Re: Anne-Marie Macpherson
ORB File No: 8175
Hearing held on: Thursday, December 18, 2025
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Kert
Members: Dr. T. Verny
Dr. G. Nexhipi
Hon. C. Nelson
Mr. W. Apted
Parties Appearing:
Accused: Anne-Marie Macpherson
Counsel: Ms. M. Addie
The person in charge of hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Ms. G. Meyers
REASONS FOR DISPOSITION
(Dated February 4, 2026)
Overview
On October 20, 2022, Anne-Marie Macpherson was found not criminally responsible on account of mental disorder (“NCR”) on Criminal Code charges of injuring or endangering an animal, and being unlawfully in a dwelling house.
Ms. Macpherson is currently subject to a disposition of the Ontario Review Board detaining her at the Forensic Service of CAMH, with privileges extending to living in the community of Southern Ontario in accommodation approved by the person in charge. The disposition also permits her to travel for up to 14 days with an approved itinerary both domestically (indirectly supervised) and internationally (accompanied by a person approved by the person in charge).
On December 18, 2025, this panel of the Review Board convened an in-person hearing at CAMH to review that disposition. Ms. Macpherson was present with her counsel, Ms. Addie.
The issues for the panel to decide are whether Ms. Macpherson poses a significant threat to public safety and, if so, what is the necessary and appropriate disposition for the coming year, considering the four factors in s. 672.54 of the Criminal Code.
None of the parties contested a finding of significant threat, and the parties jointly submitted that the current disposition remains necessary and appropriate in the circumstances. We agree. These are our reasons.
Background and Index Offences
Ms. Macpherson is 49 years of age. Her current diagnoses include major depressive disorder (recurrent, most recent episode severe, with psychotic features, in remission) and cannabis use disorder (in sustained remission). She was raised in Toronto, primarily by her father. She reportedly had a childhood marked by parental neglect, but was nonetheless able to graduate high school and obtain both a BA and an M. Ed degree. She worked for many years in elementary schools, mostly in supportive teaching roles and as a librarian. Her two older siblings, with whom she remains close, live in Seattle.
Apart from the index offences, Ms. Macpherson has no history of criminal offending. She does, however, have a well-documented history of recurrent major depressive episodes that became increasingly severe leading up to the index offences. The depressive episode preceding the index offences was the most severe to that date and was the first with psychotic features. At the time, Ms. Macpherson was living in a basement apartment, was on leave from work, was having financial difficulties, and was not taking her medications (she had apparently run out of medication). She was also using cannabis regularly. In the days leading up to the offences, she experienced a “break from reality” – she was unable to leave her house and experienced auditory hallucinations and persecutory delusional beliefs, believing people and police were out to get her to bring her to hell.
In the early morning hours of May 4, 2022, Ms. Macpherson’s upstairs neighbours were asleep in their apartment. Upon hearing loud knocking at their front door, the neighbours went to the door and saw Ms. Macpherson, who suddenly left and returned downstairs to her apartment.
The neighbours were concerned for Ms. Macpherson’s safety and called 911. Police attended at her apartment and noticed a still-bleeding significant cut to Ms. Macpherson’s left hand. While one officer performed first aid, another went into the rear bedroom of her apartment, where he observed a dead dog on the floor with an incision from its neck to its tail. A bloody knife was on the floor next to the dog.
While police were still present, Ms. Macpherson walked out the front door of her apartment and up the stairs to the main floor, with the police officers following. She entered the neighbours’ apartment, stated something to the effect of, “I need to get her,” and then ran toward the victims, who had just exited their bedroom. Officers took physical control of Ms. Macpherson, but she struggled and would not let them handcuff her. They were able to do so after several minutes and placed her under arrest.
Ms. Macpherson’s in-patient NCR assessment in respect of the index offences occurred at the St. Joseph's Hospital in Hamilton. As she grew up and lived in Toronto, following her initial ORB hearing in November 2022, the Board ordered that she be transferred to, and detained at, CAMH.
Ms. Macpherson was admitted to CAMH in February 2023, and remained on a general forensic unit for a year. While an inpatient she was adherent with medications and treatment plans, and did not present any management concerns. She progressed in her privileges; by October 2023, she was using indirectly supervised community passes. In February 2024, her mental status was stable, and she was described as functioning at a high level. She was discharged to a subsidized, supported apartment in mid-February 2024.
Ms. Macpherson’s initial tenure in the community was unremarkable. She reported as required, maintained compliance with medication and actively engaged in leisure activities to structure her time. In March 2024, she also got a new puppy. In late April 2024, Ms. Macpherson told members of her Forensic Outpatient Service (“FOPS”) team that she had smoked cannabis and drank alcohol around the time of her birthday in mid-April. She said she had started smoking and drinking with cousins, but continued to do so on her own in her apartment. After self-reporting she continued using cannabis but stopped in early May, when her case manager warned her that her housing and/or community living could be in jeopardy if she continued.
Ms. Macpherson seemed relatively stable until early July 2024, when she decompensated abruptly over a period of a few days. When she was brought into hospital shortly after midnight on July 6, 2024, she was mute and unresponsive to directions. She presented as catatonic for the remainder of that day and the next. She would not accept food or medication and there was no improvement in her presentation until late on July 7th, when she agreed to take lorazepam. As she stabilized, Ms. Macpherson told staff that she had missed about five days of her regular medications prior to her admission but denied any real problems leading up to admission.
Over the next several weeks, Ms. Macpherson continued to exhibit instability in her mental state. In mid-September 2024, she experienced further decompensation with re-emergence of depressive symptoms and possible catatonia. At some point in late September or early October, she was found incapable with respect to antidepressant and antipsychotic medications. Her sister became her substitute decision maker, but Ms. Macpherson continued to decline her oral medications.
It was in this context, and in the presence of various stressors, that Ms. Macpherson experienced a precipitous decline in her mental state on the evening of October 3 and the morning of October 4, 2024. Her behaviour was concerning and bizarre, and chemical restraints were required due to the ongoing risk of self-harm. Over the next week her mental status fluctuated, and she remained on constant observation. In light of her unstable mental status, she was transferred to a medium-secure unit on October 11, 2024. On that unit she continued to refuse all medications except lorazepam. After medication administration protocols were enacted to ensure her compliance, Ms. Macpherson’s mental state improved.
Course Since the Last Hearing
At the time of Ms. Macpherson’s last annual hearing in December 2024, she remained an inpatient at CAMH. Though the information is not contained in the hospital report, last year’s reasons indicate that the panel was informed in oral evidence that on November 29, 2024, Ms. Macpherson hit another patient in the face. She advised the treatment team that she had been responding to auditory hallucinations. Following the assault, she was placed in seclusion for two days.
Last year’s panel also received oral evidence that late at night on December 3, 2024, Ms. Macpherson entered another client’s room. She told staff she had been experiencing command hallucinations of a sexual nature, and was again placed into locked seclusion for one day. Given this behaviour, at the time of the hearing last year, Ms. Macpherson was at Level 1 privileges, which allowed her only escorted passes on the hospital grounds. The treatment team was attempting to optimize her medication regimen, had stopped her lorazepam, and increased her aripiprazole.
At the current hearing we received evidence in the form of an updated hospital report and the oral evidence of Dr. Igoumenou, who was providing coverage for Dr. Kravtsenyuk, Ms. Macpherson’s psychiatrist. That evidence revealed as follows: The most recent clinical year was a much more positive one for Ms. Macpherson. While an in-patient for the first part of the year, she experienced a sustained period of psychiatric stability after her medication was optimized. Her privileges were gradually and incrementally reintroduced. In hospital she maintained compliance with medication, used her passes appropriately and was fully abstinent from substances.
On August 25, 2025, Ms. Macpherson was discharged back to her apartment. Since then, the outpatient team has described her as “pleasant, cooperative, organized and reliable, with no behavioural concerns, missed appointments or functional decline.” (hospital report, p. 32) She has been fully compliant with medication and her drug screens have been negative. She has been socially active, including volunteering at her residence, attending weekly CAMH activities, and travelling with (or to see) family.
Significant Threat and Disposition
Ms. Macpherson’s risk to public safety flows from her mental disorder. At the time of the index offences, she was untreated, using cannabis and experiencing persecutory and religious delusions and auditory hallucinations. She acted on these symptoms leading to the death of her dog, aggression toward her neighbours and physical resistance of the police. This is illustrative of her potential for aggression and violence in the context of a relapse of her depressive symptoms and the emergence of psychotic symptoms.
Although currently stable, Ms. Macpherson is highly susceptible to recurrent depression, and she remains at elevated risk of relapse and/or non-adherence with recommended treatment absent the supervision and monitoring provided to her by the FOPS. When psychiatrically stable, she has fairly good insight into her historical difficulties. However, her insight has historically deteriorated when she has been unwell, and her ability to recognize less overt symptoms of her psychotic illness has remained partial, even when she is clinically stable. At present, therefore, to mitigate her risk of serious deterioration and associated behavioural disturbance and violence, “ongoing access to proactive interprofessional supports and clinical monitoring are integral,” as required under a disposition. As such, the test for significant threat is met.
We also agree that the current detention disposition remains necessary and appropriate to manage Ms. Macpherson’s risk. We recognize that Ms. Macpherson had a very positive clinical year – she returned to community living, enjoys a good relationship with the treatment team, is socially engaged and has strong family support and involvement. She maintained abstinence from substance use and has remained medication adherent and psychiatrically stable.
However, the events of the prior reporting period (2023-2024) demonstrate the necessity of continuing the current disposition. In the spring/summer of 2024, a detention disposition allowed Ms. Macpherson’s clinical team to intervene quickly with increased monitoring and eventual readmission in response to signs of her emerging depression. It also allowed for her ongoing hospitalization, stabilization, and observation to ensure her sustained stability before consideration of discharge. As it remains a feature of her depressive episodes that Ms. Macpherson can become very unwell, psychotic, and withdrawn within a short period of time, the warrant associated with a detention disposition remains an essential tool to assist in returning her to the hospital should that be necessary. The ability of the hospital to approve her accommodation also ensures that Ms. Macpherson’s housing is appropriate to support her stability in the community.
DATED this 4th day of February, 2026, at the City of Toronto, in the Region of Toronto.
Ms. S. Kert
Alternate Chairperson
Office of the Registrar
Ontario Review Board