Re: Gregory Narine
ORB File No: 7193
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: Gregory Narine
Counsel: Ms. M. Perez
The Person in Charge of Hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Mr. M. Feindel
REASONS FOR DISPOSITION
(Dated February 14, 2025)
Overview
On July 26, 2017, Gregory Narine was found not criminally responsible (NCR) on the Criminal Code charge of second-degree murder. His father was the victim.
Mr. Narine is currently subject to a disposition of the Ontario Review Board (the Board) dated January 16, 2024, which detains him at the Forensic Service of the Centre for Addiction and Mental Health, Toronto (CAMH or the hospital), with the outer limit privilege to live in the community in supervised accommodation approved by the person in charge. Mr. Narine currently resides at LOFT housing.
On January 8, 2025, this panel of the Board convened a hearing at CAMH to review Mr. Narine’s disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. Narine attended the hearing and was represented by counsel, Ms. Perez.
The issues for the Board to decide were whether Mr. Narine is 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 initial positions. Hospital counsel submitted that a continuation of the current detention order on the same terms and conditions is appropriate. Crown counsel agreed with the hospital position. Mr. Narine’s counsel said her client is requesting an absolute discharge.
For the reasons which follow, the Board finds Mr. Narine is a significant threat to the safety of the public and the necessary and appropriate disposition for the coming year is a continuation of the current detention order, unchanged.
Index Offence
- The circumstances of the index offence are excerpted from last year’s Board Reasons dated February 9, 2024, at paragraphs 5 to 6:
On August 3, 2016, Mr. Narine and his parents attended a doctor’s appointment together. When they returned to the family residence in Brampton, Ontario, his mother went upstairs to change. While upstairs, she heard her husband call out to her. When she came downstairs, she saw her husband slouched over on the couch, apparently injured. She also saw her son walk quickly into the furnace room of the house. She went to her neighbour’s residence and asked them to call the police. When police arrived, they observed that the accused’s father slouched over on the couch, with a three inch long wound below his left nipple, stab wounds on his back and hand and a large volume of blood on his body.
The police found the accused in an upstairs room sitting in a sofa chair, rocking gently with his hands at his side and listening to music. He did not respond to police directives or questions other than to nod his head, affirming that his name was Greg. The accused’s finger was injured, and he was taken to hospital where he received three stitches.
Background and Course Since Last Hearing
The hospital report dated December 30, 2024 (exhibit 1) details Mr. Narine's personal background, his psychiatric history, and the circumstances of the index offence. The hospital report can be referred to for full details. Some relevant information will be highlighted.
Mr. Narine is 66 years of age. He is diagnosed with schizophrenia. He is treatment capable for psychiatric decisions and is capable to manage his financial affairs. He has been under the Board’s jurisdiction for approximately seven years.
Mr. Narine is single, has never married and has no children. As mentioned, he currently resides at LOFT, supervised and transitional housing (since August 2023).
Mr. Narine was born in Trinidad and came to Canada with his family in 1970 at the age of 12. After graduating from high school, he studied mechanical engineering technology at the Ryerson Institute of Technology. He passed his first year but failed his second. He completed a two-year diploma course in numerical control at Humber College in 1984.
Mr. Narine has had a very erratic employment history since completing his education. He last worked as a mail sorter for two days at Canada Post in 1996. At the time of the index offence, he was unemployed and living at home with his parents.
Mr. Narine was very quiet and shy as a child and did not have friends. He first became ill in 1982 when he began acting strangely and was hospitalized for two weeks. He received electroconvulsive therapy (ECT) in 1984, and again in 1992. He was diagnosed with schizophrenia in 1986 when he reported hearing voices that told him to kill people and included other command hallucinations. He has been treated with a variety of antipsychotic medications since that time. He has experienced paranoia through the years and told the clinical team that he largely stayed home to protect himself. He discontinued his prescribed medication approximately three weeks prior to committing the index offence. Almost immediately after stopping the medication, he began experiencing auditory hallucinations, describing these as voices in his head.
Mr. Narine’s progress from 2017 to 2023 at CAMH is described in detail in the hospital report and need not be reproduced here. It is sufficient to say that in the beginning, he did not interact with peers, spoke to staff only when he had a request or was asked a direct question and spent most of his time in bed. His level of activity increased slowly through the years and his mental state remained stable. He had limited insight into his diagnosis but was adherent with his medication. His engagement with others began to improve in late 2021. Mr. Narine was discharged to LOFT transitional housing in August 2023, and transitioned well, although he required support attending to his activities of daily living and prompting to increase engagement.
The hospital report indicates that Mr. Narine’s insight into his illness and symptoms is limited. He also has only partial insight regarding the circumstances of the index offence. At times he states that he “killed” his father, while at other times, he states that his father is alive.
During the past year, Mr. Narine’s care continued to be provided by Dr. Ali and the FOPS outpatient team. Mr. Narine continues to have a psychiatrist at LOFT, Dr. Cavanagh.
During the year in review, Mr. Narine's medications remained unchanged. His mental health was stable; however, he continues to display residual paranoia and delusional thoughts which have been long standing. He also presents with negative prominent symptoms which affects his motivation and ability to independently manage activities of daily living. He requires considerable prompting. Mr. Narine was compliant with clozapine medication and blood work. He was compliant with appointments and was cooperative with staff direction at the home. He participated in the life enrichment program through LOFT housing. The location of his LOFT housing physically changed in the last year, and he transitioned well to the new location. The team is still awaiting permanent housing for Mr. Narine.
Mr. Narine continues to enjoy the support of his mother and sister since he has been discharged to the community. Unfortunately, in the past year his mother suffered a stroke. Mr. Narine continued to visit his mother while she was in the hospital.
Evidence at the Hearing
Dr. Ali gave the evidence for the hospital at the hearing. The doctor is Mr. Narine’s outpatient psychiatrist and the author of the hospital report, the contents of which were adopted in her evidence.
Dr. Ali described the extensive support and supervision provided to Mr. Narine at LOFT housing. It is a 24-hour staffed facility with a psychiatrist on site to prescribe his antipsychotic medication. In addition, his medication is provided to him by staff, and they directly monitor his compliance. Mr. Narine requires permanent housing as LOFT is considered transitional only and he has been there approximately 18 months.
Mr. Narine will require a single room in permanent housing due to the nature of the index offence and his residual symptoms of paranoia. At times, Mr. Narine thinks other people are talking about him and given the gravity of the index offence, there are elevated concerns for public safety if he shared a room. This requirement adds to the challenge of finding permanent housing.
Dr. Ali was clear that in transition to more permanent housing, Mr. Narine will continue to require high support and it will be similar housing to what he currently has at LOFT. That is, medication administration will be required and close supervision and monitoring including assistance with activities of daily living.
Mr. Narine continues to take his clozapine medication and is cooperative with the blood work. His medication has been unchanged now for several years and Dr. Ali suggested his baseline mental status is his current presentation, with residual symptoms of schizophrenia.
Dr. Ali said that if granted an absolute discharge, and not under the oversight of the hospital, ongoing medication administration and compliance would be significant concerns. The doctor also said housing would be an issue.
Mr. Narine has only partial insight regarding the index offence and the need for treatment /medication to attenuate the symptoms of his illness. It was the opinion of Dr. Ali that Mr. Narine would fall away from services, discontinue his medication and his symptoms would worsen due to increased paranoia. He would misinterpret cues in the environment, all of which would inevitably lead to violence, with the potential for severe violence.
Dr. Ali said a detention order is necessary to give the hospital the authority to approve his supervised housing. This would not be possible on a conditional discharge. Dr. Ali also noted the expressed wish of Mr. Narine to move back to Trinidad. as he said he would do. There is currently no community team to transition Mr. Narine from the forensic system if granted an absolute discharge.
Crown counsel asked Dr. Ali about the reference at page 21 of the hospital report, and she agreed with the stated content as currently applicable: “Mr. Narine’s insight is limited. He can state that he has a mental illness, however he does not believe that he needs to continue his medications in the future. He often states that he wants to move to Trinidad. His insight into the index offence fluctuates”.
The doctor agreed that Mr. Narine’s residual symptoms are not present all the time but if you ask him questions, for example regarding the index offence, he will often provide non-sensical answers. To his credit, Mr. Narine is willing to share his odd thoughts with the team, but he does not understand that they are symptoms of his illness.
The doctor did not agree with counsel, Ms. Perez, that a community treatment order (CTO) could effectively manage Mr. Narine, if he was granted an absolute discharge. Dr. Ali said that Mr. Narine would not necessarily be certifiable for admission under the provisions of the Mental Health Act as his presentation may not meet criteria. A CTO would only provide the authority to have Mr. Narine attend at the hospital but not admitted. Dr. Ali said that even if unwell because of missed medication (clozapine), Mr. Narine would not necessarily be certifiable.
The doctor said that Mr. Narine would likely decompensate without supports. If granted an absolute discharge, LOFT would not evict Mr. Narine. Despite this, the doctor could not predict where Mr. Narine would reside as permanent housing is required, and the necessary arrangements would be made through the hospital. Left to his own devices, the doctor believed Mr. Narine would not be able to find suitable alternative accommodation.
No further evidence was called at the hearing.
In final submissions the parties maintained their original positions from the outset of the hearing.
Analysis and Conclusion
Significant Threat to the Safety of the Public
The threshold issue for the Board is to determine if Mr. Narine remains a significant threat to the safety of the public.
According to Winko, a significant threat to the safety of the public means a real risk of physical or psychological harm to members of the public that is serious in the sense of going beyond the merely trivial or annoying. The conduct giving rise to the harm must be criminal in nature and serious. The evidence to determine whether an individual is a significant threat to the safety the public can include the past and expected course of the NCR accused’s treatment, if any, the present state of the NCR accused’s medical condition, the NCR accused’s own plans for the future, the support services existing for the NCR accused in the community as well as the opinion of the treating professionals responsible for the care of the accused.
The Board adopts with approval the following assessment of risk as set out in the hospital report at page 23, as follows:
“Mr. Narine’s risk of future violence arises from a risk of decompensation of his mental illness. There is a significant risk that his mental state could decompensate particularly if he becomes non-compliant with medication. Ceasing to take prescribed medication, unexpected changes or sudden transitions in routine, collapse of social supports for any reason, major or minor life challenges that tax his limited coping abilities would pose threats of destabilization and elevate risk to re-offend. Additionally, harbouring anger or feelings of persecution (perceived) and inability to manage irritants, conflict or anger triggers could also become destabilizing factors resulting in conditions where re-offending may occur. Lastly, re-experiencing symptoms of mental illness which feel troubling or frightening would likely not be disclosed to family or care providers in which case could would also likely lead to further destabilization and risk of re-offending.
Should his mental state decompensate, he would have very florid and bizarre delusions (such as about aliens, or having female genitals (as previously reported), and auditory hallucinations, including command hallucinations). The index offence indicates that the severity of any future violence could be extreme. Anyone could potentially become the focus of his psychotic symptoms, and therefore anyone could be potentially at risk, however, family members, or those in close proximity to him, such as those he may cohabit with would be at most risk.”
The Board accepts the uncontroverted expert evidence of Dr. Ali, as supplemented by the hospital report, that Mr. Narine remains a significant threat to the safety of the public.
The Board shares the concerns of the treatment team that the gravity of the index offence speaks to the level of violence that Mr. Narine is capable of when experiencing symptoms of his major mental illness. The Board notes that Mr. Narine continues to experience residual symptoms of paranoia despite being optimally treated with antipsychotic medication. He suffers from a treatment resistant form of the illness which, in the Board’s view, significantly elevates his risk profile given the gravity of the index offence and his paranoia and delusional thoughts, which has been longstanding and likely is his baseline mental status.
The Board finds that there is no evidence before us regarding Mr. Narine’s own future plans, or the supports he would have in the community if granted an absolute discharge. The absence of this support is not always material to the issue of significant threat, but in this case, these are important factors to consider due to the gravity of the index offence, its relative recency, and Mr. Narine’s residual symptoms of paranoia.
The necessary and appropriate disposition is a continuation of the detention order on the same terms and conditions. Mr. Narine can continue to reside in the community in supported housing where he can take advantage of further community reintegration and programming. It is key to his well-being that his medication is administered on site and there is a psychiatrist who prescribes his antipsychotic medication. These are all protective factors which mitigate Mr. Narine’s risk.
This is not a case where a conditional discharge warrants serious consideration as there is a need for the hospital to approve Mr. Narine’s housing. None of the parties asked the Board to consider this disposition. Regardless, the Board finds that a critical risk management factor is the place where Mr. Narine resides. He requires housing that provides proper structure, support and supervision. This can only be assured with a detention order (and not a conditional discharge). See Runnalls (Re) 2012 ONCA 295 at para.12.
The Board wishes to comment on Mr. Narine’s cooperative attitude with the treatment team and the staff at LOFT housing. He is to be commended for his efforts in maintaining these relationships in the manner that he has.
In making the necessary and appropriate disposition, the Board has considered the paramount factor of public safety, Mr. Narine’s community reintegration, his mental condition, and his other needs, all as required by s. 672.54 of the Criminal Code.
DATED this 14th day of February 2025, at the City of Toronto, in the Toronto Region.
Mr. C. Fraser
Alternate Chairperson
Office of the Registrar
Ontario Review Board