Ontario Review Board
Re: Wesley McEwan
ORB File No: 7794
Hearing held on: Monday, March 3, 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: Mr. J. Weinstein Members: Dr. R. D. Chandrasena Dr. B. Sheppard Ms. K. Tomaszewski Ms. C. Plyley
Parties Appearing:
Accused: Wesley McEwan Counsel: Mr. W. Glover
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Ms. K. Dalrymple
REASONS FOR DISPOSITION
(Dated April 10, 2025)
Introduction
On November 2, 2020, Wesley McEwan was found not criminally responsible on account of mental disorder (“NCR”) on charges of utter a threat to cause death or bodily harm, assault with a weapon (x2), utter a threat to burn, destroy, or damage property, arson-reckless disregard for life (x3), and assault police officer, contrary to the Criminal Code of Canada (the “Criminal Code”).
Mr. McEwan is currently subject to a disposition of the Ontario Review Board (the “Board”) dated March 22, 2024, detaining him at the Southwest Centre for Forensic Mental Health Care, St. Joseph's Health Care London (the “Hospital” or “Southwest”) with privileges up to and including the ability to live in the community of Elgin or Middlesex County in accommodation approved by the person in charge.
On March 3, 2025, a panel of the Board convened to review Mr. McEwan's disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. McEwan was present for his hearing and was represented by counsel throughout the proceedings.
The issues to be determined are whether Mr. McEwan represents 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.
At the commencement of the hearing, counsel for the Hospital submitted that Mr. McEwan continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition is a continuation of his current Disposition with an expansion in the geographic area for indirectly supervised passes in section 2(c); the addition of indirectly supervised travel to and from the destination in section 2(f); and an increase in reporting frequency from a minimum of two times per month to four times per month.
Counsel for the Attorney-General adopted the Hospital’s position.
Counsel for Mr. McEwan adopted the Hospital’s position but added a request to include ‘indirectly supervised’ for 72-hour passes.
The Hospital took no position with respect to the addition of indirectly supervised 72-hour passes. The Attorney-General adopted the Hospital’s position.
During the course of the hearing, panel members raised concerns about the exclusion of cannabis and alcohol from the ‘abstain’ clause.
In closing submissions, the parties maintained a joint position with respect to the issues of significant threat, and the changes to the Disposition recommended by the Hospital.
The Hospital and the Attorney-General took no position on the issues of including indirectly supervised 72-hour passes and including cannabis and alcohol in the ‘abstain’ clause, although counsel for the Attorney-General strongly urged the Board to give due consideration to expanding the abstain clause in the interests of protecting the public safety.
Counsel for Mr. McEwan urged the Board to include indirectly supervised 72-hour passes, and opposed the extension of the ‘abstain’ clause to include cannabis and alcohol.
For the reasons set out below, the Board finds that Mr. McEwan continues to represent a significant threat to the safety of the public and that a detention disposition with the changes recommended by the Hospital; the inclusion of indirectly supervised 72-hour passes; and the extension of the ‘abstain’ clause to prohibit cannabis and alcohol use, is the necessary and appropriate disposition to manage the risk to the safety of the public having regard to the criteria set out in s. 672.54 of the Criminal Code.
Evidence at the Hearing
- The Board received documentary evidence in the form of a Hospital Report, dated January 7, 2025, marked as Exhibit 1. The Board also heard viva voce testimony from Dr. Ajay Prakash, Mr. McEwan's treating psychiatrist.
Index Offences
- The circumstances of the index offences are excerpted from last year’s Reasons for Disposition, as follows:
"Wesley Andrew McEWAN (date of birth January 6, 1986) was thirty-four years of age at the time of this incident. McEWAN suffers with mental health issues and was diagnosed with schizophrenia at the age of seventeen years of age. McEWAN currently lives with his father, who is also McEWAN's caregiver.
McEWAN has had numerous incidents with the Sarnia Police Service since 2004, the majority of the calls classified as Mental Health Act assistance calls involving McEWAN. On July 13, 2020, Sarnia Police Service officers were dispatched to McEWAN's in the city of Sarnia, Ontario.
A neighbour had called the police reporting that McEWAN was banging on the neighbour's door with a stick, causing damage to the door and siding of his house. When police arrived, the neighbour advised that McEWAN had gone back to his father's apartment.
Officers tried to speak to McEWAN. McEWAN responded by yelling and screaming at the officers and stating that his neighbour had a debt collector for a bike gang living with him and he has been breaking into MCEWAN's place, stealing things.
COUNT 1: Utter Threats to Cause Death, contrary to section 264.1(1)(a)
McEWAN was extremely agitated, slammed the door and continued to yell at the officers from inside the apartment. McEWAN was heard yelling 'I'm going to kill whoever comes through this door!'
At one point, McEWAN emerged from a window on the lower side of the residence, brandishing a large stick. McEWAN then stated, “I'm going to kill the first person who comes in and start slitting throats!”. McEWAN retreated back into the residence. Officers breached the door in an attempt to apprehend McEWAN under the Mental Health Act as he was presenting as being a danger to himself and others.
McEWAN had barricaded the doorway at the top of the stairway which prohibited officers from accessing his apartment.
COUNT 2, 3: Assault with a Weapon, contrary to section 267(a) x2
McEWAN began to throw household items at the officers that were now at the bottom of the stairs leading up to his apartment. Constable Philip VEALE# 244 was standing outside the house, at the front, when McEWAN opened the window above the front porch, climbed out, and threw a vacuum cleaner, mirror and other miscellaneous household items at Constable VEALE #244. McEWAN threw a flowerpot at Constable Tim VANCOWENBERG #212 and threw other items at the officers on the porch.
McEWAN then returned back into the residence.
COUNTS 4: Uttering Threats to Cause Property Damage contrary to section 2G4.1(1)(b)
At 1:32 p.m. McEWAN stuck his head out the rear window on the east side of the residence and stated to Constable Sean VANVLYMAN #208, "I'm going to burn this fucking place down."
COUNTS 5, 6, 7: Arson Disregard for Human Life, contrary to section 433(a) x3
McEWAN then went back inside and a very short time later, officers observed a lot of smoke coming out of the back of the residence windows. Sarnia Fire was contacted.
Officers observed McEWAN hanging out the back window to escape the large amount of smoke caused by a fire McEWAN had lit within the apartment.
Other officers evacuated the remainder of the house and removed three people from the basement unit, an adult male and two children (a two-year-old and an infant).
Officers moved a mattress from the backyard to position below the apartment window to ease McEWAN's fall and McEWAN jumped from the window, landing on the mattress where he was taken into custody. McEWAN was advised that he was being apprehended under the Mental Health Act. Constable VANVLYMAN #208 transported McEWAN to Bluewater Health for a mental health assessment where McEWAN was admitted for treatment and observation.
COUNTS 8: Assaulting A Peace Officer, contrary to section 210(1)(a)
While at the hospital, McEWAN became agitated and combative. McEWAN spit on Constable VANCOWENBERG # 212 and also threw a punch at Constable VANCOWENBERG #212.
McEWAN was then restrained to resume his assessment and treatment by hospital health professionals.”
The Hospital Report outlines Mr. McEwan's history and background and need not be repeated here in detail. In brief, Mr. McEwan is 39 years old. Mr. McEwan is married with no dependents. He has a limited employment history and began receiving ODSP when he was 20 years old.
Mr. McEwan has a history of substance use, which began when he was approximately 16 to 18 years old, with the use of cannabis and alcohol. Prior to the index offences, he did not have a criminal record. However, he had several police contacts, the majority of which were related to his mental health issues.
Mr. McEwan is diagnosed with suffering from schizophrenia and polysubstance abuse.
Mr. McEwan originally transitioned to the community on May 18, 2022. In August 2023, he moved into a CMHA market value– rent apartment with his wife.
He is considered to be capable of making treatment decisions and decided in 2023 to discontinue anti-psychotic medications.
Course Since the Last Disposition
While in the community, Mr. McEwan demonstrated good executive functioning skills with appropriate planning, organizing and executing daily tasks. He was responsible for completing most of the home tasks including getting groceries, remembering to pay bills, doing laundry, and contacting the landlord as needed. He was able to maintain part-time employment at a pizza shop until July 2024.
By letter dated August 7, 2024, the hospital notified the Board that Mr. McEwan was admitted to hospital on July 26, 2024, following strong symptoms of psychosis including delusions and paranoia in addition to admitted use of methamphetamine.
The Board convened a hearing on November 20, 2024, to review Mr. McEwan’s restriction of liberty. The evidence before the Board during that hearing is set out below, and is excerpted from the Board’s Reasons for Decision, dated November 27, 2025:
Upon readmission, Mr. McEwan was started on Abilify, 10 milligrams, by tablet. That was titrated up to 20 milligrams per day in August.
Mr. McEwan’s wife is no longer an approved person although she continues to be valued by the hospital as an important support for her husband. Mr. McEwan’s spouse did not advise the hospital of the use of substances and tended to minimize psychotic symptoms that her husband was experiencing. The forensic team continues to hope that Mr. McEwan’s spouse has a good relationship with the team.
Mr. McEwan had stopped his antipsychotic medications for a year prior to readmission. The forensic team did not catch the signs of decompensation or substance use until about a month before his most recent admission.
It is difficult to tease out which comes first: substances or noncompliance with medication. There is little question that addictions were a key driver.
Mr. McEwan believed that crystal meth would assist his relationship with his wife, and that it helped him recover memories, which the hospital characterized as delusional.
Upon admission to hospital, it became clear that Mr. McEwan had been consuming crystal meth for some months.
Mr. McEwan’s mother called in with serious concerns on June 4 and July 26, 2024.
As noted, the hospital did not pick up decompensation until a few weeks before the admission.
Mr. McEwan cooperated with his readmission. He has been working well with staff. He wants to avoid crystal meth and cannabis.
Mr. McEwan is permitted cannabis and alcohol under his present Disposition but that may need to be revisited at his next annual hearing in March of 2025.
Mr. McEwan’s insight is not perfect. He has limited insight into his illness.
Mr. McEwan was previously on an injectable antipsychotic. Returning to an injectable will be explored.
- Mr. McEwan was discharged from the Hospital on December 5, 2024, and returned to the community to live with his wife in their apartment.
Evidence from the Hospital Report
Mr. McEwan has poor insight into his mental illness. Although he generally agrees with the diagnosis of schizophrenia, he does not believe that it needs to be treated with antipsychotic medication, nor does he feel that he was more stable when medicated. Mr. McEwan indicated that he would not have any signs or symptoms of relapse, nor would he ever become stressed. He stated there was nothing that he could do to ensure he remains well stating he was “already healthy enough”.
On September 29, 2024, Mr. McEwan stated, “on or off medication I can be stable”, “I was before, and I can act just like I am right now while talking with you.” He then stated, “I mean I will continue to take the pills and they do work making me feel relaxed.” Although at times he is able to recognize the benefits of the medication, he has consistently refused to switch from oral to injectable Abilify and he is capable to consent to treatment therefore his future compliance with medications in an unstructured environment is uncertain.
On December 18, 2024, regarding the Abilify, Mr. McEwan stated, "I don't mind taking it..." and stated that his wife agrees with the medications but gave the impression that she is ambivalent about the usefulness of the medications and "doesn't notice a difference whether on it or off it". Mr. McEwan added that he wants to take medications "until my absolute". When asked about medication compliance without forensic supervision, he gave circumstantial and then somewhat contradictory answers e.g., he stated he will make a decision at that point, that he is happier with this medication compared to Invega, that he will take it for the rest of his life, but then added that he may not take it for the rest of his life depending on his relationship with Carlos (who is part of Mr. McEwan’s delusional system of beliefs).
Mr. McEwan denied the potential of becoming aggressive/violent even when his mental status deteriorates and/or a result of using substances.
He acknowledged that he needed to be admitted to the Hospital after using methamphetamine, although he continued to voice that the benefits of using it were that he became able to have access to his covered memories about his past (delusional beliefs).
Mr. McEwan was informed that he would benefit from attending an addiction recovery program, but there was a waitlist, so he agreed to attend peer-supported programs in the Hospital or community while on the waitlist.
Mr. McEwan attended NA weekly on Saturdays, AA weekly on Mondays and Celebrate Recovery on Sundays. He has also been attending one-on-one appointments with CMHATV addictions services Lynn Brown every other week, which has been consistent since approximately November 2024. Mr. McEwan described his recent admission as a good learning experience with respect to substance use and recovery work and indicated that he planned to continue with Lynn Brown and NA.
However, since being discharged from the Hospital, he has stopped engaging in all community addiction support services, citing that he does not need any further support. He stated that he plans to continue to use cannabis, and drink alcohol moderately but abstain absolutely from other substances.
Mr. McEwan acquires his cannabis from his father.
A risk assessment was conducted (HCR-20 V3) on January 22, 2024, which indicated that overall, Mr. McEwan presented a low risk of violent reoffending in the next 12 months, if he remained on a detention disposition while living in the community and a moderate risk if granted a conditional discharge.
On January 7, 2025, a risk assessment was conducted (HCR-20 V3) which indicated that Mr. McEwan’s risk of violent reoffending has increased since last year. He currently presents a moderate risk of violent reoffending in the next 12 months if he remains on a detention disposition while living in the community. His risk would increase to high if granted an absolute discharge.
Evidence at the Hearing
- Dr. Ajay Prakash testified on behalf of the Hospital as follows:
Mr. McEwan has continued his structured leisure activities since being discharged to the community and has regained his job, working for the pizza business two to three times per week.
The treatment team continues to recommend to Mr. McEwan to not use cannabis and alcohol.
Mr. McEwan self-reports that he continues to use cannabis and alcohol regularly, similar to the levels of use prior to his admission to the Hospital in July 2024.
Although Mr. McEwan was largely well when he was not taking antipsychotic medication despite using cannabis and alcohol, Mr. McEwan’s risk of violent behaviour is driven by his drug use. It was the use of crystal methamphetamine that precipitated his most recent admission to the Hospital.
Mr. McEwan has not been assessed around his ability to refrain from using crystal methamphetamine. Expanded passes can provide an opportunity to assess this.
Mr. McEwan requires the support of the treatment team to support and observe his commitment to taking antipsychotic medications, given the nature of addictions, the negative impact of cannabis and alcohol, and his limited insight.
Mr. McEwan’s insight into his illness and need for medications fluctuates but has not improved. He is externally motivated to take the prescribed medications. He accepts oral medications but does not accept the recommended long-acting injection form of medication.
He has good personal supports from his wife, his father in Sarnia, and his mother who lives ‘out west’.
His wife was removed as an Approved Person, and he has no other Approved Persons. This has affected the ability to use passes, which is the reason for the Hospital’s recommendation that indirectly supervised travel be added to the Disposition. The Hospital contemplated indirectly supervised 72-hour passes but takes no position on it at the hearing.
The treatment teams hopes to continue to provide education to his wife, and to work to improve Mr. McEwan’s insight with respect to his addictions.
Mr. McEwan is ‘pre-contemplative’ with respect to treating his addictions and is not suitable yet for residential treatment programing. He thinks that it is safe for him to use cannabis and alcohol, but not safe to use crystal methamphetamine.
Dr. Prakash is concerned about Mr. McEwan’s ability to control his cannabis and alcohol use.
The treatment team does not anticipate sudden decompensation on a 72-hour pass.
Because Mr. McEwan’s risk has increased over the past year, the Hospital is recommending an increase in the frequency of reporting to a minimum of four times per month.
In response to questions from counsel for the Attorney-General, Dr. Prakash agreed that Mr. McEwan’s parents were not Approved Persons because Mr. McEwan did not want them to become Approved Persons, and that the difficulty of using passes without having an Approved Person resulted from Mr. McEwan’s own choice.
In response to questions from counsel for Mr. McEwan, Dr. Prakash testified that including indirectly supervised passes in the Disposition would provide an incentive for Mr. McEwan. If Mr. McEwan travels to see his father on an approved itinerary, it is likely that his father will report to the Hospital if Mr. McEwan deviates from the approved plans. There was no evidence that Mr. McEwan will abscond or deviate from the approved plans. Risk to the public would be low on an indirectly supervised 72-hour pass.
In response to questions from the Board, Dr. Prakash testified that:
The index offences were serious.
Cannabis and alcohol are risk factors with respect to schizophrenia and that each enhances the risk of decompensation/violent behaviour independently of each other.
The treatment team has no knowledge of the frequency, amount or potency of the cannabis and alcohol used by Mr. McEwan, except as self-reported by Mr. McEwan.
The treatment team revisited the question of whether cannabis and alcohol should be permitted under the Disposition and recommend no change. The reason for this was that from 2023 to 2024 Mr. McEwan used cannabis and alcohol without taking antipsychotic medications, and was not admitted to the Hospital until crystal methamphetamine ‘came into play’. Mr. McEwan is more stable now than last year because he is being treated with antipsychotic medication.
The following paragraph (15) from the Board’s Reasons for Disposition (2024) is still true:
Mr. McEwan does not value hospital admissions and it is unknown whether he would come into the Hospital voluntarily. Furthermore, with decompensation comes a loss of judgment. It is unknown whether Mr. McEwan’s wife would be willing to contact the treatment team and help facilitate a readmission (notwithstanding that she is an approved person). Mr. McEwan is not engaged in substance use programming as he does not believe that it is necessary. Even if Mr. McEwan does not wish to entertain further addiction programming (the last one he attended was August to September 2021) it would be useful to him to engage in some relapse prevention counselling. The last one he attended was August to September 2021. To his credit, Mr. McEwan has good insight into the potential dangers of using crystal methamphetamine, which was the substance he was using at the time of the index offences.
- The following paragraph (20) from the Board’s Reasons for Disposition (2024) is still true:
Furthermore, Mr. McEwan's wife has minimized the hallucinations that Mr. McEwan is currently exhibiting, and it is unknown whether she would reach out to the treatment team if she felt that he was decompensating. In addition, Mr. McEwan lacks insight into his mental illness and the need for treatment and would likely not be able to detect signs of decompensation. For these reasons, the Hospital requires the ability to admit Mr. McEwan expeditiously should he begin to decompensate. In these circumstances the Mental Health Act (MHA), would not be effective in addressing his risk to the safety of the public. For these reasons, the Board finds that a discharge with conditions would not be adequate to protect the safety of the public and a detention order remains necessary and appropriate.
There was a lapse in monitoring prior to the last admission to the Hospital such that actual crystal methamphetamine use was not fully detected by testing. The team did notice an increase of symptoms and increased their visits to Mr. McEwan. It was a gradual increase in symptoms.
Mr. McEwan’s father did not notice a change in mental status in Mr. McEwan when he attended a wedding from July 19-21, but shortly after this Mr. McEwan deteriorated quickly when he used crystal methamphetamine after using cannabis and alcohol.
Cannabis and alcohol are a gateway to using crystal methamphetamine. There is a direct connection between using cannabis and alcohol and crystal methamphetamine. Crystal methamphetamine led to serious decompensation, with a risk of behaviour similar to the index offences.
Mr. McEwan is open about his opinion that he does not think he needs antipsychotic medications. There is no evidence that he has stopped taking the medications without the team’s knowledge, but it is possible. Dr. Prakash stated that it might be possible to test for the levels of Abilify in Mr. McEwan’s blood.
The only time Mr. McEwan had a prolonged period of abstinence from cannabis and alcohol while adherent to antipsychotic medications was when he was an inpatient at the Hospital.
If Mr. McEwan’s use of cannabis and alcohol was restricted it would cause distress to Mr. McEwan in the short term. If it was prohibited in the Disposition, it would make Mr. McEwan’s time as an outpatient “fragile” since he might be readmitted if he breaches the Disposition. In the long-term, it is possible with addictions programming that his insight into his addictions will improve over time.
Mr. McEwan’s situation is clinically complex to balance. One the one hand, the treatment team saw a slow increase in symptoms over the course of a year, and then with the use of crystal methamphetamine, there was a significant change within a few days’ time. On the other hand, cannabis and alcohol played a significant role in the long and slow decline in Mr. McEwan’s mental status.
In response to further questions by counsel for Mr. McEwan, as to whether use of cannabis and alcohol in the context of medication compliance was ‘a gateway to the use of crystal methamphetamine’, Dr. Prakash testified that he could not say because he would need more information and would need to ‘see how it plays out’. An important variable in assessing the risk is the amount of cannabis and alcohol used. Dr. Prakash anticipated however that if Mr. McEwan remained compliant with the medications, cannabis and alcohol use might not lead to decompensation.
No further evidence was called.
All parties maintained their initial positions.
Analysis and Conclusion
The Board accepts the evidence of Dr. Prakash, as supported by the Hospital Report, and finds that Mr. McEwan continues to represent a significant threat to the safety of the public. The Board notes that all parties are in agreement on this issue.
The Board accepts and relies upon the risk factors set out in the Hospital Report, which the Board finds are well supported by the evidence:
Mr. McEwan is diagnosed with a major mental illness, namely schizophrenia. He continues to experience ongoing symptoms including paranoia, delusions, hallucinations and grandiose magical thinking and does not believe they are associated to his level of risk. He required a readmission to hospital due to his decompensated state;
Mr. McEwan has demonstrated affective, behavioural and cognitive instability;
Mr. McEwan initially declined to participate in substance use programming, reporting awareness that crystal methamphetamine would impact him negatively and that he did not want to use this again. However, he continued to consume alcohol and cannabis regularly and relapsed into crystal meth use this review year, which impacted his mental state negatively. His ongoing use of substances places him at an elevated risk for future violence;
Mr. McEwan has a history of noncompliance with treatment, requiring a CTO in the past. He has poor insight into his need for treatment and states he is stable on or off medications. He is not agreeable to a long-acting injection at this time and his acceptance of any medication is externally motived by moving back to the community and through the forensic system;
Mr. McEwan has poor insight into his mental illness and violence risk;
Mr. McEwan’s stressors will likely continue to revolve around finances, finding employment and managing cravings. He does not have adequate coping strategies to manage his stress and has used crystal meth as a means of coping this review year;
Mr. McEwan’s primary support is his wife, Jocelyn. However, she has not been helpful in mitigating his risk and was removed as an Approved Person. Mr. McEwan has no real social network, and his parents are not readily accessible as they live at a distance;
Mr. McEwan does not have any professional community based mental health supports outside of the forensic system and has consistently identified that he does not require support in the future.
The Board finds that a conditional discharge would not be adequate to protect the safety of the public and a detention order remains necessary and appropriate. The parties are in agreement that a detention disposition is necessary and appropriate. Mr. McEwan lacks insight into his mental illness, his need for treatment, and would likely not be able to detect signs of decompensation. Mr. McEwan’s wife is no longer an Approved Person, and it is unknown whether she would reach out to the treatment team if he was decompensating. According to Mr. McEwan, she does not notice a difference whether he is treated or not. Mr. McEwan continues to use cannabis and alcohol, and relapsed into crystal methamphetamine use this year. It was Mr. McEwan’s mother, not his wife, who alerted the treatment team to Mr. McEwan’s decompensation. Mr. McEwan will be able to exercise 72-hour indirectly supervised passes this year, and his ability to avoid use of crystal methamphetamine has yet to be assesssed in these circumstances. For these reasons, the Hospital requires the ability to admit Mr. McEwan expeditiously should he begin to decompensate. In these circumstances the Mental Health Act (MHA), would not be effective in addressing his risk to the safety of the public.
Dr. Prakash told the Board that Mr. McEwan’s father is an important source of support for Mr. McEwan, although he provides Mr. McEwan with cannabis. Because there are no Approved Persons, Mr. McEwan would not be able to visit his father in Sarnia without indirectly supervised passes. The doctor also testified that the risk to the public on 72-hour passes is minimal, because Mr. McEwan’s father would likely alert the treatment team to any breach of an approved itinerary, and because Mr. McEwan is unlikely to deteriorate quickly on a 72-hour pass.
The Board accepts the evidence of Dr. Prakash that the risk to the public on a 72-hour indirectly supervised pass is low, and notes that the Hospital has the discretion to refuse an indirectly supervised pass if it determines that this would not be appropriate in the circumstances.
The Board accepts that broadening the geographic scope of indirectly supervised passes and adding indirectly supervised travel to and from a 14-day pass is appropriate in the circumstances.
Given Mr. McEwan’s lapse into crystal methamphetamine use last year, and his serious decompensation, the Board agrees that it is appropriate to increase the minimum reporting frequency to four times per month.
The Board is cognizant of the fact that Mr. McEwan did not engage in any violent acts over the past year. Nonetheless, the Board determined that it is necessary and appropriate to extend the ‘abstain’ clause to include a prohibition on the use of cannabis and alcohol, for the following reasons.
Dr. Prakash indicated that use of cannabis and alcohol is a risk factor and can be a gateway to crystal methamphetamine use. Dr. Prakash was clear that cannabis and alcohol use are not recommended for persons diagnosed with schizophrenia.
The evidence supported a conclusion that the use of cannabis and alcohol with medication noncompliance contributed to Mr. McEwan’s mental decompensation during the reporting period. The use of crystal methamphetamine in combination with medication noncompliance and the use of cannabis and alcohol led to a sudden decompensation in Mr. McEwan’s mental status. Mr. McEwan has only been both abstinent and medication compliant while an inpatient at the Hospital.
Dr. Prakash was unable to comment on whether the use of cannabis and alcohol while remaining medication compliant would likely lead to decompensation and/or use of crystal methamphetamine. The doctor stated that more information is necessary, and that the quantity, frequency and potency of cannabis and alcohol used is an important variable. Dr. Prakash was equally unable to comment on whether remaining medication compliant would be sufficient to protect Mr. McEwan from mental deterioration and/or relapse into the use of crystal methamphetamine in the context of continued cannabis and alcohol use.
The treatment team has no independent knowledge of the amount, frequency, or potency of the cannabis and alcohol used by Mr. McEwan, as the treatment team has relied on Mr. McEwan’s self-reports. The treatment team is unable to predict the amount, frequency, or potency of the cannabis and alcohol which will be used by Mr. McEwan in the upcoming year.
Medication compliance is a strong protective factor. However, Mr. McEwan’s compliance with medication is externally motivated. He states that he does not need medication. He is capable of making treatment decisions and he has a recent history of discontinuing medication. The Board accepts the evidence of the Hospital Report that “his future compliance with medications in an unstructured environment is uncertain”.
The Board is cognizant that the use of cannabis and alcohol is important to Mr. McEwan’s lifestyle. However, in considering the criteria set out in s. 672.54 of the Criminal Code, the Board notes that the paramount consideration is the safety of the public. In the context of the events of the past year, which include regular use of cannabis and alcohol, medication noncompliance, relapse into crystal methamphetamine use and a resultant increase in Mr. McEwan’s risk to the safety of the public, the Board determined that the interest of the protection of the safety of the public outweighs Mr. McEwan’s enjoyment of cannabis and alcohol, and that the ‘abstain’ clause should be extended to include a prohibition on the non-medicinal use of cannabis and alcohol.
For the foregoing reasons, the Board finds that Mr. McEwan continues to represent a significant threat to the safety of the public and that the necessary and appropriate and least onerous and least restrictive disposition is a detention disposition as described above.
In making this disposition, the Board has taken into consideration the criteria set out in s. 672.54 of the Criminal Code, which includes 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.
The Board wishes Mr. McEwan every success in the upcoming year.
DATED this 10th day of April 2025, at the City of Toronto, in the Region of Toronto.
Ms. K. Tomaszewski
Legal Member
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Office of the Registrar
Ontario Review Board