Ontario Review Board
Re: Mr. Chanta Sar
ORB File No. 5273
Hearing Date: January 29, 2025
Hearing Location: St. Joseph’s Healthcare, Hamilton
Pursuant to: ss. 672.81(1) Criminal Code of Canada;
Before:
Alternate Chairperson: Mr. J. Weinstein
Members: Dr. R. Buckingham Dr. L. O. Lightfoot Ms. B. Little Mr. K. McKenna
Parties Appearing:
Accused: Mr. Sar Counsel: Mr. T. McIver
The Person in charge of Hospital: Counsel: Ms. L. Barney
Attorney General of Ontario: Counsel: Ms. A. Lepchuk
REASONS FOR DISPOSITION
(Dated March 25, 2025)
Introduction
Mr. Sar was found not criminally responsible on October 7, 2009, for the Criminal Code offence of forcible entry.
He is currently subject to a detention order under a Disposition dated February 12, 2024, with privileges that extend to living in the community in approved accommodation, and reporting 4 times monthly.
A panel of the Ontario Review Board convened this annual hearing on January 29, 2025, at St. Joseph’s Healthcare, Hamilton, West 5th Campus, (St. Joseph’s) to review his Disposition pursuant to s. 672.81(1) of the Criminal Code of Canada. Mr. Sar was present.
At the commencement of the hearing, the Hospital recommended that the current detention order continue with a change to the reporting requirement from 4 times monthly to not less than 2 times monthly. This recommendation was supported by counsel for the Attorney-General. Counsel for Mr. Sar advised the panel that his client was requesting an absolute discharge, but if the panel concluded that Mr. Sar is a significant threat to the safety of the public, he was requesting a conditional discharge.
After considering the evidence, the panel concluded that Mr. Sar is a significant threat to the safety of the public, and that a continuation of the detention order with the same terms and conditions, with the change in reporting as suggested by the Hospital, is necessary and appropriate.
Index Offence
The following are the facts related to the index offence.
"On Monday, May 25th, 2009 at approximately 12:48 p.m. the accused Chantha SAR went into the backyard of 26-2 Weiden Street, in the City of St. Catharines. The accused cut the screen door in the rear of the townhouse, enabling him to unlock the door: The accused entered the townhouse and began to walk up the stairs of the townhouse. The accused was found by the occupants of the townhouse [K.D.] and (A.V.] walking up the stairs. The accused then walked down the stairs and exited the front door to the unit.
[K.D.] and [A.V.] contacted Police and observed the accused standing watching them from the backyard of 5 Louis Avenue. The immediate area was searched with negative results. Police spoke with the superintendent, Loraine JAMES of 5 Louis Avenue, who stated that a male matching that physical description resides in unit 105, which is the same unit that the girls had watched the accused enter. Police were let into unit 105 by the accused’s brother Chanthia SAR. Police located the accused within the unit and placed him under arrest for Break and Enter with Intent. While Police were placing the accused in the rear of a marked Police vehicle, a female identified as [A.K.] advised that the accused had followed her and her young child around the park just north of 5 Louis Avenue.
Police attempted to obtain a statement from [A.K.] at the time of this writing; however, they were not able to get in contact with her.
Police re-attended 26-2 Weiden Street and obtained a statement from [K.D.] and [A.V.]. It should be noted that the two females looked to be approximately 15-16 years old, much younger than their actual age.
Evidence
The evidence at this hearing consisted of the Hospital Report dated December 30, 2024, and the testimony of Dr. Shariati, Mr. Sar’s treating psychiatrist.
Mr. Sar is diagnosed with schizophrenia and cannabis use disorder, in remission.
His criminal record is as follows:
(a) Sexual assault 2003;
(b) Theft and failing to comply with probation 2003;
(c) Failing to comply with probation x 3 2004 and 2005;
(d) Failing to comply with probation 2007
(e) Failing to comply restraint order, obstruct peace officer, and assault with intent resist arrest.
Mr. Sar was born in Cambodia and when he was age four, his parents escaped to Thailand with him and his younger brother. They remained there as refugees for several years before coming to Canada. His parents divorced in 1992. His mother is described as a hard-working woman who occasionally held two jobs, one at the Nabisco factory in the Niagara Region, and the other at a greenhouse
It is reported that Mr. Sar was physically abused by his father, although details are limited. Mr. Sar's brother also told a member of the Hospital team that he and Mr. Sar had been fondled by a Vietnamese man with whom their mother had been in a relationship. A hospital
social worker noted that Mr. Sar's mother did not want the younger brother to disclose any further details in respect of this sexual abuse.
Mr. Sar stopped attending school in grade 11. He had once been suspended for fighting. Regarding his employment history, Mr. Sar had worked at the same greenhouse where his mother was employed. He also worked at a pizza shop but has reportedly not worked since his first admission to St. Joseph’s. Mr. Sar is single, with no dependents. He reportedly had a few girlfriends before he became ill.
Mr. Sar is known to have used alcohol and cannabis regularly, and to have experimented with ecstasy, cocaine, hallucinogenic mushrooms, and ketamine. In particular, he reported starting to drink at age 17. He said that he drank one 40-ounce bottle of vodka per week for approximately three years between ages 19 and 22. He had begun to use cannabis earlier, at about 12 years of age. He said that his period of heaviest use was between the ages of 17 and 25, when he estimated that he used a gram per day. He acknowledged that his substance use had a negative impact upon his motivation, his family difficulties, and on his legal troubles. According to Mr. Sar, he had not used drugs or alcohol for about one year prior to his 2009 index offence.
Mr. Sar had no history of psychiatric care prior to undergoing a court-ordered assessment at St. Joseph’s following his arrest in 2002, for sexually assaulting his half-sister, for which he was convicted in 2003 as noted above.
The Hospital Report relates in considerable detail, drawing on information provided by Mr. Sar's mother and brother, the symptoms and signs Mr. Sar exhibited during a two-week period leading up to his arrest for the 2002 sexual assault. These behaviours were described as peculiar, bizarre, and uncharacteristic. He became reclusive, his hygiene deteriorated, he was unable to sleep, and he complained of headaches. He engaged in bizarre behaviour like breaking a speaker of a music system for no apparent reason, placing unlit candles throughout the house, and placing Bibles in the rooms of his sister, mother, and brother. He exhibited paranoid behaviours like putting tape over small nail holes in the bathroom, because he was afraid that he was being filmed. He told his brother that the Devil had brought bottled water into their home, that it was poison, and that it should not be consumed. He frequently did not speak, and would stare into space, appearing to be listening to a voice. He was preoccupied with biblical and religious themes and was concerned about himself and family members being controlled, for example, by the television.
His brother became frightened of Mr. Sar's peculiar behaviour, particularly when Mr. Sar approached him and asked if he wanted to be killed by Mr. Sar so that he (the brother) could go to heaven. Mr. Sar also talked about committing suicide and going to heaven.
Mr. Sar was admitted to St. Joseph’s in 2003 to assess his fitness to stand trial for charges arising from sexual assault of his then nine-year-old half-sister. He was found unfit to stand trial and returned to St. Joseph’s pursuant to a Treatment Order. He reportedly improved with treatment, but upon release, discontinued his medications. After serving 170 days in pretrial custody, he was convicted of sexual assault and placed on probation for two years.
Although accepted into a community mental health program, Mr. Sar never engaged in outpatient treatment, and did not take his medications, up until the 2009 index offence. His presentation returned to what it had been prior to his hospital admission, including isolating himself and being religiously preoccupied. His mother and brother described the following: hiding under the porch at night; sleeping naked in the snow; appearing to be afraid of something; worrying that people were stealing from him; and throwing away his identification.
Some years later, in 2019, Mr. Sar revealed that at the time of the offence, he was under the control of a voice on his computer, named “Mercedes.” During a re-admission to St. Joseph’s that year, he stated again that he experienced a “voice” and stated that this voice on his computer was making him move. In 2020, he again spoke of the index offence, stating that at the time the computer in his brain was controlled by someone named “Matt” but that now he had control of his brain and would not enter someone else’s home.
Mr. Sar was initially found unfit to stand trial on July 17, 2009, and a Treatment Order was issued. He was returned to court and found NCR on October 7, as noted above. His condition improved significantly following the start of medication after his admission to St. Joseph’s. He was eventually placed on long-acting injectable antipsychotic medication. According to Mr. Sar, the medication helped him in that his previously-expressed auditory hallucinations were no longer present. However, he continued to endorse active delusional thoughts, including that he was God, that he created the universe and all humankind, and that his skeleton was made of diamond, making him virtually indestructible. Occasionally, his delusions included suicidal thoughts, in that he described plans to drown and then re-incarnate himself. One longstanding delusional theme was that he was a woman in the past, committed suicide and re-created himself.
Mr. Sar suffered psychotic symptoms essentially over the entirety of his time, to date, under the ORB. His delusional system is consistently described as entrenched, grandiose, and resistant to antipsychotic treatment, including clozapine, Invega Sustenna, and haloperidol. However, as long as he was taking his prescribed medication, his delusional scheme did not appear to inhibit his daily functioning and he was not reported to have engaged in aggressive or violent behaviours. Risk management challenges noted in the Hospital Report over the years include:
Consistently poor insight into his schizophrenia and need for treatment;
Recurrent cannabis abuse despite knowing he was prohibited from using it, and despite repeated teaching from health care providers that it was deleterious to his mental health;
Poor motivation to participate in programming, and to work or go to school;
Poor engagement in recent years (particularly since receiving his Conditional Discharge in 2019) with both the St. Joseph’s forensic outpatient team and the Niagara ACTT; and
Refusing to continue with intramuscular injections of long-acting antipsychotics.
During Mr. Sar’s early years at SJHH (prior to his discharge to live with his mother and brother in 2015), he experienced rapid deterioration in his mental state if he either consumed substances or stopped taking his antipsychotic medication. For example, he was found in an almost catatonic state on the hospital grounds on October 30, 2012 after consuming several salvia cigarettes while on an indirectly supervised pass. He was taken to the Emergency Room. A week later, he expressed violent thoughts towards nursing staff and co-patients. He normally socialized well with his co-patients and engaged politely (though often in a guarded fashion) with unit staff.
On another occasion, in September of 2013, he was at large without leave with a co-patient for several days. He was without his clozapine during this time. Upon his return, his presentation was bizarre and he was overtly displaying psychotic symptoms. His behaviour was disorganized, and he was responding to internal stimuli (auditory hallucinations). His condition improved as his medication was re-introduced. Despite experiences such as these, Mr. Sar’s insight into his illness, his need for medication, and the impact of his ongoing substance use on his mental state continued to be poor to limited. He was poorly motivated to engage in therapeutic programming.
Mr. Sar began living with his family on March 30, 2015. He spent most of his time indoors watching movies and playing video games. Mental status monitoring by the St. Joseph’s Forensic Outpatient Team revealed that Mr. Sar’s grandiose delusional thinking persisted, including that as the Creator, he used a computer to create the world and its inhabitants. He believed that he owns the homes in his neighbourhood, but would never enter them as he was not “programmed” to do so. He did not believe that he had schizophrenia or that his thinking was a symptom of his illness. He stated that he did not require medication and was only taking it due to being told to do so. Nevertheless, he did not require re-admission to hospital for the balance of 2015 and 2016, and demonstrated good engagement with his Assertive Community Treatment (ACT) team, with no apparent incidents of verbal or physical aggression.
The fragility of Mr. Sar’s mental condition was further illustrated in 2017, when his adherence to his oral medication came into question. His long-standing delusions became more bizarre and elaborate and he became less reluctant to express them. He spoke of transporting himself to another dimension, having no bodily organs, being made of a computer, and being able to eliminate people. The frequency of his injections was increased.
By the end of July 2017, Mr. Sar’s drug screens were testing positive for amphetamines and methamphetamines. He was re-admitted to St. Joseph’s. His entrenched psychotic symptoms were considerably more florid and included new beliefs, such as experiences of connecting with the bodies of other people and being able to feel their emotions and read their thoughts. He also described having made 100 people “disappear” through his computer that controls everyone. There were also auditory and visual hallucinations. Of potential significance, having regard to the circumstances of the index offence, he spoke of being re-created as a male version of Avril Lavigne and waking up in a house in St. Catharines that he had walked past on several occasions, but had not entered because he did not see a keyhole.
Mr. Sar refused antipsychotic medication and was found incapable of consenting to psychiatric treatment. Over the course of three months of treatment with Haldol, his symptoms gradually decreased in intensity, and he was discharged back to his home. His mother became his Substitute Decision Maker (SDM). The ACT team took on the administration of his prescribed injections and Mr. Sar self-administered his oral medication (Olanzapine). Nevertheless, he continued to maintain that he did not have a mental illness and that medication cannot work due to his brain being a computer.
Despite the ongoing expression of delusional thoughts, the treatment team was of the view that antipsychotic medication had thus far prevented his thought processes and behaviour from becoming disorganized and had minimized his perceptual disturbances. All drug screens for the year tested negative. His risk to the community appeared to be successfully managed with the combination of long-acting injectable medication, living with family who oppose the use of illicit substances, forensic system oversight, and being followed in the community by an ACT Team. Accordingly, the treatment team recommended a Conditional Discharge, which was ordered by the Board on February 1, 2019.
Mr. Sar’s first year on a Conditional Discharge was challenging. Drug screens showed the use of cannabis from February to July and from September to November of 2019, and his reporting was increased to weekly in June. He was re-admitted to St. Joseph’s from July 30-September 13 due to mental state deterioration and cannabis consumption. He presented as floridly psychotic, stating that he could “feel” the souls of dead people passing through him almost daily. He could see people die and come back to life within seconds. He also verbalized auditory hallucinations, stating that the computer chip in his brain talks to him and that there are different people (usually women) operating the computer in his brain.
Mr. Sar was discharged to the community after his psychotic symptoms decreased in intensity. However, his drug screens continued to test positive for cannabis from September 27 to December 2, 2019. He was re-admitted to SJHH in December 2019 and again in February 2020 due to cannabis use and mental state deterioration. Due to the pandemic, he was highly isolated in his home for the balance of 2020. There was a mild fluctuation in his mental state in June with a new delusional idea being incorporated into his system of beliefs: he declined to take his Haldol injection from the ACTT worker, stating (in an apparent joking manner) that a “robot dragon” that he had created in the past would “chew her up and kill her.” This did not cause significant concern to the ACTT at the time
In late January of 2021, Mr. Sar stated that he and his family had decided to discontinue his long-acting injections of haloperidol. During a later videoconference, his mother said that the ORB Disposition was the only reason they had agreed to antipsychotic medication. His brother said that they would not be opening their door to anyone. A Form 1 was issued under the Mental Health Act; however, Mr. Sar and his family evaded police efforts to locate him until February 5, 2021, when he was finally admitted to St. Joseph’s. On admission, he demonstrated a level of agitation not seen during previous hospital admissions. He verbally threatened staff and co-patients and slammed his door when walking out of appointments with his psychiatrist.
Mr. Sar’s delusional thought content was more florid and overtly violent during this admission: he described having 20 dragons in different cities that he created to eat people who do not believe that he is God, and that he was tired of putting up with people not believing he is God. When asked whether he would actually want the “dragons” to hurt people, he said, “I don’t care; they deserve it.” Still, he denied thoughts of hurting others or himself.
During this admission, Mr. Sar’s mother stated that she no longer wished to be her son’s SDM, and the role was taken up by his brother, Chanthea. The mother expressed that Mr. Sar was “fine” and did not need medication. Chanthea demonstrated a better understanding of his brother’s mental illness but was unwilling to have him re-started on injectable medication. He said that Mr. Sar was blaming his family for the pain caused by his injections. Oral Haldol was initiated during the admission, and after Mr. Sar successfully completed a 14-day leave of absence from the hospital (by opening his door each morning so that the ACT team could supervise him taking his oral medication), he was discharged from hospital on April 30. The balance of the 2021 reporting year was uneventful. He returned to his baseline mental state with the oral medication; he answered the door for his ACT team except on two occasions when he said he was sleeping; he spent most of his time at home either sleeping or playing video games; and there were no reported incidents of physical aggression.
From January 2022 until October 27, 2022, Mr. Sar was doing well: taking his medications under the supervision of the ACT Team that saw him six days per week; and reporting every two weeks to the Forensic Outpatient Clinic. His mental status was fairly stable, and he presented as cooperative and pleasant. He was generally cooperative with mental status exams and urine drug screens which all tested negative for substances during those ten months. He expressed delusional thought content but denied suicidal and homicidal ideation. Mr. Sar spent his time on his computer and going for walks with friends. The Conditional Discharge, though challenging for the ACT Team which had to supervise the oral administration of antipsychotic medication almost daily, appeared sufficient in helping to effectively manage Mr. Sar’s risk.
This arrangement collapsed on October 27, when Mr. Sar refused to take his oral medication or to answer the door or telephone for the ACTT worker. Numerous calls and messages from his forensic case manager yielded no responses. Similarly, there was no answer at his door or responses to phone messages on October 28. Police were contacted. Mr. Sar was found walking down the street on October 30 and re-admitted to hospital. He explained to hospital staff that he did not answer his door or phone because his name was not Chantha; rather, it was “God.”
On November 2, Mr. Sar’s SDM (his brother Chanthea) withdrew consent for all antipsychotic medication. He explained that he wanted to see how Mr. Sar would do when off medication completely, knowing that this may require a prolonged period of in-hospital monitoring. He claimed that the medication had not been effective in achieving remission of the psychotic symptoms and Mr. Sar was complaining of negative side effects. In addition, Mr. Sar admitted using cannabis prior to his admission, and his drug screens tested positive for cannabinoids from November 1 through November 23, 2022
On admission, Mr. Sar was observed to be irritable, guarded and withdrawn, though there was no agitation or aggression. He expressed the belief that he was God and was the oldest person in the world at “14 billion years.” He was observed walking very quickly around the unit, which was out of character for him. He tended to stay in his room, only coming out for meals or to contact his family.
Mr. Sar was transferred to the Orchard 3 unit on November 16, 2022. His delusional thought content expanded since his re-admission, and he became less inhibited about expressing it. Among the expressed delusions was Mr. Sar’s statement that “Jenn Star” was on his computer for fifteen years and that this blocked his ability to see things. He talked about how he had married “Jenn Star” in the year 2000 and that “Avril Lavigne” was his daughter. Mr. Sar also asked his psychiatrist, Dr. Chauhan, if she recalled when she was “superman and put the dunce cap on everybody.” Mr. Sar reported that “Jenn Star” was off of his “computer,” which is what he called his brain.
Mr. Sar remained an inpatient until May 28, 2024, when he was discharged back to his mother’s residence. There have been no readmissions since May 2024.
During his time in the hospital, Mr. Sar exercised passes to visit his mother and brother at their home. He returned to the hospital without incident and reported that the visits went well. He continues to be incapable to consenting to treatment, and his brother remains his SDM.
Mr. Sar had no positive urine drug screens during the year, and there are no reported incidents of aggression. However, he was cautioned on numerous occasions to refrain from touching co-patients. He often became quite silly with co-patients and was seen playfully fighting. On one occasion, he touched a co-patient on their buttocks, which was “not well received”.
Mr. Sar was often actively psychotic, continuing his past pattern of bizarre and grandiose delusions. During the latter part of the year, he began to express new delusional themes, including that his actual full name is “God, Universalis, Nike”. He wrote these words and underlined their first letters, stating that his name is “GUN” for short.
Mr. Sar also spoke of his belief that there are “five galaxies” and that people are currently in the “third galaxy.” He stated that there are only “8000 to 10,000” people on Earth with star names and that these are the only people who have souls. He indicated that he is only going to the next galaxy with “good people” because he is “corrupted by people on earth who don’t understand him.” He reported that he is “100 percent certain” he is God and that he has no organs; thus, medications cannot work on him. He also expressed a belief that he would be going to the next galaxy soon with only family members and people who believe he is God. He continued to describe his body as having no organs, a computer instead of a brain, and a diamond skeleton.
In August of 2023, a space at a TRHP program residence, Emmaus Place, became available as an option for community living. The home provided 24-hour supervision and on-site medication administration. The treatment team strongly encouraged Mr. Sar to consider this, as it was felt to be the best option for him. The social worker and his psychiatrist (Dr. Chauhan) spoke to him about building his own independence and explained that he could still visit with his family in St. Catharines. Mr. Sar spoke with his family about the bed offer and toured the residence. A family meeting was arranged for the purpose of encouraging him to take this opportunity to live in the community. He ultimately declined the opportunity, instead expressing a desire to return to his mother’s home in St. Catharines.
Since his discharge to his mother’s residence in May 2024, Mr. Sar has been followed by the forensic outpatient program (FOP.) He is seen by his case manager once per week, and bi-weekly check-ins with his transitional case manager. He is also seen weekly by Niagara ACTT.
The reports from these various agencies indicate that Mr. Sar is generally calm and cooperative, and has attended all scheduled appointments. He still, intermittently, expresses delusional and grandiose thought content, such as, he is the creator of the universe. He also has reported having multiple names, including “God Nike,” and “Calvin Klein.” He reports having special powers, and that historically, he has been other persons, such as, Avril Lavigne, and that he wrote all her music.
Mr. Sar reports that he has been adherent to his prescribed medication regimen, and a urine drug screen collected on August 28, 2024, confirmed the presence of his prescribed medication.
He denied using any prohibited substances, and all urine drug screens this past year have been negative for prohibited substances.
Mr. Sar’s SDM for treatment are his mother, Bea, and his brother, Chanthea.
The Hospital Report indicates that while in hospital this past year, prior to his discharge, Mr. Sar would often approach staff with bizarre and grandiose thoughts, which were congruent with his delusional symptoms. Although he denied experiencing auditory hallucinations, the delusional thought content continued throughout his time in the hospital. He has stated that he is made of air and can heal instantly. He stated that he is Jesus, but that he doesn’t tell many people, because the last time he told someone he was crucified.
In May, prior to his discharge, Mr. Sar informed his nurse that he was going to Cambodia for a month with his family. He believed that his Disposition permitted this travel plan. Mr. Sar and his family were advised that travel outside the country would not be considered at that time.
Mr. Sar met with the Concurrent Disorders Capacity Building Team on two occasions to create a comprehensive relapse prevention plan. He told the Team that he does not trust the ACT Team to administer his medications in the community. He believed that his medication was excessively shaken creating bubbles before being administered, which created bubbles in his veins. The plan is for the case manager to have a 2nd person present when the medications are being administered. Mr. Sar now receives a long-acting injectable antipsychotic.
The most recent psychological risk assessment was completed in 2022. Since there have been no changes to the dynamic risk factors or the protective factors, the assessment is still considered valid. His risk for violent reoffending is considered moderate with intensive case management combined with external control. His risk for psychological harm is considered high.
Dr. Shariati testified at this hearing in his capacity as Mr. Sar’s treating psychiatrist. He has been treating Mr. Sar for approximately one year.
In his testimony, Dr. Shariati expressed that the year has been unremarkable for Mr. Sar, but that a continuing concern are the grandiose delusions. He would also like to see Mr. Sar engage in structured programming to mitigate the risk of relapsing.
Regarding Mr. Sar’s risk to the public, Dr. Shariati testified that Mr. Sar’s current stability is a function of extensive external controls. His insight into his diagnosis is low, and he does not believe that has schizophrenia or requires antipsychotic medication. He only takes his medication because he is a nice agreeable person, according to Mr. Sar.
Without a Disposition, and the support of the forensic outpatient team, Mr. Sar would discontinue his medication, and likely relapse into substance use. This would cause a deterioration of his mental health, and with his ongoing delusions, an increase in the risk of violent behaviour, said Dr. Shariati.
It was Dr. Shariati’s opinion that the Mental Health Act was not appropriate to manage the risk to public safety. It is important for the hospital to approve Mr. Sar’s accommodation, and for the hospital to quickly return Mr. Sar to the hospital should he experience a decline in his mental health. Dr. Shariati also stressed the importance of urine drug screens to monitor Mr. Sar for substance use.
Regarding use of the Mental Health Act as an alternative to a detention order, Dr. Shariati referred to the fact that Mr. Sar was on a conditional discharge from February 2019 to February 2023, and had to be readmitted to hospital after stopping his medication. The Board found it necessary to issue a detention order in February 2023. Dr. Shariati does not believe that Mr. Sar would voluntarily return to hospital if requested. Dr. Shariati is not certain that Mr. Sar would meet the requirements of the Mental Health Act for involuntary readmission, and in any event, does not believe that his SDM, his brother, would consent to readmission given the brother’s often negative attitude towards antipsychotic medication.
Dr. Shariati testified, in answer to questions from Mr. Sar’s counsel, that he attributes Mr. Sar’s abstinence from substances for two years to the external controls and his knowledge that there are regular drug screens. It is also Dr. Shariati’s opinion that Mr. Sar would not continue taking his antipsychotic medication if he were granted a conditional discharge because he does not believe he has schizophrenia or any need for medication. He believes he is God and omnipotent.
Dr. Shariati indicated that Mr. Sar was started on a long-acting injectable antipsychotic in December 2023. This stabilized his condition, and made it possible for the team to discharge him to the community in May 2024.
In response to questions from the panel, Dr. Shariati advised that Mr. Sar has not been physically violent or aggressive since the index offence. Although there was no physical violence during the index offence, his forced entry into a stranger’s home was terrifying for the occupants.
Dr. Shariati was asked if a community treatment order with the support of the ACT Team would be sufficient. He replied that this would be considered in the future, but that it is premature at this time. He referred to Mr. Sar not having been in the community for a complete year since his recent discharge. He would also like to see additional guidance and psychoeducation for his family to ensure that they understand the importance of medication as part of his treatment. It is also important for the hospital to have the ability to readmit Mr. Sar to the hospital quickly if his condition deteriorates, and approve his accommodation, which require a detention order, in Dr. Shariati’s opinion.
Dr. Shariati indicated that he has met with Mr. Sar’s brother to educate him on schizophrenia and the benefits of antipsychotic medication. Dr. Shariati is not convinced that Mr. Sar’s brother fully understands what he was told. Dr. Shariati intends to continue meeting with Mr. Sar’s brother to further the education. Dr. Shariati believes that either an ACT Team or the Canadian Mental Health Association would also be able to provide education to the family regarding Mr. Sar’s illness and the importance of antipsychotic medication.
Dr. Shariati was asked if there were any paraphilia concerns given the sexual assault conviction, and the reference to young girls being followed by Mr. Sar at the time of the index offence. He replied that these events occurred many years ago, and that he has not observed anything that would suggest the presence of a paraphilic disorder.
Submissions
The Hospital submitted that Mr. Sar is a significant threat to the safety of the public, and that the risk is currently managed appropriately under a detention order. Reference was made to the psychological assessment, in which Mr. Sar’s risk of physical violence is considered moderately low, but the probability of psychological harm is considered high.
The Hospital submitted that it is premature to consider a conditional discharge. Mr. Sar was on a conditional discharge in 2021, had to be readmitted to hospital, and ultimately, the Board placed Mr. Sar on a detention order. The Hospital also referred to the fact that Mr. Sar’s brother, his SDM, withdrew consent for all treatment in November 2020. Mr. Sar was unmedicated for a prolonged period of time.
Counsel for the Attorney-General concurred with the submissions of the Hospital. He added that the risk factors present when Mr. Sar was previously on a conditional discharge remain. As well as withdrawing consent for treatment, his brother also assisted Mr. Sar evade the ACT Team when they attended at his home. He submitted that a conditional discharge would create a great risk to the safety of the public.
Counsel for Mr. Sar submitted that Mr. Sar has been abstinent from substances for 2 years, and that Mr. Sar has expressed a desire to remain abstinent. He further stated that there is no history of physical violence, and that we should not assume that the events leading to Mr. Sar’s readmission, when he was on a conditional discharge, will repeat itself. He suggested that the current home environment is a very stable and supportive residence for Mr. Sar. Counsel expressed that a conditional discharge was sufficient to manage Mr. Sar’s risk to the community.
Analysis
Mr. Sar has been under the jurisdiction of the Review Board for many years.
He is diagnosed with schizophrenia, and continues to experience deeply entrenched grandiose delusions. His various delusional beliefs are well documented in the Hospital Report, and the result of these delusions is that he is not mentally ill and has no need for medication.
Mr. Sar has a history of not taking his prescribed medication. It is indicated in the Hospital Report that Mr. Sar’s behaviour prior to the sexual assault in 2003 was bizarre, and he was experiencing paranoia. Following his assessment at St. Joseph’s, he was released into the community, and provided with the opportunity to obtain outpatient treatment. He was also directed to take antipsychotic medication. He did not seek treatment or take any medication until the index offence in 2009. During this time, he was symptomatic, and there is reference to him sleeping naked in the snow.
The Hospital Report indicates that Mr. Sar experiences a rapid deterioration of his mental condition if he stops taking his medication, or if he consumes substances.
In 2017, he was re-admitted to hospital after using substances. He refused antipsychotic medication and was found incapable to consent to treatment.
Mr. Sar was granted a conditional discharge in February 2019. Re-admissions to hospital followed in July 2019, December 2019, and February 2020. The re-admissions were a result of substance use and deteriorating mental health.
In January 2021, Mr. Sar and his family decided to discontinue his long-acting injectable antipsychotic medication. His mother advised the staff that they only agreed to the medication because of the Review Board Disposition. With the assistance of his family, Mr. Sar evaded the outpatient team and the police until February 5th. On admission to the hospital, he was described in the Hospital Report as having a level of agitation never seen before. He was verbally threatening staff and co-patients. His delusions were more florid. His brother refused to re-start the long-acting injectable antipsychotic.
In October 2022, he was refusing to take his medication, and refusing to answer the door for his outpatient team. His mental condition declined significantly. His brother, his SDM, was complicit with Mr. Sar in evading the ACT team. On November 2, 2022, his brother withdrew consent for treatment. Mr. Sar was admitted to hospital and was highly delusional.
With proper supervision, and antipsychotic medication, Mr. Sar’s condition stabilized, and he was discharged to his mother’s home in May 2024. There have been no behavioural issues with Mr. Sar since his discharge, but his grandiose delusions continue unabated.
The panel finds that there is ample evidence to conclude that Mr. Sar is a significant threat to the safety of the public.
He has no insight into his illness and need for treatment, and it is very evident that his adherence to his medication and his cooperation with the outpatient team is motivated by the existence of a detention order and the risk of being readmitted to the hospital. Without this external control, Mr. Sar would stop his medication and engagement with the outpatient team. More intense symptoms would result. His behaviour in this condition, would most likely become bizarre, and possible paranoid, and put the public safety at a significant risk.
The panel does not believe that a conditional discharge is sufficient to manage the risk to public safety. His condition is similar today to what it was in October 2022, when he was re-admitted while on a conditional discharge. It is important for the hospital to have the ability to re-admit Mr. Sar to the hospital very quickly should he stop his meds and decompensate. It is also necessary for the Hospital to approve his housing.
After considering all the evidence, the panel concludes that a detention order is necessary and appropriate.
In coming to this conclusion, the panel has applied the principles provided in s. 672.5401 of the Criminal Code.
Dated this 25th day of March 2025, at the City of Toronto, in the Toronto Region.
Kevin McKenna
Legal Member
Office of the Registrar
Ontario Review Board