Ontario Review Board

Re: Maxell Pate

ORB File No: 8417

Hearing held on: Thursday, January 9, 2025

Place of Hearing: Royal Ottawa Mental Health Centre

Pursuant to: Section 672.81(1) of the Criminal Code

Before:

Alternate Chairperson: Ms. M. Labrosse

Members: Dr. S. Lessard

Dr. G. Glancy

Mr. D. D’Intino

Mr. M. Hajek

Parties Appearing:

Accused: Maxwell Pate

Counsel: Ms. M. Munsterman

Person in charge of the hospital: Representative Dr. M. Strike

Attorney-General of Ontario: Counsel: Ms. M. Dufort

REASONS FOR DISPOSITION

(Dated March 21, 2025)

Introduction

1. On October 31, 2023, the accused, Maxwell Pate, was found not criminally responsible on account of mental disorder on charges of assault with a weapon or imitation weapon, possession of a weapon, etc./dangerous to public peace, dangerous operation of motor vehicle, and mischief, all contrary to the Criminal Code of Canada.

2. Mr. Pate is currently subject to a disposition of the Ontario Review Board dated January 30, 2024, which detains him at the Secure Forensic Unit of the hospital with privileges up to and including to live in the community in accommodation approved by the person in charge.

3. On January 9, 2025, the Ontario Review Board convened at the Royal Ottawa Mental Health Centre, hereinafter referred to as the hospital, to conduct Mr. Pate’s annual review hearing pursuant to s. 672.81(1) of the Criminal Code. Mr. Pate attended his hearing and was represented by his counsel, Ms. Marni Munsterman.

4. A hospital report dated December 21, 2024, was entered as Exhibit No. 1 for the hearing.

5. The issues to be determined by the Board are whether Mr. Pate continues to represent a significant threat to the safety of the public and, if so, to determine the necessary and appropriate disposition.

6. For the reasons set out below, the Board finds that Mr. Pate continues to pose a significant threat to the safety of the public and that the maintenance of the current disposition, namely a detention order, with the addition of travel passes for up to seven days with the prior approval of the hospital and a written itinerary, is the necessary and appropriate disposition in all of the circumstances. Additionally, Mr. Pate will be allowed to operate his motor vehicle, but only with the prior approval of the person in charge.

Index Offences

7. The details of the index offences are set out in last year’s Reasons for Disposition as follows:

“On April 28, 2022 Mr. Pate attended the Montfort Hospital to see his psychiatrist, Dr. Campbell. Dr. Campbell had asked security guards (three) to be present due to Mr. Pate’s tendency to become violent. One of the guards noticed that Mr. Pate seemed to be concealing something in his right hand, and Mr. Pate was told that he could not leave without seeing the psychiatrist. Mr. Pate responded by stating “Good luck trying to take me. I promise you it’s not gonna end well.” He then ran toward the elevator while the guards followed. Mr. Pate then opened a folding hunting knife that was about six inches long, and he pointed it at the security guards. He was able to go on the elevator and fled the area while the hospital went into lockdown and police were called.

8. On August 03, 2022, Mr. Pate was observed operating his vehicle in the wrong direction on O’Connor Street, driving past an officer from the Ottawa Police Service (OPS) who performed a U-turn and attempted to conduct a traffic stop. The officer observed Mr. Pate speed up and turn into the gates of Parliament Hill. The gates opened, but the vehicle was prevented from proceeding forward by the metal pillars designed to prevent vehicles from passing”.

Personal Background

9. Mr. Pate’s personal, legal and psychiatric history are set out in detail in the hospital report. Briefly summarized, Mr. Pate is 31 years of age and was born in Peterborough, Ontario, where he grew up with his mother, his two sisters and his stepfather. He was the second in a sibline of three. He described a lot of dysfunctions during his childhood, mostly due to his parents’ drug addiction issues. He reported having experienced psychological abuse and physical abuse.

10. Mr. Pate graduated from high school and played football competitively. He started working on a farm when he was only twelve and worked at Farm Boy for a period prior to experiencing a psychotic episode. More recently, he was working in construction, but he had not worked in that job for a few months leading up to the initial index offence.

Criminal History

11. Mr. Pate’s CPIC does not indicate a previous criminal history.

Psychiatric History

12. The hospital report references some information being disclosed by Mr. Pate about his psychiatric history. Mr. Pate reported that he had never been hospitalized before the age of 25, and that he never attempted suicide. He reported having been hospitalized at the Montfort hospital on two occasions, each lasting a couple of weeks, when he was 25 and 27 years of age. He was exhibiting paranoid and delusional behaviour. He was treated by Dr. Campbell and was placed on a Community Treatment Order (CTO). His CTO conditions included the need to remain compliant to his oral antipsychotic medication, but he stopped taking it at some point due to feeling more lethargic and struggling to wake up in the morning.

13. In May 2020, Mr. Pate was brought to hospital on a Form 2 at the request of his mother and sister. It was reported that he was noncompliant with medication.

14. A review of Mr. Pate’s psychiatric history showed that he was previously diagnosed with schizoaffective disorder and that he had psychotic symptoms since the age of seventeen.

15. Mr. Pate was admitted to the Montfort Hospital from March 30 to April 9, 2022. He had been brought to hospital by police on a Form 2 completed by his sister after he recently ran away from her house and had been living in his vehicle. During the admission, Mr. Pate refused to re-start long-acting injectable antipsychotic medication.

16. Mr. Pate’s current diagnosis is schizophrenia, in partial remission.

Evidence at the Hearing

17. The hospital’s evidence was presented through its report dated December 21, 2024, and the oral testimony of Dr. Melanie Strike who is Mr. Pate’s attending psychiatrist. This evidence is summarized below.

18. Dr. Strike adopted the contents of the hospital report and advised that Mr. Pate was detained at the Ottawa-Carleton Detention Centre at the time of his initial hearing before the Board. He had stopped taking his oral anti-psychotic medication and was observed to be paranoid and expressed fearful beliefs that his arms and plasma chromosomes were melting.

19. Following a lengthy period in custody, Mr. Pate was admitted to the Forensic Assessment Unit at the hospital on April 3, 2024. He was initially refusing to take medication but after some time, and with the involvement of his sister at a family meeting, Mr. Pate started accepting some medication which helped to attenuate his symptoms. Mr. Pate began to significantly improve after he was started on a course of Clozapine. He was then discharged fairly quickly from the hospital into the Lebreton Program in late November 2024, as a result of the significant improvement of his mental condition.

20. Mr. Pate was discharged to Lebreton on November 27, 2024. Dr. Strike added that the hospital was still working on optimizing the Clozapine in order to address the ongoing residual symptoms.

21. According to the reports from Lebreton, Mr. Pate has been doing well. He is engaging well the Lebreton program, though he frequently needs reminders for his appointments. Mr. Pate is taking Clozapine independently, and though his blood levels are low, there is no evidence that he is non-compliant. Dr. Strike anticipates increasing the dose of Clozapine in order to reach target blood levels.

22. Mr. Pate continues to have some symptoms including somatic symptoms. He is experiencing great anxiety about the different symptoms that he perceives to be causing him pain. He is engaging with an occupational therapist to assist him in managing this. Mr. Pate recently underwent a CT scan to further explore sinus problems that he was experiencing, and which were making him quite anxious. He received good support from his family to help him get through this. Dr. Strike confirmed that the stress and anxiety related to physical symptoms continues to be an issue and that this is partly attributable to the symptoms of his mental illness.

23. Mr. Pate is very focused on returning to paid employment as he is driven by the desire to contribute to his family meaningfully, and to have the satisfaction and confidence that he gets from working. Mr. Pate was previously working in construction and maintains a good relationship with his former employer with whom he has discussed the possibility of returning to work for. The hospital has some concerns about Mr. Pate’s desire to return to his former employment as this is where he was working when he was very ill and this could be destabilizing for him.

24. In order to do work, Mr. Pate wants to be able to drive as it would be very inconvenient for him to have to take public transportation to job sites. Dr. Strike stated that there are concerns about him returning to work too soon as he is still early in his rehabilitation and community reintegration.

25. Mr. Pate continues to require assistance to be able to focus on his schedule and the things that he has to accomplish and frequently needs reminders. Though the hospital is generally supportive of the goal of paid employment, it is important to be cautious about when this should happen. Dr. Strike went on to say that there is typically a three-month integration period at the Lebreton residence where residents are not supposed to be working and instead focusing on their mental health rehabilitation and programming.

26. With respect to the issue of driving, Mr. Pate currently has a driving prohibition in his disposition. Dr. Strike has concerns about Mr. Pate starting to drive but anticipates that this could be possible over the course of the next 12 months. The hospital is also in favour of including travel passes in the disposition to enable Mr. Pate to go visit his mother in Peterborough. It is likely that over the course of the next 12 months Mr. Pate could be in a position to exercise his travel passes should he continue on his current trajectory.

27. In response to questions posed to her by counsel for the Attorney General, Ms. Dufort, Dr. Strike confirmed that Mr. Pate has previously voiced opposition to injectable medication but that this is still an option to consider adding a long-acting injectable to his current regime of Clozapine. Dr. Strike considers that Mr. Pate is capable of consenting to treatment and acknowledges that he has past trauma associated with injectable medication. It is her intention to provide Mr. Pate with more information on the benefits of injectable medication but she also believes that it would be acceptable for him to continue only on Clozapine. Dr. Strike confirmed that it is difficult to know if he is taking it correctly because of the cognitive symptoms that he has.

28. In addition to cognitive and negative symptoms Mr. Pate also has ongoing residual positive symptoms that are similar to those at the time of the index offences in the form of delusional content. Regarding Mr. Pate’s insight into his ongoing symptoms, he is able to acknowledge that his behaviour was not good at the time of the index offences, but he does not necessarily recognize that his thoughts were delusional.

29. In terms of the plan for the coming year, Mr. Pate will be expected to continue with the Concurrent Disorders and ongoing case management, but he will have completed some of the group programming that he is currently engaged in.

30. Dr. Strike is concerned that adding work too soon could be a potential destabilizer, particularly given that Mr. Pate already had issues managing his appointments and needs reminders. She confirmed that the hospital is supportive of the importance of work for him but will try to steer him towards a manageable reintegration in the work force. Overall, Dr. Strike believes that Mr. Pate will continue to collaborate with the treatment team as he is extremely pro-social and would not go against the hospital on either employment or driving issues. Dr. Strike also noted that Mr. Pate does not have a car available to him at this time.

31. With respect to community living, Mr. Pate hopes to live independently but is not pushing the limits at this time and is following the recommendations of the treatment team to gradually progress to independent living. Mr. Pate continues to receive ODSP and he is aware that if he starts to earn employment income there are limits on what he can earn before there is a claw-back on his level of ODSP. It is important for Mr. Pate to continue to have drug coverage. Dr. Strike also thinks that he is likely to qualify for a rent supplement (FSHP) when he is discharged from the Lebreton Program.

32. In response to questions posed to her by counsel for Mr. Pate, Ms. Munsterman, Dr. Strike confirmed that Mr. Pate is extremely collaborative with the treatment team and he has come to accept the fact that his reintegration will be gradual. Dr. Strike agreed that his level of collaboration is a protective factor in the overall management of his risk.

33. Dr. Strike confirmed that Mr. Pate’s insight into the need to take medication and how the medication benefits him is good. He has difficulty recognizing the symptoms of his illness which is not unusual in these cases and may never resolve completely but at this time this does not affect his functioning.

34. In response to further questions posed to him by Ms. Munsterman, Dr. Strike stated that Mr. Pate is not experiencing any major side effects from Clozapine but for constipation for which he is accepting support to address this side-effect. Dr. Strike explained that Mr. Pate does not like to complain and that the treatment team is trying to encourage him to be more open about these things. Mr. Pate otherwise maintains good healthy habits, including exercise and good nutrition.

35. Mr. Pate benefits from excellent family support and likes to help out his sister Katie who has a young child and is expecting another child. He is willing to consent to contact between the treatment team and his family so that they are a part of his circle of care.

36. In response to questions posed to her by members of the panel, Dr. Strike expressed her opinion that Mr. Pate’s ongoing delusional beliefs are much less intense and prominent than they were at the time of the index offences but they will be carefully monitored before Mr. Pate is allowed to drive given the nature of the next offences. Dr. Strike also stated that she is not aware that recent political developments have affected the content of Mr. Pate’s delusions.

37. In response to further questions posed by members of the panel, Dr. Strike stated that she is not sure whether or not Mr. Pate’s driver’s license has been medically suspended but that the treatment team will look into that, as well as looking into the suitability of any employment that Mr. Pate ultimately wishes to engage in.

38. Finally, Dr. Strike stated that she expects that Mr. Pate will remain in the Lebreton Program for at least the next year with the goal of transitioning to independent living. The treatment team will assist Mr. Pate in finding suitable accommodation after that time.

39. The hospital report contains details of the functional assessment that was completed in the last year and concludes that Mr. Pate is a good candidate for transitional housing and to participate in a self-medication program and that he is a good candidate for part-time paid or volunteer work provided his mental health remained stable.

Evidence of Maxwell Pate

40. Mr. Pate testified at his hearing and stated that he is unsure whether his driver’s license had been medically suspended. He is willing to work with the treatment team to determine

that. He also stated that he will follow the hospital’s conditions with respect to when he can resume driving.

41. Mr. Pate stated that he is open to looking for other work if there are concerns about his former job and stated that he has previously been a manager at a Farm Boy and that he ultimately wants to be a fully functioning member of the community. He also used to play Rugby and is interested in looking into the leagues in the Ottawa area.

42. Mr. Pate acknowledged that he has had difficulties with treatment of his mental health in past years but that over the course of the last year the treatment that he is receiving is better than anything he has experienced before.

43. The hospital risk assessment is summarized at pages 42 and 43 of the hospital report as follows:

OPINIONS AND RECOMMENDATIONS:

Based on the violence risk assessment above, it is my opinion that Mr. Pate presents a significant risk to the safety of the public.

It is my opinion that the necessary and appropriate disposition to manage Mr. Pate’s risk to the public is a detention order with permission to reside in the community in an accommodation approved by the person-in-charge.

He has a long history of difficulties adhering to treatment recommendations, where he stopped psychiatric medication and used various substances. These factors repeatedly destabilized his psychotic disorder, where he experienced intense and distressing persecutory delusions that drove him to keep weapons on him to protect himself from the government or other perceived threats. He often believed his younger sister was being targeted and he felt compelled to defend her from perceived threats, and his fear and desperation ultimately drove his behaviour during the index offences.

While his positive symptoms of schizophrenia have improved considerably, he continues to have attenuated thought disorder and limited insight into the index offences, his psychotic disorder and his risk of violence. He is on oral antipsychotic medication which he takes without monitoring. He remains in the early days of recovery from substance use and reintegration to the community. For these reasons, the Form 49 needs to remain available to the forensic team over the next year to ensure that we can quickly admit him to hospital and keep him admitted for sufficient duration to improve his risk factors to a level appropriate for outpatient management.

I also believe the approved accommodation condition remains necessary to manage his risk of harm to others and to himself. He has a history of housing instability and homelessness and he lacks insight into his functional and cognitive deficits and the impact of stress on his mental health. Without a detention order with an approved accommodation condition, he would likely seek independent housing and return to a demanding job in the construction industry before these transitions are recommended by his multidisciplinary treating team. He would thereby be at risk of deterioration of his treatment-resistant schizophrenia.

I recommend that Mr. Pate be permitted to travel for up to one week throughout Ontario. This will allow him to visit his mother in Peterborough, who is one of his main supports. Otherwise, I recommend that his existing conditions continue.”

44. No other evidence was presented.

Submissions of the Parties

45. The Board was presented with a joint submission of all parties that Mr. Pate continues to pose a significant threat to the safety of the public and that a detention order with community living in approved accommodation remains the necessary and appropriate and least onerous and least restrictive disposition. The parties were also ad idem with the added conditions that Mr. Pate be permitted to drive, only with the written permission of the hospital and for Mr. Pate to be allowed to travel up to seven days within Ontario with prior written approval and an approved itinerary.

Analysis and Disposition

46. Having considered all of the evidence presented at the hearing, and the joint submission of the parties, the Board does find that Mr. Pate continues to meet the threshold of 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 by the Supreme Court of Canada decision Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625.

47. Mr. Pate suffers from a serious mental illness and has a diagnosis of schizophrenia, in partial remission. He has presented with symptoms since the age of 25. He has a history of non-compliance with medication. The index offences included threatening with a knife and dangerous operation of a motor vehicle. He presents several risk factors as described in the hospital report.

48. Despite the fact that he continues to experience residual symptoms of his illness, Mr. Pate is progressing well through his rehabilitation. He was recently discharged to the Lebreton transitional program and is collaborating well with his treatment team. Mr. Pate has been assessed as a good candidate to eventually progress to independent living, but he is expected to spend the next year at the Lebreton residence to help him prepare for this.

49. Mr. Pate has good family support. His sister and mother are very involved in his circle of care. Mr. Pate’s desire to be a contributing member of his family and of the community appears to be a great motivator for him.

50. Though it is still early in Mr. Pate’s rehabilitation, the outlook is positive. The hospital will continue to work on the treatment of his illness and ensure that driving and employment are resumed only when he is ready. A detention order continues to be required to ensure the proper management of Mr. Pate’s mental illness, including the necessity to approve accommodation and to ensure that there are appropriate supports in place as he continues to move towards more independence.

51. We accept the joint submission of the parties, including the addition of travel passes to permit travel to Peterborough to visit with his mother, with prior approval of the hospital and an approved itinerary. We also agree that it is necessary and appropriate to replace the driving prohibition with a condition permitting Mr. Pate to operate a motor vehicle but only with the prior approval of the hospital.

52. Accordingly, having considered the four factors set out in 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, the Board finds that a detention order remains the necessary and appropriate, and least onerous and least restrictive disposition in all of the circumstances.

DATED this 21^st^ day of March 2025, at the City of Toronto, in the Toronto Region.

Ms. M. Labrosse Alternate Chairperson

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Office of the Registrar

Ontario Review Board