Ontario Review Board
Re: C. (M. L.)
ORB File No: 3957
Hearing held on: Tuesday, March 4, 2025
Place of Hearing: St. Joseph’s Healthcare Hamilton, West 5th Campus
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Mr. C. Flanagan Members: Dr. K. Hand Dr. A. Kerry Mr. K. McKenna Mr. A. Mete
Parties Appearing: Accused: C. (M. L.) Counsel: Mr. A. Rai Person in charge of Hospital: Counsel: Ms. L. Barney Attorney General of Ontario: Counsel: Ms. J. McKenzie
REASONS FOR DISPOSITON
(Dated April 9, 2025)
Introduction
On March 24, 2004, C. (M. L.) was found not criminally responsible on account of mental disorder (“NCR”) on charges of assault, sexual interference with person under sixteen, and sexual assault, all contrary to the Criminal Code.
Mr. C. (M. L.) is currently subject to the terms and conditions of a Disposition of the Ontario Review Board (“ORB”) dated March 8, 2024, detaining him at the Forensic Psychiatry Program of St. Joseph’s Healthcare Hamilton, West 5th Campus (“SJHH” or the “Hospital”) with certain privileges, including to live in the community in accommodation approved by the person in charge.
On March 4, 2025, a panel of the Board convened at the SJHH to conduct Mr. C. (M. L.)’s annual review, and to make a Disposition pursuant to s. 672.81(1) of the Criminal Code.
Mr. C. (M. L.) attended the hearing and was represented by his counsel, Mr. A. Rai. A Hospital Report dated February 26, 2025, was filed as Exhibit 1 at the hearing.
The issue for the hearing is whether Mr. C. (M. L.) continues to pose a significant threat to the safety of the public and, if so, to determine the necessary and appropriate Disposition in all the circumstances.
Initial Position of the Parties
At the outset of the hearing, the parties were canvassed as to their recommendations to the Board.
Ms. Barney, on behalf of the Hospital, submitted that Mr. C. (M. L.) remains a significant threat to the safety of the public and recommended a Conditional Discharge Disposition on the terms and conditions as set out on pages 86-87 of the Hospital Report.1
Ms. McKenzie, on behalf of the Attorney General of Ontario, submitted that based on the Hospital Report and subject to the evidence of Dr. Naidoo, she expected to support the Hospital’s recommendation.
Mr. Rai, on behalf of Mr. C. (M. L.), conceded significant risk to the safety of the public and agreed with the Hospital’s recommendation.
Index Offences
- The circumstances of the index offences are taken from the Hospital Report as follows:
Sexual Assault, Sexual Interference (February 23, 2002)
“On February 23, 2002, Mr. C. (M. L.), who was then 23 years old, was living in his mother’s home, as were other members of his family, including his 12-year-old sister. At 7:30 p.m., Mr. C. (M. L.) entered his sister’s bedroom, where she was alone talking to friends on the telephone. Mr. C. (M. L.) looked “high” and “not very sober”. His eyes were red, he smelled of smoke, and he was muttering to himself. He asked his sister if she had weed, but she did not answer. She didn’t think he knew who she was. He locked the door behind him, turned off the lights, ripped the telephone cord out of the wall, removed his sister’s clothing, pushed her down on the bed, and had sexual intercourse with her. He did not use a condom and ejaculated on his sister. His sister disclosed this information to friends, who eventually notified school authorities. The CAS and the police were contacted. Mr. C. (M. L.) turned himself in to the police on February 28, 2002. His sister told the police that Mr. C. (M. L.) smoked all the time, had depression and would sleep all day.”
Assault with a Weapon (November 1, 2002)
“On November 1, 2002, at 10:00 p.m., during an argument that Mr. C. (M. L.) was having with his mother in the kitchen of her home, Mr. C. (M. L.) grabbed a knife, approached his mother, raised the knife over his head and said, “I'll stab you, I'll stab you”. His mother asked him to put the knife down, and he put it on the ground. Mr. C. (M. L.) then became very quiet. His mother was aware that after quiet periods, Mr. C. (M. L.) sometimes became violent and broke things, so she took her computer into her daughter's room and locked the door behind her.
Mr. C. (M. L.)'s mother telephoned the police, who attended the residence and found Mr. C. (M. L.) sitting on the couch in the living room, with a knife nearby. Mr. C. (M. L.) remained still and did respond to police commands. The police apprehended him under the Mental Health Act and took him to a hospital. After being assessed for less than 15 minutes, he was released, and the police arrested him.
Mr. C. (M. L.)'s mother told the police that one week prior to the incident, Mr. C. (M. L.) said to her that he was going to “kill you all while you are sleeping”. She felt that Mr. C. (M. L.) could carry out his threats if he was depressed. She reported that Mr. C. (M. L.) was not taking medication and had not seen his doctor for approximately six months. She was of the view that Mr. C. (M. L.) was not capable of caring for himself in his then current state.”
Criminal History
- On May 15, 1998, Mr. C. (M. L.) was sentenced to a conditional discharge and two years of probation after being convicted of assault with a weapon, arising out of an incident in which he argued with his mother and hit his half-sister in the leg with a hockey stick.
Personal Background/Psychiatric History
Mr. C. (M. L.)’s personal background and psychiatric history are set out in detail in the Hospital Report filed as an exhibit at the hearing.
Briefly, Mr. C. (M. L.) is a 46-year-old, single male. He was born in Dominica and his biological parents never married. His mother married Davidson Riviere when Mr. C. (M. L.) was 10 years old, and the family immigrated to Canada in 1989. He has two younger half-sisters, and one older stepsister. His parents subsequently separated, and Mr. C. (M. L.) subsequently resided with his mother and grandmother.
Mr. C. (M. L.) left high school in Grade 9 without graduating. He subsequently had intermittent employment including temporary positions in factories, a courier company, and a furniture supply company. His employment was difficult over the years due to his psychiatric admissions to hospital.
Mr. C. (M. L.) began drinking and smoking marijuana at age 19. He admitted that he was cannabis-intoxicated when he hit his sister Amanda with a hockey stick, sexually assaulted his stepsister, and when he threatened his mother. He has had many casual relationships and fathered three children, with whom he has little or no relationship.
According to his mother, Mr. C. (M. L.) first became ill after he lost his job in 1999. She described him as “talking to himself, laughing, speaking nonsense, paranoid, afraid of people, heights”, and basically summarized his behaviour as “really weird”. He was first admitted to Humber River Regional Hospital between March 27 and April 7, 2000. His mother escorted him to the emergency room due to increasingly severe depressive symptoms. While in hospital, he experienced auditory hallucinations, passive suicidal ideation, had little emotional expression, lacked insight into his need for hospitalization, and asked to be discharged. He was diagnosed with major depressive disorder, substance use (cannabis), and schizotypal personality disorder. Following discharge, in June 2000, Mr. C. (M. L.)’s girlfriend reported that he was no longer taking his medication and resumed smoking marijuana.
On August 21, 2001, Mr. C. (M. L.) was admitted overnight to hospital for an “acute stress reaction”. On admission he was severely despondent, angered easily, uttered suicidal threats, and denied having a mental illness. In February 2022, Mr. C. (M. L.) committed the sexual index offences against his younger sister.
On November 1, 2002, the police returned Mr. C. (M. L.) to hospital after he threatened to stab his mother and sister. He was on release at the time for the February 23, 2002, index offences. He was arrested for this incident after he was discharged from hospital. A treatment order was issued and after two months in hospital he was found fit to stand trial and released with conditions that he reside with his aunt and see his family doctor. Although his doctor referred him to a psychiatrist, he did not see one, and did not receive any medication.
Mr. C. (M. L.) was found NCR on March 24, 2004, for both the February and November 2002 offences. Following the NCR verdict, he was admitted to the Centre for Addiction and Mental Health (“CAMH”) and subsequently transferred to SJHH on October 15, 2020. On November 7, 2021, Mr. C. (M. L.) was discharged to the community living at Denholme Manor, a Residential Care Facility, in Hamilton, Ontario.
On December 23, 2021, staff at Denholme Manor reported to the Forensic Outpatient Team that Mr. C. (M. L.) had not returned to the home. Mr. C. (M. L.) was readmitted to hospital on December 29, 2021. He was again readmitted to hospital between October 31 and November 21, 2022, and between April 4 and May 9, 2023. Mr. C. (M. L.) is financially supported by the Ontario Disability Support Plan (ODSP) and resided in the community at the time of the hearing.
Current Diagnosis
- Mr. C. (M. L.) is diagnosed with Schizophrenia, Substance Use Disorder (Alcohol, Cannabis, Stimulant), Severe, in remission in controlled environment, and Unspecified Personality Disorder.
Evidence at the Hearing
The evidence was presented through the oral testimony of Dr. Y. Naidoo to supplement the evidence contained in the Hospital Report filed at the hearing. Dr. Naidoo became Mr. C. (M. L.)’s most responsible physician in 2021.
Dr. Naidoo advised that Mr. C. (M. L.) had a positive reporting year. He has not any required readmission and is capable of consenting to treatment. Mr. C. (M. L.) currently resides at Kelly’s Residence, a fully supported group home in Hamilton, Ontario. During the reporting year, there have been no concerns raised by staff, no AWOL attempts, or any inappropriate sexual behaviour or physical aggression.
Mr. C. (M. L.) meets with the forensic outpatient team on a bi-weekly basis. Over the course of the reporting year, Mr. C. (M. L.) has been more forthcoming and less guarded with the treatment team. Mr. C. (M. L.) now enjoys a positive attitude which Dr. Naidoo pointed out is important, as historically, Mr. C. (M. L.) has felt negatively towards himself, which has been a significant trigger for substance use.
Mr. C. (M. L.) has abstained from any substances over the reporting year and has completed several substances use programs. In this regard, on his own initiative, Mr. C. (M. L.) commenced a program online to improve his substance use insight. Mr. C. (M. L.) was not able to continue with this program due to internet issues at his residence. Dr. Naidoo advised that there is potential to move Mr. C. (M. L.) from his current group home to a transitional accommodation. This would allow him to re-engage with relapse prevention online and develop his independent skills for living independently in the community.
Dr. Naidoo stated that Mr. C. (M. L.) has been fully adherent with his treatment regimen. In January 2025, due to reported side effects, Mr. C. (M. L.)’s injectable antipsychotic medication, aripiprazole, was reduced from 400mg to 300mg. In this regard, the doctor cautioned that the team is still monitoring any changes in his mental state.
Regarding Mr. C. (M. L.)’s insight, Dr. Naidoo stated he appreciates the benefit of his medication. He can describe his symptoms and recognizes that absent medication he is likely to exhibit symptoms of mania and psychosis. When asked by a Board member, Dr. Naidoo stated that Mr.' C. (M. L.)’s inappropriate sexual behaviour (index offence) occurred in the context of acute psychosis and mania, rather than caused by a separate paraphilic disorder.
Dr. Naidoo described Mr. C. (M. L.)’s insight into substance use as fair to good. He has maintained abstinence for close to two years and has been able to withstand any cravings that might arise when around others that use substances. Mr. C. (M. L.) assisted staff during two CPR events in February and December 2024. Despite these stressful incidents, he did not engage in substance use. Further, all his urine drug screens were negative throughout the reporting year.
Mr. C. (M. L.)’s insight into the index offence is described as good. He can appreciate that at that time, he was suffering from symptoms of psychosis and mania, which resulted in him engaging in disinhibited sexual behaviour. He reportedly remains quite remorseful of the incident.
Mr. C. (M. L.) is currently near the top of the waitlist for Emmaus Place, a transitional rehabilitation accommodation offered through Good Shepherd and the forensic outpatient program. This accommodation is much bigger than his current accommodation and would allow Mr. C. (M. L.) to continue with his online substance use program. This transitional residence is available for two years, which Dr. Naidoo advised should be sufficient to prepare Mr. C. (M. L.) for independent living. When asked by a Board member, Dr. Naidoo acknowledged that it would be appropriate to name both residences in Mr. C. (M. L.)’s Disposition.
Dr. Naidoo advised that Mr. C. (M. L.) has been stable on his existing reporting frequency. The doctor recommended a reduction to not less than once per month to allow the treatment team to further assess Mr. C. (M. L.)’s mental state while living in the community.
Mr. C. (M. L.) continues to maintain phone contact with his family but has yet to visit them. He meets every week with a recreational therapist from CMHA, who engages him in various programs, and every other week with his treatment team case manager. Dr. Naidoo advised that recently, Mr. C. (M. L.) has secured the services of Dr. Ibrahim, a family doctor.
Dr. Naidoo believes Mr. C. (M. L.) represents a significant threat to the safety of the public. He advised that should Mr. C. (M. L.) discontinue his medication, he would likely exhibit symptoms of psychosis and engage in violence, which would include inappropriate sexual behaviour. In this regard, the doctor adopted the clinical risk summary found on page 86 of the Hospital Report, which stated in part:
“Despite those positive factors, Mr. C. (M. L.) has a long history of substance abuse, myriad relapses, the presence of his major mental disorder and his history of violence when unwell. As such, a gradual approach to his rehabilitation continues to be necessary. The treatment team is of the unanimous opinion that Mr. C. (M. L.) continues to meet the threshold for significant threat. While he has made tremendous progress toward his appreciation for his illness and his vulnerability to substance relapse, he has done so while under strict external control.”
- Dr. Naidoo supported a Conditional Discharge Disposition. The doctor stated that the risk under a Conditional Discharge Disposition would be low to moderate. He agreed with and highlighted the passage from the psychological risk assessment by Dr. B. Losier, which stated on page 85 of the Hospital Report:
“If Mr. C. (M. L.) is granted a Conditional Discharge, the opinion provided in the 2024 psychological update by Dr. Losier is upheld and the Low-Moderate recidivism classification will remain.” The reasoning for maintaining the current risk classification is predicated on the paucity of information available on Mr. C. (M. L.)’s ability to maintain his current progress long term and response to the presence of reduced oversights and reporting requirements.
Dr. Naidoo highlighted that Mr. C. (M. L.)’s positive attitude and ongoing cooperation with the team would allow the MHA to manage his risk. The doctor advised that Mr. C. (M. L.) has attended hospital when asked, can follow proper direction, and remains open to discussing ongoing stressors with his treatment team. He elaborated that if Mr. C. (M. L.) were to exhibit exacerbation of his symptoms of psychosis, the team would be able to act early, before his insight would deteriorate to the degree that he would not be cooperative and would be violent. In that regard, his long-acting medication provides a good safety net for deterioration in his symptoms of psychosis. Dr. Naidoo further highlighted that Mr. C. (M. L.) is content at his residence and in his opinion would not reside in any accommodation not recommended by his treatment team.
No other evidence was presented at the hearing.
Final Submission of the Parties
Ms. Barney, on behalf of the Hospital, submitted that Mr. C. (M. L.) had a positive reporting year. He was discharged in May 2023 and has required no readmission to hospital. He continues to reside at Kelly’s Residence with positive staff reports and engages well with the forensic outpatient treatment team. Mr. C. (M. L.) attends the hospital when required, is currently engaged with the CMHA recreational therapist, and continues to engage in substance abuse programs. Mr. C. (M. L.) has been adherent to his medication regimen, is capable of consenting to treatment and appreciates the need and benefit of his medication. All urine drug screens have been negative, and he has been abstinent from substances for almost two years. The evidence is that he would attend hospital voluntarily and if he decompensated, he would meet MHA criteria for admission. Finally, Ms. Barney supported the inclusion of each address (Kelly’s Residence and Emmaus Place) in Mr. C. (M. L.)’s Disposition.
Ms. McKenzie, on behalf of the Attorney General of Ontario, agreed with the Hospital’s submissions and supported a Conditional Discharge Disposition. She submitted that Mr. C. (M. L.) had a positive year, was medication compliant, no hospital readmissions, and his drug screens have all continued to be negative. Mr. C. (M. L.) remains stable, and his risk is low to moderate on a Conditional Discharge Disposition. Ms. McKenzie highlighted that considering the recent reduction in Mr. C. (M. L.)’s antipsychotic medication, a requirement to reside at either of the two supported accommodations was appropriate.
Mr. Rai, on behalf of Mr. C. (M. L.), submitted that it has been a positive year. Mr. C. (M. L.) agrees that a Conditional Discharge Disposition is the most appropriate and least restrictive and least onerous Disposition. There have been no incidents of aggression or violence or inappropriate sexual behaviour. Mr. C. (M. L.) has remained medication compliant, with no substance issues, despite two notable stressors during the reporting year. He has developed insight into the negative effect of substances and has remained substance free since April 2023. He completed a relapse prevention program in June 2024 and has a good relationship with his treatment team. Finally, Mr. Rai submitted that Mr. C. (M. L.) has no objection to adding the suggested residency clause to his Disposition.
Analysis and Conclusion
The threshold issue for the Board to determine is whether Mr. C. (M. L.) continues to represent a significant threat to the safety of the public. Notwithstanding, the joint submission by the parties, based on the testimony of Dr. Naidoo and the evidence contained in the Hospital Report filed as an exhibit, this Board finds that Mr. C. (M. L.) remains a significant threat to the safety of the public as set out in s. 672.5401 of the Criminal Code.
Mr. C. (M. L.) has multiple diagnoses, including a major mental illness (Schizophrenia), substance use disorder and an unspecified personality disorder. His index offences include an assault against his mother, where he used as knife, and serious sexual inappropriate behaviour towards his sibling, a twelve-year-old minor. Notably, he has a long history of substance abuse with several relapses, including incidents of violence when he has become unwell.
Mr. C. (M. L.) has had a productive and positive reporting year while living at a group home in the community. There has been no sexual inappropriate behaviour or physical aggression, no concerns raised by staff, and he has not required any readmission to hospital. In addition, Mr. C. (M. L.) has been fully adherent to his treatment regime, has ongoing phone contact with his family, meets every week with a recreational therapist from CMHA, and has recently secured the services of a family doctor.
Importantly, as emphasized by Dr. Naidoo, unlike the past where Mr. C. (M. L.)’s negative attitude towards himself has been a trigger for substance use, Mr. C. (M. L.) has developed a positive attitude and enjoys a good relationship with his forensic outpatient team. All urine drug screens have been negative, and he has been abstinent for almost two years. Mr. C. (M. L.)’s insight into substance use is described by Dr. Naidoo as fair to good, and he has completed several substances use programs. Notably, he engaged in an online relapse prevention program on his own initiative. Further, Mr. C. (M. L.)’s insight into the index offence is good. He appreciates he was suffering from symptoms of psychosis and mania which resulted in the disinhibited behaviour and reportedly remains quite remorseful of the incident.
While he has made significant progress, this Board is mindful that he has done so while under strict external control by the outpatient treatment team and staff at his group home residence. Consequently, this Board agrees with the parties, that a Conditional Discharge Disposition is appropriate at this juncture. As highlighted by Dr. Naidoo, whose evidence we accept, Mr. C. (M. L.)’s positive attitude and cooperation with the forensic outpatient team would allow the MHA to manage the risk. The evidence is that Mr. C. (M. L.) would return to hospital voluntarily should he be requested to do so. Further, Dr. Naidoo is confident that the MHA would allow the hospital to act early during any exacerbation of Mr. C. (M. L.)’s symptoms of psychosis, preventing a decline in his insight that could lead to non-cooperation and violence. In this regard, Mr. C. (M. L.)’s long-acting medication provides a good safety net for any deterioration in his symptoms of psychosis.
Given Mr. C. (M. L.)’s ongoing support and supervision at his current group home (Kelly’s Residence) and the likelihood of his transfer to transitional supported housing at Emmaus Place during the upcoming year, this Board finds that a residency clause at either accommodation is an appropriate and necessary condition in his Disposition.
Accordingly, this Board finds that the necessary and appropriate Disposition is a Conditional Discharge, on the following conditions:
- Reside at Kelly’s Residence 18 Rutherford Avenue, Hamilton, ON, L8M 1Y4 or Emmaus Place 35 Aikman Avenue, Hamilton, ON, L8M 3M8.
- Abstain absolutely from the non-medical use of alcohol or drugs or any other intoxicant.
- Submit samples of his/her urine and/or breath to the person in charge of the facility for the purpose of analyzing whether the accused has ingested alcohol, drugs or any other intoxicant (person in charge will be ordered to require the accused to submit samples of urine and/or breath).
- Refrain from having in his possession any firearm, ammunition or other offensive weapons, or being in the company of any person possessing a firearm other than a peace officer.
- Report to the person in charge of the facility or his or her designate, not less than once per month.
- Refrain from contact or communication, direct or indirect, with R. (T.) (his half-sister) unless she provides prior consent and there has been approval and authorization by the hospital.
- refrain from being alone in the presence of any person under the age of 16 years in the absence of supervision, or without the approval of the person in charge of the St. Joseph's Healthcare Hamilton, West 5th Campus, or his or her designate.
- on his consent, agree to take medication and treatment as prescribed by his psychiatrist or as directed by the person in charge of the St. Joseph’s Healthcare Hamilton, West 5th Campus, or his or her designate, in accordance with s. 672.55(1) of the Criminal Code.
- upon request of the person in charge of St Joseph’s Healthcare Hamilton, West 5th Campus, or his or her designate, will immediately attend for psychiatric assessment.
- advise the person in charge of the St. Joseph's Healthcare Hamilton, West 5th Campus, or his or her designate, in advance, of any absence from his residence of 24 hours or more.
- notify, in writing, the person in charge of the St. Joseph's Healthcare Hamilton, West 5th Campus, or his or her designate and the Ontario Review Board 24 hours in advance of any change of existing address or telephone number.
- upon notice, attend before the Ontario Review Board as required; and
- keep the peace and be of good behaviour.
- In reaching our decision, this Board has considered the need to protect the public from dangerous persons, Mr. C. (M. L.)s’ mental condition, his reintegration into society, and his other needs.
DATED this 9th day of April 2025, at the City of Toronto, in the Toronto Region.
Mr. C. Flanagan Legal Member __________________________
Office of the Registrar Ontario Review Board