Ontario Review Board
Re: Uchenna Onochie
ORB File No: 6876
Hearing held on: Wednesday, January 29, 2025
Place of hearing: St. Joseph's Healthcare Hamilton
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. J. Weinstein
Members: Dr. R. Buckingham Dr. L.O. Lightfoot Mr. K. McKenna Ms. B. Little
Parties Appearing:
Accused: Uchenna Onochie Counsel: Mr. M. Schloss
The person in charge of hospital: Counsel: Ms. L. Barney
Attorney General of Ontario: Counsel: Ms. A. Lepchuk
REASONS FOR DISPOSITION
(Dated February 25, 2025)
Introduction:
On December 17, 2015, Mr. Uchenna Onochie was found not criminally responsible on account of mental disorder on a charge of second-degree murder, contrary to the Criminal Code of Canada (“Criminal Code”).
Mr. Onochie is subject to a Disposition of the Ontario Review Board (the “Board”), dated February 5, 2024, which orders that he be detained at the Forensic Psychiatry Program of St. Joseph's Healthcare Hamilton - West 5th Campus (“St. Joseph's”).
On January 29, 2025, the Board convened a hearing at St. Joseph's to conduct the annual review of the current Disposition.
Mr. Onochie was present and was represented by his counsel, Mr. M. Schloss.
A Hospital Report, dated January 14, 2025 (the "Hospital Report"), was entered as Exhibit 1.
The issue at this hearing is whether Mr. Onochie 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.
For the reasons set out below and based on the expert evidence and opinions before it, the Board concluded that Mr. Onochie continues to represent a significant threat to the safety of the public. The Board ordered that the necessary and appropriate Disposition in the circumstances is the continuation of the existing Detention Order.
Current Psychiatric Diagnoses:
- Schizophrenia
Substance use Disorder, in remission.
Index Offence:
- The circumstances giving rise to the Index Offence are extracted from last year's Board Reasons, as follows:
“On December 16, 2015, Uchenna Onochie came before this court for trial on a charge that, on the 17th of January, 2015, he killed Aloy Onochie and thereby committed Second Degree Murder; contrary to S. 234(1) of the Criminal Code…
There is no dispute with respect to the facts surrounding the death of Aloy Onochie. At the time of his death, he was 60 years of age and was residing with the defendant, his 18year-old son, in a condominium apartment near the intersection of Finch Avenue and Yonge Street in Toronto. Is it admitted that he died as a result of multiple stab wounds that were inflicted by the defendant late on the evening of Saturday, January 17. Immediately after the infliction of those injuries, the defendant fled from the apartment and ran to the Finch subway station in his bare feet, clad only in a t-shirt and pajama pants. He was covered in blood and he was brandishing a knife. When the police arrived, the defendant refused to drop the knife because, he said, ‘The devil is here.’ Eventually, the police were able to persuade him to drop the knife and he was taken into custody.
There is no suggestion that the defendant had any lawful justification or excuse for the assault on his father; nor is there any evidence of provocation. The joint position of the Crown and the defence, however; is that the defendant should not be found guilty of murder or of any other offence because he was not criminally responsible for his conduct.”
Course Since Last Disposition:
- Mr. Onochie’s course since his last Disposition is set out in detail in the Hospital Report. The following extracted paragraphs are relevant to this hearing:
“He passed his Canadian citizenship test this reporting period and participated in the Oath of Citizenship.
Mr. Onochie resides independently in a 2-bedroom market rent apartment. He remains on a waitlist for subsidized housing through the City of Hamilton.
As mentioned above, Mr. Onochie denies having his finances as a significant stressor, however he often fixates on his need to save money for retirement, to purchase a car, and to travel to Nigeria to visit his father’s grave. He often explores ways to obtain and make money and has consistently expressed a desire to have a roommate to ease his perceived burden of paying market rent. He does not receive ODSP and has a balance owing where he pays approximately $26/month until January 2027. He also owes the CRA approximately $800 and has been paying this down from approximately $1300 since April of 2024.
Mr. Onochie works full-time at Amazon (YHM1 Amazon Fulfillment Centre), Sunday to Wednesday 0700-1730. He often works overtime on Saturdays, and some Thursdays during their busy periods. He has work accommodations due to his mental illness, which promotes a less stressful environment. He reports strong support from his supervisors and can balance work and attending appointments at the Forensic Outpatient Clinic without issue.”
Position of the Parties:
Counsel for the hospital was recommending a Conditional Discharge, upon terms set out on page 70 of the Hospital Report, including the right for international travel, with an itinerary approved by the person in charge, and accompanied by an Approved Person.
Counsel for the Attorney General recommended a continuation of the existing Detention Order Disposition.
Counsel for Mr. Onochie agreed with the recommendations of the hospital.
For the purposes of this hearing, counsel for Mr. Onochie advised that significant threat was not in dispute.
Evidence at the Hearing:
- The Board had available to it the evidence, and documents forming the Record, the Exhibits, and oral evidence from Dr. Prat. Dr. Prat co-authored the Hospital Report and testified as follows:
a) He has been Mr. Onochie’s attending psychiatrist since approximately 2020.
b) He has read the Hospital Report and adopts its contents.
c) Mr. Onochie has resided in the community over the past reporting year and has not required any readmissions to hospital. He currently reports to the Forensic Outpatient Team on a weekly basis.
d) Mr. Onochie has a full working schedule. He works five days a week, sometimes six.
e) There have been no positive urine drug screens this reporting period.
f) Mr. Onochie does have a number of stressors in his life, particularly his finances.
g) Mr. Onochie was planning to sublet part of his apartment to lower his cost of living.
h) Mr. Onochie initially considered having another forensic patient move in with him, but his family did not approve. The treatment team had to educate Mr. Onochie as to all the possible risks and consequences of subletting an apartment. The forensic patient decided not to move in with Mr. Onochie, and Mr. Onochie next considered a friend of a friend, despite barely knowing this potential subtenant. The treatment team encouraged him to do his homework and research what is actually entailed in subletting part of his apartment.
i) Mr. Onochie is a very kind and trusting person, perhaps somewhat naïve. He did not fully anticipate the potential consequences of sharing his apartment, including the possible impact on his mental health.
j) Mr. Onochie continues to experience chronic, daily auditory hallucinations, which he reports are derogatory in nature. He is quite forthcoming with the treatment team when asked about these symptoms. They are long-standing and have not changed in the last five years. What has significantly changed is Mr. Onochie’s increased ability to use coping skills, rather than as-needed medications, to cope with these symptoms.
k) Mr. Onochie is prescribed Ativan and Cogentin on a PRN basis, which he takes every morning with his scheduled medications, regardless of whether he is experiencing anxiety or perceptual disturbances.
l) Mr. Onochie believes that if he were to stop these as-needed medications, his auditory hallucinations would worsen.
m) He would describe Mr. Onochie as being optimally treated.
n) Mr. Onochie has very good insight into his illness and his need for medication. He understands that an increased intensity in the voices is an early warning sign.
o) His attention was brought to the following paragraph from page 67 of the Hospital Report:
“He has not retained nor used cognitive coping skills from Cognitive Behavioural Therapy for psychosis (CBTp), which is considered a foremost resource to manage residual symptoms. Relatedly, insight into early warning signs was absent. He has not been receptive to recent offers for therapy or psychosocial support. Indeed, as Mr. Onochie has moved into the community, his reflections on and willingness to engage in therapy or services outside of medication management has decreased. A similar trend was seen with his transparency in terms of stressors (e.g., social skills, job, finances). Although he has good appreciation of his mental health, he appears to have poor insight into the relative risk of reliance on benzodiazepines in light of his historical substance use diagnosis.”
He did not agree with this portion of the report.
p) While Mr. Onochie was an inpatient, the treatment team worked hard to reduce the amount of PRN medication he was taking.
q) Mr. Onochie has a strong desire to remain stable, so that he can continue with his employment. The most important factor for Mr. Onochie’s ongoing stability is his vocational activities, in which he takes great pride.
r) It is also important for Mr. Onochie to maintain a positive social network with prosocial peers, which he appears to be doing.
s) It is very difficult for Mr. Onochie to engage in CBT for psychosis, because of his extensive work schedule, but he may be able to do so on a 1:1 basis, with his case manager.
t) His attention was then drawn to the following paragraph on page 67 of the Hospital Report:
“While low risk under his current supervision framework (i.e., Detention Order with community living, frequent UDS, weekly reporting), Mr. Onochie is considered at low-to-moderate risk for reoffending under a Conditional Discharge with increasing liberties.”
He agrees with this assessment.
u) The first time Mr. Onochie was discharged into the community did not go well; he had difficulty managing this new freedom. He entered into some seemingly problematic relationships, and he engaged in some “sketchy business” with other patients.”
v) The treatment team does not have any concerns about Mr. Onochie being overly reliant on his current medication regimen.
w) However, the following scenario occurred which was not contained in the Hospital Report:
i) He had prescribed Ativan every four hours, and he did not put a limit on the amount of Ativan to be dispensed per week.
ii) The pharmacy had been dispensing six pills a day since June until December, although Mr. Onochie was only supposed to be using one Ativan per day. Therefore, Mr. Onochie had received approximately 800 or more pills than he needed.
iii) Mr. Onochie could not explain what happened to these pills and had no recollection of them being dispensed.
iv) He required Mr. Onochie to visit with the pharmacy, to figure out what had happened.
v) The treatment team still has no clear understanding of what happened to these 800 plus pills. They did not believe Mr. Onochie was personally using these excess Ativan pills; they would have noticed changes in his personality, and he would have appeared very sedated if he had been.
vi) At some point, after having been confronted with this issue, Mr. Onochie retrieved a bottle containing 70 pills and returned them to the treatment team.
x) If Mr. Onochie were granted a Conditional Discharge, he would likely return to the hospital upon request.
y) The recommended requirement to stay at his current residence, as per the terms listed on page 70 of the Hospital Report, would be sufficient to manage Mr. Onochie’s risk to public safety.
- In response to questions from counsel for the Attorney General, Dr. Prat testified:
a) He confirmed multiple times with the pharmacy that they had, indeed, dispensed six pills a day to Mr. Onochie. It is unlikely that the pharmacy would be incorrect about the amount, as such a large discrepancy would have been reflected in their inventory. He is willing to give Mr. Onochie the benefit of the doubt and believe that he does not remember what happened to the excess pills. While it is possible that Mr. Onochie was being dishonest, he does not believe it is likely.
b) He agreed that Mr. Onochie had engaged in “sketchy behaviour” in the past, including selling cigarettes when he was at Emmaus Place, which was one of the reasons he was discharged from that residence.
c) He agrees that Mr. Onochie tends to be susceptible to negative peer suggestions, as set out on pages 66 and 67 of the Hospital Report. However, he does not believe that peer pressure had anything to do with the missing Ativan.
d) Another reason Mr. Onochie was discharged from Emmaus Place in 2021 was his inappropriate conduct with female tenants and staff. This behaviour is no longer a concern about Mr. Onochie, as he has gone through appropriate psychoeducation therapies about boundaries with women.
e) Mr. Onochie’s risk of decompensation, should he stop taking his clozapine versus his Abilify, is of greater concern.
f) Mr. Onochie is now receiving his Ativan in blister packs, so the team can monitor his use. He is taking Cogentin to control the side effects of his antipsychotic treatment.
g) Mr. Onochie is very sensitive to stress. It increases the frequency, and intensity, of the voices. It is easy to see him responding to these voices when they become more intense.
h) His attention was then drawn to the following section of the Hospital Report:
“He currently has no way of managing stress, aside from listening to music or using PRN medication. It is my impression that Mr. Onochie is operating at the border of his stress tolerance/management skills currently.”
Dr. Prat did not agree with this paragraph of the Hospital Report. He believes that Mr. Onochie has managed stress in a very appropriate manner, if not in an optimal manner. He does agree, however, that Mr. Onochie is at the border of his stress tolerance.
i) He acknowledged that, at one point, Mr. Onochie had been prepared to have a person from Nigeria, who was known to use substances, live with him. However, Mr. Onochie sought the treatment team’s input, and he subsequently agreed that he would not be an appropriate co-tenant.
j) He disagreed with the Hospital Report’s characterization that Mr. Onochie rejected the team’s recommendation, became fixated on having another forensic patient live with him, and was dismissive of potential complications.
k) He is confident that the Mental Health Act would be sufficient to bring Mr. Onochie back to hospital, should he be experiencing decompensation.
l) Mr. Onochie’s employers interact with him, are aware of his mental status, and provide allowances for him. They would contact the treatment team if they noticed a change in his behaviour, as would his family.
- In response to questions from counsel for Mr. Onochie, Dr. Prat testified:
a) Clinically, Mr. Onochie has been mentally stable for quite some time.
b) Mr. Onochie has not had any positive drug tests. He has had plenty of opportunity to use drugs, and was with people using alcohol in December, but he remained abstinent.
c) The treatment team is hoping to reduce his reporting requirements on a gradual basis.
d) Mr. Onochie would keep the same treatment team, even if granted a Conditional Discharge.
e) Mr. Onochie is very good at his work and would not want to do anything that would jeopardize his ability to work and earn money. Work is a protective factor and provides stability and structure for him.
f) Taking Ativan on a daily basis does not cause any immediate harm to, or negative consequences for, Mr. Onochie.
g) The reason Mr. Onochie received so many Ativan from the pharmacy is that the prescription had been set up for automatic refills. It was refilled monthly, for a period of six months.
h) A Conditional Discharge would represent the least onerous and least restrictive Disposition at this time.
i) Should Mr. Onochie breach any of the terms of a Conditional Discharge, and not return to the hospital voluntarily, there is no doubt that the police would pick him up quickly at the hospital’s request, given the serious nature of the Index Offence.
- In response to questions from the panel, Dr. Prat testified:
a) He disagrees with the statement contained in the Risk Assessment that Mr. Onochie’s insight in early warning signs was absent. He also disagrees with its assertion that Mr. Onochie has not been receptive to recent offers for therapy or psychological support. His willingness to engage in therapy, and services outside medication management, has decreased only because of the amount of work that he is doing. He further refutes that Mr. Onochie has been quick to reject any suggestions by the team that impinge on his plans, which are relatively short sighted and focused on immediate gratification.
b) Mr. Onochie is getting proper psychological support from his case manager and the rest of the treatment team.
c) As set out in the Hospital Report, Mr. Onochie would benefit from support in the following areas: financial planning, increased insight into early warning signs and increased insight into the risk for decompensation related to stress and antisocial peer affiliation.
d) The treatment team would be able to pick up early signs of any decompensation, as a return of Mr. Onochie’s paranoia would be quickly noticeable.
e) The recommendation for a Conditional Discharge was initially unanimous, until the issue of the missing Ativan pills arose.
f) The doctor who authored the Risk Assessment section was included in an e-mail communication where the team still believed a Conditional Discharge was appropriate, despite not being aware of the new information regarding the issue of the excess Ativan pills at the time of writing the Risk assessment.
- No other evidence was called.
Analysis and Conclusions:
Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board agrees with the joint submission: Mr. Onochie remains a significant threat to the safety of the public.
In 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. Prat, in addition to the documentary evidence before us.
In particular, the Board relies on the following extracted paragraphs from the Hospital Report:
“Mr. Onochie has had a very positive and successful year. He was discharged one year ago, and he has not required any readmissions since then. He continues to present with residual symptoms of psychosis which he manages well with coping strategies and PRN medication. He has continued to work substantially which, thus far, has been a very positive factor in his recovery, by promoting independence and self-esteem. Mr. Onochie seems to continue to express concerns regarding his inability to save enough money for retirement; this does not seem to constitute a risk factor on its own but induces stress that requires monitoring. Indeed, he is at risk of making unwise decisions, such as having roommate move in with him. This may not be the most suitable situation if not thought out carefully. So far, he has been relying heavily on the Forensic Outpatient team’s feedback.
Despite the very positive year and the absence of relapsing symptoms, and particularly in light of the failed discharge into the community that took place in 2021, it is important to be cautious regarding the next steps of Mr. Onochie’s rehabilitation. He continues to present with several risk factors including the nature of his mental illness that remains active, his past substance use history, the nature of the index offense, and the ongoing need to take PRN medication in case of stress. In my clinical opinion he continues to meet the threshold for significant threat to public safety.
In the past, when provided with less supervision, he had difficulties coping with this and engaged in maladaptive behaviour. There is no doubt that the work he has actively engaged in in terms of interpersonal relationships has been meaningful and has led to the successful discharge so far. However, having a step allowing a lesser level of supervision, while continuing to receive the support of the forensic team with whom he has developed a trusting relationship, is essential to ensure longstanding success. This is the reason that the team and I are of the opinion that a Conditional Discharge is the necessary and least onerous step at this point.”
The Board agrees with the position of the Attorney General: based on the evidence before us that a Detention Order is the most appropriate Disposition at this time. This conclusion takes into consideration the requirement that the paramount consideration must be the safety of the public. The Board has very serious concerns about what happened with the excess Ativan pills. It is hard to believe that Mr. Onochie did not receive in excess of 800 pills. The doctor agreed that the pharmacy has strict inventory controls and would not likely make such a mistake. We can only surmise what happened to these pills. This very serious, unknown factor compels us to proceed very cautiously.
Both the doctor’s evidence and the Hospital Report are quite clear that Mr. Onochie’s finances are a very big source of stress for him. Mr. Onochie is quite preoccupied with finding ways to make money, which has prevented him from fully appreciating the potential consequences of his plans to improve his financial situation.
It is also worth noting that the Hospital Report increases Mr. Onochie’s risk of reoffending, from “low” on a Detention Order with community living, to “low-to-moderate” on a Conditional Discharge. The Index Offence was very serious, and this increased risk, at this stage, is not acceptable to the Board.
The Board also relies on the following passages from the Risk Assessment, despite the fact that Dr. Prat did not agree with most of them.
“He has not retained nor used cognitive coping skills from Cognitive Behavioural Therapy for psychosis (CBTp), which is considered a foremost resource to manage residual symptoms. Relatedly, insight into early warning signs was absent. He has not been receptive to recent offers for therapy or psychosocial support. Indeed, as Mr. Onochie has moved into the community, his reflections on and willingness to engage in therapy or services outside of medication management has decreased. A similar trend was seen with his transparency in terms of stressors (e.g., social skills, job, finances). Although he has good appreciation of his mental health, he appears to have poor insight into the relative risk of reliance on benzodiazepines in light of his historical substance use diagnosis.
He currently has no way of managing stress, aside from listening to music or using PRN medication. It is my impression that Mr. Onochie is operating at the border of his stress tolerance/management skills currently.”
The Risk Assessment is quite clear that Mr. Onochie would benefit from support in the following areas: financial planning, increased insight into early warning signs and increased insight into the risk for decompensation, related to stress and antisocial peer affiliation. The Board is concerned that Mr. Onochie seems to be focused on immediate gratification, especially regarding his drive to become more financially secure.
Mr. Onochie continues to be focused on having a roommate to help with financial stress, which would be an unknown variable; as per the Hospital Report, although it would alleviate some of his financial burden, having a roommate would undoubtedly increase his stress level.
In consideration of all the evidence, submissions of the parties and criteria set forth in s. 672.54, the paramount consideration being the safety of the public, in addition to the mental condition of Mr. Onochie, his reintegration into society and his other needs, the necessary, and appropriate Disposition is to continue with the Detention Order.
DATED this 25th day of February, 2025, at the City of Toronto, in the Region of Toronto.
Mr. J. Weinstein Alternate Chairperson
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Office of the Registrar Ontario Review Board