Re: Tjerk Oosterhof
ORB File No: 6726
Hearing Held On: Wednesday, January 8, 2025
Place of Hearing: Centre for Addiction and Mental Health
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
Ms. R. Chopra
Parties Appearing:
Accused: Tjerk Oosterhof
Counsel: Ms. M. Addie
Person in charge of Hospital: Representative: Ms. L. Senko
Attorney-General of Ontario: Counsel: Mr. M. Feindel
REASONS FOR DISPOSITION
(Dated February 18, 2025)
OVERVIEW
- On March 30, 2015, Tjerk Oosterhof was found not criminally responsible on account of mental disorder on charges of theft exceeding $5000, mischief not exceeding $5000, uttering a threat to cause death or bodily harm, using an imitation firearm while committing an indictable offence, assault with a weapon, and assault, all contrary to the Criminal Code. Mr. Oosterhof’s last annual review was conducted on November 1, 2023. He is currently subject to a disposition of the Ontario Review Board dated November 16, 2023, which detains him at the Centre for Mental Health and Addiction – Forensic Service (CAMH), with a term that permits him to live in the community in supervised accommodation approved by the person in charge, and his residence is the high intensity behavioural unit at the Baycrest Centre in Toronto.
ISSUES
On January 8, 2025, the Board convened at CAMH for a mandatory review of the disposition further to s. 672.81(1) of the Criminal Code. The issue before the Board was to determine whether Mr. Oosterhof continues to pose a significant threat to the safety of the public and, accordingly, to determine the necessary and appropriate disposition for him consistent with the factors set out in s. 672.54 of the Criminal Code. Mr. Oosterhof did not attend the hearing, he was represented by Counsel, Ms. Addie, with instructions to proceed in his absence. An order permitting him to be absent from the hearing was issued according to s. 672.5(10)(a) of the Criminal Code.
The Hospital asked the Board to conclude that Mr. Oosterhof continues to represent a significant threat to the safety of the public, and a Detention Order remains necessary, as already set out in his current disposition, with no change. Counsel for the Attorney General agreed with the Hospital’s recommendation, joined by Counsel, Ms. Addie, also in agreement with the Hospital’s recommendation, conceding the issue of ‘significant threat’, and a joint position was put forward for the Board’s consideration.
FINDINGS
- After reviewing the evidence, the Board concluded that Mr. Oosterhof continues to represent a significant threat to the safety of the public. His level of insight is very little. He suffers from Schizophrenia and his diagnosis of Major Neurocognitive Disorder, with the recently added features of Dementia, which combined, impedes his insight into his mental status, contributing to both behavioural and cognitive challenges. His treatment plan includes the appropriate level of monitoring and supervision, which is required at this time. For the reasons that follow in more detail below, the Board concluded that a Detention Order is necessary and appropriate in the circumstances.
PERSONAL BACKGROUND
The Hospital Report dated December 9, 2024, was entered as an exhibit at the hearing. The following background information, including the events surrounding the 2013 index offences, has been taken from the Report, summarized here as follows.
Mr. Oosterhof was arrested under the Mental Health Act on May 10, 2013, for throwing beer bottles from his balcony. He had a caregiver until about five weeks prior, after which his behaviour worsened. He was arrested again on May 11, 2013, for possessing a concealed knife and attempting to incite a co-accused to stab a victim. The victim reported multiple incidents of harassment, including Mr. Oosterhof drinking antifreeze from the victim’s car trunk and damaging his vehicle's tires. On May 11, Mr. Oosterhof encouraged a co-accused to kill the victim, who threatened the victim with a handgun and scissors. Both were arrested by police shortly after.
Mr. Oosterhof is 82 years old, born in Holland. He reported that he had earned a Bachelor of Science degree while living there. He expressed that he enjoyed his educational experience and did not encounter any behavioural problems, describing himself as an average student. After relocating to Canada, he entered the construction industry, as his educational qualifications were not recognized. He worked in construction for two decades before beginning to receive social assistance, coinciding with the onset of his depression. By March 2004, he reported being on long-term disability due to alcohol dependence.
Mr. Oosterhof has a significant history of alcohol abuse, which began in 1997 following his mother's death. He experienced a short period of sobriety in 2003 while undergoing addiction treatment. However, during a 2004 assessment at CAMH, it was revealed that he had spent $40,000 from an inheritance on alcohol in the prior year, in addition to selling his sailboat to finance his addiction. Additionally, he reported that his excessive drinking led to the loss of all his friends.
In terms of his relationship history, it is unclear, as he has alternately stated that he has never been married and has no children, as well as claiming to have been married and to have fathered two sets of twins, whom he reported to have last seen in 1977.
He has maintained occasional contact with his sister, who lives in Holland, and during 2021, his nephew sent him photographs of family members. Beyond these limited interactions, he has not had regular communication with any other relatives.
A records check of the Canadian Police Information Centre database showed that Mr. Oosterhof possesses a significant criminal history, with various offences recorded since 1973. He accumulated around 20 convictions from 1973 to 2005. These offences ranged from driving under the influence, weapon possession, assault and sexual assault, among others. His most recent conviction before the index offences was for mischief under $5000 in 2005. Notably, there were no recorded criminal activities between 2005 and his arrest in 2013.
PSYCHIATRIC BACKGROUND
The psychiatric background information is contained in the Hospital Report. The following is a summary of the psychiatric hospital admissions before and after the court finding that he was not criminally responsible of the index offences.
Mr. Oosterhof first sought psychiatric treatment in 2004 at CAMH during a fitness assessment, when he was diagnosed with alcohol abuse and dependence disorder, and the presence of antisocial personality traits.
After committing the index offences, he was admitted to CAMH and was deemed unfit to stand trial for the following two years. Records indicate that he spent significant periods in seclusion due to threatening and aggressive behaviour and was uncooperative regarding his personal and mental health history, denying any mental illness and refusing to comply with antipsychotic medication.
After the ‘not criminally responsible’ finding, Mr. Oosterhof remained at CAMH until February 15, 2018, when he was discharged to the Fairview Nursing Home. He had also been evaluated for potential primary neurodegenerative disease. He stayed there until June 4, 2018, when he walked away. His housing offer was withdrawn, leading to subsequent hospital readmission. On February 1, 2023, Mr. Oosterhof was discharged to the Baycrest Centre’s Long-Term Care behavioural unit, a 24-hour supervised facility designed for individuals with high care needs.
Mr. Oosterhof’s current psychiatric diagnoses are Schizophrenia, Major Neurocognitive Disorder due to Multiple Etiologies, Alcohol Use Disorder (in remission in a controlled environment) and Antisocial Personality Traits. Mr. Oosterhof has been found not capable of consenting to, or refusing consent for psychiatric treatment, and he is not capable of managing his finances independently. His substitute decision maker for both treatment and financial decisions has been appointed by the Office of the Public Guardian and Trustee. He is financially assisted by the Ontario Disability Support Program.
EVIDENCE AT THE HEARING
Mr. Oosterhof’s course in hospital this reporting year is detailed in the Hospital Report and summarized here, along with updated information provided at the hearing by his attending psychiatrist, Dr. M. Pearce.
During the reporting year, Mr. Oosterhof remained in a ‘high needs’ behavioural unit at the Baycrest Centre. He did not require re-admission to CAMH, showing significant improvement, likely due to Clozapine treatment. He was visited by the forensic outpatient service once or twice a month. On December 2, 2024, he was admitted to North York General Hospital with bacteremia, a productive cough, and shortness of breath, where he continues to receive prescribed medication without complications.
Mr. Oosterhof’s mental state showed relative stability during the year. He took his medication mixed with food and consistently expressed a desire to return home, yet he did not engage in exit-seeking or aggressive behaviours. Staff at Baycrest reported that he was not a management concern, although he continued to voice grandiose delusions and lacked insight into his mental illness or treatment needs.
Plans were made for Mr. Oosterhof's transition to a secure long-term care unit at the Baycrest Centre. This new unit will not have a dedicated psychiatrist or behavioural support team, though consultations will be available if required. His care will be managed by a family doctor in this new setting. Dr. Pearce provided a clinical update on Mr. Oosterhof's condition. Mr. Oosterhof remains at North York General Hospital on a medical unit and has recently been deemed ready to return to long-term care after recovering from various medical issues, including bacteremia. Due to his extended stay of over 30 days, his previous placement at Baycrest has been relinquished, which may prolong his transition back there. He may be able to return quickly, but he might need to go to a different facility temporarily before going back to Baycrest.
In terms of Mr. Oosterhof's physical condition, Dr. Pierce observed improvements compared to the last time he saw him. Dr. Pierce visited Mr. Oosterhof earlier on the day of the hearing. Although he had experienced several concerning and potentially life-threatening medical problems, he seemed better. Mr. Oosterhof discussed his dislike for his lunch, which remained untouched. Regarding the estimated timeline for his return to Baycrest, the expectation was that Mr. Oosterhof would be leaving the hospital within a couple of weeks, facilitating his return to Baycrest soon.
After further inquires, Dr. Pierce compared Mr. Oosterhof's current mental status to his condition from a year ago, noting significant improvements. Over the past year, Mr. Oosterhof's medication regimen has changed slightly, which has contributed to his overall betterment. He has shown a notable decrease in disagreeableness and combativeness, which had previously been concerning.
Dr. Pierce expressed optimism about Mr. Oosterhof's progress, highlighting that prior to his recent medical issues, there had been a plan to transition him to a regular long-term care facility rather than a behavioural unit, given the reduction in incidents over the months. Dr. Pierce hopes to resume that plan in the upcoming year.
SUBMISSIONS
- The parties essentially reiterated their original position. Counsel Ms. Addie expressed that it was heartening to note Ms. Oosterhoff's mental status has improved over the last couple of years, as he is less agitated and more able to engage. He survived his medical crisis, given that it was potentially life-threatening.
ANALYSIS AND CONCLUSION
(a) Significant Threat
Where there is a risk of serious physical or psychological harm to members of the public resulting from conduct that is criminal in nature but not necessarily violent, the Board must find that the threshold for ‘significant threat’ has been met. The issue of whether Mr. Oosterhof continues to pose a significant threat to the safety of the public was not contested at the hearing, however, we have considered the issue and we have made an independent finding.
Based on the testimony of Dr. Pearce and the relevant contents of the Hospital Report, we find that Mr. Oosterhof remains a significant threat to the safety of the public, and accordingly, he is not entitled to be discharged absolutely. Mr. Oosterhof has a complex psychiatric profile where his primary diagnosis of Schizophrenia is further compounded by other diagnoses, including Dementias. The limited medical treatments to target those features, and the cognitive decline that will most surely continue, all contribute to his continuing level of risk to public safety.
Several factors convince us that the threshold for ‘significant threat’ has been met. The evidence was clear, and we agree that Mr. Oosterhof’s ability to manage his Schizophrenia is fragile at this point, and his risk would increase with a lack of adherence to psychiatric care, insufficient follow-up with necessary mental health services, and a return to substance use, particularly alcohol, would more than likely follow. These factors would quickly worsen his psychotic symptoms, which would be displayed through both physical and verbal aggression. He remains symptomatic of Schizophrenia, marked by persistent irritability, emotional instability, and continuing break through delusions.
Over the past year, his pronounced grandiose thoughts have been particularly noticeable. However, he has shown considerable improvement with the administration of Clozapine. Nonetheless, it is important to understand this progress within the context of his inability to make psychiatric treatment decisions. But for the consent of his substitute decision maker, his past psychiatric history indicates that he was non-adherent to his prescribed medications, and there is a likelihood that he will discontinue his medication if not monitored with the necessary level of oversight moving forward. It is also important to highlight that his diagnosis of Major Neurocognitive Disorder also inhibits the potential for improving his insight into his mental status, contributing to both ongoing behavioural and cognitive challenges. Based on all these factors, we find that continued oversight under the Board will be vital to his overall recovery process, which highlights the need for continued close monitoring to ensure both his safety and that of the public.
(b) Necessary and Appropriate
The plan of care in place for Mr. Oosterhof is very comprehensive, given that he is currently facing a very challenging situation. His care plan appropriately addresses his level of threat to the safety of others given that he is subject to the level of monitoring provided by his treatment teams, including the forensic psychiatry services at CAMH. His psychiatric treatment and care involves the necessary level of supervision, evaluation, and adjustment to manage his risk level. Without the forensic treatment teams, and their interventions and support, his recovery path would most certainly decline.
Community living without supervision is not appropriate for Mr. Oosterhof at this time because his overall health relies on the clinical expertise he is being provided with. This plan is in place because there remains a serious risk of grave harm occurring to the public and he continues to present a significant treatment challenge at this point in time.
Both the community and the CAMH treatment teams are key in helping Mr. Oosterhof achieve and maintain mental stability, and we find given all the circumstances, that he could not be managed without the current level of assistance and supervision. We also find it heartening that he has survived his recent physical health issues considering its severity, and we wish him well in the upcoming year. We conclude on the evidence before us that the most necessary and appropriate outcome for Mr. Oosterhof is to continue his recovery process under the supervision and authority of the Ontario Review Board, in accordance with a Detention Order, giving the hospital the necessary authority to approve his housing accommodations in the upcoming months.
DATED this 18^th^ day of February, 2025 at the City of Toronto, in the Toronto Region.
Ms. A. La Viola
Legal Member
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Office of the Registrar
Ontario Review Board