Ontario Review Board
Re: Keegan H. Elliott
ORB File No: 7029
Hearing held on: Friday, September 26, 2025
Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. G. Beasley Members: Dr. T. Verny Dr. R. Chandrasena Ms. K. Tomaszewski Ms. M. McKinnon
Parties Appearing:
Accused: Keegan H. Elliott Counsel: Ms. N.C. Circelli
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. D. Rows
REASONS FOR DISPOSITION
(Dated November 20, 2025)
Introduction
On September 22, 2016, the accused Keegan H. Elliott, was found not criminally responsible on account of mental disorder on charges of assault with a weapon and assault causing bodily harm, contrary to the Criminal Code of Canada. By reason of a Disposition of the Ontario Review Board (“ORB”) dated October 7, 2024, Mr. Elliott was ordered to be detained at the Southwest Centre for Forensic Mental Health Care (“Southwest Centre”), St. Joseph's Health Care London. Mr. Elliott's Disposition included privileges up to residing in the community of Elgin or Middlesex Counties in accommodation approved by the person in charge.
On September 26, 2025, the ORB convened a hearing at Southwest Centre for the purpose of the annual review of Mr. Elliott's Disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. Elliott was in attendance and represented by counsel, Ms. Circelli. Ms. Zamprogna appeared as counsel for the hospital and Mr. Rows as counsel for the Attorney General of Ontario.
Index Offences
- The circumstances of the index offences are taken from the Hospital Report as follows:
“Count 1: Assault with Weapon
On or about the 8th day of May in the year 2016 the city of Windsor in the Southwest Region did, in committing an assault on [victim name], use a weapon, namely a Brick, contrary to section 267, clause (a) of the Criminal Code (CC)
Count 2: Assault cause Bodily Harm
On or about the 8th day of May in the year 2016 at the City of Windsor in the Southwest Region did, in committing an assault on {victim name], cause bodily harm to him, contrary to section 267, clause (b) of the Criminal Code (CC).
The following has been excerpted from the Crown Brief Synopsis:
On Sunday, May 8, 2016, at approximately 3:30 pm [witness names] observed a male party carrying a brick, walking on the sidewalk in the 300 block of Ouellette.
At the same time, [victim name] was parking his bike in front of the House of India, at 325 Ouellette. [Witness names] observed the male with the brick approach [the victim] and strike him in the head with the brick causing [the victim] to fall to the ground. Once on the ground the suspect began to kick [the victim] and was heard to say, "You are trying to kill me, and you are an Assassin". The suspect continued to yell at [the victim] and continued kicking him on the ground. After assaulting [the victim] the suspect walked north on Ouellette.
Windsor Police officers attended and noted that [the victim] had a 1" cut to the right side of the head, a small cut to the left side of the head, and a scrape to the left elbow.
Officers received information from [a witness] that the suspect responsible for the assault on [the victim], was the same male that officers had been dealing with earlier.
Officers had earlier spoken to a male party, identified as the accused as Keegan Elliott, in the 300 block of Ouellette Ave, kicking at cars. [A witness] called the police to report the incident.
After speaking with [witnesses] officers were satisfied that Elliott was the suspect in the assault. [The victim] was blindsided by the assault and did not see Elliott strike him. Elliot was located by officers at the corner of Ouellette and Park and was still in possession of the brick used in the assault.
At 4:10 PM Elliott was placed under arrest for Assault with a Weapon. He was provided his constitutional rights to counsel which he indicated he understood. His identity was confirmed using an MTO driver Inquiry photo.
[The victim] was transported to Hotel Dieu Hospital where he received 7- 10 stitches for the 1" cut on the left side of his head. He did not require further treatment.
Investigators later viewed photos of [the victim's] injuries and determined that Elliott would also be charged with Assault Bodily Harm. An investigator attended the detention unit at Windsor Police Headquarters and advised Elliott that he was also being charged with Assault Bodily Harm. He was provided his constitutional rights to counsel which he indicated he understood.”
Current Diagnoses
- Mr. Elliott's current diagnoses as taken from the Hospital Report are:
Bipolar Disorder, type 1
Cannabis Use Disorder
Neurocognitive Disorder Secondary to Traumatic Brain Injury
Attention Deficit Hyperactivity Disorder (ADHD)
Background and Personal History
Mr. Elliott’s background and personal history are reviewed in the Hospital Report which was filed as an exhibit. Accordingly, there will be no extensive reference to those details in these Reasons. Information from Mr. Elliott's mother described her son as a caring, kind, and active child. At the age of seven, he was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). His initial prescription of Ritalin was cancelled due to an adverse reaction. He was then tried on other ADHD medications which he used sporadically until high school. His mother described an uneventful childhood until the age of 10 which was the onset of his inability to stay still, impulsivity, rage, and aggression towards her. Mr. Elliott had contact with an adolescent psychiatrist commencing at the age of 10. Mr. Elliott was able to complete his high school education and graduated from grade 12. He then returned to school for an additional year with the intention of completing a machinist apprenticeship course, but his substance use eventually led to him dropping out of the program. Mr. Elliott's employment was limited to part-time work as a dishwasher in a restaurant and providing lawn care. Mr. Elliott has not had any significant relationships. As set out in the Hospital Report, Mr. Elliott has a significant history of substance use commencing at the age of 14. He began consuming marijuana at the age of 14 and alcohol at the age of 15. It is suspected that more recently he began to use crystal methamphetamine although this has been denied by Mr. Elliott.
Mr. Elliott has a history of admission to hospital for mental health treatment prior to the commission of the index offences. The first admission was in December of 2014 when he was brought to the hospital by family members. He had been using crystal methamphetamine, expressing suicidal ideation and depression, and was demonstrating psychotic symptoms on assessment. During this admission he assaulted a number of staff and co-patients. On discharge his final diagnosis included “psychosis secondary to drug use; schizophrenic form of psychosis or schizoaffective disorder; possible bipolar mood disorder mixed type with intermittent explosive behaviour.” Mr. Elliott was brought to hospital at Mackenzie Health in Toronto following a psychotic episode at Canada’s Wonderland. A toxicology screen on admission to the hospital was positive for THC. Mr. Elliott was formed under the Mental Health Act (MHA) and transferred to hospital in London. Mr. Elliott had a number of other admissions to hospital prior to the index offences. Typically, these admissions were as a result of or involved violence to others.
Position of the Parties
- At the outset of the hearing, Ms. Zamprogna submitted that Mr. Elliott continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition was the continuation of the current Detention Order with some amendments to the geographical boundaries of his permitted passes. Both Mr. Rows and Ms. Circelli joined the hospital in the recommendation.
Evidence
The evidence on behalf of the hospital was presented by Dr. Quinn. He is Mr. Elliott's attending psychiatrist and the author of the Hospital Report. Dr. Quinn stated that Mr. Elliott has been in and out of hospital over the past reporting year. When Mr. Elliot is in the hospital, he has a better sleep/wake cycle and is typically in a better mood with less paranoia. When living in the community, Mr. Elliott would stop sleeping due to a lack of structure and supervision resulting in increased mood and psychotic symptoms. This in turn led to more reckless behaviours which would result in his return to hospital. Dr. Quinn stated that Mr. Elliott does significantly better from a mental health perspective when he is in the hospital than when he is residing in the community.
Mr. Elliott has demonstrated some modest improvement in his mental status in the hospital. He has historically struggled with simple tasks such as signing in and out of the unit and being in locations where he is not supposed to be. Dr. Quinn said that these behavioural issues and difficulty with boundaries is his baseline. He attributed them to a combination of Mr. Elliott's bipolar disorder and his traumatic brain injury as factors. Dr. Quinn stated that one significant loss for Mr. Elliott was when his mother moved further away from the hospital. This resulted in a change from what had historically been weekly passes to visit with her to once per month. Mr. Elliott is very close with his family and enjoyed those visits. This resulted in more irritability and more inappropriate behaviour.
Dr. Quinn said there had been some changes to Mr. Elliott's medication. As a result of his blunted presentation on olanzapine, it was initially withdrawn. This improved the blunting, but it has now been reintroduced at a lower dosage. Dr. Quinn said that Mr. Elliott's medications are “optimized for his current environment.” Mr. Elliot is compliant with medication and takes them because he is told to. Dr. Quinn said that Mr. Elliott would not be able to manage medication compliance by himself. He expresses great frustration at being “stuck” in the system. Dr. Quinn said that Mr. Elliott does have a behavioural plan and that that level of structure and support is why there is such a difference in his behaviour between the hospital and the community. Mr. Elliott is currently on the waiting list to be accepted by the Dale Brain Injury Clinic for specialized accommodation. Dr. Quinn stated that placement in a residence run by the Dale Brain Injury Clinic would be the optimum plan. Mr. Elliott has been on their waitlist for over a year. The hospital is also looking at the possibility of transitioning Mr. Elliott to a smaller group home, possibly in the Chatham area, so that he can be closer to his family.
Dr. Quinn said that there have not been any issues of substance use while Mr. Elliott has been in the hospital. He has not received any specific counseling for substances and would not be suitable for a residential placement. Substance use is part of the 1:1 counseling that he receives. Dr. Quinn said that he thought that Mr. Elliott would benefit from attending AA in the hospital and the peer support that it provides. However, Mr. Elliott would have to want to engage in that program. Mr. Elliott has acknowledged that the alcohol use which resulted in him ending up in the emergency room at the hospital was a result of his boredom while living in the community. He said that he thought he would “give alcohol a try.”
Dr. Quinn adopted the risk assessment set out in the Hospital Report. He also agreed with the re-offence scenario as set out on pages 68 and 69. Dr. Quinn said that Mr. Elliott follows a pattern when residing in the community. There is no structure to his lifestyle and as a result, he has significant sleep issues. The lack of sleep then results in mood symptoms which develop into paranoia and aggressive behaviour. This results in the significant risk to the safety of others in the community.
Dr. Quinn said that Mr. Elliott does attend the Dale Brain Injury Program once per week at the present time. He also makes use of his approved person passes to go out into the community. Dr. Quinn testified that the hospital must have the ability to approve Mr. Elliott's accommodation and also have the ability to return him quickly to hospital in the event of decompensation in his mental status. He said that the Mental Health Act (MHA) would not be sufficient to safely manage Mr. Elliot in the community.
In response to a question from Mr. Rows, Dr. Quinn stated that the Dale Brain Injury Clinic can manage an individual with both a traumatic brain injury and a diagnosed mental illness. Mr. Elliott was interviewed and accepted by Dale Brain Injury for a residential program and is on a waitlist for their accommodation.
In response to questions from Ms. Circelli, Dr. Quinn stated that in his opinion Mr. Elliott would have a limited awareness of the development of symptoms of decompensation. He is not presently on any waitlists other than for the Dale Brain Injury Clinic accommodation. As stated earlier, Dr. Quinn said that the treatment team are looking for the possibility of transitioning him to a smaller group home, hopefully in the Chatham area. Dr. Quinn said that Mr. Elliott is designated as Alternative Level of Care, meaning that he is ready to go to the community once suitable accommodation is found for him. Dr. Quinn said that Mr. Elliott does have some level of understanding of his need for medication. Dr. Quinn was asked whether or not Mr. Elliott expressed cravings to use substances. Dr. Quinn said that when asked, Mr. Elliott has stated that he would be interested in trying cannabis. Dr. Quinn stated that he does not look at this answer as exhibiting any form of addiction but is more Mr. Elliott's impulsivity and boredom leading him to wanting to try different things.
The Board did not have any questions for Dr. Quinn.
Neither Mr. Rows nor Ms. Circelli called evidence at the hearing.
Submissions
- At the conclusion of the evidence, all counsel reiterated the joint submission made at the outset of the hearing that the necessary and appropriate disposition was a continuation of the current Detention Order with amendments to the geographical area for passes.
Analysis and Disposition
- The threshold issue for the panel to determine is whether or not Mr. Elliott continues to represent a significant threat to the safety of the public. The “significant threat” standard is an onerous one. There must be both a likelihood of a risk materializing and the likelihood that serious harm will occur. An accused is not to be detained based on mere speculation; the Board must be satisfied as to both the existence and gravity of the risk of physical or psychological harm posed by the accused to deny them an absolute discharge. As set out in Winko (1999] 1999 CanLII 694 (SCC), 2 S.C.R. 625) the threat must be:
(1) More than speculative in nature and must be supported by the evidence;
(2) Significant in the sense of there being a real risk of physical or psychological harm to individuals in the community and in the sense that this potential harm must be serious; and
(3) The conduct creating the harm must be criminal in nature.
The Board is unanimous in accepting the joint submission of the parties that Mr. Elliott remains a significant threat to the safety of the public. Mr. Elliott suffers from a major mental illness, a bipolar disorder, which is complicated by the effects of the traumatic brain injury. Historically, when he experienced a decompensation in his mental status, it led to violent behaviour such as in the index offences. While Mr. Elliott is compliant with his medication within the structure and supervision of the hospital, his insight into his need for treatment is poor and underdeveloped. He has a strong history of non-adherence to treatment while living in the community. He also has poor insight into his mental illness and his risk of violence to others. At the present time, his mental health support rests with the treatment team at the hospital. He has been accepted by the Dale Brain Injury Program for treatment and a residential placement but has required significant support to participate meaningfully with them.
The provisions of s. 672.54 of the Criminal Code provide direction to the Board in crafting the necessary and appropriate disposition. The paramount concern is the safety of the public. The Board is unanimous in accepting the opinion of the treatment team that Mr. Elliott cannot be managed under a less restrictive disposition because he requires the high level of supervision offered by the detention disposition, including approving his housing placement and supporting a rapid return to hospital in the event of decompensation. Without supervision he would likely relapse into substance use and become non-adherent with his antipsychotic medication, worsening his symptoms and increasing the risk to the safety of the public. The Mental Health Act would not be sufficient to protect public safety. As set out by Dr. Quinn in his evidence, the treatment team are actively looking for suitable accommodation in a smaller group home for Mr. Elliott, preferably in the Chatham area. As an alternative, Mr. Elliott also remains on the list for accommodation with the Dale Brain Injury Program which could cater both to his traumatic brain injury and his diagnosed mental illness.
DATED this 20th day of November 2025, at the City of Toronto, in the Region of Toronto.
Mr. G. Beasley Alternate Chairperson
Office of the Registrar Ontario Review Board