Re Marsala, 2025 CanLII 86843

Ontario Review Board

Re: Riccardo Marsala

ORB File No: 3335

Hearing held on: Wednesday, July 16, 2025

Place of hearing: Centre for Addiction and Mental Health (Via Zoom Video Conference)

Pursuant to: Section 672.81(2.1) of the Criminal Code

Before: Alternate Chairperson: Mr. J. Weinstein Members: Dr. R.W. Hill Dr. G. Stones Mr. D. D’Intino Mr. J. Cyr

Parties Appearing: Accused: Riccardo Marsala Counsel: Mr. A. Rai

The person in charge of hospital: Representative: Dr. P. Darby

Attorney General of Ontario: Counsel: Ms. V. Culp

AMENDED REASONS FOR DECISION

(Dated August 26, 2025)

Please see the underlined change to original reasons made March 24, 2026, at paragraph 18.

Introduction:

1On March 20, 2001, Mr. Riccardo Marsala was found not criminally responsible on account of mental disorder, on a charge of utter death threat, contrary to the Criminal Code of Canada (“Criminal Code”).

2Mr. Marsala is subject to the terms and conditions of a Disposition of the Ontario Review Board (the “Board”), dated May 8, 2025. Pursuant to this Disposition, he is detained at the Forensic Service of the Centre for Addiction and Mental Health, Toronto (“CAMH”).

3Pursuant to s. 672.56(2) of the Criminal Code, CAMH notified the Board, by letters dated June 16, 2025, and July 3, 2025, that Mr. Marsala’s liberty had been restricted. Pursuant to the letter dated June 16, 2025, Mr. Marsala was admitted to the Crisis and Critical Care Unit 4 (“CCCU4”), from June 6, 2025, to June 16, 2025 (“ROL #1”). By letter dated July 3, 2025 (“ROL #2”), CAMH advised that Mr. Marsala was admitted as an inpatient to the Psychosis Recovery and Treatment Unit 7 (“PRTU7”) because of concerns about his behaviour in the community, and he remains there.

4On July 16, 2025, the Board convened a hearing at CAMH to review the two restrictions of Mr. Marsala’s liberty, pursuant to s. 672.81(2.1) of the Criminal Code.

5Mr. Marsala was represented by his counsel, Mr. A. Rai. Counsel advised that his client did not wish to attend his hearing, but he had instructions to proceed on his behalf. An order was made, pursuant to s. 672.5(10)(a), on the consent of all parties, allowing Mr. Marsala to be absent from this hearing.

6An ROL Report (“ROL Report”), dated July 3, 2025, was entered as Exhibit 1.

7A Hospital Report (“Hospital Report”), dated April 9, 2025, was entered as Exhibit 2.

8The issues at this hearing are whether ROL #1 was warranted, necessary and appropriate, at the time and up to its conclusion. The next issue is whether ROL #2 was warranted, necessary and appropriate at the time of its onset and whether it continues to be so.

9For the reasons set out below and based on the expert evidence and opinions before us, the Board concluded, with respect to ROL #1, that the initial restriction of liberty was necessary and appropriate and that it continued to be so, until June 16, 2025. The Board further concluded that, with respect to ROL #2, the initial restriction of liberty was warranted, necessary and appropriate, as is the ongoing restriction of liberty. The Board found that these restrictions were necessary for public safety, and they represented the least onerous, and least restrictive, interventions available.

Position of the Parties:

10At the outset of the hearing, the parties were canvassed as to their positions with respect to both ROL #1 and ROL #2. Dr. Darby, as the representative for the hospital and as the most responsible physician, Mr. Rai, as counsel for Mr. Marsala, and Ms. Culp, as counsel for the Attorney General, jointly agreed that both Restrictions of Liberty were warranted, necessary and appropriate.

Index Offence:

11The circumstances giving rise to the Index Offence are extracted from last year’s Board Reasons, as follows:

“On December 4, 2000 while at his mother’s house Mr. Marsala picked up a knife in the kitchen and then put the knife down. He then told his mother, “I want to kill you.” Mr. Marsala attempted to immediately apologize but his mother called the police and he was arrested.”

Current Diagnoses:

[12] Schizophrenia Substance Use Disorder in remission in a controlled setting Personality Disorder Unspecified Rule out Paraphilic Disorder

Reason for ROL #1

13The ROL Report set out the reasons for Mr. Marsala’s first readmission, ROL #1, to CAMH:

“Following his discharge from hospital in March, 2025 Mr. Marsala returned to his residence at LOFT and continued to be followed up by the Forensic Outpatient Service team. For several months there was little change in his presentation. He continued to be religiously preoccupied, often request extra medication, and at times exhibited regressed behavior, particularly lying on the floor in various areas of his residence.

On June 5, 2024, Mr. Marsala went absent from his residence. He bought alcohol at a local store and again was wandering in the street. He expressed increasingly paranoid ideation and reported the "Jehovah" had been telling him to lie down and that he could not control it. Given Mr. his increasingly regressed and risky behaviour and his pattern of similar behaviour in the past, it was felt that he needed to be admitted to hospital. He was admitted to CAMH on June 6, 2025.

Mr. Marsala was transported to CAMH by the police. On admission, he was extremely vague about any precipitants to his behaviour overnight. As it is normal for his baseline, he was very religiously preoccupied, repeatedly talking over Jehovah and asking interviewing staff to identify the Bible. He complained of hearing voices, but was extremely vague about their content. He acknowledged use of alcohol and of lying down in various areas of his residence, but was unable to describe any precipitant, and was unable to identify any interventions that he thought might help address this behaviour.

During his admission, Mr. Marsala's behaviour was quite settled. He did not lie down in common areas of the inpatient unit. His mental status appeared to be at baseline. His clozapine level was reviewed and appeared to be within therapeutic limits. After a few days, Mr. Marsala indicated that he felt better and wished to return home. Liaison continued between the inpatient and outpatient teams. Given the chronicity of his behaviour and the absence of any acute behavioural issues, he was discharged back to his residence on June 16, 2025.

Reason for ROL #2

14The ROL Report provides the following reasons for Mr. Marsala’s ROL #2:

“Following his most recent admission, Mr. Masala returned to his residence and his care with the Forensic Outpatient Service team resumed.

Unfortunately, Mr. Marsala's behaviour escalated quite quickly after his return to his residence. He more frequently laid down in various areas of his residence, including in the common area used by other clients. They expressed concern that they were afraid that they might step over him when he laid down in the hallway. He also became more intrusive with staff, often pushing his way into the inner office where medication was administered, then lying down and refusing to leave. He also entered the office of the housing manager, laid down on the floor and refused to leave.

The housing manager also reported that Mr. Marsala had appeared intoxicated almost every day since he had returned from his admission and had recently reported that "Bob Marty wants me to smoke weed".

Given the escalation in Mr. Marsala's behaviour and the concern that this would put his housing in jeopardy, it was decided that he needed to be admitted for a somewhat longer admission with more intense interventions aimed at breaking the cycle of his regressed behaviour.”

Course in Hospital

15Mr. Marsala’s course in hospital is set out in detail in the ROL Report. The following extracted paragraphs are relevant to this hearing:

“Mr. Marsala was admitted to a non-forensic unit. He continued to engage in childlike and regressed behaviour and continued to ask for increasing amounts of medication. At times when he does not wish to engage with assessments, he covers his head with bed sheets and will not engage further with staff. He has continued to periodically lie down on the floor.

Given the persistence of this pattern of behaviour and the increasingly frequent emergency visits and admissions to hospital, it is felt that Mr. Marcella requires more intensive intervention to attempt to break this cycle. Unless this occurs, his housing is in significant jeopardy.”

Evidence at the Hearing

16The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Darby. Dr. Darby is Mr. Marsala’s treating psychiatrist and authored the ROL Report. He testified as follows:

a) Both of Mr. Marsala’s readmissions to hospital were the results of his personality disorder traits.

b) In addition to Mr. Marsala suffering from schizophrenia, he also exhibits traits of both dependent, and borderline, personality disorders. It is his personality disorder traits that often lead to his readmissions to the hospital, as was the case with these last two readmissions.

c) Mr. Marsala’s most concerning behaviour is his tendency to lie down when he believes his needs are not being met. The treatment team has noticed an escalation in both the frequency, and the disruptive effect, of this behaviour, at his LOFT residence.

d) His most recent readmission was necessary because Mr. Marsala was pushing his way into the manager’s office at LOFT, lying down and refusing to leave. Mr. Marsala would exhibit this lying down behaviour in the medication room, the common areas and the entrance to the lounge. This behaviour was becoming increasingly intolerable, and he was at risk of losing his housing.

e) The treatment team felt it was necessary to readmit Mr. Marsala on both occasions, to help him develop better coping strategies and to manage his escalating and aggressive behaviour.

f) Both ROL #1 and ROL #2 were necessary and appropriate interventions. The current restriction of liberty remains necessary and appropriate in order to ensure the safety of both Mr. Marsala and others.

g) The treatment team believes that Mr. Marsala’s medication regimen is optimized and that Mr. Marsala’s behaviour is solely as a result of his personality disorder traits.

h) LOFT is prepared to keep a bed for Mr. Marsala, if the treatment team advises them that they believe progress is being made and that he will be able to return to LOFT.

17No other evidence was called.

Analysis and Conclusions:

18The Board agrees that restrictions of liberty have taken place, pursuant to the decision of the Ontario Court of Appeal in R v MLC (2010 ONCR 843), as well as Regina v Campbell (2018 ONCA 140).

19Given Mr. Marsala’s increasing regressive risk behaviour, and his pattern of similar behaviour (lying down) in the past, the hospital had no choice but to readmit Mr. Marsala for both ROL #1 and ROL #2. Given the escalation of Mr. Marsala’s behaviour, and the jeopardy it could pose for his housing, the hospital was right to readmit him on June 24, 2025. The Board also agrees that the treatment team must keep him in hospital, until he can develop better coping mechanisms, so that he does not become a threat to himself and to others when returned to his residence, nor lose his housing.

20Based on the evidence before us, the Board has concluded that the hospital’s decision to significantly restrict Mr. Marsala’s liberty, by readmitting him from June 6 to June 16, 2025, was warranted and necessary. The Board has also concluded that, based on the evidence before us, the hospital’s decision to significantly restrict Mr. Marsala’s liberty, by readmitting him on June 24, 2025, and his ongoing restriction, were warranted and necessary. These two restrictions of liberty were the least onerous, least restrictive options, and they were warranted for the safety of the public.