Re: Daniel Ballok
ORB File No: 5278
Hearing held on: February 17, 2026
Place of hearing: St. Joseph’s Healthcare Hamilton, West 5^th^ Campus
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. K.A. Connidis
Members: Dr. J. Cheston Dr. S. Bouskill Mr. D. D’Intino Ms. B. Little
Parties Appearing:
Accused: Daniel Ballok Counsel: Mr. M. Schloss
The Person in Charge of Hospital: Counsel: Ms. L. Barney
Attorney General of Ontario: Counsel: Mr. I. Shaikh
REASONS FOR DISPOSITION
(Dated April 14, 2026)
Introduction
On June 15, 2009, Daniel “Dani” Ballok was found not criminally responsible on account of mental disorder, on charges of assault and failure to comply with probation, contrary to the Criminal Code of Canada (“Criminal Code”).
Ms. Ballok1 is subject to a Disposition of the Ontario Review Board (the “Board”), dated March 3, 2025, which orders that she be detained at St. Joseph’s Healthcare Hamilton (SJHH) with privileges up to and including residing in the community of Hamilton in supervised accommodation approved of by the Person in Charge.
On February 17, 2026, a panel of the Ontario Review Board (ORB) convened in person and a hearing was held at SJHH. The purpose of the hearing was to determine if Ms. Ballok continues to represent a significant threat to the safety of the public as defined in the Criminal Code of Canada, and if so, what is the necessary and appropriate Disposition for her for the year ahead.
For the reasons set out below, the Board unanimously finds that the threshold for significant threat to the safety of the public is met in Ms. Ballok's circumstances, and that the necessary and appropriate Disposition is a continuation of her current Detention Order Disposition with no changes to its terms and conditions.
Current Psychiatric Diagnoses:
Schizophrenia;
Cocaine Use Disorder, in early remission, in a controlled environment;
Alcohol Use Disorder, in sustained remission, in a controlled environment;
Gender Dysphoria
Index Offences:
- The facts arising from the index offences of June 11, 2008, are set out in the Hospital Report (at pages 4-5, quoting the Crown Brief Synopsis, and pages 6-7, relating to some of the background to the Index Offences –and in related previous events of February 22, 2008 (from a Supplementary Occurrence Report), and in June 3, 2008, shortly before the Index Offence (from a Crown Brief Synopsis). The Index Offences are described there as follows:
Facts of Index Offences:
"The following is quoted from the Supplementary Occurrence report:
“On February 22, 2008 at approximately 8:45am Officers Allen & McNight were dispatched to attend the Wesley Centre at 195 Ferguson Ave N, Hamilton regarding a call for an unwanted male refusing to leave the building. Officer Allen arrived first, and was directed by staff to the stairwell area of the building. There he located the male. He was initially identified only as “Daniel” by staff. Officer Allen asked him to leave, but he refused, and swore repeatedly at Officer Allen. Officer McNight arrived a short time later, and also asked him to leave. He too received the same response from “Dan”. He was uncooperative, and would not identify himself, or answer any questions that were put to him.
"At 9:25am, Officer Allen arrested him for failing to identify himself, and leave as directed. He refused to get up, and had to be carried out of the building. During the struggle, he ripped a finger off the left hand glove of Officer Allen, while he was still wearing it. He was taken outside, where he was searched, and subsequently cuffed. He was transported to Station 10 [in] custody, where he was lodged.
"Further investigation revealed his identity to be: Daniel Peter BALLOK (78-02-24). Information was received that BALLOK was presently released on a probation order.
"The order is for: Assault and FTC Probation. Start date of July 27, 2007 for 3 years.
"He was found to be breaching the condition of Keep the peace and be of good behaviour.”
Without Prejudice Positions of the Parties:
At the commencement of the hearing, the parties were canvassed for their initial positions.
The Hospital took the position that the evidence meets the threshold for significant threat to the safety of the public in Ms. Ballok's circumstances, and that the necessary and appropriate Disposition for the coming year is a continuation of the existing Detention Order with no changes to its terms and conditions.
Counsel for the Attorney General supported the Hospital’s position.
Counsel for the accused advocated for a Conditional Discharge with a consent to treatment term and a Young clause and advised that Ms. Ballok would be willing to remain in Hospital until appropriate housing could be secured.
Past Personal History and Background Circumstances:
Ms. Ballok is a 46-year-old single transgender woman and father of two adult children. She is diagnosed with schizophrenia, cocaine use disorder, alcohol use disorder, antisocial personality disorder and, at least by history, gender dysphoria.
Ms. Ballok began to have outbursts of anger and oppositional behaviour while still in public school. In high school, she began to use cannabis and other substances. She stole her mother’s car. She was described as impulsive and lacking remorse. Her mother first observed signs of delusions and bizarre behaviour when Ms. Ballok was in her late teens.
Ms. Ballok had a lengthy relationship with a woman that started in her early teens. They had two children together – the first born when she was 16 years old. By the time she was 21 years old they had separated. The children lived with their mother for a time but were then cared for by Ms. Ballok’s parents. Ms. Ballok also lived with a woman for two years when she was in her late twenties. The relationship ended when she was charged with domestic assault.
Ms. Ballok has a criminal record that includes dangerous driving, failing to comply, obstruct peace officer, drug possession and three assaults. The last of these convictions (which resulted in one day of custody after pre-sentence custody was accounted for) were registered a week before the index offences.
When Ms. Ballok was 25 years old, she had her first psychiatric admission to hospital and within a year was admitted three more times. She was paranoid, experiencing auditory hallucinations and was physically aggressive. She improved with treatment but did not remain compliant with treatment when discharged from hospital.
Ms. Ballok went two and a half years without an admission. She was living with her common law partner at the time. Between the end of the relationship sometime in 2007 and the index offences in 2008, Ms. Ballok stopped taking her long-acting injectable antipsychotic medication, was homeless for a time, and increased her use of cocaine. She had two more psychiatric admissions due to psychosis (both related to cocaine use and withdrawal), as well as two psychiatric admissions for assessments of fitness to stand trial. After her arrest for the index offences, it took several months for her to become fit to stand trial.
Under the jurisdiction of the Board, Ms. Ballok’s mental state was stabilized before she moved into transitional housing in the community in 2010. Between then and 2022, Ms. Ballok lived in the community but had frequent readmissions to hospital, some lengthy, due to decompensation in her mental status. Cocaine use was usually the cause of her decompensation, but she was also, occasionally, not fully compliant with medications. She came close to being evicted from her housing twice.
During a hospitalization in 2022, the team decided that Ms. Ballok was no longer suitable for transitional housing – after twelve years, she had not progressed to more independent housing. Ms. Ballok has stayed in hospital since then, awaiting a bed in high support housing.
Ms. Ballok has continued to use cocaine in hospital, and her mental state has worsened in response. In 2023, she failed to return from a pass into the community and was returned to the hospital by police the next morning.
Ms. Ballok typically avoids taking responsibility for her actions – she denies substance use (and other behaviours) and blames others. She frequently alleges that others are responsible for secretly giving her drugs.
Ms. Ballok had a long history of gender dysphoria. She has described “phases” as far back as childhood (dressing as a female at play and being rejected for it). From the beginning of her time under the Board, she was offered services related to transitioning and met with some physicians she was referred to but she demonstrated significant ambivalence about proceeding. Since her return to hospital in 2022, Ms. Ballok has been undergoing hormone therapy.
Ms. Ballok’s father and brother have died while she has been under the jurisdiction of the Board. Her primary support, other than professional forensic services, is her mother. Unfortunately, the relationship has been somewhat complicated by the fact that Ms. Ballok’s mother is also the primary support for Ms. Ballok’s adult children with whom she has a challenging relationship.
Evidence at the Hearing:
The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Alatishe, who is Ms. Ballok’s attending psychiatrist.
Dr. Alatishe testified by way of update to the Hospital Report that overall, the patient has had a relatively good year. There was one instance where a urine drug screen (UDS) returned positive for cannabis and cocaine, and that substance use had led to some changes in the patient’s mental state, but apart from that, there were no incidents of violence or aggression in the past reporting year.
Dr. Alatishe explained that Ms. Ballok’s physical health has remained stable, although she has been diagnosed with obstructive sleep apnea and requires the use of a CPAP machine. Adhere to this health-critical treatment remains an issue. Ms. Ballok has been engaging with her family and has been compliant with her oral medications as well.
Dr. Alatishe explained that when previously residing in the community at Emmaus Place, Ms. Ballok struggled because it was more of a semi-independent living arrangement and she needed more support than was offered. Ms. Ballok typically does very well in highly structured environments such as that of the Hospital.
Dr. Alatishe provided several reasons why a Conditional Discharge was not the necessary and appropriate Disposition at this time. Firstly, there is no housing placement available for Ms. Ballok at this time and even with the patient consenting to remaining in Hospital for the time being, on a Conditional Discharge she could leave at any time.
Dr. Alatishe further testified, secondly, that on a Conditional Discharge Ms. Ballok would likely choose housing that is not suitable for her needs because she lacks insight into what degree of support she requires. He explained that the patient feels that she can reside fully independently, which historically has been very problematic for her, and that she doesn’t fully appreciate the degree of oversight and supervision she requires.
Even though Ms. Ballok has been placed on some waiting lists for appropriate housing, Dr. Alatishe explained that there have been instances where she wanted to remove herself from those lists because she didn’t want to reside in that type of accommodation. Dr. Alatishe explained that the type of accommodation that Ms. Ballok would choose is not suitable from a clinical point of view and would impact the risk that she poses to the public.
Thirdly, if the patient were granted a Conditional Discharge, the Hospital would have to rely on the Mental Health Act to readmit her, which Dr. Alatishe opined would be insufficient to manage her risk in the community and promptly readmit her to Hospital if needed.
On that latter point, Dr. Alatishe highlighted that Ms. Ballok has a history of medication non-compliance and has recently been switched to an oral medication which requires supervision to administer. Moreover, Ms. Ballok continues to struggle with substance use even while in Hospital, which adds to the need for the Hospital to have the authority and ability to promptly readmit her to Hospital in the event of a decompensation in her mental status.
Dr. Alatishe testified that as it concerns substance abuse, Ms. Ballok’s insight is “fair”. While on the surface Ms. Ballok seems to acknowledge that substance use is a factor that has led to negative outcomes and troubles in her life, when she relapses into substance use, she does not acknowledge or take responsibility for the relapse and externalizes blame for that relapse or offers various rationalizations.
In response to questions from the Crown Attorney, Dr. Alatishe opined that the relationship between Ms. Ballok and her daughter is more of a risk factor than a protective one because they both struggle with addictions and Ms. Ballok has been known to use substances in the presence of her daughter.
On the issue of housing, Dr. Alatishe testified that Ms. Ballok is on a waitlist for 24 hour a day supportive housing and has been for some time. This type of housing is clinically appropriate according to the doctor because it offers 24-hour supervision, meal preparation and medication supervision. There is no estimate of how long Ms. Ballok may be waiting for housing.
In response to questions from Mr. Schloss, Dr. Alatishe agreed that when Ms. Ballok has relapsed into substance use there have been reports that the substance use involved her daughter. Dr. Alatishe was unsure if the daughter is attending any programming or treatment to address her substance abuse, but he did agree that if this was the case, then that would help alleviate some of the stressors on Ms. Ballok.
Dr. Alatishe further agreed that Ms. Ballok has been medication compliant this past reporting year, is independent in her activities of daily living, and that Ms. Ballok’s mother has been and continues to be a significant source of support for her.
Regarding the supportive housing waiting lists, Dr. Alatishe confirmed that the patient has been on two waiting lists since 2022 and that this is a common length of time for most patients. Dr. Alatishe agreed that perhaps part of the hesitation from Ms. Ballok to reside in group homes is a concern about the potential for coresidents to engage in substance use and that this concern could be viewed as a positive sign.
Dr. Alatishe cautioned however that the patient’s concern in this regard needs to be viewed in light of her fluctuating insight. While he agreed in part that Ms. Ballok may relapse because of cravings for substances, she lacks the insight to learn from her relapses and is unable to acknowledge what triggers her substance use.
In response to questions from the Panel, Dr. Alatishe confirmed that Ms. Ballok was discharged previously to reside in the community in 2010 and required readmissions to the hospital in 2010, 2011, 2012, 2015, 2018, 2019, 2020, 2021 and 2022. According to the doctor, the single factor that ties all these readmissions together is a decompensation in Ms. Ballok’s mental status, but these instances of decompensation were caused by different factors, ranging from stressors to substance abuse.
Dr. Alatishe was then asked what changes in the patient’s mental status were observed when she had recently consumed cannabis and cocaine, to which he replied: increased irritability, increased periods of sleep, isolating behaviour and some evidence of residual psychiatric symptoms such as breakthrough psychotic symptoms with crack cocaine usage.
In response to a question from the Alternate Chair, Dr. Alatishe advised that Ms. Ballok’s gender transition process and gender dysphoria diagnosis do not affect her degree of risk to the public.
In re-examination by Mr. Schloss, Dr. Alatishe agreed that Ms. Ballok’s identity as a transgender female does complicate the housing process to some degree, given that her gender-identity specific needs must be accommodated.
At the conclusion of the evidence, all parties maintained their initial positions. Analysis and Conclusions
Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board finds that the threshold for significant threat to the safety of the public is met on the evidence of Ms. Ballok's circumstances at this time, and holds that a continuation of the existing Detention Order Disposition is the least onerous and least restrictive, necessary and appropriate Disposition for the year ahead.
The Panel has come to this decision after a careful review of the Ontario Court of Appeal decision in Ramos (Re), 2025 ONCA 820. While the facts in Ramos differ significantly from that of the present case, the ratio decidendi is relevant to all cases that the Board hears.
In summary, the case of Ramos (at paragraph 18) requires the Board to:
Remain attentive to constitutional protections and avoid the influence of stereotypes or prejudice;
Give thoughtful weight to the reasonable wishes and preferences of NCR individuals, while still prioritizing community safety;
Undertake a careful, individualized assessment that avoids assuming permanent or inherent dangerousness and instead evaluates the person’s present clinical and social circumstances;
Keep the legal thresholds distinct from hospital preferences or institutional rule compliance, recognizing that clinical convenience cannot substitute for the legal test and conducting a holistic assessment which acknowledges strengths and improvements;
Exercise its own independent judgment when reviewing professional opinions; and
Approach hearsay evidence with care, ensuring that any reliance on such information is fair, balanced, and consistent with the Board’s dual role of protecting both individual rights and public safety.
In determining whether Ms. Ballok represents a significant threat to the safety of the public, the Board has carefully analyzed the evidence as it relates to the Supreme Court of Canada decision in Winko, 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625 and the definition of the term in s. 672.5401 of the Criminal Code. It is well-established in the seminal Supreme Court decision in Winko and the many cases which have applied and elaborated it, that significant threat to the safety of the public cannot be speculative. It must entail a real risk of serious physical or psychological harm arising from conduct that is both serious and criminal in nature.
While the presence of significant threat was not contested by Mr. Schloss at this hearing, the Panel must nonetheless come to its own conclusion in this respect based on the evidence before it.
Ms. Ballok suffers from a psychotic disorder which is largely treated by her current medication regimen and the structure and supports of the forensic mental health system. However, as set out in the testimony of Dr. Alatishe, which was well supported by all the evidence, even in a highly structured environment, she still struggles with abstaining from cannabis and cocaine, which when consumed has caused a decompensation in her mental status and breakthrough psychotic symptoms, even when she remained medication compliant.
As per the Hospital Report, Ms. Ballok has a longstanding history of polysubstance abuse, with cocaine in particular identified as the chief culprit in several psychiatric admissions prior to the commission of the index offences.
While the index offences were not the most serious that the Panel has seen, Ms. Ballok does have a criminal record for violent offences against her mother and a prior romantic partner, as well as convictions for serious driving offences which are described in the hospital report as coinciding with some bizarre behaviour.
Ms. Ballok has a history of being noncompliant with psychiatric medications, lacking follow through with community-based mental health supports and substance abuse treatment. Cocaine use in particular was linked to psychotic symptoms in past hospital admissions.
Cocaine use remains a concern. The hospital report notes that in 2024, Ms. Ballok was involved in multiple instances of cocaine use which sometimes coincided with the expression of bizarre thinking, irritability, sleeplessness and paranoia.
In the past reporting year, Ms. Ballok has arguably made substantial progress given that there were only two incidents of substance use, but her insight into the negative consequences of substance use remains poor. Once again, when Ms. Ballok ingested cannabis and cocaine, she expressed paranoid beliefs and racing thoughts, engaged in minimal sleep, experienced disorganized behaviour and endorsed seeing “demons”.
While these symptoms did not result in any physical aggression this year, in the Hospital environment, historically, substance usage by Ms. Ballok has coincided with physical violence or other behaviour that was dangerous to the public.
The evidence of Dr. Alatishe at the hearing was that while Ms. Ballok does well in the structured environment of the Hospital, she has historically struggled in less structured environments as evidence by her history of readmissions to Hospital over the last 16 years. Part of those struggles appear to be related to the insufficient level of support provided to her by her previous housing arrangements.
The Hospital has tried to address those concerns by having Ms. Ballok placed on two waiting lists for 24/7 supervised housing, but those lists are notoriously long.
A complicating factor in this is that it appears Ms. Ballok also lacks insight into the degree of support she requires in order to thrive outside of the Hospital setting.
Ms. Ballok requires a high level of support because, as outlined at page 107 of the Hospital Report, she has limitations with her independent living skills to the degree that safety concerns have been raised. Furthermore, given her historical noncompliance with medication and her relatively recent change to oral antipsychotics, her ability to self-administer medications and adhere long-term to that treatment remains unknown at present.
The hospital report indicates that the psychological risk assessment conducted in 2021 by Dr. Heather Moulden remains valid. That assessment found Ms. Ballok to pose a low-moderate risk of reoffending with the intensive monitoring and support of the Forensic Psychiatry Program and while under the auspices of the Review Board. It stands to reason that absent those controls, her risk to the public would be higher.
It is for those reasons that the Panel concurs with the Parties that Ms. Ballok represents a significant risk to the safety of the public.
Turning now to the issue of the least onerous and least restrictive, necessary and appropriate Disposition, the Panel first considered whether a Conditional Discharge should be granted.
Mr. Schloss in submissions seemingly conceded that the main reason why Ms. Ballok wishes for a conditional discharge was her desire to reside in the community and her realization that it is unlikely that she would be offered housing in the coming year.
Mr. Schloss argued that a treatment clause and a Young clause would address the Hospital and Crown’s concerns about medication and treatment compliance, and that those clauses if breached would lead to her detention in Hospital.
He further added that Ms. Ballok would voluntarily remain in Hospital until “something suitable could be found and will be willing to listen to the Hospital’s input if she finds something before moving out”.
The Panel had difficulty with a few Mr. Schloss’ submissions made on behalf of Ms. Ballok in support of the conditional discharge.
Firstly, if Ms. Ballok recognizes that suitable housing – and by suitable the Panel means 24/7 supervised housing as recommended by the Hospital – is unlikely to be available in the coming year, and Ms. Ballok wishes to voluntarily remain in Hospital until such housing is found, then the Panel fails to see how and why a conditional discharge with the conditions articulated by Mr. Schloss would be any different than the current Detention Order Disposition.
The second issue, which is more concerning, is that the uncontested evidence of Dr. Alatishe at the hearing was that Ms. Ballok requires 24/7 supportive housing and that she fails to appreciate this need. The Hospital’s main concern seemed to be that absent a Detention Order, they would not be able to dictate where in the community Ms. Ballok would reside and that she would choose housing similar to that which she resided in previously, which did not meet her needs.
After considering that uncontested evidence and further, the fact that Ms. Ballok’s word that she would voluntarily remain in Hospital until “suitable housing” could be found is unenforceable, the Panel prefers the evidence of the Hospital on the housing issue.
To be clear, the Panel finds that absent a Detention Order, Ms. Ballok would leave the Hospital and choose housing that does not meet her needs, which based on her recent experiences would likely result in further substance abuse, leading to mental status decompensation, an erosion in her insight and likely medication noncompliance.
Ms. Ballok’s lack of appreciation for her need for highly supportive housing, coupled with her deficits in independent living skills, persuade the Panel that she would not remain in Hospital voluntarily until 24/7 supportive housing was found, but rather, that she would remain only until she found housing that she deemed suitable.
If the Panel were to grant her a Conditional Discharge, Ms. Ballok would be free to leave the Hospital and reside where she wished while simultaneously complying with the terms and conditions of the Disposition. The Hospital would then have to effectively wait until Ms. Ballok either breached a condition of the Discharge or her mental status decompensated to the point where she could be brought to the Hospital pursuant to the Mental Health Act.
In weighing the totality of the evidence, the Panel finds that granting Ms. Ballok a Conditional Discharge under the current circumstances would not accord with the factors set out in s. 672.54 of the Code:
672.54 When a court or Review Board makes a disposition under subsection 672.45(2), section 672.47, subsection 672.64(3) or section 672.83 or 672.84, it shall, taking into account the safety of the public, which is the paramount consideration, the mental condition of the accused, the reintegration of the accused into society and the other needs of the accused…
The Panel finds that ordering a Conditional Discharge without suitable 24/7 supportive housing in place would not only pose a significant threat to the safety of the public, but further, would be neither responsive to the needs of Ms. Ballok nor would it further the reintegration of the patient into society.
It is abundantly clear that Ms. Ballok requires a significant amount of support to maintain her daily needs and her psychiatric stability and does not yet appreciate those high needs. The Panel finds that granting a Conditional Discharge at this juncture would not only set Ms. Ballok up for another failed attempt at community integration but would actually impede her rehabilitation and reintegration while posing an unacceptable risk to the safety of the public.
In consideration of all the evidence, the submissions of the parties, the wishes of Ms. Ballok and the criteria set forth in s. 672.54 - the paramount consideration being the safety of the public, in addition to the mental condition of Ms. Ballock, her reintegration into society and her other needs - the Panel finds that a continuation of the existing Detention Order Disposition with no changes to its terms and conditions is the necessary and appropriate Disposition.
DATED this 14^th^ day of April 2026, at the City of Toronto, in the Toronto Region.
Mr. D. D’Intino
Legal Member
___________________________
Office of the Registrar
Ontario Review Board