Re: Ronald Martin Adler
ORB File No: 4030
Hearing held on: Wednesday, February 5, 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: Ms. C. Finley Members: Dr. S. Lessard Dr. L. Leong Mr. P. Capelle Mr. A. Bouvier
Parties Appearing:
Accused: Ronald Martin Adler Counsel: Ms. L. McCullough
The person in charge of hospital: Representative: Dr. P. Darby
Attorney General of Ontario: Counsel: Mr. C. Coughlan
REASONS FOR DISPOSITION
(Dated March 21, 2025)
Introduction
Ronald Adler was found not criminally responsible by reason of mental disorder (NCR) on August 30, 2004, on charges of threaten death, carrying a concealed weapon, and fail to comply with probation, contrary to the Criminal Code of Canada. Mr. Adler is currently subject to a disposition of the Ontario Review Board (Board/ORB) dated February 22, 2024, detaining him on the General Forensic Unit of Centre for Addiction and Mental Health, (CAMH/the hospital), with discretionary privileges up to residing in the community in approved accommodations.
On February 5, 2025, the Board convened a panel to conduct the annual review of Mr. Adler’s disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. Adler was not present. He was represented by Ms. McCullough who requested an order pursuant to s. 672.5(10) of the Criminal Code excusing his presence. On the consent of all parties, Mr. Adler was permitted to be absent for the hearing.
At the outset of the proceedings, all parties were canvased as to their positions on the issues to be determined by the Board: whether Mr. Adler continues to represent a significant threat to the safety of the pubic, and if so, the necessary and appropriate disposition having regard to the criteria set out in s. 672.54 of the Criminal Code.
Dr. Darby, on behalf of the hospital, submitted that Mr. Adler continues to represent a significant threat to the safety of the public and the necessary and appropriate disposition is a continuation of the current detention order. Mr. Coughlan, on behalf of the Ministry of the Attorney General, and Ms. McCullough concurred in the hospital’s positions. Thus, a joint recommendation was put before the panel.
Findings
- For the reasons that follow, the Board finds that Mr. Adler continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition is a continuation of the current detention order with the same terms and conditions.
The Evidence
- The evidence at the hearing consisted of the Hospital Report, dated January 20, 2025 (ex. 1), and the viva voce evidence of Mr. Adler’s treating psychiatrist, Dr. Darby.
The Index Offences
- On December 30, 2003, Mr. Adler was in a meeting with the victim at the Ontario Disability Support Program offices. Mr. Adler had been harassing and making threats towards staff over the previous few days. On that day, he made a direct threat to the victim, stating she was going to get a bullet right through the head. He became very aggressive and threw a chair across the office, causing property damage. The victim feared for her safety and for the safety of her staff.
On February 20, 2004, Mr. Adler was back at the ODSP office. Police were called. In the process of taking him into physical custody, he made a move to reach inside his jacket. A search revealed that he had a knife concealed in his jacket with a seven-inch serrated blade.
Background Information
The Hospital Report contains considerable information relating to Mr. Adler’s personal background and psychiatric history. It need not be reviewed in detail in these Reasons beyond the following material points. Mr. Adler is a 58-year-old man who was born and raised in Toronto. He completed high school and then studied political science at the University of Toronto. He dropped out after two years due to the onset of symptoms of his mental illness. He currently has no contact with his parents.
Mr. Adler first starting consuming alcohol at the age of 16. At some point, he started mixing alcohol with codeine in order to increase the effects of alcohol. He then began to use marijuana and cocaine in his 20s, which worsened his auditory hallucinations and led to paranoia. Mr. Adler also abused prescribed medication including Tylenol#1 and Tylenol#3 and benzodiazepines (Ativan).
Mr. Adler has a lengthy criminal record that is included on pp.8-10 of the Hospital Report. It includes multiple convictions for violence and threatening behaviour.
Mr. Adler first began to experience psychotic symptoms in 1985, when he was 17. He was admitted to Lakeshore Psychiatric Hospital and ultimately diagnosed with Schizophrenia. Upon discharge he was followed as an outpatient for approximately two years. He then became noncompliant with treatment and exhibited disruptive and aggressive behaviour. After being admitted to Mississauga Hospital, he reportedly threw furniture and threatened staff. Shortly thereafter, he also was diagnosed with Borderline Personality Disorder and Substance Use Disorder.
Between 1987 and 2001, Mr. Adler had 27 attendances at various hospitals. On a number of occasions, he presented at an emergency department after consuming alcohol or drugs and requested admission. On other occasions, he was noncompliant with medication and presented as uncooperative, suspicious, guarded and threatening.
In May 1995, he was found unfit to stand trial on charges of failing to comply with probation and mischief. He came under the jurisdiction of the ORB and subject to a detention order detaining him at Mental Health Centre Penetanguishene (MHCP), Oak Ridge Site (now Waypoint). He was floridly psychotic, with extreme anger and disruptive behaviour at the time of his admission. He was verbally abusive and threatening towards staff and required physical and chemical restraints. He was eventually found to be fit to stand trial and released into the community from Court.
Between 1997 and 2001, there were at least 5 occasions when Mr. Adler was charged with an offence, found unfit to stand trial, and admitted to hospital pursuant to a Treatment Order. On each occasion he was treated with antipsychotic medication, eventually found fit to stand trial and released back into the community.
Mr. Adler was found not criminally responsible on August 30, 2004. He was initially detained at the Mental Health Centre, Penetanguishene and then transferred to CAMH in March, 2007. In the spring of 2009, he was discharged to the community. Over the course of the following ten years, Mr. Adler had numerous readmissions to hospital. These readmissions were required due to a deterioration in Mr. Adler’s mental state resulting from stopping his medication and/or problematic use of substances.
In August 2017, Mr. Adler was residing in the community at Regeneration House. The day after his ORB hearing, the treatment team received a call from staff at Regeneration House, expressing concerns about him. There was smoke coming from his unit. Mr. Adler initially refused to allow them to enter his unit, but eventually complied, at which point they observed that his microwave was burnt. The following day, he purchased a new microwave and there was, again, smoke from his unit. Housing staff discovered that the box to the microwave had been badly burned, resulting in emergency services being called. His tenancy at Regeneration House was terminated at that time and other housing options became more difficult.
In December 2018, Mr. Adler was discharged to LOFT housing, a 24-hour supervised high support residence. Staff were on-site and supervised the administration of Mr. Adler’s medication.
Course since the Last Disposition
- Mr. Adler’s current diagnoses are:
Schizophrenia
Alcohol Use Disorder, in sustained remission
Opioid Use Disorder, mild-moderate severity
Sedative-Hypnotic Use Disorder, mild-moderate severity
Borderline and Antisocial Personality Traits
Mr. Adler has continued to reside at LOFT housing and appears happy to continue to reside there. No significant changes in his mental status have been observed. Mr. Adler remains guarded and suspicious when interacting with his treatment team. During a meeting with his community physician, Mr. Adler reported that he continues to hear voices, though he reported that the voices do not bother him. This information came as a surprise to the team.
Mr. Adler has limited insight into his mental illness, his ongoing need for treatment and his risk for relapse. He continues to lack any meaningful engagement with the treatment team. He reluctantly provided random urine samples for screening, which have consistently been positive for Codeine. This is due to his daily use of Tylenol 1’s.
Mr. Adler has not engaged in any programming and lacks daily structure. He struggles with hoarding and declines treatment or any kind of intervention to address his behaviour.
Dr. Darby testified before the Board. He described Mr. Adler as extremely guarded, which manifests itself as soon as he enters the room. Dr. Darby advised that he had learned that the week before the hearing, Mr. Adler had stuffed paper down his toilet causing it to flood his room. This caused damage to the third floor of the building where Mr. Adler’s room is located as well as damage to the apartment below and the ground floor. LOFT staff have warned Mr. Adler about this behaviour many times in the past.
After this incident, there was an angry exchange between Mr. Adler and the housing staff when he was told that he would have to bear the cost of repairing the damage caused by the flooding. Dr. Darby noted that Mr. Adler was very angry with the treatment team as well. This was the first time in quite some time that Dr. Darby had seen Mr. Adler angry and the doctor was struck by the intensity of his anger. Dr. Darby expressed some optimism that the issue of the cost of the repairs would be resolved and would not result in Mr. Adler having to move.
Dr. Darby testified that Mr. Adler is marginally capable so, should he experience a deterioration in his mental status, Box B of the Mental Health Act would not apply. In the doctor’s opinion, Mr. Adler would not attend the hospital voluntarily. When asked if he would be agreeable to return to hospital in the event of any decompensation, Mr. Adler, usually guarded in his response, indicated that he did not want to return to hospital. As a result, the doctor and the hospital were recommending a detention order.
Dr. Darby indicated that when he asked probing questions of Mr. Adler about his auditory hallucinations, Mr. Adler was quite dismissive and did not want to talk about it. He indicated that Mr. Adler has a very low frustration level which is currently managed within his very circumscribed calm life. The doctor testified that there may be other more overt paranoid thoughts at play but in his opinion, Mr. Adler’s low frustration was the factor at play in the confrontation with the housing manager.
Dr. Darby testified that Mr. Adler is likely not optimally treated. Mr. Adler has severe treatment resistant schizophrenia. His lack of engagement with the treatment team is quite striking. However, Mr. Adler is deemed capable of making treatment decisions and has not been willing to increase the dosage of his medication.
The Hospital Report includes the following passage under Composite Assessment of Risk, at p. 51:
In risk assessment, one of the best predictors is a patient’s history of violence. Mr. Adler’s history of violence involves several assault convictions, including use of weapons. When unwell and paranoid, he tends to resist arrest and become combative with security personnel. Early episodes of violence were directed at family members.
Mr. Adler does not become violent during the early stage of psychotic deterioration. However, he does deteriorate within several days of becoming non-adherent with oral medication, and when in this deteriorated state becomes more aloof and guarded and less likely to accept the supports he otherwise tends to begrudgingly accept. Non-adherence to medication would then escalate further and lead to acute risk of violence.
Mr. Adler’s history of abuse of sedating agents, codeine, and benzodiazepines, are factors that can increase the likelihood of future partial non-adherence to oral antipsychotic medication, thus contributing to the risk of violent recidivism.
- All parties maintained the joint submission.
Analysis and Conclusion
The panel carefully considered the Hospital Report and the evidence of Dr. Darby and unanimously finds that Mr. Adler continues to represent a significant threat to the safety of the public. Mr. Adler suffers from a severe treatment resistant schizophrenia and continues to experience auditory hallucinations though he does not find them bothersome. He is extremely guarded and paranoid when interacting with members of the clinical team. Mr. Adler has a long history of medication noncompliance leading to a deterioration in his mental status and aggressive and violent behaviour, similar to the index offences. While under the jurisdiction of the Board, Mr. Adler also has a significant history of decompensations in the community, requiring readmissions to hospital. The panel finds that he meets the threshold for significant threat.
Having found that Mr. Adler continues to represent a significant threat to the safety of the public, the panel must consider the necessary and appropriate disposition taking into consideration the criteria set out in s. 672.54 of the Criminal Code, which includes the need to protect the public from dangerous persons, the mental condition of the accused, the integration of the accused into society and the other needs of the accused.
The panel unanimously finds that the necessary and appropriate disposition is continuation of the current detention order. Dr. Darby is optimistic that Mr. Adler will be able to continue to reside at the LOFT residence. However, should that not be the case, the hospital requires the ability to approve Mr. Adler’s accommodations. Mr. Adler has successfully achieved 3 years in the community because of the stability provided by the support and supervision of his current residence. He is able to live a very circumscribed lifestyle with minimal interactions with staff and co-residents. He also has the benefit of staff supervising the administration of his medication.
Further, the panel accepts Dr. Darby’s expert opinion that the provisions of the Mental Health Act would not be available to return Mr. Adler to hospital should he experience a deterioration in his mental status. He would not agree to return to hospital voluntarily and, because he has been deemed capable, Box B would not be available.
Accordingly, the panel finds that the necessary and appropriate disposition is a detention order with the same terms and conditions. In arriving at this conclusion, the panel has considered the paramount factor of the safety of the public, Mr. Adler’s community reintegration, his mental condition, and his other needs as required by s. 672.5 of the Criminal Code.
DATED this 21st day of March, 2025, at the City of Toronto, in the Toronto Region.
Ms. C. Finley
Alternate Chairperson
Office of the Registrar
Ontario Review Board