Re: Alexander N. James
ORB File No: 6594
Hearing held on: Friday, January 10, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Mr. C. Fraser Members: Dr. W. Johnston Dr. T. Stirpe Ms. A. La Viola
Parties Appearing: Accused: Alexander N. James Counsel: Mr. J. Halberstadt
The Person in Charge of Hospital: Counsel: Ms. L. Senko
Attorney General of Ontario: Counsel: Mr. M. Feindel
REASONS FOR DISPOSITION
(Dated February 20, 2025)
Overview
On August 14, 2014, Alexander James was found not criminally responsible (NCR) on the Criminal Code charges of aggravated assault and assaulting a peace officer.
Mr. James is currently subject to a disposition of the Ontario Review Board (the Board) dated January 31, 2024, which detains him at the Centre for Addiction and Mental Health, Toronto (CAMH or the hospital), with the outer limit privilege of living in the community in accommodation approved by the person in charge.
On January 10, 2025, this panel of the Board convened a hearing at CAMH for the annual review of Mr. James’ disposition pursuant to s. 672.81(1) of the Code. Mr. James was present at the hearing and represented by counsel, Mr. Halberstadt. The public member was unavailable (for the day) due to unforeseen circumstances and all parties agreed that we could proceed as a four member panel. We did not foresee an issue with a divided panel in our deliberations.
The issues for the Board to decide at the hearing were first whether Mr. James remains a significant threat to the safety of the public and, if so, what is the necessary and appropriate disposition for the coming year based on a consideration of the factors in s. 672.54 of the Criminal Code.
At the outset of the hearing, the parties were asked for their positions. Hospital counsel recommended a change in the disposition to a conditional discharge with various terms including consenting to treatment and abstaining from substances. Crown counsel supported the hospital position as did counsel for Mr. James. In the result, the Board was presented with a joint recommendation by the parties.
For the reasons which follow, the Board finds Mr. James is a significant threat to the safety the public and the necessary and appropriate disposition for the coming year is the one jointly recommended by the parties, a conditional discharge with various terms to be explained in these Reasons.
Index Offences
- In September 2013, two members of the Toronto Police Service encountered Mr. James who was obstructing traffic by sitting on a curb with his legs extended into the roadway. Police asked Mr. James to move but he ignored them. When they attempted to take control of him so traffic could proceed, he fought the officers. One officer fell to the ground, striking his head and suffering a concussion. The other officer struck his head and suffered seizures resulting in a loss of consciousness. Other police officers attended the scene and were able to take control of Mr. James. At the time, he was uttering that he was God and had been sent by prophets. He had not been taking prescribed medications to control his schizophrenia at the time of the incident.
Background and Course Since Last Hearing
The hospital report dated December 18, 2024 (exhibit 1) details extensively Mr. James’ personal and psychiatric history. This information does not need to be repeated in these Reasons. Some relevant information will be highlighted.
Mr. James is 33 years of age. He has current diagnoses of schizophrenia, in partial remission, and cannabis use disorder, moderate, in partial remission. Mr. James is treatment capable for psychiatric decisions and can manage his financial affairs. He has been under the jurisdiction of the Board for 10 years.
Mr. James was born in Toronto and is the only child of parents who divorced in 2014. Mr. James reported being closer to his mother during his formative years and having a close relationship with his paternal grandmother whom he visited in Jamaica during his childhood.
Mr. James attended two elementary schools. Mr. James graduated high school and attended York University for two years and studied information technology. He was not able to handle increased academic expectations and began failing courses in his second year.
Mr. James does not have a significant employment history. He worked as a courier during his teenage years in the summers and then worked at McDonald’s. When he left university, he worked as a sewing machine operator and then walked off the job after he started hearing voices. He also worked at Mr. Lube and Weed Man at different times and a local hotel. His most recent full-time employment was as a general labourer in a small shop which produced metal products, a position he left in 2022 following a self-reported head injury. He is currently financially supported by Ontario Disability Support Program benefits.
Mr. James is single with no children.
Mr. James’ psychiatric history is detailed in the hospital report at pages 7 to 12. He was first diagnosed with schizophrenia in 2013 prior to the commission of the index offences.
Mr. James had several brief admissions to hospital in 2013 due to bizarre and disorganized behaviour. Mr. James has no criminal record or convictions. He has had police contacts, but these were in the period prior to the commission of the index offences. The details of these contacts are referred to in the hospital report at pages 13 to 15. It does not appear that criminal charges resulted from these interactions. The police were involved with Mr. James due to him exhibiting odd behaviour in public settings.
Mr. James began drinking alcohol at age 17 and reported first using marijuana at age 18. Over time his cannabis use became chronic. He reported that he stopped using cannabis in 2014 because he did not want to “relapse”. Unfortunately, he returned to substance use over the 2017 period leading to a return of acute psychosis.
In 2018, his condition appeared to have improved. His drug tests were negative for cannabis, although positive for alcohol. He was medication compliant, more engaged in employment and socially active, and pursued adult education. He had insight into his condition (hospital report, pages 24 and following). The Board continued to order his discharge on conditions. He appeared to be on a positive trajectory.
In January of 2021, around the time of his move to an independent apartment, there was a negative change in his attitude toward the treatment team. He viewed them with suspicion, became covertly non-compliant with medication, and by the end of March was displaying “prominent irritability, paranoia and thought disorder” (hospital report, page 28). He was still not violent or aggressive and did not require readmission to hospital.
He also believed that the modest use of alcohol, cannabis or other psychoactive substances would not have any significant impact upon his mental health. He lacked awareness of the symptoms of early psychosis and did not accept the recommendations of his treatment team. He believed that he did not require support to maintain his mental health. He did not engage in programming, nor have employment or educational pursuits. Considering this regression, in 2023, the hospital believed that Mr. James’ risk to the safety of the public had increased and recommended that the conditional discharge be replaced by a detention order, subject to community living privileges. As noted above, the Board made this order.
In January of 2023, Mr. James moved back to his mother’s apartment, but did not inform the treatment team. He indicated the move was necessary as he could not afford his apartment. He left his employment and was on a waiting list for accommodation. He did engage in some programming. Mr. James had to be seen by the treatment team more frequently due to a deterioration in his condition.
Mr. James also was consuming alcohol and gave inconsistent answers when queried about cannabis consumption. There were indications of use, separate from his inconsistent admissions. Mr. James was also not forthright with the treatment team. For example, his mother had gone to Florida to attend to family matters in November 2023, but this was not disclosed. He was misleading when asked more directly about the team contacting his mother. Finally, it was admitted she would not be returning to Canada until well into January 2024. He was not interested in obtaining employment. He spent most of his time watching television, or writing.
As noted in the hospital report, Mr. James has not required hospitalization in the past year and has not been a behavioural or management problem in the community. He has not engaged in violence, aggression or any concerning behaviours. He has complied with all reporting requirements. He has been medication compliant, and his psychosis remains in partial remission. He has not consumed substances. As noted, his daytime activities and routine remain limited and unstructured.
Evidence at the Hearing
Dr. Swayze gave the evidence for the hospital at the hearing. The doctor had no updates to provide since the preparation of the hospital report.
The doctor was asked why a conditional discharge is now appropriate for Mr. James. The doctor advised that overall Mr. James has had a good year with notable greater co-operation with the treatment team and engagement. Mr. James still experiences residual psychosis; however, he has been co-operative for several months augmenting his intramuscular antipsychotic with oral medication. The doctor said Mr. James has co-operated fully and his insight has improved far beyond what it was in the past. This is in understanding his mental illness as well as the need for medication.
Dr. Swayze described the residual symptoms of the schizophrenia illness as mild to moderate and impacting more the negative symptoms rather than observing any positive symptoms such as delusions or hallucinations. These are not present.
The doctor was asked if Mr. James would likely attend the hospital voluntarily should the need arise because of mental status decompensation in the coming year. The doctor was confident that Mr. James would attend the hospital if asked to do so and would agree to a readmission voluntarily if asked by the team.
Mr. James continues to reside with his mother in a one-bedroom apartment and the hospital report mentions a possible move by his mother from this location. The doctor clarified that this situation remains in flux and that the mother was thinking of moving due to financial difficulties. The doctor said there is portable funding available through York Region that would follow Mr. James if his housing situation became precarious, at least in the short term. It is the opinion of Dr. Swayze that the hospital does not need to approve housing.
In response to questions from Crown counsel, the doctor clarified that Mr. James attends at the pharmacy every day to receive his oral antipsychotic medication (except Sunday).
Mr. James is currently reporting not less than once a month. In fact, the case co-ordinator has more regular contact with Mr. James, and she attends at the residence more frequently when Mr. James’ mother is traveling. Mr. James receives his intramuscular medication every 12 weeks.
Mr. James also attends a music group every Monday at the hospital.
In all the circumstances, Dr. Swayze was satisfied that there is no need to increase the reporting from what is currently in the disposition as there is frequent contact with Mr. James apart from when the doctor sees him.
The doctor was asked by counsel for Mr. James what is required to move Mr. James towards an absolute discharge. The doctor said the path is to continue to fully engage with the treatment team and to make gains which will establish a solid foundation for a stable mental status. This will give confidence to the treatment team to recommend an absolute discharge in the future.
No other evidence was called at the hearing.
In final submissions all the parties maintained their original positions from the outset, which was a joint recommendation to the Board, with one caveat. Crown counsel submitted that the reporting condition should be more frequent as this would lessen the amount of unstructured time for Mr. James and also facilitate the hospital keeping eyes on him.
Analysis and Conclusion
The Board finds Mr. James is a significant threat to the safety of the public based on s. 672.5401, and Winko, and its related authorities.
The Board notes that the parties did not contest a finding of significant threat. Despite this, the Board makes its own finding of significant threat to the safety of the public based on the expert evidence of Dr. Swayze, as supplemented by the hospital report.
Mr. James suffers from a major mental illness, schizophrenia, which is partially treatment resistant. Mr. James still exhibits residual symptoms (negative) of the illness. As noted, overall, this has been a positive year for Mr. James but in the past, he has been medication noncompliant and not forthright with the treatment team, exhibiting limited insight into his illness and the adverse effects of substance use, especially cannabis and alcohol. The Board notes that Mr. James has a limited support network and much of his time is unstructured. If psychotic, Mr. James is unable to appreciate that he is suffering from the symptoms of a mental disorder.
The Board agrees with and adopts the re-offence scenario that is described in the hospital report at page 46 as follows:
“If Mr. James is to reoffend, this will likely occur in the context of variable/noncompliance with his antipsychotic, exposure to destabilizers and stressors to which Mr. James has limited supports, the return to his historical pattern of the use of cannabis and psychoactive agents and the acute exacerbation of psychosis. While psychotic, Mr. James has engaged in violent behaviours such as those at the time of the index offences.
Mr. James experienced such a scenario in the spring of 2017, consuming cannabis and alcohol, precipitating psychosis and most recently the spring and summer of 2022 in the form of significant thought disorder with disorganization; this appeared to correlate with substantive stressors and modest alcohol use. While psychotic, Mr. James is unable to appreciate that he is suffering from symptoms of a mental disorder and appropriately seek out treatment and professional support.”
Mr. James is considered a low moderate risk for violent recidivism as scored on the HCR-20 version 3 in the past reporting year.
Based on the foregoing, the Board makes a positive finding of significant threat to the safety of the public.
The Board agrees that a conditional discharge disposition is necessary and appropriate for Mr. James in the coming year. The Board accepts the evidence of Dr. Swayze that there has been a marked change in Mr. James during the past reporting year. Mr. James is more engaged with the treatment team and there is a noted improvement in his overall insight.
The Board does not agree with the reporting condition recommended by the Crown (not less than two times per month). The Board accepts the evidence of Dr. Swayze that it is not required as currently there are several contacts with Mr. James during a one month period including home visits by his case co-ordinator and his attendance at the music group at the hospital every Monday. This is in addition to Dr. Swayze's regular contact with Mr. James.
In summary, the terms of the conditional discharge will be to report not less than once per month, abstain from alcohol and drugs, submit samples to test for same, a weapons prohibition, consent to take treatment, and on arrest for a breach, to be returned to hospital under s. 672.92(1)(b) of the Criminal Code. The travel term will read not to travel outside the province of Ontario without an itinerary approved in advance by the person in charge.
In arriving at our conclusion, the Board has considered the paramount factor of the safety of the public, Mr. James’ mental condition, his community reintegration, and his other needs, all as required by s. 672.54 of the Criminal Code.
A disposition will issue accordingly.
DATED this 20th day of February 2025, at the City of Toronto, in the Toronto Region.
Mr. C. Fraser Alternate Chairperson
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Office of the Registrar Ontario Review Board