Re: Alexis C. Akonobi, 2025 CanLII 13640

Re: Alexis C. Akonobi

(DOB: 28.08.84)

ORB File No: 8674

Hearing held on: Thursday, January 9, 2025

Place of hearing: St. Joseph's Healthcare Hamilton West 5th Campus, 100 West 5th Street

Pursuant to: Section 672.47(1) of the Criminal Code

Before:

Alternate Chairperson: Mr. M.D. Segal Members: Dr. R.W. Hill Dr. S. Wiseman Ms. C. Murray Mr. A. Mete

Parties Appearing:

Accused: Alexis C. Akonobi Counsel: Mr. R.W. Browne

The person in charge of hospital: Counsel: Mr. S. O’Brien

Attorney General of Ontario: Counsel: Mr. B. Adsett

REASONS FOR DISPOSITION

(Dated January 27, 2025)

Introduction

1On November 21, 2024, Alexis Akonobi was found not criminally responsible on account of mental disorder, on charges of Possession of a Weapon for a Dangerous Purpose and Assault with a Weapon, both contrary to the Criminal Code of Canada (Criminal Code”). That finding was based on an NCR report of Dr. Aaron Wu and Dr. Rebecca Marsh dated October 29, 2024.

2The Court did not make a Disposition and ordered, pursuant to s. 672.47(1) of the Criminal Code, that Ms. Alexis Akonobi be detained at St. Joseph’s Healthcare Hamilton, West 5th Campus, Forensic Psychiatry Program (“the hospital” or “St. Joseph’s”) pending a Disposition of the Ontario Review Board (the “Board” or “panel”).

3On January 9, 2025, the Board convened a hearing at St. Joseph’s to make an initial Disposition.

4Ms. Akonobi was present at the hearing and was represented by counsel, Mr. Russell Browne.

5Documents were entered as Exhibits, including the following:

a) Exhibit 1 - Hospital Report dated December 27, 2024 (the "Hospital Report")

b) Exhibit 2 – Criminal File consisting of the agreed statement of facts, original assessments and various charging paperwork.

6The issue at this hearing is whether Ms. Akonobi is a significant threat to public safety, as defined in s. 672.5401 of the Criminal Code. If so, the necessary and appropriate Disposition in the circumstances must be determined, bearing in mind the factors enunciated in s. 672.54 of the Criminal Code.

7For the reasons set out below and based on the expert evidence and opinions before it, the Board concluded that Ms. Akonobi represents a significant threat to the safety of the public. The Board further concluded that her risk can be properly managed with a Detention Order at St. Joseph’s on the terms and conditions set out in our formal Disposition. The Board concluded that this is the necessary and appropriate, least restrictive and least onerous Disposition in the circumstances.

Current Psychiatric Diagnosis

8Schizophrenia

Position of the Parties

9At the commencement of the hearing, the parties were asked for their initial without prejudice positions. Counsel for the hospital submitted that Ms. Akonobi represents a significant threat to the safety of the public and recommended a Detention Order Disposition at St. Joseph’s with the outer edge of privileges to include entering the community of Southern Ontario, accompanied by staff or person approved by the person in charge.

10Counsel for the Attorney General adopted the hospital’s position set out above.

11Counsel for Ms. Akonobi did not contest the issue of significant risk. He agreed with the hospital’s position.

12Final submissions were consistent with the initial positions. Therefore, there was a joint submission on all issues.

Index Offences

13The circumstances giving rise to the Index Offences are extracted from page 3 of the Hospital Report, as follows:

“On Sunday May 26th, 2024, the accused, Alexis AKOBOBI while in her residence located at 2420 Baronwood Drive unit 3601, in the Town of Oakville did possess a weapon in the form of a knife and used it to threatened her roommate NL with a knife.

The accused got into an argument with her roommate in regards to the air conditioning being turned off. The accused then got upset and went and grabbed a kitchen knife and a balloon. The accused then stated to her roommate "that if she does not turn on the air conditioning then her and her family are in trouble and that they are not in my kingdom". The accused then used the kitchen knife to stab the balloons and her roommate ran up to her son's room where they secured the door and called Police at 6:24 PM and waited for Police to arrive.

At 6:37 PM Police arrived on scene and conducted call outs in attempts to get the accused to come out of the residence peacefully. The accused failed to comply with demands so Police entered the residence and located the accused in her bedroom on the third floor. The accused then took a fighting stance to which the accused resisted arrest but was subsequently arrested at 6:50 pm.”

Background Information and Course in Hospital

14Ms. Akonobi is a 40-year-old woman. She was born in Nigeria. In 2003, Ms. Akonobi moved to New Brunswick to attend university. She graduated with a Bachelor of Nursing degree with honours and worked as a nurse in Calgary and Stony Plain, Alberta. Ms. Akonobi married her husband in 2010 and moved to Toronto. She secured employment as a nurse at Waypoint Centre for Mental Health Care, Forensic Program.

15Ms. Akonobi had her first psychotic episode during visit to her family in Nigeria. She was hospitalized during this psychotic episode. Upon her return to Ontario, she was hospitalized in Mississauga. Ms. Akonobi returned to Stony Plain in 2012 to work with geriatric patients. She had a psychiatric admission to hospital in Calgary, Alberta in the autumn of 2012.

16Ms. Akonobi returned to Ontario to be with her husband after her 2012 hospitalization. Several hospitalizations followed, during which time her husband remained supportive. The marriage ended in July 2022 when Ms. Akonobi left her husband and accused him of being abusive. She then struggled with stable housing for two years.

17In 2023 and 2024, two community treatment orders (“CTOs”) were issued to assist Ms. Akonobi with maintaining her medication regimen. In both cases, Ms. Akonobi did not follow up with her appointments and could not be located by the clinical teams.

18Ms. Akonobi is currently considered capable to consent to treatment. Due to concerns about her insight, her capacity to consent to treatment is regularly assessed and re-evaluated. When not capable in the past, her husband at the time acted as her substitute decision maker (‘SDM’). She is capable to manage her property.

19Ms. Akonobi does not use alcohol, tobacco, or illicit substances.

20Ms. Akonobi has no prior criminal history.

21Ms. Akonobi is supported by the Ontario Disability Support Program (‘ODSP’) and Canada Pension Plan (‘CPP’).

22Ms. Akonobi was admitted to St. Joseph’s on July 31, 2024. Following her NCR finding on November 21, 2024, Ms. Akonobi was returned to the Forensic Assessment Unit at St. Joseph’s on a Warrant of Committal to await her hearing before this Board.

23Staff observe that Ms. Akonobi continues to express she is communicating with Jesus and hearing Jesus’ voice. She believes that she is the wife of Jesus.

24On August 8, 2024, Ms. Akonobi made homicidal threats to her treating physician at the hospital.

25During assessment in the hospital, Ms. Akonobi made periodic clicking noises with her mouth. She explained that she does this when she feels she is under spiritual attack. She presented with prominent religious and grandiose delusions, such as being a Goddess and being married to Jesus. At the time of admission, Ms. Akonobi was irritable, oppositional, displayed threatening behaviour and religious delusions. Over time her irritability has decreased and her approach to the clinical team has improved. Although, Ms. Akonobi has now become more agreeable to taking medication, she reports that she takes the medication because “Jesus tells [her] to”. The hospital report notes that she continues to exhibit symptoms which resemble those present during her index offences and initial admission.

Evidence at the Hearing

26The Board had available to it the documents forming the Record, the Exhibits, and oral evidence from Dr. Aaron Wu, who is Ms. Akonobi’s psychiatrist and author of the hospital report.

27Dr. Wu testified that he has been Ms. Akonobi’s attending psychiatrist since her criminal responsibility assessment in October 2024. When he first became involved in her care, she displayed residual symptoms of her illness including delusions, a belief that she was married to Jesus, and auditory hallucinations. At this time, the residual symptoms remain but do not dominate her conversations.

28Ms. Akonobi is on two oral medications including haloperidol and paliperidone. Her treatment needs to be optimized, which could include optimization of the haloperidol or treatment with other antipsychotic medications. A long-acting injectable medication would reduce the risk of non-compliance in the community which has traditionally been a problem for her.

29Dr. Wu testified that upon assessing her risk to the public, he has taken into account static and clinical risk factors. Ms. Akonobi’s illness was not adequately managed in the community despite CTOs, hospitalizations, and receiving other supports in the community. Based on the index offence, when she is ill, she misinterprets others’ actions and external stimuli as threatening. She has ongoing residual symptoms and challenges with insight. Therefore, she meets the criteria for significant threat. Absent the oversight of the ORB and hospital system, Ms. Akonobi is at real risk of relapsing and causing harm to the public.

30Dr. Wu testified that he is not recommending community living because Ms. Akonobi still requires medication optimization, needs to develop insight into her illness, and needs community supports to be put in place.

31Ms. Akonobi had been struggling living in the community since approximately 2022. She has not had stable housing since that time. The CTOs were not successful.

32Ms. Akonobi’s residual symptoms impact her ability to plan, perform complex tasks, and may impact her ability to perform tasks she will have to do in the community.

33There is no evidence that Ms. Akonobi has refused medication. The team assessed whether she was diverting her medication. However, it was determined that she has swallowed her medications. Ms. Akonobi’s insight fluctuates and therefore the assessment of her capacity is ongoing. She was found incapable to consent to treatment in March 2024. However, she is capable today. Her capacity continues to be assessed on an ongoing basis.

34Ms. Akonobi and the team have discussed increasing her oral medication. She has not overtly refused. They have discussed side effects. Ms. Akonobi has described a clear mind as the benefit of medication. She has been unable to connect the lessening of delusions with her medication regimen. Her insight into the need for medications is still underdeveloped.

35Ms. Akonobi’s nursing background has not assisted with her insight into medications. Her illness has impacted her ability to understand the necessity of medications.

36Ms. Akonobi’s insight into her index offence is limited.

37The hospital may consider approaching her sisters to be approved persons in the future if they remain in regular contact with Ms. Akonobi despite the fact that one lives in British Columbia and the other in California.

38In response to questions of the panel, Dr. Wu will have to observe Ms. Akonobi on passes before he can opine on her elopement risk.

39She required seclusion when she was untreated, disorganized in behaviour and frequently making threats toward staff. Violent ideation is not a concern at this time.

40Dr. Wu does not know why she received a driving prohibition in 2022, as per the hospital report. He does not know if substances were involved or if the prohibition was for another reason.

41The panel specifically asked Dr. Wu why he believes that his recommendation for an abstinence clause is the least onerous and least restrictive term given that there is no evidence of her using alcohol or substances. He testified that any amount of alcohol or substances could impact Ms. Akonobi’s illness and efficacy of treatment. He did not point the panel to any instance of alcohol or substance use by Ms. Akonobi.

42In response to questions of the panel, Dr. Wu testified that he did not believe Ms. Akonobi would achieve indirect privileges off hospital grounds in the coming year. However, he stated that the hospital would be willing to bring an early board to address this issue if this becomes a reasonable privilege for Ms. Akonobi more quickly than anticipated.

43No other evidence was called.

Analysis and Conclusions

44Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board finds that the joint position with respect to significant threat is well supported in the evidence. Ms. Akonobi represents a significant threat to the safety of the public.

45In Winko, the Supreme Court outlined that, in coming to the conclusion on the issue of significant risk, a Review Board should closely examine a range of evidence, including: the circumstances of the original offence; the past and expected course of the accused’s treatment; the present state of the NCR accused’s medical condition; the NCR accused’s own plans for the future; the support existing for the NCR accused in the community; and most importantly, the recommendations provided by experts who examined the NCR accused. In coming to our conclusion in this matter, the Board relies on the uncontroverted expert evidence of Dr. Wu, in addition to the documentary evidence before us.

46Ms. Akonobi is diagnosed with schizophrenia. She has a history of non-compliance with psychiatric medications. During both periods that she was subject to a Community Treatment Order, Ms. Akonobi failed to take her medications and her treatment team could not find her. While suffering symptoms of schizophrenia, she demonstrated aggressive behaviour in the community leading to her index offences. She continued to exhibit this aggressive behaviour in the hospital, which required seclusion until she received adequate treatment to quell her behaviours.

47Ms. Akonobi does not believe she has schizophrenia. She does not believe she needs psychiatric treatment. She continues to have significant symptoms including religious and grandiose delusions. The hospital report is clear that the symptoms associated with her schizophrenia have caused significant impairment in several life domains and are intimately related to her risk level.

48In particular, the Board relies on the summary and opinion set out in the Hospital Report on page 19, and agrees with its conclusions, excerpted as follows:

“After reviewing risk and protective factors relevant to Ms. Akonobi, her risk for reoffending is considered to fall in the Low-Moderate to Moderate range while under the strict supervision of a Detention Disposition, given that she remains symptomatic and there are concerns about her medication compliance. However, if legal and medical oversight was decreased or removed, her risk of reoffending increases to the High range. The primary factors driving this risk categorization are her diagnosis of Schizophrenia, her lack of insight, and history of problems complying with treatment and supervision efforts to address the same. Indeed, if Ms. Akonobi were to not comply with her medication regimen, it is likely she would quickly decompensate and a similar symptom profile she presented with when she was first admitted would emerge. Specifically, she is likely to become more withdrawn, oppositional, guarded, and irritable. Her well-established and intense delusional network (e.g., she is a Goddess who is married to Jesus) would also be likely to become more apparent in interactions, as well as be more prominently reflected in her behaviour. Specifically, she likely would begin demonstrating disorganized behaviours and those indicative of her experiencing internal stimuli. As demonstrated by her actions during the index offences and those toward staff upon admission, when unwell Ms. Akonobi is at risk of perpetrating violent behaviour. Therefore, if she were to become acutely unwell, it is foreseeable that she could re-offend in a violent manner”.

49Given the Board’s finding of significant threat, it is charged with shaping a Disposition for the coming year. The Board finds that the necessary and appropriate, least onerous and restrictive disposition is a Detention Order. However, the Board finds that the abstinence term proposed in the joint submission is not the least restrictive and least onerous term and, therefore, should not be included in the Disposition.

50When determining the necessary and appropriate disposition the Board must remind itself that the burden of justifying a restrictive Disposition always remains with the Board and if the Board is uncertain then the resolution must default in favour of the liberty of the individual.

51The law is clear that a joint submission by the parties is to be given significant weight by the Board. However, the Board is not bound by a joint submission. It is the responsibility of the Board to come to its own conclusions with respect to the issues before it.

52The Board has, as Laskin J.A. observed in Osawe (Re), at para. 33, “the undoubted authority, indeed the duty, to reject a joint submission if it is of the view that the joint submission does not meet the requirements of s. 672.54 of the Criminal Code.” Automatic acceptance of a joint submission is inconsistent with the Board’s statutory mandate: Thurston (Re), 2015 ONCA 351, at para.43; Osawe (Re), at paras. 33 and 57; Hassan (Re), at para. 25.

53When the Board considers that it might reject a joint submission, it is obligated to provide procedural fairness to the parties. With respect to the abstinence clause the Board provided that opportunity to the parties to recognize the concern of the Board. In particular, the Board asked pointed questions of Dr. Wu regarding his reasoning that the inclusion of an abstinence clause is the least restrictive and onerous term absent any evidence of alcohol or substance use or misuse.

54The Board does not accept that general concerns Dr. Wu has relating to substance use and mental health stability relate to Ms. Akonobi. There is no evidence that Ms. Akonobi uses, or at any time used, illicit drugs or alcohol. There was no reference to substances in the criminal charging documents, the NCR report, the risk assessment, the hospital report, the summaries of her 13 prior psychiatric admissions to hospital, or the evidence of Dr. Wu. Further, there is no evidence that illicit drugs or alcohol contributed to the psychiatric condition leading to the index offences or any offences. In fact, the NCR report and Hospital Report both specifically state, “She does not use alcohol, tobacco or illicit substances.”

55The Board discussed at length the possibility that the driving prohibition of 2022 could have arisen for several reasons including substance use while driving, a Highway Traffic Act offence, a criminal offence, or due to a reported medical condition. The hospital did not offer any information, either in their answers on questioning of the panel or in the hospital report, that shed light on the reasons for the prohibition. The Board finds that it is unreasonable to make any conclusions regarding reasons for the 2022 driving prohibition without more information.

56For these reasons, the Board accepts the joint submission with the exception of the abstinence clause, which shall be excluded from the Disposition.

57The Board points out that it is including in the Disposition the standard term requiring the submission of urine and/or breath samples for the purpose of analyzing whether the accused has ingested alcohol, drugs, or any other intoxicant. In the coming year, should the hospital gather any information that supports their position that an abstinence clause should be included in the Disposition, it will be able to present such evidence at the next annual hearing.

58The Board is very pleased that Ms. Akonobi’s sisters and parents are supportive of her and that she is receptive to the support of her family. The Board wishes Ms. Akonobi the best for her recovery in the coming year.

59Upon consideration of all the evidence, the submissions of the parties, and the criteria set forth in s. 672.54, the paramount consideration being the safety of the public, in addition to the mental condition of Ms. Akonobi, her reintegration into society and her other needs, we conclude that the necessary and appropriate Disposition is that Ms. Akonobi be detained subject to the terms and conditions set out in our formal Disposition.