Ontario Review Board
Re: Matthew Aeichele
ORB File No: 8404
Hearing held on: Thursday, January 9, 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 Ms. R. Chopra
Parties Appearing:
Accused: Matthew Aeichele Counsel: Mr. A. Rai
The Person in Charge of Hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Ms. V. Culp
REASONS FOR DISPOSITION
(Dated February 20, 2025)
Overview
On October 10, 2023, Matthew Aeichele was found not criminally responsible (NCR) on the Criminal Code charge of aggravated assault.
Mr. Aeichele is currently subject to a disposition of the Ontario Review Board (the Board) dated January 18, 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 accommodation approved by the person in charge.
On January 9, 2025, this panel of the Board convened a hearing at CAMH for the annual review of Mr. Aeichele’s disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. Aeichele was present for the hearing and represented by counsel, Mr. Rai.
The issues for the Board to decide were whether Mr. Aeichele 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 recommended a continuation of the current detention order on the same terms and conditions. Crown counsel supported the hospital. Mr. Aeichele requested a conditional discharge and was consenting to the inclusion of a Young term which would require Mr. Aeichele’s attendance and readmission to hospital if requested. Counsel submitted that residence and treatment terms (which can be included in a conditional discharge disposition) are not necessary for Mr. Aeichele.
For the reasons which follow, the Board finds Mr. Aeichele 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 Offences - Surrounding Circumstances
The circumstances of the index offence and the period following, including the NCR assessment, are aptly summarized in last year's Board Reasons dated February 6, 2024, at paragraphs 8 to 17. These paragraphs are fully reproduced in these Reasons.
Mr. Aeichele and the victim were strangers. Approximately three months before the offence, Mr. Aeichele and the victim met each other at the front of their building while smoking cigarettes and had a brief conversation.
A few days later, Mr. Aeichele approached the victim in the same location and punched him in the face without any provocation. The victim asked Mr. Aeichele why he punched him. Mr. Aeichele responded, “My girl” and fled to his apartment. The victim did not call the police. The victim did not know who Mr. Aeichele’s girlfriend was and never had any interaction with her.
On May 1, 2022, the victim was smoking in front of a Loblaws store. Mr. Aeichele appeared, aggressively approached the victim and began stabbing him without provocation and knocked him to the ground. Mr. Aeichele continued his attack against the victim while he was on the ground. Ultimately, the victim was able to get up and run away. Mr. Aeichele pursued the victim until he was able to escape by stepping into a streetcar.
As a result of this attack, the victim suffered lacerations to the back of his head, to the area above his left ear, to his neck and to his right thigh. None of these injuries were life threatening, but they caused the victim to bleed profusely. He also suffered a left suboccipital hematoma. He was taken to the Sunnybrook Hospital where he received stitches and staples to close his wounds.
On May 3, 2022, Mr. Aeichele’s mother, called 911 to report that Mr. Aeichele was having a mental health crisis. She wanted the police to conduct a wellness check on him. She advised the police that her son was diagnosed with paranoid schizophrenia; that he was not on his medication; was delusional and believed his girlfriend’s mother was going to kill him; that someone in the building was raping his girlfriend; that he wanted to hurt someone; and that he may have already hurt someone in the building.
Shortly after Mr. Aeichele’s mother called 911, police officers attended at the accused’s residence to conduct a wellness check. Mr. Aeichele told the officers that he used methamphetamine not long before their arrival. The officers apprehended Mr. Aeichele under the Mental Health Act. The police then entered his apartment and observed a black taser and a switchblade hunting knife on the bedside table, an airsoft handgun (a replica gun that shoots plastic pellets) in the laundry hamper and a 6-inch foldable blade stabbed into the floor next to his bed.
Mr. Aeichele was arrested for possession of prohibited weapons and taken to Sunnybrook Hospital for a psychiatric assessment. While at the hospital, Mr. Aeichele advised the police that he had been diagnosed with schizophrenia, had not taken his prescribed medication in about a year and was hearing voices and seeing smoke come from the vent below his window in the living room that smelled like rotting flesh.
On May 4, 2022, the police conducted a more comprehensive, judicially authorized search of the accused’s apartment. They seized a taser, a switchblade, two airsoft handguns, a sword, three hunting style knives and black boots with blood stains. They also seized electronic devices inside Mr. Aeichele’s freezer. Mr. Aeichele had placed the devices in the freezer because he believed that frozen electronics could not be used to spy on him.
Also on May 4, 2022, the police became aware that it was Mr. Aeichele who had committed the stabbing on May 1, 2022, and arrested him for attempted murder, aggravated assault, carrying concealed weapons and weapons dangerous. He was detained at the Toronto South Detention Centre pending his trial.
On August 24 and 25, 2022, at the request of counsel for Mr. Aeichele, the accused was interviewed by Dr. Roland Jones, a forensic psychiatrist in the Forensic Service at CAMH for a psychiatric assessment of his criminal responsibility. It was Dr. Roland’s opinion that Mr. Aeichele suffered from chronic and recurrent drug induced psychosis and severe drug addiction, that he was experiencing psychiatric symptoms at the time of the offence and that the symptoms were sufficiently severe to deprive him of his ability to appreciate the nature and quality of his actions in relation to the offences charged. Based on Dr. Jones’ evidence, Mr. Aeichele was found NCR on the single offence of aggravated assault. The Crown withdrew all of the other charges.
Background and Course Since Last Hearing
The hospital report dated December 13, 2024 (exhibit 1) contains considerable detail about Mr. Aeichele’s personal history, his longstanding serious substance use history, and the circumstances of the index offence. It is not necessary to fully recount these details in these Reasons. Some relevant information will be highlighted.
Mr. Aeichele is a 32-year-old male. He was born in Toronto and is the youngest of three male siblings. Both of his brothers committed suicide, one in 2012 and the other in 2018. His parents divorced when he was 9 years of age. Following the divorce, he lived primarily with his mother but spent some time living with his father as well. He got involved with gangs at high school, got into fights and sold cannabis. He stopped attending school regularly starting in grade 9, got involved in criminal behaviour and worked for a gang as lookout. He continued to be involved with gangs into his 20’s and sold drugs.
Mr. Aeichele attended an adult learning center off-and-on from the age of 20 to 24 but found it difficult because of his cocaine and alcohol consumption. He graduated high school after attending an on-line program two years ago.
Mr. Aeichele has been diagnosed with obstructive sleep apnea, heart-failure and infective endocarditis as a result of injecting fentanyl and methamphetamine.
Mr. Aeichele has had several romantic relationships. Prior to the index offence, he lived in an apartment in Toronto with a girlfriend. He was financially supported through the Ontario Disability Support Program. He has never been married and has no dependents.
Mr. Aeichele began drinking alcohol at 13 and was drinking regularly by 16. He began using cannabis at 15 and smoked daily until 2020. He suffered from anxiety in high school and began taking diazepam, Percocet, oxycodone and methamphetamine. From the age of 17, he has also abused ketamine, cocaine, OxyContin, and crack cocaine at various times. He had an accidental heroin overdose in 2014 that required an intensive care admission. He resumed using heroin regularly over the past three years, and at the time of the index offence also used methamphetamine daily, injected testosterone regularly, used GBH regularly and used ketamine and crack cocaine occasionally.
Mr. Aeichele was admitted to CAMH for four days at the age of 17 after developing psychotic symptoms in the context of using ketamine. He was first diagnosed with a substance induced psychotic disorder at 18. He has been seen as an outpatient and admitted as an inpatient at CAMH and other psychiatric facilities repeatedly ever since, in relation to drug abuse, bizarre ideations, manic episodes, feelings of paranoia, visual and auditory hallucinations, delusions, irritability, anxiety, depression, mood swings and other psychotic symptoms, and has been treated with a variety of medications.
Mr. Aeichele was first arrested at 15 in relation to an assault of his brother. He was arrested at 19 for assaulting his stepfather. In 2013, he was convicted of assaulting a TTC driver. He has also been convicted of failing to comply with a recognizance. He has never been sentenced to a term of imprisonment. Mr. Aeichele has also engaged in the following instances of troubling behaviour that were either not the subject of criminal charges, or for which he was not convicted.
On April 9, 2020, police were called to respond to Mr. Aeichele’s violent behaviour directed at his father. Mr. Aeichele became upset about his father’s answer to a question he posed about a television show and hit him in the face, cutting his eyebrow. His father did not wish to proceed with criminal charges because he considered the incident to be mental health related.
On August 11, 2021, Mr. Aeichele punched his father in the head twice and threatened to break his nose. When the police arrived, Mr. Aeichele told them that he had done this because he believed his father was involved in paedophilia and that he had children inside the walls of his home and beneath the floors. He admitted to smoking methamphetamine a few hours earlier. The police transported Mr. Aeichele to St Michael's Hospital. While in the waiting room, he began banging his head against the wall.
On April 6, 2022, police were called to Mr. Aeichele’s address. When they arrived, Mr. Aeichele was not present, but his girlfriend was. Upon being permitted to enter the apartment, the officers observed that the unit appeared to have been trashed, with several items, including garbage, cans and bottles strewn about. Mr. Aeichele’s girlfriend told them that Mr. Aeichele had accused her of taking $200 that he had misplaced, and the apartment was in disarray because she had been searching for the money.
On April 16, 2022, the police were again called to Mr. Aeichele’s apartment. They learned that Mr. Aeichele and his girlfriend had engaged in a heated argument, and when his girlfriend became aggressive, Mr. Aeichele slapped her in the face. As a result, Mr. Aeichele was arrested and charged. Whatever happened to this charge, there was no conviction.
Mr. Aeichele was incarcerated prior to the NCR finding in October 2023 and thereafter was transferred to CAMH with his initial hearing in January 2024. After the hearing, he was transferred to a secure unit in April and then in August 2024 was transferred to a general forensic unit where he currently resides.
Overall, Mr. Aeichele has had a positive year, and he has participated in therapeutic programming and rehabilitative activities. He has been motivated to pursue employment goals and is hopeful of an imminent transition to community living.
As highlighted in the hospital report (page 19) Mr. Aeichele does not take any psychiatric medications and all his prior psychotic episodes are considered attributable to substance use, rather than a primary psychotic illness. This opinion of the team is substantiated by several diagnostic assessments which have been completed on Mr. Aeichele.
Mr. Aeichele has participated in substance relapse prevention programming which is ongoing. The hospital report notes that at times he demonstrated a negative attitude claiming boredom and wanting to only do “mandatory” programs which will advance his privileges.
Mr. Aeichele has attended individual therapy with a psychotherapist (FORCAT) and the feedback from his therapist about his engagement has been positive.
Mr. Aeichele is at privilege level 9 which permits overnight indirectly supervised passes. Mr. Aeichele continues to enjoy strong family support.
Mr. Aeichele is participating in an internship work program which will conclude in February of this year. He works two shifts a week and has received training both in-person and online for work-related skills.
Evidence at the Hearing
Dr. Valoo gave the evidence for the hospital at the hearing. The doctor is Mr. Aeichele’s treating psychiatrist on FGUA, a general forensic unit. The doctor was asked for updates from the preparation of the hospital report, and she advised that there were a few.
There was a successful overnight visit recently to Mr. Aeichele’s mother's residence. Within the next week the treatment team intends to extend passes for up to 36 hours for Mr. Aeichele to stay at his mother's residence from Sunday to Monday each week.
Another update provided by Dr. Valoo was Mr. Aeichele's willingness to participate in a risk assessment. Previously, he had refused participation in the PCL-R assessment. This will be scheduled soon.
Another update was regarding housing for Mr. Aeichele. An application has been submitted to transitional housing, THRP2, as Mr. Aeichele is clinically ready for discharge. There is a vacancy at the home which is on hospital grounds and the team is hopeful that Mr. Aeichele will be the successful applicant. It is anticipated the treatment team will know this outcome within the next few weeks.
Dr. Valoo did not think that Mr. Aeichele would require 24-hour supervised housing, but he does require staff to observe his mental status and to communicate with the outpatient team in the event of any relapse into substance use.
The doctor identified substance use as the most salient risk factor for Mr. Aeichele. It is critical for Mr. Aeichele to maintain abstinence as he transitions from being an inpatient to community living. There will be a significant adjustment and exposure to stressors and triggers. There is a high risk of relapse as he transitions. This concern is based on Mr. Aeichele’s significant and long-standing substance use history which has included many admissions to hospital.
It is the doctor's opinion that, at least for Mr. Aeichele’s initial period in transitioning to the community, he will require supportive housing. The doctor was asked why a detention order is necessary and appropriate. The doctor gave two reasons. One, the ability to approve accommodation is critical to ensure that Mr. Aeichele is in a housing facility that will have a reporting relationship with the outpatient team. Given Mr. Aeichele’s significant substance use history involving many illicit drugs, it is critical for the hospital to maintain eyes on Mr. Aeichele in the initial stages of his transition to community reintegration. The housing will also provide needed structure and support for Mr. Aeichele.
The second reason for a detention order was the inadequacy of the provisions of the Mental Health Act to ensure Mr. Aeichele’s timely return and admission to hospital should the need arise. Mr. Aeichele’s decompensation in the past has been directly related to substance use. His presentation when under the influence of certain illicit substances can be florid psychosis, especially if he is using crystal methamphetamine. The doctor also said that at times in the past when Mr. Aeichele has gone to hospital after experiencing adverse effects from illicit drug use, he has left against medical advice.
The doctor wanted to highlight many positive aspects of the past year for Mr. Aeichele, including his participation in programs and a seamless trajectory to the highest level 9 privileges. The doctor said that “many congratulations” are due Mr. Aeichele for his positive trajectory.
The doctor expressed concern that if there was no residence term in a conditional discharge disposition, Mr. Aeichele would not meet criteria under the Mental Health Act, and he would be free to leave the hospital. There is no available accommodation which has been identified, and Mr. Aeichele has never spoken with the team about his desire to live elsewhere. The doctor expressed serious concerns for relapse if Mr. Aeichele resided in inadequately supported housing.
The doctor confirmed that in the past year, there have been no positive urine drug screens and Mr. Aeichele's insight is very good. This insight is for substance use and the likelihood of decompensation, potentially leading to criminal offending. It has been over three and a half years since Mr. Aeichele used illicit drugs (the commission of the index offence in May 2021).
The doctor agreed with Mr. Aeichele’s counsel that he has expressed remorse for the index offence. He has strong independent living skills which were confirmed by an occupational therapy assessment. The doctor agreed with counsel’s suggestion that the hospital could request an early review if they had concerns about relapse and Mr. Aeichele’s decompensation. The doctor went further and said that this route would be unsatisfactory as too much time would pass with a heightened risk to public safety and there would be no certainty that Mr. Aeichele, pending the early hearing, would be certifiable under the Mental Health Act.
The doctor said that Mr. Aeichele occupies his time through the paid internship which ends in February which is two shifts a week, he participates in online courses, and he also goes to the gym daily. He is also independent with his activities of daily living, including errands regarding his finances and grocery shopping and spending time with his family. The doctor considers Mr. Aeichele to be “well occupied” with not much down time in his day.
Mr. Aeichele gave evidence at the hearing. He said that he would stay in the hospital voluntarily until transitional housing is available. He said the resources he has received at CAMH have been invaluable to him and he understands the need for support to transition successfully to the community. He said that he volunteers Monday and Friday at the canteen (he clarified the doctor’s evidence on this subject). He said he is likely to agree to THRP2 housing that has been identified for him, although he expressed some misgivings about the structure of the home around mealtime. He advised that it is a communal meal each day at 5:00 p.m. and because he is a good cook and very clean, he wants more independence, for example at TRHP1 housing. The Board was grateful to receive Mr. Aeichele’s evidence and thanked him.
No further evidence was called at the hearing.
In final submissions the parties maintained their initial positions from the outset of the hearing.
Analysis and Conclusion
The Board finds Mr. Aeichele 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 issue of significant threat to the safety of the public was not contested at the hearing. Despite this, the Board makes its own finding of significant threat based on the expert evidence of Dr. Valoo, as supplemented by the hospital report.
Although Mr. Aeichele does not have a primary psychotic illness, he has been diagnosed with a serious substance use disorder which led to the commission of a grave and violent index offence. He nearly took the life of the person he attacked with a knife. Mr. Aeichele has been an inpatient at the hospital for a relatively short period of time and although he is to be commended for his positive trajectory and his efforts at furthering his community reintegration, it is still early in his recovery. He has a serious and long-standing history of stimulant use disorder, cannabis use disorder, alcohol use disorder, opioid use disorder and sedative use disorder. These have all been in sustained remission in a controlled environment, but this is a relatively brief period given the long-standing history of substance use which dates back over 20 years to when he was a teenager and using ketamine at 17 years of age.
The Board adopts with approval the following re-offence scenario which is set out in the hospital report at page 27:
“If Mr. Aeichele were to reoffend, it would likely occur in the context of substance use, which would lead to a relapse of a psychotic episode. In this state, Mr. Aeichele would become paranoid, experience auditory and/or visual hallucinations, and become agitated and disorganized. While psychotic, his insight and reasoning would be impaired, and his disturbed perceptions would precipitate both verbal and physical threats and aggression. If physically aggressive, he may resort to using weapons such as a knife, and this would have a high likelihood for physical injury which could potentially be lethal. Victims could include from his family, intimate partner, and/or others who Mr. Aeichele perceives as a threat.”
The Board notes that in the past Mr. Aeichele has misused crystal methamphetamine, ketamine, cocaine and GHB, and he has experienced several episodes of psychosis, some of which required hospitalization. If experiencing psychosis, the Board believes there is a high likelihood of harm to others which would be serious and criminal in nature. As noted, the index offence was extremely violent and occurred while Mr. Aeichele was psychotic after using crystal methamphetamine.
Based on the foregoing risk factors, the Board makes a positive finding of significant threat to the safety the public.
The Board finds the necessary and appropriate disposition is a continuation of the detention order. The Board agrees with the expert evidence of Dr. Valoo that it is critical to risk management that the hospital have the authority to approve housing for Mr. Aeichele. This is especially important in the early stages of his community reintegration which is anticipated to occur soon. The Board is concerned about the long-standing serious substance use disorders. The Board agrees with the expert evidence that the potential for relapse is high if Mr. Aeichele is not in a supported and supervised residence.
The Board finds that it is a critical for public safety that the hospital approve housing which will have supervision of Mr. Aeichele during the initial stages of his community reintegration. The Board notes that there is no alternative housing identified by Mr. Aeichele. The Board is concerned that Mr. Aeichele (despite his evidence that he would stay in the hospital pending placement) would change his mind and leave the hospital against medical advice if he grows frustrated with a delay in transitioning him to housing in the community. This would be the scenario if Mr. Aeichele was on a conditional discharge disposition without a residence term. The Board believes that without adequate housing, it is a virtual certainty that Mr. Aeichele would relapse into illicit drug use and be at a greater risk of harm to others. Only a detention order can provide the hospital with the authority to approve where Mr. Aeichele resides. See Runnalls (Re) 2012 ONCA 295 at para. 12.
Mr. Aeichele has yet to demonstrate a record of abstinence outside of the highly supervised and structured environment of a forensic inpatient unit. The Board notes that prior to the commission of the index offence, his engagement with outpatient psychiatric care was limited and inconsistent.
The Board also agrees that timely intervention and return to hospital for admission and stabilization is critical for protection of the public and to limit the adverse effects of illicit drug use on Mr. Aeichele. The Board accepts the evidence of Dr. Valoo that the provisions of the Mental Health Act would be inadequate to ensure timely intervention. A feature of substance use with Mr. Aeichele is the rapid onset of psychosis. There is a heightened risk to public safety which would not be adequately addressed with reliance on the provisions of the Mental Health Act as there are timing constraints and uncertainty of admission.
For these reasons, the Board finds the detention order disposition is necessary. Even though we did not support Mr. Aeichele’s request, we are impressed by his commitment to his recovery. He is to be commended for his efforts in the past year. We wish him well.
In arriving at our conclusion, the Board has considered the paramount factor of the safety of the public, Mr. Aeichele’s mental condition, his community reintegration, and his other needs, all as required by s. 672.54 of the Criminal Code.
DATED this 20th 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