Ontario Review Board
Re: Patrick Alejandrino
ORB File No: 8244
Hearing held on: Friday, October 10, 2025
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Sections 672.81(1) and 672.81(2.1) of the Criminal Code
Before:
Alternate Chairperson: Ms. L. Banks
Members: Hon. C. Nelson Dr. L.E. Cappe Dr. J.C. Rose Mr. J. Cyr
Parties Appearing:
Accused: Patrick Alejandrino Counsel: Ms. M. Addie
The Person in charge of Hospital: Representative: Dr. R. McMaster
Attorney General of Ontario: Counsel: Ms. S. Cressman
REASONS FOR DISPOSITION
(Dated November 12, 2025)
Introduction:
[1]. On February 2, 2023, Patrick Alejandrino was found not criminally responsible (“NCR”) on charges of assault (x2), assault causing bodily harm, theft under and fail to attend court, all contrary to the Criminal Code of Canada (“Criminal Code”).
[2]. Mr. Alejandrino is currently subject to an Ontario Review Board (“the Board”) disposition dated July 24, 2024, which detains him at the Forensic Service of Centre for Addiction and Mental Health (“CAMH” and “the Hospital”) with privileges up to and including the ability to live in the community in accommodations approved by the person in charge.
[3]. On October 10, 2025, a panel of the Board convened at CAMH to conduct an annual review, pursuant to section 672.81(1) of the Criminal Code. All parties appeared in person. Mr. Alejandrino was represented by his counsel, Ms. M. Addie.
[4]. On August 14, 2025, the Board received a letter of Sham Hishmeh, Manager, Office of the Person in Charge, advising of a restriction of liberty commencing August 6, 2025. Therefore, the Board panel also convened to review the restriction of Mr. Alejandrino’s liberty pursuant to s. 672.81(2.1) of the Criminal Code.
[5]. The issues to be determined by the Board were whether Mr. Alejandrino constitutes a significant threat to the safety of the public as defined in section 672.54 of the Criminal Code and as further defined in the Supreme Court of Canada's decision in Winko, 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625. In the event of a positive finding of a significant threat, the secondary issue to be determined is what is the necessary and appropriate disposition, which is also the least onerous and least restrictive, taking into account the factors set out in section 672.54 of the Criminal Code.
[6]. The further issue at this hearing is whether the hospital’s decision to increase the restrictions on Mr. Alejandrino’s liberty was warranted, necessary and appropriate at the date of onset, August 6, 2025, and whether it continues to be so as of the date of this hearing.
[7]. At the outset of the hearing, the Hospital recommended that the current detention order be continued without change to its terms and conditions. Additionally, the Hospital opined that the restriction of liberty, beginning on August 6, 2025 (and still in effect at the hearing), was warranted, necessary and appropriate. Both Ms. Cressman and Ms. Addie joined the Hospital’s position.
Findings:
[8]. For the Reasons that follow, the Board found that the statutory threshold for significant threat is met. The Board finds that the necessary and appropriate disposition is to continue the current detention order, with no changes to its terms and conditions.
[9]. The Board further finds that the significant restriction of Mr. Alejandrino’s liberty was necessary and appropriate, and the least onerous and least restrictive measure from the time it was imposed through to the date of this hearing.
Index Offences:
[10]. The index offences as they appeared in last year’s Reasons are as follows:
On Thursday, October 14, 2021, at approximately 10:26 am, the victim, [name removed], was sitting on the curb just north of [address removed], Toronto, on the west side, while waiting for the TTC bus. While sitting on the curb the accused; ALEJANDRINO, Patrick DOB 1992.07.20 suddenly appears directly in front of the victim punching and shuffling back in forth in what the victim described as shadow boxing in very close range to the victim. This action by the accused caused the victim to feel uncomfortable and in an attempt to avoid the suspect the victim stood to his feet and walked north bound on Sherbourne Street to stand at the bus stop.
The accused follows the victim and once again begins punching at the air while shuffling back and forth this time much closer to the victim. The victim jolts back to dodge the punches by the accused which causes him to loose his balance and fall onto the ground. The accused mounts the victim and punches him in the face at least twice that the victim recalls. The victim had a five dollar bill in his hand which he was going to use to pay for transit which the accused abruptly took from the victims hand.
With the five-dollar bill taken from the victim, the accused gets up and walks to the TD bank located at [address removed] and lingers in the vestibule.
Toronto Police Officers arrive on scene and are able to quickly gather the details from the victim and a witness, with the assistance of the witness officers located the accused in the vestibule of the TD bank.
The accused is subsequently arrested and transported to 51 Division where he was released on a from 10 promise to appear.
On Thursday October 14, 2021 shortly before 8:00 pm the victim was walking southbound on Parliament St. approaching Front St. E. in the City of Toronto. The accused blocked the victim's path and began to mumble at her incoherently. The victim asked the accused to leave her alone when he proceeded to kick her in the stomach. The victim attempted to cross the street to seek assistance from Toronto Police 51 Division, however the accused again blocked her path. A passerby intervened and assisted the victim in being able to escape the accused and call the police station for help.
Officers located the accused out front of the police station and placed him under arrest. The accused was given his rights to counsel and held for a show cause hearing.
No injuries were sustained by the victim during this incident
On Monday July 25, 2022 the accused and victim were at the St. George Subway Station located at [address removed] Toronto, Ontario. At this time the victim was heading downstairs to catch a subway train when he was approached by the accused and punched in the face for unknown reasons. The victim managed to hold the accused down until TTC Special Constables arrived and arrested the accused.
The accused was transported to 53 Division where he was held pending a show cause hearing. Injuries: The victim sustained a 2 inch laceration above his left eye.
Mr. Alejandrino’s History and Current Circumstances:
[11]. The Hospital Report (Exhibit 1) contains considerable information with respect to Mr. Alejandrino’s personal, educational, medical, and psychiatric background and should be referred to for details. The following was carried forward from last year’s Reasons.
[12]. Mr. Alejandrino is a 33-year-old man of Filipino-Irish descent born and raised in Toronto. His parents divorced when he was an infant. His mother primarily raised him until she passed away when he was 13 years old. He continued to live with his stepfather until age 18, when he moved in with a friend and his godmother.
[13]. Mr. Alejandrino reported that he was kicked out of his family friend’s home due to a physical altercation. He began accessing the shelter system, staying predominantly at Turning Point Youth Shelter, where he was connected with Dr. Mitesh Patel, who became the mainstay of Mr. Alejandrino’s early mental health treatment. Dr. Patel provided prescriptions and assisted with an ODSP application. It was reported by Turning Point staff that Mr. Alejandrino did not demonstrate any issues with violence or aggression during his time there. Mr. Alejandrino moved to Bedford Residence after aging out of Turning Point but reported that he was asked to leave this residence after punching a TV and not being able to pay for the damages.
[14]. Mr. Alejandrino started smoking marijuana at 11 years old, using an average of three grams per day. During a psychological assessment at CAMH, he endorsed lifetime use of tobacco products, alcohol, cannabis, cocaine, amphetamines, inhalants, sedatives and opioids. Mr. Alejandrino’s self-report about the quantity of his cannabis use differed from previous reports, revealing that his smoking had escalated up to seven grams daily in his 20s. He admitted that his substance use has strained interpersonal relationships and has led to legal difficulties, vocational failures, and financial hardship.
[15]. Mr. Alejandrino began to experience mental health issues in late adolescence, beginning with depression after his mother died. His first hospitalization resulted from a presentation to the Emergency Department of North York General Hospital in 2010. His behaviour was bizarre. He expressed delusions and paranoid ideation about his financial trustee, including “thoughts of killing her as well as thoughts of hurting somebody else.”
[16]. Throughout several further contacts with the civil mental health system, Mr. Alejandrino’s presentation was often noted to be exacerbated by, if not primarily caused by, his chronic use of cannabis, and he was inconsistently compliant with medication. While incarcerated at the Toronto South Detention Centre, Mr. Alejandrino was connected with CAMH’s Forensic Early Intervention Service (FEIS) before transfer to Ontario Shores Centre for Mental Health Sciences (“Ontario Shores) for an NCR assessment. He was admitted on a subtherapeutic dose of olanzapine, 5mg oral daily, but did not present with any mood or psychotic symptoms, as was consistent with clinical notes from FEIS.
[17]. To assist with diagnostic clarification, Mr. Alejandrino’s olanzapine was further decreased to 2.5mg, and no psychotic symptoms emerged. He did not demonstrate any verbal or physical aggression and successfully engaged in recreational groups. He was advised to abstain from all substance use in perpetuity as his psychosis appeared to flow directly from his substance use.
[18]. Mr. Alejandrino has no criminal record.
Course since previous hearing:
[19]. On September 16, 2024, Mr. Alejandrino was discharged to CAMH’s Transitional Rehabilitation Housing Program – 2 (TRHP-2), which is located near the hospital. He resided at TRHP-2 without issue for the remainder of the reporting year until an unexpected unauthorized leave from his residence on July 20, 2025.
[20]. Before the unauthorized leave, Mr. Alejandrino met all his reporting requirements, and there were no critical incidents. At TRHP-2, he completed all his chores on assigned days, without prompting and had no issues meeting his curfew.
[21]. He demonstrated good insight into the connection between his circumstances surrounding the index offence, including homelessness and substance use, and their impact on his mental health.
[22]. Mr. Alejandrino demonstrated strong insight into his illness and viewed his medication as very helpful in managing his symptoms. He has demonstrated openness to receiving support and psychoeducation related to stress management. He also attended bi-weekly meetings with Dr. Pauls (psychologist) until November 2024, although these stopped after Dr. Pauls left the organization. He attended CBT stress and coping and Mindfulness as an inpatient.
[23]. All urine drug screens completed during the current reporting year have been negative for substances and alcohol.
[24]. On July 19, 2025, Mr. Alejandrino signed in for curfew; however, he was not observed by staff the following day, and TRHP-2 residents also stated that they had not seen him. A missing person report was filed with the Toronto Police Service.
Current Diagnoses:
[25]. Mr. Alejandrino’s diagnoses at the time of the hearing included schizophrenia (rule out cannabis induced psychosis) and cannabis use disorder.
Evidence at the hearing:
[26]. In addition to the Hospital Report the Board heard oral evidence from Mr. Alejandrino’s attending forensic psychiatrist, Dr. R. McMaster.
[27]. Dr. McMaster testified that, apart from the recent period of unauthorized leave described below, Mr. Alejandrino has had an excellent reporting year. He has a good rapport with the team and was progressing toward being transitioned to a less supervised community housing.
[28]. Regarding the AWOL episode referred to above, on July 19, 2025, Mr. Alejandrino eloped from his community residence. The Hospital was not aware of Mr. Alejandrino’s whereabouts until he presented himself to the CAMH Forensic Outpatient department on August 6, 2025. Staff instructed him to attend the CAMH emergency department for assessment and admission to the hospital.
[29]. During the unauthorized leave, Mr. Alejandrino experienced homelessness, stayed in stairwells, and used cannabis on multiple occasions. Upon his return to the hospital, he exhibited increased disorganization and delusional content, including nihilistic beliefs about dying if he remained at his residence. However, Dr. McMaster noted that Mr. Alejandrino has also stated that he eloped because of a desire to use cannabis.
[30]. Initially, Mr. Alejandrino was admitted to a Critical Care and Crisis Unit (CCC), a civil mental health unit, until his eventual transfer to the schizophrenia unit, which is also a civil mental health unit. Dr. Horwitz became Mr. Alejandrino’s inpatient treating psychiatrist following his transfer to the schizophrenia unit. Dr. Horwitz and his team observed Mr. Alejandrino to be off his baseline, likely due to extensive cannabis use, and he was exhibiting depressive symptoms. As a result, he was started on an antidepressant and his Invega Trinza injection was increased from 350mg to 525mg. Following medication adjustments, Mr. Alejandrino showed improvement in his mental state, becoming more organized and reflective about what happened.
[31]. Mr. Alexandrino has been cooperating with staff during his inpatient stay, with no major or critical incidents. The forensic outpatient team conducted several assessments throughout the hospitalization, and Dr. McMaster has consulted with Dr. Horwitz. It is noted that Mr. Alejandrino’s insight and motivation to abstain from cannabis have increased. He has been participating in relevant programming and has started passes on hospital grounds as preparation for discharge.
[32]. Dr. McMaster confirmed that Mr. Alejandrino’s bed in TRHP 2 housing has been maintained. At the time of the hearing, the forensic treatment team (in consultation with Dr. Horwitz’s team) was planning to discharge Mr. Alejandrino back to his community residence. In preparation for discharge, Mr. Alejandrino will be given indirectly supervised community passes early next week. If everything goes well, it is anticipated that he will be discharged as early as next week.
[33]. The doctor testified that the treatment team determined that Mr. Alejandrino’s residual symptoms do not elevate risk to public safety at this juncture. Dr. McMaster expressed that maintaining Mr. Alejandrino in the hospital with indirectly supervised passes would not meaningfully change his risk profile. The recent increase in antipsychotic medication provides reassurance about an ongoing positive trajectory, as Mr. Alejandrino has responded well to this medication in the past. In response to a question from a panel member about whether Mr. A had returned to his baseline presentation, the doctor advised that “he was close but not yet there” because of his residual symptoms of psychosis. He continues to express odd beliefs about the necessity for sun exposure in order to live, as well as nihilistic beliefs about death and perceptual abnormalities, including auditory hallucinations.
[34]. Dr. McMaster was uncertain about whether decompensation preceded the unauthorized leave or resulted from cannabis use. He expressed his opinion that strong motivation to use cannabis likely contributed to the unauthorized leave. Mr. Alejandrino’s narrative about the leave has not been entirely consistent, though this may also be explainable by his psychosis and disorganization. He confirmed that Mr. Alejandrino has since demonstrated insight that he must remain at his community residence and not take another unauthorized leave.
[35]. No further evidence was called.
Final Submissions of the Parties:
[36]. All parties maintained their initial joint recommendation to the Board in final submissions.
Analysis and Conclusions:
The restriction of Liberties
[37]. The analytical framework established by Campbell (Re), 2018 ONCA 140, requires the Board to consider the liberty norm and the liberty status of an accused in a restriction-of-liberty case. The liberty norm and liberty status for each restriction must be examined to determine the significance of the increase (if any) on the restriction of an accused’s liberty caused by the restriction. In determining the liberty norm of an accused at the outset of each period of restriction, the Board must “take a contextual approach, one that considers the individual’s pattern of liberty in the recent past.” ((Re) Campbell, ibid at para. 66). The liberty she/he was actually experiencing (rather than what she/he was entitled to) at the time of the increase is what the Board is to consider, and that “liberty must be of sufficient duration to have become, objectively speaking, the NCR accused’s norm” ((Re) Campbell, supra at para. 65).
[38]. Pursuant to the decision of (Re) Campbell, the Board agreed that a restriction of liberty had taken place. Before his readmission to the hospital, Mr. Alejandrino resided in the community and had the option to leave his residence and enter the community under indirect supervision. Following his re-admission, Mr. Alejandrino had no indirectly supervised community access and was unable to live in the community. The Board found that the restrictions of liberty placed upon Mr. Alejandrino, beginning on August 6, 2025, with his admission to a CCC unit, and continuing to the date of the hearing, represented the least onerous and least restrictive intervention in the circumstances.
[39]. Mr. Alejandrino breached his Disposition by absconding from his community residence and he did not inform his housing staff or his forensic team of his whereabouts. While AWOL, he engaged in substance use and experienced homelessness. He presented with active psychotic symptoms when he returned to the hospital on August 6, 2025, which necessitated admission for stabilization. Indeed, medication adjustments were required to return Mr. Alejandrino to his baseline. At the time of the hearing, he continued to reside in the hospital and was engaging in a structured discharge plan. There was no alternative intervention for the hospital to consider at that time.
Significant Threat
[40]. Ongoing significant risk to the safety of the public cannot be speculative. It must entail a real risk of serious physical or psychological harm arising from conduct that is both serious and criminal in nature. In determining whether Mr. Alejandro continues to pose a significant threat to public safety, the Board has carefully analyzed the evidence in relation to s. 672.5401 of the Criminal Code of Canada and as further defined in the Supreme Court of Canada's decision in Winko, 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625.
[41]. Based on the evidence, the Board unanimously finds that the test for significant threat has been met. The Board relies on the expert opinion of Dr. McMaster and the Hospital Report in arriving at its independent conclusion. Mr. Alejandrino lives with a psychotic disorder, schizophrenia, and recently experienced a relapse of symptoms in the context of cannabis use. Psychotic symptoms and substance use relapses were precipitated by an unauthorized absence from his community residence.
[42]. As outlined in the reoffence scenario on page 39 of the Hospital Report, we accept that:
If Mr. Alejandrino were to reoffend, it would likely be in the context of psychotic symptoms exacerbated by substance use. In the absence of external monitoring, he will likely disengage with services, use substances and become non-adherent with medication, which will increase his risk of relapsing into a psychotic episode, similar to his mental state at the time of the index offence.
The necessary and appropriate Disposition
[43]. Flowing from the Board’s finding that Mr. Alejandrino continues to pose a significant threat to public safety, it must shape a Disposition for the year ahead. It’s paramount consideration in doing so must be the safety of the public, while also considering Mr. Alejandrino’s needs pursuant to s. 672.54 of the Criminal Code of Canada. The necessary and appropriate disposition for Mr. Alejandrino provides him as much freedom as possible without subjecting the community to a real risk of dangerous behaviour.
[44]. The Board agrees with the joint position before us. The evidence before us indicates that a continuation of the current detention order, with no changes, remains necessary and appropriate, as well as the least onerous and least restrictive disposition. Upon his return from his recent unauthorized absence from July 20 to August 6, 2025, Mr. Alejandrino presented with active symptoms requiring stabilization. His symptoms also reflected nihilistic delusions associated with his housing. Collectively, this demonstrates that the Hospital continues to require the authority of a detention order to readmit Mr. Alejandrino to the hospital, as well as the ability to approve his accommodations.
[45]. Accordingly, considering public safety, which is paramount, as well as Mr. Alejandriono’s mental health, his reintegration into the community, and his other needs, we agree that a continuation of the current detention disposition is the necessary and appropriate disposition for the coming year, and so order.
DATED this 12th day of November, 2025, at the City of Toronto, in the Toronto Region.
J. Christine Rose, Ph.D., C.Psych.
Psychologist Member
Office of the Registrar
Ontario Review Board