Re: Paul Ikeda-Douglas
ORB File No: 7994
Hearing held on: Tuesday, January 21, 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. M. Labrosse Members: Dr. R. Buckingham Dr. W. Loza Ms. L. Banks Mr. W. Apted
Parties Appearing:
Accused: Paul Ikeda-Douglas Counsel: Mr. D. Escudero
The person in charge of hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Mr. C. Ponesse
REASONS FOR DISPOSITION
(Dated March 18, 2025)
Introduction
Paul Ikeda-Douglas was found not criminally responsible on account of mental disorder on December 15, 2021, on charges of criminal harassment and uttering threats to cause death or bodily harm, both contrary to the Criminal Code of Canada.
Mr. Ikeda-Douglas is currently subject to an Ontario Review Board Disposition dated February 2, 2024, which detains him at the Secure Forensic Service of the Centre for Addiction and Mental Health, Toronto (“CAMH”), on terms and conditions including permission to live in the community of the Greater Toronto Area, specifically excluding Hamilton, in accommodation approved by the person in charge.
On January 21, 2025, the Ontario Review Board convened a hearing at CAMH to review Mr. Ikeda-Douglas’ Disposition pursuant to s. 672.81(1) of the Criminal Code. The hospital was represented by Ms. M. Warner and the Attorney General by Mr. C. Ponesse. A Hospital Report dated December 23, 2024, was entered as Exhibit 1 for the hearing.
The issues for the hearing are whether Mr. Ikeda-Douglas continues to pose a significant threat to the safety of the public and, if so, to determine the necessary and appropriate, least onerous and least restrictive disposition, in all the circumstances.
For the reasons set out below, the Board finds that Mr. Ikeda-Douglas continues to pose a significant threat to the safety of the public and that the maintenance of the current detention order, on the same terms and conditions remains the necessary and appropriate Disposition in all of the circumstances.
Index Offences
- The details of the index offences are extracted from last year's Reasons for Disposition as follows:
“The offences occurred between December 1, 2020, and May 25, 2021.
The complainant and Mr. Ikeda-Douglas were in a relationship for 3 months in 1998. They had no contact since that time.
At the time of this offence, Mr. Ikeda-Douglas was bound by a Release Order with the Toronto Police Service. No conditions were breached during this incident.
On May 25, 2021, the complainant, a medical doctor, called police regarding unwanted contact from Mr. Ikeda-Douglas since December 2020. She stated that between December 2020 and January 2021, Mr. Ikeda-Douglas was calling her at her office. He would falsely identify himself as a doctor and expressed an immediate urgency to speak with the complainant. The receptionist estimated that over 50 voicemails were left on the office phone during that time, not including the times contact was made over the phone.
Between January 2021 and May 25, 2021, Mr. Ikeda-Douglas began posting YouTube videos and Facebook rants about his relationship with the victim, while also slandering her. Between these dates, the complainant received over 16 voicemails and a text on her personal cell phone from Mr. Ikeda-Douglas. On the voicemails, he made mention about dragging her from her office, showing her how he is a monster, and impregnating her. He also mentioned that if she called the police, she would require a gun or a safe house.
The complainant indicated she was fearful of Mr. Ikeda-Douglas.”
Background History
Mr. Ikeda-Douglas’ personal, legal and psychiatric history are set out in detail in the Hospital Report. Briefly summarized, Mr. Ikeda-Douglas is presently 64 years of age, he was born in Toronto and has three younger sisters. He has never been married and has no children.
Mr. Ikeda-Douglas attended elementary and secondary school in Markham. He completed some post-secondary studies and completed a two-year training program to become a paramedic. Prior to the index offences, he was living alone in the family home in Toronto. He was on an administrative leave from a position as a paramedic.
He had some involvement in the criminal justice system as well as the mental health system prior to the index offences. He has no criminal convictions prior to the index offences.
Mr. Ikeda-Douglas was involved in harassing and threatening behaviour towards family, neighbours and strangers. He made a number of harassing and threatening phone calls to his sisters between September 2020 and January 2021. These were described as aggressive and escalating in nature. One sister was reportedly granted a restraining order against Mr. Ikeda-Douglas. Mr. Ikeda-Douglas was also cautioned by police, escorted off of public property, and apprehended under the Mental Health Act (“MHA”) for numerous incidents of harassing various individuals in the one to two years leading up to the index offences. In addition, Mr. Ikeda-Douglas had outstanding charges in Toronto related to a number of occurrences in the year preceding the index offences, characterized by alleged similar behaviours demonstrated during the index offences and described above.
In August of 2022, Mr. Ikeda-Douglas entered into a s. 810 Peace Bond for a period of one year, and a charge of criminal harassment was withdrawn. A second charge of criminal harassment was resolved by a plea, the granting of an absolute discharge, and the imposition of a three-year common-law Peace Bond.
Mr. Ikeda-Douglas was involved with the mental health system. Starting in 2007, Mr. Ikeda-Douglas has had numerous emergency department visits, often in the company of the police due to bizarre behaviour and aggression, though he was usually discharged on the same day or the next day.
Mr. Ikeda-Douglas also has a significant history of polysubstance abuses. The hospital report details use of different types of recreational drugs, including stimulants (cocaine, crack cocaine), hallucinogens (LSD, MDMA, psilocybin, peyote, DMT), cannabis, and ketamine. He used cocaine regularly in the months preceding his arrest. Mr. Ikeda-Douglas also described a history of problematic alcohol use, referring to himself as a “functioning alcoholic.”
Following the NCR finding, Mr. Ikeda-Douglas was initially at St. Joseph's Healthcare Hamilton and was transferred to CAMH in February of 2022, at which time he was symptomatic and expressing delusional beliefs. Mr. Ikeda-Douglas was admitted to the General Forensic Unit of the hospital but around February 2, 2023, he started experiencing a mental health decompensation during which he sustained a self-inflicted laceration which caused him to be admitted to hospital at St. Michael’s where he was treated for the injury and returned to CAMH on February 11, 2023. For safety reasons he was transferred to the Forensic Assessment Unit and upon improvement of his symptoms he was transferred back to the General Unit on February 27, 2023. Mr. Ikeda-Douglas remained in hospital during that year and in September of 2023 he received a diagnosis of likely ALS resulting in referrals to Sunnybrook Hospital and to palliative care services at Mount Sinai Hospital for consultation.
Mr. Ikeda-Douglas’ current diagnoses are:
- Schizoaffective disorder, bipolar type;
- Substance use disorder (alcohol and stimulants); and
- Narcissistic personality disorder.
Evidence at the Hearing
The hospital’s evidence was presented through the Hospital Report dated December 23, 2024, and through the oral testimony of Dr. D. Jaiswal, who is Mr. Ikeda-Douglas’ attending psychiatrist. This evidence is summarized below.
Dr. Jaiswal sought to bring a clarification to the Hospital Report regarding an incident where Mr. Ikeda-Douglas tested positive for alcohol. On November 19, 2024, when Mr. Ikeda-Douglas was presented with the fact that he had tested positive for alcohol, he initially reported that he had consumed a cup of sake. He later acknowledged that he had consumed three cups of sake. As a result, Mr. Ikeda-Douglas’ privileges were withheld as this is a breach of the terms of his Disposition.
Dr. Jaiswal confirmed that Mr. Ikeda-Douglas currently has level 4 passes but that by the end of this week he would likely progress up to level 5 which would allow for him to attend psychosocial programs on the hospital grounds.
Mr. Ikeda-Douglas has been approved for long-term care housing at Kensington Gardens, however, he remains on a waitlist for admission. In the meantime, an application has been made for transitional housing at White Squirrel Way, which is considered community housing but is on the grounds of the hospital. According to Dr. Jaiswal, this facility would be adequate to meet Mr. Ikeda-Douglas’ physical requirements due to his ALS diagnosis.
Mr. Ikeda-Douglas’ psychotherapist retired in December of 2024 and though he initially declined a referral to a different therapist as he was exploring the possibility of continuing with the same therapist virtually, has now agreed to have the team look for a referral to a new therapist.
With respect to Mr. Ikeda-Douglas’ mental condition over the course of the last reporting period, Dr. Jaiswal confirmed that in February of 2024, Mr. Ikeda-Douglas reported symptoms consistent with major depression which were addressed with medication which brought his mood back to baseline. In November of 2024, Mr. Ikeda-Douglas is also noted to have had a brief episode of hypomania as the nursing staff were concerned that he was presenting as elevated and expressing some delusional content. It is now believed that this was triggered by increased caffeine use. In the opinion of Dr. Jaiswal, these episodes show that Mr. Ikeda-Douglas’ mental state still warrants supervision and can require further medication adjustments to address fluctuations.
With respect to the ALS diagnosis, it has been confirmed that Mr. Ikeda-Douglas suffers from an atypical variant of ALS which has a better prognosis than the normal form of ALS. This atypical variant primarily affects Mr. Ikeda-Douglas’ upper limbs. He is currently being tested with respect to his pulmonary function and the test results are expected shortly. Dr. Jaiswal also confirmed that Mr. Ikeda-Douglas has received some treatment for his ALS under a clinical trial.
Any community placement for Mr. Ikeda-Douglas will have to meet both his mental health and physical health needs. He is likely to experience further decline in physical health as result of his diagnosis of ALS. Not having proper housing and support would be a stressor and could further impact Mr. Ikeda-Douglas' mental condition as stress is an ongoing risk factor.
In response to questions posed to him by counsel for the Attorney General, Mr. Ponesse, Dr. Jaiswal responded as follows:
a. The waitlist for long-term care is lengthy and it could take several months before Mr. Ikeda-Douglas is accepted for transitional housing.
b. Changes in environment are also potential stressors. The treatment team is working with Mr. Ikeda-Douglas to ensure that he transitions to a supportive setting to address both his mental health stability and his physical needs. Mr. Ikeda-Douglas is currently engaged in mindfulness and will continue with individual therapy which assists in mitigating the risk brought upon by potential stressors.
c. With respect to insight, Dr. Jaiswal believes that Mr. Ikeda-Douglas’ insight into the need to take antipsychotic medication is rudimentary, and that he has stated that he may not need to continue with treatment in the long term.
d. Regarding the likely time for decompensation, should Mr. Ikeda-Douglas not be properly medicated or should there be decompensation caused by stress, Dr. Jaiswal confirmed that stressors could likely cause decompensation to occur within weeks whereas with medication non-adherence it could be days to weeks. It is difficult to catch early subtle signs of decompensation for those who are not familiar with Mr. Ikeda-Douglas’ baseline.
In response to questions posed to him by counsel for Mr. Ikeda-Douglas, Mr. Escudero, Dr. Jaiswal remains of the opinion that Mr. Ikeda-Douglas still meets the threshold for significant threat to the safety of the public even though he is experiencing upper extremity weakness due to his ALS diagnosis. The index offences were committed with the use of telecommunications and Mr. Ikeda-Douglas is still capable of doing this. He still has the underlying major mental illness and is still vulnerable to stressors or decompensation from inadequate medication.
Dr. Jaiswal indicated that in addition to the application for transitional housing at White Squirrel Way, the treatment team has also been exploring transitional housing through LOFT. Either option is likely to take several months due to their wait lists.
In response to questions posed by members of the Panel, Dr. Jaiswal responded as follows:
a. The non-contact provision with the victim of the index offence is still necessary and appropriate to be included in Mr. Ikeda-Douglas’ current Disposition. Mr. Ikeda-Douglas continues to entertain some preoccupations that the victim might wish to reconcile with him. Dr. Jaiswal believes that he tends to minimize the severity of the index offence. In any event, the non-contact provision continues to present external control against contact with the victim of the index offence.
b. Dr. Jaiswal clarified that the episode which required Mr. Ikeda-Douglas to be placed in seclusion took place prior to the commission of the index offences while Mr. Ikeda-Douglas was very unwell. Similarly, the incident with the prank recording of the 911 call and the self-inflicted laceration in 2023 occurred when Mr. Ikeda-Douglas was not treated with antipsychotic medication. Since he has been treated with antipsychotic medication, Mr. Ikeda-Douglas has not displayed any such behaviours. It is the opinion of Dr. Jaiswal that Mr. Ikeda-Douglas is optimally treated at this time.
c. Dr. Jaiswal stated that Mr. Ikeda-Douglas suffers from a major mental illness which is susceptible to stressors and psychoactive substances. If he was not under treatment and using psychoactive substances, Mr. Ikeda-Douglas would exhibit active mental health symptoms that would cause him to act out in similar fashion to the index offences.
d. Dr. Jaiswal confirmed that at last year's hearing, the team had recommended the removal of international travel passes because of the uncertainty of the diagnosis. Again, in November of 2024, the treatment team cites concerns with the feasibility of international travel due to incidents of substance use and indicated at that time that international travel was not supported. Dr. Jaiswal clarified that he would be concerned if Mr. Ikeda-Douglas was to travel internationally for a lengthy period or were he to do so without accompaniment by an approved person. He expressed his opinion that Mr. Ikeda-Douglas should not be approved for travel for more than seven days and with an approved person who has undergone the process of approved persons of CAMH.
e. With respect to the episode of alcohol use in November 2024, Mr. Ikeda-Douglas acknowledged that this was contrary to his Disposition and that it impacted the level of trust between him and the treatment team, however, his insight as to the impact of alcohol use on his mental health is limited in the opinion of Dr. Jaiswal.
f. The type of threat posed by Mr. Ikeda-Douglas is primarily that of psychological harm that is not trivial and meets with the definition of significant threat to the safety of the public.
Submission of the Parties
The hospital submits that Mr. Ikeda-Douglas continues to meet the threshold of significant threat to the safety of the public and that the maintenance of the current Disposition, namely a detention order with community living in approved accommodation, remains the necessary and appropriate disposition in all of the circumstances. Counsel for the hospital, Ms. Warner, added that they are at a critical juncture in Mr. Ikeda-Douglas’ rehabilitation as he is on the verge of a very significant discharge. This requires his treatment and supervision to be carefully orchestrated so that he may progress to that community discharge.
Counsel for the hospital, Ms. Warner, confirmed that the hospital’s instructions to her are to seek no change to the existing travel provision in the Disposition. Ms. Warner acknowledged that over the course of the next year it is unlikely that the hospital would recommend the outer envelope of those privileges based on the clinical observations of Dr. Jaiswal but that her instructions are not to recommend any change to that provision at this time. In addition, Ms. Warner confirmed that the hospital has a framework in place for approved persons.
Counsel for the Attorney General, Mr. Ponesse, indicated his support of the hospital recommendation including that of leaving the travel provisions unchanged given that as part of the hospital’s risk management they have discretion to restrict the travel as they see fit according to the current provisions of the Disposition.
Counsel for Mr. Ikeda-Douglas, Mr. Escudero, also indicated his support of the hospital recommendation and added that his client does, however, maintain that he was less of a threat than he once was.
Analysis and Conclusion
Having considered all of the evidence tendered at the hearing, and the joint submission of the parties, the Board finds that Mr. Ikeda-Douglas continues to pose a significant threat to the safety of the public as set out in s. 672.5401 of the Criminal Code of Canada and as further defined in Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625.
Mr. Ikeda-Douglas suffers from a major mental illness, schizoaffective disorder. When unwell, he exhibits an expansion of his mood, delusions, impaired judgement, and poor behavioural controls. Historically, in the context of acute manic and/or psychotic episodes, he has engaged in aggressive and threatening behaviours towards members of the public.
Mr. Ikeda-Douglas has a significant history of substance use, including cannabis, stimulants, and alcohol. Substance use can precipitate an acute episode of psychosis and mania, and result in decompensation in his mental state. Substances would also likely impair his judgement and upend his behavioural control. A mere few months ago, Mr. Ikeda-Douglas was found to have a positive urine drug screen for alcohol, which he acknowledged but initially minimized when confronted with the test result.
Though he remains in hospital, Mr. Ikeda-Douglas has been approved for placement at Kensington Gardens, a LTC residence; however, there is an extensive waitlist. In the interim, he may be discharged to a transitional residence on the hospital grounds in the coming months.
Mr. Ikeda-Douglas suffers from a variant of ALS which affects his upper limbs and is reportedly slower to progress. His risk to the public is not significantly diminished because of his diagnosis, given that nature of the index offences.
The Board finds that a conditional discharge would not be adequate to manage Mr. Ikeda-Douglas’ risk at this time. Given the possibility of a discharge in the next year, and the need for continued supervision and monitoring of his mental and physical health, it is important that the hospital retain the authority to approve accommodation. In addition, Mr. Ikeda-Douglas’ mental heath can decompensate quite quickly with the use of substances or non-compliance with treatment.
The current clinical evidence does not support travel for a duration of three weeks but given that such travel would only take place at the hospital’s discretion, with an approved itinerary and an approved person, we agree that it can remain in the Disposition.
In coming to our decision that the detention order, on the same terms and conditions, remains necessary and appropriate and the least onerous and least restrictive disposition, we have considered the factors at s. 672.54 of the Criminal Code, namely the protection of the public, which is the paramount consideration, the mental condition of the accused, his reintegration into society and his other needs.
DATED this 18th day of March, 2025, at the City of Toronto, in the Region of Toronto.
Ms. M. Labrosse Alternate Chairperson
Office of the Registrar Ontario Review Board