Re: Peter Couto
ORB File No: 5061
Hearing held on: Wednesday, November 26, 2025
Place of hearing: Waypoint Centre for Mental Health Care
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. C. Fromstein
Members: Dr. R. Wood Hill
Dr. G. Stones
Ms. J. Mills
Ms. C. Plyley
Parties Appearing:
Accused: Peter Couto
Counsel: Mr. T. Whillier
The Person in charge of Hospital: Representative: Ms. T. Newman
Attorney General of Ontario: Counsel: Ms. S. Curry
REASONS FOR DISPOSITION
(Dated December 15, 2025)
Introduction
On March 4, 2008, Mr. Peter Couto was found not criminally responsible on account of mental disorder on a charge of assault causing bodily harm, contrary to Criminal Code of Canada. He is currently subject to a Disposition dated October 8, 2024, detaining him at the Waypoint Centre for Mental Health Care – High Secure Provincial Forensic Programs, Penetanguishene (‘Waypoint’ or ‘Hospital’).
On November 26, 2025, a panel of the Board convened at Waypoint to review Mr. Couto’s disposition. The purpose of the hearing is to determine if Mr. Couto continues to represent a
significant threat to the safety of the public, and, if so, to create a Disposition that is necessary and appropriate to manage that risk.
At the outset of the hearing, Mr. Whillier, counsel for Mr. Couto, informed the Board that Mr. Couto did not wish to attend the hearing. Mr. Whillier had received instructions to proceed in his absence. There was not a great deal of explanation for the decision other than Mr. Couto did not wish to be disturbed to attend the hearing. He also did not attend the hearing last year. No parties had any objections, and an order was made pursuant to s. 672.5(10)(a) to permit his non-attendance.
The parties provided their initial positions. Ms. Newman, on behalf of the hospital, stated the hospital position is that Mr. Couto remains a significant threat to the safety of the public and there should be no change to his current disposition. Ms. Curry, on behalf of the Crown, agreed. Mr. Whillier indicated that his client supports the hospital position.
At the conclusion of the hearing the Board found, on the evidence before us, that Mr. Couto continues to meet the threshold test of significant threat, and that the necessary and appropriate Disposition is a continuation of his current Disposition without change.
Index Offence
- The circumstances giving rise to the index offence can be summarized as follows: On November 6, 2007, Mr. Couto was an involuntary patient in a rehabilitation unit at Credit Valley Hospital. He repeatedly punched his roommate, who was a 76-year-old male with terminal lung cancer. There had been no apparent provocation. The victim of the assault sustained several cuts to his face and blackening of both eyes. Two nurses witnessed the events and locked themselves in a room, fearing for their safety.
Background
The details of Mr. Couto’s background are set out in the Hospital Report so need not be repeated. Mr. Couto is presently 50 years of age, born February 15, 1975.
Mr. Couto’s current diagnoses set out in the hospital report include Schizoaffective Disorder, Alcohol Use Disorder in sustained remission in a controlled environment and Cannabis Use Disorder in sustained remission in a controlled environment. Dr. Mishra corrected the Hospital Report to add the diagnosis of Major Neurocognitive Disorder with multiple etiologies with behavioural disturbance.
Mr. Couto was first diagnosed with schizophrenia in 1994, having been brought to Peel Memorial Hospital by police after being disruptive at school. He required five-point restraints at that time due to his violent behaviour. When he was 21 years of age, in 1996, his mother reported that Mr. Couto assaulted his brother. Over the years following his diagnosis he showed frequent non-compliance with medication.
Mr. Couto has a lengthy history of alcohol and marijuana use, reflected in his diagnoses.
Mr. Couto also has a history of suicide attempts, including in 2007 wherein he fractured his pelvis and vertebrae after jumping off a balcony.
Following his finding of NCR, Mr. Couto was admitted to the Centre for Addiction and Mental Health (“CAMH”). On June 6, 2008, suddenly and without warning or provocation, he assaulted two co-patients and a female nurse. He was as a result transferred on a Form 1 to Oakridge (now Waypoint). While at Waypoint he continued to experience residual psychotic symptoms, notwithstanding compliance with medication. He often assaulted staff and co-patients without warning.
Mr. Couto received electroconvulsive therapy (ECT) treatments at Oakridge which resulted in significant progress. As a result, he was transferred back to CAMH in July 2015. Unfortunately, there he repeatedly assaulted nursing staff and was returned to Waypoint two months later.
At the time of last year's hearing, Dr. Mishra, his attending psychiatrist, noted that Mr. Couto had shown some improvement with the increase in clozapine dosage. However, despite those circumstances he was deemed not appropriate to have even escorted hospital grounds privileges. A medication assessment was requested as well as a geriatric psychiatric assessment. The geriatric consult took place in December 2024. It recommended an adjustment in his medications, and this was done, with his haloperidol dose being reduced. The consult summarizes that as Mr. Couto’s cognition declines, it can be anticipated that his impulsivity will increase.
The Hospital Report sets out that over the course of the past treatment year, Mr. Couto was transferred in January 2025 from Beckwith A to Awenda A. He has shown periods of clarity while other times shows poor cognitive acuity.
Mr. Couto remains impulsive and has ongoing symptoms of paranoia. He believed people were coming into his room, punching, and raping him and experienced somatic hallucinations. He also experienced auditory hallucinations of voices telling him to fight others. He continued to voice grandiose, paranoid, and persecutory delusions.
In the past year Mr. Couto attempted to strike staff on at least two occasions and effectively assaulted staff and a co-patient three times. He required seclusion on 13 occasions, totalling 25 days, which is an increase from the previous review period.
Mr. Couto resides in a room that is padded which provides enhanced protection from falls or agitation. He has a television in his room. Despite encouragement, he declines group activities and programs. Mr. Couto’s mother calls him on a monthly basis but has not visited at the hospital.
Mr. Couto is generally compliant with treatment and cooperative with the blood monitoring for clozapine. He continues to experience psychotic symptoms despite treatment with three oral antipsychotic medications including clozapine, haloperidol and methotrimeprazine and a long-acting injection of haloperidol decanoate.
It is the unanimous opinion of the clinical treatment team that he continues to represent a significant threat to the safety of the public. His ongoing violence and the need for frequent management with seclusion lead to the unanimous recommendation of his treatment team that he remain at the High Secure Provincial Forensic Program at Waypoint for the coming year with no change to his current disposition.
Dr. Mishra provided testimony. Mr. Couto suffers from schizoaffective disorder and also neurocognitive disorder. He continues to have active symptoms which are somewhat treatment refractory. He shows ongoing violent behaviour on a regular basis which is managed by his environment and the medication. It is the skill of the team being able to spot a change in his behaviour and in de-escalating him quickly which is effective. Absent that, Mr. Couto would cause significant injury to someone. The limiting factor is his frailty and slowness but when agitated, his agitation level is quite extreme.
The team has some limitations because of Mr. Couto’s physical frailty in the amount of medication that they can prescribe. He was given ECT treatments, but this led to significant cognitive problems. When a trial was made with a higher dose of medication, this led to sedation followed by pneumonia and an increased risk in falls.
Mr. Couto does not deal well with confinement in his room. The treatment team seeks to strike the balance between minimizing his social isolation and mitigating his risk to others. He has done better since he moved to the Awenda unit which has less stimulus in the environment. He tried a padded seclusion suite and has chosen to stay there. There are 15 minute checks to see if he wishes to exit. He likes it particularly because of the TV in his room. He had previously broken the two TVs in his other rooms when he got angry. The TV in this room is behind plexiglass and high up. Mr. Couto is very fond of his TV programs. Given the complexity of his risk being imminent and significant, he continues to meet the threshold of significant threat. He cannot for the same reasons be managed in a less secure facility.
Dr. Mishra was asked if Mr. Couto has any insight into his condition. Dr. Mishra responded this is minimal, if at all. Sometimes Mr. Couto will speak to the doctor and at other times, not. There have been times where Mr. Couto shows some awareness of where he is and why he is there, indicating that he has a mental illness and hears voices and sees things, but these are very brief conversations. In the last months Dr. Mishra is not sure if Mr. Couto is fully aware of where he is on a daily basis. He has a very fixed routine which assists him. He does not understand what would be expected of him to progress through the Ontario Review Board system.
Dr. Mishra noted that during the geriatric consultation with Dr. Bingham that the doctor did not disagree with the methods being used. The goal is minimizing Mr. Couto’s medication and using the lowest possible dose without leading to an exacerbation of his psychosis. A behavioural management team has been implemented and this seems to be working as well.
Dr. Mishra was asked where Mr. Couto’s neurological issues stem from seeing that he is only 50 years of age. Dr. Mishra opined that Mr. Couto has a long history of substance use as well as an unhealthy lifestyle. Also, the fact that he had an untreated psychosis for a long time has been a contributing factor to his compromised neurological status. Dr. Mishra added that some effects from clozapine might be contributing but stopping or lowering Mr. Couto’s clozapine dosage has a significant negative effect. That said, Dr. Mishra described Mr. Couto an outlier in terms of the extent of his neurological impairment in consideration of his age.
Mr. Couto has visits from his mother and he maintains a good relationship and brightens up when he sees her.
Submissions
- All the parties maintained their initial positions and had nothing to add.
Analysis and Conclusion
The Board finds unanimously that Mr. Couto remains a significant threat to the safety of the public. The evidence is quite clear that he represents a significant risk of harm based on his continued active symptoms of his mental disorder. Mr. Couto has frequent thoughts of harming others and voices threats, including of sexual assaults on staff and engages in violent behaviour on a regular basis. The team works hard to manage this through closely watching for changes in his behaviour
sand de-escalating him quickly and through managing him by way of the environment and his medication regimen. As Dr. Mishra noted, absent that Mr, Couto would cause significant injury to someone.It is clear from the evidence that the least onerous and least restrictive disposition is one wherein Mr. Couto remains at Waypoint in the High Secure Provincial Forensic Program. He is currently residing in a padded room which he prefers and enjoys because he can access his TV. Because of the setup he has not been able to damage the TV as he did in his past living environments. There are 15-minute checks to see if he wants to leave his room. The treatment team continues to work to balance Mr. Couto’s medication requirements with his physical condition and frailty.
For all of these reasons, we make the disposition requested by all parties, maintaining his current disposition without change. We do so in consideration of the factors set out in s. 672.54 of the Criminal Code.
DATED this 15th day of December 2025, at the City of Toronto, in the Toronto Region.
Ms. C. Fromstein
Alternate Chairperson
Office of the Registrar
Ontario Review Board