Re: Sarah Michele Day
ORB File No: 8770
Hearing Held On: Thursday, July 17, 2025
Place of Hearing: Waypoint Centre for Mental Health
Pursuant To: Section 672.47(1) of the Criminal Code
Before: Alternate Chairperson: Ms. C. Finley Members: Dr. J. Ferencz Dr. B. Bordoff Ms. A. La Viola Mr. A. Bouvier
Parties Appearing: Accused: Sarah M. Day Counsel: Mr. A. Rastgou Person in charge of Hospital: Representative/Counsel: Ms. T. Murdock Attorney-General of Ontario: Counsel: Ms. J. Armenise
REASONS FOR DISPOSITION
(Dated August 21, 2025)
Overview
Sarah M. Day was found not criminally responsible on account of mental disorder on April 22, 2025, on charges of flight from peace officer, dangerous operation of a vehicle and obstruct peace officer, contrary to the Criminal Code. The Honourable Justice L. Chapin did not make a disposition, instead, Ms. Day was remanded to the Waypoint Centre for Mental Health Care on a Warrant of Committal for a hearing before the Ontario Review Board.
On June 13, 2025, the Board received notice pursuant to Rule 13 of the Ontario Review Board Rules of Procedure, recommending that Ms. Day’s transfer and detention to the Centre for Addiction and Mental Health.
At the outset of the hearing, the Hospital, along with Counsel for the Attorney General, submitted that Ms. Day is a significant threat to the safety of the public and proposed a transfer to the Centre for Addiction and Mental Health on a Detention Order with terms and conditions as outlined in the Hospital Report. Counsel for Ms. Day stated that Ms. Day is not a ‘significant threat’, and an Absolute Discharge should be ordered under the circumstances.
Issues
- On July 17, 2025, the Board convened at Waypoint for an initial hearing further to s. 672.47(1) of the Criminal Code to make a disposition. The Board has been asked to determine whether Ms. Day is a significant threat to the safety of the public at the time of the hearing, and further, what is the necessary and appropriate disposition in the circumstances for Ms. Day according to the factors set out in s. 672.54 of the Criminal Code.
Findings
- After reviewing the evidence and submissions presented at the time of the hearing, the Board concluded that Ms. Day represents a significant threat to the safety of the public. A transfer from Waypoint to the less secure setting at CAMH is the least onerous and least restrictive outcome. A Detention Order, with the addition of community living in approved accommodation is the necessary and appropriate disposition having regard to all the factors considered and outlined in more detail below.
PERSONAL BACKGROUND
The Hospital Report dated June 12, 2025, was entered as an exhibit at the hearing. The following background information, including the events surrounding the index offences has been taken from the Hospital Report, summarized here as follows.
On November 11, 2021, in heavy traffic on the Don Valley Parkway, Sarah Michele Day was observed driving a white Lexus on the shoulder with hazard lights activated. When the police attempted a traffic stop, she failed to comply, instead weaving dangerously through traffic in an attempt to evade officers. Her driving was reckless and posed a risk to public safety. She was eventually stopped, resisted arrest, and was taken into custody. After requesting medical attention, she was transported to hospital and later released on conditions to appear in court. However, she failed to appear, and a Bench Warrant was issued on August 24, 2023, and she was eventually re-arrested on November 5, 2023, following a person-in-crisis call.
Ms. Day is 57 years old and resides in Toronto. She owns her home and has had a history of professional success. She holds a university degree in Political Science and Philosophy from the University of Western Ontario. Earlier in her career, she held very senior roles in the insurance and mortgage industries. In later years, she pursued training in alternative medicine and began identifying as a homeopath. She reported working in that capacity, although collateral sources indicate that she has not maintained a consistent practice in recent years. Ms. Day has two adult sons and was previously married in 2001. She is now divorced and estranged from both her children and her extended family. Although her sister is listed as her substitute decision-maker, Ms. Day has declined contact and does not recognize her authority. She currently lacks meaningful familial or community support and has expressed a strong preference for autonomy and independence, including opposition to psychiatric intervention.
A check of the Canadian Police Information Centre database shows that Ms. Day has approximately 10 entries, including the index offences. Records indicate that she was released with conditions on charges of harassment by watching and besetting in October 2021. Ms. Day has a province-wide driving prohibition.
Psychiatric Background
Ms. Day’s current psychiatric diagnoses are Schizoaffective Disorder – Bipolar Type, Functional Neurological Disorder (Conversion Disorder) with mixed symptoms. She has been found incapable of making decisions about her medical treatment, but she is capable of managing her finances.
Ms. Day has a well documented history of severe and persistent mental illness, traceable to 2011. Her psychiatric history includes multiple involuntary hospital admissions, typically characterized by acute psychotic symptoms, including paranoid delusions, disorganized thought processes, mood dysregulation, and impaired insight.
Over the years, her diagnoses have evolved, however, the consistent clinical finding has been her profound lack of insight, chronic non-compliance with medication, and rejection of conventional psychiatric care. She has frequently attributed her symptoms to traumatic brain injury, specifically a series of concussions she reports sustaining in 2010 and 2011, despite neurological assessments failing to support this explanation. Her delusional beliefs have included persecutory ideation, grandiosity, and alternative health beliefs that have interfered with treatment.
Previous episodes of illness have involved concerning behaviour such as setting fires, impulsive and risky driving, interpersonal aggression, and defiance of legal and medical directions. Her clinical course is marked by chronic resistance to care, and limited engagement with voluntary services. The most recent risk assessment identifies several areas of concern. These include active and untreated psychosis, poor insight, impaired judgment, prior violations of legal conditions, and minimal internal or external protective factors.
Evidence at the Hearing
The Board heard oral testimony from Dr. A. Jones, the attending psychiatrist, who provided a comprehensive overview of Ms. Day’s clinical presentation and risk profile. Dr. Jones confirmed that Ms. Day continues to meet the diagnostic criteria for Schizoaffective Disorder – Bipolar Type, and that her symptoms remain only partially controlled. She explained that Ms. Day lacks insight into her illness and does not recognize the need for medication. Her compliance has been maintained only due to the structure of the forensic setting. Dr. Jones noted that the current medication regimen was recently initiated after Ms. Day refused to continue with paliperidone, citing concerns about breast cancer. It is too early to say if it will be effective.
Although she has not displayed overt aggression during her admission, Dr. Jones emphasized the chronic nature of her illness and its historical association with high-risk behaviours, including lighting fires, driving despite prohibition, and unprovoked interpersonal aggression.
After further inquiry, Dr. Jones testified that Ms. Day remains resistant to psychiatric care and would likely disengage from services if discharged. In particular, she consistently denies the need for follow-up care and has no established connections with outpatient providers. Dr. Jones expressed concern that Ms. Day’s refusal to engage with mainstream health care, and her history of pursuing unregulated alternative treatments, placed her at high risk of relapse and reduced the likelihood of voluntary reestablishing therapeutic engagement if symptoms re-emerged.
In addition, Dr. Jones stated that an incendiary device prohibition was not recommended because Ms. Day has no history of deliberate fire-setting, and with her current medication her risk can be managed without such a restriction. Regarding Ms. Day’s licence to practise homeopathy, Dr. Jones noted that the College requires members to self-report charges, but neither she nor Waypoint were obligated to do so. Ms. Day confirmed she has not yet reported her charges, stating she would wait until the matter was resolved.
On community living, Dr. Jones indicated Ms. Day may be suitable for an approved placement within a year, likely moving directly from Waypoint into accommodation under CAMH’s supervision, as no interim local placement was contemplated. The Mental Health Act would not ensure her continued treatment. Her past hospitalizations have been brief, or refused entirely, and if granted an absolute discharge she would likely leave hospital, stop medication, relapse quickly, and pose a heightened risk of harm to the public.
Ms. Day testified on her own behalf. She denied having a mental illness and maintained that her past difficulties were due to traumatic brain injuries sustained in 2010 and 2011. She opposed the use of psychiatric medication and described her hospital stay as unnecessary and traumatizing. Ms. Day expressed a desire to return home, resume her work as a homeopath, and rebuild her life independently. She denied posing any risk to the public and maintained that she had not driven since the date of the index offences.
Submissions
The Hospital submitted that Ms. Day should be detained and transferred to CAMH, emphasizing that Ms. Day continues to meet the criteria for a high level of clinical supervision given her poor insight, refusal of treatment, and vulnerability to relapse. She remains on a relatively new medication (Abilify), with limited evidence of sustained therapeutic effect, and there is an ongoing need to monitor her response and adjust treatment as clinically indicated. The Hospital supported granting certain structured privileges as appropriate, subject to clinical discretion, but maintained that a Detention Order is essential to protect the public and promote Ms. Day’s rehabilitation.
Counsel for the Attorney General supported the Hospital’s recommendation, stressing an Absolute Discharge is not appropriate given the circumstances. Ms. Day continues to pose a significant risk of serious physical or psychological harm to others, based on her longstanding illness, lack of insight, and previous dangerous behaviours. Ms. Day’s stated intentions to refuse treatment and disengage from psychiatric follow-up were incompatible with community safety.
Counsel for Ms. Day submitted that she should be granted an Absolute Discharge. Counsel argued that the index offences did not involve direct harm to others, and that Ms. Day has not exhibited any violent behaviour during her current admission. He emphasized her desire to return home, her stable housing situation, and her past professional success, no history of violence and low risk of recidivism. Counsel submitted that further detention was unnecessarily restrictive and not justified on the current evidence, and that the Mental Health Act could be used to return her to hospital if necessary. Ms. Day has a nice home, and she would like to return there to live.
Analysis and Conclusion
(a) Significant Threat
The Board is tasked with determining whether Ms. Day poses a significant threat to the safety of the public, as defined by the Supreme Court of Canada in Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625, and, if so, what disposition is necessary and appropriate pursuant to section 672.54 of the Criminal Code.
The evidence before the Board, including the expert testimony of Dr. Jones and the clinical records contained in the hospital report, clearly establishes that Ms. Day continues to suffer from a serious and apparent treatment resistant mental illness. Her diagnosis of a mental disorder is longstanding, and her illness has been marked by persistent delusions, poor judgement, disorganized thinking, and chronic non-compliance with treatment.
Despite being admitted to a secure forensic unit, Ms. Day continues to deny that she has a mental illness and refuses to acknowledge the necessity of psychiatric treatment. Her current medication regimen was only recently initiated, and her response to it remains under review. She discontinued her prior antipsychotic due to delusions about breast cancer. The Hospital Report and Dr. Jones’s testimony make it clear that, absent the authority of the Board, Ms. Day would likely discontinue medication and likely disengage from all follow-up care.
While Ms. Day has not demonstrated violent behaviour during her current admission, her historical risk profile includes dangerous driving, flight from police, property damage, and interpersonal aggression. The evidence shows that her most concerning behaviours emerge during periods of untreated psychosis. Without treatment, her symptoms have previously led to acts that endangered both herself and others.
We note that the clinical team provided a comprehensive assessment of risk factors, which include a long illness course with repeated hospitalizations, legal involvement, and documented behavioural dysregulation. There are minimal protective factors. Ms. Day is estranged from her family, has no community support, and strongly opposes any involvement with the mental health system.
The evidence before us confirms that Ms. Day continues to suffer from a serious and persistent mental illness that substantially impairs her ability to make rational decisions about her health, treatment, and conduct. She remains noncompliant with recommended treatment, has limited insight into the nature and impact of her illness, and demonstrates minimal understanding of the risks posed by her behaviour while unwell. No evidence was presented that her mental state has changed as a result of any other viable treatment options. Based on the totality of the evidence, we find that Ms. Day poses a significant threat to the safety of the public, and as required, a disposition must be made.
(b) Necessary and Appropriate
We are not satisfied that a disposition other than a Detention Order would adequately protect the public. A Conditional Discharge is not viable because Ms. Day lacks the capacity and willingness to voluntarily engage in psychiatric care. There is no indication that she would comply with conditions or return to hospital if required. The Mental Health Act has proven inadequate in the past and offers insufficient control over her behaviour. An Absolute Discharge is also inappropriate, as she remains a significant threat to public safety.
The Board concludes that continued detention, with a transfer to CAMH for treatment in a more specialized forensic setting, is necessary and appropriate. The privileges proposed by the Hospital allow for gradual, clinically guided increases in autonomy and provide a structured pathway toward eventual reintegration, should her clinical condition stabilize, and her insight improve. Accordingly, the Board finds the least onerous and least restrictive disposition that protects the public, while supporting Ms. Day’s recovery and reintegration efforts is a Detention Order, with the possibility of community living, in approved accommodations.
DATED this 21st day of August 2025, at the City of Toronto, in the Toronto Region.
Ms. A. La Viola Legal Member
___________________ Office of the Registrar Ontario Review Board