Re Natalie R. Heaton, 2025 CanLII 76484

Re: Natalie R. Heaton

ORB File No: 6783

Hearing held on: Thursday, April 10, 2025

Place of Hearing: Providence Care Hospital, Kingston

Pursuant to: Section 672.81(1) of the Criminal Code

Before:

Alternate Chairperson: Ms. K.A. Connidis

Members: Dr. R. Kunjukrishnan Dr. W. Loza Ms. N. Nathanson Mr. R. Rainboth

Parties Appearing:

Accused: Natalie R. Heaton Counsel: Mr. M. Davies

The person in charge of hospital: Counsel: Ms. T. Tom

Attorney-General of Ontario: Counsel: Ms. J. Ferguson

REASONS FOR DISPOSITION

(Dated July 28, 2025)

Introduction

1. On June 5, 2015, Ms. Heaton was found not criminally responsible on account of mental disorder ('NCR') on a charge of arson–reckless disregard for human life, and since then has remained under the jurisdiction of the Ontario Review Board (the 'Board'). Ms. Heaton is currently subject to a Disposition of July 23, 2024, discharging her with privileges and conditions including that she reside at a specified address, on her consent take recommended psychiatric treatment, refrain from substance use, upon notice immediately attend at the hospital for assessment, and not travel outside the City of Kingston except with an approved itinerary.

2. On Thursday, April 10, 2025, this panel of the Board convened a hearing at Providence Care Hospital ('the hospital') to conduct an early review of Ms. Heaton's current Disposition, in response to that request in a letter from the hospital dated February 12, 2025.

3. The issues to be decided were whether the significant threat to the safety of the public that is posed by Ms. Heaton at this time, requires a change in the terms of her current Disposition, in order to ensure it remains the necessary and appropriate disposition. In deciding this issue, the Board is required by s. 672.54 of the Criminal Code to consider four factors, being the safety of the public, as the paramount consideration, and Ms. Heaton's mental condition, reintegration into society, and her other needs.

4. The evidence at the hearing included a Hospital Report dated March 28, 2025 (the ‘Hospital Report’) and the viva voce evidence of Dr. M. Chan.

Initial Positions of the Parties

5. At the outset of the hearing, Ms. Tom advised that the hospital was seeking a change in Ms. Heaton's disposition to a Detention Order, with the conditions set out in the Hospital Report (pgs. 53-54). Ms. Ferguson, counsel for the Attorney-General, joined in the hospital’s position. Mr. Davies, counsel for Ms. Heaton, advised that they were content to leave the Disposition as it is, with no change in its terms, and were making no submissions on the significant threat issue. On that basis, Ms. Tom advised that the hospital would rely on the evidence in the Hospital Report on that issue, which the Board chairperson confirmed was acceptable.

The Index Offence, from the Hospital Report

6. The circumstances of the index offence are set out briefly in the Hospital Report, and can be summarized as follows:

On December 14, 2014, Ms. Heaton set fire to the inside of her room in a shared house in Belleville. A co-tenant witnessed the event, contacted the fire department, and evacuated the other residents. Firefighters contained and extinguished the fire, which was confined to the single room. Police arrived and Ms. Heaton was arrested on the charge of arson.

Personal History, from the Hospital Report

7. The Hospital Report should be referred to for details of Ms. Heaton's relevant personal background prior to the index offence. As that Report is an exhibit, its contents are not reiterated here. However, the following points are noted.

8. Ms. Heaton was born in August 1993 and is now 31 years old. From the time she was about one year old, she and her three sisters were raised and adopted by their aunt and uncle, and were part of an evidently stable and good home with an extended family of relatives. Little is known about her first year of life, when the Children’s Aid Society became involved in the girls' care, as their biological mother was unable to care for them and biological father not in the picture, apparently as results of drinking and drug abuse.

9. Ms. Heaton is described as having "bloomed" at five years old, after a successful surgery to repair a congenital heart condition, and as growing up as a bright student and very artistically talented young person. She made good grades throughout primary and high school, and was on the honor roll during high school, when she was still residing in the family home. She also engaged in many extracurricular activities, including swimming, skating, horseback riding, and dance.

10. At the age of sixteen, she was reportedly traumatized when a close friend died in a tragic accident. Around that time, her family noticed changes in her behaviour. She began using street drugs and running away at night. At one point, six months after she had run away, her family located her and picked her up in "a drug home" in Trenton, after receiving a call that she had been assaulted. She stayed in her family home for only a month, and then left again.

11. Around this time, in about 2010, Ms. Heaton was referred to psychiatric services at the Quinte Health Centre in Belleville, but she did not remain adherent with prescribed medications. She completed high school in an alternative schooling program. She began in the Graphic Design program at Loyalist College in Belleville, with tuition assistance from her parents, but had to leave due to drinking and non-attendance; she later tried the program again, but had to drop out. Her mother believed she was not well at that time.

12. Ms. Heaton resided in transitional and co-op housing programs run by the Youth Hab agency in the community of Belleville, from November 2013 to June 2014, when she moved out. She then lived in her own room in a shared rooming house. She immediately had difficulties in that setting. Numerous concerns were noted – including her alcohol or drug use; her difficulty making friends and forming relationships, at one point obsessively texting and calling another resident whom she was romantically interested in, and her vulnerability to sexual and financial exploitation. She was evicted within a few months.

13. She moved to a second rooming house, where her difficulties extended to damaging the walls, kitchen, and living areas. The landlord made a police complaint after discovering the vandalism, which upset her. She later described hearing derogatory voices at the time, putting her down, and her acts of vandalism being controlled by people in the neighbourhood.

14. Ms. Heaton began receiving mental health care in the community in early 2014. Initially, she saw a psychiatrist for anxiety, and was then referred to the Heads Up! First Episode Psychosis Intervention Program ("E.P.") in Belleville / Kingston, which she began in March 2014. In the course of her follow-up visits there, she exhibited increasing thought disorder, paranoid thinking, and poor communication; her physician there prescribed antipsychotic medication, but again she did not remain medication adherent.

15. In November 2014, Ms. Heaton's deteriorating mental state and psychosis (including paranoia and thought control by others) caused her physician to recommend a voluntary hospital inpatient admission. She declined. At around this time, she also apparently discovered she was adopted, and that created further turmoil for her.

16. It was at the second rooming house that the arson occurred. At the time, Ms. Heaton was in a very disorganized and psychotic mental state. She later described that she had been struggling with wanting to punish herself, by worsening her situation so she would go to jail and then playing with a lighter, and setting flames to the fridge, the walls, and then inside her bedroom. In assessing her criminal responsibility for the offence, the psychiatrist's opinion was that she could not appreciate her behaviour or its consequences.

17. Over the years prior to the index offences, Ms. Heaton had no psychiatric admissions to hospital, and when she did receive mental health care in the community, as noted to above, she had no consistent follow-up or adherence to medication.

18. Prior to the index offence, Ms. Heaton had had two involvements with the criminal justice system, on a shoplifting charge and, in September 2014, an arrest on charges of assault and theft.

Current Psychiatric Diagnoses, from the Hospital Report (pgs. 1, 45-46, 47, 48)

19. Ms. Heaton is diagnosed with:

(1) schizophrenia,

(2) substance use disorder,

(3) nicotine addiction,

(4) borderline personality traits, and

(5) dependent personality traits.

Course under the Board’s Jurisdiction, from the Hospital Report

20. Reference should be made to the Hospital Report for an account of Ms. Heaton's course under the Board following the NCR finding. That Report sets out detailed annual summaries for the years from 2015 up to the most recent Board review in June 2024, and an update to March 2025, as well as summaries of the expert risk assessments and risk management recommendations respecting Ms. Heaton.

21. The Hospital Report is an exhibit, the contents of which need not be reiterated here. This is particularly so in light of the extensive evidence respecting the issues to be decided, which was given orally by Dr. Chan at the hearing, and is summarized below.

Viva Voce Evidence of Dr. M. Chan

22. Dr. Chan, a co-author and co-signatory of the Hospital Report, is Ms. Heaton's treating outpatient psychiatrist. Dr. Chan testified in chief, in summary and somewhat arranged in topics for ease of reading, as follows:

(a) Dr. Chan has been Ms. Heaton’s treating psychiatrist for one and a half years. They were in contact previously, at the time of the Court assessment about ten years ago.

(b) This early hearing was requested due to escalating problems with Ms. Heaton and her boyfriend (also referred to as "Mr. C." in these Reasons).

(c) This first came up in February 2024, and was covered at the June 2024 ORB hearing. It has escalated since then. In October 2024, her behaviour ramped up again, in communications and name-calling interactions with her boyfriend, which in Dr. Chan’s opinion have become harassment.

(d) Ms. Heaton gives lip service only to this problem: she agrees that her behaviour is not acceptable and says it will not happen again, and then it happens again, and recurs.

(e) She has declined some interventions to address it, and accepted others. Right now, she is working in weekly individual psychotherapy sessions with Dr. Douglas, on the relationship issues. She has not taken on other recommended treatment options.

(f) Her boyfriend, Mr. C., is also a forensic outpatient. Dr. Chan was involved in his care some years ago. Those created complications, and he now has a different psychiatrist.

(g) Dr. Chan is aware that Mr. C. has been suffering greatly from this behaviour, but has been unable to pull away from the relationship. It is very clear to his clinician and to Dr. Chan himself that it is a harmful relationship. While there have been nasty communications before, it has now gone beyond that, and escalated in the spectrum of behaviours to times when she has attacked him. His glasses were broken in November 2024. On January 24, 2025, she broke his phone and his glasses, and there was blood, when he tried leave, and she got very upset. In the past, she has thrown containers of drinks at him.

(h) Ms. Heaton came into the hospital voluntarily in November 2024. She came again at the end of January 2025, with encouragement, after a delay due to Mr. C.'s and then her delay in reporting the problem. She remained for six weeks, until March 12, 2025, when she said she did not want to stay, and left against medical advice. It seems she left because his birthday was coming up. They wanted her to stay right up until this hearing, but at that point she was not in an acute condition, so they did not attempt an admission under the Mental Health Act criteria. Within days of March 12th, her behaviour resumed, when they reached out to each other by phone. He wanted intimacy and she was offended by that. The team engaged with both of them, and she minimized what she did, and complained that he complained.

(i) The pattern has continued, with her harassment to the point where his mental health is suffering. This past month her behaviour has had great detrimental effect on Mr. C. This has now been going on for the past year or more.

(j) The police are not involved. The victim, Mr. C., does not want the police involved, and he has a history of police involvement. Dr. Chan and the team thought that, despite Ms. Heaton's best intentions, there would be recurrence. They were conflicted about not calling the police, and have struggled with that. They decided to pass this question on to the Director of the hospital's Forensic Program, who passed the question on up to the hospital administration. There does not appear to be a hospital policy directive on this question.

(k) Yesterday, there was a repeat. Ms. Heaton roped her boyfriend into driving her to an appointment. They stopped for coffee at a Tim Horton’s. While there, someone talked to him about his hockey jersey, and she "lost it", grabbed his backpack, kicked at it, and tried to grab the coffee from his hand, to throw at the other guy. Dr. Chan heard what had happened second-hand in a telephone conference, which Ms. Heaton could not attend because of her bed bug situation. In the account she gave, she minimized what happened. She said she tried to block the coffee and there was a struggle, which drew blood when she scratched the back of his hand. She denied the attack. When asked why it happened, she did not want to talk about it.

(l) They offered her a voluntary admission, and she came in at 4 p.m. yesterday. When Dr. Chan asked her then why this happened, she said, “Because he walked too slowly”. Dr. Chan questioned this, and also said that if she cannot tolerate the physical sight of her boyfriend that is not a good relationship. She did not disagree with him. But she also always recants.

(m) Yesterday, she came in voluntarily, but today she said she wants to go back home after the Board hearing, to meet with the pest control people.

(n) The team has contact with Ms. Heaton several times a week now. Last year she was forthcoming with the team, but not now; now she gives lip service but holds back. She does not deny that she engages in this behaviour, and she promises she will change, but that has not panned out.

(o) The team has said that clearly this relationship is an abusive set-up. In the past history between them, Mr. C. had the controlling behaviour, but not now. For example, at the last ORB hearing, when it was noted there was blood in the incident at that time, he interjected to say no, there was no blood, even though this was documented.

(p) Minor things seem to set Ms. Heaton off. It sounds to Dr. Chan as if this is not a viable relationship. The problem is escalating, and the team is clearly concerned about the more serious acts now. She minimizes them, and Mr. C. is suffering, and he does not want to involve the police.

(q) The team has got past thinking this problem is due to her diagnosis. It is not related to her psychotic illness, but to her personality functioning in the relationship. They have concluded that the problem arises when she does not get what she wants from her boyfriend.

(r) Considering her diagnoses, they have identified some of this behaviour as arising out of her personality traits. Dr. Douglas could not nail down the disorder, but Dr. Rose and prior physicians found that it looks like a borderline personality disorder. For practical purposes, the team is saying that her personality traits are factoring into the relationship, and she is having problems with her emotional functioning in it.

(s) The team and Dr. Chan are very upset about this situation. It is very vexing for the team to cope with this, and it is not usual in the NCR system. They began to ask themselves what they can do themselves. They came up with the solution to ask for a Detention Order, to be able to keep the two separate and not in contact.

(t) The recommendation is to tighten up the disposition to a Detention Order, so that Ms. Heaton cannot simply leave after voluntarily coming into the hospital, and to have a strong No Contact order to make sure there is no incident.

(u) The team emphasized that Mr. C. is the victim, and he is incapable of separating himself from the relationship. This Order could mean in essence the end of the relationship, but there was nothing else they could do. Ms. Heaton is unable to make any change in her behaviour. She does come into hospital voluntarily, but she also leaves when she wants to go, and she can still call or text her boyfriend.

(v) With a detention order, they could control her admission and her discharge. They would use the detention order try to get to the bottom of this, to engage Ms. Heaton in looking at her emotional functioning. Yesterday, Dr. Chan said to her that it seems that there is no relationship here and that she cannot tolerate Mr. C., and she did not disagree. In the hospital, they can supervise her and her access to a land line.

(w) When asked if a No Contact provision is sufficient to protect her boyfriend from the risk of harm, Dr. Chan replied that she might breach that – and then what? It would be important to have the detention order to manage the risk to her boyfriend.

(x) Dr. Chan noted the need to not minimize or maximize the situation, as both parties are forensic outpatients of the hospital.

(y) Ms. Heaton is very choosy about what programs she will do. In a special program called “Resolve Counselling Agency”, they work with problems where the woman is the perpetrator of intimate partner violence. This program for women offenders is the main one they would like to see her participate in, but she would not go. There is also couples’ counselling, but they as a couple did not pursue that.

(z) When asked his opinion with respect to her insight into her need for therapeutic work on this problem, Dr. Chan said that she needs insight into her abusive conduct, and is minimizing the impact of her behaviour. She does engage with Dr. Douglas, but there have been no break-throughs there.

23. In answer to questions from Ms. Ferguson, Dr. Chan testified, in summary:

(a) If a Detention Order was given today, Ms. Heaton would be spending at least six weeks in hospital, but this decision would be made at the team level.

(b) Mr. C was informed that he could contact Victim Services, but he never wanted to go there. He is not wanting to cause harm to her. He has been supported by an outpatient team.

(c) With respect to other injuries suffered by Mr. C, Ms. Heaton struck him about the face, just prior to November 2024. In February 2024, she struck his nose, which he denied and tried to minimize. So, in a relationship about ten years duration, the escalation seems to have been going on for the past year and a half. It has nothing to do with the psychotic situation, Dr. Chan confirmed.

(d) Dr. Chan agreed that Ms. Heaton could be charged and arrested for this behaviour, and potentially go to jail, and his sense is that she would be very fearful of the justice system being involved. Dr. Chan's focus was on how a Detention Order and a No Contact Order could help Ms. Heaton make better choices, rather than whether they could have an inhibiting effect on her engaging in her risky behaviour.

24. In answer to questions from Mr. Davies, Dr. Chan testified:

(a) Ms. Heaton is doing very well on the antipsychotic medication treatment for her diagnosed schizophrenic illness. The medication is adequate and doing the job of managing that illness, and there is no plan to change it. Last year Ms. Heaton was pushing Dr. Chan to change it, but now there are no concerns about her adherence.

(b) Ms. Heaton is fully engaged in the psychotherapy with Dr. Douglas.

(c) In the testing done by Dr. Douglas, the criteria were not found to make a diagnosis of borderline personality disorder.

(d) With respect to alcohol and cannabis use, Ms. Heaton has reported having cravings from time to time, but there has been no use that he and the team are aware of.

(e) Ms. Heaton's current community housing is appropriate. It is her own apartment, subsidized through the Mental Health Association, and close to the hospital. She has lived there for a few years now, and she enjoys having her own space there.

(f) With respect to the bed bug infestation there, people are coming next week to deal with it, and she wants to prepare her living space for when they come. She would be able to leave the hospital on a pass, to go out and prepare her apartment.

(g) Ms. Heaton has not directed violence elsewhere than towards her boyfriend.

(h) To the question whether her boyfriend has been violent towards her, Dr. Chan replied that he has tried to defend himself. In January, he fell and as a result hit her elbow. There is no dispute between them that she is the aggressor.

(i) With respect to why Mr. C. has no interest in going to the police, a year ago Dr. Chan would have said that it was because Mr. C. wanted to maintain their relationship. But now having heard second-hand that he is terrified to keep involved in the relationship, Dr. Chan does not know whether he wants to continue it. This change in his feeling about the relationship has been ongoing in recent months, including after the driving and coffee events at Tim Horton's on the day before the hearing [i.e., on April 9th].

(j) This is not referred to in the Hospital Report, because Dr. Chan does not have any direct contact with Mr. C. This information about the change in Mr. C.'s feeling about the relationship and his fear of police involvement in it, is not direct information but second-hand from Mr. C.'s case manager; it is not Dr. Chan's word for it, and he could not put it in the Hospital Report. Dr. Chan assumes Mr. C. himself has agency.

(k) The information about the events at Tim Horton's came from Mr. C. and was filtered through others. It was put to Dr. Chan that he called Ms. Heaton's version "minimized" because it did not match that version. Dr. Chan acknowledged that he could be biased, that he did not have direct information and had not seen photographs he had asked for, and that he might himself be using loaded words.

(l) The counselling program was recommended by Ms. Heaton's outpatient case manager in recent weeks, and perhaps also by Dr. Rose. Ms. Heaton declined it. Dr. Chan did not know if it is an individual or group program. Dr. Chan would still recommend it to her, even if the relationship ends. The problem could be ongoing and happen in a further relationship with someone else. Dr. Chan talked with her about this and that she should attend to this stuff within herself.

(m) Ms. Heaton has a pattern of coming into the hospital voluntarily after an incident occurs, and then leaving; this has happened for the past three admissions, the last time she left being a month prior ago, in March 2025.

(n) The purpose of having Ms. Heaton stay in hospital is to make a physical separation from Mr. C., and monitor that, and continue with the treatment approaches. To be fair, Dr. Chan added, she could also do those as an outpatient. The purpose of a Detention Order is partly to bring her into hospital, but not entirely, as there are other things that could be done when she is in hospital.

(o) Mr. C. is an outpatient. He came into the hospital after the January incident, after about a ten-day delay, before Ms. Heaton came in.

(p) With respect to contacting the police, Dr. Chan's understanding is that it is not the practice of the hospital to make that call without the consent of the victim. It is always up to the victim whether the police should be contacted, and so it is up to Mr. C. It is the same policy whether a patient or a staff person is a victim of assault.

25. In answer to questions from the Board panel about the structure of Ms. Heaton's life in the community outside her relationship with Mr. C., Dr. Chan testified that she currently goes to the recreation centre. She was going to Recovery College, but dropped out, and she has been talking about going back to college.

Submissions Made by the Parties

26. In closing submissions, Ms. Tom noted the incidents since October 20024 of Ms. Heaton's harmful physical, verbal, and property damaging behaviour (set out in the Hospital Report, pg. 44, as in Dr. Chan's evidence at the hearing). A request for a Detention Order had been made at the hearing in June 2024, when there were less violent acts; the Board gave a Conditional Discharge, with an added treatment clause. This has not worked. The series of incidents since then shows that Ms. Heaton's violent behaviour is escalating, increasing the risk to the public, which includes her boyfriend. Protecting the public is the primary purpose of the Ontario Review Board regime.

27. A Detention Order would make it possible to bring Ms. Heaton into hospital and to admit her, when there is concern that escalating behaviour arising from her mental health issues. She is coming in voluntarily – with convincing – but she is not staying in hospital and is not addressing her behaviour, which is not trivial, and its seriousness is escalating. The Conditional Discharge has not worked, and the Mental Health Act won't work.

28. The hospital needs two more tools. A Detention Order is needed to manage the clear ongoing risk of harm that is happening: to bring her into hospital, not for six months but at least six weeks, so that the team can engage her in therapeutic processes, which have been very slow and challenging for her. The Resolve Counselling Program can be done as an outpatient or an inpatient. There is no evidence to say a Detention Order is the only way to engage with counselling, but Ms. Heaton is not engaging in the treatment that would address her risk. She will be able to deal with the bed-bugs problem in her apartment as an inpatient, using passes.

29. A No Contact clause is also needed. The hospital is not going to bring Ms. Heaton in and just keep her in; they have the capacity from this moment in time to address the immediate risks. Without a No Contact clause, their hands are tied with respect to contact between them. Ms. Tom suggested that Mr. C.'s consent be incorporated in the clause, for times when he is not necessarily in that space to not contact her.

30. Ms. Ferguson adopted Ms. Tom's submissions entirely. Ms. Ferguson pointed out, in support of a No Contact clause, that the importance of public safety also goes beyond Mr. C. to people who are around when hot liquids are thrown. Ms. Ferguson referred to the obligation to protect the public notwithstanding a victim's wishes, in recognition that victims of violence are often unable to stand up for themselves, for various reasons, and intervention of others is needed to say: "You, X, cannot continue to do this to Y." She described how that is addressed in the criminal justice system, where there is an obligation to charge a person arrested for intimate partner violence, even if the victim does not want charges laid or a No Contact order made.

31. Mr. Davies highlighted in closing that Ms. Heating would like to keep the Disposition as it is, and not add conditions respecting her boyfriend, and that what has gone right is important: she has been doing very well, her psychosis is under control, she has a place to reside that is appropriate, and there has been no violence in any other context than this.

32. Mr. Davies expressed his concern about the quality of the evidence respecting her boyfriend, and the filtered evidence that came to Dr. Chan which has made it less than clear. At the same time, Mr. Davies and his client accept the issues respecting her behaviour, as Ms. Heaton has said the same herself to Dr. Chan, and to that extent, the Conditional Discharge has not worked to keep her boyfriend safe.

33. However, Mr. Davies submitted, the hospital has not demonstrated how anything would have been or will be different with a Detention Order in place. There has been no difficulty in bringing her into hospital, maybe with some to-ing and fro-ing. There has been no assertion of signs of decompensation in her illness. There has been little done in the way of therapeutic endeavours, and there is no point in forcing that; she has to do it willingly. There is nothing done if she is just kept in hospital so that nothing happens between the two of them.

34. With respect to a No Contact clause, Ms. Heaton's position is that it should not be included. If the clause is included, Mr. Davies urged the Board panel not to treat Mr. C. in a patronizing manner with just a blanket prohibition but to consider including the exception of Mr. C.'s written, revokable consent to contact. If he is feeling overwhelmed, he can revoke his consent and have peace and quiet that way.

Findings and Conclusions of the Board

35. It was not in issue at this early review hearing that Ms. Heaton continues to present a significant threat to the safety of the public at this time. This finding is well supported by the evidence of Dr. Chan at the hearing and the information set out in the Hospital Report, and need not be further addressed in these Reasons.

36. The two changes recommended by the hospital to Ms. Heaton's existing Disposition are to replace the Conditional Discharge with a Detention Order and to add a No Contact provision to the existing terms.

37. We agree on all the evidence that a Detention Order is necessary and appropriate at this time to protect the safety of the public, including Mr. C. Just as Ms. Tom summarized in her submissions, Ms. Heaton's continually escalating seriously harmful behaviour towards Mr. C. has not been able to be managed under the Conditional Discharge. Her pattern of leaving her voluntary admissions to hospital at will, against medical advice, has been a barrier to managing her risk.

38. Nor has the treatment condition in the Conditional Discharge been effective in ensuring Ms. Heaton engages in recommended therapeutic treatment approaches. Her working with support in these types of treatments, as an individual and in couples or group programs, is crucial to helping her develop the ability to manage her risks arising from the diagnosed personality traits (on their own and as factors potentially compounding any substance use or medication non-adherence risk, which are not at all live issues at this time, but have a longstanding history making them real and foreseeable risks at this time.

39. Dr. Chan recommended these treatments to Ms. Heaton whether or not the relationship with Mr. C. continues. We agree. The personality traits and associated emotional and relationship difficulties have been challenges and risks for Ms. Heaton at least since her problems in shared housing in 2014, leading up to her index offence of arson in March 2015. They may very well continue into other future relationships and interpersonal interactions, if not effectively addressed.

40. We take Mr. Davies' point that there is little therapeutic value in simply keeping Ms. Heaton in hospital to separate her from Mr. C. Dr. Chan was clear in his responses that a detention in hospital would not simply be used that way. It would be an opportunity both to pause the cycle of escalating violence, and to help her engage in therapeutic treatments with active and close support from the hospital team and staff, then return to her apartment and apply new emotional insight and relationship skills in her community social life, under the oversight of her ACT and outpatient teams.

41. We also agree that a No Contact clause is necessary and appropriate at this time, to protect Mr. C., and also to help Ms. Heaton structure her time and focus, both when in hospital and when in her apartment, on developing insight, and personal skills and more comfort in relationships.

42. We have considered the points raised by the parties with respect to the No Contact clause terms, and terms used by the Board in similar circumstances in other forensic hospitals. We have concluded that the most helpful and appropriate clause, in the circumstances of Ms. Heaton and Mr. C., is to provide for both Mr. C.'s revokable written consent and also the hospital's approval, by requiring Ms. Heaton to "refrain from contact or communication, direct or indirect, with [Mr. C.], except with his written revocable consent provided to the person in charge of the hospital, or their designate, and with the approval of the person in charge, or their designate".

43. The approval of the hospital is perhaps particularly important in this case. We agree with Mr. Davies that there is a lack of clarity in the evidence respecting the incidents of escalating harassment and violence by Ms. Heaton, due to communication filters protecting Mr. C.'s privacy and autonomy. While the evidence is amply sufficient for our decision on the issues, we think it is important that the PIC be advised of a consent to contact by Mr. C., and obtain the relevant advice in making its decision in the proper exercise of its discretionary authority.

44. The purview of the Board is not to make relationship decisions for Ms. Heaton, but to serve the paramount purpose of protecting the safety of the public. Ms. Heaton's engagement in effective treatment is a crucial part of doing that. In our view, in doing that, these new terms of her disposition will also best serve Ms. Heaton's own needs and interests, including in learning how to be better able to engage well in treatments, develop skills in relationships and self-care, and progress towards living a safe and secure life in the community.

45. Ms. Heaton's positive qualities and strengths in her young life are briefly noted above in these Reasons. Among them, she has been a talented artist and a bright student. She has been active in sports and recreation, including horseback riding, swimming (winning awards), and dancing. She faced a major surgery challenge in her young life, and came out of that time very well. At this time, she has been thinking of going back to college. We hope she will be able to do that whenever she is ready.

46. We wish all the best to Ms. Heaton, in her work with her treatment team and other people who support and guide her in her treatment programs and community activities, and all the best to Ms. Heaton and her family in their times together.

DATED this 28th of July, 2025, at the City of Toronto, in the Toronto Region.

Ms. K.A. Connidis

Alternate Chairperson

Office of the Registrar

Ontario Review Board