year as the start of her methamphetamine use. The convictions include numerous failures to comply with court orders, as well as possession of illicit substances, uttering threats, assault, and mischief over $5,000. There are several instances where additional charges have been withdrawn, presumably by way of global resolutions of other charges. Her most recent convictions were in December of 2018 and included assault and uttering threats.

19Ms. Knight has a limited prior psychiatric history, from March of 2018, when she was admitted to hospital after sending her father a text message stating that she was contemplating suicide.

20Ms. Knight was admitted to the Southwest Centre on December 15, 2021, following her NCR verdict. She was found incapable of making psychiatric treatment decisions on January 12, 2022, and the Public Guardian and Trustee (PGT) became her substitute decision maker (SDM). She received antipsychotic medication. By the time of her pre-Board conference on January 21, 2022, she expressed that she was feeling much better, acknowledged that she had a mental illness, and agreed that she would continue taking her prescribed medication.

21On June 2, 2022, Ms. Knight tested positive for methamphetamine and dextroamphetamine. She admitted to using substances at least five times within the week. Even though she was adherent to her medication, her initial reporting period was marked by affective, behavioural, and cognitive instability, especially during the time that she was using substances.

22Ms. Knight actively participated in numerous rehabilitative programs in the Hospital as well as a residential drug treatment program and 12-week follow up module, leading up to the time of her discharge to community living in 2023. The Hospital Report (p. 33) summarizes her stated goals upon re-entry into the community as follows:

Ms. Knight stated that the goal of being with and eventually living with her children, partner, and father in Sarnia was the main reason she would stay substance free, "It's just not worth it to use." Ms. Knight cited her relationship with her children as a strong motivation for her to abstain from drugs and not relapse/reoffend. She also noted that her father attends AA and has been a strong support. Further, Ms. Knight stated that she had a realization that she has more freedom and less external controls living in the community, which has precipitated her substance use cravings. However, she described recognizing these feelings as potentially dangerous, and seeking out distractions to cope with the cravings. She also noted that she was aware of crystal methamphetamine being used often by other residents at Indwell. She stated that she reaches out to sober peers to go for a walk, and this has provided distraction while the cravings passed.

23As noted earlier and below in the review of the oral testimony at the hearing, Ms. Knight is questioning her diagnosis of schizophrenia and suggesting that her index offences were the result of a substance-induced psychosis. This theme has arisen before. In the portion of the Hospital Report (pp. 33-34) summarizing the 2023-2023 reporting period, the following statements appear concerning her insight into these matters:

Ms. Knight’s insight into her mental health continued to develop. At times, she understood that her diagnosis of schizophrenia was a life-long illness, including recognizing her symptoms. However, at other times, she believed that her illness was only substance use induced, and when speaking about her symptoms stated, “[I] only had symptoms when I have done lots of drugs or when coming off drugs, I would hear voices, that’s the big one, before coming to the hospital, and after I had my son, I would talk to voices all day long…it was exhausting." Ms. Knight accepted health teaching of having a primary psychotic disorder when the treatment team reviewed her history, which included being symptomatic with psychosis for months after drug use.

Ms. Knight’s insight into her need for treatment continued to develop. She completed the self-medication program and was quickly proficient in learning all of her medications, reasons for taking them, and common side effects. As noted above, Ms. Knight actively engaged in psychotherapeutic programming. She stated that she was committed to taking her anti-psychotic medication because it had been the reason she had made such great progress and that it was helping her towards her goal of returning to her children. However, when discussing medication changes, the treatment team asked Ms. Knight what might happen if she were to stop taking her medication and she responded that she might be okay due to her psychosis being a result of substance use.

Ms. Knight’s insight into her risk for violence continued to develop. She noted that staying on track with anti-psychotic medication was the best way to control her schizophrenia and to stay highly functioning and symptom free. However, at times as noted above she attributed her lack of positive symptoms to her substance use abstinence. She recognized that a relapse in substance use could increase her risk of violence.

24During the most recent reporting period, Ms. Knight provided more information as to her thoughts and the role of both substances and her illness at the time of the index offences (Hospital Report, p. 47):

Ms. Knight believes that her delusions and hearing voices contributed to the index offence. She stated that she believed her daughter was being trafficked in the nearby apartment, and that is why she tried breaking down the door. She also stated that she was actively using substances at the time, and this contributed to her actions. Ms. Knight believes that being unmedicated was a huge factor in the offence occurring and stated that, within a few days of receiving treatment, she no longer thought that her daughter was being trafficked or her delusions to be true. Ms. Knight also recognizes the impact the index had on the victim.

Evidence of Dr. Ajay Prakash

25Dr. Prakash said that Ms. Knight has done very well, despite two occasions of crystal methamphetamine use, in hospital in June of 2022 and once in the community in December of 2023. Dr. Prakash has not seen Ms. Knight in 2025, as Dr. Mokhber took over her care in January.

26Dr. Prakash reviewed Ms. Knight’s methamphetamine use history, stating that it has been a coping strategy of hers for years. He said that the recommended Detention Order, with the “abstain from substances” clause removed, is intended to support Ms. Knight’s reintegration while maintaining public safety. With the removal of this clause, Dr. Prakash saw the coming reporting period as a “testing year,” observing that Ms. Knight has been facing and will continue to face many stressors. Dr. Prakash noted, to Ms. Knight’s credit, that despite her stressors, she has not been readmitted to the Hospital and has shown strength. She has made “emergency calls” to the treatment team, and the team has supported her through those occasions. In response to a panel member’s question, Dr. Prakash confirmed that Ms. Knight looks to the team for support during times of distress.

27Dr. Prakash testified that appointments with the team are stressful for Ms. Knight, so the team is recommending a reduction in the reporting frequency. She requires team support in keeping her appointments but at the same time is doing well managing her multiple priorities.

28Dr. Prakash adopted the Hospital’s stated reasons (Report, pp. 54-56) for the opinion that Ms. Knight represents a significant threat to the safety of the public, including the re-offence scenario. He also supported the applicability of the most recent HCR-20 v. 3 assessment, which placed her risk for violence as “high” in the context of an Absolute Discharge.

29In Dr. Prakash’s opinion, a Conditional Discharge is not realistic in the current year. In this regard, he referred to the January 20, 2025 update to the Hospital Report, which referred to Ms. Knight’s difficult living situation, her relatively recent move, her need for support, and the unlikelihood of her voluntary return to the Hospital. Also, because Ms. Knight would not qualify under the “Box B” criteria, he said the Mental Health Act would not provide a proactive mechanism for effecting her involuntary admission.

30Asked by a panel member how Ms. Knight’s case management would work under a Conditional Discharge, Dr. Prakash said that the Outreach Team would still be involved but would not be able to directly admit her to the Hospital. The reporting frequency would need to be sufficient to allow for a seven-day monitoring of Ms. Knight’s condition. Dr. Prakash agreed, in response to questions from Ms. Knight’s counsel, that a s. 672.55 “consent to treatment” clause could form part of a Conditional Discharge and that a breach of such a term could result in Ms. Knight’s return to the Hospital for an assessment. An involuntary admission would have to meet Mental Health Act criteria.

31Dr. Prakash addressed Ms. Knight’s recently expressed desire to revisit her diagnosis of schizophrenia. He stated that he would be open to exploring diagnostic issues but opined that this should be done under the forensic system. He referred to a referral form that Ms. Knight had emailed to her family doctor in Sarnia, copying the Hospital, on April 16, 2025. The referral requested is to a service known as “Psychotherapy Matters” which connects family doctors to a psychiatrist to conduct “virtual” (remote) consultations. According to the form, Ms. Knight was requesting diagnostic clarification, medication recommendations, and recommendations for managing side effects. Ms. Knight’s family doctor did not wish to engage with this service and asked the Hospital whether they wished to do so.

32Dr. Prakash responded to a panel member’s question as to the Hospital’s response to the request. In consultation with Ms. Knight, Dr. Mokhber agreed to explore the diagnostic issues.

33Counsel for Ms. Knight reviewed with Dr. Prakash the programming undertaken by Ms. Knight since her arrival at the Hospital. Dr. Prakash agreed that her involvement in drug treatment programs was substantial. He also agreed that Ms. Knight’s involvement in Narcotics Anonymous and the engagement with an additions counsellor with the Annex (as confirmed by the letter introduced in evidence) was the result of her own initiative.

34Counsel for Ms. Knight challenged the treatment team’s view that Ms. Knight was engaging in “impression management”. Dr. Prakash agreed that this characterization would not apply to her desire to remain abstinent, which he agreed was sincere.

35Dr. Prakash agreed with Ms. Knight’s counsel’s suggestion that the involvement of the Hospital is not “instrumental” in Ms. Knight’s life, as she has lived in the community since August of 2023, is working full time and caring for her child, is receiving drug abstinence support on her own, and picks up her medication from a pharmacy, takes it to her family doctor, and receives her injection from him.

36Dr. Prakash also agreed with counsel’s suggestion that Ms. Knight had not engaged in physical violence since the index offences. Dr. Prakash agreed that there was no information as to whether drug use was involved in the incidents leading to her assault convictions.

37Asked by Ms. Knight’s counsel what he envisioned in the next year before supporting a Conditional or Absolute Discharge, Dr. Prakash mentioned continued stability, including upon exploration of the diagnostic issue and potentially coming off her medication. He agreed that it is not unreasonable for Ms. Knight, particularly considering the notes from Dr. Anyaegbuna at Bluewater Health, to question whether she had substance-induced psychosis instead of schizophrenia.

38Concerning the likelihood of Ms. Knight’s voluntary return to the Hospital if requested by her treatment team, Dr. Prakash agreed that Ms. Knight’s history in the community is one of cooperation with the Forensic Outreach Team and that so far, there has been no issue with her following up and making herself available to the team.

39A panel member asked Dr. Prakash questions concerning the potential speed with which Ms. Knight’s mental state would decompensate in the absence of her long-acting antipsychotic medication. Dr. Prakash postulated a range of weeks to months. With the resumption of crystal methamphetamine use, Dr. Prakash said that the timeframe would be closer to weeks, but it could also be a matter of hours or days. Asked his opinion as to whether Ms. Knight would continue taking her medication in the absence of a Disposition, Dr. Prakash answered in the negative, stating that even with a Disposition, she wants to stop.

40Counsel for Ms. Knight suggested that this opinion overstated Ms. Knight’s reason for seeking an independent psychiatric consultation. Dr. Prakash then referred to a clinical note from a March 5, 2025 meeting between Ms. Knight and Dr. Mokhber, copies of which were then provided to the parties and the panel. In the note, which is in evidence as previously observed, Dr. Mokhber recorded that Ms. Knight had discussed the possibility of discontinuing her long-acting antipsychotic with her family doctor. Dr. Mokhber’s concluding statement in the “Assessment” portion of the note reads:

“The patient expresses a strong desire to discontinue her long-acting antipsychotic due to concerns about stigma and unwanted attention related to forensic oversight.”

Evidence of Dr. Mokhber

41Dr. Mokhber began her evidence by stating that she sees much potential and a bright future ahead for Ms. Knight. She stressed the need to take next steps carefully and gradually, including any potential medication changes. Dr. Mokhber was previously Ms. Knight’s inpatient psychiatrist in 2022, including during a period of drug use as noted above. She stated that when Ms. Knight used drugs, the experience showed how quickly her decompensation can occur. She believed that due to her prior drug use, Ms. Knight is very vulnerable to a new psychosis.

42Dr. Mokhber testified that it is fair to re-assess Ms. Knight’s diagnosis at this time. She could not be categorical but said that it was likely that the diagnosis would change. She stated that she would approach the investigation without any bias, and that if a change is to be made, including to medication, either the Hospital or Ms. Knight could seek an early Board hearing.

43Dr. Mokhber’s opinion regarding the management of Ms. Knight’s risk under a Conditional Discharge is summarized below in the analysis of the necessary and appropriate Disposition.

Evidence of Ms. Knight

44In giving her evidence, Ms. Knight presented as a confident, intelligent and articulate witness. She updated the panel by stating that she lives with her partner and son, Xavier, and that her daughter, A., is now transitioning into her care. As a result, she still appears in family court in Sarnia, as both the Sarnia and St. Thomas CASs are involved with her family. Once A. is fully in her care, she expected that there would be a six-month supervision order.

45Ms. Knight testified that she currently receives an injection of Abilify every four weeks and has been on it for some two years. She said she would continue to take it following an Absolute Discharge. While she currently experiences physical side effects, she believes that most are from her previous medication, Invega. She hopes that these physical effects can be reversed.

46Ms. Knight spoke of the positive effects of her Invega medication as well, stating that it helped “tremendously” within days and that her earlier thoughts with respect to her children being harmed were no longer an issue.

47Ms. Knight testified that she has a substance abuse issue involving crystal methamphetamine, explaining that it started in March of 2014 due to “an incident that devastated me”. She elaborated that the father of one of her children died from an overdose.

48Ms. Knight stated that she currently attends Narcotics Anonymous two to three times per month and sees her addictions counsellor three to four times monthly. She reduced her work hours to accommodate these appointments. She testified that she would “absolutely” continue with these supports if she received an Absolute Discharge, and also said that she would be able to benefit from CBT programs with the CMHA and STEGH (St. Thomas-Elgin General Hospital).

49Ms. Knight’s counsel returned to the subject of her attitude toward maintaining her medication after receiving an Absolute Discharge. Ms. Knight said that she would definitely continue taking it, though perhaps at a lower dose. Asked whether she would continue it unless and until a medical practitioner changed it, she said that she really did not want to change her medication, as Abilify was doing “just fine” for her. She would consider reducing the dose, however.

50Ms. Knight described the incidents leading to her convictions for assault in 2016 and 2018, stating that the 2016 incident did indeed involve drug use on her part. Responding to later questions by counsel for the Attorney General, she agreed that those convictions both resulted from guilty pleas, and that the 2016 assault involved the use of a weapon (a screwdriver). She stated that she is better placed to avoid violence now than she was in 2020, as she has coping mechanisms and more resources to help her address her emotions before they build up.

51Ms. Knight described matters that concerned her about her involvement with the Hospital. First, she said that when she brought her physical side effect issues to Dr. Prakash’s attention, either before or shortly after her last Board hearing, he told her to take these matters up with her family doctor. She also mentioned the process of seeking her community overnight passes. She said that the Hospital wants two weeks’ notice of her requests for passes. The Sarnia CAS sometimes schedules appointments on short notice, which makes the process difficult.

52With respect to the proposed referral to a “virtual consultation” with a psychiatrist, Ms. Knight explained that she simply wants an outside service rather than the Hospital to provide a diagnostic opinion. She was frustrated that her family doctor will not make decisions about her treatment without first consulting the Hospital. She said that she had an appointment through the remote service, but it was cancelled because the referral form was not signed.

53Asked by counsel for the Attorney General as to why she was looking for a “third party” diagnostic opinion, Ms. Knight said that it was due to her relationship with the Hospital and her feeling of being treated as “just a patient” rather than as a person. She has occasionally withheld information from the treatment team because team members always ask her only about what stressors she is experiencing.

54Asked by a panel member about how a Detention Order would be different from a Conditional Discharge from her point of view, Ms. Knight said that she would not be opposed to a Conditional Discharge, but the CAS sees her forensic status in a negative light, as posing a risk, and therefore an impediment to having her child. The CAS sees a Detention Order as providing for the possibility of her return to the Hospital.

55No further evidence was led following Ms. Knight’s testimony.

Analysis and Conclusions

Significant Threat

56Considering the evidence in its entirety, the panel found that Ms. Knight continues to represent a significant threat to the safety of the public. The panel accepts and relies upon Dr. Prakash’s opinion to this effect. In his opinion, without adherence to prescribed medication, and with a return to the use of crystal methamphetamine, violent behaviour would re-emerge. The potential for such behaviour causing serious physical or psychological harm is, in the panel’s estimation, real and substantial. That likelihood is neither speculative nor minuscule.¹

57We begin by noting Ms. Knight’s evidence that she is currently caring for two of her children. On one hand, this is identified in the recent actuarial risk assessment as a strong protective factor in her favour as she is by all accounts a responsible parent seeking to do her best for her children. On the other hand, her history discloses a pattern of harassing, threatening, and violent behaviour when she has perceived, particularly when unwell, that she was being kept away from her children or that her children were being harmed in some way. The index offences demonstrate that she is at risk of such behaviour when acting in response to psychotic symptoms resulting from her illness, exacerbated by methamphetamine use.

58The legal identification of the index offences as mischief does not speak to the nature or degree of harm caused. Rather, it is the impact of Ms. Knight’s behaviour on the victim who suffered from cerebral palsy and whose door she kicked in that speaks to the kind of serious harm that Ms. Knight’s behaviour would likely cause, even though unintentionally on her part. Furthermore, Ms. Knight’s presentation at the hospital following her apprehension included the yelling of delusional ideas about health care staff trying to kill her, as well as people placing her under surveillance and trying to harm her children. Attempts to de-escalate her failed and she started swinging at a nurse, prompting security staff to restrain her.

59These incidents are set against a background of earlier criminal offences that included an assault with a weapon (a screwdriver) that Ms. Knight testified involved her drug use, and an assault upon her sister at a family court proceeding involving Ms. Knight’s daughter, A.. In the period covered by the index offences, Ms. Knight was apprehended under the Mental Health Act between January 31 and February 3, 2020, after knocking on the doors of other tenants and yelling at them. According to the Hospital Report (p. 10), she physically assaulted another tenant in front of her children between February 3 and 5, 2020, following which police attended. The female victim did not want Ms. Knight charged and just wanted her to get help. Thereafter, in the period leading up to the index offences in February, the police received many complaints related to Ms. Knight’s erratic and unpredictable behaviour, threats, banging on doors, accusations, yelling, following and videotaping tenants throughout the building. Tenants were afraid for their safety and reluctant to leave their apartments.

60This history demonstrates to the panel’s satisfaction that in the event that Ms. Knight were to experience a mental health decompensation and act out by engaging in criminal conduct, the resulting harm, whether physical or psychological, would be serious and in no sense merely trivial or annoying.² The question then becomes: what is the likelihood of the occurrence of such behaviour? Put another way, is there a real likelihood of this risk materializing?³

61The re-offence scenario in the Hospital Report is instructive in this regard and is reproduced here for convenience:

“Absent the significant support that the Forensic Outreach team has provided her, Ms. Knight would likely continue to experience stressors and manage them with significant substance use as she had done historically. She would no longer have the support of the Forensic Outreach team to help her in managing stressors. As well, absent a mental health team, Ms. Knight would not have proactive access to her anti-psychotic injection, significantly increasing her risk for non-compliance with medication. Given this, her psychotic and affective symptoms, including paranoid delusions and auditory hallucinations, would re-emerge resulting in result in violent behaviours similar to those noted during the index offences.”

62With adherence to her medication, abstinence from substances, the strong support of her outpatient treatment team, and her own strength of character, Ms. Knight has shown a remarkable degree of stability in the community in coping with many challenges and stressors. She has not exhibited psychotic symptoms and has not acted out in a harmful way in almost two years in the community. She has taken initiative in enlisting community supports to help sustain her abstinence. She is to be commended for her resilience, determination and resolve.

63However, while seeking to assure the Board in her evidence of her commitment to stay on her medication after receiving an Absolute Discharge, Ms. Knight is again questioning her diagnosis of schizophrenia and wishes an independent review of this. As she is capable of making treatment decisions, she can withdraw her consent to her long-acting injectable medication at any time. In addition, over the past reporting period, as in the past, she has continued to experience cravings for methamphetamine. It is also expected that the challenges she has faced (financial concerns, working at two jobs, caring for her children and home, and significant relational conflict with her partner, to name a few) will continue. Ms. Knight acknowledges that in the past, using crystal methamphetamine was for her a means of coping with stress and giving her energy to manage the demands of work and caring for children. She resumed its consumption after completing a 35-day residential drug treatment program in 2017.

64Ms. Knight has recently switched from having her injection administered at the Forensic Outpatient Clinic to asking her family doctor in Sarnia to do this. However, he will not prescribe or modify it and is unwilling to manage her mental health. There is no non-forensic mental health service in place that provides the support and monitoring currently done by the Forensic Outreach Team, which has come alongside her on several occasions over the past year when she has made some rash or impulsive choices, thus helping to maintain her stability.

65Ms. Knight’s living situation in St. Thomas appears stable for now. However, as the events of the past reporting period have demonstrated, the relationship with her partner is difficult and sometimes volatile, and her living situation can be put in question.

66For the foregoing reasons, the panel finds that the re-offence scenario quoted above is not speculative. Absent forensic oversight, there is a real and substantial likelihood that Ms. Knight would become overwhelmed by one or more of the pressures in her life and her coping skills would fail her. This would likely result in her resumption of methamphetamine use, to which she previously returned after completing a residential program in 2017.

67Based on Ms. Knight’s history, mental status decompensation would likely be rapid and severe (even if she remained on her medication, which itself is questionable), particularly if she were to again develop paranoid fears about harm to her children. There would then be a real likelihood of her engaging in criminal conduct, similar to what has occurred in the past, with the potential to again causing serious harm to others.

Necessary and Appropriate Disposition

68The panel finds that the necessary and appropriate Disposition at this juncture is a Conditional Discharge, which is the least onerous and least restrictive for Ms. Knight bearing in mind the statutory factors in s. 672.54 of the Criminal Code. Absent an affirmative finding that Ms. Knight’s risk to the community cannot be safely managed under a Conditional Discharge, it is difficult to conclude that a Detention Order is the “least onerous and least restrictive” Disposition. The restraints on her liberty must be limited to what is necessary⁴.

69As noted above, Ms. Knight has done remarkably well under the Board’s oversight and with the care and support of her treatment teams. She is an obviously intelligent person who recognizes that she has overcome a difficult background. Since returning to living in the community, Ms. Knight has, with one exception when she lived in an environment where both legal and illicit substances were readily available, remained abstinent from those substances. Her other accomplishments in relation to employment, caring for her children, finding a home, and finding supports for her continued abstinence have already been reviewed.

70Ms. Knight has taken many steps to show that she can live independently in the community, with support from her forensic outreach team. Consistent with the twin goals of protecting the public and maximizing her own liberty, a Conditional Discharge is the necessary and appropriate Disposition currently. The panel notes that such a Disposition has the added benefit of enhancing Ms. Knight’s personal freedom by eliminating the requirement that she obtain permission from the Hospital before making weekend visits to her father in Sarnia.

71The panel is mindful of the possibility that there will be medication changes for Ms. Knight during the next reporting period. Dr. Mokhber stated that she is considering tapering down and potentially discontinuing Ms. Knight’s medication. From her training as a neuropsychiatrist, she knows the damage to the brain that drug use can produce. Having been Ms. Knight’s treating psychiatrist when she used drugs as an inpatient, she is aware that Ms. Knight is vulnerable to the emergence of a new psychosis. Therefore, although the Hospital proposed removal of the substance use abstention clause in the context of a Detention Order, the panel finds it necessary to keep this in place under the Conditional Discharge, at least while diagnostic and medication investigations are underway.

72Dr. Mokhber did not believe that monitoring and responding to the impact of medication changes or reductions could be achieved as effectively or efficiently under the Mental Health Act (in the context of a Conditional Discharge) as under a Detention Order. The panel also motes that in closing submissions, after Ms. Knight’s counsel proposed monthly reporting as a term of a Conditional Discharge, Hospital counsel submitted that for the Mental Health Act to be effective in this case, Ms. Knight would need to report at least weekly. [It is recalled that the Hospital recommended a reduction in reporting frequency to at least monthly under a Detention Order to reduce the stress experienced by Ms. Knight by more frequent appointments.]

73The panel appreciates the compelling nature of Dr. Mokhber’s evidence and acknowledges the Hospital’s concern that under a Conditional Discharge, Ms. Knight may need to have more frequent appointments so that any deterioration in her mental condition can be detected and addressed. Dr. Mokhber also pointed out that if a medication reduction or discontinuance is accomplished safely, the Hospital or Ms. Knight could ask for an early Board hearing.

74There is some residual risk that adjustments to Ms. Knight’s medication could result in a mental status deterioration that, while concerning, would not authorize the Hospital to detain Ms. Knight involuntarily under the Mental Health Act. The panel is satisfied that this risk is sufficiently mitigated by the combination of the retention of the prohibition against substance use and the requirement for weekly appointments during the upcoming reporting period while diagnostic and medication adjustment investigations are to be undertaken.

75We note the potential difficulties posed by the requirement of weekly reporting, in view of Ms. Knight’s many time demands. Perhaps arrangements can be made for some appointments to be conducted remotely. We leave this to the good judgment of the treatment team.

76In closing, the panel wishes Ms. Knight the best of success as she continues the positive trajectory that has been her journey under the Hospital’s care over the last few years. We also encourage her to work in collaboration with Dr. Mokhber and her treatment team, including in relation to the anticipated diagnostic re-evaluation. Ms. Knight should place confidence in Dr. Mokhber’s objectivity and desire to see Ms. Knight do well. It is to be hoped that the process will lead to a path forward for Ms. Knight that moves her to full and successful reintegration into the community.

Footnotes

1. 1The panel has directed itself as to the applicable legal principles bearing on the assessment of what constitutes a “significant threat,” including but not limited to those discussed in the cases of Re Wall, 2017 ONCA 713 and Re Krivicic, 2018 ONCA 535, referred to by counsel for Ms. Knight.
2. 2Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625, at para. 62; Re Viola, 2025 ONCA 33 at para. 12.
3. 3Re Carrick, 2015 ONCA 866 at paras. 16-17.
4. 4Winko, supra, at para. 54.