Re Kelly R. Elijah, 2026 CanLII 51051

Ontario Review Board

Re: Kelly R. Elijah (a.k.a. Kelly R. McLean)

ORB File No: 7849

Hearing held on: Wednesday, April 15, 2026

Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas

Pursuant to: Sections 672.81(1) and 672.81(2.1) of the Criminal Code

Before: Alternate Chairperson: Mr. G. Beasley Members: Dr. S. Simpson Dr. S. Wiseman Ms. K. Tomaszewski Ms. C. Plyley

Parties Appearing: Accused: Kelly R. Elijah Counsel: Mr. C.P. Dobson The person in charge of hospital: Counsel: Ms. J. Zamprogna Attorney General of Ontario: Counsel: Mr. J. Huber

REASONS FOR DECISION AND DISPOSITION

(Dated May 25, 2026)

Introduction

1. On February 19, 2021, the accused Kelly Elijah was found not criminally responsible on account of mental disorder on charges of assault with a weapon (x2), failure to appear or to comply with an appearance notice, robbery with a weapon, being unlawfully in a dwelling house, and assault, all contrary to the Criminal Code of Canada. By reason of a Disposition of the Ontario Review Board (“ORB”) dated April 11, 2025, Ms. Elijah was ordered to be detained at the Southwest Centre for Forensic Mental Health Care – St. Joseph's Health Care London (the “hospital”) with privileges up to and including residing in the community of Southwestern Ontario in accommodation approved by the person in charge.

2. On January 13, 2026, Dr. Ajay Prakash, the Interim Medical Director of the hospital advised the ORB that Ms. Elijah had been readmitted to the hospital on January 2, 2026, and remained in the hospital as of the date of the letter. Dr. Prakash advised that the readmission constituted a Restriction of Liberty (ROL), pursuant to s. 672.56(2)(b) of the Criminal Code. On April 15, 2026, the ORB convened a hearing at the hospital for the purpose of both an ROL hearing and the annual hearing for Ms. Elijah pursuant to ss. 672.81(2.1) and 672.81(1) of the Criminal Code. Ms. Elijah was in attendance at the hearing and represented by counsel, Mr. Dobson. Ms. Zamprogna appeared as counsel for the hospital and Mr. Huber as counsel for the Attorney General of Ontario.

Index Offence

3. The circumstances of the index offences are stated in the Hospital Report, but are summarized well in last year’s Reasons for Disposition, as follows:

“On June 25, 2019, Ms. Elijah attended a pharmacy in Watford, Ontario. She asked the pharmacist for Oxycontin patches and, when told she did not have a prescription, the pharmacist asked her to leave the pharmacy. She produced a pair of scissors and a knife and stated she would use them if not given the “oxys and patches.” She then physically forced her way past the pharmacist and started grabbing at bottles of pills on the shelves.

She started scratching and biting the pharmacist and the two fell to the floor. While on the floor she bit at boxes of medication and birth control pills, trying to ingest them. Another employee tried to pull her off the pharmacist and was kicked in the stomach as a result. She tried to cut the pharmacist’s foot or shoe with the knife in her possession. Pharmacy employees ceased their efforts to stop the accused, who then began going through the dispensary and the refrigerator, grabbing items and boxes. She drank from a bottle of orange juice used to mix with methadone prescriptions, although it contained no methadone. She fled from the pharmacy, and an employee followed her into a shed, where another confrontation occurred. Ms. Elijah ran back to the pharmacy while holding the knife, stating to the pharmacist, “I’ll do it, don’t make me do it.” She then again ran out of the pharmacy, carrying various medications she had taken. No injuries were reported by anyone in the pharmacy.

In the course of her flight away from the pharmacy she entered the back patio door of an apartment and continued inside, running through the apartment and exiting through the front door. She then went into another apartment, pushed her way past the occupant, said she needed to use the bathroom, and entered the bathroom. The occupant called police and the accused left. The occupant found a knife and some drugs in the bathroom. Ms. Elijah was subsequently arrested by police and placed in custody. She had ingested unknown amounts and types of medications.

Ms. Elijah was on bail at the time of the offences, having been placed on bail on November 8, 2019, one condition of which prohibited her from the possession of weapons.

On November 8, 2020, Ms. Elijah approached a donut shop and began to actively swing an object at two males nearby. One of the males sustained a minor scratch on his left ear, the bridge of his nose, and a knuckle. When police approached her, she was observed to have a knife in her hand, and she began to stab the tires of vehicles in the parking lot in which she was located. A gunpoint arrest was conducted due to her possession of a knife. During the gunpoint arrest she was observed to walk toward one of the police officers with a knife in her hand, causing the police to deploy a taser, which caused Ms. Elijah to fall to the ground. Following her arrest, she was found to be in possession of a spring-assisted knife, which is a prohibited weapon.”

Current Diagnoses

4. The current diagnoses taken from the Hospital Report, are as follows:

Schizoaffective Disorder

Substance Use Disorder

Criminal Record

5. Ms. Elijah's only criminal history prior to the index offence was a conviction for assaulting a police officer in February 2010.

Background and Personal History

6. Ms. Elijah’s personal history is outlined in the Hospital Report in detail and will not be repeated in these Reasons. By way of summary, Ms. Elijah is a 40-year-old Indigenous woman. She is the youngest of five children with three half siblings and one full sibling. Her father passed away in 2021. Ms. Elijah had no difficulties with school until she reached grade 10. After beginning an association with a different peer group, Ms. Elijah dropped out of school but completed her high school education as an adult. She has worked in the past as a waitress and a house painter. Ms. Elijah was married but her husband died of cancer at the age of 25 in 2009. She has one child, a daughter, who was raised by Ms. Elijah’s family until she was a teenager.

7. Following her husband's death, Ms. Elijah began to abuse substances. She had a significant history of substance use from the age of 14. It is reported that she had used oxycodone, psilocybin, cocaine, ecstasy, and LSD, with her drug of choice being fentanyl and crystal methamphetamine.

Psychiatric History

8. As set out in the Hospital Report, Ms. Elijah had a number of attendances at hospital as a result of drug use and suicidal ideation prior to the index offences. In January 2018, she slashed herself with a knife and jumped off an overpass on Hwy. 402 while under the influence of crystal methamphetamine. Ms. Elijah was hospitalized under the Mental Health Act and had a number of serious injuries to her pelvis, broke an ankle, broke an elbow and a closed head injury.

Position of the Parties

9. At the outset of the hearing, Ms. Zamprogna stated that in the opinion of the hospital the decision to readmit Ms. Elijah to the hospital was necessary and appropriate and the least onerous option available to the hospital at the time that it was made. Ms. Zamprogna stated the recommendation of the hospital was that Ms. Elijah continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition was a continuation of the current Detention Order but with the addition of a clause requiring her to abstain from the consumption of alcohol and other substances. Mr. Huber supported both the opinion of the hospital with respect to the ROL and the continuation of the Detention Order as requested. Mr. Dobson also agreed with the submission of the hospital with respect to both the ROL and the necessary and appropriate disposition.

Gladue Report

10. In the Reasons for Decision dated May 8, 2025, the Alternate Chairperson of the ORB stated that in light of Ms. Elijah’s Indigenous heritage, a Gladue Report should be prepared in advance of the next year. As set out in correspondence dated March 16, 2026, from Aboriginal Legal Services to the ORB, Ms. Elijah did not wish to participate in any interviews for the purpose of the preparation of a report and did not want a Gladue Report. As a result, Aboriginal Legal Services closed their file.

Evidence

11. The evidence on behalf of the hospital was presented by Dr. Ajay Prakash. Dr. Prakash stated that he had been Ms. Elijah’s attending psychiatrist for the previous two years while she was residing in the community and at the time of the ROL. He was no longer her attending psychiatrist following her transfer from the FRU to the FTU. He was the co-author of the Hospital Report which was filed as an exhibit. Dr. Prakash stated that prior to her readmission to hospital, Ms. Elijah had been doing relatively well in the community residing at Clarke Centre Transitional Rehabilitation Home in London. However, Dr. Prakash stated that changes in Ms. Elijah’s medication in September 2025 led to a decompensation in her mental status ultimately resulting in her readmission. Following the removal of the abstain clause at her last ORB hearing, Ms. Elijah began to use alcohol in the community in May 2025. She also began more significant drug use of both methamphetamine and cocaine. This resulted in observable changes in her mental status. Her negative symptoms increased and she demonstrated failure to adhere to the Clarke Centre’s rules and routines. Her involvement in structured programming declined significantly. Dr. Prakash stated that the Clarke Centre is meant to be a transitional residence with a soft two-year time limit. As Ms. Elijah was approaching the end of her two years of residence, and in the absence of any transition plan to another residence, the decision was made to readmit. Ms. Elijah to the hospital.

12. Dr. Prakash testified that Ms. Elijah was originally admitted to the Forensic Rehab Unit (FRU) on January 5, 2026. In February she was transferred to the Forensic Treatment Unit (FTU) because of demonstrated instability and a lack of cooperation with the Rehab Unit programming and staff. Ms. Elijah’s MRP is now Dr. Malka. At the present time, Ms. Elijah has level 1 privileges which allow her 30 minutes, three times a day, in hospital indirectly supervised. Dr. Prakash stated that Ms. Elijah had done well in March but towards the end of the month and into April there were multiple issues because of her ongoing instability. As a result, she lost all privileges on the Forensic Treatment Unit.

13. Dr. Prakash stated that the plan is to optimize Ms. Elijah’s medications once again. Ms. Elijah does not believe that the adjustment to her medications was the cause of her decompensation in mental status. The treatment team hopes that the structure of the hospital will help improve Ms. Elijah’s insight into her major mental illness and her need for treatment. Dr. Prakash stated that the changes in the medication took place at Ms. Elijah’s request. At the time that they were made they were reasonable and the treatment team was looking for the lowest effective dose of medication. Dr. Prakash stated that Ms. Elijah had been abstinent from substance use for multiple years before the most recent relapse. He stated that in his opinion the trigger was the lowering of her antipsychotic medication dosage. Ms. Elijah has no insight into the relationship between the reduction in her medication and her return to substance use.

14. Dr. Prakash stated that Ms. Elijah has indicated she is not interested in pursuing any Indigenous programming. She did not believe that the preparation of a Gladue Report would help her. He stated that it is possible that Ms. Elijah would be able to return to the Clarke Centre when she is ready for discharge back to the community. There may be some financial barriers to that as she owes the Clarke Centre money. Finally, Dr. Prakash stated that in his opinion, Ms. Elijah continues to represent a significant threat to the safety of the public for the reasons set out in the Hospital Report. He stated that the treatment team needs to have the ability to approve Ms. Elijah’s accommodation in the community.

15. Mr. Huber did not have any questions for Dr. Prakash.

16. In response to questions from Mr. Dobson, Dr. Prakash agreed that Ms. Elijah had not demonstrated any violence while residing in the community. Dr. Prakash said that Ms. Elijah’s instability is a result of the bipolar component of her illness. A reduction in her antipsychotic medication resulted in a significant change in her mood. Ms. Elijah is considered to be capable of consenting to treatment, and she will not agree to an increase in her medication. She does not believe that she is having any symptoms of her illness but believes that the changes are due to the environment. Dr. Prakash stated that there were difficulties with Ms. Elijah’s presentation at the Clarke residence at the end of her stay. She demonstrated a withdrawal from engagement with the Outpatient Team and was more defiant.

17. Ms. Elijah has not been able to engage with Dr. Malka and has indicated that she wishes to have a new MRP. Dr. Prakash stated that there will be a meeting with Ms. Elijah on May 5, 2026, for the purpose of discussing changes in her treatment team. Dr. Prakash acknowledged that Ms. Elijah had gone from two years of residing in the community to being in the hospital without any privileges. The team recognizes that this is a significant change in her status and are trying to get her back on track. Dr. Prakash stated that Ms. Elijah lost the level 1 privileges she had because she left a program early and got into arguments with staff. There was also a dispute over a food order being delivered to the hospital which resulted in an argument and shouting but was determined to be the result of an error by staff. That particular staff member apologized for the mistake. Dr. Prakash stated that Ms. Elijah demonstrates a pattern of externalizing blame to others and minimizing issues.

18. In response to questions from members of the Board, Dr. Prakash stated that the medication changes for Ms. Elijah commenced in March of 2025 with adjustments made in both May and September 2025. Dr. Prakash stated that for future planning, the treatment team is looking for a less supervised home. There are financial issues which will have to be dealt with. All possible options are being considered to reintegrate Ms. Elijah into the community.

19. No further evidence was called at the hearing.

Submissions

20. At the conclusion of the evidence, all counsel reiterated the submissions made at the outset of the hearing with respect to both the ROL and the necessary and appropriate disposition for the upcoming year.

Analysis, Decision and Disposition

ROL Decision

21. At the outset of the hearing, all counsel submitted that the decision to readmit Ms. Elijah to the hospital on January 5, 2026, was warranted at the time that it was made and the least restrictive option available to the treatment team. Counsel also supported the opinion of the hospital that Ms. Elijah’s continued detention in the hospital was necessary and appropriate. For the reasons set out in the ROL Report dated February 4, 2026, the Board is unanimous in accepting the joint submission of counsel. The decision to readmit was a culmination of changes in Ms. Elijah's behaviour which commenced following her annual review in April 2025. At that time, the abstain from alcohol clause was removed from Ms. Elijah’s Disposition, resulting in her increase in alcohol and cannabis consumption. Ms. Elijah, who is capable of consenting to treatment, also requested a reduction in her antipsychotic medication. This resulted in a decompensation in her mental status, an increase in her impulsivity and a return to the use of methamphetamine. Ms. Elijah also began to disengage from involvement with the treatment team and the staff at the Clarke Centre. She showed limited interest and motivation in exploring daily activities to promote structure in her routine. Ms. Elijah acknowledged to Dr. Prakash that she had returned to using crystal methamphetamine. As indicated by Dr. Prakash, Ms. Elijah’s time at the Clarke Centre was also ending with no other transition plan in place. As a result, the decision was made to readmit Ms. Elijah to the hospital.

Disposition

22. The threshold issue for the panel to determine is whether or not Ms. Elijah continues to represent a significant threat to the safety of the public. The “significant threat” standard is an onerous one. There must be both a likelihood of a risk materializing and the likelihood that serious harm will occur. An accused is not to be detained based on mere speculation; the Board must be satisfied as to both the existence and gravity of the risk of physical or psychological harm posed by the accused to deny them an absolute discharge. As set out in Winko (1999] 1999 CanLII 694 (SCC), 2 S.C.R. 625) the threat must be:

(1) More than speculative in nature and must be supported by the evidence;

(2) Significant in the sense of there being a real risk of physical or psychological harm to individuals in the community and in the sense that this potential harm must be serious; and

(3) The conduct creating the harm must be criminal in nature.

As stated by McLachlin, J. (as she then was) at para. 69

“it is for the court or Review Board, acting in an inquisitorial capacity, to investigate the situation prevailing at the time of the hearing and determine whether the accused poses a significant threat to the safety of the public. If the record does not permit it to conclude that the person constitutes such a threat, the court or Review Board is obliged to make an order for unconditional discharge.”

23. The Ontario Court of Appeal re-emphasized the onerous test in Re: Gibson 2022 ONCA 527, per Lauwers J.A. at para. 9:

Huscroft J.A. said in Carrick (Re), 2015 ONCA 866, 128 O.R. (3d) 209, at para. 17, that “the ‘significant threat’ standard is an onerous one”. He added that “[t]he board must be satisfied as to both the existence and gravity of the risk of physical or psychological harm posed by the appellant in order to deny him an absolute discharge.” Mere speculation is insufficient. See also, Sim (Re), 2020 ONCA 563, at paras. 63-65, per Strathy C.J.O., Marmolejo (Re), 2021 ONCA 130, 155 O.R. (3d) 185, per Tulloch J.A., at paras. 33-37.

24. The Board is unanimous in accepting the opinion of Dr. Prakash as supported by the Hospital Report and the evidence at the hearing that Ms. Elijah continues to represent a significant threat to the safety of the public. Ms. Elijah suffers from a significant major mental illness. Although she had demonstrated success in transitioning to the community, a requested reduction in her antipsychotic medication together with a significant increase in substance use resulted in a decompensation of her mental status. Ms. Elijah’s insight into her mental illness, need for treatment, and risk of violence is not fully developed. Ms. Elijah continued to display borderline, antisocial, and avoidant traits throughout the reporting period. She minimized the risk associated with her return to substance use. Ms. Elijah presents a real risk of an exacerbation of the symptoms of her major mental disorder, including mood elevation and psychotic features such as paranoia and disorganized thinking. A deterioration in her mental state would increase the risk of violent behaviour towards individuals in her environment as a response to perceived threats, consistent with her index offence.

25. In crafting a disposition for Ms. Elijah, the Board is obliged to consider the terms of s. 672.54 of the Criminal Code. The paramount concern is the protection of the safety of the public. The Board must also consider Ms. Elijah’s reintegration into the community and her other needs. Following her annual disposition hearing in April 2025, there was a steady decline in Ms. Elijah’s mental status. The removal of the abstinence clause led to her return to both alcohol and cannabis use. Ms. Elijah’s requested change to her antipsychotic medication resulted in changes in her mood and an increase in impulsivity. In Dr. Prakash's opinion, this led to her return to substance use including cocaine and crystal methamphetamine. Although there was no observable psychosis or demonstrated violence, Ms. Elijah had ongoing difficulty adhering to rules and expectations within structured settings. The result was the need for the hospital to return Ms. Elijah to the hospital in the circumstances set out above. The Board is unanimous in finding that the necessary and appropriate disposition is a Detention Order with the changes as recommended by the hospital and supported by all counsel. Of these, the most important is a reintroduction of the clause requiring Ms. Elijah to abstain from alcohol and other substances.

DATED this 25th day of May 2026, at the City of Toronto, in the Region of Toronto.

Mr. G. Beasley Alternate Chairperson

Office of the Registrar Ontario Review Board