Re: Kay Louise Belk, 2025 CanLII 84074

Re: Kay Louise Belk

ORB File No: 8772

Hearing held on: Monday July 28, 2025

Place of Hearing: Ontario Shores Centre for Mental Health Sciences

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

Before:

Alternate Chairperson: Mr. R. Bigelow

Members: Dr. A. Park Dr. A. Kerry Mr. J. Goldenberg Mr. J. Cyr

Parties Appearing:

Accused: Kay Louise Belk Counsel: Mr. M. Lipchitz/ Mr. I. Donnelly

The person in charge of hospital: Counsel: Ms. A. Marshall

Attorney General of Ontario: Counsel: Ms. N. MacDonald

REASONS FOR DISPOSITION

(Dated August 20, 2025)

Introduction

1On April 17, 2025, Kay Louise Belk was found not criminally responsible on account of mental disorder (NCR) on a charge of attempted murder contrary to the Criminal Code. The court did not make a disposition and referred the matter to the Ontario Review Board (the Board) to do so.

2On Monday, July 28, 2025, the Board convened a hearing at Ontario Shores Centre for Mental Health Sciences (the Hospital) pursuant to section 672.47(1) of the Criminal Code to make an initial disposition. Ms. Belk was present at the hearing and represented by counsel, Mr. Lipchitz and Mr. Donnelly. Ms. Belk’s husband, the victim of the index offence, was also present at the hearing and filed a victim impact statement. The issues to be determined at the hearing were whether Ms. Belk constitutes a significant threat to the safety of the public as defined in section 672.5401 of the Criminal Code and, if so, to determine 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.

Initial Positions of the Parties

3At the commencement of the hearing, the parties were requested to provide their initial without prejudice positions with respect to the issues before the Board. Counsel for the Hospital indicated that it was the Hospital’s position that Ms. Belk represented a significant threat to the safety of the public and that the necessary and appropriate disposition was a detention order with the privileges as set out at pages 21-22 of the Hospital Report.

4Counsel for the Attorney General supported the Hospital position.

5Counsel for Ms. Belk submitted that his client was not a significant threat to the safety of the public and accordingly was entitled to be discharged absolutely.

Evidence at the hearing

6The evidence at the hearing consisted of the Record before the court at the NCR hearing, a transcript of the NCR hearing, the reasons of the court for the NCR finding, an initial Hospital Report, a victim impact statement from Russell Belk who read an abbreviated version of the statement as well as providing oral evidence, and the oral evidence of Dr. Hartfeil, author of the NCR assessment filed at the NCR hearing and author of the Hospital Report.

Findings:

7For the Reasons that follow, the Board finds that Ms. Belk represents a significant threat to the safety of the public and that the necessary and appropriate disposition is a detention order on the terms as recommended by the Hospital.

Index Offence:

8The allegations surrounding the index offence as summarized in the Hospital Report are as follows:

On December 15, 2024, York Regional Police attended 2 Neon Lane in the town of Georgina for a weapons call. The complainant, Ms. Amy Pepper, reported her that her mother Ms. Kay Belk had just stabbed her father Mr. Russell Belk. During the stabbing, Ms. Belk made an utterance that she was “killing the family.”

When the officers arrived both parties were separated. Mr. Belk was on the floor upstairs with his daughter Ms. Pepper holding pressure to his injury. There was blood on the floor and both of the knives used were now on the kitchen counter. Ms. Belk was arrested for attempted murder based on the stabbing and the utterance. Ms. Belk was provided with her rights to counsel and cautioned to which she indicated he understood. She was then searched, handcuffed to the front, and escorted to the police cruiser. Ms. Belk was transported to 3-District Headquarters before subsequently being apprehended under the Mental Health Act and transported to Southlake Regional Health Centre.

The victim, Mr. Belk was also transported to Southlake Regional Health Centre via ambulance. Police also attended the hospital with Mr. Belk to complete the Domestic Violence Risk Management (DVRM), victim safety planning and medical release form.

9Ms. Belk’s recall of the events surrounding the index offence as summarized in the Hospital Report is as follows:

At the time of the alleged offense, Ms. Belk heard a “mechanical” or robotic voice saying that she “had to kill somebody.” She did not recognize the voice; it was “just some robotic voice, that's all I know.” She described it as “robotic, metallic,” and when asked she said that it “seemed loud.” The voice was deep; more male than female but “robotic.” Because the voice told her to kill somebody, she grabbed a knife and “just stabbed my husband” but “I didn’t even know it was my husband until I did it.” She recalled that Amy came into the bedroom and stopped her from harming him further. When asked who she thought she was stabbing, Ms. Belk replied “I don’t know. I didn’t know it was my husband. I don’t know who it was… I stabbed somebody [and] it turned out to be my husband.”

Ms. Belk continued: “I thought he was the evil one that the robotic voice was talking about… [I] thought it was some evil person.” She said that the voice told her to “kill this evil person.” When asked to clarify if the voice told her to stab or kill an “evil” person or just “someone,” Ms. Belk was unable to do so.

Background Information Regarding the Accused:

10Ms. Belk is 79 years of age and was raised in Minnesota where she completed her primary and high school education and attended an arts college. She has an older sister who was born with a heart defect (patent ductus arteriosus) and required multiple surgeries to correct it. Although her sister was able to dress, bathe and use the toilet by herself, she “would forget things almost immediately” and attended a special school. Prior to her mother’s death, Ms. Belk promised her that she would care for her sister for the rest of her life. At the time of the index offence, Ms. Belk’s sister resided with her at her home.

11Ms. Belk married her current husband when she was in her 20s. She worked at an advertising agency until her daughter was born and has not worked formally since then. She was a part-time artist trying to sell her work.

12In 2021, Ms. Belk sustained a head injury after a fall and attended hospital due to “progressive confusion”. She required neurosurgical operations (craniotomies) for evacuation of chronic subdural hematomas on two occasions. Subsequently, she was noted to present with higher-level executive functioning deficits and memory impairments.

Substance Use History

13Ms. Belk started drinking alcohol in her 20s but never drank excessively or daily and eventually quit drinking altogether. Although she had been around people using marijuana when she was younger, she never tried it herself and denied any history of illicit drug use or other substance use-related problems.

Legal History:

14Ms. Belk had no involvement with the criminal justice system prior to the index offence.

Psychiatric History

15Although Ms. Belk denied any past psychiatric consultation or hospitalizations, collateral information indicates that she experienced a severe episode of postpartum depression following the birth of her daughter and has been treated with antidepressant medication for over 50 years.

Current Diagnoses

16Ms. Belk’s current diagnoses are as follows:

Major neurocognitive disorder due to multiple etiologies (Alzheimer’s, traumatic brain injury, subdural hematoma, vascular), moderate, with other behavioral or psychological disturbance

Evidence of Dr. Hartfeil

17Dr. Hartfeil indicated that she had written the NCR assessment filed with the court at the NCR hearing as well as the Hospital Report, the contents of which she adopted. However, she indicated that she was no longer Ms. Belk’s most responsible physician as Ms. Belk was housed on a geriatric unit at the hospital and was being treated by physicians assigned to that unit. By way of an update to the Hospital Report, she indicated that the sleep study referred to in the Report had been completed and determined that Ms. Belk suffered from severe sleep apnea. A CPAP machine is being considered. The study also determined that Ms. Belk had elevated PLM (periodic limb movements), and the Hospital was reviewing bloodwork to see if the cause for this could be determined.

18Dr. Hartfeil indicated that the geriatric unit provides Ms. Belk with a better living environment than a forensic unit. Although Ms. Belk is one of the higher functioning patients on the geriatric unit, she still requires a significant level of assistance. Treatment for Ms. Belk’s dementia depends upon the type of dementia she suffers from. Ms. Belk suffered a brain injury resulting in two brain surgeries, and vascular changes were also noted. No treatment is available which would stop the progression of her illness but there are some medications which may slow down the progression. She was not currently prescribed any medication for that purpose due to the possibility that she had experienced side effects from a medication which had been prescribed for her by her family physician which has a potential to cause or exacerbate dreams or nightmares.

19Dr. Hartfeil stated that Ms. Belk’s case was unusual in that there was no history of aggression or personality disorder, and that until a few years prior to the index offence, she was a high functioning individual. The biggest risk factor was the progression of her illness.

20Dr. Hartfeil noted that the staff on the geriatric unit believed that a long-term care facility would likely be the most appropriate placement for Ms. Belk in the long term. She was aware that Ms. Belk’s family had access to resources to support her in a long-term care facility and that the Hospital needed to determine exactly what resources are needed to both manage her risk as well as her well-being. A return to the family home might be possible but the Hospital would have to do an assessment of exactly what resources were required and available and the level of monitoring available to ensure the safety of Ms. Belk as well as her family.

21Dr. Hartfeil stated that the Hospital was not recommending any indirectly supervised access to the community as Ms. Belk becomes easily confused and would not be safe on her own in the community. However, the Hospital was recommending accompanied passes with staff or an approved person and that her husband would likely be approved.

22Dr. Hartfeil was asked why the Hospital was not supporting a disposition of a conditional discharge and she indicated that the hospital had to assess exactly what were Ms. Belk’s needs and what resources would be provided for her in the community. The Hospital also had a concern with respect to whether her family underestimates Ms. Belk’s risk. Dr. Hartfeil also was concerned that the family would likely not work with the treatment team due to this underestimation of risk. However, she indicated it was the Hospital’s hope that Ms. Belk would be able to transition back into the community in the reasonably near future.

23In response to questions from counsel for the Attorney General, Dr. Hartfeil stated that the geriatric unit where Ms. Belk was currently placed has aspects of both a general forensic unit and a secure forensic unit in the Hospital. The door to the unit is locked and, in general, patients on the unit do not leave without escort. She also noted that over the number of months that Ms. Belk had been in hospital, there had been some deterioration and an increase in her need for assistance as well as more confusion and memory issues.

24In response to questions by counsel for Ms. Belk, Dr. Hartfeil indicated that she had personally spoken with Ms. Belk and Ms. Belk had indicated that she wanted to leave hospital and would not return if requested. She also understood that other staff members had communicated with Ms. Belk’s family and that it was clear that they also want her to come home as soon as possible, but emphasized that the Hospital needed to ensure that necessary supports were in place prior to any consideration of Ms. Belk returning to the family home.

Evidence of Russell Belk

25Mr. Belk indicated that until her fall, his wife was fine but subsequent to the fall began to have issues with memory. For example, although she was able to do some domestic tasks, she could not be allowed to be near the stove as she would forget to turn it off. In his opinion, the diagnosis of progressive dementia was speculative. Since the time of the index offences, his only direct contact with his wife had been in the visiting room at the Hospital.

26He indicated that he would do whatever was best for his wife that he was in a financial position to provide whatever care she may require including 24-hour care at home.

27He did not believe that there was any risk of her hurting him but noted that he had installed a lock on his bedroom door.

Final Submissions of the Parties.

28All parties maintained their initial positions at the conclusion of the hearing.

Analysis and Conclusion, significant threat:

29The Board finds that Ms. Belk continues to represent a significant threat to the safety of the public. She suffers from a major neurocognitive disorder with behavioural and psychological disturbance. The expert opinion evidence before the Board, which we accept, is that, unfortunately, the impact of the disorder is progressive which is supported by the decline in her MoCA scores over a relatively short period of time. Although the precise cause of her behaviour at the time of the Index Offence remains unclear, whether as a result of hallucinations linked to dementia, an adverse medication effect or an unrecognized sleep disorder, at the time of the index offence, Ms. Belk was acting in a confused and disoriented, dreamlike state, under the influence of command hallucinations.

30The evidence of the Hospital, which the Board also accepts, is that an assessment of Ms. Belk’s needs both in terms of managing risk and in terms of her care must be completed prior to any consideration of a discharge into the community. Although Ms. Belk’s husband has indicated that he is both willing and financially able to provide whatever his wife may need, no particulars were provided as to exactly what would be offered beyond indicating that Ms. Belk would never be alone. Although there can be no doubt that Ms. Belk’s family have the best of intentions, it also appears that her family may underestimate her risk as well as the progression of her dementia. It is noteworthy that although Mr. Belk indicated he has no fear whatsoever of his wife causing him harm, he has installed a lock on his bedroom door.

Analysis and Conclusion, Necessary and Appropriate Disposition:

31The Board also finds that the evidence supports a detention order disposition. In all the circumstances, it is clear that the Hospital needs the authority to approve accommodation in order to manage risk and meet Ms. Belk’s needs and the restrictions of her access to the community without appropriate accompaniment is also justified given the level of her dementia and her need for assistance to ensure her safety.

32The Board accepts that it may well be that, after an assessment of Ms. Belk’s needs and exactly what support her family is able to provide, a discharge to the family home may be appropriate. The Board encourages Ms. Belk’s family to work with the Hospital to develop a plan for appropriate care for Ms. Belk which addresses both her needs and her risk.