Ontario Review Board
Re: Andrew Rentel (DOB: 02.11.74)
ORB File No: 6689
Hearing held on: Tuesday, May 19, 2020
Place of hearing: St. Joseph’s Healthcare Hamilton, West 5^th^ Campus, 100 West 5^th^ Street
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Hon. J. David McCombs Members: Ms. K. Chalmers, Dr. Jack Ellis, Dr. William J. Komer, Ms. Betsy Little
Parties Appearing:
Accused: Andrew Rentel Counsel: Mr. J. Chrolavicius
Person in charge of the Hospital: Counsel: Ms. K. Robb
Attorney General of Ontario: Counsel: Ms. A. Lepchuk
REASONS FOR DISPOSITION
(Dated June 23, 2020)
Overview:
On February 4, 2015, the accused, Andrew Rentel, was found not criminally responsible on account of mental disorder on charges of dangerous operation of a motor vehicle (x2), failure to stop at the scene of an accident, possession of a controlled substance, breaking and entering (committing) (x3), breaking and entering (intent), arson - damage to property, possession of a weapon for dangerous purpose, assault with a weapon, robbery, possession of property obtained by crime (x2), flight from a police officer, and mischief – not exceeding five thousand dollars, all contrary to the Criminal Code of Canada. Mr. Rentel is currently subject to a Disposition dated May 24, 2019 discharging him subject to a number of conditions including that he report to the person in charge of St. Joseph’s Healthcare Hamilton, West 5^th^ Campus (“St. Joseph’s”) or his or her designate not less than once every two months and keep the peace and be of good behaviour.
On May 19, 2020, a panel of the Ontario Review Board convened by way of video teleconference to hold a hearing to review Mr. Rentel’s Disposition. Mr. Chrolavicius advised the Board that he had spoken to Mr. Rentel about participation in the Hearing. Mr. Rentel advised his counsel that he would not be attending and wanted Mr. Chrolavicius to participate on his behalf. Mr. Rentel was excused by the Alternate Chair pursuant to Section 672.5(10) of the Criminal Code.
Index Offences:
- A summary of the circumstances giving rise to the Index Offences are taken from last year’s Reasons for Disposition dated June 10, 2019 as follows:
“a) In approximately March or April 2014, Mr. Rentel's wife noted that his sleep pattern had changed, the first sign that he was not doing well. She begged him to receive psychiatric treatment but he refused.
b) By July 2014, Mr. Rentel was experiencing significant psychiatric symptoms, including racing thoughts, feelings of restlessness and poor appetite. He became easily agitated and irritable, and experienced referential thinking, grandiosity, paranoid and auditory delusions. He believed he had special telepathic powers and had beliefs about conspiracies involving gangs. He also began interpreting special meaning from everyday things. His family described him as being in a highly paranoid and delusional state. He became obsessed with the computer, only slept for an hour at a time and believed that he was receiving messages from the radio. He was also consuming significant amounts of marijuana.
c) On July 25th, 2014, Mr. Rentel was charged with the first set of Index Offences when, in a manic state, he drove in a manner that placed public safety at high risk, including driving on the opposite side of the road. Upon arrest, Mr. Rentel was found to be in possession of just over 20 grams of marijuana. Given his unusual presentation, the police transported Mr. Rentel to the Brantford General Hospital. He presented to the hospital in a manic state and with poor insight. He also tested positive on drug screening for cannabis and benzodiazepines. Though he acknowledged marijuana use, he denied the use of prescription medications. He was admitted on a Form 1, was diagnosed with probably bipolar affective disorder and was started on psychiatric medications. At the same time, Transport Canada was notified about his reckless driving.
d) Mr. Rentel was discharged home on August 6th, 2014. Despite treatment, he continued to experience a number of delusional beliefs, including about various conspiracy theories, his gang involvement and his being the messiah on a mission.
e) On August 14th, 2014, Mr. Rentel told his wife that he was going to Europe and left their apartment with some personal belongings. His wife was concerned about his odd behaviour and contacted the police, who found Mr. Rentel a short time later at a restaurant in Brantford. He agreed to accompany the police to the St. Leonard’s Society of Hamilton facility, where he stayed for a few hours but did not receive treatment. Upon leaving St. Leonard's, Mr. Rentel saw a car and, believing that the vehicle was linked with his gang, he got into the vehicle and asked the driver to give him money and drive him to a nearby hotel. The driver eventually drove Mr. Rentel to the police station, and the police took Mr. Rentel to the Brantford General Hospital for assessment. Clinical records indicate that the police informed the emergency room staff that Mr. Rentel had told them that he “wanted to kill everybody in 21 days”. Mr. Rentel also reportedly made threats to kill his wife and children because he believed they were special agents, and he engaged in inappropriate sexual behaviour toward a female nurse. Mr. Rentel was admitted on a Form 1 for assessment and was started on medication. He remained in hospital as an involuntary patient.
f) On August 15th, 2014, Mr. Rentel eloped from the Brantford General Hospital where he was being held on an involuntary basis. He described an urge to run, in part to get away from police who he believed might be spies trying to kill him. He eventually ended up in a residential area where he broke into a number of homes. He also assaulted a gas bar attendant and was involved in a high-speed chase with the police, resulting in the second set of index offences from August 16th, 2014.”
Position of the Parties:
- It is the Hospital’s position that Mr. Rentel continues to represent a significant threat to the safety of the public. The Hospital proposed a continuation of Mr. Rentel’s current conditional discharge but adding back the abstinence clause which had been removed at last year’s annual review. Counsel for the Hospital advised that Mr. Rentel would like permission to use alcohol. The Hospital was not opposed, so the abstinence clause would exclude alcohol. Counsel for the Attorney General agreed with the Hospital on the issue of significant threat and the disposition generally but wished to hear from Dr. Kolawole on the issue of alcohol use. Having heard the evidence, she indicated that she was in agreement with the exclusion of alcohol from the abstinence clause. Mr. Chrolavicius, on behalf of Mr. Rentel, was in agreement with the position of the Hospital and the parties presented a joint submission to the Board.
Background:
The Hospital Report dated April 15, 2020 (Exhibit 1) and the Attachment dated May 5, 2020 (Exhibit 2) detail the accused’s background and course in hospital and in the community subsequent to the Index Offences and need not be repeated in detail.
Mr. Rentel has a history of substance use beginning at age 20, in particular, cannabis, although there is a past history of experimenting with other street drugs. The Hospital Report also notes a past history of fairly heavy alcohol consumption.
The Hospital Report notes that Mr. Rentel was charged with Assault, Assault with a Weapon and Threatening Death in 2009, after assaulting his wife. Initially found Unfit to Stand Trial, he was admitted to Penetanguishene Mental Health Centre pursuant to a treatment order. This was his first psychiatric hospital admission. He subsequently returned to Court, pleaded guilty and was given a three-year probation order which, inter alia, required him to remain under the care of a community psychiatrist and receive treatment.
Mr. Rentel was initially diagnosed with schizophrenia. This was later changed to Bipolar 1 Disorder. His current diagnoses are Bipolar Disorder and Cannabis Abuse Disorder (in remission).
Mr. Rentel responded well to psychiatric treatment but, at the end of his probation, he discontinued treatment. The Hospital Report notes that he began to “self-medicate irregularly with leftover medication when he felt unwell”. He had further admissions to hospital as set out in the summary of the Index Offences.
Mr. Rentel was detained on a General Forensic Unit at St. Joseph’s following his initial hearing before the Ontario Review Board in March 2015. He was successfully discharged to his family home in Brantford, Ontario on February 18, 2016 and received a Conditional Discharge at his annual hearing in May 2017.
Mr. Rentel was voluntarily re-admitted to hospital on November 7, 2018 when he and his wife separated, and he required independent accommodation. He remained in hospital until February 5, 2019. As noted in last year’s Reasons for Disposition, Mr. Rentel’s forensic psychiatrist confirmed that this hospital stay was prompted by psycho-social stressors as opposed to any decompensation in Mr. Rentel’s mental status.
In August 2019, Mr. Rentel reported to his case manager possible symptoms of hypomania. He reported difficulty sleeping and experiencing a “burst of energy” the night before. However, there were no other signs or symptoms of psychosis or mood instability until April 2020, detailed below.
The Hospital Report notes that Mr. Rentel has been using cannabis on a regular basis. He reports using up to one gram per week. Mr. Rentel was seen by the Substance Use specialist in the Forensic Psychiatry Program and the low risk guidelines for cannabis use were reviewed. All urine samples collected during the reporting period have been presumptive positive for cannabis.
Mr. Rentel disclosed use of psilocybin mushrooms at a party in June 2019, experiencing thought disorganization and light intensification. He experienced no residual effect and displayed good understanding of the potential consequences and risks of substance use when discussed with him. He said he would try to abstain from using substances other than cannabis.
Mr. Rentel has consumed alcohol infrequently and usually only one drink and mainly when celebrating a special occasion.
Mr. Rentel is currently unemployed. He expressed interest in part-time work but feels it will be hard to obtain given his criminal record. Prior to his admission, he was not engaged in recreational activities although he bought a fitness app to encourage more walking. He spent an extensive amount of time online. He was counselled about falling victim to a possible online scam.
Mr. Rentel’s relationship with his ex-wife is strained. The Hospital Report notes that this affects his contact with his children although he maintains contact with text messaging and has visited a few times over the year.
Mr. Rentel moved from Brantford to Hamilton in November 2019. He lives with his parents, but his brother is renovating the basement to make it into a separate apartment for him.
The treatment team has expressed concern over the lack of structure in Mr. Rentel’s day since his move to Hamilton and his signs of poor judgement which have required counselling and advice on substance use and internet activity.
The treatment team notes that Mr. Rentel’s current Disposition is a “source of structure, support, supervision and risk mitigation”. His insight into his mental disorder and his risk to the public when unwell remain areas of focus in psychoeducation.
The treatment team concluded, at the time of preparation of the Hospital Report, as follows:
“Given the recent changes in his lifestyle and living arrangements, and the very serious nature of Mr. Rentel’s index offences, in the context of his propensity for rapid decompensation from non-adherence to treatment and exposure to potential destabilizers, it is the treatment team’s opinion that Mr. Rentel continues to meet the threshold for significant threat to the safety of the public.
In the absence of the structure, supervision, and support that an ORB disposition currently provides, Mr. Rentel’s risk of decompensation and re-offending would be high. It is therefore our opinion that the necessary and appropriate disposition to manage his risk remains a Conditional Discharge Disposition.”
The Hospital concurred and, at that time, recommended no changes to Mr. Rentel’s current Disposition.
The Attachment to the Hospital Report notes that, on April 22, 2020, Mr. Rentel advised his forensic outpatient case manager that he had been feeling manic for over a week, with “elevated mood, racing or disorganized thoughts, increase in energy, decreased need for sleep, all while increasing his use of Cannabis”. He enrolled for and received benefits under the Canadian Emergency Response Benefit for which his was not eligible and lost a portion of the money gambling online and used crystal meth for about four days in a row. However, on April 20, 2020, his mood became low and he felt depressed with some suicidal ideation. He admits not taking his mood stabilizer for some weeks.
The Attachment notes that, given Mr. Rentel’s risk of aggressive and dangerous behaviour in the context of relapse, he was offered hospital admission for stabilization and risk management which he accepted as a voluntary patient.
The Attachment notes that Mr. Rentel has responded rapidly to the admission and he has returned to his baseline. There has been a change in the frequency of his long acting injection. His insight has improved. He acknowledges that smoking cannabis and using substances contributed to the deterioration he experienced prior to his admission. While hospitalized, he has been abstinent and has expressed a desire to stop drug use. The plan going forward is to resume regular substance use counselling and relapse prevention sessions.
The treatment team recommends that the prohibition against the non-medical use of alcohol or drugs or any other intoxicant, which was removed from Mr. Rentel’s Disposition at his last annual review, be reintroduced.
A Psychological Risk Assessment Report dated May 15, 2020 was introduced into evidence (Exhibit 3). It concludes that Mr. Rentel’s risk for violence is considered moderately low with the monitoring and support currently in place by virtue of his Disposition.
Evidence at the Hearing:
Dr. Kolawole, Mr. Rentel’s attending psychiatrist, gave evidence at the Hearing. He confirmed that Mr. Rentel had been discharged back to living at his parent’s home on May 13, 2020. Mr. Rentel was doing well. He stated that Mr. Rentel’s brother was in the process of renovating the basement of the home to make a separate apartment of some sort, so he expected Mr. Rentel to stay at that address for the foreseeable future.
Dr. Kolawole also addressed the issue of the exclusion of alcohol from an abstinence clause. Dr. Kolawole believes that the initial wording of the abstinence clause which included alcohol was an oversight. While alcohol is included in the standard abstinence clause, it is not needed in this case. He stated that Mr. Rentel has responsibly used alcohol over the course of the year and there has been no indication of binge drinking and no positive tests for alcohol.
Dr. Kolawole confirmed that the reference in the Hospital Report to an increase in substance use referred to Mr. Rentel’s use of cannabis and mushrooms over the course of the year as well as, more recently, crystal meth.
The treatment team has reviewed the risks of substance use generally with Mr. Rentel including alcohol use and will continue these reviews in the year going forward. Dr. Kolawole indicated that Mr. Rentel had good insight into the impact excessive substance use would have on his mental stability.
In response to a question from the Board, Dr. Kolawole agreed that, given the removal of alcohol from the abstinence clause, there was no further need for testing of breath as well as urine and therefore reference to testing of breath could be removed as well.
The treatment team is looking to improve Mr. Rentel’s insight into his mental disorder and the risk he poses when unwell. Psychoeducation is carried out by Dr. Kolawole, Mr. Rental’s case manager and the substance use specialist. Dr. Kolawole stated that Mr. Rentel is currently seen once weekly by each of them. He confirmed that the weekly meetings with the substance use specialist would continue for the time being.
Dr. Kolawole was asked about the transition of Mr. Rentel to non forensic support. He stated that the team has not progressed very far in this regard since Mr. Rentel’s move to Hamilton but that hopefully in the year going forward such supports would be put in place.
No further evidence was called at the hearing.
Analysis and Conclusion:
The Board agrees with the joint submission of the parties that Mr. Rentel continues to represent a significant threat to the safety of the public. We rely on the evidence of Dr. Kolawole and in the Hospital Report, the Attachment to the Hospital Report and the Psychological Risk Assessment.
Mr. Rentel suffers from a major mental illness, Bipolar Disorder, together with Cannabis Abuse Disorder (in remission). Mr. Rentel has a history of substance use beginning at age 20, in particular, cannabis, as well as experiments with other street drugs. He also has a past history of fairly heavy alcohol consumption. Mr. Rentel was charged with assault, assault with a weapon and threatening death in 2009 after assaulting his wife. After pleading guilty he was given a three-year probation order which required him to remain under the care of a community psychiatrist and receive treatment. However, at the end of this probation, he discontinued treatment and self-medicated irregularly. At the time of the serious index offences, Mr. Rentel was again experiencing significant psychiatric symptoms but refused to receive psychiatric treatment.
While Mr. Rentel’s diagnoses indicate that his Cannabis Abuse Disorder is in remission, the Hospital Report notes that Mr. Rentel has been using cannabis on a regular basis and he has disclosed the use of psilocybin mushrooms at a party in June 2019, experiencing thought disorganization and light intensification. While the Hospital Report states that Mr. Rentel has displayed a good understanding of the consequences and risks of substance use, he has said he would try to abstain from using substances other than cannabis.
Mr. Rentel reported a possible episode of hypomania in August 2019, experiencing difficulty sleeping and a burst of energy the night before. While there were no other signs or symptoms of psychosis or mood instability at that time, a further more significant episode occurred in April 2020. While feeling manic in April he increased his use of cannabis and also used crystal meth for about 4 days in a row. Following this, his mood became low and he felt depressed with some suicidal ideation. He has admitted to not taking his mood stabilizer for some weeks. This resulted in his agreement to re-admission to hospital as a voluntary patient for stabilization and risk management. During that hospitalization, he acknowledged that smoking cannabis and using substances contributed to his deterioration and has expressed a desire to stop drug abuse.
The Board accepts the treatment team’s conclusion that, given Mr. Rentel’s recent separation and move to his parent’s home, as well as the serious nature of the index offences and his propensity for rapid decompensation from non-adherence to treatment and exposure to potential destabilizers, he continues to meet the threshold for significant threat to safety of the public.
The Board also agrees with the joint submission of the parties that there be a continuation of Mr. Rentel’s Conditional Discharge on the same terms as currently in place, together with the addition of an abstinence clause which would prohibit the use of drugs or any other intoxicant excluding alcohol. As a result, the requirement to submit samples for testing would be amended to exclude samples for breath and would exclude testing for alcohol. The Board accepts the evidence of Dr. Kolawole that inclusion of alcohol from an abstinence clause was an oversight simply following the standard abstinence clause which was not needed in Mr. Rentel’s case. It was noted by Dr. Kolawole Mr. Rentel has responsibly used alcohol over the course of the year and has good insight into the impact excessive use of all intoxicants have on his mental stability.
The Board agrees that psychoeducation to improve Mr. Rentel’s insight into his mental disorder and the risk he poses when unwell should continue in the year under review.
It is hoped that, with the resolution of his arrangements with his ex-wife and contact with his children, Mr. Rentel can now focus on getting some structure into his day through some employment and/or recreational activities.
The Board accepts the conclusion of the treatment team that, absent the structure supervision and support that Mr. Rentel’s current Disposition provides, Mr. Rentel’s risk of decompensation and reoffending would be high. The Disposition will continue Mr. Rentel’s current Conditional Discharge with the abstinence clause and samples for testing as outlined in these Reasons.
In coming to this conclusion, the Board has considered its responsibility pursuant to s. 672.54 of the Criminal Code to make a Disposition that is necessary and appropriate in the circumstances taking into account the safety of the public which is the paramount consideration, the mental condition of the accused, his reintegration into society and his other needs.
DATED this 23^rd^ day of June, 2020, at the City of Toronto, in the Toronto Region.
Ms. Kathryn I. Chalmers Legal Member
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Office of the Registrar Ontario Review Board