Re: D. (E. A.)
ORB File No: 8169
Hearing held on: Tuesday, April 7, 2026
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Ms. C. Fromstein Members: Hon. N. Kozloff Dr. J. Kis Dr. A. Kerry Mr. S. Doherty
Parties Appearing: Accused: D. (E. A.) Amicus Curiae: Mr. A. Pollard The person in charge of hospital: Counsel: Mr. J. McIntyre Attorney General of Ontario: Counsel: Mr. D. Brandes
*Pursuant to s. 672.501(1) of the Criminal Code, the Ontario Review Board prohibits the publication, broadcasting, or other transmission of any information that could identify a victim in this matter or a witness who is under 18 years of age.
REASONS FOR DISPOSITION
(Dated May 21, 2026)
Introduction
On October 7, 2022, D. (E. A.) was found not criminally responsible (“NCR”) on account of mental disorder on charges of fail to comply with probation (February 11, 2020, to March 5, 2020); indecent act, indecent exposure to a person under sixteen years, and fail to comply with probation (August 20, 2020); assault with a weapon (x2), and possession of a weapon for a dangerous purpose (March 12, 2021); and, obstruct police, all contrary to the Criminal Code.
D. (E. A.) is currently subject to a Disposition of the Ontario Review Board (“ORB” and “the Board”) dated March 26, 2025, ordering that she be detained at the General Forensic Unit at the Centre for Addiction and Mental Health, Toronto (“CAMH”) with conditions up to and including living in the community in accommodation approved by the person in charge.
On Tuesday, April 7, 2026, the Board convened a hearing to review D. (E. A.)’s Disposition pursuant to section 672.81(1) of the Criminal Code. As no counsel had been retained to represent D. (E. A.), arrangements were made for Mr. A. Pollard to appear as amicus curiae counsel by order of the Board.
The issues to be determined at the hearing were whether D. (E. A.) 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 the necessary and appropriate Disposition (which is also the least onerous and least restrictive in the circumstances) is, taking into account the factors set out in section 672.54 of the Criminal Code.
For the reasons that follow, the Board finds that D. (E. A.) continues to represent a significant threat to the safety of the public, and that the necessary and appropriate Disposition which is also the least onerous and least restrictive in the circumstances is a Detention Order with the same terms and conditions as contained in the previous Disposition.
Positions of the Parties
At the commencement of the hearing the parties were requested to provide their initial without prejudice positions with respect to the issues before the Board.
Counsel on behalf of the Hospital advanced the position that D. (E. A.) continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition is a Detention Order on the same terms and conditions as last year’s Disposition dated March 26, 2025.
Counsel for the Attorney General supported the Hospital position.
Mr. Pollard on behalf of D. (E. A.) advanced the position that the necessary and appropriate disposition is a Conditional Discharge that would permit D. (E. A.) to reside with her mother or her grandmother.
The Evidence
- The evidence at the hearing consisted of the Hospital Report dated March 3, 2026 (Exhibit 3) and the viva voce testimony of Dr. K. Valoo, who is D. (E. A.)’s most responsible physician and one of the authors of the Hospital Report.
Background
D. (E. A.)’s personal and background history - including Childhood and Family History, Education History, Employment History, Relationship History, Psychiatric History, Medical History, Substance Use History, and Legal History - is set out in detail in the Hospital Report. As the Hospital Report is an exhibit in this hearing it is only necessary to set out in these reasons a brief summary of the salient information therein.
D. (E. A.) is a 35-year-old transgender woman whose preferred name is A. She is single with no children and supported by the Ontario Disability Support Program (“ODSP”). Her parents (with each of whom she maintains contact) separated when she was approximately nine months old. She has two siblings and four half siblings.
D. (E. A.) has a Grade 9 education. She left home at the age of 17. She lived in shelters and worked in the sex industry. She has a diagnosis of HIV and has been prescribed various antiretrovirals but was historically non-compliant with treatment. She was restarted on HIV treatment in 2022 and has also received treatment for Hepatitis C during her current admission at CAMH. In addition, she receives treatment for metabolic conditions including weight gain, diabetes, and high cholesterol.
According to her criminal record, between 2014 and 2020 D. (E. A.) incurred numerous convictions for offences included utter threats, assault with a weapon, weapon dangerous, obstruct police, mischief, indecent act, and fail to comply.
D. (E. A.) has a significant history of substance use. She has been diagnosed in the past with amphetamine use disorder, and reported using cannabis, crack cocaine, and crystal methamphetamine daily prior to her detention.
Her psychiatric history is extensive. The following summary is reproduced from last year’s Reasons for Disposition dated April 30, 2025:
"The Hospital Report outlines D. (E. A.)’s extensive history of receiving mental health services for Schizoaffective Disorder, Bipolar Type which was complicated by polysubstance abuse and an underlying personality disorder. The Hospital Report included summaries of at least 18 psychiatric admissions between 2012 and 2021. D. (E. A.) frequently presented with aggression, auditory hallucinations, delusions, religious preoccupation, sexually inappropriate behaviours, substance use, and noncompliance with psychiatric medications. Locked seclusion was often required in order to manage her behaviours. D. (E. A.) lived a transient lifestyle and often left hospital against medical advice. There was also reference in the Hospital Report to failed community treatment orders and attempts to follow D. (E. A.) in the community with little success."
Index Offences
- The following is reproduced from the Hospital Report at pp. 10-11:
"Failure to Comply Probation (February 11, 2020, to March 5, 2020)
On January 23, 2020, D. (E. A.) appeared in Court where she was convicted of Indecent Public Act (sic), Fail to Comply Probation, Obstruct Peace Officer and Mischief under $5,000. She was adjudged a suspended sentence and placed on probation for 12 months. On February 11, 2020, D. (E. A.) failed to abide by “condition #4” and failed to report to her probation officer as directed. A warrant was subsequently issued for her arrest.
Indecent Act, Indecent Exposure to Person under 16 years and Fail to Comply
with Probation (August 20, 2020)
On August 20, 2020, officers were flagged down regarding an exposure that had just occurred. The complainant and her 2-year-old daughter were walking when the accused passed by and had his penis out of his pants. He turned and began to “twerk” his body up and down towards the complainants. Officers were able to locate the male a short distance away and placed him under arrest. They learned that he was on probation for a similar type of act.
Assault with a Weapon x2, Possession of a Weapon for a Dangerous Purpose (March 12, 2021)
On March 12, 2021, the victims were completing their night patrol at 55 Bloor Street West when they observed the accused loitering inside the premise. At approximately 1910h, the victims approached the accused, at which point they observed the male holding an Exacto knife. At approximately 1910hs, the accused presented the knife at the victims and began to charge at them. The victims managed to escape without injury and called police. Officers attended the area and the accused was placed under arrest."
Note: There is nothing in the materials regarding the date of and facts underlying the offence of Obstruct Police.
Course from the Index Offences to the NCR Finding
In the Fitness Assessment conducted by Dr. M. Patel dated October 7, 2021, he opined that D. (E. A.) was unfit to stand trial. He observed that she had not been compliant with prescribed psychotropic medications and had refused to engage in the assessment. She was subsequently admitted to CAMH and placed on a 60-day Treatment Order, following which she remained unfit, following which she was referred to the jurisdiction of the Board. With treatment there was gradual improvement in her mental state and ability to engage in fitness assessment.
Following her initial hearing before the ORB, D. (E. A.) was found fit to stand trial and placed on a Detention Order while waiting for her matter to return to Court. On June 1. 2022 she appeared in Court and was subsequently released on bail to her father’s care as surety and discharged from CAMH. Outpatient services were arranged with CAMH on an Out of Custody Treatment Order (“OCTO”) under the care of Dr. I. Swayze.
Course Since NCR Finding
The Hospital Report details D. (E. A.)’s course since the NCR finding and only a brief summary is necessary for the purposes of these reasons.
She was readmitted to CAMH on October 13, 2022, pending her initial ORB Hearing and has been an inpatient at CAMH since that time. Her mental status remained unchanged following readmission. At baseline she presented as cognitively disorganized (though pleasant and cooperative with the clinical team) and medication compliant. She had limited insight into her diagnosis of schizoaffective disorder and poor insight into her substance use issues.
There have been numerous incidents of concern during her time at CAMH including multiple incidents of cigarette smoking on hospital grounds, verbal abuse (including racist comments) and threats to staff and fellow patients, drug use including cannabis and methamphetamine, and inappropriate sexual comments to and behaviour towards both staff and fellow patients.
At the beginning of the most recent reporting period (March 2025 to February 2026) D. (E. A.) continued to exhibit prominent symptoms of her schizoaffective disorder, most notably labile mood, impulsivity, risk-taking behaviours, and disorganization of thinking and speech. Her symptoms were exacerbated by features of her borderline personality disorder including emotional instability quick temper, and recurrent interpersonal conflicts.
After she was found incapable of consenting to treatment in June of 2025 her parents agreed to act as co-substitute decision makers, and her medication regime was altered with the result that her mental status and behavioural stability gradually improved.
A psychological assessment in October 2025 confirmed her below-average cognitive and adaptive abilities.
Risk Formulation
- The Hospital Report contains the details of D. (E. A.)’s risk formulation at pp. 31-33. For the purpose of these reasons, it suffices to reproduce the “final risk judgment” and the “clinical risk factors/re-offence scenario”:
"Final Risk Judgment
Taken together, when weighing D. (E. A.)’s pertinent risk and protective factors, her risk of any future violence would be high in the context of a Conditional Discharge. A continuation of her current Detention Order would mitigate this risk to moderate by ensuring that she remained connected with an appropriate level of professional care and psychiatric treatment commensurate to her present needs.
Clinical Risk Factors/Re-offence Scenario
Criminogenic risk factors include active symptoms of a treatment-resistant major mental illness, a history of non-compliance with medications, recreational substance use (both historically and in the recent past), a lack of an adequate pro-social support network, and difficulties with stress and coping.
In risk assessments, one of the best predictors is a patient’s history of violence. D. (E. A.)’s offence appears to have occurred when she was in a floridly psychotic state. She has a history of poorly controlled schizoaffective disorder, in the context of medication non-compliance and recreational substance use.
If D. (E. A.) were to re-offend, this would likely transpire in the following way. In the absence of adequate professional oversight and a stable living environment, psychosocial destabilizers would likely lead to non-compliance with medication, failure to cope with stressors, and increased substance use. This would result in worsening of her mental state, including an exacerbation of manic and psychotic symptoms, which would then increase her risk of violence towards others. Potential victims of violence could include any individual within her proximity, including professional contacts, social contacts, or strangers."
Diagnosis, Composite Assessment of Risk
- The Hospital Report sets out D. (E. A.)’s diagnoses and the team’s composite assessment of risk, as follows:
"Diagnosis
Schizoaffective Disorder, Bipolar Type
Substance Use Disorders (cannabis, stimulants) in early remission in a controlled environment
Borderline Personality Disorder"
"Composite Assessment of Risk
Given D. (E. A.)’s history of mental illness, substance use, previous violence while unwell, clinical course over the past reporting period, and risk assessment scores, it is the clinical team’s opinion that she continues to meet the threshold for significant threat as defined in Section 672.5401 of the Criminal Code."
Risk Management
- The following is extracted from the Hospital Report:
"Medication
D. (E. A.) suffers from treatment-resistant schizoaffective disorder, with ongoing residual symptoms in spite of treatment with adequate doses of antipsychotic and mood stabilizing medications. She has a history of medication non-compliance while in the community. Though she has remained overall compliant with medication while in the supportive and structured environment of the hospital setting, she has made frequent requests to discontinue her mood stabilizer and has intermittently exhibited noncompliance with medications (or threatened to do so) when her requests have not been met. Our principal risk management intervention continues to be pharmacological treatment. Continuation of long-acting injectable antipsychotic medication (in combination with oral mood stabilizing medication) is critical to ensuring continued medication compliance.
Lack of Insight
D. (E. A.) shows limited insight into the symptoms of her major mental illness and the role of ongoing medication adherence in maintaining psychiatric stability, the consequences of recreational substance use on her mental health, as well as her status under the Ontario Review Board.
D. (E. A.) will benefit from ongoing programming and therapeutic interventions to improve her insight and maximize her functioning. Continuing psychoeducation about the course of her major mental illness, and discussions about factors which increase and mitigate the risks of a relapse, will also be helpful. Due to her fluctuating and overall poor engagement in psychotherapeutic services, the use of interventions such as a behavioural plan which incentivizes engagement is required to facilitate this.
Substance Use
D. (E. A.) has a significant history of recreational substance use, which has exacerbated her psychotic and mood symptoms. Prior to her current hospitalization, she experienced longstanding regular use of cannabis, crack cocaine, and crystal methamphetamines, and this, in combination with medication non-compliance, precipitated various psychotic decompensations and hospitalizations. During the current admission, D. (E. A.) has re-engaged in recreational substance use on multiple occasions, resulting in a lack of progress with regards to off-unit privileges and discharge planning. Despite ongoing psychoeducation, D. (E. A.)’s insight into the deleterious effects of substance use on her mental remains limited at present. She will benefit from continuation of therapeutic interventions to improve her insight into the adverse effects of substance use and to strengthen her relapse prevention plan. The continuation of an enforceable substance prohibition clause in her ORB disposition remains integral to her risk management plan, particularly in consideration of ongoing progression of off-unit privileges."
- The recommendation of the clinical team as set out in the Hospital Report is reproduced below:
"Team Review of Recommendation
The team is of the unanimous opinion that a continuation of the current disposition, that being a detention order at the Forensic Service of CAMH with the provision for community living, is necessary and appropriate to manage D. (E. A.)’s risk to the public. She experiences ongoing symptoms of her mental illness such as emotional lability and disorganized thinking, and has limited insight into her mental illness, the consequences of substance use, and her status within the forensic system. Her limited insight has contributed to instances of recreational substance use and slower progression within the pass ladder system. Under the current disposition, ongoing admission to the forensic psychiatric inpatient environment has allowed D. (E. A.) to received intensive support and oversight to ensure that her mental status has not deteriorated further. With comprehensive behavioural plans and close monitoring, she has made meaningful clinical gains by the end of the reporting period, including improved medication adherence, greater compliance with institutional and unit rules, progression in off-unit privileges, and more consistent engagement with structured programming. The team is optimistic that a continuation of this disposition will facilitate ongoing intervention to further optimize her treatment regime, stability, and independence. Should she manage indirectly supervised passes more successfully over the upcoming year and show improved engagement in therapeutic programing, she may be suitable for commencement of discharge planning to supervised community housing. By contrast, under a Conditional Discharge, D. (E. A.)’s risk to the safety of the public would not be manageable. She has clearly stated a desire to leave the inpatient unit as soon as possible, has expressed a goal to resume recreational substance use, and likely would not meet criteria for involuntary admission under the Mental Health Act at this time. She has no available community living at present, and therefore under a Conditional Discharge she would like leave the hospital and become precariously housed, leading to further elevations of her risk of violence. As has been the case in the past, in this scenario the Mental Health Act may be sufficient to initiate a psychiatric assessment but may not be sufficient to facilitate ongoing admission to adequately address violence risk factors."
Evidence at the Hearing
Dr. K. Valoo testified: she is one of the authors of the Hospital Report and has been D. (E. A.)’s most responsible physician since July 2024.
Regarding updates to the Hospital Report, the doctor advised that on March 5, 2026, D. (E. A.) progressed up the pass ladder to independent passes off the unit (10 minutes per day). On March 10, 2026, and again on March 12, 2026, D. (E. A.) returned late from her passes, coincident with the observations by the clinical team regarding a deterioration in D. (E. A.)’s mental stability and her increasing nausea and vomiting, the cause(s) of which the team was at that point unable to determine. Her passes were suspended for a few days.
On March 19, 2026, D. (E. A.)’s UDS results for March 13, 15, and 16 came back positive for methamphetamines. The clinical team was now concerned about her recreational substance use as well as her mental instability and agitated behaviour on the unit, and D. (E. A.) was scaled back to level 3 passes (accompanied on hospital grounds and escorted (1 to 1) off hospital grounds into the community.
D. (E. A.)’s blood work showed that the level of lithium (mood stabilizer) was sub-therapeutic and significantly lower than the results from only a few weeks earlier. The team commenced enhanced monitoring of the administration of her medication and her lithium levels stabilized, all of which suggested the strong possibility of D. (E. A.)’s covert non-compliance with medication and/or self-induced vomiting possibly in combination with drug use.
Concerned that D. (E. A.) was using substances during her independent passes and that she had been non-compliant with her medication, and having ruled out other possible causes of her nausea and vomiting, the team reduced her pass privileges. The various explanations provided by D. (E. A.) for her positive urine drug screen (“UDS”) results were described as “highly unlikely” and included not knowingly consuming drugs and being in close proximity to others who consumed drugs. Notably, when staff had searched for D. (E. A.) at the time of one her late returns from an independent pass off the unit, she was seen in the company of a friend of hers who had previously provided her with recreational drugs.
During the past year D. (E. A.) intermittently declined oral medication despite staff attempts to explain to her that her needs were not otherwise being fully met. Dr. Valoo noted that before her positive USDs the team had seen an overall improvement in D. (E. A.)’s mental state which seemed to be related to the optimization of her medication as a result of a switch to Lithium, and which supported the inference that her deterioration likely arose due to medication non-compliance.
Dr. Valoo opined that a psychological assessment would likely be helpful to the team in understanding D. (E. A.)’s thought process, in more effectively communicating with her, and in developing plans to support her.
It was noted that for undisclosed reasons her father had recently declined to be an “approved person.” The doctor noted that D. (E. A.)’s mother was seeking to be and approved person, that the application process was underway, but that there had been delays in her providing needed documents.
Regarding “significant threat”, Dr. Valoo cited D. (E. A.)’s history of and present risk factors for violence and her ongoing symptoms of schizoaffective disorder, her borderline personality disorder and intellectual impairment, her history of recreation drug use (which has in the past exacerbated her psychosis and her risk of violent behaviour), and her low levels of insight and motivation.
Dr. Valoo reiterated that if granted an Absolute Discharge and upon leaving hospital D. (E. A.) would resume recreational drug use and discontinue her medication. She has been clear with the clinical team that she does not believe she needs medication, nor would she take it. Lacking the support of her clinical team, the combination of substance use, and medication non-compliance would likely result in a reemergence of florid psychotic and mood symptoms which could culminate in violence as in the past.
Dr. Valoo opined that D. (E. A.) would not meet the Mental Health Act (“MHA”) standard for involuntary admission to CAMH. As for accommodation in the community, she noted that while D. (E. A.)’s family remains involved “to some degree” they have been clear that they believe D. (E. A.) requires inpatient care and would not offer her housing.
Regarding D. (E. A.)’s alternative level of care (“ALC”) designation, the doctor explained that this was done after her medication had been adjusted to connect her with potential housing vacancies for which she would be otherwise ineligible. An ALC designation usually indicates that no revision in medication is required even if the patient still requires behavioural and therapeutic supports. The clinical team remains hopeful the designation will eventually allow her to be connected to community housing with a high level of support.
Dr. Valoo stated that D. (E. A.) could not be managed under a Conditional Discharge, and that a Detention Order with conditions up to and including living in the community would require accommodation with a very high levels of support comparable to the support she receives in hospital. This accommodation exists but there are numerous applicants competing for spots which rarely become available.
Dr. Valoo repeated that if D. (E. A.) were to leave hospital her psychotic symptoms would likely reoccur as a consequence of medication non-compliance and recreational substance use. The doctor explained that she presents with observable mood symptoms even when she is medication compliant. Historically she has been violent and/or threatened both physical and sexual violence which the doctor opined was likely to recur absent a sufficient level of supervision.
The doctor stated that D. (E. A.) would not be suitable for outpatient care absent a very high level of support in place. She has expressed a clear desire to resume recreational drug use and discontinue medication, either of which would very likely result in a deterioration of her mental state. The doctor opined that D. (E. A.) would be “unmanageable” as an outpatient.
Regarding the possibilities of accommodation with her mother, grandmother, or on her own, Dr. Valoo stated that her parents are the only family members who are actively involved and that they would not allow D. (E. A.) to live with them. She posited that if her family felt able to support her in that way it was something the team would have to explore and emphasized that it would require “very careful consideration” given her active risk factors.
Asked if the hospital would support a term allowing D. (E. A.) to spend up to 72 hours at the residence of an approved person, she responded “potentially yes but that would require an evaluation by the clinical team of the ability of the approved person to manage her risk factors for violence. She noted that the current Disposition would already permit that.
Dr. Valoo observed that accommodation in the community is not on the immediate horizon given the scarcity of intensive, highly supportive, community-based housing that could manage her.
Dr. Valoo reported that after a period of very minimal use following the reduction in pass levels D. (E. A.) is back to regular use of her Level 3 passes.
In response to questions from the panel regarding her intellectual disability, the doctor acknowledged that there is no such diagnosis in the Hospital Report that is confirmed by a psychologist. She agreed that Ms. Defloriminte’s assessed cognitive impairments would make her eligible for passport funding.
She said that D. (E. A.) has been compliant with her lithium medication.
Regarding housing, the doctor reiterated that D. (E. A.) currently requires 24/7 supervised, possibly locked housing with supported administration of medication.
Given D. (E. A.)’s clinical course and her mental status, Dr. Valoo was asked whether her eligibility for certain high intensity housing was static or whether rehabilitative steps could be pursued to expand the housing possibilities. The doctor indicated that her situation was not seen to be static and that efforts to expand her options would resume. She added that even though there have been fluctuations in her privileges, over recent weeks D. (E. A.) had made more progress than she did during the summer of 2025 which gives the team reason to be optimistic.
Asked to what she attributed this improvement, the doctor replied that it was the adjustment to her medication, in particular the fact that the change to lithium resulted in an overall improvement in her mood stabilization. D. (E. A.) was now able to retain and understood information regarding the outcome of substance use and this had prolonged her motivation not to use before it waned, and relapse occurred. The hope is that she will learn from this, and the team will try to bolster her efforts through treatment and counselling.
Asked whether D. (E. A.) has ever been referred for Dialectical Behavioral Therapy (“DBT”), she replied that the current interdisciplinary clinical team and the individual support it provides is considered sufficient, but that DBT might be an option for future consideration.
Asked about D. (E. A.)’s sexual comments and behaviours during the past year and what level of insight she has shown following these incidents, Dr. Valoo replied that her insight is partial regarding sexual behaviours. There has been some reduction in those incidents during recent months as a result of the behavioral plan implemented to discourage those behaviours which is attributed to her understanding of the adverse consequences of such behaviour to herself (external motivation) rather than her understanding of the wrongfulness or hurtfulness of her behaviour to others (internal motivation).
Regarding the index offences, D. (E. A.) will often say that she does not remember them or that they did not happen.
She has attended various programs with encouragement from the team. She is now making use of off unit passes (both accompanied and escorted). Last week she had one escorted pass to go on a recreational outing with a group. These recreational outings include such activities as attending the mall and local farm visits. Her next step up the pass ladder will be accompanied passes into the community. The team will need to evaluate her readiness after a number of escorted passes. The team reviews and considers increases in pass level at least weekly.
Regarding housing, the clinical team will have to very carefully consider what accommodation is available and appropriate to provide D. (E. A.) with the best option especially given her intellectual deficits. The clinical team and housing providers would work together to provide her with the necessary supports. Supervised accommodation is necessary and the least onerous and least restrictive disposition. The wording in the current Disposition gives the team the ability to consider all kinds of housing and to connect her with the best option.
Regarding her sporadic engagement with passes, it is apparent that her motivation in the past several months was driven by her desire to smoke cigarettes which is not permitted at her current pass level.
Final Submissions
Counsel on behalf of the hospital submitted that the necessary and appropriate Disposition is a Detention Order with the same terms and conditions as last year’s. Counsel cited D. (E. A.)’s history of and present risk for violence, her drug use, her history of medication noncompliance, her limited insight, and her low level of motivation. Lacking adequate psychiatric care and living in unstable accommodation, she would likely stop taking her medication and relapse into substance use, all of which would lead to a worsening of her psychotic mood symptoms and result in a scenario similar to the index offences.
Counsel argued that under a Conditional Discharge her risk would not be manageable as she requires close 24/7 monitoring and high support accommodation.
Counsel added that D. (E. A.) is not ready to be discharged to the community at this time nor does her ALC designation suggest that she is. The hospital must be able to approve accommodation. The Mental Health Act is not sufficient to manage her risk.
D. (E. A.)’s wish to reside with her mother, or grandmother, is not realistic because her family supports in-patient accommodation.
Regarding her substance use issues, the relevant conditions in the current Disposition must remain in place as D. (E. A.) lacks insight, her stated goal is to use, and substance use has clearly exacerbated her mental health issues in the past. Counsel also pointed to her apparent recent use of methamphetamines.
Counsel adopted what Dr. Valoo said about “supervised” accommodation namely that the Board does not need to stipulate “supervised” in the Disposition as the hospital will only approve the level of housing that is appropriate to D. (E. A.)’s current circumstances and adding that she might not need “supervised” at a future time.
Counsel on behalf of the Attorney General adopted the hospital position (a Detention Order with no changes) arguing that the evidence firmly establishes that D. (E. A.) remains a significant threat and that the only way to mange her risk is under a Detention Order. Counsel acknowledged the progress she has made while arguing that the proposed Disposition will allow for the possibility of community living in approved accommodation, adding that hospital approval is absolutely necessary.
On behalf of D. (E. A.), Mr. Pollard reiterated her hope that the Board would consider an Absolute Discharge, asserting that she has supports in the community.
Analysis and Conclusion
Having carefully considered the Hospital Report and the testimony of Dr. Valoo, the panel is unanimous in finding that D. (E. A.) continues to represent a significant threat to the safety of the public.
It is apparent to us that despite adequate medication psychotherapeutic treatment she continues to exhibit active symptoms of her major mental illness which are complicated by her borderline personality disorder and exacerbated by even occasional substance use.
Given her history of criminal behaviour, non-compliance with medication, and pattern of substance use over many years, and given her limited insight into her mental illness and her need for therapeutic medication to address it as well as her poor insight into the adverse effects of substances on her mental state, the panel is satisfied that were she not subject to the jurisdiction of the Board, D. (E. A.)’s mental status would become destabilized through a combination of unstable housing, psychosocial stressors, medication non-adherence, and substance use. This decompensation would inevitably increase her risk of violence towards others just as it did at the time of the index offences.
Moreover, the panel is unanimous in holding that a continuation of the Detention Order with the same terms and conditions as the previous Disposition is the necessary and appropriate, least restrictive and least onerous Disposition in these circumstances. D. (E. A.) continues to require the intensive observation, support and oversight which can only provided in an inpatient setting in order to progress in her rehabilitation.
The panel is also unanimous in holding that a Detention Order is required for the protection of the public. As the Disposition will allow D. (E. A.) to advance up the pass ladder to living in the community, the hospital requires the ability to approve housing that will provide the level of support she requires, and which meets her needs and to rapidly bring her back to and keep her in hospital in the event of decompensation.
The panel observes that DBT is reputedly the “gold standard” for the psychotherapeutic treatment of borderline personality disorder and encourages its consideration as a viable option for D. (E. A.) by the clinical team.
In closing, we adopt the final words of last year’s Reasons for Disposition:
"D. (E. A.) is encouraged to make efforts to work with the treatment team, follow the rules, abstain from substance use, and engage in her recovery so that she can progress towards discharge to the community and pursuing her life goals."
DATED this 21^st^ day of May, 2026, at the City of Toronto, in the Toronto Region.
Hon. N. Kozloff Legal Member
__________________ Office of the Registrar Ontario Review Board