Court of Appeal for Ontario

Date: 2021-03-31 Docket: C68631

Judges: Watt, Hoy and Nordheimer JJ.A.

In the Matter of: Matthew Bilodeau

An Appeal Under Part XX.1 of the Code

Counsel: Stephen F. Gehl, for the appellant Rebecca Schwartz, for the respondent, The Attorney General of Ontario Julie A. Zamprogna Balles, for the respondent, The Person in Charge of the Southwest Centre for Forensic Mental Health Care St. Joseph’s Health Care London

Heard: March 26, 2021 by video conference

On appeal from the disposition of the Ontario Review Board, dated July 16, 2020, with reasons dated August 4, 2020.

Reasons for Decision

[1] Mr. Bilodeau appeals the disposition of the Ontario Review Board, continuing his conditional discharge but reducing his obligation to report to the Hospital to not less than two times per month.

[2] Counsel for Mr. Bilodeau argues that the Board’s finding that he continues to pose a significant threat to the safety of the public was unreasonable and seeks an absolute discharge. In particular, he argues that the Board’s finding that he poses a significant threat was speculative, not grounded in the evidence, and failed to consider that his only incident of violence was the index offence, he has been compliant with medication for eight years, and he has voluntarily returned to the Hospital when symptomatic.

[3] We are not persuaded that there is any basis for this court to intervene. The Board’s conclusion was reasonable and is grounded in the evidence. The path to its conclusion is clear. The Board’s decision reflected “an internally coherent and rational chain of analysis” that was “justified in relation to the facts and law”: Canada (Minister of Citizenship and Immigration) v. Vavilov, 2019 SCC 65, 441 D.L.R. (4th) 1, at paras. 83, 85.

[4] The Board reviewed and considered the evidence of Mr. Bilodeau’s treating physician, Dr. Ugwunze, and the Hospital Report. The evidence on which the Board’s disposition rests includes the following.

[5] On April 3, 2012, Mr. Bilodeau was found not criminally responsible on account of mental disorder on two charges of attempt murder, after stabbing his father with a large butcher knife and stabbing his mother in the chest with a smaller knife. The offence occurred less than two weeks after he had stopped his medication.

[6] Mr. Bilodeau is diagnosed with schizoaffective disorder, substance use disorder (in remission) and anxiety disorder NOS.

[7] At the time of the disposition under appeal, Mr. Bilodeau lived alone in a one-bedroom apartment. However, he continued to suffer from active psychotic symptoms and continues to require oversight. Dr. Ugwunze opined that should Mr. Bilodeau miss two doses of any of the three anti-psychotic medications he takes, his mental state would deteriorate significantly within 48 hours. Further, Dr. Ugwunze’s evidence was that the therapeutic level of one of his anti-psychotic medications, clozapine, is affected by his use of cigarettes and, as a result, his medication levels require monitoring to ensure that they remain within the therapeutic range.

[8] Mr. Bilodeau has made progress and, in the year under review, steps were made to transfer Mr. Bilodeau’s care from a forensic outreach team to an Assertive Community Treatment Team (ACTT). But as a result of restrictions arising from the COVID-19 pandemic, a therapeutic relationship had not developed by the time of the Board hearing. Dr Ugwunze explained that a developed therapeutic relationship was necessary to manage Mr. Bilodeau’s medication, given his attempts to negotiate reductions and question the authenticity of his medication. Mr. Bilodeau struggles to adjust to change and it takes him a long time to build therapeutic trust.

[9] Mr. Ugwunze testified that, if given an absolute discharge at this time, Mr. Bilodeau’s risk of violent re-offending would increase to at least moderate and might actually be higher.

[10] The Board found that “the evidence before us is quite clear and given the severity of the index offence and [Mr. Bilodeau’s] propensity for extreme unprovoked and unpredictable violence it is imperative that he needs to be actively monitored by a therapeutic team that knows him well”.

[11] The Board did not misapprehend that there was only one incident of violence. While there was only one incident of violence, it was extreme and unprovoked. The risk of violence if Mr. Bilodeau does not maintain therapeutic levels of medication is clear. In its reasons, the Board noted the evidence of medication compliance under the forensic outpatient team, while also noting Dr. Ugwunze’s evidence that, while compliant, Mr. Bilodeau has, at times, expressed not wanting to take his medications. The Board’s review of the evidence included that in July 2018, and on prior occasions, Mr. Bilodeau returned to the hospital at his own request and that Mr. Bilodeau has been adhering to his relapse prevention program as best he can. But the Board also considered the risk that a transition, such as to the ACTT, poses.

[12] Contrary to counsel for Mr. Bilodeau’s assertion, the Board did not signal that Mr. Bilodeau would always present a significant threat to the safety of the public, given the nature of his mental illness and the gravity of the index offence. Rather, the Board accepted the evidence of Dr. Ugwunze of the need for a strong therapeutic relationship to manage that risk and that Mr. Bilodeau had not yet developed such a relationship outside of the forensic team.

[13] Accordingly, the appeal is dismissed.

“David Watt J.A.” “Alexandra Hoy J.A.” “I.V.B. Nordheimer J.A.”