RE: Ramanan Muthulingam
ORB File No: 6639
Hearing Held On: Monday, September 22, 2025
Place of Hearing: Waypoint Centre for Mental Health
Pursuant To: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. T. Mann
Members: Dr. K. Hand Dr. G. Kerry Ms. A. La Viola Ms. R. Chopra
Parties Appearing:
Accused: Ramanan Muthulingam Counsel: Mr. D. Northcott
Person in charge of Hospital: Representative/Counsel: Mr. J. Thomson
Attorney-General of Ontario: Counsel: Ms. S. Curry
REASONS FOR DISPOSITION
(Dated November 5, 2025)
OVERVIEW
- Ramanan Muthulingam was found not criminally responsible on account of mental disorder on October 15, 2014, on a charge of attempted murder, contrary to the Criminal Code. He is currently subject to a disposition of the Ontario Review Board dated September 6, 2024, detaining him at the Waypoint Centre for Mental Health Care – High Secure Provincial Forensic Programs, Penetanguishene, Ontario. The terms of his detention order include hospital and grounds privileges, beyond the secure perimeter, escorted by staff.
ISSUES
On September 22, 2025, the Board convened at Waypoint for a hearing further to s. 672.81(1) of the Criminal Code to review the disposition. The Board was asked to determine whether Mr. Muthulingam represented a significant threat to the safety of the public at the time of the hearing, and further, what the necessary and appropriate disposition is in the circumstances according to the factors set out in s. 672.54 of the Criminal Code.
At the outset of the hearing, Counsel for the Hospital and Counsel for the Attorney General submitted that in their respective views – Mr. Muthulingam continues to represent a significant threat to the safety of the public – both agreeing that he requires the secure setting at Waypoint, under the current disposition, with no change. On the contrary, Counsel for Mr. Muthulingam submitted that the Board should consider an absolute discharge, or in the alternative, a conditional discharge would be appropriate. Mr. Muthulingam gave a brief statement to the Board in which he expressed frustration at his continued hospitalization and some delusional content, following which he left the hearing. An order was granted excusing him from the balance of the hearing.
FINDINGS
- After reviewing both the documentary and oral evidence, and submissions of the parties presented at the time of the hearing, the Board found that Mr. Muthulingam represents a significant threat to the safety of the public. Accordingly, the Board determined that a detention order is required to manage the risk to the public, and for reasons that follow in more detail below, a conditional discharge does not appropriately address Mr. Muthulingam’s level of risk. The high secure setting at Waypoint continues to be necessary and appropriate. As a result, the Board concluded that the current disposition will continue to be in place, with no change at this time.
PERSONAL BACKGROUND
The Hospital Report dated August 14, 2025, was entered as an exhibit at the hearing. The following background information, including the events surrounding the index offence has been taken from the Hospital Report, summarized here as follows.
On June 4, 2014, Ramanan Muthulingam attended at the Scarborough General Hospital (the mental health outreach office at 1225 Kennedy Road), to see the doctor (victim) there. The victim called him to an examination room. Ramanan Muthulingam followed, produced a knife, and cut the victim’s throat, and he then dropped the knife, stating, “I will be waiting outside.” Police arrested Muthulingam outside the office. The victim sustained a four-inch neck laceration requiring sutures. The injuries sustained were non-life threatening.
Mr. Muthulingam is now 45 years old. He was born in Sri Lanka and moved to Germany at age 11 with his family before immigrating to Canada at the age of 19. Mr. Muthulingam completed schooling in Sri Lanka with average grades, later completed some high school in Germany (speaks and reads German), and upon coming to Canada experienced academic difficulties, but reported ultimately graduating and did not pursue post‑secondary studies. He attended L’Amoreaux Collegiate Institute in Scarborough but was asked to leave due to his age. He obtained some additional high‑school credits from out‑of‑province institutions. The Hospital Report notes that Mr. Muthulingam denies any formal diagnosis of a learning disorder or ADHD and reports no behavioural or social problems.
Mr. Muthulingam has a history of alcohol, cannabis, and a single reported cocaine use. He reported that he first drank alcohol at age 21 and first used cannabis at age 25. He denied daily use or withdrawal, hospitalizations, or substance‑induced psychosis, and denies use of other illicit drugs or nonprescribed opioids. Collateral records suggest he began cannabis use in high school.
Mr. Muthulingam reported beginning work at age 17 in a German factory and later held many short‑term factory jobs obtained through agencies (typically for a few months). He was most recently employed as a machine operator until 2014. He initially denied ever being fired but conceded one termination for overstaying vacation. Collateral information describes him as a generally competent worker with occasional attendance and commitment issues.
A check of the Canadian Police Information Centre database shows that Mr. Muthulingam has a criminal record starting in 2013 with various charges withdrawn in 2015 and 2016. The record also shows a 2003 aggravated assault wherein Mr. Muthulingam attacked his cousin, uncle and a neighbour with a broken shovel, causing head injuries to his uncle that required medical attention and injuries to the neighbour.
Also, it should be noted that he was charged with an assault arising from an incident on February 24, 2022, at Ontario Shores Centre for Mental Health Sciences. The altercation involves allegations that Mr. Muthulingam pulled a fellow patient to the floor and repeatedly kicked him in the head, causing an injury. As a result, a criminal responsibility assessment at Waypoint was undertaken related to that charge. On August 17, 2023, he was found guilty of assault, receiving a suspended sentence and 12 months probation.
PSYCHIATRIC BACKGROUND
Mr. Muthulingam’s current psychiatric diagnoses are Schizophrenia and Cannabis Use Disorder (moderate). He has been found incapable of making decisions about his medical treatment, but he is capable of managing his finances. His sister is his substitute decision-maker. He is financially supported by the Ontario Disability Support Program.
From November 13 to December 19, 2003, Mr. Muthulingam was admitted to CAMH from the Toronto East Detention Centre for a pre‑sentence assessment related to the July 2003 offences. In the year prior he had been decompensating with social withdrawal, increasing suspiciousness (including fear his food was poisoned and belief in covert cameras), talking to himself, insomnia, auditory hallucinations, and delusions of reference tied to perceived messages from friends or co‑workers. Neuropsychological testing during this admission suggested low‑average premorbid intellectual functioning, indicating a reading level around Grade 4. He was found not criminally responsible on February 13, 2004, with an absolute discharge following Ontario Review Board proceedings.
In August 2006 he was admitted to the Rouge Valley Health System under the Mental Health Act on a Form 1 (for suicidal ideation after police intervention for damaging property). He exhibited marked paranoia and poor medication adherence and was discharged on antipsychotic and sedative medications. In December 2011 he was admitted to the Scarborough General Hospital after calling police/crisis services and expressing grandiose and homicidal ideation, with noted delusional and disorganized thought content.
Mr. Muthulingam was admitted to Ontario Shores on June 10, 2014, pursuant to the Mental Health Act, on a Form 48 (Order of Assessment) and he remained under the hospital’s forensic care through June 23, 2022.
He was subsequently transferred to Waypoint following a disposition by the Ontario Review Board dated May 23, 2023, where he has remained since.
EVIDENCE AT THE HEARING
The evidence included comprehensive testimony from Dr. Mishra regarding the current mental health status and behaviour of Mr. Muthulingam. Mr. Muthulingam has been under his care since September 2022. Dr. Mishra stated that Mr. Muthulingam has recently been stabilized on clozapine. He achieved a C3 privilege level on August 28th after having been out of seclusion since June 20, 2025.
Dr. Mishra stated that the administration of clozapine was started in September 2024, and Mr. Muthulingam has accepted this medication regimen. Dr. Mishra noted that there is no immediate risk posed by Mr. Muthulingam while he remains in a secure and highly structured environment, currently the Beckwith unit.
Despite stabilization, Mr. Muthulingam continues to exhibit symptoms consistent with grandiose and persecutory delusions, including ongoing concerns about perceived threats from individuals and female staff. He remains fixated on his sister, believing she is holding his fortune, and he expresses anger towards her. He also believes he is Jesus and that his hospitalization is a natural calamity.
Additionally, he maintains beliefs concerning European leaders and other conspiracy theories, which have remained unchanged from previous assessments. Dr. Mishra observed that Mr. Muthulingam tends to incorporate past doctors/therapists into his delusions, sometimes claiming to have been to school with them or planning to marry a female therapist, however, these often shift and lack consistency. Dr. Mishra indicated that Mr. Muthulingam can plan attacks and act on them without warning. Consequently, he himself takes extra precautions such as having staff with him when interacting with Mr. Muthulingam.
Dr. Mishra reported that Mr. Muthulingam desires to live in the community and recounted an incident where he arranged to marry a relative. Despite his delusions, he does not demonstrate remorse for past violent acts, which are best managed within the structured environment of Waypoint, specifically on the Beckwith unit, where he has been most recently held and has only been out of seclusion for three months.
During this period, he has been observed to be engaging appropriately in activities such as obtaining food and socializing with other patients, with no maladaptive behaviours noted. Medication adjustments, primarily involving clozapine, appear to have contributed to decreased impulsivity and violence. However, Mr. Muthulingam does not attribute his improvements to medication, nor does he believe electric convulsive therapy (ECT) would be beneficial – he has only agreed to taking clozapine. His family – including his sister, who is the substitute decision-maker – and mother remain supportive, though their relationship is strained, and he refuses to communicate with them, believing they are trying to take his money away. Nevertheless, they stay in contact with Dr. Mishra and the social worker.
After further inquiries, Dr. Mishra explained that ECT was considered but rejected, and ongoing cognitive-behavioural therapy (CBT) for psychosis is deemed challenging given his tendency to incorporate therapeutic sessions – and therapists – into his delusional framework.
Regarding the titration of clozapine, Dr. Mishra reported that the clinical team discussed the possibility of increasing the dose for a more robust therapeutic effect. While 475 mg is considered a good dose at present, past attempts to elevate the dosage have been halted when Mr. Muthulingam chose to stop taking the medication. The current plan is to gradually titrate upward with caution, carefully monitoring to prevent him from refusing medication again. Over the next year, there is an understanding that a higher dose may not necessarily result in a better response, and careful monitoring and assessment will be essential to determine effectiveness and tolerability.
Lastly, Dr. Mishra noted that current concerns primarily revolve around the risk of violence if he is discharged, given his active delusions and history of assaulting a fellow patient who was merely watching television. Mr. Muthulingam exhibits a profound lack of insight into his condition, often demonstrating behavioural impulsivity, especially when incorporating others into his delusional planning, which is indicative of his continuing risk of violence. Generally, he maintains friendly interactions with other patients but remains cautious around staff, requiring supervision during interactions. The treatment team recognizes that he has been successfully maintained out of seclusion for several months and hopes to sustain this progress over the next reporting year.
SUBMISSIONS
After hearing the evidence, the parties' closing submissions reflected their initial positions. Counsel for the Hospital emphasized that Mr. Muthulingam presents a significant threat to the safety of the public and argued that his detention at Waypoint is necessary and appropriate, recommending no change to his current disposition. Counsel for the Attorney General concurred with the Hospital’s position, agreeing that Mr. Muthulingam remains a significant threat, particularly due to his delusional state, and considered it extremely premature for a conditional discharge. Overall, the Hospital and the Attorney General agreed that all evidence supported maintaining Mr. Muthulingam at Waypoint.
Counsel for Mr. Muthulingam, on the other hand, advocated either for an absolute discharge or a conditional discharge – leaving the decision to the Board – essentially maintaining the same position as at the outset.
ANALYSIS AND CONCLUSION
(a) Significant Threat
The Board must first determine whether Mr. Muthulingam continues to pose a significant threat to the safety of the public as defined in Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625. Based on the totality of the evidence, including the testimony of Dr. Mishra, recent clinical findings, and the actuarial risk assessment results, the Board concludes that Mr. Muthulingam continues to meet the legal threshold for ‘significant threat’.
Mr. Muthulingam's HCR-20 assessment reveals numerous static and dynamic risk factors across all domains, including an extensive history of violence, criminality, instability in interpersonal relationships, poor insight, persistent symptoms, and inconsistent responses to supervision and treatment. He exhibits significant difficulties managing stress, historical resistance to supervision, and a history of medication manipulation. His poor insight is well-documented, noting that he fails to appreciate factors that influence his mental status, such as medication compliance and drug use, all of which underscore the challenges in effectively mitigating his level of risk. His past violence is a critical concern. Mr. Muthulingam’s history of violence began in adulthood, involving family, peers, hospital staff, and the use of weapons, causing significant injury. He has demonstrated a range of antisocial behaviours, which appears to have been driven by both personality factors and drug use, exacerbating his mental illness.
Currently, despite treatment with clozapine, Mr. Muthulingam continues to exhibit persistent delusional content marked by grandiose and persecutory themes. He believes he is Jesus, that his confinement will result in natural calamities, and maintains delusions involving European leaders – beliefs that have remained unchanged. These delusions significantly impact his relationships, particularly with family, who are integrated into his delusional system as targets. This isolates him from support and fuels behaviours that pose risks to others. Mr. Muthulingam has a history of incorporating individuals into his delusional narrative, resulting in hostile actions, such as the unprovoked assault on a fellow patient. These delusions, coupled with a lack of insight, perpetuate impulsive and potentially dangerous behaviours that impede his rehabilitation. He displays a deep lack of insight and continues to voice violent ideation. The fact that he has a history of incorporating individuals into his delusional narrative, resulting in hostile and aggressive actions like his unprovoked assault on a fellow patient, further solidifies our concern about the very real potential for similar incidents to occur, similar to the serious and violent index offence.
(b) Necessary and Appropriate
The Board must next determine the disposition that is necessary and appropriate in the circumstances. The disposition must embrace the principle of ‘least onerous and least restrictive’ with due consideration given to Mr. Muthulingam’s liberty interests, which must also be consistently weighed together with concerns about public safety (the paramount concern), his mental condition, and his reintegration into society, as required by s. 672.54 of the Criminal Code.
With regards to whether an absolute discharge would be appropriate, in the circumstances, we find that Mr. Muthulingam is not entitled to an absolute discharge because he continues to represent a significant risk to the safety of the public. Given the persistent symptoms, continued need for structured support, and the potential for violence should his delusions become more activated, an absolute discharge would place the community at an unacceptable risk as there would be no mechanism to ensure medication compliance, monitoring, or the capacity to intervene proactively should his condition deteriorate.
A conditional discharge is similarly inappropriate. The necessary conditions to ensure Mr. Muthulingam's safe reintegration into the community are not currently available, nor are they reasonably foreseeable. Further, Mr. Muthulingam has shown a resistance to treatment and limited compliance, and it is unlikely he would adhere to the conditions required to manage his risk in the community. Given the absence of a robust community support system, continued delusions, and past violence, a conditional discharge would not adequately mitigate the risk to public safety.
In light of all of the evidence, the Board finds that Mr. Muthulingam's continued detention in a secure forensic facility remains necessary and appropriate. Despite stabilization on clozapine and time out of seclusion, his prognosis is guarded, given his history of illness, history of medication non-compliance, and persistent delusions. While more improvements or stability might be achieved, there are considerable concerns and complexities that prevent a more optimistic finding at this point in time.
Moreover, Mr. Muthulingam has demonstrated a clear pattern of devaluing, minimizing, and blaming others for his violent acts, showing a fundamental inability to take responsibility for his behaviour. This lack of accountability, coupled with his impulsive and unpredictable nature, significantly increases the risk that he will engage in further acts of violence if placed in a less-secure, less-structured environment.
Given the concerns outlined above, it is our view that the current plan to gradually titrate the medication upward with caution, with the understanding that a higher dose may not necessarily improve his response, making it vital that the clinical team undertake constant assessment and monitoring is acceptable. We agree with the clinical team – this is essential to gauge treatment effectiveness and medication titration tolerability moving forward. Mr. Muthulingam’s continued detention in the high-secure provincial forensic program, with the necessary structure and support, is the most appropriate way to manage the risk effectively. In conclusion, Mr. Muthulingam requires the high-security setting at Waypoint to manage his ongoing symptoms and risk of violence. As a result, the current disposition will remain in place, with no change at this time.
DATED this 5th day of November 2025, at the City of Toronto, in the Toronto Region.
Ms. A. La Viola Legal Member
Office of the Registrar Ontario Review Board