Re: Joseph M. Pepin
ORB File No: 5681/6941
Hearing held on: Friday February 21, 2025
Place of Hearing: St. Joseph's Healthcare Hamilton
Pursuant to: Sections 672.81(1) and 672.81(2.1) of the Criminal Code
Before:
Alternate Chairperson: Mr. R. Bigelow Members: Dr. S. Simpson Dr. M. Kalia Mr. S. Doherty Ms. L. Maunder
Parties Appearing:
Accused: Joseph Pepin Counsel: Mr. M. Schloss
The person in charge of hospital: Counsel: Ms. L. Barney
Attorney General of Ontario: Counsel: Ms. C. Gzik
REASONS FOR DECISION AND DISPOSITION
(Dated April 2, 2025)
Introduction
On August 17, 2010, Joseph Pepin was found not criminally responsible on account of mental disorder (NCR) on a charge of a threating to burn, destroy or damage property contrary to the Criminal Code.
On March 17, 2015, he was also found NCR in the Province of Quebec on charges of dangerous operation of a motor vehicle and assault contrary the Criminal Code. He was initially ordered detained by the Commission d’examen des Troubles Mentaux (CETM), otherwise known as the Quebec Review Board, at the Institut Philippe-Pinel de Montréal. However, on February 25, 2016, he was transferred back to Ontario under the jurisdiction of the Ontario Review Board (the Board) pursuant to sections 672.86 of the Criminal Code. He is currently subject to a disposition of the Board dated February 22, 2024, ordering his detention at the Forensic Psychiatry Program of St. Joseph’s Healthcare Hamilton (the Hospital) with privileges up to and including residence in the community in accommodation approved by the person in charge.
By letter dated February 7, 2025, the Hospital notified the Board pursuant to section 672.56(2) of the Criminal Code that Mr. Pepin, who had been residing in the community, was readmitted to hospital on January 9, 2025, and remained in hospital until January 25, 2025, a period exceeding seven days.
On February 21, 2025, the Board convened a hearing to review Mr. Pepins’s disposition pursuant to section 672.81(1) of the Criminal Code as well as to review the circumstances surrounding the restriction of his liberties between January 9 and January 25, 2025, pursuant to section 672.81(2.1) of the Criminal Code with the consent of all parties. Mr. Pepin was present at the hearing and represented by Counsel, Mr. Schloss.
The issues to be determined at the annual review were whether Mr. Pepin continued to represent a significant threat to the safety of the public as defined in section 672.5401 of the Criminal Code and, if so, what was the necessary and appropriate disposition which was also the least onerous and least restrictive, taking into account the factors set out in section 672.54 of the Criminal Code. The issues to be determined at the restriction of liberty review were to determine whether both the initial and continuing restriction of Mr. Pepin’s liberties until his discharge from hospital were necessary and appropriate.
Positions of the Parties
At the commencement of the hearing the parties were requested to provide their initial without prejudice positions with respect to the issues before the Board. All three parties submitted that the necessary and appropriate disposition was a continuation of the current detention order with the only change being the amendment of term 4(a) prohibiting the nonmedical use of intoxicants to read abstain absolutely from the non-medical use of alcohol or drugs or any other intoxicant, save and except for cannabis.
With respect to the restriction of Mr. Pepin’s liberties, all three parties submitted that both the initial and continuing restriction until his discharge was necessary and appropriate in the circumstances.
Findings:
- For the Reasons that follow, the Board finds that Mr. Pepin continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition is a continuation of the current detention order with the only change being the amendment of the term prohibiting nonmedical use of intoxicants to exclude cannabis obtained from licensed dispensaries with low THC content and high CBD: THC ratios.
Index Offences:
- The circumstances surrounding the index offence taken from last year’s reasons for disposition are as follows
“February 5, 2010—First Set of Index Offences:
Mr. Pepin visited his parents’ residence in an agitated state and was off his medication. He threatened to burn his parents’ house down as well as his own. He was hearing voices which told him to burn his 4-year-old daughter. He later advised that instead of burning his daughter, he had burned his cat. Subsequent investigation found that he had killed his cat by placing it in a wood-burning stove.
January 22, 2015—Second Set of Index Offences:
Mr. Pepin was an outpatient of the North Bay Regional Health Centre. He absconded and was arrested for dangerous operation of a motor vehicle and assault in the Province of Quebec.”
Background Information Regarding the Accused:
- The Hospital Report outlines Mr. Pepin's personal background, criminal history, and psychiatric history, which need not be repeated here in detail. They are accurately summarized up to his annual review in 2023 in last year's Reasons for Disposition as follows:
Mr. Pepin has extensive psychiatric history dating back to his first hospitalization in North Bay in 2005. Since then, he has had several hospitalizations as a result of his major mental illness. He also engaged in marijuana and alcohol use from approximately age 15 and has reported past use of LSD and ecstasy.
Of note, Mr. Pepin was previously found NCR in connection with charges of endangering life and assault causing bodily harm in 2005 and he received an Absolute Discharge on October 15, 2007. The index offences for this NCR finding involved Mr. Pepin striking his grandfather on the head with a blunt instrument and disconnecting a natural gas line to release the gas into his grandparents’ home while they were asleep. He was initially charged with two counts of attempted murder.
Mr. Pepin has never been married but he has 2 children from two previous relationships. On September 22, 2016, he was discharged from St. Joseph’s to live in the community of Hamilton under a General Detention Order. The transition to community living went well and two years later, on October 19, 2018, he was granted a Conditional Discharge. Less than two months after receiving a Conditional Discharge, Mr. Pepin stole a car and absconded. He was involved in a single car accident and he was arrested on December 7, 2018 and convicted of related offences and placed on probation for three years.
At his ORB annual hearing in 2019, his Conditional Discharge Disposition was set aside and he was placed on a Detention Order with privileges up to living in the community in accommodation approved.
On June 2, 2020, Mr. Pepin was discharged to live in supervised housing supported by the Good Shepperd Homes. He has been readmitted to the hospital on numerous occasions since his discharge triggered primarily by breaches of his Disposition relating to the requirement that he abstain from alcohol and illicit substances.
Mr. Pepin was readmitted to the hospital on three occasions as follows: (i) February 10 - March 7, 2022 (as a result of his tampering with his urine samples); (ii) March 16 - August 9, 2022 (as a result of his methamphetamine use); and (iii) September 9 – November 15, 2022 (as a result of cannabis use and suspected tampering with urine samples). As has been the case in past years, his hospital readmittances were as a result of his use of illicit substances in breach of his Disposition and his tampering with urine samples or providing urine samples from other patients.”
- Mr. Pepin’s current diagnoses are
Schizophrenia
Cannabis Use Disorder, in sustained remission
Alcohol Use Disorder, in sustained remission
Cocaine Use Disorder, in sustained remission
Legal History:
- In addition to the index offences and the mischief and assault causing bodily harm charges for which he received an absolute discharge in 2007, Mr. Pepin was convicted of impaired driving and failing to stop at the scene of an accident in October 2004 and received a 15-month conditional sentence and a three-year driving prohibition.
Evidence of Dr. Alatishe
Dr. Alatishe advised that he had been Mr. Pepin’s attending psychiatrist since 2016 and had read and adopted the contents of the Hospital Report. The most significant incident over the reporting year was Mr. Pepin’s readmission to hospital from January 9 to January 25, 2025, the circumstances of which were set out in the Hospital Report at page 69. Dr. Alatishe stated that in his opinion both the initial restriction of Mr. Pepin’s liberties and the continuing restriction until his discharge was necessary and appropriate. Mr. Pepin was in violation of his disposition, and it appeared that he was not at his baseline. As soon as it was clear that he had returned to his baseline, he was discharged, and he has been substance free since discharge.
Dr. Alatishe noted that Mr. Pepin had been adherent to medication over the reporting year and up until January of this year had been abstinent from the consumption of any substances since 2022. He continued to reside in a Good Shepperd subsidized apartment and has a positive relationship with both the Good Shepperd staff as well as the treatment team.
Although the treatment team continues to encourage him to remain abstinent from all substances including cannabis Mr. Pepin has consistently indicated his desire to use cannabis. The treatment team believes that the best way to assess the full risk of cannabis use is to closely monitor use and any impact on Mr. Pepin’s mental health. The treatment team believes that, although there would be an increase in risk should Mr. Pepin use cannabis, that increase would be manageable if Mr. Pepin use cannabis in accordance with Canada’s Lower-Risk Cannabis Use Guidelines (the Guidelines).1
Dr. Alatishe stated that Mr. Pepin has agreed to only buy cannabis with low THC content and high CBD: THC ratios from licensed dispensaries and has agreed to continue to engage with substance abuse counselling.
In response to questions from counsel for the Attorney General, Dr. Alatishe indicated that Mr. Pepin had indicated that he wanted to use cannabis between three and five times per week which is not consistent with the lower risk guidelines.
In response to questions from counsel for Mr. Pepin, Dr. Alatishe noted that there were a number of stressors weighing on Mr. Pepin at the time that he commenced to use cannabis in January. However, he was not clinically depressed or displaying any psychotic symptoms.
In response to questions from panel members, Dr. Alatishe indicated that Mr. Pepin understood the negative impact of the use of stimulants such as cocaine and methamphetamine on his mental health including paranoia and hypomania. He also indicated that should the prohibition from cannabis use be removed the treatment team would monitor Mr. Pepin much closer and look for any subtle signs of changes in mood.
Analysis and Conclusion, Significant Threat:
Although the issue of significant threat was not contested at the hearing, the Board nevertheless makes an independent finding that Mr. Pepin does represent a significant threat to the safety public. He suffers from a major mental illness, schizophrenia, as well as a long history of polysubstance abuse. When unwell he experiences command hallucinations with homicidal and suicidal themes, persecutory delusions, Capgras delusions and has a long history of acting out violently in the community. Despite medication compliance he continues to experience symptoms of his illness, demonstrates poor insight into his mental health and continues to experience violent ideation.
Mr. Pepin also has a history of noncompliance with recommended medication and polysubstance abuse. Without the supervision and support provided by his detention disposition, he is likely to return to the use of substances including cocaine and methamphetamine which would certainly result in a deterioration in his mental state and put him at increased risk to act out violently.
Analysis and Conclusion, Necessary and Appropriate Disposition:
The Board finds that the evidence amply supports the joint submission that the necessary and appropriate disposition is a detention order on the terms as recommended by the Hospital. Given his history of the nonadherence to medication, substance use and aggression, his adherence to medication and abstinence from stimulant use needs to be closely monitored while in the community in order to manage risk. The treatment team needs to approve accommodation in order to ensure that appropriate supervision is in place and that any decompensation in community would be quickly noted and he could be returned to hospital before meeting the criteria under the Mental Health Act.
The Hospital report outlines the treatment team’s rationale for supporting an amendment to the condition prohibiting use of nonmedically prescribed alcohol or drugs as follows:
The treatment team carefully considered Mr. Pepin’s request to have the condition prohibiting cannabis use removed from his current disposition. It was the team’s opinion that while any substance use, including cannabis, is not recommended in an individual with a psychotic disorder that it would be possible to manage this risk effectively under the authority of a Detention Order. The team will continue to provide Mr. Pepin with education regarding the risks of cannabis use. If Mr. Pepin is permitted to use cannabis, we will also provide the Canada’s Lower-Risk Cannabis Use Guidelines and monitor his use and mental state closely. A detention order would permit the hospital to return Mr. Pepin to hospital immediately upon concern that his risk to the community has increased. In discussion with Mr. Pepin, he was able to see the rationale that a detention order would be the only safe manner to assess his ability to use cannabis in a relatively safe manner.
Mr. Pepin has agreed to follow the recommendations contained in the guidelines to only use cannabis obtained from licensed dispensaries with low THC content and high CBD: THC ratios. The Board accepts the opinion of the treatment team that with careful monitoring and adherence to those terms any increase in risk to the public can be safely managed.
The Board notes that the guidelines recommend that cannabis use be limited to “occasional use, such as only one day a week or on weekends, or less” which conflicts with Mr. Pepin’s expressed intention to use 3 to 5 times per week. The Board strongly suggests that Mr. Pepin follow the guidelines’ recommendations with respect to frequency of use but is of the view that such a stipulation in his disposition would be unenforceable.
DATED this 2nd day of April 2025, at the City of Toronto, in the Toronto Region.
Robert Bigelow Alternate Chairperson
Office of the Registrar Ontario Review Board
Footnotes
- Published by the Public Health Agency of Canada and the Canadian Research Initiative in Substance Misuse. https://www.canada.ca/content/dam/themes/health/carousel/LRCUG%20Evidence%20Brief%20Final%20English%20v2.pdf. A copy of the guidelines is attached as exhibit A.