Re: Marja Johnson
ORB File No: 7229
Hearing held on: Tuesday, May 20, 2025
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Kert
Members: The Hon. B. Allen Dr. S. Hucker Dr. M. Mamak Mr. A. Bouvier
Parties Appearing:
Accused: Marja Johnson Counsel: Ms. C. Whillier
The Person in charge of Hospital: Representative: Dr. T. Wilkie
Attorney General of Ontario: Counsel: Ms. L. Earle
REASONS FOR DISPOSITION
(Dated July 7, 2025)
Introduction
[1]. On September 27, 2017 Ms. Marja Johnson was found not criminally responsible by reason of mental disorder on a charge of aggravated assault contrary to the Criminal Code.
[2]. Under s. 672.81(1) of the Criminal Code, a panel of the Ontario Review Board (the Board) was convened on May 20, 2025 at the Centre for Addiction and Mental Health (CAMH or the Hospital) to review Ms. Johnson's risk to the public safety and the appropriate disposition under s. 672.54 of the Criminal Code.
[3]. Ms. Johnson’s existing disposition dated June 7, 2024 orders a conditional discharge, among other conditions, requiring her to reside at a LOFT high-support residence in Toronto. Toronto, Ontario.
[4]. The parties jointly take the position that Ms. Johnson no longer poses a significant threat to public safety and that the necessary and appropriate disposition is an absolute discharge.
Disposition
[5]. For the reasons set out below the Board concludes, under s. 672.54 of the Criminal Code, that Ms. Johnson no longer poses a significant threat to public safety and that the necessary and appropriate disposition is an absolute discharge.
Current Diagnoses
[6]. Ms. Johnson’s current diagnoses are schizophrenia, cannabis use disorder in remission and major depression disorder.
The Evidence
[7]. The Board has before it the Hospital Report dated April 12, 2025 which contains an account of Ms. Johnson’s personal and psychiatric background which need not be repeated in detail here. The Board also has the oral evidence of Dr. Treena Wilkie, the author of the Hospital Report.
Index Offence
[8]. The circumstances of the index offences are described in the Hospital Report and are summarized as follows:
[9]. Both the accused Marja Johnson and the victim resided at 54 Ossington Avenue in Toronto. This is a 3-storey, multi-unit residential home associated with CAMH for persons ready to transition away from a secure mental health facility. The victim resided in unit #201 and Ms. Johnson, in unit #202. On November 21, 2016 the victim was exercising in his room when Ms. Johnson knocked on his door. He opened the door and told her to wait a moment as he had to get dressed. As the victim turned away from the door to his room Ms. Johnson pushed the door open and immediately stabbed the victim in the upper left chest area. She was holding an approximate 4-inch flip knife in her right hand and swung the knife at the victim from above her right shoulder in a downward stabbing motion.
[10]. After stabbing the victim Ms. Johnson turned back around and left the victim’s room. The victim fearing for his safety ran downstairs to a common area away from Ms. Johnson and called 911. Officers arrived on scene a short time later and found the victim had sustained a puncture wound on his upper left chest and was bleeding profusely. As other officers arrived on scene they located a quantity of blood in the 2nd floor hallway. Officers checked the area for more victims and located Ms. Johnson a short time later. She readily admitted stabbing the victim and pointed out a knife that was lying a short distance from her hand. Ms. Johnson was placed under arrest, given her rights to counsel and transported to the police station.
[11]. Ms. Johnson had been smoking cannabis before she committed the index offence. She has committed no further criminal offences or acts of violence since the index offence.
Criminal History
[12]. Ms. Johnson has a criminal record dating back to the early 1980s and early 1990s for thefts and failures to comply with court orders for which she received suspended sentences.
Substance Use
[13]. Ms. Johnson has a history of cannabis use. Cannabis has contributed to a worsening of her psychotic symptoms and to subsequent acts of violence.
Ms. Johnson’s Personal and Psychiatric History
Before the Current Reporting Year
Personal History
[14]. Ms. Johnson is a 64-year-old single woman, born in Ontario and without dependants. She is currently not in a relationship with a domestic partner but indicated she has had several short-term relationships in the past. She had an eight-year relationship with a boyfriend with whom she did not cohabit. Ms. Johnson moved out of the family home when she was age 16 which was around the same time her parents separated. She lived independently until she was hospitalized for the first time at CAMH on June 10, 1993. Ms. Johnson was admitted and discharged from several hospitals over the years. She resided for about 20 years at the premises at 54 Ossington Avenue where the index offence occurred.
[15]. Ms. Johnson had worked part-time for short periods at restaurants. She is financially supported by Ontario Disability Support Program benefits and her finances are managed by the Office of the Public Guardian and Trustee.
Psychiatric History
Before the Current Reporting Year
[16]. Ms. Johnson’s early psychiatric records from the 1990s and early 2000s disclose psychotic and mood symptoms manifesting in delusions with typically persecutory themes. The hospital records note at least one suicide attempt during the 1990s.
[17]. In 2017 following the index offence Ms. Johnson was admitted to the Forensic Assessment and Treatment Unit (FATU) at CAMH pursuant to a Warrant of Committal dated September 27, 2017. At CAMH Ms. Johnson presented with psychotic symptoms with delusional themes that typically involved persecution and command-type auditory hallucinations. She endorsed paranoid beliefs that people were out to harm her including Hospital staff.
[18]. Ms. Johnson showed limited insight into the symptoms of her mental illness. She superficially acknowledged having schizophrenia and had some understanding that the auditory hallucinations were symptoms of her illness. Ms. Johnson was compliant with her anti-psychotic medication.
[19]. In January 2018 Ms. Johnson was transferred to a general forensic unit at CAMH. And although she still experienced various delusions she used community passes appropriately mainly without incident. At this time she was reluctant to participate in structured activities and health education and did not accept that she suffered from a mental illness.
[20]. During the period 2019 to 2020 Ms. Johnson continued to experience delusions. With an increase in her antipsychotic medication, her psychotic symptoms improved. Although she craved illicit substances her urine tests were negative. While Ms. Johnson acknowledged her diagnosis of schizophrenia and that her medications were for the treatment of that illness she lacked insight into the psychotic nature of her symptoms when she experienced them. She stated that she would probably not take medications if she were not supervised in the Hospital. During this period the clinical team began to discuss the prospect of community living which Ms. Johnson resisted indicating she preferred to remain at the Hospital because she was comfortable.
[21]. Ms. Johnson became involved in some therapeutic programs particularly those that were women-centred and centred on art and self-care. On January 23, 2020 the unit social worker submitted an application for Ms. Johnson to be considered for a bed opening at Regeneration House which had 24-hour on-site staff and provided staff-observed medication administration, had structured activities at the residence and offered staff supervised outings.
[22]. However there was little change in Ms. Johnson’s mental state over that reporting period. She continued to experience delusions, hallucinations and some mild thought disorganization. There were no serious incidents or use of illicit substances but Ms. Johnson continued to resist involvement in programming.
[23]. During the period 2021 to 2022 Ms. Johnson made some progress. On May 6, 2021 she was discharged to a transitional community housing placement at the same LOFT housing in Toronto. Ms. Johnson’s mental status remained stable overall during that year. She continued to experience symptoms of psychosis including auditory hallucinations of various voices including those of animals. She expressed numerous delusions but not any suicidal or homicidal ideation. Her anti-psychotic medications were increased.
[24]. Ms. Johnson adjusted well to community living presenting with no significant concerns about her mental status. However she was inconsistent in reporting to appointments with her Forensic Out Patient Services (FOPS) team and was found to be absent from her residence during the time of her appointments. There were no significant changes in her symptoms of psychosis but, overall, Ms. Johnson reported that there was improvement in her mood and thinking. She was on a waitlist to transition to permanent housing.
[25]. During the period 2022 to 2023 Ms. Johnson continued to reside at the same LOFT residence in Toronto. Ms. Johnson’s mental status remained stable overall during this year, with chronic residual symptoms of psychosis. She continued to experience auditory hallucinations of multiple voices including those of animals. There were no changes to Ms. Johnson’s psychotropic medications during this review period. She did not report any significant side effects of her current psychotropic medications.
[26]. Ms. Johnson showed reluctance to transition to more permanent community housing. In December 2022 she had considered asking to return to a CAMH general forensic unit. The clinical team encouraged her to continue on the path to more permanent housing. She was being considered for LOFT alternative housing.
[27]. During the reporting year 2023 to 2024 Mr. Johnson transitioned to more permanent LOFT high-support housing in Toronto where her care was managed by the FOPS team.
[28]. There were no significant incidents of violence, self-harm or absconding events during this period. Urine drug screens were negative for illicit substances. Ms. Johnson’s mental status remained stable overall during this year, with chronic residual symptoms of psychosis. She continued to experience auditory hallucinations of multiple voices including those of animals. Ms. Johnson spent most of her time in the residence and declined involvement in CAMH programs. There were no significant changes to Ms. Johnson’s psychotropic medications during this review period.
The Current Reporting Period – March 2024 to April 2025
[29]. During the current reporting period Ms. Johnson continued to reside at the same LOFT high-support housing accommodation. That residence provides support with self-care, meal preparation, housekeeping and the use of transit.
[30]. Ms. Johnson’s care was managed by Dr. Treena Wilkie and a case manager with FOPS until August 2024 and subsequently by a case manager from the Canadian Mental Health Association (CMHA) transitional team. LOFT also provided a primary case manager and she saw a psychiatrist, Dr. Eom and a family physician who attended the home on a weekly basis.
[31]. The following factors reflect her progress during the current reporting year: there have been no significant incidents of violence or self-harm; no absconding events; her mental status remains fairly stable with chronic residual psychotic symptoms involving auditory hallucinations of multiple voices; she does not participate in any structured activities outside of the LOFT residence; she experienced three notable incidents of persecutory delusions involving LOFT housing and the FOPS staff involving negative communications by others and flushing cigarettes down the toilet in response to a command auditory hallucination; she remained medication compliant and reported improvement in her mood, a decrease in irritability and more clarity in her thinking. There was one incident of her being observed smoking cannabis on the LOFT premises.
[32]. Ms. Johnson is treatment capable. In late November 2024, at the suggestion of Dr. Eom, Dr. Wilkie spoke to Ms. Johnson about a Community Treatment Order (CTO). Ms. Johnson was receptive to this if it meant she was not under the authority of the Board. She indicated that her main priority is to ensure supports are available to prevent deterioration in her mental state, to support medication compliance and to help avoid her return to the Hospital.
[33]. A Community Treatment Plan (CTP) was developed and discussed with Ms. Johnson which focused on three elements: Ms. Johnson taking her medication as prescribed, abstaining from substances and meeting with mental health professionals. Ms. Johnson expressed commitment to her medication regime but supported having the CTP in place as a safeguard against something happening if she were to stop her medication.
[34]. Ms. Johnson initially expressed some ambivalence about an absolute discharge as she was accustomed to the support of the FOPS, LOFT and the CMHA team especially with respect to monitoring the self-administration of her medication. However in April 2025 she consented to the CTP to be managed by Dr. Eom.
[35]. The clinical team concluded as follows on the issue of risk:
Based on the above risk assessment, Ms. Johnson is likely at a low-moderate risk for violence while under the auspices of a CTO, given her underlying major mental illness, substance use disorder and treatment/supervision difficulties. This risk would be further elevated by medication non-adherence, increased stress, and/or relapse into substance use.
Ms. Johnson is on a Community Treatment Order. In that context the clinical team opines that Ms. Johnson no longer represents a significant threat to the community, as defined by Section 672.5401 of the Criminal Code of Canada.
Oral Evidence of Dr. Treena Wilkie
[36]. Dr. Wilkie testified that Ms. Johnson had been under her care since March 2021. She provided no material updates to the Hospital Report.
[37]. Dr. Wilkie testified that Ms. Johnson’s risk in the past arose from the symptoms of her major mental disorder, her substance use, periods of disconnection from treatment services, her social isolation and her lack of structured activity. Dr. Wilkie confirmed the conclusion in the Hospital Report that while the intensity of Ms. Johnson's psychosis has decreased she continues to experience psychotic symptoms. Regarding a question from Crown counsel about treatment for Ms. Johnson’s ongoing psychotic symptoms, Dr. Wilkie testified that Ms. Johnson has consented to the optimization of her medications as proposed by her outpatient team.
[38]. Dr. Wilkie commented that the services at Ms. Johnson's 24-hour high-support structured housing are directed at mitigating the effects of her vulnerabilities. Ms. Johnson has the benefit of housing staff on site that include a designated case manager, a personal support worker, a family doctor and a psychiatrist. She no longer expresses the reluctance she once had to being outside the care of CAMH. Ms. Johnson has a good rapport with the housing staff who have grown to know her well. Dr. Wilkie anticipates that she will remain at her current housing if granted an absolute discharge. She testified that CAMH and the housing case manager will work together, in consultation with Ms. Johnson, and if an absolute discharge is granted, a timeline for transition will be set at that time.
[39]. Dr. Wilkie pointed out that it was during this reporting year that Ms. Johnson first consented to a CTO in consultation with her case manager. The doctor confirmed that Ms. Johnson is agreeable to the goals of the CTO which are to supervise medication compliance, monitor her substance use and ensure her attendances with her case manager. Dr Wilkie indicated that the CTO will be renewed in six months and she anticipates that it will be ongoing thereafter.
[40]. It is Dr. Wilkie’s opinion that in the circumstances the Mental Health Act is sufficient to address any need for hospital care while she is being managed in the community under the CTO.
[41]. Given the destabilizing effect of cannabis on Ms. Johnson's mental health, Dr. Wilkie spoke about the incident during the current reporting year when on the residence premises Ms. Johnson briefly smoked marijuana offered by co-residents. This is the only time Ms. Johnson used cannabis since the index offence. Dr. Wilkie indicated that Ms. Johnson reaffirmed the importance of remaining abstinent in keeping with her consent to the CTO and admitted to poor judgment in accepting the marijuana. This incident has alerted the team to be more observant of Ms. Johnson’s whereabouts.
The Parties’ Positions
[42]. The parties advanced the joint position that, as the evidence no longer supports a finding that Ms. Johnson poses a significant threat to public safety, the appropriate disposition is an absolute discharge.
The Board’s Determination
[43]. While mindful of the parties’ joint position the Board is required to come to an independent determination.
[44]. Based on the evidence before us, the Board unanimously accepts the opinion, as stated in the Hospital Report, that Ms. Johnson no longer remains a significant threat to public safety within the criteria outlined in Winko and as defined in s. 672.5401 of the Criminal Code. The Board considered the criteria, as set out in s. 672.54, namely, the paramount criterion of the safety of the public and Ms. Johnson’s community re-integration, her mental condition and her other needs.
[45]. We accept, in accordance with s. 672.54 of the Criminal Code, that the necessary and appropriate disposition in the circumstances is an order for an absolute discharge as, in the Board’s opinion, Ms. Johnson no longer represents a significant threat to the community as defined by section 672.5401 of the Criminal Code.
[46]. The Board arrives at that decision for the following reasons.
[47]. The Board finds that the Hospital Report and Dr. Wilkie’s oral evidence amply establish that Ms. Johnson is no longer a significant threat.
[48]. Over the current reporting year Ms. Johnson has demonstrated improvement in the life circumstances that once posed a threat to her mental health and the safety of the public. Considering the violent nature of the index offence, affected by the consumption of cannabis, the Board places some emphasis on the fact that since the index offence she has not engaged in any violent acts and, except for the one brief incident during this reporting year, she has not used cannabis. And Ms. Johnson has admitted to a lapse in judgment and expressed regret for the incident. There is also the added fact that Ms. Johnson has a dated criminal record that involves minor offences, dissimilar to the index offence, that occurred several decades ago.
[49]. The Board is fortified in its conclusion by the fact Ms. Johnson has consented to a CTO and associated CTP to monitor her medication, drug abstinence and follow-up appointments with her treatment team. Further Dr. Wilkie expects the CTO to be ongoing after being renewed in six months. The Board is confident that under the CTO Ms. Johnson’s residual psychotic symptoms can be managed.
[50]. Despite Ms. Johnson's past reluctance to leave the care of CAMH she has grown into community living since her discharge to housing in May 2021. She enjoys her LOFT housing and has developed a positive rapport with the housing staff so much so that it is anticipated that she will remain there going forward. Regarding her limited community engagement, it is acknowledged that Ms. Johnson's community contact is restricted by mobility issues.
[51]. The Board agrees with the Hospital that under the circumstances the Mental Health Act criteria can be met and will be sufficient to address any concerns that arise that might require admission to hospital.
[52]. The Board wishes in conclusion to acknowledge the substantial strides Ms. Johnson has made during the last two reporting years and encourage her to stay on her positive trajectory.
[53]. The Board concludes, under s. 672.54 of the Criminal Code, that Ms. Johnson no longer represents a significant threat to the community as defined by section 672.5401 of the Criminal Code and is entitled to be absolutely discharged from the authority of the Board.
DATED this 7th day of July, 2025, at the City of Toronto, in the Toronto Region.
The Hon. B. Allen
Legal Member
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Office of the Registrar
Ontario Review Board