Ontario Review Board
Re: Marissa Joanne Jacob
ORB File No: 5352
Hearing held on: May 14, 2025
Place of hearing: North Bay Regional Health Centre – North Bay
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. R. Steinberg
Members: Dr. M. Kalia Dr. P. Prendergast Hon. A. Sosna Ms. D. Smith
Parties Appearing:
Accused: Marissa Joanne Jacob Counsel: Mr. U. Agostino
The Person in charge of Hospital: Representative: Ms. C. Condie Counsel Mr. P. Trenker
Attorney General of Ontario: Counsel: Ms. D. McCaig
REASONS FOR DISPOSITION
(Dated June 9, 2025)
Introduction:
Ms. Jacob was found not criminally responsible on May 25, 2009, of assault with a weapon, assault, and breach of probation. She has remained under the jurisdiction of the Ontario Review Board since that time and is presently subject to a disposition dated May 9, 2024, that orders her detention at the North Bay Regional Health Centre and grants her privileges, the most liberal of which includes indirectly supervised hospital and grounds privileges, accompanied community entry, and accompanied travel passes for up to seven days with an approved itinerary.
The Board convened a hearing at the North Bay Regional Health Centre on May 14, 2025, to review the disposition, as required by section 672.81(1) of the Criminal Code. At the outset of the hearing counsel for the hospital suggested that maintenance of all terms of the present disposition, with the addition of a community living provision, was the necessary and appropriate disposition in the present circumstances. Counsel for Ms. Jacob supported the position of the hospital, while counsel for the Attorney General wished to hear evidence before stating her position on the addition of the community living condition.
Index Offences:
- The facts of the index offences are set out in the April 22, 2025, hospital report, which was marked as Exhibit 1 at the hearing. Briefly stated, they are that on March 14, 2009, Ms. Jacob was in her family residence in the First Nation Territory of Webequie. She started striking her sister on the head with her fists, and when her father tried to intervene, she lunged at him and attempted to stab him twice with a metal fork. At the time she was subject to two separate probation orders and was accordingly charged with breaching those orders.
Background and History:
Ms. Jacob is presently 36 years of age. She has four siblings. Both her parents are said to be disabled and receive disability payments. She displayed prominent behavioural problems in her childhood, including substance abuse, fire setting, fighting, and breaking and entering premises, and was in foster care between the ages of 14 and 16.
Her level of functioning is described over several years in a variety of settings, both institutional and community, as having been marginal at best. Regular reports were received of violent and aggressive behaviour within the family, which included verbal threats, breaking objects, intimidation, and the use of weapons. Substance abuse has been an ongoing issue. Her mental state has been described over time as unstable.
Ms. Jacob’s family reported that her mental state was deteriorating daily without medication in the weeks prior to the index offences. She left the family home regularly to access alcohol and cannabis. The index offences occurred in that context.
Before being found not criminally responsible Ms. Jacob accumulated a history of criminal convictions including assault, assault with a weapon, and arson. A formal criminal record is not set out in the hospital report, but it notes she was charged with sexual assault involving unwanted touching with two female co-residents in her group home in 2020. She was sentenced to a six-month conditional sentence and 12 months probation on February 25, 2022, and was registered as a sexual offender.
Her psychiatric history is extensive and is detailed in the hospital report. It cites a number of admissions to hospital for psychiatric care prior to the index offences. Her first admission occurred when she was 14-years of age. Records indicate a history of having been sexually assaulted and a history of previous suicide attempts by overdose.
The hospital report traces Ms. Jacob’s course of treatment while she has been subject to the jurisdiction of the Board and details her treatment in the past year. Her present diagnoses are Mixed Cluster B Personality Traits, Substance Use Disorder, Mild Intellectual Disability, and Unspecified Psychotic Disorder. She is prescribed a psychotropic medication and is said to have adhered to her medication regimen during the past period of review. Her medical status has been stable and her diabetes is well managed.
Exhibit 1 notes that Ms. Jacob has a longstanding history of alcohol and substance use. On January 16, 2025, she eloped from the hospital while exercising indirectly supervised privileges and was returned in a highly intoxicated condition. She had obtained money from a co-patient and taken a bus to the mall and a cab to her boyfriend’s home. They proceeded to a hotel where they consumed alcohol. However, since that time Ms. Jacob has been successfully reintegrated into the in-patient Hummingbird Lodge hospital environment and has actively participated in her behavioural care program. She admitted to her psychotherapist that when she leaves the hospital without authorization, she does so due to the urge to consume alcohol.
Ms. Jacob diligently follows her prescribed medication regimen and has demonstrated relative psychiatric stability. Nevertheless, the report notes that adherence to medication alone has not sufficiently mitigated her psychotic symptoms or impulsive behaviours.
In the view of the treatment team, Ms. Jacob’s care plan has encouraged prosocial behaviour. However, she is evaluated as presenting a significant risk of elopement, particularly when provided with indirectly supervised privileges, as indicated by her history of unauthorized absences to engage in substance use.
Given her history of problematic behaviour using electronic devices, it has also been necessary to maintain a comprehensive safety plan for computer and telephone use to ensure her continued support and safety. Notable incidents in the past year referred to in the hospital report confirm treatment providers’ view that Ms. Jacob needs consistent guidance and close supervision when using a telephone or electronic devices capable of accessing the internet. After her unauthorized absence in January 2025, Ms. Jacob on April 14, 2025, called the switch board operator, asked for the hospital’s internet password, and expressed a desire to arrange transportation to pick her up at the hospital.
Ms. Jacob engages in daily reviews of her behavioural contingency plan with her assigned nurse. Her behavioural plan involves a reward system which permits a special snack after a number of days of compliant behaviour. On February 13, 2025, after obtaining seven high-level reinforcements, the behavioural analyst suggested amending the compliance requirement from seven to nine days, and Ms. Jacob accepted. She has continued to participate in her care plan, which the treatment team attributes to her increased prosocial behaviour.
The hospital report notes that Ms. Jacob has been in regular contact with members of her family, some of whom travelled from Webequie First Nation to attend her 2024 hearing. Her father has expressed interest in becoming an approved person, but delay has been experienced in the application because he has to date been unable to obtain a criminal record check.
Ms. Jacob receives Passport funding through Developmental Services Ontario and in the past has had access to a Passport worker who has facilitated outings on both hospital grounds and in the community. However, her worker left the program in early April 2025, and she is presently awaiting the assignment of a new staff member to continue the accompanied activities.
Ms. Jacob is incapable of managing her finances and the Office of the Public Guardian and Trustee manages her Ontario Disability Support Program benefits. As noted above, she resides in Hummingbird Lodge, an all-female trauma-based program within the Forensic Program. Although she is not yet ready for community placement, the treatment team is of the opinion that the most suitable accommodation in the community for her will be a 24-hour/7-day per week supervised home such as the Dual Diagnosis Transitional Rehabilitative Housing Program (DD-TRHP).
The authors of the hospital report conclude Ms. Jacob continues to pose a significant threat to the safety of the public because she suffers from a severe and persistent Unspecified Schizophrenia Spectrum and Other Psychotic Disorder with treatment refractory auditory hallucinations, has a Personality Disorder with Antisocial and Borderline Features, Substance Abuse Disorder, and a Mild Intellectual Disability associated with Fetal Alcohol Spectrum Disorder; engages in unpredictable, aggressive and violent behaviour, exacerbated by alcohol and illicit substance use when unwell; is highly impulsive and tends to focus on immediate gratification, with little ability to foresee the consequences of her actions; has a longstanding criminal record, including convictions for assault, assault with a weapon and arson, and has a history of violence against hospital staff; has had unsuccessful attempts to be reintegrated into the community in the past and has breached her disposition on multiple occasions since being found not criminally responsible in 2009; has a significant history of alcohol and substance use, eloped in the present reporting period, and used substances; and has a long history of elopement from hospital and group homes.
In their opinion her condition necessitates ongoing psychiatric monitoring and reassessment of her treatment’s effectiveness. They feel her privileges should remain restricted for the time being, with gradual reassessment as significant and sustained progress is demonstrated. Her insight into her mental illness is described as being poor, her behaviour as unpredictable, and she is said to be easily influenced toward negative behaviours.
Their unanimous conclusion is that she requires a further sustained period of forensic inpatient hospitalization. They nevertheless suggest the addition of a privilege permitting her to live in the community in supervised accommodation to ensure maintenance of her position on waiting lists and to motivate her in treatment.
Evidence at the Hearing:
Dr. G. Munro, Ms. Jacob’s attending psychiatrist since March 2024, testified on behalf of the hospital at the hearing. She confirmed that Ms. Jacob was transferred to the North Bay Hospital in the summer of 2022 and is presently a resident of Hummingbird Lodge. Dr. Munro stated that Ms. Jacob has made significant gains in the past year, particularly during the past six months. Her behavioural care plan has succeeded in encouraging prosocial behaviour and greater stress tolerance. She confirmed the reward system requirement was increased from seven to nine days with the concurrence of Ms. Jacob.
Ms. Jacob engages in many Indigenous cultural services available at the hospital, including Minowacihewin – Regional Service for Indigenous People (MINO). She participates in beading groups, smudge ceremonies on the unit, the Fall Feast, Four Moon ceremonies, and Bannock socials. Her participation in other Indigenous cultural events is set out in the hospital report. She also contacts her family daily, mostly by telephone. Webequie First Nation is located about 500 kilometres north of Thunder Bay and her present disposition allows seven-day travel to visit family there. Unfortunately, financial concerns have made it difficult for the hospital to provide staff to accompany her that distance. The hospital is considering taking Ms. Jacob to Thunder Bay to visit with her family.
Although Ms. Jacob had previously expressed a desire to return to the Thunder Bay Regional Hospital to be closer to her family, she has recently agreed to remain in North Bay to continue her treatment and the specialized programming in which she is involved. Dr. Munro stated the hospital would continue to recommend highly supervised accommodation if Ms. Jacob is transferred to Thunder Bay.
She supported the hospital position that the addition of a community living condition was necessary and appropriate at present for the purposes mentioned above. Due to her history, Dr. Munro was quite clear that only highly supervised accommodation would be considered if Ms. Jacob were to be discharged from the hospital. She thought that if Ms. Jacob continues on her present trajectory in treatment, she will be appropriate for discharge to highly supervised housing toward the end of the coming year. However, the hospital seeks a term permitting “approved accommodation” instead of “24/7 supervised accommodation”, as the former increases the availability of residential accommodation and opportunities for placement.
In response to questions by Ms. McCaig, Dr. Munro confirmed Ms. Jacob suffers from an alcohol use disorder and her unauthorized leaves of absence from the hospital usually relate to her desire to consume alcohol. However, in highly supervised group home accommodation no alcohol would be permitted and oversight by staff will be continuous. She noted that the substance abstention and testing clauses will remain in the disposition if the panel accepts the hospital recommendation.
In response to questions by Mr. Agostino, Dr. Munro indicated that a discussion of the reinstitution of indirectly supervised hospital and grounds privileges will be undertaken in early June 2025. She was unaware when a new Passport worker will be assigned, as that agency is unaffiliated with the hospital, and agreed Ms. Jacob would greatly benefit from being closer to her family.
Dr. Munro stated that Ms. Jacob’s ability to de-escalate her conduct has improved in the last year, although sometimes she needs “as needed” medication, which she requests on her own.
No evidence was adduced by counsel for the Attorney General or the accused. In their final submissions all counsel supported the hospital recommendation that the necessary and appropriate disposition for the coming year was maintenance of all terms of the present disposition and the addition of a community living condition.
Conclusion:
Having considered the evidence, the exhibits, and submissions of counsel, the panel concludes that Ms. Jacob continues to represent a significant threat to the safety of the public. As stated above, she suffers from a severe and persistent Unspecified Schizophrenia Spectrum and Other Psychotic Disorder, with treatment refractory auditory hallucinations. When unwell, she engages in unpredictable, aggressive, and violent behaviour that is exacerbated when she uses alcohol or illicit substances. She has a longstanding criminal record, which includes offences of violence, and she has been placed on the Sex Offender Registry for ten years due to her recent conviction for sexual assault. She has breached her disposition on multiple occasions in the past, has a significant history of alcohol and substance use, and a long history of elopement from the hospital and group homes. If left to her own devices it is clear she would fall away from treatment, become non-compliant with her medication regimen, and use substances, which, as in the past, would very likely result in aggressive and violent behaviour.
We agree with the observation of treatment providers and the testimony of Dr. Munro that Ms. Jacob has made substantial progress in the past year and that maintenance of all terms of the present disposition and the addition of the community living condition is the necessary and appropriate order that is the least restrictive and onerous for the coming year. In so concluding, we have considered the factors set out in section 672.54 of the Criminal Code, public safety being paramount. We have also considered the need to maintain Ms. Jacob’s position on waiting lists for community accommodation and the beneficial therapeutic effect of the addition of the suggested term.
DATED this 9th day of June 2025, at the City of Toronto, in the Toronto Region.
R. Steinberg
Alternate Chairperson
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Office of the Registrar
Ontario Review Board