Re: Mavis Alexander
ORB File No: 5224
Hearing held on: Tuesday, April 14, 2026
Place of hearing: Centre for Addiction and Mental Health Via Zoom Videoconference
Pursuant to: Section 672.81(2.1) of the Criminal Code
Before: Alternate Chairperson: Mr. D. Sandor Members: Dr. P. Prendergast Dr. G. Nexhipi Ms. M. den Haan Mr. A. Mete
Parties Appearing: Accused: Mavis Alexander Counsel: Ms. M. Murphy
The person in charge of hospital: Counsel: Ms. S. Rosales Zelaya
Attorney General of Ontario: Counsel: Mr. D. Brandes
REASONS FOR DECISION
(Dated June 3, 2026)
Introduction
On November 27, 2008, Mavis Alexander was found not criminally responsible by reason of mental disorder on a charge of arson with disregard for human life, contrary to the provisions of the Criminal Code of Canada. Ms. Alexander is subject to a Disposition of the Ontario Review Board, dated July 8, 2025, detaining her at the Forensic Service of the Centre of Addiction and Mental Health, Toronto (hereinafter referred to as “the Hospital”). That Disposition grants Ms. Alexander certain privileges, including that of living in the community in accommodation approved by the person in charge of the Hospital. It also imposes certain conditions, including that of abstaining absolutely form the non-medical use of alcohol, drugs or any other intoxicant, and that she submit samples for the purpose of monitoring her compliance with the abstention condition.
On December 12, 2025, the Hospital forwarded a Restriction of Liberty Notice to the Ontario Review Board, consistent with the provisions of section 672.56(2) of the Criminal Code, advising that Ms. Alexander had been admitted to the Hospital on an in-patient basis on December 4, 2025, and continued to be detained on the CCCU7 unit at that time. In response, this hearing was scheduled to review the restriction of Ms. Alexander’s liberty, pursuant to section 672.81(2) of the Criminal Code. Ms. Alexander was not in attendance, but was represented by counsel, Ms. Murphy, who was fully instructed. Leave was given to proceed in the absence of Ms. Alexander, pursuant to section 672.5(10) of the Criminal Code. The parties confirmed that the liberty norm Ms. Alexander had enjoyed prior to December 4, 2025, was restored on April 8, 2026, with her discharge from the Hospital and return to the community.
The record for the hearing included the Notice of Hearing, the Restriction of Liberty Notice mentioned above, the Board’s response to that Notice dated December 12, 2025, the most recent Disposition (also mentioned above), the Reasons for that Disposition and a Hospital Report authored in June 2025. On the consent of all parties, a Restriction of Liberty Report, dated April 10, 2026, was entered into evidence as Exhibit 1.
The parties were canvassed for their initial positions. All confirmed their expectation that the evidence would establish that the restriction of Ms. Alexander’s liberty from December 4, 2025, to April 10, 2026, was justified and necessary and represented the least onerous and least restrictive option available to the Hospital throughout that time period. None sought any changes to the reigning Disposition.
For the following reasons, the Board agrees with that joint submission.
Evidence
By way of context, on January 17, 2008, Ms. Alexander set fire to a couch in her apartment while experiencing a psychotic episode. Ms. Alexander is diagnosed with schizoaffective disorder, bipolar type. She lived a traumatic childhood and began showing the symptoms of major mental illness when she was about 16 years old. Outside of the index offence, she has no history of involvement with the criminal justice system. The record indicates that, at the time of the last hearing, Ms. Alexander remained very fragile. Her mental illness was characterized as “treatment resistant.” She had limited insight and was at a high risk of discontinuing psychiatric treatment and falling away from psychiatric services absent supervision and monitoring.
Exhibit 1 explains that Ms. Alexander was admitted to the Hospital from the community on December 4, 2025, in a state of decompensation, experiencing both the positive and negative symptoms of her major mental illness. She presented as behaviourally disorganized, made delusional statements, engaged in inappropriate laughter and intermittent responding to internal stimuli. She had poor hygiene and was wearing multiple layers of soiled clothing and made bizarre references to family members. While she did not display aggressive behaviours, it was clear that she was in a state that required hospitalization and stabilization.
Over the following months, gradual improvement was observed. Ms. Alexander’s thought was increasingly organized, she showed improved engagement with staff and enhanced attention to hygiene. She participated in unit routines and was able to engage in reality-based and goal-directed conversations. By February 2026, she stopped experiencing problems with urinating on clothing and with some disrobing behaviours she had previously exhibited. She remained calm, pleasant and showed progress toward her baseline functioning notwithstanding continued intermittent responding to internal stimuli. By April 2026, she was psychiatrically stable, behaviourally manageable and began going through discharge planning that brought her back to her liberty norm with a discharge from the Hospital on April 8, 2026. She no longer endorsed active psychotic symptoms and was adherent to oral clozapine and her long-acting injectable antipsychotic medication.
Exhibit 1 provides a helpful summary of the concerns that were adopted by the parties in their submission in support of the restriction of Ms. Alexander’s liberty:
Given the acuity of her presentation, her impaired capacity to care for herself, and the known association between medication non-adherence and rapid psychiatric relapse, the Restriction of Liberty implemented at that time was clinically necessary to mitigate risk, ensure medication stabilization, and provide a structured therapeutic environment….Since that time, Ms. Alexander has demonstrated gradual and sustained improvement in her mental state with adherence to treatment, improved organization of thought, and increased engagement in care. Over the course of her admission, her behavioural stability improved, and she successfully progressed through graduated privileges and reintegration activities without incident. She ultimately achieved sufficient psychiatric stabilization to allow for safe discharge from hospital and has since returned to supervised community housing with outpatient supports in place.
Dr. Kravtsenyuk’s evidence to the panel was harmonious with that contained in the Restriction of Liberty Report. Dr. Kravtsenyuk added that Ms. Alexander’s decompensation was likely a product of a constellation of factors including physical unwellness and missed medications. She explained that medication compliance remains a major issue for Ms. Alexander and is being monitored by Ms. Alexander’s supports in her supervised accommodations. Staff have been educated as to subtle changes to watch for as signs of suboptimal treatment in Ms. Alexander.
Importantly, Dr. Kravtsenyuk described efforts engaged in by the treatment team to address Ms. Alexander’s increasing decompensation before bringing her to the Hospital. She described efforts to meet with Ms. Aleander at her home, to provide her with education regarding her medication and need to work with housing staff and other supports. Frequency of appointments increased but it was shortly evident that Ms. Alexander’s psychotic symptoms were approaching a state where a real concern for, firstly, the safety of the public and secondly her own mental health and treatment needs required admission.
No further evidence was called, and the parties maintained their positions at the end of the hearing as set forth at the hearing’s commencement.
Analysis and Conclusion
As stated above, the Board agrees with the joint submission that the restriction of Ms. Alexander’s liberty was justified and necessary and represented the least onerous and least restrictive option available to the Hospital from the time commenced on December 4, 2025, through to Ms. Alexander’s discharge back to the community on April 8, 2026. Ms. Alexander had been non-compliant with treatment and was spiralling into serious decompensation while in the community. She was showing both the positive and negative symptoms of her major mental illness and was approaching a level of psychosis that approximated that manifest at the time of the commission of the index offence. Efforts to address the decompensation short of admitting Ms. Alexander to the Hospital were undertaken without success. The primary objective of assuring the safety of the public, and the other objectives of ensuring that Ms. Alexander’s mental health and other needs were met, mandated the restriction of her liberty.
The evidence also established that the restriction of Ms. Alexander’s liberty decreased as she became treatment compliant and attained to her baseline functioning. She was reintegrated back to her liberty norms in a gradual but appropriate fashion through to her discharge on April 8, 2026.
As a result, it is the Board’s conclusion that the restriction of Ms. Alexander’s liberty was justified and necessary and represented the least onerous and least restrictive option available to the Hospital and remained so throughout the period spanning December 4, 2025, to April 8, 2026.
The Board thanks all that participated in this hearing and encourages Ms. Alexander in her treatment compliance and engagement with housing staff and the treatment team throughout the remainder of this review period.
DATED this 3rd day of June, 2026, at the City of Toronto, in the Toronto Region.
Mr. D. Sandor Alternate Chairperson
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Office of the Registrar Ontario Review Board