Ontario Review Board
Re: Kristopher Ginn
ORB File No: 5616
Hearing held on: Tuesday, January 28, 2025
Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. T. Mann Members: Dr. A.D. Jones Dr. H. Moulden Ms. K. Tomaszewski Ms. C. Plyley
Parties Appearing:
Accused: Kristopher Ginn Counsel: Mr. S.F. Gehl
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. D. Rows
REASONS FOR DISPOSITION
(Dated March 31, 2025)
Introduction:
[1]. On May 19, 2010, Kristopher Ginn was found not criminally responsible on account of mental disorder on charges of assault causing bodily harm and assault, contrary to the Criminal Code of Canada. He is currently subject to a disposition of the Ontario Review Board dated December 13, 2023, discharging him subject to several conditions that include a residency provision, minimum reporting requirements, abstention and testing clauses, and a clause that if he were to be arrested for a breach or anticipated breach of the terms of his Disposition, he may be delivered to the Southwest Centre for Forensic Mental Health Care, St. Joseph's Health Care London.
[2]. On January 28, 2025, the Board convened a hearing at the Southwest Centre for Forensic Mental Health to review that Disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. Ginn was present and represented by counsel, Mr. S.F. Gehl.
[3]. The record for the hearing consisted of a Revised Notice of Hearing dated December 13, 2024, the most recent Disposition dated December 13, 2023, and the Reasons for Disposition dated February 16, 2024.
[4]. On the consent of all parties, a Hospital Report dated October 28, 2024, was entered into evidence, and marked as Exhibit 1.
[5]. At the outset of the hearing, the parties were canvassed as to their initial without prejudice recommendations to the Board. The Hospital and the Attorney General were aligned in recommending that Mr. Ginn be found to present a significant threat and that the necessary and appropriate Disposition would be a continuation of his conditional discharge, with the removal of the condition that he abstain from substances. Mr. Gehl on behalf of Mr. Ginn did not concede the issue of significant threat, but endorsed the proposed change to the terms proposed by the Hospital should significant threat be found.
Evidence at the Hearing
[6]. The Board had available to it evidence in the form of the above-noted Hospital Report and oral evidence from Dr. Arun Prakash, Mr. Ginn’s treating psychiatrist. The Hospital Report is cumulative in nature, and included a synopsis of the two index offences, as follows:
“Assault Causing Bodily Harm
On March 31, 2009…the victim, Steven Stewart was outside of Victoria Hospital, 375 South Street, London. Stewart was seated on a park bench having a cigarette when he was approached by the accused, Kristopher Ginn who asked for a cigarette. Stewart handed over his package of cigarettes and a lighter to Ginn. A few moments later, Ginn jumped to his feet and yelled “I’m the devil, I am going to kill everyone.” Ginn then proceeded to punch Stewart with a closed right fist in the face. Stewart was knocked to the ground at which point Ginn proceeded to kick Stewart in the abdomen approximately 30 times. A citizen passing by stopped the attack and Ginn left the area.
Stewart was transported to Victoria Hospital where it was revealed he had suffered two broken ribs as a result of the assault by Ginn.
Assault
The accused, Kristopher Ginn, and the victim, Dennis Orval Ireland, are known to each other as both reside at the London Psychiatric Hospital located at 850 Highbury Ave. N.
On Saturday, November 07, 2009, both the accused and the victim were in their residence at 850 Highbury Ave N, London, Ontario. At approximately 6:00 pm the accused proceeded to walk past the victim and began calling him a “baby fucker” and “child molester.” The altercation escalated to the point where the victim advised the accused to “shut up.” This then prompted the accused Ginn to spit on the victim striking him with the spit in the chest area.”
Background
[7]. The Hospital Report provides a great deal of information concerning Mr. Ginn's personal and mental health history, details of the index offences, and his course in hospital following his admission. Given that the Hospital Report was made an exhibit in this hearing, it is not necessary to reproduce in detail the information contained within it in these Reasons.
[8]. Of note, however, is that Mr. Ginn’s struggles with major mental illness have been long standing. He has had many attendances at and admissions to hospital for psychiatric issues. He was most frequently observed to have symptoms of psychosis, including auditory command and visual hallucinations. At times he harboured a great deal of resentment towards authority figures and tended to be irritable and argumentative.
[9]. Mr. Ginn was convicted of sexual assaults involving minors when he was in his early teens. To his credit, Mr. Ginn turned himself into the police because he felt guilty and wanted to confess. The sexual assaults involved a three-year old male cousin and a five-year-old female friend of the family who he was babysitting. Additionally, he had many interactions with police that did not result in criminal charges in the context of his mental health difficulties.
[10]. Historically, Mr. Ginn used several substances including crack cocaine and intravenous drugs. Mr. Ginn’s use of alcohol and cannabis started at age 14. He started using cocaine at the age of 18. Other substances used included LSD, psilocybin, heroin, amphetamines and ecstasy. Mr. Ginn reported he also abused prescription medications.
[11]. Notably, Mr. Ginn has a significant history of non-adherence to treatment and follow up. He has a history of discharging himself from hospital early and absconding.
[12]. Mr. Ginn is diagnosed with Schizophrenia, Substance Use Disorder - in Sustained Remission and Pedophilia.
Recent Progress Under the Jurisdiction of the Board
[13]. At the time of his last annual hearing, Mr. Ginn had continued to live in the community in a 24/7 supervised group home run by the Community Homes for Opportunity (CHO) Program. Overall, his reporting period was characterized by mood stability and a reduction in auditory hallucinations. Mr. Ginn was forthcoming with his treatment team about their presence. While he continued to have grandiose ideation, this too had reduced in frequency and intensity. He did not manifest any cognitive difficulties although he did continue to require support from staff in organizing his professional supports and services.
[14]. Very positively, Mr. Ginn had not demonstrated any violent or threatening behaviours nor had he been observed engaging in any inappropriate sexual behaviours or verbalizations which was an improvement from previous years. To his great credit, Mr. Ginn continued to be abstinent from substances.
[15]. Nevertheless, there continued to be a number of ongoing concerns, particularly with respect to Mr. Ginn’s expressing a desire to use cannabis and alcohol and his lack of insight into the disinhibiting effect of substances on the level of his risk to others. There were also concerns that if he were to use substances, and such use was not coupled with indicators of decompensation, Mr. Ginn could not easily be re-admitted to hospital. There also were continued concerns associated with whether Mr. Ginn would be compliant with medications in the absence of a forensic disposition. Dr. Prakash was very clear that Mr. Ginn’s continued abstention from use of substances was critically important to managing his risk of committing a serious violent offence if he stopped taking his medication or began using substances, or both.
Progress over the Current Review Period
[16]. From the Hospital Report, the evidence before this panel is that Mr. Ginn had another good year overall. He continued to reside in his group home in St. Thomas, where he has lived since October 2020. Mr. Ginn continued to experience residual symptoms of his illness which did not interfere with his daily functioning. It was noted throughout the year that although Mr. Ginn continued to hear voices, their frequency and intensity had significantly decreased. As was the case during the previous review period, Mr. Ginn remained open with staff about the presence of these voices, consistently reporting their frequency and intensity. Mr. Ginn sometimes felt lonely as he did not have the voices to talk to regularly. He reported that the voices are nicer to him than they once were and are not commanding.
[17]. Mr. Ginn's mood remained consistently positive with no significant fluctuations. There were no reports of suicidal thoughts or of extremes in either elation or sadness. He did not anger easily, nor did he engage in any self-harm. At times in recent months, Mr. Ginn ruminated more upon his pedophilia diagnosis, believing it is the primary obstacle to his moving forward with employment. However, this did not impact his mood to the point that it affected his daily activities. No cognitive difficulties were observed.
[18]. Mr. Ginn independently planned and organized tasks related to areas of personal interest, but this did not generalize to managing tasks associated with his physical care or activities of daily living, including attending medical appointments. In this regard, he relied heavily on group home staff to manage his appointments and transportation. However, Mr. Ginn was co-operative and accepting of support, care and supervision. He showed a positive attitude and did not experience any difficulties with rule adherence or problematic behaviours and all interactions with community members have been polite and appropriate.
[19]. Mr. Ginn demonstrated remarkable perseverance in the face of repeated rejections regarding his various inventions. This suggests that he is developing more adaptive mechanisms to cope with disappointment.
[20]. In April of 2024, there was an incident between Mr. Ginn and another resident at the group home, in which the other resident threatened him with death while fidgeting with something in his pocket that the other resident mentioned was possibly a knife. Mr. Ginn appropriately sought assistance from staff and called 911, demonstrating a high degree of appropriate problem-solving in the face of considerable stress.
[21]. Mr. Ginn has a history of being somewhat isolative or seclusive from others due to paranoia or anxiety related to being judged or mistreated because of his index offence. This year with the encouragement of group home staff, he increased his socialization with other residents. He met regularly with his group home worker for monthly 1:1 visits, when they often went for walks, thus demonstrating a deepening engagement with staff.
[22]. According to the Hospital Report, Mr. Ginn’s insight into his index offence improved but was still fluctuant. In addition to expressing remorse for the harm he caused to the victims, he attributed his actions to “not being in the right state of mind” and “not thinking clearly”. He remained ambivalent as to whether his interaction with the victims was real or his hallucinations tricking him. Notwithstanding this, Mr. Ginn vowed that he would not repeat the same behaviour. There were, however, other times where Mr. Ginn’s insight was assessed as being partial in that he would blame others for his index offences and minimize their severity and make inappropriate comments around the topic of pedophilia and his attraction to children.
[23]. His insight into his mental illness has also improved but remains underdeveloped. He is able to accurately identify primary diagnoses and is accepting of both, he understands that his experience of hearing voices is part of his illness structure and that his auditory and visual hallucinations have significantly improved over the past few years. However, regarding his diagnosis of pedophilia, Mr. Ginn believes it to be “very under control”. Importantly, he does seem to understand that neither of his diagnoses can be cured but accepts that they can be well managed through treatment and self-awareness. Mr. Ginn was referred to psychology for a sexual risk assessment which occurred October 9, 2024. The results of this assessment are discussed below.
[24]. To his credit, Mr. Ginn has now been abstinent from substances for over 16 years. All randomized drug and urine screens have been negative. While he denies experiencing any cravings to use substances, every now and then, he wonders about the possibility of occasional use. More recently, he voices that he has no intention of using substances in the future because it would be “taking a risk” with his mental health.
[25]. Mr. Ginn’s insight into his need for treatment has improved but remains underdeveloped. He believes his medication accounts for only 50 percent of his progress and attributes the other half to personal growth. Mr. Ginn is willing to remain on medication for as long as his doctor deems it necessary. Mr. Ginn does not connect his psychiatric medications to their role in reducing his risk of re-offending, indicating a lack of insight into how his treatment contributes to his stability.
[26]. Mr. Ginn remains incapable of making treatment decisions in connection with his mental illness. His substitute decision maker remained the Office of the Public Guardian and Trustee. Mr. Ginn takes a host of psychiatric medications intended to treat the symptoms of his psychiatric diagnoses, as well as the antiandrogen drug, cyproterone.
[27]. Mr. Ginn has been referred to the Elgin Assertive Community Treatment (ACT) Team for post-forensic psychiatric aftercare but his application is still pending. There is a plan to issue a Community Treatment Order prior to Mr. Ginn’s discharge from the Forensic Program, but given the likelihood that he would not independently pursue professional support if left to his own devices, this will need to involve the ACT team accepting him into their care, which is currently unconfirmed.
[28]. In October 2024, Mr. Ginn co-operated in a psychological assessment into his risk of sexually re-offending, which was completed by Dr. L. Fazakas-deHoog, with the assistance of K. Bedek, a psychometrist at the Hospital. Results from the STATIC-99R, an actuarial risk tool, found that Mr. Ginn’s overall score placed him at an above average risk for being charged or convicted of another sexual offence. The testing also identified a number of protective factors for Mr. Ginn, including his age at release, years in the community without re-offending and that his sexual charges stemmed from when he was an adolescent. Mr. Ginn demonstrates a good understanding that he is not to sexually engage with children. Additionally, Mr. Ginn did not harbor cognitive distortions about child molestation or rape that would indicate the need for therapeutic intervention. However, more concerningly, he displayed limited insight into the chronic nature of his pedophilia diagnosis and expressed some openness to discontinuing his antiandrogenic medication. As such, it was suggested that a Community Treatment Order or other incentive to remain medication compliant would aid in lowering his overall risk of re-offending.
[29]. Future plans include removing the abstention clause from Mr. Ginn’s Disposition to test his ability to remain abstinent from substance use absent the extrinsic support of his disposition. Also, once accepted by the ACT team, efforts will commence to help Mr. Ginn establish a relationship with the team members prior to his being eligible to receive an absolute discharge.
[30]. As for significant threat, Mr. Ginn represents a low risk for violence in the context of a conditional discharge disposition. This risk would increase to moderate if he were to be granted an absolute discharge without adequate professional supports in place. However, once professional supports have been fully established, and supported by the implementation of a CTO, Mr. Ginn’s risk for violence would decrease to low within the context of an absolute discharge.
[31]. The Hospital Report describes Mr. Ginn’s Re-Offense Scenario as follows:
“Absent psychiatric support and supervision and given Mr. Ginn’s underdeveloped insight into his mental illness, his diagnosis of pedophilia, and his need for treatment, he would likely stop taking his medication and may resort to substance use, which would result in an exacerbation of psychotic symptoms and heighten his risk of reoffence. As in the Index offence, his symptoms would likely result in violent behaviours.”
[32]. As to a disposition, the treatment team considered an absolute discharge but feels it is premature at this juncture. While Mr. Ginn has maintained successful tenure in the community, he remains impacted by residual symptoms of his mental illness and his insight remains partial in all domains. Without the involvement in the forensic system, he would be unlikely to independently pursue professional support if left to his own devices. Consequently, the treatment team continues to recommend that a conditional discharge is appropriate until adequate professional community-based mental health supports are established.
Evidence at the Hearing
[33]. Dr. Prakash provided oral evidence at the hearing. He first endorsed the contents of the Hospital Report, including the assessment of significant threat, and then provided an overview of Mr. Ginn’s progress over the review period. Dr. Prakash confirmed that Mr. Ginn continues to reside at his group home and that he has made good progress. His auditory hallucinations have quieted, showing that his medication regimen is effective. Dr. Prakash noted that this was the first time in 15 years that Mr. Ginn has experienced a cessation of his voices. The diminution of his auditory hallucinations has allowed Mr. Ginn to be more social and less seclusive to his room. He continues to work on his inventions but is no longer hyper-focused on them. This is positive in that he has not jeopardized his housing by spending too much money developing his inventions.
[34]. Dr. Prakash indicated that Mr. Ginn continues to struggle at times with his insight, especially related to his ongoing need for medication. He experiences significant side effects from anti-psychotic medication (eg high prolactin levels) which is a concern because the side effects could cause him to stop taking it. If this were to happen, Mr. Ginn would decompensate, his auditory hallucinations would intensify, and the voices could urge him to stop taking his medication altogether.
[35]. As for Mr. Ginn’s diagnosis of pedophilia, Dr. Prakash outlined for the Board that so long as he continues to take his antiandrogen medication, his risk of sexual reoffending is low. Ongoing vigilance is warranted in this regard, because Mr. Ginn has difficulty connecting his diagnosis to heightening his risk to public safety. While he knows that touching children is bad, he sometimes thinks that he is cured and that he no longer needs medication. As recently as the week before the hearing, he was questioning both his risk and his diagnosis.
[36]. Dr. Prakash advised that use of substances is not currently a risk factor for Mr. Ginn. He is maintaining his abstinence through a combination of intrinsic and extrinsic support. Dr. Prakash agrees with the treatment team’s recommendation to remove the “abstain from” clause to assess whether Mr. Ginn can continue to be abstinent without the extrinsic support of a term in his disposition.
[37]. Dr. Prakash said that a term of a future CTO requiring Mr. Ginn to take medication for both of his mental health diagnoses would help support his continued compliance and lower his risk, as would a residency clause requiring him to stay in his group home. For these reasons, the treatment team is recommending that Mr. Ginn have the support of an ACT team as he needs regular, proactive monitoring to manage his compliance with medication.
[38]. In response to questions from Mr. Gehl, Dr. Prakash stated that if an ACT team were to accept Mr. Ginn and be able to work with him for a period of five or six months under the terms of a CTO, the Hospital would look into calling an early hearing to review his disposition. Dr. Prakash agreed with the suggestion that if Mr. Ginn had already been connected with an ACT team, and with a CTO in place, the treatment team would have considered recommending that he be granted an absolute discharge.
[39]. In response to questions from the Board as to the basis for Mr. Ginn’s improved condition since his last annual review, Dr. Prakash said the treatment team feels it has to do with better control of his auditory hallucinations. While Mr. Ginn has previously experienced periodic ‘gaps’ in his symptomology, this past year has been different as the ‘gap’ has been more sustained and appears to have led to a lessening of his preoccupation with his inventions as well as negative symptoms, both of which have greatly impacted him in the past.
[40]. Dr. Prakash emphasized that if Mr. Ginn were to stop taking his psychiatric medications, he would quickly decompensate and that it would take a very long time for him to get back to his baseline, due to the treatment-resistant nature of his Schizophrenia. The treatment team would ensure that both groups of medications (antipsychotic and antiandrogen) would be included in the CTO and that the treatment team would provide support for the ACT team if necessary to increase their comfort level in terms of working with Mr. Ginn’s antiandrogen medication.
[41]. Dr. Prakash was asked to account for Mr. Ginn’s historical diagnosis of Antisocial Personality Disorder (ASPD) no longer being a concern. The doctor said that the behaviours and attitudes consistent with this diagnosis were likely due to his sub-optimally treated psychotic illness. Dr. Prakash added that the Outreach team has not observed evidence of ASPD over the time staff have worked with Mr. Ginn.
Submissions
[42]. Ms. Zamprogna’s submissions on behalf of the Hospital emphasized the positive progress Mr. Ginn has made over the review period but also his need for external supervision to support medication compliance and control of his ongoing psychiatric symptoms and pedophilic thoughts.
[43]. Mr. Rows for the Attorney General adopted Ms. Zamprogna’s submissions and highlighted the real risk of serious physical or psychological harm that Mr. Ginn would pose to others absent the appropriate supports. Mr. Rows endorsed the cautious approach proposed by the Hospital to shore up Mr. Ginn’s community-based supports over the coming year.
[44]. Mr. Gehl submitted that Mr. Ginn no longer posed a significant threat based on Dr. Prakash’s assertion that had the necessary post-forensic supports been in place, the treatment team would have recommended an absolute discharge. Mr. Gehl advised that should the Board determine that Mr. Ginn is a significant threat, he did not dispute the proposed terms.
Analysis and Conclusion:
[45]. Having heard and considered all of the evidence and the submissions of the parties, the Board is of the view that Mr. Ginn poses a significant threat to the safety of the public. This finding is based on the uncontroverted evidence of Dr. Prakash, together with the documentary evidence available at the hearing, including the assessment report of Dr. Fazakas DeHoog. The Board adopts in their entirety the risk assessments contained in the Hospital Report at pp 216 - 221, including the Clinical Assessment of Risk at p. 219 and the likely re-offence scenario at p. 218.
[46]. The Board finds the following summary of Mr. Ginn’s risk to be particularly apt:
Overall, Mr. Ginn presents a low risk for violence in the context of a conditional discharge disposition. His risk would increase to moderate if granted an absolute discharge without adequate professional supports in place (i.e. the ACT team). Once professional supports are fully established and a CTO is in place, Mr. Ginn’s risk for violence would decrease to low with an absolute discharge.
[47]. The Board carefully reflected on whether Mr. Ginn’s current constellation of symptoms and behaviours met the threshold of significant threat as defined by Winko, The Board kept uppermost in mind that there is no presumption on an NCR accused to provide evidence they are not a significant threat and further that where the Board is unable to make a positive finding of significant threat, an NCR accused is entitled to an absolute discharge.
[48]. In this case, the Board finds there is ample evidence to support a finding that Mr. Ginn remains a significant threat to public safety given his diagnoses of (treatment refractory) Schizophrenia, which has historically led to violence, as well as his diagnosis of Pedophilia, where the results of a recent STATIC-99R place him at an above-average risk for being charged or convicted of another sexual offence.
[49]. Mr. Ginn’s insight into his mental illness, need for treatment and violence risk has improved, but it remains partial overall. Without supervision, he would be unable to manage his antipsychotic and sex-drive suppressing medications independently, and it is more probable than not that Mr. Ginn would decompensate if he were to discontinue taking his medication or use substances. The fact that Mr. Ginn continues to “test himself” with thoughts of sexual interactions with children, and that he occasionally still muses about taking the occasional celebratory (alcoholic) drink, supports the conclusion that he requires ongoing assessment, close monitoring and treatment to manage his risk of re-offending.
[50]. Turning to the issue of the necessary and appropriate disposition to manage Mr. Ginn’s risk and his care for the coming year, the Board finds that a conditional discharge is the least onerous and least restrictive disposition having regard to all the circumstances.
[51]. The evidence demonstrates unequivocally that with support and supervision, Mr. Ginn has had another very good year under the Board’s jurisdiction. He is mentally stable, cooperative with group home staff and members of the Outreach team, compliant with his medication regimen, and presented no behaviour management difficulties. He has made gains in socialization and seems more content to remain in his group home residence in St. Thomas. He remains abstinent from substance use.
[52]. The Board concurs with the Hospital that Mr. Ginn continues to require support and supervision to maintain compliance with medication and that his residing in a 24/7 supervised group home, working in conjunction with his forensic disposition, provides this. Because Mr. Ginn’s diagnoses are life-long, antipsychotic and antiandrogen medication is essential.
[53]. The Board accepts the evidence that Mr. Ginn cannot maintain compliance with medication in the absence of external support and supervision. In order to make continued progress, adequate post-forensic support to manage his risk and his care needs to be in place. Ideally, this support will take the form of an ACT team to provide regular monitoring and the extrinsic legal support of a CTO to ensure medication compliance. Once these measures are in place, and Mr. Ginn has developed a positive therapeutic rapport with his new team, consideration may then be given to whether his presentation meets the threshold of significant threat.
[54]. In terms of the least onerous and least restrictive disposition, the Board supports the removal of the abstention requirement from Mr. Ginn’s conditional discharge disposition. Mr. Ginn has done very well abstaining from substance use over the many years he has been under the jurisdiction of the ORB. Because of the connection between disinhibited, risk-enhancing behaviour and consumption of substances, including alcohol, it is necessary for the treatment team to be able to assess the extent to which Mr. Ginn can remain abstinent without the extrinsic support of a term in his disposition prohibiting him from doing so. It is best that this assessment occurs while Mr. Ginn is still under the jurisdiction of the Board and being monitored by treatment team members who know him well and with whom he has a high degree of trust. The testing provisions in his conditional discharge disposition remain the same to permit ongoing monitoring of this important risk factor.
[55]. In arriving at our Disposition, the Board has considered the paramount factor of the safety of the public, Mr. Ginn’s community reintegration, his mental condition and his other needs, all as required by s. 672.54 of the Criminal Code.
DATED this 31st day of March 2025, at the City of Toronto, in the Region of Toronto.
Ms. T. Mann Alternate Chairperson Office of the Registrar Ontario Review Board