Ontario Review Board
Re: G. (R.)
ORB File No: 6440
Hearing held on: Monday, March 3, 2025
Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas
Pursuant to: Sections 672.81(1) and 672.81(2.1) of the Criminal Code
Before: Alternate Chairperson: Mr. J. Weinstein Members: Dr. R.D. Chandrasena Dr. B. Sheppard Ms. K. Tomaszewski Ms. C. Plyley
Parties Appearing: Accused: G. (R.) Counsel: Mr. T. Whillier
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Ms. K. Dalrymple
REASONS FOR DECISION AND DISPOSITION
(Dated April 10, 2025)
Introduction:
On November 27, 2013, G. (R.) was found not criminally responsible on account of mental disorder (“NCR”) on charges of attempt murder, and assault with a weapon, contrary to the Criminal Code of Canada (the “Criminal Code”). Mr. G. (R.) is currently subject to a disposition of the Ontario Review Board (the “Board”) dated March 25, 2024, detaining him at the Southwest Centre for Forensic Mental Health Care, St. Joseph's Health Care London (“Southwest” or the “Hospital”) with privileges up to and including the ability to live in Elgin or Middlesex Counties in accommodation approved by the person in charge.
On December 13, 2024, the Hospital notified the Board pursuant to s. 672.56(2) of the Criminal Code of a significant restriction of Mr. G. (R.)’s liberty exceeding seven days (the “ROL”). In that letter the Hospital stated:
Prior to readmission, Mr. G. (R.) was residing in independent housing in St. Thomas and supported by the Forensic Outreach team since August 29, 2022. Prior to admission to hospital, Mr. G. (R.) contacted the hospital requesting for an admission secondary to an increase in stressors around housing issues, financial issues, and difficulties with medications. In this context, Mr. G. (R.) used both alcohol and cannabis”
On March 3, 2025, a panel of the Board convened to review the ROL pursuant to s. 672.81(2.1) of the Criminal Code, and Mr. G. (R.)’s disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. G. (R.) was present for his hearing and was represented by counsel throughout the proceeding.
The issues to be determined are whether the ROL was necessary and appropriate and represented the least onerous and least restrictive measure at the time it was imposed and up to the time it ended; and whether Mr. G. (R.) poses a significant threat to the safety of the public, and if so, the necessary and appropriate disposition to manage that risk, having regard to the criteria set out in s. 672.54 of the Criminal Code.
With respect to the ROL, at the commencement of the hearing, counsel for the Hospital submitted that the restriction of Mr. G. (R.)’s liberty was necessary and appropriate and represented the least onerous and least restrictive measure at the time it was imposed and continued to be so at the time it ended. Counsel for the Attorney General and counsel for Mr. G. (R.) agreed with the Hospital’s submission. All parties maintained their respective positions on the ROL in closing submissions.
With respect to the issues of significant threat and the disposition, at the commencement of the hearing, counsel for the Hospital submitted that Mr. G. (R.) remains a significant threat to the safety of the public and there should be no change to his current disposition except to broaden the geographic area of where he can reside, as set out in the Hospital Report. Counsel for the Attorney General and counsel for Mr. G. (R.) agreed with the Hospital's recommendation. All parties maintained these respective positions in closing submissions.
For the reasons set out below, the Board finds that the restriction of Mr.G. (R.)’s liberty on November 25, 2024 was significant and was necessary and appropriate and represented the least onerous and least restrictive measure at the time it was imposed, and continued to be so until the time it ended on December 16, 2024.
For the reasons set out below, the Board finds that Mr. G. (R.) continues to represent a significant threat to the safety of the public and there should be no change to his current disposition except to expand the geographic area of where he can reside, as set out in the Hospital Report.
Evidence at the Hearing:
- The Board received documentary evidence in the form of a Hospital Report and Restriction of Liberty Report dated January 15, 2025, marked as Exhibit 1. The Board also heard viva voce testimony from Dr. B. Robertson, a psychiatry resident under the supervision of Dr. Quinn, Mr. G. (R.)’s treating psychiatrist. Dr. Robertson has worked with Mr. G. (R.) since he was admitted to the Hospital on November 25, 2024. Dr. Robertson adopted the contents of the Hospital Report.
Index Offences:
- The circumstances of the index offences are excerpted from last year’s Reasons for Disposition:
"On May 12, 2013, the victim, who is the mother of the accused, attended her daughter’s condominium in London for a Mother’s Day movie night and sleepover with her daughter and son. At approximately 3:00 a.m. on May 13, 2013, her daughter and her daughter’s boyfriend heard the victim's screams. They attended her bedroom and observed the accused standing over his mother holding a large kitchen carving knife. The victim was still in bed and the accused was making thrusting motions toward her with the knife. When her daughter and the boyfriend stepped in to defend the victim the accused swung a knife toward her daughter's boyfriend, missing him. Mr. G. (R.) eventually dropped the knife and was pinned to the ground by the boyfriend. Police attended and arrested the accused for attempted murder. The accused suffered lacerations to his right hand, which required five stitches, and surgery for a severed tendon in the middle finger of his left hand. The victim suffered lacerations to her thumb, left cheek, behind her left ear, and on the middle finger of her right hand, while her daughter's boyfriend suffered a small puncture wound in his left shoulder, which required one stitch, and a laceration to his left forearm that required seven stitches.”
Mr. G. (R.) is currently diagnosed as suffering from bipolar disorder 1, substance use disorder), and maladaptive personality traits.
The Hospital Report outlines Mr. G. (R.)’s history and background and need not be repeated here in detail. The following history and background are excepted from last year’s Reasons for Disposition:
In brief, Mr. G. (R.) is 28 years old. He was raised in London, Ontario and has two older sisters. His parents separated when he was five years old. Mr. G. (R.) initially resided with his mother and sisters for three years before moving to live with his father when his mother remarried. Mr. G. (R.) was living with his father at the time of the index offences.
Mr. G. (R.) has a history of substance use beginning when he was 14 years old and was reported to be using substances regularly in the months leading up to the index offences. Prior to the index offences, Mr. G. (R.) had no criminal record. Subsequent to the index offences, in 2013 and 2016 he was convicted of assault.
Changes were noted to Mr. G. (R.)’s mental health when he started grade 11. He was experiencing anxiety and depression, with a notable decline in academic performance. His mother described him as isolative and withdrawn, and there was a clear deterioration in his hygiene. He was spending money excessively, and hoarding things in the home. His family suspected he was engaged in substance use on a regular basis.
Following the index offences, Mr. G. (R.) was placed at the Syl Apps Youth Centre (“SAYC”) where he was diagnosed with schizophrenia, cannabis abuse disorder, and obsessive-compulsive personality disorder. Mr. G. (R.) was subsequently transferred to Southwest as an adult.
Testimony of Dr. Robertson:
ROL
Dr. Robertson testified that Mr. G. (R.) requested an admission to the Hospital on October 23, 2024. He was admitted overnight and discharged to his home in the community, an independent supported forensic residence managed by St. Leonard’s Community Services that is known as the Forensic Supportive Housing Program (FSHoP).
On November 25, 2024, Mr. G. (R.) again requested admission to the Hospital. He was admitted and remained an inpatient at the Hospital until the date of the hearing. Mr. G. (R.) requested an admission because he was struggling in his community apartment, and felt he needed stabilization. He was not coping well with stressors in the community including financial difficulties, difficulty with a neighbour, and symptoms of his major mental illness.
As noted in the Hospital Report, Mr. G. (R.) did not reach out to the outreach team before he packed up his apartment, gave items away, found a home for his cat, and quit his job in anticipation of being admitted to the Hospital.
Dr. Robertson testified that on admission, Mr. G. (R.) displayed symptoms of bipolar disorder and his personality disorder. He was impulsive, irritable and challenging of supervision. He admitted that prior to the admission, he went to a bar and drank three beers, and smoked one joint of cannabis.
The hospital admission was voluntary. The ROL pertained to the restriction of Mr. G. (R.)’s indirectly supervised access to the community. Dr. Robertson testified that Mr. G. (R.)’s indirectly supervised access to the community was restored on December 16, 2024.
Dr. Robertson told the Board that on December 4, 2024, Mr. G. (R.) agreed to take a therapeutic dose of lithium. Once on a therapeutic dose of lithium, Mr. G. (R.) improved with respect to symptoms of irritability, anxiety, and disorganization, and he became more cooperative and agreeable. The ROL ended on December 16, 2024.
Significant Threat and Disposition
Apart from the lithium, both of Mr. G. (R.)’s medications are administered to him by long-acting injection. Mr. G. (R.) continues to demonstrate a lack of insight and judgment and has ongoing symptoms of his major mental illness. Mr. G. (R.)’s mental state fluctuates.
Dr. Robertson agreed that the following paragraphs from last year’s Reasons for Disposition remain true at this time:
People with bipolar disorder have a high rate of relapse and relapse very quickly. Relapse can be due to medication non-adherence or other factors such as stress, lack of sleep and substance use (in Mr. G. (R.)’s case alcohol and/or cannabis has been an issue for him this year.). As a result of substance use, Mr. G. (R.) has experienced frequent mood fluctuations although no sustained deterioration. Mr. G. (R.) has recently connected with Alcoholics Anonymous (AA). Mr. G. (R.) is not ready to move to a residential treatment program but the ability to attend one should remain in his disposition as a goal going forward.
Mr. G. (R.) will continue to require support and supervision of varying levels while he is in the community. The Mental Health Act (MHA) would not allow the treatment team to react fast enough to manage his risk, given the speed with which he is likely to decompensate. Mr. G. (R.) continues to exhibit some impulsivity. He recently left his employment without discussing this with the treatment team. The treatment team are making efforts to find employment for him that is more suited to his skills and interests.
Mr. G. (R.) had many stressors this year, including several losses, of his aunt, a family friend, his grandfather and a cousin.
In addition to these losses, Mr. G. (R.) has struggled with his finances, a difficult neighbour, and symptoms of his mental illness.
To his credit, Mr. G. (R.) has spent considerable time during the current hospital admission in one-to-one therapy talking about these stressors.
Mr. G. (R.)’s insight into his need for antipsychotic medication and lithium fluctuates, but improved with therapeutic doses of lithium. When he is well Mr. G. (R.) recognizes that he will need these medications on a life-long basis, but his insight fades when he is unwell. He will continue to need external supervision to remain adherent.
Mr. G. (R.) continues to be vulnerable to substance use, particularly in times of stress, as happened in November 2024. Mr. G. (R.) is active in AA and has AA friends. However, he still has challenges flowing from his maladaptive coping strategies. He has declined the Hospital’s most recent offer to attend a residential treatment program.
Mr. G. (R.) has exercised three 7-day passes to visit his mother, and uses passes to the community several times per week for AA and to visit AA friends. All passes have gone well with no concerns.
The plan moving forward is to prepare for Mr. G. (R.) to transition back to living in the community. Both Mr. G. (R.) and his mother feel that at this time the first choice would be to move back to a FSHoP residence, if he is accepted. Mr. G. (R.) has dealt with his bankruptcy; his medications have been ‘sorted out’; all treatment teams and FSHoP workers are aware of this situation with his former neighbour, and his insight has improved with the addition of lithium to his treatment regime.
If Mr. G. (R.) is not able to return to FHoP, his mother is willing to have him live with her. This is the reason for the recommended expansion of the area in which Mr. G. (R.) can live to Southwestern Ontario.
Before Mr. G. (R.) could live with his mother, the treatment team will need to meet with his mother to discuss logistics, safety, substance use, and relapse prevention so that she is fully educated on how to respond if things do not go well.
Dr. Robertson testified that although his mother was the victim of the index offence, she is not at any particular risk compared to a general member of the public, i.e. she is not at risk just because she is his mother. When Mr. G. (R.) is unwell, he suffers from referential delusions, finding meaning in otherwise benign things that can trigger a violent response. In Dr. Robertson’s opinion, his mother just happened to be there when this violent response was triggered.
If Mr. G. (R.) lives with his mother, it will be important for her to maintain close contact with the team.
Dr. Robertson anticipates that it will be a matter of weeks before a leave of absence is in place for living in the community, either at FSHoP or his mother’s residence.
Counsel for the Attorney-General indicated that Mr. G. (R.)’s mother planned to attend the hearing, but that she had understood that it was scheduled for later in the week.
No further evidence was called by the parties.
Analysis:
ROL
The analytical framework established by Campbell (Re), 2018 ONCA requires the Board to consider the liberty norm and the liberty status of an accused on a restriction. The liberty norm and liberty status for each restriction must be examined to determine the significance of the increase (if any) on the restriction of an accused’s liberty caused by the restriction. In determining the liberty norm of an accused at the outset of each period of restriction, the Board must “take a contextual approach, one that considers the individual’s pattern of liberty in the recent past.” ((Re) Campbell, para. 66). The liberty she/he was actually experiencing (rather than what she/he was entitled to) at the time of the increase is what the Board is to consider, and that “liberty must be of sufficient duration to have become, objectively speaking, the NCR accused’s norm” ((Re) Campbell, para. 65).
The test to be applied to significant increases in the restriction of liberty is the same as is required for dispositions. It must be determined if the significant increase is necessary and appropriate to protect the safety of the public.
The Board finds that Mr. G. (R.) experienced a significant restriction of liberty during the period of the Hospital admission when he did not have indirectly supervised access to the community. Prior to this admission, Mr. G. (R.) exercised indirectly supervised access to the community while he was living in the community.
When Mr. G. (R.) was admitted to the Hospital, and his indirectly supervised access to the community was restricted, Mr. G. (R.)’s mental status had deteriorated. He had used cannabis and alcohol. He was not coping well with stressors. He was irritable and challenging to authority. He was not accepting of treatment with lithium.
With the addition of lithium to his treatment regimen, Mr. G. (R.) improved across all symptoms, and became more agreeable and accepting of supervision. As a result of this stabilization, Mr. G. (R.)’s indirectly supervised access to the community was restored on December 16, 2024.
Given this constellation of factors, the Board finds that the significant restriction of Mr.G. (R.)’s liberty remained necessary and appropriate and the least onerous and least restrictive measure from its commencement on November 25, 2025, until the ROL ended on December 16, 2024.
Significant Threat and Disposition
The Board accepts the testimony of Dr. Robertson, as supported by the Hospital Report, and makes an independent finding that Mr. G. (R.) continues to represent a significant threat to the safety of the public.
The index offence was serious. As noted in the Hospital Report, as a result of a deterioration in his mental state, which occurred following a period of relative stability, Mr. G. (R.) engaged in an unprovoked and serious assault on a co-patient in July 2021. This incident demonstrates the fragility of Mr. G. (R.)’s mental illness and the speed with which he can deteriorate.
Mr. G. (R.)’s insight into the need for treatment and supervision, and his insight into his mental illness, substance use, and risk of violence is variable, depending on his mental state and his adherence to the recommended medications. Mr. G. (R.)’s willingness to remain on lithium has yet to be determined.
During the reporting year, when under stress, Mr. G. (R.) relapsed into cannabis and alcohol use. Substance use remains a salient risk factor for him. For these reasons, the Board is in agreement that Mr. G. (R.) continues to represent a significant threat to the safety of the public.
The Board adopts the overall clinical assessment of risk, and the re-offence scenario set out in the Hospital Report at pages 200 to 202.
The Board notes that all parties are in agreement on this issue.
As noted in last year’s Reasons for Disposition, Mr. G. (R.) continues to require a great deal of support in the community to manage his risk to the safety of the public. For this reason, it is important for the Hospital to have the ability to approve his accommodation to ensure his medication compliance and support him in remaining abstinent from substances. Furthermore, given the rapidity with which Mr. G. (R.) can deteriorate and become violent, it is necessary for the Hospital to have the ability to readmit him at the first sign of decompensation. In these circumstances reliance on the MHA would increase Mr. G. (R.)’s risk to safety of the public. For these reasons, the Board finds that a detention order remains necessary and appropriate.
A conditional discharge is not appropriate at this time. The Board accepts and adopts the following set out on page 202 of the Hospital Report:
Mr. G. (R.) is not being considered for an alternative disposition at this time, as he requires close supervision and monitoring to manage his symptoms and to prevent his reoffending. A conditional discharge would not be appropriate at this juncture as he has remained impacted by symptoms of his mental illness which resulted in two readmissions to hospital this review year, and the need to give up his independent apartment. As outlined in section 22 of his 2024 reasons for disposition, Mr. G. (R.) again continued to require a great deal of support in the community to manage his risk to the safety of the public. He insight into his mental illness, need for treatment and violence risk remains underdeveloped. He has had issues with medication noncompliance and relapsing into substance use this review year, specifically at a time of increased stress. Mr. G. (R.) is prone to dysregulation and will likely experience ongoing stress related to his finances and living situation and does not have adequate coping strategies to deal with this stress on his own. It will be necessary for the hospital to maintain the ability to approve his accommodation to ensure his medication compliance and support him in remaining abstinent from substances. It will be necessary for the hospital to be able to bring him back to hospital expediently in the event of decompensation. In these circumstances, reliance on the Mental Health Act would increase Mr. G. (R.)’s risk to safety of the public.
As noted in the Hospital Report, Mr. G. (R.) entered the forensic system as a young man. His maladaptive personality traits are mostly in response to a lack of learning and a lack of coping mechanisms that most people develop as a young person. The Hospital is attempting to support Mr. G. (R.)’s successful transition into the community by managing Mr. G. (R.)’s risk to the safety of the public with a detention disposition, while still permitting him to live further from the Hospital with his mother, should that become the plan moving forward.
The Board encourages Mr. G. (R.) to work closely with the treatment team, and to accept the treatment team’s treatment recommendations, including a residential treatment program.
The Board also encourages the treatment team to stay in close contact with Mr. G. (R.)’s mother, particularly if he resides with her, both to protect her safety and to support Mr. G. (R.) in this transition.
The Board wishes Mr. G. (R.) every success in his transition to the community.
Disposition
In making a disposition, the Board must take into consideration the criteria set out in s. 672.54 of the Criminal Code, which is the safety of the public, which is the paramount consideration, the mental condition of the accused, the reintegration of the accused into society and the other needs of the accused.
For the foregoing reasons, the Board finds that Mr. G. (R.) continues to represent a significant threat to the safety of the public and that there should be no change to his current disposition except to expand the geographic area in which Mr. G. (R.) is permitted to reside, as set out in the Hospital Report.
DATED this 10th day of April 2025 at the City of Toronto, in the Toronto Region.
Ms. K. Tomaszewski Legal Member
Office of the Registrar Ontario Review Board