Re Camilla Shapiro, 2026 CanLII 21143

Re: Camilla Shapiro

ORB File No: 8635

Hearing held on: Tuesday, February 3, 2026

Place of hearing: Centre for Addiction and Mental Health

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

Before:

Alternate Chairperson: Mr. M. Segal

Members: Hon. N. Kozloff

Dr. G. Chaimowitz

Dr. H. Moulden

Mr. S. Duffy

Parties Appearing:

Accused: Camilla Shapiro

Counsel: Ms. M. Addie

The person in charge of hospital: Counsel: Ms. S. Rosales Zelaya

Attorney General of Ontario: Counsel: Mr. C. Coughlan

REASONS FOR DISPOSITION

(Dated March 10, 2026)

Introduction

1. On September 23, 2024, Camilla Shapiro was found not criminally responsible (“NCR”) on account of mental disorder on charges of assault, and assault causing bodily harm, contrary to the Criminal Code.

2. Ms. Shapiro is currently subject to a Disposition of the Ontario Review Board (hereinafter also “the ORB” and “the Board”) dated February 18, 2025, ordering her detention at the General Forensic Unit of the Centre for Addiction and Mental Health (hereinafter “CAMH” and “the hospital”) with privileges up to and including living in the community in supervised accommodation approved by the person in charge.

3. On Tuesday, February 3, 2026, the Board convened a hearing to review Ms. Shapiro’s disposition pursuant to section 672.81(1) of the Criminal Code. Ms. Shapiro was present at the hearing and represented by Counsel, Ms. M. Addie.

The Issues

4. The issues to be determined at the hearing were whether Ms. Shapiro continues to represent a significant threat to the safety of the public as defined in section 672.5401 of the Criminal Code and, if so, what is the necessary and appropriate, least onerous and least restrictive disposition, taking into account the factors set out in section 672.54 of the Criminal Code.

The Evidence

5. The Hospital Report dated January 26, 2026, was filed as Exhibit 1 in the hearing. In addition, we heard the viva voce testimony of Dr. Ipsita Ray, one of the authors of the Hospital report and Ms. Shapiro’s treating psychiatrist.

Positions of the Parties

6. At the commencement of the hearing, the parties were asked to provide their initial without prejudice positions with respect to the issues before the Board. Counsel on behalf of the Hospital advised that the position of the Hospital was that there be no change to the current disposition. Counsel on behalf of the Attorney General agreed with the hospital’s position. Counsel for Ms. Shapiro agreed with her colleagues and expressly conceded that Ms. Shapiro continues to represent a significant threat to the public. Put another way, a joint submission on both issues was presented to the panel.

Findings

7. For the reasons that follow, the panel finds that Ms. Shapiro continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition is a Detention Order with the terms and conditions as recommended by the parties.

Background Information

8. The following is reprinted from last year’s Reasons for Disposition dated March 20, 2025:

"The Hospital Report provides only limited background information for Ms. Shapiro. Much of the information comes from Ms. Shapiro herself and she has been noted to be an unreliable historian. Basic facts, such as her immigration status in Canada, are yet unknown to the team. While there are available medical records dating back to 2021, these are all compromised, based as they are on Ms. Shapiro’s self-reporting. Additionally, obtaining medical records is complicated by Ms. Shapiro having used a variety of different names. Ms. Shapiro declined to provide consent to allow the hospital to access medical records in the United States.

There is no reliable information on Ms. Shapiro’s parents, siblings, or her experiences in childhood. There are no available sources of collateral information. Ms. Shapiro identified as a straight woman though she acknowledged being born with a penis and expressed interest in its surgical removal. According to medical records, Ms. Shapiro has been mostly without a fixed address since 2021, including staying in several shelters and sleeping outdoors.

Ms. Shapiro has declined to provide consent for the release of medical records from the United States, where she reported previously receiving psychiatric care. The first known engagement with psychiatric services in Ontario was in October 2021. Ms. Shapiro was brought to the emergency department of the Credit Valley Hospital by police. She reported previously being diagnosed with bipolar disorder, schizophrenia, anxiety, and post-traumatic stress disorder (PTSD), and reported having many prior psychiatric admissions to hospital and eight prior suicide attempts. She was admitted to the psychiatric unit for diagnostic clarification. The discharge diagnosis was borderline personality disorder. No medications were prescribed.

A month later, Ms. Shapiro presented at the emergency department of CAMH. She endorsed experiencing significant trauma; however, she would not elaborate further. She reported that she had escaped from a cult in Indiana, USA, where she grew up. She further endorsed that people from the cult were coming to harm her. However, no objective evidence of psychosis was observed throughout her admission.

Over the following two years, Ms. Shapiro presented to multiple hospital emergency departments. According to hospital records, she did not appear to be experiencing psychotic symptoms. It was believed that she was seeking admission and she was discharged back to the community.

In May 2022, Ms. Shapiro was found unfit to stand trial and was admitted to CAMH pursuant to a Treatment Order. Upon admission, Ms. Shapiro presented as grandiose, hyper-talkative, and disorganized. She exhibited flight of ideas, was distractible, and unable to participate meaningfully in assessment due to her mental condition. She became agitated, verbally aggressive, and threatening to staff and was placed in seclusion. She was treated with the antipsychotic medication olanzapine. This was the first of three similar admissions to CAMH between May 2022 and January 2023. Note: Ms. Shapiro’s local criminal record listed four mischief charges and two assault charges, withdrawn on October 11, 2023. In April 2024, Ms. Shapiro was arrested after an argument at her shelter, where she got into a verbal dispute with a staff member and allegedly struck and broke a window. She was charged with Mischief Under $5,000 and taken to a local hospital for assessment."

The Index Offences

9. The circumstances surrounding the index offences are set out in the Hospital Report:

"March 23, 2024: Assault

Synopsis for Plea

On March 23, 2024, at approximately 7:50 pm, the victim and the witness walked outside of the Eaton Centre at the intersection of Dundas Street East and Shuter Street, in the city of Toronto. Ms. Shapiro approached the victim and allegedly slapped her across the left side of her face with her right hand. As a result, the victim fell to the ground, scraping her left knee in the process. The witness confronted Ms. Shapiro before eventually calling the police. Officers arrived shortly after and placed Ms. Shapiro under arrest for Assault.

Additional File Information

Body camera footage from March 23, 2024, showed Ms. Shapiro speaking tangentially and in a non-sensical manner. Much of the content vocalized was word salad. She referenced her male genitalia being removed. She initially told police she was a minor born in 2010, though when pressed, she provided a birth date in 2004. Police cruiser footage of the same date showed Ms. Shapiro talking and laughing to herself and responding to internal stimuli. She referenced various chemicals being removed from her genitals. At one point, she started yelling sporadically, “Bitch, shut the fuck up!” Booking hall footage of the same date showed Ms. Shapiro’s delayed response time to questions and slow physical movements. She was able to follow directions.

May 7, 2024: Assault Cause Bodily Harm

Synopsis for Plea

On May 7, 2024, at approximately 10:05 am, the victim was standing in front of her tent located at 10 Trinity Square. The victim was seen on CCTV having a verbal altercation with Ms. Shapiro. The victim threw her coffee in Ms. Shapiro’s face. Ms. Shapiro allegedly forcefully shoved the victim to the ground and pushed her head into the ground with both hands. The victim suffered an injury to her mouth and her left hand and lost some teeth. A witness separated the two and Ms. Shapiro left the area. Ms. Shapiro was arrested.

Additional File Information

According to body camera footage from May 7, 2024, Ms. Shapiro rambled in a disorganized manner and laughed inappropriately when interacting with the police. She asked to call 311 and made several statements about the WHO, her hair, and that her lawyer was a “CEO with Victoria’s Secret.” In the police cruiser, footage from this date showed Ms. Shapiro rambling about various names and relationships in a tangential manner. She laughed to herself without a clear stimulus. Booking hall footage from this date showed Ms. Shapiro continuing to speak tangentially and, at times, indiscernibly about topics unrelated to what she was being asked and laughing inappropriately."

Course of Treatment Following the NCR Finding

10. The Course of Treatment up to last year’s Board hearing is summarized in last year’s Reasons for Disposition and set out below:

"Since her admission to CAMH, Ms. Shapiro has been generally cooperative and polite with staff. She has participated in recreational programming on the unit. There have been no instances of violence or aggression necessitating locked seclusion.

Ms. Shapiro evidences a primary psychotic illness, either schizophrenia or schizoaffective disorder. Although compliant with medication, Ms. Shapiro exhibits ongoing symptoms of psychosis including auditory hallucinations, a disorganized thought process, and grandiose delusions about her wealth, employment, and family situation. She also was noted by staff to be responding to internal stimuli.

Ms. Shapiro also evidences symptoms of borderline personality disorder, including affective lability, problems with anger and irritability, recurrent self-harm, suicidality, impulsivity, and possibly identity disturbance. More information is required to confirm this diagnosis.

Ms. Shapiro’s insight into the benefits of medication is superficial. She does not believe that there would be any difference in her mental state were she to stop the medication. She does not believe that her failure to comply with medication is related to her risk of violence. She has yet to engage in psychotherapeutic programming.

The Hospital Report includes the following composite assessment of risk, at p. 28:

Since Ms. Shapiro's involvement with mental health services in 2021, she has presented numerous times in a psychotic state, following medication non-adherence, exposure to stressors, and unstable housing. Her mental state has resulted in frequent emergency department visits across the city and resulted in criminal charges. When unwell, she experiences hallucinations, delusions (paranoid and grandiose), disorganized thoughts and behaviours, suicidal ideation, impulsivity, aggression, and irritability. During such periods of decompensation, she has been assaultive towards others, including during the above-index offences. Acts of violence and behavioural dyscontrol can be anticipated when she is experiencing active psychotic symptoms of her mental illness, likely in the context of non-compliance with medication use, exposure to stressors, and housing instability. Ms. Shapiro has continued to exhibit psychotic symptoms despite compliance with antipsychotic medication."

11. Dr. Dupré was Ms. Shapiro’s treating psychiatrist at the time of last year’s hearing. Her testimony at that hearing is summarized in last year’s Reasons for Disposition:

"Dr. Dupré testified before the Board. She reported that Ms. Shapiro has remained adherent to her medication but has been hesitant to agree to a recommended increase in the dosage. Ms. Shapiro typically denies experiencing psychotic symptoms, notwithstanding observations by staff.

Dr. Dupré indicated that the plan for the next year is to build the therapeutic alliance between the treatment team and Ms. Shapiro. Further, efforts will be made to obtain collateral information relating to Ms. Shapiro’s background and personal history. Ms. Shapiro will be able to participate in therapeutic programming and, assuming appropriate behaviour, receive progressive privilege passes. Dr. Dupré anticipates a positive trajectory for Ms. Shapiro, including possible discharge to appropriate accommodations that would include medication supervision."

Course of Treatment over the Past Year

12. The course of treatment over the past year is set out in the Hospital Report and reproduced below:

"Ms. Shapiro was an inpatient at the Women’s General Forensic Unit at CAMH over the reporting year. She was under the care of Dr. J. Dupré until July 2025, and thereafter Dr. I. Ray. She remained subject to a detention order with the provision for community living. Over the course of the reporting year, Ms. Shapiro had no breaches of her ORB disposition. She utilized passes, up to indirectly supervised, on hospital grounds and accompanied passes into the community, for the purpose of programming, rehabilitation and recreational activities. There were no incidents of absconding from the hospital (AWOL), misuse of privileges, or incidents of locked seclusion. All her random urine drug screens were negative for prohibited substances.

Over the course of the review period, Ms. Shapiro demonstrated improvement in her mental state, with reduced behavioural dysregulation and disorganization of thought. She appeared less guarded and more forthcoming during assessments. She reported being born and raised in Indiana and described the individuals who claim to be her family as members of a cult. She maintained a belief that she was kidnapped as an infant and that this group was responsible for a surgical “sex change” when she was approximately two years old, stating that a penis had been implanted surgically. She vaguely recalled her biological father attempting to retrieve her but being turned away by the alleged cult. She reported no direct memories of her biological parents, whom she described as famous individuals, identifying her father as Colson James Baker (a well-known singer) and her mother as Liana Ren Shapiro (a model), and stated that her father was wealthy and owned multiple properties in Los Angeles.

Ms. Shapiro continued to endorse these persecutory and grandiose beliefs with strong conviction and sustained preoccupation. When asked about her gender identity, she stated, “I am a woman and I was born as a girl.” She expressed a belief that she has a uterus, which she stated had been confirmed on pelvic ultrasound. She spoke about aspirations of becoming a famous singer and reported that she was creating music with plans to submit it to major record labels, including Sony Music and Universal Music. She often became irritable when her beliefs were challenged.

Ms. Shapiro consistently denied suicidal ideation, intent, or plan. She endorsed a history of auditory hallucinations but reported that the voices had completely resolved. She remained intermittently guarded during assessments, was at times reluctant to disclose personal history, and was noted to be a poor historian.

There were two notable incidents of assault, first on July 8, 2025, and a second incident on August 18, 2025. During the first incident a co-patient punched Ms. Shapiro in an unprovoked attack. In a separate incident, another co-patient pulled her hair. To her credit, Ms. Shapiro did not retaliate during any of these incidents. She was provided with supportive counselling and closely monitored to help prevent further occurrences.

Regarding insight into the index offence, Ms. Shapiro described her actions as aggressive behavior in perceived self-defense, stating, “They were coming to fight me.” She demonstrated limited insight into her mental illness and the ongoing need for medication. Although she acknowledged a diagnosis of schizophrenia and recognized that medication helped her remain calm, sleep well, and reduced auditory hallucinations. However, she demonstrated poor insight into the presence and impact of her underlying delusional beliefs.

Ms. Shapiro was deemed capable of making her own treatment decisions. Her psychiatric medications comprised of Clozapine 500 mg daily, which was started in April 2025. She was compliant with these medications. There were some notable improvements in her mental state with medication optimization. She agreed to ongoing medication adherence following discharge and demonstrated receptiveness to psychoeducation regarding the necessity of long-term antipsychotic treatment.

With respect to her physical health, Ms. Shapiro was referred to the Gender Identity Clinic (GIC) in February 2025. After consultation with the GIC, Ms. Shapiro was started on hormone therapy in November 2025. She is currently receiving Estradiol 2 mg daily and Spironolactone 50 mg twice daily. Ms. Shapiro had Clozapine induced tachycardia as a side effect and this is being monitored closely by the hospitalist.

In terms of programming, Ms. Shapiro participated in interventions aimed at enhancing her insight into her mental health symptoms. She completed Illness Recovery sessions, as well as individual sessions within the Substance Misuse Relapse Prevention Program, and also successfully completed forensic systems modules. Although she has been actively engaged in programming, she continued to demonstrate limited understanding to certain aspects of the forensic system. She remained involved in the unit token economy to support motivation and engagement in programming. In addition, she has been a consistent participant in the unit cooking program and grocery group.

Regarding her privilege level, Ms. Shapiro had indirectly supervised passes on hospital grounds and accompanied passes to the community, which is Level 5 on the CAMH pass ladder.

Ms. Shapiro has submitted an Access Point application but there are no active housing applications at this time. She does not qualify for social assistance. Ms. Shapiro expressed a wish to return to the United States in the future and live in Los Angeles. She has recently provided consent for the treatment team to obtain her past medical records from Indiana. However, she remains ambivalent about accepting assistance from the team with obtaining personal identification documents to pursue an application for immigration status in Canada.

Regarding social support, Ms. Shapiro does not have any contact with her family or friends."

13. Ms. Shapiro’s Mental Status is addressed at p. 25 of the Hospital Report, as follows:

"MENTAL STATUS EXAMINATION (January 2026)

Ms. Shapiro was casually dressed, and was kempt and tidy. She appeared older than her stated age. There were no grossly abnormal psychomotor movements. A rapport could be established with ease. When asked about inconsistencies in her narrative, Ms. Shapiro would become irritable and often ask to end the interaction. Her speech was low in volume and had a soft quality. Her affect was generally euthymic. Ms. Shapiro’s thought form was mostly organized. She expressed numerous grandiose delusions about her wealth, employment, and family situation. She also expressed persecutory delusions about her family and being kidnapped by cult members. She denied suicidal or violent ideation. She endorsed auditory hallucinations, which she reported had resolved recently. She was unable to describe their content when asked. Her insight into her status under the ORB was minimal. Her insight into her mental illness was limited. She had reasonable judgment with respect to taking her prescribed medications."

14. Ms. Shapiro’s psychiatric diagnoses are set out in the Hospital Report:

"Diagnoses

Ms. Shapiro has a longstanding history of presenting to the hospital with a disorganized thought process, grandiose delusions, and auditory hallucinations. She has evidenced significant functional impairment from these symptoms, including obtaining housing, securing employment, and understanding her court process. These symptoms have improved somewhat with antipsychotic treatment in the past. However, she continues to endorse significant grandiosity, disorganized thinking, and auditory hallucinations at the time of this assessment. She, therefore, likely meets the diagnostic criteria for a diagnosis of schizophrenia.

Ms. Shapiro has previously reported some substance use with cannabis, though there is no confirmation with urine drug screens. She continues to demonstrate significant psychotic symptoms while in the hospital for several months, with presumably less access to substances. This suggests a purely substance-induced psychosis is significantly less likely.

Ms. Shapiro also evidences symptoms of borderline personality disorder. These include affective lability, problems with anger and irritability, recurrent self-harm, suicidality, impulsivity, and possibly identity disturbance. Borderline personality disorder was her primary diagnosis after most emergency department encounters, where she evidenced strong behavioural manifestations of the disorder, such as conditional suicidality and a help-seeking and help-rejecting pattern. While some of these features may be attributable to her psychotic disorder, including problems with anger, lability, and impulsivity, others appear more characterological. However, more information on Ms. Shapiro’s background is required to confirm that these symptoms began in the developmental period and were consistently present throughout her life.

Ms. Shapiro expresses a wish to pursue gender-affirming surgery for removal of her penis. However, presently, it is not clear whether she meets the diagnostic criteria for gender dysphoria, given her ongoing psychotic symptoms and disorganization when discussing this topic. For example, Ms. Shapiro reports she is a biological woman and does not identify with a transgender identity. Once Ms. Shapiro’s psychotic symptoms have been treated, this diagnosis will be re-evaluated.

In regards to malingering, as it is suggested throughout Ms. Shapiro’s medical records, psychological testing demonstrated significant positive impression management, including minimization of psychological difficulties, anger and impulsivity. However, Ms. Shapiro was not found to be malingering with psychiatric symptoms. If anything, she globally underrepresented her burden of psychiatric symptoms and presented herself as more functional than she is. Therefore, while Ms. Shapiro’s self-report is unreliable, and there are times when she is clearly fabricating information on her background to the team, her psychiatric symptoms appear on balance and genuine."

15. The Hospital Report contains fulsome details of the Risk Assessment conducted in relation to Ms. Shapiro. For our purposes it will suffice to reproduce the Composite Assessment of Risk:

"Composite Assessment of Risk

According to R. v. Winko, a “significant threat to the safety of the public” means a real risk of physical or psychological harm to members of the public that is serious in the sense of going beyond the merely trivial or annoying. The conduct giving rise to the harm must be criminal in nature. Further, it is noted that evidence to determine whether an individual is a significant threat to the safety of the public can include the past and expected course of the NCR accused’s treatment, if any, the present state of the NCR accused’s medical condition, the NCR accused’s own plans for the future, the support services existing for the NCR accused in the community, as well as other items.

Based on the factors noted above, it is my opinion that Ms. Shapiro represents a significant threat to public safety.

Since Ms. Shapiro’s involvement with mental health services in 2021, she has experienced multiple episodes of psychotic decompensation, often in the context of medication non-adherence, psychosocial stressors, and housing instability. These episodes have resulted in frequent emergency department presentations across the city and have contributed to the laying of criminal charges.

During periods of illness, Ms. Shapiro exhibits prominent psychotic symptoms, including hallucinations, paranoid and grandiose delusions, disorganized thought processes and behaviours, suicidal ideation, impulsivity, irritability, and aggression. When acutely unwell, she has demonstrated assaultive behaviour toward others, including in relation to the above-noted index offences.

Acts of violence and behavioural dyscontrol are therefore foreseeable during periods of active psychosis, particularly in the setting of medication non-adherence, exposure to psychosocial stressors, and unstable housing. Notably, Ms. Shapiro has continued to experience residual psychotic symptoms despite periods of reported adherence to antipsychotic treatment."

16. The recommendation of Ms. Shapiro’s treatment team is set out at p. 30 of the Hospital Report:

"Team Review of Recommendation

The team is of the unanimous opinion that a detention order at the Forensic Service of CAMH with the provision for community living is necessary and appropriate to manage Ms. Shapiro’s risk to the public. Given her history of medication non-adherence, inconsistent engagement with outpatient services, limited social supports, and behavioural instability, a supportive housing environment with an appropriate level of supervision is indicated. A detention order is required to appropriately manage her risk in the community, by allowing the hospital to approve accommodations and responding timely to rapid changes in her mental state which would not be possible under the Mental Health Act of Ontario."

Evidence of Dr. Ray at the Hearing

17. In response to questions from counsel for the hospital, Dr. Ray opined that Ms. Shapiro had a positive year.

18. She reiterated the diagnosis of Schizophrenia and stated that Ms. Shapiro continues to experience residual psychosis including both persecutory and grandiose delusions.

19. In May of 2025, clozapine was initiated and is still being titrated. The plan for Ms. Shapiro is for the treatment team to fine tune her medication and to provide her with psychoeducational programming.

20. Regarding collateral background information about Ms. Shapiro, Dr. Ray reported that Ms. Shapiro recently gave her consent for the hospital to obtain her records from Indiana, which is a positive development given the relative dearth and questionable reliability of the information obtained thus far, much of which was via Ms. Shapiro’s self reports.

21. However, Dr. Ray also reported that Ms. Shapiro is ambivalent about engaging with the clinical team regarding her immigration status, which she opined will be an obstacle to Ms. Shapiro’s progress insofar as it may adversely affect her ability to obtain suitable accommodation.

22. The doctor then reiterated the team recommendation and went on to explain why a detention order is the necessary and appropriate disposition: (a) Ms. Shapiro is at a stage of the process when her medication is still being titrated and accommodation suitable to her needs and circumstances is still being sourced; (b) the Mental Health Act is not a viable alternative in the event she is discharged into the community as Ms. Shapiro is not (or may not be) certifiable and the hospital must be able to bring Ms. Shapiro into hospital rapidly at the earliest signs of decompensation; and (c) the hospital must be able to approve housing which necessarily will be high support.

23. In response to questions from counsel for the Attorney General about why she thinks Ms. Shapiro is ambivalent about cooperating, Dr. Ray explained that Ms. Shapiro’s delusions are primarily related to her family, that those delusions are prominent and consistent, and that Ms. Shapiro has a fear of being sent back to Indiana (albeit she wants to go to California). Dr. Ray is hopeful that the optimization of her antipsychotic medication may resolve these engagement issues.

24. Asked about the danger of Ms. Shapiro absconding, the doctor replied that she is currently on Level 5 passes, and the team has been and will continue to be very cautious about her passes to reduce the risk of absconding.

25. In response to questions from counsel for Ms. Shapiro, Dr, Ray acknowledged that Ms. Shapiro’s agreement to allow the hospital to obtain collateral information from Indiana indicates some attenuation of her fears and may even assist in determining her immigration status and an accurate identification.

26. Asked if Ms. Shapiro has access to money, Dr. Ray replied in the negative, adding that the understanding is that the hospital will arrange housing for her.

27. The doctor agreed with counsel’s suggestion that there has been no indication that Ms. Shapiro desires to abscond.

28. The doctor stated that Ms. Shapiro was floridly psychotic at the time of the index offences and observed that Ms. Shapiro had failed to follow up with treatment plans after previous hospitalizations.

29. In response to questions from the panel regarding Ms. Shapiro’s lack of financial resources and her day-to-day needs, Dr. Ray replied that she gets clothing from the CAMH store and other necessities on her unit.

30. She was unable to say if Ms. Shapiro has an immigration counsel, adding that there is also an identification issue.

31. Dr. Ray agreed with the suggestion that there is a link between Ms. Shapiro’s sexual identification and her psychosis. Given that, she agreed that it was concerning that Ms. Shapiro has started hormone therapy and was contemplating gender -affirming surgery. That said, it is apparent to Dr. Ray that Ms. Shapiro does want to transition to be a female.

32. Asked about Ms. Shapiro’s Borderline Personality Disorder diagnosis and whether it might complicate her treatment, Dr. Ray responded that Ms. Shapiro seemed to be responding well to the Clozapine and agreed that if the medication was effective, it would resolve not only her psychotic symptoms but also impact positively on her other issues.

Final Submissions

33. In final submissions, all counsel congratulated Ms. Shapiro on a good year and supported the joint submission.

Analysis and Conclusion

34. Having carefully considered the evidence including the Hospital Report and the testimony of Dr. Ray, the panel is unanimous in agreeing with the joint submission of all the parties that Ms. Shapiro continues to pose a significant threat to the safety of the public. Her risk is informed most especially by her history of violence, her psychiatric diagnoses, and her history of falling away from treatment and non-adherence to medication leading to decompensation. Her risk is enhanced by the fact that even when adherent to medication she continues to experience multiple symptoms of psychosis.

35. Section 672.54 of the Criminal Code requires us – when determining the necessary and appropriate disposition - to consider the need to protect the public from dangerous persons, the mental condition of the accused, her reintegration into society and her other needs.

36. Ms. Shapiro is still at a stage where her antipsychotic medication is being fine tuned. Accommodation suitable to her treatment needs and financial circumstances is still being sourced. The hospital has yet to gain access to information about her background which may assist with her reintegration into society and her other needs.

37. Moreover, the uncontradicted and convincing evidence is that the hospital must be able to bring Ms. Shapiro into hospital rapidly at the earliest signs of decompensation. It is also apparent on the evidence that the Mental Health Act is not a viable alternative in the event she is discharged into the community. It will take too long. Ms. Shapiro is not (or may not be) certifiable. Finally, the hospital must be able to approve housing with an appropriate level of supervision.

38. In the result, the panel finds that the necessary and appropriate, least restrictive, and least onerous disposition is a detention order at CAMH with privileges up to and including community living (as well as all of the other conditions in her current disposition).

DATED this 10^th^ day of March, 2026, at the City of Toronto, in the Toronto Region.

Hon. N. Kozloff

Legal Member

Office of the Registrar

Ontario Review Board