Ontario Review Board
Re: T. (L.)
ORB File No: 5402
Hearing held on: Friday, January 17, 2025
Place of hearing: North Bay Regional Health Centre – North Bay Site
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. P. Capelle Members: Dr. J. Watts Dr. P. Wright Ms. L. Banks Mr. J. Cyr
Parties Appearing:
Accused: T. (L.) Counsel: Mr. C. Bracken
The person in charge of hospital: Counsel: Mr. P. Trenker
Attorney General of Ontario: Counsel: Ms. M. Mazurski
REASONS FOR DISPOSITION
(Dated March 20, 2025)
Introduction:
On June 23rd, 2009, Mr. T. (L.), was found not criminally responsible on account of mental disorder (“NCR”) on charges of utter threat to cause death or bodily harm (x2), assault with a weapon, possession of a weapon for dangerous purpose, breach of probation and mischief - not exceeding $5,000, all contrary to the Criminal Code of Canada (“Criminal Code”). Mr. T. (L.) is currently subject to the terms and conditions of a Disposition of the Ontario Review Board (“ORB” or the “Board”) dated December 20, 2023, pursuant to which he is ordered detained at the Forensic Programs, North Bay Regional Health Centre–North Bay Site (“North Bay RHC” or the “hospital”), and is subject to a number of terms and conditions, including the privilege to enter the community of North Bay, indirectly supervised.
On January 17, 2025, a panel of the ORB convened at the hospital to conduct an annual review of Mr. T. (L.)’s Disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. T. (L.) was present at the hearing and was represented by his counsel, Mr. Bracken.
The Board had to decide whether Mr. T. (L.) continued to pose a significant threat to the safety of the public, and if so, the necessary and appropriate Disposition having regard to the criteria set out in s. 672.54 of the Criminal Code.
For the reasons set out below, this Board finds the test for significant threat continues to be met and that the necessary and appropriate Disposition under the circumstances is that Mr. T. (L.) continue to be subject to the terms of his existing Detention Order Disposition.
Index Offences:
- The incidents giving rise to the above-noted charges are set out in full in the Hospital Report to the ORB dated December 9, 2024 (the “Hospital Report”) and are summarized here, as follows:
The charges all relate to an attack by the accused on his brother and mother on January. 3rd and 4th, 2009, at their home. While the events unfolded, the accused was in possession of a knife, although injuries to the brother arose as a result of kicking and punching and not the use of a weapon. He did however hold a knife to his brother’s throat.
The police, who had been alerted by the mother as to what had transpired, and attended at the residence. At that time, T. (L.) exited the residence with ice pick shovel and went towards the officers. He caused damage to a police car. Mr. T. (L.) had consumed alcohol despite being bound by a Probation Order prohibiting same. At the time of the index offences, Mr. T. (L.) was suffering from persecutory delusions.
Of note, in May 2024, Mr. T. (L.)’s brother, Lawrence, who was a victim of the index offences, passed away due to an overdose.
Positions of the Parties:
At the outset of the hearing, all parties were canvassed as to their initial recommendations to the Board. Counsel for the hospital recommended that Mr. T. (L.) remained a significant threat to public safety and that the necessary and appropriate Disposition continued to be his existing Detention Order.
Counsel for the Crown supported the hospital’s recommendation.
Counsel for Mr. T. (L.) was supportive of the hospital’s recommendations and conceded the issue of significant threat for the purposes of this hearing.
All parties maintained their joint recommendation to the Board in closing submissions.
Personal Background:
Mr. T. (L.)’s personal, psychiatric and legal history are set forth in full in the Hospital Report and as that document was made an Exhibit at the hearing, that information will not be repeated here but for the following material highlights.
Mr. T. (L.) is a 32-year-old Indigenous man who was born in Little Current, Ontario. He spent most of his young life with his family on Manitoulin Island. His parents have been separated for many years. He has four siblings. Mr. T. (L.)’s educational history included a number of school suspensions. After some counselling, he attained good grades and did not engage in fights at school. He ultimately dropped out of school in the second semester of Grade 9.
Criminal History:
Mr. T. (L.) has a criminal record, which began in 2005. It includes convictions for break and enter, obstruction of justice, pointing firearms, assault, and failure to abide by court orders.
Additionally, Mr. T. (L.) had been previously charged under the Youth Criminal Justice Act for Failure to Comply.
Psychiatric History:
Mr. T. (L.)’s psychiatric history began in 2008 after an attempted suicide. He has a history of using substances from a young age, including alcohol, crack cocaine, ecstasy and other drugs with his main drug of abuse being marijuana.
Initially after his NCR finding, Mr. T. (L.) was detained at Cecil Facer Youth Centre in Sudbury, Ontario. He was admitted to Oak Ridge of Waypoint Centre for Mental Health Care in the summer of 2009. He was transferred to Ontario Shores Centre for Mental Health Sciences in February of 2011.
He was transferred from Ontario Shores to North Bay RHC in December 2022.
Current Diagnoses:
- Mr. T. (L.)’s current diagnoses are:
Schizophrenia;
Cannabis Use Disorder;
Alcohol Use Disorder;
Gambling Disorder; and
Antisocial Personality Disorder.
Evidence at the Hearing:
The Board heard evidence from Dr. S. Le who has been Mr. T. (L.)’s attending psychiatrist since July 2024. Prior to her involvement, Dr. Munro was Mr. T. (L.)’s attending psychiatrist until his care was transferred to Dr. Gagnon in January 2024.
Dr. Le testified that Mr. T. (L.) continues to be assessed as capable to make treatment decisions. He receives a daily oral dose of the antipsychotic medication, Seroquel, at 600 mg. The Hospital Report indicates that at the beginning of the reporting period, Mr. T. (L.) had requested a reduction in the dosing of this medication given his suspicions that the medication was causing a reduction in the size of his genitals and a decrease in his libido. After health teaching was provided, Mr. T. (L.) agreed to stay at his current dose of this medication. He has not requested any further medication reductions since that time. The Hospital Report indicates that Mr. T. (L.) has a history of medication non-compliance leading to rapid decompensations in his mental state.
Dr. Le stated that Mr. T. (L.)’s mental state has remained stable over the year in review. He has acknowledged that his medication alleviates the symptoms of his illness and generally, he does not report any concerning side effects. He has denied thoughts of self-harm or harm to others; however, he typically reported experiencing daily auditory hallucinations, which he stated do not cause him significant distress.
Dr. Le testified that the treatment team believes that he would benefit in a modest increase in the dose of his Seroquel; however, the doctor commented that Mr. T. (L.) is resistant to any enhancements or changes to his treatment primarily out of concerns regarding potential side effects. Of note, Dr. Le stated that at his baseline, Mr. T. (L.) continues to experience auditory hallucinations but, to his credit, he is able to recognise these experiences as symptoms of his illness and manage them appropriately.
All urine drug screens conducted over the year in review have returned negative for the presence of alcohol, drugs or other intoxicants and Mr. T. (L.) has denied experiencing cravings. He has refused to engage in any individual or group substance use programming but has recently expressed that he will join a Cognitive Behavioural Therapy (“CBT”) group aimed at substance abuse challenges and is scheduled to begin in January 2025.
Mr. T. (L.) resided at Deer Lodge at the beginning of the year in review. Initially, he could not access off-unit privileges but could access the secure courtyard. On October 15, 2024, he was approved for increased privileges, allowing him full hospital grounds access, with 1:1 supervision. He was transferred to Owl Lodge on October 21, 2024 and he settled in there well. He continues to reside there and expresses being content on that unit.
Following Mr. T. (L.)’s last annual ORB hearing in December 8, 2023, Mr. T. (L.) experienced an exacerbation of the symptoms of his illness. He presented as agitated and angry and voiced persecutory beliefs about staff possibly tampering with his food and having harmed him in the past. He expressed resentment towards specific staff members, leading to a heightened risk of violence towards staff and necessitating increased monitoring. He did not act out with physical aggression.
In August 2024, Mr. T. (L.) acknowledged that he could be dangerous to others when unwell, and he agreed that PRN medication could be of assistance. He acknowledged the need to recognize his triggers for violence and agreed to engage in psychotherapy. He consented to a behavioural plan that included a transition to a lower level of care, provided he adhered to medication requirements. Staff noted no behavioural outbursts or violent threats from him. Dr. Le stated that Mr. T. (L.) has used PRN medications appropriately.
By October 2024, Mr. T. (L.) demonstrated sustained improvement in engagement with the treatment team. He was meeting regularly with the Psychometrist to focus on developing community skills. He was transferred to another rehabilitative unit, Owl Lodge, on October 21, 2024 and has managed the change well. The doctor stated that there are more privileges available to patients on Owl Lodge, as opposed to Deer Lodge. Dr. Le advised that Deer Lodge is primarily an assessment unit for patients who are acutely ill. She explained that Owl Lodge is a rehabilitative unit.
At the present time, Mr. T. (L.) is able to exercise hospital and grounds privileges, staff accompanied and 1:1 staff accompanied privileges in the community for therapeutic programming. He has not been granted indirectly supervised privileges to date but that privilege level has been requested by his treatment team and will likely be approved in the immediate future. The doctor advised that these indirectly supervised privileges will be granted on a gradual, step-wise basis. To date, Mr. T. (L.) has utilized his existing privileges appropriately and without incident. Dr. Le commented that she is hopeful that Mr. T. (L.) will progress to indirectly supervised community passes over the course of the upcoming year.
In terms of programming, Mr. T. (L.) started individual psychotherapy sessions with a Psychometrist in September 2024 and he has focused on improving his communication with others and working on relapse prevention strategies. He has not agreed to otherwise engage in addiction treatment programming or to work with the concurrent disorders’ clinician in individual sessions. As stated, he is scheduled to start a CBT substance use group later this month.
Dr. Le stated that there has been significant engagement by Mr. T. (L.) over the past reporting year as he has been actively engaged in his rehabilitation. As well, he has put considerable efforts into improving his interactions with co-patients, which has been an area of considerable challenge in the past. He has been forthcoming with Dr. Le and other treatment team members.
Mr. T. (L.) us actively engaged in a variety of recreational and sports activities which he enjoys. He also participated in various unit social activities.
The Hospital Report indicates that Mr. T. (L.) did not wish to participate in having a Gladue Report completed. As well, he declined engagement with Mînowacihewin and offers to participate in smudging ceremonies. He did not attend culturally-relevant events available to him.
Mr. T. (L.) receives ongoing support from his family and he speaks with his mother, brother and sister monthly by telephone. Mr. T. (L.)’s brother and niece visited him in December 2023 and he enjoyed the visit.
Unfortunately, Mr. T. (L.)’s brother, Lawrence, died of a drug overdose which hospital staff learned of in May 2024. Mr. T. (L.)’s family did not inform him of this event, but once verified by staff, Mr. T. (L.) spoke briefly with his mother. He declined staff’s offer to facilitate his virtual attendance at the funeral. He appeared stoic about the loss and managed the loss without incident.
Dr. Le testified that Mr. T. (L.) continues to meet the threshold of posing a significant threat to public safety. She endorsed the risk factors outlined in the Hospital Report, as follows:
“Mr. T. (L.) experiences a significant and chronic mental health condition, specifically Schizophrenia. During periods of exacerbation, he displays persistent auditory hallucinations alongside paranoid and religious delusions. Despite receiving treatment, he has continued to demonstrate psychotic symptoms throughout the current reporting period;
Mr. T. (L.) has also been diagnosed with Antisocial Personal Disorder and Gambling Disorder;
Mr. T. (L.) has a significant history of polysubstance abuse and has been diagnosed with Cannabis Use Disorder and Alcohol Use Disorder. Mr. T. (L.) has a history of using substances while residing in other facilities;
Mr. T. (L.) has a history of non-compliance with antipsychotic medication while living in the community, resulting in a mental health decompensation requiring re-admission to the hospital. Mr. T. (L.) also has a history of non-compliance since his admission to NBRHC;
Mr. T. (L.) has a significant history of aggression against family members, co-patients, hospital staff and police. His history of problems with violence dates back to his childhood;
Mr. T. (L.) has been in the forensic system since he was 18;
Mr. T. (L.) has a long history of problems with violence that have resulted in various charges that began in his early youth, resulting in detention in the youth correctional facility, Cecil Facer. While his psychotic illness may have driven some of his violent behaviour, his records also document that some of it “has not been secondary to psychosis, but was driven by substance use and antisocial personality structure.”;
Mr. T. (L.)’s past charges include Assault with a Weapon, Assault, Assault Peace Officer, Assault Peace Officer with a Weapon, Possession of a Weapon, Pointing a Firearm, and Utter Threats;
Mr. T. (L.) has a documented history of challenges in consistently adhering to established rules and regulations and unwillingness to participate in treatment;
Mr. T. (L.) has a long history of traumatic experiences that began in his early childhood;
Mr. T. (L.) has a long history of engaging in inappropriate sexual acts; and
Mr. T. (L.) did not engage in any addiction programming or individual sessions with the concurrent disorder clinician throughout this reporting period.”
According to the Risk Assessment contained in the Hospital Report, “As far as his risk of violent reoffending is concerned, as long as he remains an inpatient, Mr. T. (L.)’s risk of reoffending is moderate. His medication appears to be working relatively well. The symptoms of his illness are not completely under control, but they are no longer distressing to Mr. T. (L.).”
Dr. Le agreed with findings of the Hospital Report indicating that: “If left to his own devices, Mr. T. (L.) would fully disengage from his mental health support and cease taking his psychotropic medications. He has not encountered issues related to substance abuse since his transfer to this facility; however, given his extensive history of substance abuse, even within a controlled environment, it is highly probable that he would quickly revert to substance use if afforded greater autonomy, potentially resulting in a deterioration of his mental state and an increased risk to public safety.
In terms of the possibility of including a community living provision in his Disposition, Dr. Le stated that she believes that Mr. T. (L.) is content to proceed at the pace recommended by the treatment team in terms of his path to community reintegration. The treatment team does not think that Mr. T. (L.) would be an appropriate candidate for community living over the course of the upcoming year. The doctor commented that Mr. T. (L.) has not yet exercised the full envelope of privileges under his existing Disposition.
The doctor testified that the unanimous opinion of the treatment team was that the necessary and appropriate Disposition continues to be Mr. T. (L.)’s existing Detention Order, without amendment.
No further evidence was called by the parties.
Analysis and Conclusions:
Having heard and considered all of the evidence and the submissions of all the parties, this Board is of the view that the test for significant threat to the safety of the public continues to be met. We make this finding based on the evidence of Dr. Le and the documentary evidence available to the Board at this hearing. Mr. T. (L.) suffers from Schizophrenia, Cannabis and Alcohol Use Disorder, Antisocial Personality Disorder and Gambling Disorder. Despite treatment with antipsychotic medication, he has continued to experience intermittent, residual symptoms of his illness over the review period. During periods of exacerbation, he displays auditory hallucinations and paranoid and religious delusions and can become agitated and threatening. He has a significant history of violent behaviour against family members, co-patients, hospital staff and police. While the symptoms of his mental illness have driven his violent behaviours, so too has his antisocial personality structure. Further, Mr. T. (L.) has a history of non-compliance with prescribed medications. His insight into his illness, the need for treatment, managing substance use, and the implications of his reoffending risk, remain underdeveloped.
According to the Hospital Report, “If left to his own devices, Mr. T. (L.) would fully disengage from his mental health support and cease taking his psychotropic medications. He has not encountered issues related to substance abuse since his transfer to this facility; however, given his extensive history of substance abuse, even within a controlled environment, it is highly probable that he would quickly revert to substance use if afforded greater autonomy, potentially resulting in a deterioration of his mental state and an increased risk to public safety.”
For all of the above-noted reasons, it is our view that the test for significant threat to the safety of the public continues to be met.
The Board finds that the hospital continues to require the authority of a Detention Order at this juncture. Mr. T. (L.) requires ongoing in-patient admission. He has not yet exercised the full envelope of privileges available to him under his Disposition. Further, the hospital must be in a position to approve his community housing when he is ready for discharge and to readmit Mr. T. (L.) to hospital should he experience deterioration in his mental state when living in the community, in order to ensure risk management. For these reasons, a less restrictive Conditional Discharge Disposition is not appropriate at this time.
The panel commends Mr. T. (L.) for his many successes over the past reporting year. He has engaged well with his treatment team and in recommended programming and therapies, which have yielded significant progress in his path towards community reintegration. We wish him success in the year ahead.
In making our decision, we have considered the need to protect the public from dangerous persons, the mental condition of Mr. T. (L.), his reintegration into society and his other needs.
DATED this 20th day of March 2025, at the City of Toronto, in the Toronto Region.
Ms. L. Banks Legal Member
___________________________
Office of the Registrar Ontario Review Board