Daniel C. James v. Person in charge of hospital and Attorney General of Ontario, 2025 CanLII 122735

Re: Daniel C. James

ORB File No: 8133

Hearing held on: Thursday, October 9, 2025

Place of hearing: St. Joseph’s Healthcare Hamilton, West 5^th^ Campus Hamilton, Ontario

Pursuant to: Section 672.81(1) of the Criminal Code

Before:

Alternate Chairperson: Mr. P. Capelle

Members: Dr. H. Bloom Dr. A. Kerry Ms. S. Clapp Mr. S. Doherty

Parties Appearing:

Accused: Daniel C. James Counsel: Mr. C. Cornale

The person in charge of hospital: Counsel: Mr. S. O’Brien

Attorney General of Ontario: Counsel: Ms. A. Lepchuk

REASONS FOR DISPOSITION

(Dated November 25, 2025)

Introduction:

1. On August 26, 2022, Daniel C. James was found not criminally responsible on account of mental disorder (“NCR”) on charges of committing an indecent act, criminal harassment (besetting or watching a dwelling house), and utter threat to cause death or bodily harm, contrary to the Criminal Code. He is currently subject to a Disposition of the Ontario Review Board (“ORB” or the “Board”) dated October 22, 2024, whereby he is detained at the Forensic Psychiatry Program at St. Joseph’s Healthcare Hamilton, West 5^th^ Campus (“SJHCH” or the “hospital”) with privileges up to and including community living within the catchment area of the hospital in approved accommodation. He is also required to abstain from substance use, refrain from possessing weapons, and refrain from contacting the victim of the index offences.

2. On October 9, 2025, a panel of the Board convened at SJHCH to conduct Mr. James’ annual review pursuant to section 672.81(1) of the Criminal Code. Mr. James attended the hearing and was represented by counsel, Mr. Cornale.

3. The Hospital Report dated September 25, 2025, was marked as Exhibit 1. In addition to the documentary evidence, Mr. James’ attending psychiatrist, Dr. Sebastien Prat, gave evidence.

4. The issues to be decided at the hearing were whether Mr. James continues to meet the test of posing a significant threat to the safety of the public as set out in section 672.5401 of the Criminal Code, and if so, what is the necessary and appropriate Disposition, taking into account the four factors set out in section 672.54 of the Criminal Code.

Position of the Parties:

5. At the outset of the hearing, the parties were asked for their initial without prejudice positions. On behalf of the hospital, Mr. O’Brien took the position that Mr. James continues to represent a significant threat to the safety of the public, and that a Detention Order with the same terms and conditions as last year remained necessary and appropriate. Ms. Lepchuk supported the position of the hospital on behalf of the Attorney General.

6. Mr. Cornale stated that the issue of significant threat was conceded, but that Mr. James was seeking a Conditional Discharge with the same conditions as the current Detention Order (abstention from substances, no weapons, and no contact), as well as a residence clause (178 King St., Welland, Ontario) and a consent to treatment clause.

7. The parties maintained these positions in closing submissions.

Findings:

8. For the reasons that follow, the panel found that Mr. James continues to pose a significant threat to public safety. The panel concluded that the necessary and appropriate Disposition, which is also the least onerous and least restrictive in the circumstances, is a continuation of the existing Detention Order.

Index Offences:

9. The circumstances of the index offences are set out in detail in the Hospital Report (at pages 3-4) and were summarized in the Psychological Risk Assessment included the 2022 Hospital Report as follows (at page 15 of the Hospital Report):

“The circumstances surrounding the index offence were such that between March and April of 2022, Mr. James was observed by the victim to be masturbating in the park, and he attempted to engage her, asking her name. The victim walked away, but she heard him threaten to kill her and her dog. Within approximately one week, the victim observed Mr. James walking around her apartment building. She indicated that sometimes she saw him staring up at her windows, or calling her derogatory names through the gated alleyway beside her building. This happened on a number of occasions, before the final incident in which the victim saw Mr. James across the street as he watched her and again threatened to kill her. The victim and Mr. James are not previously known to one another.”

10. Mr. James reported that all of the accusations against him were false and he did not know the victim of the index offences.

Background:

11. Mr. James’ personal history is outlined in the Hospital Report in detail and will not be repeated here. In summary, Mr. James is a 36 year old single man with no children. His biological father was not involved in his life. The Hospital Report stated that Mr. James was exposed to extensive family violence between his mother and stepfather between the ages of 2 and 9 years old. Mr. James completed high school and then worked in the restaurant industry, however he often left employment positions because he believed his coworkers were talking about him. Mr. James is currently supported by the Ontario Disability Support Program.

12. The Hospital Report stated that Mr. James’ mother reported that his mental health began declining when he was 18 years old. He started to become more withdrawn and isolated, and believed that others were talking about him and poisoning his food. Mr. James’ mother reported that he had periods of stability when he was compliant with medication and recommendations from the treatment team. He had lived in various independent and supportive housing options within the Niagara region, however prior to the index offences he had been calling the police and reporting false claims about his neighbours.

Criminal History:

13. Mr. James has no prior criminal record.

Psychiatric History:

14. The Hospital Report outlines Mr. James’ psychiatric history prior to the index offences, which began in 2009. Between 2011 and 2016, Mr. James had multiple admissions where he exhibited symptoms including hearing voices, paranoia, delusions, flight of ideas, poor hygiene, and bizarre behaviour. On one occasion Mr. James was brought to the hospital by police after he was found naked walking down the street. His symptoms were often attributed to noncompliance with medication. He was also a regular user of cannabis. Mr. James received diagnoses of Schizophrenia and Marijuana Use Disorder. The Hospital Report stated that Mr. James received periodic outpatient psychiatric follow-up from approximately 2011, and received a long-acting injectable antipsychotic medication until the end of 2021. Mr. James ceased taking any psychiatric medication as of February 2022 and was not receiving treatment at the time of the index offences.

15. The Hospital Report stated that Mr. James was noted to be “profoundly psychotic” upon his admission to the hospital for assessment of his criminal responsibility with multiple grandiose and persecutory delusions. He had no insight into his illness and refused all medications. He threatened staff and was required to be placed in seclusion. Mr. James was found incapable of consenting to treatment.

16. Following the NCR finding, Mr. James continued to be very psychotic, with aggressive, threatening and inappropriate behaviours. Mr. James was compliant with treatment, and over time his delusions become less intrusive and he became more settled. However, he continues to hold bizarre beliefs and delusional thought content, which have been determined to be refractory symptoms. These symptoms can lead to interpersonal conflicts.

17. The Hospital Report stated Mr. James’ current diagnoses as Schizophrenia and Substance Use Disorder (Unspecified) in sustained remission in a controlled setting. Mr. James is incapable of consenting to psychotropic treatment and his mother is his substitute decision-maker. He is capable of managing his finances.

Evidence at the Hearing:

18. The Hospital Report stated that Mr. James was discharged to the community on July 21, 2025. He currently resides in a one-bedroom independent apartment supported by Gateway Residential and Community Support Services. Dr. Prat testified that this was Mr. James’ first choice for housing and it is close to his mother. He is seen by the Forensic Outpatient Team for scheduled appointments twice per week. Due to historic concerns with medication adherence, Mr. James’ medications are observed by a local pharmacy (except Sundays when the pharmacy is closed). There have been no notable incidents since Mr. James’ discharge to the community. He has regular visits with his mother and father at his apartment.

19. The Hospital Report stated that Mr. James continues to demonstrate impaired insight and judgment into his illness, the need for medication, and his involvement with the Forensic Program. He remains delusional, grandiose, and very disorganized at baseline and continues to assert that he was wrongly accused of the index offences.

20. Although Mr. James is capable of managing his property, the Hospital Report stated that this capacity “remains questionable” as he has been noted to struggle with managing his finances and declines assistance from staff.

21. The Hospital Report noted that Mr. James had been offered a subsidized apartment at St. Joseph’s Home Care Program in May 2025, but after the initial transition to this residence Mr. James terminated the opportunity due to the environment and fear for his safety. Dr. Prat testified that Mr. James had an altercation with another tenant and did not feel safe. They tried to resolve the situation but Mr. James was adamant that he would not return there.

22. The Hospital Report stated that the results of the Psychological and Risk Assessment Report dated June 27, 2023 conducted by Dr. Heather Moulden remained valid. That assessment concluded that Mr. James’ risk for violent and sexual recidivism was considered to be in the moderate range on a Detention Order. It also stated that due to ongoing symptoms and limited insight Mr. James was not an appropriate candidate for a Conditional Discharge.

23. The Hospital Report included a discussion of Mr. James’ treatment regimen, and the gradual discontinuation of Valproic Acid earlier this year. It stated that for several months Mr. James’ mental status remained stable with no acute symptoms. However, in February 2025, when they started preparing Mr. James for discharge to the community, “he started displaying more agitation and was more preoccupied with delusional content, such as misrecognizing a baby as being his and believing that his sperm had been transferred to the baby’s mother. He was also of the opinion that a staff member had the ability to communicate with him telepathically. He said that “God sent him messages” to understand what was true and what was not” (at page 51). Olanzapine was subsequently added and these symptoms resolved quickly.

24. The Clinical Risk Summary stated the following about the issue of significant threat and the appropriate disposition (at page 52):

“Mr. James continues to present with several risk factors, including the nature of his mental illness, his lack of insight into the need for treatment, the delusional themes involving random community members, and the agitation associated with these when he becomes acutely psychotic. Moreover, he has been recently discharged into the community, and his compliance with follow-up remains to be tested to ensure long-term stability. The fact that he has continued to request a review of his treatment is indicative that his stability depends on external control. Therefore, I am of the clinical opinion that Mr. James continues to present a significant threat to public safety. His care requires management under a detention order. Based on the acute symptoms he presented over the past year and his inability at that time to consider staff advice, we need to have the ability to bring him back to the hospital rapidly to ensure community safety and prevent further decompensation. A Conditional Discharge would not permit this to be achieved in a timely manner.”

25. Dr. Prat testified that he had been Mr. James’ most responsible physician since October 2024. He stated that Mr. James continues to have ongoing symptoms including chronic delusional ideas, and he has no insight into them. Dr. Prat stated that he and Mr. James have “agreed to disagree” as to whether his beliefs are reality based or not.

26. Dr. Prat stated that Mr. James has a simple lifestyle with no particular goals. He spends time on his computer playing video games, smoking cigarettes and getting groceries with his mother.

27. Dr. Prat reiterated that Mr. James has only been discharged for a few months, and stated that there have been no readmissions or major concerns. Mr. James attends at the pharmacy daily for observation of his oral medication. Although Mr. James has no insight and has requested that this medication be discontinued, he has nonetheless taken it. Mr. James has also attempted to negotiate a change in the pharmacy, but Dr. Prat testified that he does not want to change it at this time because they have developed a rapport with that pharmacy and it forces Mr. James to get out of his apartment on a daily basis.

28. Dr. Prat testified that Mr. James continued to meet the test for significant threat and cited the nature of his mental illness, including that when he is actively psychotic he is agitated, paranoid, and not receptive to feedback as a result of his lack of insight. Dr. Prat also referenced Mr. James’ history of substance use and noted that that would increase the risk of further decompensation. Dr. Prat testified that if he were absolutely discharged, Mr. James is likely to stop taking medication and this would significantly impact his risk.

29. Dr. Prat testified that it is “way too soon” for a Conditional Discharge. He noted that the first attempt at discharging Mr. James to the community had not been successful, and therefore they need to be cautious. Dr. Prat also stated that there remains a risk that Mr. James will not be compliant with his medication, even with the pharmacy observation in place. Dr. Prat hopes to be able to decrease the monitoring by the pharmacy and see how Mr. James does. Dr. Prat testified that the hospital needs to be able to act in a timely manner to readmit Mr. James if there is a decompensation, and only a Detention Order allows for that. Dr. Prat also noted that although Mr. James likes where he lives, it is not close to the hospital.

30. Dr. Prat testified that he hopes to see improved insight from Mr. James in the coming year although he was not convinced that this could be achieved in the short term, if ever. He noted that Mr. James is close to optimally treated, and his delusional thinking is not preventing him from living his life. Dr Prat would also like to see Mr. James have a more structured routine with engagement in activities and therapeutic programming, however Mr. James often finds reasons not to engage. Finally, Dr. Prat stated that Mr. James’ budgeting difficulties could be a major destabilizer.

31. In response to questions from Ms. Lepchuk, Dr. Prat testified that Mr. James can stay in his apartment as long as he is involved in the forensic system. Beyond that he was not sure. He confirmed that Mr. James’ insight into the need for medication is absent. Dr. Prat also stated that Mr. James is unable to recognize stressors, and they continue to learn how he behaves in the community and what impacts him.

32. In response to questions from Mr. Cornale, Dr. Prat acknowledged that Mr. James had not engaged in violence or aggression over the past year, although he did have the period from February to March when he was more psychotic and his comments were concerning. Dr. Prat agreed that Mr. James had been entirely compliant with medication during the reporting year, and stated that although he has no insight he accepts the medication. Dr. Prat added that on one occasion there was a miscommunication with the pharmacy and Mr. James attended at the hospital on his own to get his medication. Dr. Prat testified that it was his opinion that Mr. James’ commitment is entirely external now and that the team needs to be careful and build a strategy to internalize the commitment.

33. Dr. Prat testified that all of Mr. James’ urine drug screens have been negative and his mother is close by and supportive. Mr. James sees the Forensic Outpatient team two to three times per week: once in person at the clinic, and one to two visits in the community. Mr. James is also seen by housing staff and the pharmacy on a daily basis. He also receives his long-acting injectable medication. Dr. Prat agreed that so far there have been no issues with Mr. James missing any of his appointments.

34. Although Dr. Prat conceded that Mr. James would probably take medication if he was on a Conditional Discharge, Dr. Prat maintained that the hospital requires the ability to admit Mr. James quickly, and the ability to approve housing in the event that this placement does not work out. More time is needed to see how Mr. James interacts in the community and address any concerns that may arise. Further, although Mr. James is on a long-acting injectable medication, it was Dr. Prat’s opinion that Mr. James would decompensate quite quickly. He based this opinion on the concerning symptoms that occurred very quickly when the Valproic Acid was discontinued. Dr. Prat stated that it is too early to say that there are no issues with Mr. James’ discharge to the community and they need to act with caution.

35. In response to a question from the panel, Dr. Prat testified that he was concerned that Mr. James may not come back to the hospital voluntarily if asked to do so. Dr. Prat referred to the recent incident where Mr. James held views about God being above everyone, and stated that there was no way that the treatment team could shift his mindset at that time.

36. Dr. Prat agreed that a more dynamic risk assessment related to Mr. James’ sexual recidivism may be appropriate in light of the fact that Mr. James’ psychotic symptoms always involve women. Dr. Prat also agreed that continuing with CBT once Mr. James is settled in the community would be helpful.

37. When asked by a member of the panel about whether Mr. James had ever attended at the hospital voluntarily in the past, Dr. Prat stated that there are often many factors involved in hospitalizations, but the overall pattern was that Mr. James had many relapses and resulting hospitalizations when there was no imposed supervision on him.

38. No further evidence was called by the parties.

Analysis and Conclusions:

39. Based on the Hospital Report and the evidence of Dr. Prat, the panel concluded that there was clear evidence that Mr. James remains a significant threat to public safety. Mr. James’ index offences were just three years ago and involved serious and disturbing events. He has a persistent mental illness and remains symptomatic despite optimal treatment. He has a history of numerous hospitalizations in the context of noncompliance with treatment, and has consistently been found to have no insight into his mental illness, the need for treatment, or the index offences.

40. The panel accepted the opinion contained in the Psychological and Risk Assessment Report dated June 27, 2023 conducted by Dr. Heather Moulden which stated the following (at page 31):

“Absent the oversight of the forensic program, Mr. James’ lack of insight and history suggest he would fall away from treatment, return to substance abuse and discontinue his medications. In this case, his baseline persistent psychosis would intensify, and the nascent behavioural controls and coping, which currently buffer the expression of his symptoms would quickly be eroded. In this case, Mr. James is at risk to engage in verbal, harassing, and threatening behavior based on his grandiose delusions, ideas of reference, and hallucinations, in which others are engaging in wrong-doing or present a threat to him or others in some way. In terms of his sexual risk, while the current assessment made it difficult to formally rule out a paraphilia, given the pattern of behavior over time and since his admission, it may be more likely that his public masturbation is more indicative of significant behavioural disorganization, combined with sexually psychotic content. Given these shared risk factors, another possible risk scenario includes a non-contact sexual offence, similar to the index offence, as a result of untreated mental illness and substance abuse.”

41. The panel found that it was premature to grant a Conditional Discharge at the current time. Although Mr. James has successfully progressed to the point where he was discharged to the community, this discharge was very recent and it remains to be seen how he does with the increased liberties and responsibilities associated with community living. Mr. James continues to experience refractory psychotic symptoms and there is evidence that his mental state is quite susceptible to changes in medication. Mr. James has no insight into his illness, his stressors, or the need for medication. He continues to believe that he has been falsely accused of the index offences. These factors require the hospital to be able to monitor Mr. James carefully and admit him to the hospital quickly if signs of decompensation are noted.

42. The panel noted that Mr. James’ history of psychiatric admissions included a number of instances where he remained symptomatic but requested discharge, and also instances where it was the opinion of the treating psychiatrist that he no longer met the criteria for involuntary hospitalization. This history, along with the evidence that Mr. James’ delusions are persistent and impervious to reason when he is unwell, led the panel to conclude that it was unlikely that he would return to the hospital voluntarily, or that the Mental Health Act would be sufficient to protect the public.

43. Finally, the panel was persuaded that in the event that the current housing placement does not work out, the hospital requires the ability to approve a change in housing.

44. As such, when considering the fours factors set out in section 672.54 of the Criminal Code, the panel concluded that a Detention Order with the same terms and conditions as last year is the necessary and appropriate, and least onerous and least restrictive Disposition for Mr. James at this time.

45. Mr. James is to be commended for his progression in the forensic system to the point that he was recently discharged to the community. He is encouraged to continue engaging with treatment team and their recommendations so that he can continue on this positive trajectory.

DATED this 25^th^ day of November 2025, at the City of Toronto, in the Toronto Region.

Suzanne Clapp

Legal Member

Office of the Registrar

Ontario Review Board