Ontario Review Board
Re: Trevaun Brown
ORB File No: 7268
Hearing held on: Wednesday, October 22, 2025
Place of hearing: St. Joseph's Healthcare Hamilton Via Zoom Video Conference
Pursuant to: Section 672.81(2.1) of the Criminal Code
Before:
Alternate Chairperson: Mr. M.D. Segal
Members: Dr. B. Sheppard Dr. G. Stones Mr. D. D’Intino Ms. R. MacIntyre
Parties Appearing:
Accused: Trevaun Brown Counsel: Ms. C. Francis
The person in charge of hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Ms. J. McKenzie
REASONS FOR DECISION
(Dated November 7, 2025)
Introduction
Trevaun Brown was on December 1, 2017, found not criminally responsible on account of mental disorder on charges of utter a threat to cause death or bodily harm (x2), contrary to the Criminal Code. Mr. Brown was subject to Disposition detaining him at the Forensic Psychiatry Program of St. Joseph's Healthcare Hamilton, West 5^th^ Campus (the “hospital”) with privileges up to and including entering the community of Hamilton, accompanied by staff or a person approved by the person in charge. On September 8, 2025, the hospital notified the Ontario Review Board (the “Board”) in writing that because of a significant incident of agitation with aggression and threats to staff on the Harbour North 3 Unit, privileges had been cancelled, and Mr. Brown was placed in seclusion.
On October 22, 2025, a Restriction of Liberty hearing was held virtually from the hospital. Mr. Brown had been criminally charged arising out of the incident. Because of stress and in view of his impending criminal charges, Mr. Brown declined to appear but had provided his counsel, Ms. C. Francis, with instructions. The Board made an order permitting the hearing to proceed in the patient's absence.
The Board had before it as Exhibit 1 a Restriction of Liberty Report dated October 14, 2025, and as Exhibit 2 a Hospital Report dated April 23, 2025, that had been filed at the last annual hearing. The Board also had before it the most recent Reasons for Disposition and most recent Disposition.
In preliminary positions, the hospital, supported by Crown counsel, advanced that the Restriction of Liberty was and continues to be appropriate, necessary and the least restrictive measure that could have been taken in the circumstances. Patient’s counsel conveyed that her client did not agree with all the facts in Exhibit 1 but that her client did acknowledge that his conduct justified the steps that the hospital had taken. By the conclusion of the evidence, and after receiving submissions, the Board agreed that the restriction was justified and appropriate and was the least restrictive measure that the hospital could have taken in the circumstances.
The Restriction of Liberty Report sets out the following facts:
“Mr. Brown was admitted directly to the Harbour North 3 rehabilitation unit. His Detention Order disposition allowed for up to hospital and grounds accompanied passes. During the first half of 2025, Mr. Brown was gradually able to earn off ward privileges which he utilized without incident. Although he was often intrusive and demanding with nursing staff, he was generally redirectable. There were brief periods of agitation in the context of Mr. Brown perceiving his needs were not being met, however he quickly settled with either brief periods in seclusion, or in his room. Although he consistently expressed opposition to his antipsychotic treatment, he was ultimately accepting of same with considerable encouragement from staff. There were no concerns regarding substance use.
On August 29, 2025, Mr. Brown presented as increasingly agitated and aggressive in the context of his perception that he should be discharged from hospital. Multiple attempts at verbal de-escalation were made. Initially, with considerable encouragement Mr. Brown was agreeable to remain in his room for the afternoon period until settled. However, he ultimately exited his room and refused to follow direction from this point onward. Mr. Brown then abruptly charged towards the unit laundry room where staff were forced to barricade themselves for their safety. He then lunged towards the nursing station door, which was held open at the time by a nursing staff who was trying to facilitate the retreat of a number of other nurses who were being targeted by Mr. Brown. Mr. Brown ultimately punched the nursing staff member in the face, before she was able to close the nursing desk door. A code white was called, and multiple security guards and professional staff escorted Mr. Brown to the seclusion suite. However, Mr. Brown continued to refuse to follow direction, and his demeanor remained hostile and aggressive. The High Acuity Transportation Team (HATT) was summoned to assist in transferring Mr. Brown to another room where he was placed in 5-point restraints. He received chemical restraint in pill form which he accepted.
For the next several days, Mr. Brown remained in physical restraints due to ongoing threats toward staff, and a lack of appreciation for the severity of his aggressive actions. On August 31, he was assessed by the on-call psychiatrist. At the time, Mr. Brown had expressed delusional beliefs that nursing staff were lying about his actions and meant to do him harm. He stated his recent aggression was warranted, as he had simply been defending himself from perceived threat.
Between August 31-September 2, Mr. Brown was routinely released from physical restraints to ambulate and attend to personal hygiene, He appeared more willing to follow staff direction, and his confrontational stance towards staff diminished, On September 3, Mr. Brown was transferred out of physical restraints and into the seclusion suite.
Ultimately criminal charges were laid against Mr. Brown in relation to the physical assault as such, arrangements were made to transfer his care to Waterfall 3. Mr. Brown was transferred to the Waterfall 3 rehabilitation unit on September 11.”
Evidence at Hearing
Dr. Wesley Sutton, the patient’s psychiatrist from December 17, 2024, to the September 11, 2025, transfer to the Waterfall 3 rehabilitation unit, testified. Dr. Sutton noted that the patient had been transferred from Waypoint in December of 2024. Initially, Mr. Brown did quite well. Mr. Brown could be intrusive with staff but could be redirected. Mr. Brown gradually earned privileges up to indirectly supervised on hospital grounds.
Dr. Sutton indicated that the events of August 29 came as a surprise as it was abrupt, Mr. Brown was agitated and aggressive and punched a nurse in the face. Dr. Sutton described the events as summarized in the Restriction of Liberty Report above. As context, Mr. Brown is 31, about 6’ 2” or 6’ 3” and solidly built. The incident might have been worse if staff had not succeeded in barricading themselves. Dr. Sutton described the efforts the hospital goes to, to avoid seclusion and restraints, and how steps were taken to lessen those restrictions as soon as practicable. While in seclusion or under restraints, or both, staff constantly observe the patient. In Dr. Sutton’s view the detention was necessary and appropriate.
The Waterfall 3 unit is identical to Harbour 3. There is no additional security in Waterfall 3.
Once released from seclusion, Mr. Brown continued to be preoccupied with staff’s intentions and felt he was unjustifiably detained. He just wanted to return home to be with his mother. His mother does not live in Canada.
Mr. Brown has started to earn back some of his cancelled privileges.
Mr. Brown is incapable to consent to treatment. He is optimally treated. The antipsychotic dose is at a high level. There are other diagnoses that complicate treatment in addition to schizoaffective disorder including antisocial personality disorder and an intellectual disability.
Mr. Brown’s agitation and aggression may have stemmed from his own misplaced belief that he was going to be released into the community. In turn that stemmed from the most recent Disposition. Dr. Sutton agreed that clear and repeated messaging from all staff may help address the patient’s comprehension of his status and the way forward.
Dr. Sutton acknowledged that some patients are prone, especially if intellectually challenged, to misunderstand the distinction between being granted a privilege in a disposition and earning that privilege.
Mr. Brown’s antipsychotic medication contains properties that are meant to temper paranoia and aggression.
Dr. Sutton acknowledged that the transfer to Waterfall 3 could be viewed as terminating the restriction.
Following August 29, the hospital considered a transfer back to Waypoint but the several months of progress prior to that date weighed in favour of maintaining Mr. Brown at St. Joseph's.
Analysis
- The parties agreed that the restriction was both necessary and appropriate following the abrupt appearance of agitation and aggression, culminating in punching a nurse in the face. Matters could have been worse. Thankfully, Mr. Brown has settled, and the hospital has transferred him to Waterfall 3 where he is starting to earn back his cancelled privileges. While it could be said that the restriction stopped on September 11, 2025, when transferred to Waterfall 3, the full range of privileges Mr. Brown had prior to August 29 that were cancelled have not been restored. Assuming the restriction continued past September 11, the ongoing restriction was necessary and appropriate. Taking extra time to explain next steps to Mr. Brown at every turn makes sense. That is important because any repeat of the behaviour that occurred on August 29 would likely result in a request to transfer Mr. Brown back to Waypoint, an undesirable result. We wish Mr. Brown well in the days ahead.
DATED this 7^th^ day of November 2025, at the City of Toronto, in the Region of Toronto.
Mr. M.D. Segal Alternate Chairperson
Office of the Registrar Ontario Review Board