Ontario Review Board
Re: Chad Lindsay Thomas
ORB File No: 8636
Hearing held on: Friday, January 31, 2025
Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas
Pursuant to: Section 672.47(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: Chad L. Thomas
Counsel: Mr. R. Cunningham
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:
On September 24, 2024, Chad Thomas was found not criminally responsible on account of mental disorder on a charge of attempted murder and possession of a prohibited weapon, contrary to the Criminal Code of Canada (“Criminal Code”).
The Court ordered, pursuant to s. 672.47(1) of the Criminal Code, that the matter of a disposition be referred to the Ontario Review Board (“the Board”) for an initial hearing.
On January 31, 2025, the Board convened this panel for a hearing at the Southwest Centre for Forensic Mental Health Care (“the Hospital” or the “Southwest Centre”) to fashion an initial disposition. Mr. Thomas was present at the hearing and represented by his counsel, Mr. R. Cunningham.
The issue at this hearing is whether Mr. Thomas 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. Thomas represents a significant threat to the safety of the public, and that the necessary and appropriate, least onerous and least restrictive disposition is that of a detention disposition order upon terms as set out in the Reasons below. Further, the Board ordered that a Gladue Report be completed.
Current Psychiatric Diagnoses:
- Mr. Thomas is diagnosed with Schizophrenia, Substance Use Disorder (stimulants, cannabis and alcohol by history), and Rule Out Antisocial Personality Traits.
Index Offences:
- The circumstances giving rise to the index offences are taken from the Hospital Report dated December 20, 2024 which was made Exhibit 1 at the hearing, as follows:
CC 239(1)(b) Attempt to Commit Murder
On the 8th day of December 2023, Chad Thomas was at 58 Erie Street South, within the Municipality of Leamington, also known as the Leamington Centre of Hope and Soup Kitchen. On this same day, Leamington OPP were dispatched to an assault that had just occurred at 58 Erie Street South, in the Municipality of Leamington. While there, Chad Thomas attacked Daniel McDonald with a knife, slashing him across the throat and stabbing him in the right side of the head. Following the attack, Mr. Thomas uttered "I just wanted to kill him."
CC 91(2) Unauthorized Possession of Prohibited Weapon
On December 8th, 2023, Leamington OPP were dispatched to an assault that had just occurred at 58 Erie Street South, in the Municipality of Leamington. During the investigation, Chad Thomas was arrested for Attempt Murder, and while searching his property a pair of silver, metal brass knuckles were located inside of his coat pocket.
Background Information:
The Hospital Report provides a great deal of information concerning Mr. Thomas’ 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. Relevant points to provide context are set out below.
Mr. Thomas is a 45-year-old Indigenous man. He was born in Leamington and had a normal birth and development. His parents separated when he was very young and he grew up living full time with his father and two brothers, in and around Walpole Island. He reported being close with his father and an aunt, both of whom he experienced as being very supportive of him. His aunt, in particular, was instrumental in supporting Mr. Thomas’ access to mental health services and letting him live with her from time to time. His father died of pancreatic cancer in 2012 and his aunt died of cancer in May of 2023. The loss of his aunt affected him greatly. His mother is also deceased.
During his developmental years, Mr. Thomas displayed behaviour problems including stealing, truancy, lying, challenging authority and running away from home. He lived in several group homes.
Mr. Thomas completed some grade 10 courses but did not otherwise complete his education. Mr. Thomas has a limited employment history. He has worked at a factory, has done occasional roofing and corn detasseling and some other seasonal and contract work. Mr. Thomas has been receiving an ODSP pension since the age of 18. Mr. Thomas has never been married or involved in any common-law relationships. He has no children. Mr. Thomas has experienced housing instability for many years. For the most part, he lived with various family members. He reported he has never lived on his own.
Of note is that Mr. Thomas’ struggles with major mental illness and substance abuse have been long standing. The Canadian Mental Health Association Windsor-Essex County Branch was extensively involved with him starting at least as early as 2001.
Mr. Thomas was followed in the community by Dr. B. Bordoff for approximately 20 years until the doctor retired in November 2024. Dr. Bordoff most often diagnosed Mr. Thomas with Schizophrenia and Substance Abuse Disorder (alcohol and cannabis). This varied at times depending on Mr. Thomas’ presentation. Dr. Bordoff’s records reflect that Mr. Thomas’ mental status fluctuated; notwithstanding treatment with antipsychotic medication. He regularly experienced periods of worsened mental status punctuated by inter-episodic periods of stability, which were sometimes fairly lengthy. The course of Mr. Thomas’ schizophrenia clearly reflected a connection between his use of cannabis, alcohol, and crystal methamphetamine and increased aggression and psychosis. Mr. Thomas’ positive symptoms frequently included auditory command hallucinations, paranoid and persecutory ideation, internal preoccupation, prominent thought disorder, thought insertion, affective instability as well as homicidal and suicidal ideation/attempts. Over the years, Mr. Thomas had many attendances at, and admissions, to hospital for psychiatric issues.
The history set out in the Hospital Report reveals that Mr. Thomas was mostly cooperative with medication administration, including injectable antipsychotic medication. However, the Hospital Report also reveals an extensive history of noncompliance and variable compliance with antipsychotic medication in addition to ongoing use of substances.
Mr. Thomas has a significant substance use history. He started drinking alcohol and using cannabis in his early teens and progressed to using a wider array of substances as he grew older, including but not limited to psychedelics (LSD and psilocybin) and stimulants (cocaine, amphetamines and methamphetamines). Substances were implicated in the commission of the index offences. Upon being admitted to the South West Detention Centre on December 9, 2023, nursing staff observed Mr. Thomas to be under the influence of drugs. His urine tested positive for cocaine, amphetamines, methamphetamines, cannabis, fentanyl, benzodiazepines and buprenorphine.
Mr. Thomas has a criminal record. He reportedly had conflicts with the law starting at a young age. Convictions between 1999 and 2003 include obstructing a peace officer, attempted break and enter with intent, mischief and failing to comply with probation. During the course of his NCR assessment in July 2023, Mr. Thomas told the psychiatrist that he “always confronted his fears with violence”.
Progress after NCR Finding:
While in custody at the South West Detention Centre, Mr. Thomas continued to be delusional. He reported punching a cellmate who went to the bathroom at the same time he did, feeling that this person had tampered with his things. In January 2024 he broke the little finger of his right hand when he punched “something” about a week earlier. In April of 2024, he was having suicidal thoughts with a plan to hang himself or use razors. Apart from these incidents, he presented as emotionally stable overall and was not a management problem. He took his prescribed psychiatric medications and did not use substances.
Mr. Thomas was admitted to the Southwest Centre on October 2, 2024, under the care of Dr. J. Quinn. It quickly became apparent that there was a significant discrepancy between Mr. Thomas’ initial self-report of symptoms and subsequent self-reports wherein he endorsed hearing voices and shrieking noises. His thought process was tangential, and he was observed smiling inappropriately at times. Mr. Thomas often spent time alone on the unit and presented as shy. He was also noted to be overly tidy and meticulous. His mood was generally congruent to the situation. At times he reported feeling anxious around missing his family and feeling he had let down. Engaging in new processes and routines tended to escalate his anxiety. He appropriately managed his feelings of anxiety by listening to music, writing poems and reading.
Following his admission to hospital, Mr. Thomas was cooperative with hospital rules and routines. No significant incidents were reported and did not pose any management difficulties. He appropriately interacted with staff and peers and engaged in programs daily.
Clinically, notwithstanding treatment with multiple antipsychotic medications, Mr. Thomas continued to demonstrate significant psychotic symptomatology. Dr. Quinn opined that Mr. Thomas would likely benefit from a trial of clozapine but to meet the qualifying criteria, three previous antipsychotic medications from two different classes had to be trialed and assessed as ineffective. To this end, a trial of the third-generation antipsychotic medication aripiprazole was started on November 19, 2024, At the time of the writing of the Hospital Report, there had been no appreciable change in his illness symptoms. Mr. Thomas is currently deemed capable of making decisions related to his treatment.
Mr. Thomas’ insight into his index offences, mental illness and need for treatment was initially very limited overall. With respect to his index offences, Mr. Thomas provided a different narrative as to their cause each time he was interviewed. Underlying paranoia and religious-based psychosis were evident in his narratives, and he externalized blame on the victim.
Mr. Thomas’ insight into his mental illness was marginally better although still incomplete. He acknowledged that he had a mental illness and that medications helped with his symptoms. However, he minimized, denied or did not recognize his psychotic symptoms and did not evince an understanding of various factors, such as substance use, aggravating the course of his illness. Mr. Thomas indirectly acknowledged his substance use disorder by requesting treatment for it but when offered to attend relapse prevention groups in the hospital, he declined.
As for his insight into treatment, Mr. Thomas accepted his medication regimen and expressed feeling that his medications helped him. Within the controlled setting of the Hospital, he was adherent to his medications. However, it was unclear whether he connected treatment with reduced risk of violent or aggressive behaviours.
Mr. Thomas voiced a strong connection with Indigenous values and teachings. He participated in a number of culturally relevant activities, including smudging, attending an Indigenous Exhibition and participating in a sharing circle.
Position of the Parties:
- Counsel for the Hospital and the Attorney General were joined in recommending that Mr. Thomas be found to represent a significant threat to the safety of the public and that a detention disposition order upon the terms set out in the Hospital Report was necessary and appropriate. Counsel for Mr. Thomas advised that for the purposes of the hearing, significant threat would not be contested but that he had a number of issues he wished to explore regarding significant threat and the proposed disposition before committing to a position.
Evidence at the Hearing:
Dr. Quinn provided oral evidence at the hearing. He first endorsed the contents of the Hospital Report including the risk assessments contained at pages 27 through 31. Dr. Quinn then provided the Board with a brief overview of Mr. Thomas’ progress since his admission to hospital, as well as an update covering the period between the preparation of the Hospital Report and the hearing.
Dr. Quinn advised that Mr. Thomas continues to have psychotic symptoms such as talking to himself or calling out when no-one is there. He also continues to show some mood symptoms, including agitation, tearfulness and thoughts of suicide as well as the occasional time when his affect is incongruous with his actions. For example, at the end of December 2024, Mr. Thomas was approached by nursing staff and punched a wall, while smiling. When staff asked him why he punched the wall, he looked perplexed and said, “I don’t know”, and proceeded to do it again.
On January 8, 2025, Mr. Thomas was transferred from the assessment unit to a treatment unit and is currently under the care of Dr. Malka. Dr. Quinn spoke with Dr. Malka a few days before the hearing to see how Mr. Thomas was faring. Dr Malka indicated that Mr. Thomas continues to present similarly as described in the Hospital Report. His mental health status remains largely unchanged. Typically, he sleeps well, has a good appetite and generally normal mood. When less mentally well, Mr. Thomas exhibits increased disorganization and mood symptoms including agitation, labile mood, and inappropriate emotional expression incongruent to the circumstances.
Dr. Quinn reported that Mr. Thomas’ insight is challenging to assess because it fluctuates from conversation to conversation. Sometimes he demonstrates good insight into his schizophrenia and sometimes he does not. He sometimes acknowledges his condition and the purpose of medication but gives inappropriate answers at other times. Dr. Quinn is hopeful that Mr. Thomas’ insight will improve and become more consistent with further treatment.
Importantly, Aripiprazole has failed to improve Mr. Thomas’ symptoms. To the contrary, an initial worsening of symptoms was observed and no significant improvement followed. Thus, plans are going ahead to implement treatment with clozapine once approval from the necessary authorities has been obtained.
Dr. Quinn confirmed that substance use exacerbates Mr. Thomas’ mental health symptoms and risk for violence, and he is in need of ongoing treatment in this regard. In Mr. Thomas’ case, substance use leads to increased agitation, aggression, lability of mood and psychosis. He requires assessment and ongoing treatment for his substance use disorder. Next steps include referring Mr. Thomas to the in-hospital concurrent disorders program and thereafter to consider attending an Indigenous-led program at Ngwaagan Gamig Recovery Centre (Rainbow Lodge), in the community of Wikwemikong, Ontario. Dr. Quinn advised the Board that Mr. Thomas has now been attending Alcoholics Anonymous sessions.
Regarding community reintegration and support, community living is not feasible in the short term due to Mr. Thomas' current needs. He is unlikely to progress to community living within the next year. He requires significant supervision and support for medication adherence and daily living activities. If Mr. Thomas’ treatment progresses well, community integration will be explored. Currently, Mr. Thomas has expressed a wish to live with one of his brothers in the community. It is unknown at this time whether this would be a viable option as the brother recently moved to another community and has been very difficult to reach. The treatment team needs to first identify and explore the willingness and ability of Mr. Thomas’ family members to serve as approved persons. Dr. Quinn said that connecting with Mr. Thomas’ family is really important so as to elicit an accurate understanding of his history. Mr. Thomas’ self-report is coloured by disorganization and to some extent paranoia and therefore unreliable, currently. The ability to go back to Mr. Thomas’ home community with him to develop a deeper and first-hand understanding of his situation and the supports that might be available to him there is one of the reasons the Hospital is recommending that he have the privilege of entering Southwestern Ontario, accompanied by staff.
Very positively, Mr. Thomas has been receptive to taking antipsychotic medication. Dr. Quinn opined that Mr. Thomas’ non-adherence to medication in the community was likely due to disorganization and practical, systemic barriers (such as lack of transportation, or ready access to services) as opposed to resistance to medication. Dr. Quinn conceded he had no clear evidence that non-adherence to medication was a factor in the index offences. Dr. Quinn identified substance use and psychosocial stress (the death of his aunt and subsequent eviction from her home by a relative) as more likely factors. In hospital, Mr. Thomas has been amenable to trialing different medications, which is very positive. However, he could benefit from developing more adaptive ways of coping with stress than reverting to substances use. Opportunities to participate in psychotherapeutic programs intended to target Mr. Thomas’ vulnerabilities will be offered to him.
Next steps include evaluating Mr. Thomas’ response to clozapine over the coming months and conducting occupational assessments to determine his support needs for future accommodation.
Dr. Quinn would like to see Mr. Thomas develop a track record of safely accessing hospital and grounds and not relapsing to use of substances, followed by beginning to develop a routine in the community, indirectly supervised. Dr. Quinn indicated that a group home with medication administration and support would be a logical next step for Mr. Thomas but not in the shorter term. Mr. Thomas has not lived independently for a sustained period of time.
Dr. Quinn expects that Mr. Thomas will be able to move from a treatment unit to a rehabilitation unit within the coming year. Mr. Thomas remains at high risk of substance use in the future and his ability to abstain will be a significant factor influencing his progress in his rehabilitation.
Dr. Quinn outlined the Hospital’s efforts to develop Indigenous programs and said that integrating Mr. Thomas’ Indigenous background into his care plan will continue. Dr. Quinn agreed that a Gladue Report could help provide the necessary context within which to develop treatment modalities and support in a way that reflects and fosters Mr. Thomas’s Indigeneity.
In response to questions from Mr. Thomas’ counsel, Dr. Quinn expressed worry that including a community living clause in Mr. Thomas’ disposition could cause a misalignment between Mr. Thomas’ priorities and those of his treatment team. This could compromise his ability to develop and maintain a positive therapeutic alliance if the team did not support his desire to progress to community living within the next 12 months.
Dr. Quinn agreed with the suggestion that the absence of a community living term in Mr. Thomas’ disposition may limit his placement options in that he would not be eligible to go on any waitlists for community housing. However, Dr. Quinn maintained his position that including a community living clause could cause a misalignment of treatment goals and frustrate Mr. Thomas. Dr. Quinn was not optimistic that Mr. Thomas would be ready for community living within the next 12 months, in part because he still experiences positive symptoms of his psychiatric illness which need to come under better control. Additionally, he also needs treatment for his substance use disorder. His clinical team needs to have a better understanding of any functional limitations that may influence the choice of accommodation. Dr. Quinn agreed that Mr. Thomas does not appear to have been involved in an Assertive Community Treatment Team (ACTT) prior to the index offences.
Dr. Quinn also agreed with the suggestion that apart from the results of the urine test administered shortly after the index offences, he did not have evidence as to whether Mr. Thomas was a fentanyl user. (Mr. Cunningham indicated that Mr. Thomas adamantly denies using fentanyl.) Dr. Quinn observed that substances purchased ‘on the street’ might be laced with substances the user did not intend to take.
Dr. Quinn emphasized the importance of Mr. Thomas engaging in different rehabilitative programs and modalities of psychotherapy such as dialectical behaviour therapy or cognitive behavioural therapy for psychosis to optimize his chances for timely and successful reintegration into the community.
No other evidence was called.
Analysis and Conclusions:
Significant Threat:
Having heard and considered the entirety of the evidence as well as the submissions of the parties, the Board finds that Mr. Thomas is a significant threat to the safety of the public.
In coming to its conclusion in this matter, the Board relies on the uncontroverted expert evidence of Dr. Quinn, and the risk assessments set out at pp 27-31 in the Hospital Report.
Mr. Thomas’ risk flows from his longstanding history of schizophrenia and substance use disorder. Symptoms of his schizophrenic illness include auditory command hallucinations and homicidal thoughts, and his chronic use of substances is highly correlated to increased symptoms of psychosis. As such, these illnesses, acting together or separately, make him vulnerable to acting out in a seriously criminal and violent fashion when sub-optimally treated, psychotic and under the influence of intoxicating substances. Mr. Thomas’ diagnostic picture is complicated by his history of antisocial traits and behaviours which require further assessment to determine their relevance. Although Mr. Thomas had been living in the community for many years with no significant history of violence and a dated criminal record, the index offence was very serious and could easily have resulted in the death of the victim.
Currently, the positive symptoms of his major mental illness are active, and it has proven challenging to find an effective treatment regimen. Mr. Thomas’ insight into his mental illness, need for treatment and his risk for violence, while evolving, needs more development to reduce his overall risk of future violence.
The Board also finds particularly apt the Re-Offense Scenario contained at page 30 of the Hospital Report, as follows:
“Absence forensic support and a supervised environment, Mr. Thomas would likely resort to living in a transient and unstable living situation. This environment elevates his likelihood of stress and relapsing into substance use. Without proper support and supervision in place, he would likely fall away from treatment and be unable to cope with the environmental and personal stressors and destabilize. His risk of violence would exacerbate, and he would perceive unknown stimuli as a threat and act out violently causing serious harm, as demonstrated in the index offences.”
48, The conclusion in the Hospital Report is that Mr. Thomas presents a low to moderate risk of re-offending if managed in hospital under a detention disposition. If living in the community, his risk of violence would be high. The Board concurs.
Least Onerous, Least Restrictive, Necessary and Appropriate Disposition:
This Board finds that Mr. Thomas is in need of care and treatment within a forensic hospital setting and a detention disposition is the necessary and appropriate vehicle within which to provide the extrinsic legal support required for him to progress in his healing journey.
Mr. Thomas’ history of non-adherence to treatment and follow-up even when connected to community-based mental health supports militates towards the conclusion that he is in need of assessment and treatment within a highly controlled environment. The Board believes that that Mr. Thomas’ risk to the safety of the public can be properly managed with a detention disposition order requiring Mr. Thomas to remain in hospital. There is no air of reality to a conditional discharge at this time.
Turning now to the necessary and appropriate terms, it is evident that Mr. Thomas’ schizophrenic illness continues to be very active, and an effective medication regimen has not been found. Mr. Thomas is in need of psychoeducation around insight and illness management. He needs to build therapeutic relationships with his new physician and treatment team. He has not had the benefit of assessment and treatment for his substance use disorder. His ability to remain abstinent in a less controlled setting or to demonstrate behavioural control off-unit has not been tested. Out-of-hospital residential treatment for his substance use disorder cannot occur until his psychosis is under better control. Further assessment is needed to determine what level of support Mr. Thomas will need when living in the community.
In other words, it is still early days, and caution is warranted with respect to Mr. Thomas’ ability to safely access the community. The Board has confidence that the Hospital will implement privileges in a safe and step-wise manner. Moreover, the Board agrees with the Hospital’s recommendation that Mr. Thomas be accorded the privilege of entering the community of Southwestern Ontario accompanied by staff or person or delegate approved by the person in charge. This will meet the twin goals of allowing the treatment team to gather relevant information about Mr. Thomas’ history and provide an opportunity for him to reconnect with his family, his culture and his community should he wish to do so.
The Board notes that Mr. Thomas has many strengths including his motivation for and co-operation with treatment, his good behaviour in hospital to date and his expressed desire to abstain from substances going forward. These features of his presentation augur well for continued positive progress over the coming year.
Mr. Thomas’ goal of attending a residential drug and alcohol treatment program to address his substance use is laudable and as such a term will be included in his disposition to permit him to do so, anywhere in the province of Ontario, up to 90 days.
The necessity for prohibitions regarding weapons, use of substances and contact with the victim is obvious from the facts and circumstances of the index offence. Further, Mr. Thomas will be required to submit samples of urine and/or breath to permit the necessary monitoring to ensure adherence to the abstention clause.
Notwithstanding Mr. Cunningham’s able submissions, the Board declines to order that Mr. Thomas be granted the privilege of living in the community in approved accommodation. Currently, Mr. Thomas’ risk remains high for relapsing into substance use and decompensation of his mental status, which would further impact his ability to sustain an independent or even modified/supported living situation at this time. The Board is persuaded by Dr. Quinn’s evidence that including a term in Mr. Thomas’ disposition permitting him to reside in the community in approved accommodation is premature and raises the spectre of a therapeutic misalignment between himself and his treatment team which would be deleterious to his progress. There remains much work to be done before it is concordant with the safety of the public and Mr. Thomas’ liberty interests for him to have the privilege of living in the community. Should it come to pass that Mr. Thomas’ progress is impeded by the lack of a community living privilege, the Hospital can request an early review of this disposition.
Finally, the Board orders that a Gladue report be prepared expeditiously and in time for Mr. Thomas’ next annual review. In discharging its inquisitorial mandate, the Board is required to pay particular attention to the unique circumstances of Indigenous persons detained in psychiatric facilities. Jurisprudence recognizes that as a consequence of Canada’s colonial history and assimilationist policies, many Indigenous persons have become disconnected from their ancestral communities, culture and associated positive social structures, and suffered many other harms. Mr. Thomas is an Indigenous person. Very little is known about his or his family’s intergenerational exposure to trauma and the ways in which colonial policies have impacted them. This information will enhance the Board’s ability to properly carry out its duty to seek, gather and review all relevant evidence affecting consideration of the factors set out in s. 672.54. Moreover, the Board finds that a Gladue report will necessarily inform Mr. Thomas’ treatment plan so that it reflects and supports his Indigeneity.
In arriving at our disposition, the Board has considered the paramount factor of the safety of the public, Mr. Thomas’ 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