Re: Lisa A. Ling
ORB File No: 8032
Hearing held on: Monday, June 9, 2025
Place of hearing: St. Joseph’s Healthcare Hamilton, West 5th Campus Hamilton, Ontario
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. L. Maunder Members: Dr. P. Darby Dr. G. Stones Mr. R. Bigelow Mr. A. Mete
Parties Appearing:
Accused: Lisa A. Ling Counsel: Mr. J. Chrolavicius
The Person in Charge of Hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Ms. J. McKenzie
REASONS FOR DISPOSITION
(Dated: July 24, 2025)
Introduction
On February 9, 2022, Lisa Ling was found not criminally responsible on Criminal Code charges of assault with a weapon, assault (x2), and utter threats (x2). At the time of the hearing, Ms. Ling was subject to a disposition detaining her at the Forensic Psychiatry Program at St. Joseph’s Healthcare Hamilton with privileges up to living in the community in approved accommodation. On June 9, 2025, the Board convened to conduct an annual review of Ms. Ling’s disposition.
All parties agreed that the evidence established that Ms. Ling remained a significant threat to the safety of the public. All parties also agreed that a detention order was no longer necessary, and that the necessary and appropriate disposition was a conditional discharge with certain conditions, discussed below.
For the reasons set out below, the panel agreed that the significant threat threshold continued to be met and that a conditional discharge was the necessary and appropriate disposition.
The Index Offences
The only information the panel was given regarding the index offences derived from the police synopsis of the charges that was captured in the NCR assessment done for the Court, recounted in the Hospital Report. The facts in Court may have differed.
On October 1, 2021, Ms. Ling attended a local grocery store. While “brandishing” a knife, she approached a stranger and said, “I’m going to kill you with my knife.” Bystanders intervened resulting in Ms. Ling tossing the knife into a flowerpot before telling the stranger “I don’t need my knife. I can kill you right now.” Ms. Ling then pushed the stranger on the back with both her hands.
Ms. Ling then turned and punched another stranger on the back with her fists while she said to him “You’re my fucking brother. I’m going to kill you.”
Background / Context
Ms. Ling is 60 years old. She was raised by both her parents and has two older brothers. The family moved frequently as her father was in the air force. As a teenager, Ms. Ling pushed boundaries and experimented with substances. She left school after grade eleven and has worked various jobs over the years.
Ms. Ling met her partner when she was in her late twenties, and they have two adult children who still live in the family home.
Ms. Ling had her first psychiatric hospitalization in 2011, when she was 46 years old. Ms. Ling became suspicious of her husband and felt threatened by him. She left the family home, went to a shelter, and contacted the police and Family and Children Services (FACS). FACS advised Ms. Ling to go to the hospital for a psychiatric assessment. In hospital, Ms. Ling was noted to be experiencing symptoms of psychosis. She was also sleeping poorly, and her mood was labile. She was treated with antipsychotic medication, and over the course of her six-week hospitalization, she stabilized.
Ms. Ling had four more hospitalizations in the ten years between her first hospitalization and the index offence. Periodically, she became unwell - her family reported that she became “easily irritated, argumentative, and suspicious”. In hospital, she was described as paranoid. During these episodes, she invariably alleged that family members were engaged in various kinds of misconduct (sexual abuse, poisoning). On one occasion, her son called the police because of a domestic dispute and Ms. Ling was aggressive and uncooperative with the police. On each occasion, Ms. Ling improved with medication. She was diagnosed with a psychotic disorder or schizophrenia.
Ms. Ling was referred for follow-up care and did have an outpatient psychiatrist for some of the time but her follow-through and whether she adhered to medications is somewhat unclear from the records. Her poor insight and expressed views regarding medications suggest she was likely not adherent.
Ms. Ling’s family reported that her mental state changed in the weeks before the index offences. She was aggressive and delusional. It seems that, at the time of the index offence, she believed the strangers in the grocery store were her brother and sister-in-law.
Ms. Ling was admitted to St. Joseph’s, originally for an assessment, in December 2021 and remained a patient there until December 2023. Her diagnosis was clarified (Bipolar Disorder, Type 1) and she began treatment with antipsychotic and mood stabilizing medications. Ms. Ling was described as polite and cooperative. Her insight was initially quite limited but improved.
Ms. Ling’s mental state decompensated in late 2022 / early 2023. She became manic and psychotic, disorganized and tangential. She endorsed thoughts of harming others (in defence, which she believed necessary based on delusions) and was secluded briefly. Her insight was notably poor in this state. She refused suggested increases to her medications. Eventually, she deteriorated to the point that she was incapable for treatment decisions. Her antipsychotic dose was then increased with good results, on the consent of the SDM.
Ms. Ling was discharged to return to her family home in December 2023.
Ms. Ling has no criminal record and has no substance use disorder.
The Current Year
Dr. Y. Alatishe, Ms. Ling’s outpatient psychiatrist, wrote the Hospital Report and testified at the hearing.
Ms. Ling remained living in her family home throughout the year. Her mental health was stable – she did not have any episode of decompensation or psychosis and was not readmitted to hospital. Dr. Alatishe described her as having had “overall, a successful year.”
At last year’s annual review, the panel removed the prohibition on alcohol. Dr. Alatishe testified that although Ms. Ling has used alcohol more often than she planned to over the year, her use has not been of concern to the team.
Ms. Ling was reassessed and found capable of consenting to treatment in April 2025. Ms. Ling’s insight into her illness, her symptoms, and her need for medications has improved. She was able to identify her illness, symptoms, and what may be signs that she is becoming unwell. Dr. Alatishe believed that in the early stages of decompensation, she would seek help from the team but as she became more unwell she would become guarded.
Ms. Ling has been compliant with her medication. Although she missed one dose and on a couple of other occasions took her medications late, the team has worked with her to put in place mechanisms to ensure consistency that have helped.
Significant Threat
- The panel was satisfied that Ms. Ling remained a significant threat to the safety of the public. Paraphrasing the evidence of Dr. Alatishe, which was unchallenged, and we accepted, when Ms. Ling’s illness is active, she experiences persecutory delusions. She feels in danger and has responded aggressively and violently in the past – including with the use of a weapon at the time of the index offence. Although Ms. Ling has been cooperative and compliant with the forensic team, Ms. Ling also has a history of not following through with treatment and poor insight, particularly when she is unwell. The index offence was not that long ago. Without oversight, Ms. Ling remained likely to fall away from psychiatric follow-up and treatment again. She would then inevitably have a re-emergence of her symptoms and would pose a real risk of her once again acting out violently towards her family or strangers.
Necessary and Appropriate Disposition
The panel agreed with the parties that the necessary and appropriate disposition was now a conditional discharge. Ms. Ling had been living in the community successfully and without readmission since December 2023. Ms. Ling was stable and settled – although Ms. Ling has some stressors in her life, she lives with her family and that is unlikely to change. She is on ODSP and does not plan to work – work was a major source of stress in the past. Although Dr. Alatishe would like to see her more engaged with community activities, she does participate in some regular activities (bingo, volleyball, chair yoga and arts and crafts) both through the hospital and in the community. Ms. Ling has been compliant with medications, does not experience negative side-effects and has not been seeking to lower her dose or make changes.
As Dr. Alatishe pointed out, Ms. Ling has gone approximately 2 ½ years without an episode of psychosis – the longest period in many years. Dr. Alatishe testified that her medications, as adjusted after her 2023 decompensation, are more therapeutic and more protective. He also attributed this to Ms. Ling’s better insight and thus better compliance with medications.
Dr. Alatishe was satisfied that the Mental Health Act would offer sufficient mechanisms to manage Ms. Ling if she became unwell. Although Ms. Ling might decompensate quite quickly (over weeks), the team sees her enough that together with Ms. Ling and her family, they will pick up the early warning signs (sleep disturbances, irritability).
In terms of conditions, the hospital recommended that Ms. Ling report not less than twice per month, abstain from non-medical use of drugs, submit urine samples, and on her consent, comply with medication as prescribed, as well as the standard oversight conditions (report any absence from her residence of more than 24 hours, notify the hospital of any changes to her address or telephone, etc.)
The panel accepted the proposed conditions were necessary and appropriate with one exception. As Dr. Alatishe acknowledged, substance use has not been a problem for Ms. Ling. She does not have a history of substance use disorder. Dr. Alatishe was not confident she had even used cannabis in the past. There was no evidence that substance use was destabilizing for Ms. Ling. Her recent alcohol use (since last year’s disposition) had been moderate. While we appreciate that substance use is not encouraged, and that the safer course for Ms. Ling may be not to use any substances, we concluded that the evidence did not establish that a substance prohibition was necessary.
DATED this 24th day of July 2025, at the City of Toronto, in the Toronto Region.
Leslie Maunder Alternate Chairperson
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Office of the Registrar Ontario Review Board