Ontario Review Board
Re: Li Kai Li
ORB File No: 8688
Hearing held on: Wednesday, February 12, 2025
Place of hearing: Ontario Shores Centre for Mental Health Sciences 700 Gordon Street, Whitby
Pursuant to: Section 672.47(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. J. Weinstein Members: Dr. P.L. Darby Dr. T. Stirpe Mr. M. Segal Mr. J. Cyr
Parties Appearing:
Accused: Li Kai Li Counsel: Mr. A. Paas
The person in charge of hospital: Counsel: Mr. K. Dow
Attorney General of Ontario: Counsel: Ms. N. MacDonald
REASONS FOR DISPOSITION
(Dated March 27, 2025)
Introduction:
On December 11, 2024, Mr. Li Kai Li was found not criminally responsible on account of mental disorder, on charges of attempt to murder by stabbing (x2) and assault, both contrary to the Criminal Code of Canada (“Criminal Code”). That finding was based on an assessment, and related report, of Dr. Hartfeil, dated April 2, 2024.
The court did not make a Disposition and ordered, pursuant to s. 672.47(1) of the Criminal Code, that Mr. Li be detained at the Central East Correction Centre – Ontario Shores Centre for Mental Health Sciences (“Ontario Shores”), pending a Disposition of the Ontario Review Board (the “Board”).
On February 12, 2025, the Board convened a hearing at Ontario Shores to make an initial Disposition.
Mr. Li was present and was represented by his counsel, Mr. A. Paas.
A Hospital Report, dated January 24, 2025 (the "Hospital Report"), was entered as Exhibit 1.
The issue at this hearing is whether Mr. Li 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. Li represents a significant threat to the safety of the public. The Board further concluded that his risk can be properly managed with a Detention Order at Ontario Shores, on the terms and conditions set out in our formal Disposition. The Board allowed that the highest level of privileges accorded to Mr. Li shall be to live in the community, in accommodation approved by the person in charge. The Board concluded that the above is the necessary and appropriate Disposition, in the circumstances.
Current Psychiatric Diagnoses:
- Schizophrenia
Cannabis Use Disorder, in remission, in a controlled environment
Index Offences:
- The circumstances giving rise to the Index Offences are extracted from the Reasons for Judgment of Justice A.A. Ghosh, released on December 18, 2024, as follows:
“The stabbing occurred inside the “Li” family home in Markham. Mr. Li lived there with his mother and two adult sisters. He failed to complete high school and had been unemployed for years. Mr. Li apparently suffered from undiagnosed mental health issues, and he regularly smoked cannabis. The women in the home paid the bills and supported Mr. Li.
On June 10, 2023, the sisters agreed to go to different rooms in the home to logon and play videogames together. Cindy Li heard their mother screaming for help, and she went to the main floor to investigate.
Cindy observed their mother laid out on the ground in a pool of her own blood. Mr. Li was standing over her and striking her. Cindy observed a wooden stick with a metal piece on the end laying across their mother. She yelled at Mr. Li for him to stop hitting their mother. He stopped.
Mr. Li stated that their mother had a “chip implanted in her brain” and was “not well” as a result. Alissa Li then entered the room. Both women told Mr. Li that he was the one who was unwell, enraging Mr. Li.
He took on a fighting stance, and then struck Cindy in the face 3-5 times, causing bruising around her eye and a small cut. Alissa tried to physically intervene, and Mr. Li began to strike her too. Their mother yelled at the women to call the police.
Mr. Li left for the kitchen, and returned holding two large kitchen knives. He began swinging them at Alissa, causing her to fall back onto the ground. He then began to “hack” her on top of her head. She held her hands over her head protectively.
Cindy ran out of the house with their mother’s cell phone. She called the police. Police attended and arrested Mr. Li at gunpoint. Both the mother and Alissa suffered permanent loss of mobility and functionality in their hands due to the nerve damage caused by the attack. Alissa has a large scar on her face. Cindy did not suffer any lasting injuries.
In acknowledging the facts, counsel submitted that Mr. Li did not have any memory of the key events, but accepted that he committed the acts alleged."
Legal History:
- Mr. Li has no prior arrests, charges, or convictions.
Psychiatric History:
- Mr. Li had never seen a psychiatrist, nor was he ever admitted to hospital for psychiatric reasons.
Substance Use History:
- Mr. Li’s substance use history is set out in detail in the Hospital Report:
“Mr. Li did not smoke cigarettes. He drank alcohol occasionally, approximately one or two shots once per week. He vaped cannabis about three times per week in relatively small quantities. He reported that this occasionally made him paranoid for ‘about five minutes’ in that he would feel that others were looking at him. He did not enjoy this feeling, and so he tended not to use larger quantities of cannabis. He denied any paranoia when not using cannabis. He denied any other substance use.”
Background Information:
- Mr. Li’s background information is set out in detail in the Hospital Report. It does not have to be repeated here in detail, but the following passages are relevant.
“At the age of eight, Mr. Li immigrated to Canada with his mother and sisters and his father remained in China.
Mr. Li reported that after finishing tenth grade he visited his father in China for two years before returning to Canada in 2010.
Prior to his arrest, and since he last worked, Mr. Li spent much of his time working out and playing games on his computer. He enjoyed “shooting games” such as Call of Duty.
Mr. Li previously attended Markville Secondary High School until dropping out in Grade 11. Mr. Li never completed his GED or obtained his high school diploma.”
Course Prior to Not Criminally Responsible Finding:
Mr. Li was admitted to the Forensic Assessment Unit (“FAU”) on February 2, 2024, for a criminal responsibility assessment.
Mr. Li was able to move out of the psychiatric intensive care area (“PICA”), into the general milieu of the unit, a few days after admission. He did not require locked seclusion, mechanical restraint, chemical restraint, or as-needed medication during this admission. He did not engage in any overtly threatening, aggressive, or violent behaviour.
Mr. Li did demonstrate bizarre and disorganized behaviour and behaviour suggestive of a perceptual disturbance.
Course Since NCR Finding:
- Mr. Li’s course since the NCR finding is set out in detail in the Hospital Report. The following passages are relevant:
“Mr. Li was admitted to the Forensic Assessment Unit (FAU) at the Ontario Shores Centre for Mental Health Sciences on December 30, 2024.
He was reluctant to share his symptoms, but after being directly questioned, he endorsed the belief that his mother and his sisters had “chips” implanted in their heads and posed some threat to him as a result. He did not endorse any hallucinations and has not been observed responding to internal stimuli during this current admission.
Mr. Li asked whether he could be treated with cannabis. However, when the necessity of antipsychotic treatment was explained, he was agreeable to the medication treatment proposed.
On January 22, 2025, he agreed to switch to the long-acting injectable form of this medication, and he received a loading dose of 800 mg.”
Position of the Parties:
Counsel for the hospital, the Attorney General and Mr. Li, advised that this was a joint recommendation: all agreed that the appropriate Disposition is a Detention Order at Ontario Shores, with the highest privilege being to reside in the community, in accommodation approved by the person in charge.
Counsel for Mr. Li advised that the issue of significant threat was not in dispute for purposes of this hearing.
Evidence at the Hearing:
The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Alioglu.
Dr. Alioglu is a Clinical Fellow working under the supervision of Dr. Hartfeil. She testified as follows:
a) She has been one of Mr. Li’s treating psychiatrists since his admission to Ontario Shores, in December 2024.
b) She has reviewed the Hospital Report and adopts its contents.
c) The treatment team is planning to transfer Mr. Li from the FAU to a General Forensic Unit at Ontario Shores, in the coming week.
d) Since Mr. Li’s most recent admission, he has presented as mostly stable, and there have been no instances of violence or aggression.
e) Mr. Li has accepted all changes to his medication regimen. He is currently on a long-acting injectable antipsychotic medication, which is given every four weeks. While Mr. Li is adherent to his medication, his insight into his need for medication can be described as underdeveloped.
f) Mr. Li has become more forthcoming since beginning his current medication, and is more engaged with the treatment team, but he is still guarded about some of his psychotic symptoms. Mr. Li is still suffering from some residual symptoms of his psychosis. There is room for him to gain insight, across all domains.
g) In the coming reporting year, they plan to engage Mr. Li in more psychoeducation, to help him gain insight into his need for medication, the risk of cannabis use to his mental stability, and the connection between his major mental illness and the Index Offences.
h) Mr. Li is on a positive trajectory. If it continues, the treatment team is hoping that he will be able to move into accommodation approved by the person in charge, within the coming reporting year.
i) There is a link between his cannabis use and the Index Offences. The police report indicates that Mr. Li was using cannabis excessively at the time of the Index Offences.
j) Initially, Mr. Li asked whether he could be treated with cannabis instead of an antipsychotic medication. However, after psychoeducation, he was agreeable to the medication treatment proposed by the hospital.
k) While Mr. Li indicated that he felt the same before and after the medication was introduced, the treatment team noticed a decrease in his guardedness and in the intensity of his symptoms. His belief that the medication has not made a difference confirms that Mr. Li has yet to internalize the benefits of remaining on his medication and that his insight is still underdeveloped in this domain.
l) As set out in the Hospital Report, Mr. Li’s major risk factors are remaining abstinent from substances and remaining adherent to his medication regimen.
m) The recommended no contact provision in Mr. Li’s current Disposition is appropriate, as his family is still quite terrified of him.
- In response to questions from counsel for Mr. Li, Dr. Alioglu testified:
a) While Mr. Li indicated that he only vaped cannabis about three times per week, in relatively small quantities, the police report, and the evidence of his sister, indicated that Mr. Li had been using cannabis excessively, at the time of the Index Offences.
b) Whether one believes Mr. Li or the police report, it is quite clear that cannabis use was involved at the time of the Index Offences and that it has a de-stabilizing effect on Mr. Li’s mental stability.
c) Mr. Li has been referred to the Empowering Progress Encouraging Connections Program (EPEC) at Ontario Shores, which provides psychoeducation and forensic treatment psychoeducation to patients .
d) As Mr. Li has been accepting of both his oral treatment and his long-acting injectable medication, she believes he is capable to consent to treatment.
- 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 finds that Mr. Li is 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. Alioglu, in addition to the documentary evidence before us.
Mr. Li still endorses a belief that a “chip was implanted in his mother’s, and his sister’s brains,” and that they pose a risk to him. He still does not interpret these delusional beliefs as part of his illness, and he has stated that he does not believe he needs medication. Mr. Li’s insight into his need for medication is described as “underdeveloped.”
In particular, the Board relies on the following excerpts from the Hospital Report:
“Overall, Mr. Li’s risk would be considered moderate-low in the context of a Detention Order, but would elevate to moderate-high if granted a Conditional Discharge at this juncture.
Primary Re-Offence Scenario of Future Violence
A likely re-offending scenario for Mr. Li involves psychiatric destabilization due to medication nonadherence and increased substance use. This would likely lead to a deterioration of his mental state, with the re-emergence of acute psychotic and paranoid symptoms, thereby increasing the risk of severe aggressive and assaultive behavior, similar to that seen during the index offenses. Potential victims would include those with whom he resides or has close relationships, such as family members or neighbors; particularly those he perceives as being connected to his delusions.
Clinical Assessment of Risk
His most salient risk factor for re-offence remained his major mental illness (schizophrenia), which still presents with some active symptoms, and into which he has limited insight. Fortunately, there have been early, significant improvements in Mr. Li’s apparent symptom burden, guardedness, and engagement with the treating team. That said, his insight into his symptoms and need for treatment remains limited, and historically he has masked and minimized his active symptoms which has made an accurate assessment of his mental status quite challenging.
A further concern is Mr. Li’s history of substance use, which has remained in sustained remission in a highly controlled environment but has not been tested since his admission. He has continued to speak in positive terms about cannabis use, including asking whether it can be used as treatment for his psychotic illness. He expressed ambivalence about future cannabis use during a recent interview.
It will also be critical for Mr. Li to maintain abstinence from substance use, with the team closely monitoring for substance use through breathalyzer and urine samples. Medication adherence support will likely be necessary. In the event of any decline in his mental state, Mr. Li may become more guarded regarding his symptoms. Therefore, close monitoring and the relatively high level of support available on a general forensic unit will be required initially while Mr. Li works to gain greater insight into his condition and demonstrates the ability to maintain stability and remain substance-free in a less secure environment.”
Given the Board’s finding of significant threat, it was charged with shaping a Disposition for the coming year. The Board agrees with the joint submissions, that the necessary and appropriate Disposition to manage Mr. Li’s risk is a Detention Order.
Given the severity of Mr. Li’s Index Offences, his guardedness, and his underdeveloped insight, it will be necessary for the hospital to intervene quickly, should he become unwell in the community, to prevent another incident of severe violence.
As set out in the Hospital Report, it is critical for Mr. Li to remain abstinent from substances, and he needs to be closely monitored when in the community, to ensure his abstinence . When Mr. Li’s mental state becomes destabilized, he becomes more guarded regarding his symptoms, so close monitoring is necessary. Therefore, the Mental Health Act would not be sufficient to protect the safety of the public. The treatment team will also need to approve Mr. Li’s housing in the community.
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. Li, his reintegration into society and his other needs, the necessary, and appropriate, Disposition is a Detention Order Disposition, upon the terms set out in our formal Disposition.
DATED this 27^th^ day of March 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