2013 QCCQ 2260, 2013 QCCQ 2260

Unofficial English Translation R. c. Tremblay 2013 QCCQ 2260 JC1649 COURT OF QUEBEC CANADA PROVINCE OF QUEBEC DISTRICT OF TERREBONNE LOCALITY OF ST-JÉRÔME “Criminal and Penal Division” No.: 700-01-117094-139 DATE: March 8, 2013 PRESIDING: THE HONOURABLE PAUL CHEVALIER, J.C.Q. THE QUEEN v. CHARLES TREMBLAY JUDGMENT [ 1 ] Can self-induced intoxication leading to a state of toxic psychosis always offset the effect of subsection 33.1 Cr. C. and allow a verdict of not criminally responsible on account of mental disorder under

section 16 Cr. C. ? THE FACTS [ 2 ] Charles Tremblay was charged with one count of assault with a weapon against Ms. C. J. and one count of assault causing bodily harm to Ms. C.

J. [ 3 ] The facts are not contested: on January 3, 2013, while hospitalized in the psychiatric intensive care unit of the Saint-Jérôme hospital, where he had been since December 21, 2012, the accused suddenly grabbed a pen from the hands of a patient hospitalized in the same unit and stabbed her in the neck and the head five times in front of hospital personnel and other patients. [ 4 ] The hospital personnel who subdued the accused described him as clearly being in a psychotic state at the time.

THE EVIDENCE [ 5 ] The psychiatrist who provided the expert report respecting the criminal responsibility of the accused concluded that it was [ translation ] “very clear that the patient was in a psychotic state at the time of the alleged act”. He left it to the Court to determine whether the psychosis was caused by voluntary drug abuse, adding that [ translation ] “it is possible that his chronic drug abuse could have triggered a latent mental illness, especially because of the strong possibility of a family predisposition to psychotic illness.

At present, it is not possible to determine whether the psychosis was solely related to drug abuse or if it was the beginning of a psychotic illness requiring long-term psychopharmacological (antipsychotic) treatment”. [1] [ 6 ] His diagnosis was psychosis [ translation ] “associated” with the abuse of illicit drugs and not psychosis [ translation ] “caused” by self- induced intoxication. [ 7 ] The psychiatrist’s report tells us that:

[ translation ] 7.1. …Two months before [the accused was] hospitalized, he was consuming crack cocaine intensively, but only for short periods when he managed to obtain money. For example, the last time (October 2012), after stealing his father-in-law’s ATM card, he managed to obtain $500 and bought 50 crack cocaine rocks, which he consumed in one or two days. He denies having consumed crack cocaine more recently. He was using amphetamines on a regular basis, however, taking four or five pills a day over a period of one to three days, and then stopping for a day or two to rest before starting again. 7.2.

More recently, he managed to obtain a drug that is less common in Quebec and goes by the name of “spice”; it contains various mixtures of chemicals, including cannabinoids from non-natural (synthetic) sources. According to what little information is available about this substance, it may be likely to cause prolonged psychotic episodes, which is also the case for those who chronically abuse amphetamines. [2] [ 8 ] The same report also states that the accused had no symptoms of psychotic illness in the past and that, according to the accused and his mother, the symptoms began two weeks before he was hospitalized.

The accused [ translation ] “felt as if a demon had taken control of his mind”; he therefore [ translation ] “stopped using drugs, wondering whether his ideas could be related to his drug use, but even after he stopped, the psychosis continued”. [3] [ 9 ] Without this Court going into details about all the hallucinations that the accused experienced, the accused believed in the imminent end of the world on December 21, 2012.

He believed he was going to die or be changed into another form of being, such as a vampire, and he was convinced that [ translation ] “he must not miss his chance to die that day”. [4] On December 21, 2012, the accused therefore attempted suicide by stabbing himself in the chest between the ribs, near his heart, which resulted in his hospitalization. [ 10 ] The Court is convinced that, even though he had stopped using drugs two weeks earlier, the self-induced, chronic and abusive consumption of various drugs caused a psychotic state, which led to the suicide attempt of December 21, 2012. [ 11 ] Despite increasing doses of antipsychotic medication, the accused was in a psychotic state from December 21, 2012, to January 3, 2013, believing, in the days around January 3, 2013, that he was on a mission to save the world by killing people, which he wanted to do by attacking C.

J. [ 12 ] During the interviews held on January 14, 2013, and January 30, 2013, the accused still presented with delirious and psychotic ideation. [ 13 ] On February 20, 2013, after constantly being on medication for two months, the accused no longer manifested any psychotic symptoms. THE LAW [ 14 ]

Section 16 Cr. C. stipulates the following: 16.

(1) No person is criminally responsible for

an act committed or an omission made while suffering from a mental disorder that rendered the person incapable of appreciating the nature and quality of the act or omission or of knowing that it was wrong.

(2) Every person is presumed not to suffer from a mental disorder so as to be exempt from criminal responsibility by virtue of subsection (1), until the contrary is proved on the balance of probabilities.

(3) The burden of proof that an accused was suffering from a mental disorder so as to be exempt from criminal responsibility is on the party that raises the issue. [ 15 ] Moreover, subsection 33.1 Cr. C. limits reliance on 16 Cr. C. and enacts the following: 33.1

(1) It is not a defence to an offence referred to in subsection (3) that the accused, by reason of self-induced intoxication, lacked the general intent or the voluntariness required to commit the offence, where the accused departed markedly from the standard of care as described in subsection (2).

(2) For the purposes of this section, a person departs markedly from the standard of reasonable care generally recognized in Canadian society and is thereby criminally at fault where the person, while in a state of self-induced intoxication that renders the person unaware of, or incapable of consciously controlling, their behaviour, voluntarily or involuntarily interferes or threatens to interfere with the bodily integrity of another person.

(3) This

section applies in respect of an offence under this Act or any other Act of Parliament that includes as an element an assault or any other interference or threat of interference by a person with the bodily integrity of another person. In other words, a person who is unaware of his behaviour as a result of self-induced intoxication may not avail him or herself of

section 16 Cr. C. to avoid criminal responsibility if he or she has interfered with the bodily integrity of another person. THE ANALYSIS [ 16 ] In Bouchard-Lebrun , [5] the leading case, “[t]he main issue [was] whether a toxic psychosis caused exclusively by a single

episode of intoxication constitutes a ‘mental disorder’ within the meaning of s. 16 Cr.

C. ” [ 17 ] In this instance, however, there is no “single episode of intoxication”, but rather a constant poly-drug use since adolescence, including amphetamines, ecstasy, crack, crystal meth and other chemical drugs, despite many therapies. [ 18 ] The Court must first determine whether it is dealing with “a disease of the mind that was unrelated to the intoxication-related symptoms”. [6] [ 19 ] To do so, the Court must first “consider the nature of the trigger and determine whether a normal person in the same circumstances might have reacted to it by entering an automatistic state as the accused claims to have done”. [7] [ 20 ] A normal person, who had stopped using chemical drugs a month earlier, could have had a short toxic psychotic episode but would not continue to be engulfed in a state of psychosis, especially with effective antipsychotic medication. [ 21 ] The state of toxic psychosis that the accused suffered from did not abate on its own after the disappearance of the effects of the drug the day after it was consumed or in the days that followed; rather, sustained medication was necessary to eliminate all the psychotic symptoms that he evidenced, which suggests that what the accused experienced was far more than a mere episode of toxic psychosis. [ 22 ] The fact that the accused, almost one month after stopping all consumption of illegal drugs still suffered from a psychosis, even though he had been taking antipsychotic medication for two weeks, tends to indicate that this was not a mere episode of toxic psychosis, but rather a mental illness. [ 23 ] The duration of the psychopharmacological (antipsychotic) treatment required to eliminate the psychotic symptoms is another element showing the presence of a mental illness, and not merely a psychotic episode caused by drug abuse. [ 24 ] The Court must also take into consideration the “continuing danger factor”; in other words it must determine whether it is dealing with “a condition [that] is likely to present a recurring danger [to others such that] there is a greater chance that it will be regarded as a disease of the mind”. [8] [ 25 ] According to the Supreme Court of Canada, “it stands to reason that danger will be recurring only if it is likely to arise again independently of the exercise of the will of the accused.” [9] The Court added that “… if the circumstances of a case suggest that a pre-existing condition of the accused does not require any particular treatment and is not a threat to others, the court should more easily hold that the accused was not suffering from a disease of the mind at the time of the alleged events,” [10] while taking care to repeat that the matter before it concerned “just one type of toxic psychosis, namely one that resulted exclusively from a single episode of self-induced intoxication.” [11] [ 26 ] We reiterate that, in this case, despite specific treatment (antipsychotic medication,) the accused wanted to kill a person one month after he stopped taking drugs and two weeks after he began taking medication, showing that he presented a danger to others, which continued to demonstrate the presence of a mental illness affecting the accused. [ 27 ] Moreover, according to studies cited by the psychiatrist in his report, [ translation ] “neuroimaging studies support the concept that drug abuse, especially chronic use, can change the neuronal architecture of the brain and that such changes can take months to reverse themselves, if they reverse themselves at all.

Development of psychotic phenomena by chronic abusers could reflect underlying neurobiological changes that are different from psychoses associated with acute intoxication and could therefore explain the presence of persistent episodes of psychotic symptoms…”. [12] CONCLUSION [ 28 ] The Court therefore finds that the evidence establishes on a balance of probabilities that the psychosis experienced by the accused was not the sole result of self-induced intoxication with drugs in December of 2012 but rather of chronic and acute poly-drug use that existed for many years and, in all likelihood, changed the neuronal architecture of the accused’s brain and caused underlying neurobiological changes [13] that ultimately triggered a latent mental illness, as suggested by the strong possibility of a such a predisposition resulting from the accused’s family history. [ 29 ] Given the persistence of the disease over a period of almost three months despite appropriate medication and the act of violence of January 3, 2013, the Court is also convinced that there is a real danger of a recurrence of danger to others that is related to the accused’s condition. [ 30 ] Accordingly, the Court finds that the psychosis affecting the accused at the time of the events was a true mental illness constituting a mental disorder within the meaning of

section 16 Cr. C. , thereby excluding the application of subsection 33.1 Cr. C. , which rules out reliance on

section 16 Cr. C. in cases of self-induced intoxication for offenses such as those before us. [ 31 ] The Court therefore renders a verdict of not criminally responsible on account of a mental disorder in respect of the two crimes that the accused is charged with. PC/nc PAUL CHEVALIER, J.C.Q. Mtre Estée Pouliot-Voukirakis For the Crown

Mtre Yves Poupart For the accused Date of hearing: March 4, 2013