Re: David Small
ORB File No: 7189
Hearing held on: Tuesday, September 9, 2025
Place of hearing: St. Joseph's Healthcare Hamilton West 5th Campus, 100 West 5th Street
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. L. Maunder
Members: Dr. P. Prendergast Dr. G. Nexhipi Mr. C. MacIntyre, KC Mr. A. Mete
Parties Appearing
Accused: David Small Counsel: Mr. M. Schloss
The Person in Charge of Hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Ms. C. Gzik
REASONS FOR DISPOSITION
(Dated October 29, 2025)
On July 31, 2017, David Small was found not criminally responsible of a Criminal Code charge of first-degree murder. At the time of the hearing, Mr. Small was subject to a disposition detaining him at the Forensic Psychiatry Program of St. Joseph's Healthcare Hamilton, with privileges up to living in the community in approved accommodation. On September 9, 2025, the Board convened to conduct an annual review of Mr. Small’s disposition.
There was no dispute between the parties that the evidence established that Mr. Small remained a significant threat to the safety of the public. The hospital and the Attorney General took the position that the evidence also established that a detention order remained the necessary and appropriate disposition. Mr. Small took the position that a conditional discharge (with robust conditions) was the necessary and appropriate disposition.
Why follow, the panel accepted that Mr. Small remained a significant threat to the safety of the public and concluded that a continuation of the detention order was necessary and appropriate at this time.
The Index Offence
- The Hospital Report includes a detailed statement of facts regarding the index offence that was filed during the Court proceedings. Briefly, Mr. Small and the deceased, Lezleigh Hopkins, were in a relationship and had been living together since August 2014. Each was being assisted by their own ACT team. In January 2015, Mr. Small was demonstrating increased paranoia and may have been “flushing” his medications. On January 15, 2015, it was decided that Ms. Hopkins would remain in the shared apartment and Mr. Small would move out at the end of January. On January 16, 2015, Mr. Small purchased a knife, went to the residence he shared with Ms. Hopkins, and stabbed her multiple times, killing her.
Background and Context
The Hospital Report details Mr. Small’s personal and psychiatric history, and his course in hospital while under the jurisdiction of the Board. He is presently 39 years old. He was born in Hamilton and he and his two sisters were raised by their biological parents. He left school in grade ten and joined the army at the age of twenty-one. Mr. Small also worked at several jobs for short periods, including landscaping, Wendy's restaurant, Walmart, and for a temporary job placement agency in doing manual labour.
Prior to the index offence Mr. Small did not have a criminal record but had a considerable history with police. The Hospital Report cites more than two dozen contacts with police services between 2003 and 2015. He had been in possession of a bayonet, a dagger, and a sword. He had carelessly discarded a cigarette causing a garage fire. He had demonstrated paranoid delusions and had been apprehended under the Mental Health Act.
Mr. Small started consuming cannabis at the age of sixteen or seventeen, and his mother has reported that when he engaged in frequent use his thoughts became disorganized, and he exhibited aggressive and hostile behaviour. He has reported drinking alcohol on weekends and smoking about a package of cigarettes per day.
Mr. Small may have experienced symptoms of schizophrenia earlier but was first assessed in 2006. It is unclear when he first received a diagnosis (there seem to be some missing records) but in 2009, he was hospitalized on four occasions, was described as having “chronic schizophrenia”, was on a long-acting injectable antipsychotic medication (with discussions taking place about a trial of clozapine), and he had the support of an Assertive Community Treatment (ACT) team. Mr. Small continued to receive psychiatric care up to the time of the index offence, with periodic hospitalizations. By and large, Mr. Small appeared to be compliant with medication and sought to optimize his treatment while minimizing side-effects.
Not long after his arrest, Mr. Small was found unfit to stand trial. He was eventually made fit under a treatment order before being found NCR.
Mr. Small was initially detained at Waypoint before being transferred to St. Joseph’s in 2019. Initially, Mr. Small was on several psychiatric medications but had residual paranoia and delusions. A switch to clozapine allowed the team to reduce and stop many medications and largely resolved his residual symptoms. Since then, he has rarely demonstrated active delusional thoughts.
Throughout his hospitalization, Mr. Small was described as pleasant, polite and cooperative. He was adherent to his medications and abstinent from substances. In almost a decade under the jurisdiction of the Board, there is one reported incident of Mr. Small becoming irritable and raising his voice with a staff member. He has engaged in no other verbal and no physical aggression.
Once transferred to St. Joseph’s, Mr. Small’s progress towards community reintegration was slowed first by the pandemic and then by the availability of appropriate housing. Nonetheless, Mr. Small made good use of the time. He completed various programs, he attended a course at Mohawk College and, beginning in May 2021 held either part-time or full-time work, for the most part as a labourer. He liked to be busy.
Mr. Small enjoyed the support of his mother and sisters and frequently used 72 hour passes to spend weekends with his mother.
In early 2024, Mr. Small was offered a one-bedroom apartment in Emmaus Place, a transitional rehabilitation housing program (TRHP) operated by Good Sheppard. It is a 24-hour staff supervised facility. He transitioned to living there over a couple of months and was discharged in June 2024.
Partly to resolve the stress of the transition (including financial stress related to his reduced eligibility for subsidies when employed) he quit working. It also became clear that Mr. Small was carrying debt that contributed to this stress although he refused help dealing with it.
Mr. Small spent time gaming but also socializing and participating in activities at Emmaus, in addition to spending time with his family.
The Reporting Year
Dr. Kolawole, Mr. Small’s attending psychiatrist for approximately five years, authored the Hospital Report and testified. We also received a summary from his community mental health worker at Emmaus Place.
Mr. Small’s current diagnosis is schizophrenia. He remains treated on his own consent with clozapine (oral) and aripiprazole (long-acting injection). His medications are dispensed to him by staff at Emmaus Place and there have been no reported concerns regarding compliance with medication. Dr. Kolawole testified that he believed Mr. Small’s insight had significantly improved over the course of the year and that he appreciates that he needs his medications. He feels, in Dr. Kolawole’s words, “deep regret and remorse” for the index offence and this insight feeds into his compliance. All urine drug screens collected have been negative for prohibited substances.
Mr. Small had a largely stable year. He continued to live at Emmaus House without incident. He was seen weekly by several members of the team (as well as TRHP staff) such that he had contact with a team member / someone checking in with him four times a week, in addition to the 24-hour staff at Emmaus House.
Mr. Small was diagnosed with type 2 diabetes this year. Despite teaching and offers of additional support, he has struggled to manage his blood sugar and to adapt to necessary dietary changes. Team members have observed that he sometimes does not have adequate or appropriate food in the house. He has lost weight. Financial struggles likely are part of the reason, but he refuses help with those as well.
Mr. Small was admitted to hospital for six days earlier this year when his family doctor discovered he had poorly controlled glucose levels. The team brought him into hospital so that they could observe him in case his physical condition led to deterioration in his mental status.
Mr. Small returned to work and to school (online) in the autumn of last year but stopped both after a few months. He struggled with the demands of his physical job (perhaps related to his undiagnosed diabetes) and thought he would prefer in person school.
Mr. Small engaged in a brief relationship with a fellow resident of Emmaus Place that ended amicably. To his credit, he cooperated when the team around the need to disclose his forensic status, including the nature of the index offence.
Mr. Small continues to go and visit his mother for weekends, regularly.
The Victim Impact Statements
Lezleigh Hopkins’ aunt and uncle and cousin filed victim impact statements and read them at the hearing. Although some of the contents fell outside the permitted scope of a victim impact statement, the parties agreed that the entirety of the statements would be read, and the panel would rely only on what was appropriate.
Ms. Hopkins’ family members poignantly described their loss, pain, and fear. They also offered a moving tribute to Ms. Hopkins with their description of her warmth, cheerfulness, and kindness.
Significant Threat
The panel accepted (as did all the parties) the evidence of Dr. Kolawole that Mr. Small remains a significant threat to the safety of the public. Mr. Small’s major mental illness, schizophrenia, resulted in him killing Lezleigh Hopkins. Before that event, Mr. Small had been ill for some time. Despite interventions, he had poor insight and was inconsistently adherent to medications.
Since being found NCR, Mr. Small has been subject to “intensive supervision” through the forensic system. Over the course of ten years, he has made significant progress. His insight into his illness and need for medications is greatly improved. This is concretely reflected in his long-term adherence to medications (and, for that matter, abstinence from substances). But, as Dr. Kolawole testified, Mr. Small’s risk continues to be mitigated by structure, supervision and active case management. He continues to have support from Emmaus House with dispensing his daily oral medications. He also gets support from occupational therapy and his case manager with finances, shopping and planning. He has been in the community a little more than a year.
Dr. Kolawole referenced Mr. Small’s history of non-adherence to medications, disengagement from services, and use of substances as adding to the risk that, without the oversight the forensic team is offering, Mr. Small would disengage from supports and treatment, stop taking his medications, and relapse into substances.
Ultimately, the panel was satisfied that Mr. Small remains a significant threat based on our assessment of the likelihood that Mr. Small will decompensate and reoffend in conjunction with our assessment of the degree of harm, should he decompensate and reoffend. While Mr. Small’s progress (most importantly, consistent adherence to medication, improved insight, absence of instances of aggression) has certainly reduced the risk he poses, this progress has been made in a carefully controlled environment. If those supports were to be withdrawn today, we were satisfied that there was a substantial risk that Mr. Small would slowly disengage from services, a trajectory that would lead to his decompensation. In Mr. Small’s case the potential degree of harm that may follow his decompensation is grave – the risk is that of him causing serious harm, potentially with devastating and permanent consequences, as he did at the time of the index offence.
The Hospital Report includes a Psychological Risk Assessment conducted by Dr. Mini Mamak in 2021. Mr. Small’s risk for violent re-offending was considered low if he were subject to a detention order disposition that permitted community living, but absent oversight his risk became significantly elevated. Although the Hospital Report noted that the 2021 risk assessment remained valid, that is partly based on the hospital not recommending a change to the disposition. Given the years that have passed, Mr. Small’s transition to the community, and the fact that Mr. Small is seeking a conditional discharge, we would like to see the hospital do a new Risk Assessment prior to the next annual hearing.
The Necessary and Appropriate Disposition
The panel concluded that the necessary and appropriate disposition remained a detention order. We were satisfied on the evidence that only a detention order was adequate to address Mr. Small’s risk to the public. We rejected the submission made by Mr. Schloss on behalf of Mr. Small that a less restrictive conditional discharge with “a host of conditions and requirements” would adequately address the risk.
Mr. Small has successfully transitioned to living in the community, often the first hurdle to progressing towards a conditional discharge. But Mr. Small has been in the community for a little over a year after ten years in hospital. He transitioned to his own apartment but one with medication administration, 24-hour supervision, and intensive supports available. In Mr. Small’s case, his clozapine is dispensed to him daily. Although compliant, he continues to need occasional reminders to take his medication. He continues to meet with staff and team members four times a week for check-ins. He utilizes intensive supports while also refusing help to resolve chronic issues that cause him stress (such as offered help to consolidate his debts). Dr. Kolawole testified that Mr. Small’s skills for independent living are not yet developed enough for him to live without support or supervision.
Overall, the degree of supervision and support Mr. Small continues to need was, in our view, inconsistent with a conditional discharge, even with robust conditions. As an example, even though Mr. Small has good insight into his need for medications, he is vulnerable to stress. He becomes overwhelmed and refuses assistance. He has a new diagnosis of type 2 diabetes and his blood sugar levels are poorly controlled. We were convinced that the fact that Mr. Small is not yet independently taking his medications was a significant impediment to a conditional discharge. Under a conditional discharge, Mr. Small would (as specifically referenced by Mr. Schloss in his submissions) have no curfew. Forgetfulness, stress, blood sugar issues, and absences from Emmaus Place would all contribute to an elevated risk that he would be inconsistent with his medication adherence, leading quickly to instability in his mental state.
Similarly, although within the framework of a conditional discharge, the panel could specify that Mr. Small must remain living at Emmaus Place and an early hearing could be held if Mr. Small was ready to move elsewhere, we believed that the need to approve housing was also a basis to retain the detention order. The hospital continues to need to approve Mr. Small’s housing and, as things currently stand, will need to be involved in the planning for any transition out of Emmaus Place. That is evident from the degree to which he currently is supported and supervised, as well as the evidence that his independent living skills are not yet such that he would manage without those supports.
Mr. Schloss also submitted that a Young clause and the other available mechanisms for returning Mr. Small to hospital were adequate to the task of managing Mr. Small’s risk, thus a detention order was not necessary for that purpose. We disagreed. While it is true that in any number of ways Mr. Small could be held in hospital for 72 hours for an assessment, it was less clear he could be held after that. Mr. Small is capable and thus, under the Mental Health Act, only Box A grounds would be available. While the severity of the index offence would be evidence of how high a risk of “serious bodily harm to others” Mr. Small can be, its remoteness in time and the absence of any violent behaviour in the interim would also be considered. Dr. Kolawole was not confident that the MHA would provide him a basis to keep Mr. Small in hospital after the initial assessment period. Other mechanisms are available, but each in their way would take time to implement or would be of uncertain efficacy. We accepted the opinion of Dr. Kolawole that the team needed a detention order to intervene quickly (and with confidence they could keep Mr. Small), in the event of a decompensation.
DATED this 29th day of October 2025, at the City of Toronto, in the Toronto Region.
Leslie Maunder
Alternate Chairperson
Office of the Registrar
Ontario Review Board