Re: Lawrence Caines
ORB File No: 8374
Hearing held on: Wednesday, February 26, 2025
Place of hearing: Waypoint Centre for Mental Health Care 500 Church Street, Penetanguishene
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. C. MacIntyre, K.C. Members: Dr. C. Krasnik Dr. G. Stones Ms. A. La Viola Ms. D. Smith
Parties Appearing:
Accused: Lawrence Caines Counsel: Mr. A. Rai
The person in charge of hospital: Counsel: Ms. T. Murdock
Attorney General of Ontario: Counsel: Ms. J. Armenise
REASONS FOR DISPOSITION
(Dated April 11, 2025)
OVERVIEW
- On August 17, 2023, Lawrence Caines was found not criminally responsible on account of mental disorder, on a charge of first-degree murder, contrary to the Criminal Code. Mr. Caines’ last annual review was conducted on February 8, 2024, he is currently subject to a disposition of the Ontario Review Board dated February 20, 2024, detaining him at the High Secure Forensic Programs – Waypoint Centre for Mental Health Care permitting him access to the hospital and grounds, beyond the secure perimeter, escorted by staff. On February 26, 2025, the Board convened at Waypoint for a mandatory review of the disposition further to s. 672.81(1) of the Criminal Code. At the time of the hearing Mr. Caines had been transferred from the Forensic Assessment Program to the Beausoleil B Program, where he resides since November 2024.
ISSUES
The issue before the Board was to determine whether Mr. Caines continues to pose a significant threat to the safety of the public, and accordingly to make the necessary and appropriate disposition for him consistent with the factors set out in s. 672.54 of the Criminal Code. Mr. Caines attended the hearing in person, along with his Counsel, Mr. Rai.
The Hospital asked the Board to conclude that Mr. Caines continues to pose a significant threat to the safety of the public, and so he is not entitled to be discharged absolutely. The Hospital recommended that the current disposition remain in place with no change at this time. Counsel for the Attorney General agreed with the Hospital’s recommendation. Counsel, Mr. Rai, submitted that Mr. Caines was also in agreement with the recommendation, conceding the issue of 'significant threat'.
FINDINGS
- After reviewing the evidence, the Board concluded that Mr. Caines continues to represent a significant threat to the safety of the public and he is not entitled to be discharged absolutely. He has fully adhered to treatment, shown no signs of violence or instability, and is considered a model patient. However, the severity of his past violence underscores the need for ongoing supervision and treatment to ensure public safety. His treatment plan includes the appropriate level of monitoring and supervision, which is still necessary at this time. For the reasons that follow in more detail below, the Board concluded that there be no change to his Detention Order at this time.
PERSONAL BACKGROUND
The Hospital Report dated January 22, 2025 was entered as an exhibit at the hearing. The following background information, including the events surrounding the 2022 Index Offence, has been taken from the Report, summarized here as follows.
On January 14, 2022, numerous 911 calls were made for a mental health well-being check on Donald Caines, (known to have been diagnosed with mental disorders), about smashing items in his apartment. Police discovered an unconscious male inside the dwelling, and another male, Lawrence Caines, running on the roof. After a foot chase, Lawrence Caines was tasered and taken into custody. He admitted to inflicting physical abuse on his brother, (Donald), who was found dead in the bathroom. Mr. Caines confessed to various acts of violence, including attempting to drown his brother, using a belt around his neck, inserting a wooden pole down his throat, and removing his eyes with a plunger handle.
Lawrence Caines is 58 years old, born in Collingwood, along with two brothers and a sister. He grew up in a home environment marked by domestic violence. At age nine, he was placed in foster care due to behavioural issues and later became a Crown Ward after his parents separated. His siblings were also placed in foster care. Mr. Caines struggled with behavioural difficulties throughout adolescence, frequently running away from foster placements. This led to his transfer to Brookside Training School and later, his incarceration. He also reported experiencing sexual abuse both while in foster care and by his brother Donald during childhood.
Having left school in Grade 9, Mr. Caines later established a garage door repair business. He was in a long-term relationship with his common-law wife from the age of 19, and despite periods of instability, they raised five children together. He has maintained ongoing contact and support from his wife and children.
Mr. Caines has a long history of alcohol abuse, which contributed to difficulties with work, relationships, and aggression, though he has been abstinent for many years. He also struggled with opioid addiction, but he reported no opioid or alcohol use since 2015. However, he has used marijuana during periods of illness, including in 2018, raising uncertainty about whether it was a form of self-medication or a trigger for his underlying mood disorder and psychosis.
A records check of the Canadian Police Information Centre database showed that Mr. Caines’ record includes 25 criminal convictions between 1984 and 2019, ranging from break and enter, escape custody, impaired driving, among others. It is noted that he was reportedly manic and psychotic during the 2009 and 2019 convictions.
PSYCHIATRIC BACKGROUND
The psychiatric background information is contained in the Hospital Report. Mr. Caines’ mental health issues began to surface in 2009. Subsequent psychiatric history includes multiple hospital admissions, notably at Rouge Valley Health System in 2019, Collingwood General and Marine Hospital in December 2021, and Waypoint from December 2021 to January 2022.
Around 2009, Mr. Caines was diagnosed with Bipolar Disorder, experiencing multiple manic episodes with psychosis, particularly when non-compliant with treatment. His symptoms have included grandiosity, paranoia, disorganized thoughts, and aggression, often leading to hospitalizations and legal issues. Substance use may have exacerbated his symptoms, but his history aligns with a primary mood disorder and psychosis. He also experienced long periods of depression between manic episodes. He was found to have poor insight, paranoia, and manic symptoms but stabilized with treatment adjustments.
During his 2022 incarceration at Central North Correctional Centre, Mr. Caines continued to exhibit symptoms of bipolar disorder with psychotic features, including religious delusions, auditory hallucinations, and impaired judgement. Medical records documented past trauma, including childhood abuse and a history of substance use, though he reported being abstinent from illicit drugs since 2016. He was treated for his condition, and his symptoms fluctuated, with reports of improved sleep and reduced hallucinations in early 2022 but recurring mood swings and paranoia later that year. He was involved in altercations while incarcerated and continued to receive psychiatric care through 2023.
By March 2023, his treatment regimen was adjusted based on his condition, and he discontinued part of his treatment at his request. His history reflects ongoing struggles with adherence to treatment, mood instability, and psychotic symptoms, and despite intermittent improvements – his condition remained complex, requiring continued psychiatric care.
Following a finding of ‘not criminally responsible’, Mr. Caines was admitted to the Forensic Assessment Unit at Waypoint on December 13, 2023, under the care of Dr. Van Impe until his transfer to the Beausoleil Program in 2024.
Mr. Caines’ current psychiatric diagnoses are Bipolar Disorder I (most recent episode severe mania), Opioid Use Disorder, Post-Traumatic Stress Disorder and Tobacco Use Disorder. Mr. Caines has been found capable of making decisions about his medical treatment, and he is capable of managing his finances independently. He receives financial assistance from the Ontario Disability Support Program.
EVIDENCE AT THE HEARING
Mr. Caines’ clinical course for this reviewing year is also documented in the Hospital Report. His attending psychiatrist is Dr. A. Mishra, and he gave evidence at the hearing, along with updated information.
Dr. Mishra reported that since Mr. Caines' transfer to the Beausoleil B Program in November of last year, Mr. Caines has demonstrated positive behaviour. He is polite and cordial in interactions with staff and peers, with no concerning incidents reported. He has been compliant with his medication and has been attending scheduled appointments. He has attained the highest privilege level available to him.
Mr. Caines is currently participating in leisure education groups, with plans for further engagement as more activities become available. While he has not yet joined informal therapeutic groups, this is largely due to timing and availability rather than reluctance on his part. The hospital expects that he will have more opportunities to engage in structured programming in the upcoming year.
Dr. Mishra believes Mr. Caines would benefit from participation in specific therapeutic groups which focus on cognitive-behavioural principles, emotion regulation, and lifestyle management. Additionally, addiction counseling will be made available to him in future.
Mr. Caines has been attending Alcoholics Anonymous meetings regularly since October 2024, and this continues to be the case. His level of insight into his symptoms is fair. At present, he demonstrates a good understanding of his illness and is capable of consenting to treatment. However, his insight tends to diminish when he becomes unwell. Currently, he is at his most stable.
The treatment plan for the coming year involves continued monitoring of his mental state, ongoing participation in therapeutic activities, and structured support to maintain stability. Historically, Mr. Caines has responded well to treatment, but when unwell, his decline can be significant. The primary goal is to ensure continued engagement in treatment and support services to sustain his recovery.
ANALYSIS AND CONCLUSION
(a) Significant Threat
Where there is a risk of serious physical or psychological harm to members of the public resulting from conduct that is criminal in nature but not necessarily violent, the Board must find that the threshold for ‘significant threat’ has been met. The issue of whether Mr. Caines continues to pose a significant threat to the safety of the public was not contested at the hearing, however, we have considered all of the evidence presented, and we have made an independent finding on the issue.
Based on the testimony of Dr. Mishra and the relevant contents of the Hospital Report, we find that Mr. Caines remains a significant threat to the safety of the public, and accordingly, he is not entitled to be discharged absolutely. Based on the HCR-20 version 3 completed on December 31, 2024, Mr. Caines presents with significant historical risk factors for violence, (scoring 9/10) including extreme violence, multiple legal issues, domestic incidents, substance abuse worsening his mental health, and repeated medication non-compliance. He has been diagnosed with a major mental illness, with a history of severe trauma, including childhood abuse and neglect. Recent improvements have been noted, particularly in his relationships and treatment adherence since hospitalization. In contrast, his Clinical (0/5) and Risk Management (0/5) sections indicate no current concerns.
Over the past review period, he has demonstrated full adherence to treatment, no evidence of violent ideation, instability, or psychiatric deterioration, and has been described as a 'model patient'. However, the extreme violence of his actions serves as a stark reminder of the severity of his illness when left untreated. His history of mental illness has been marked by repeated severe relapses, often triggered by medication noncompliance and substance use. These episodes have resulted in florid mania, grandiose delusions, and unpredictable, dangerous behaviour, including multiple violent incidents. His risk assessment must be considered in the context of his current security level, daily monitoring, treatment and supervision at Waypoint. Moreover, this must be balanced with the primary focus remaining on public safety.
(b) Necessary and Appropriate
The plan of care in place for Mr. Caines appears to be adequate, and we commend him and the treatment team for his recovery progress thus far. However, we see that he is in the early stages of recovery, and rehabilitation efforts. His current disposition appropriately addresses his current level of threat to the safety of others given that he is subject to the level of supervision provided by the high-security levels at Waypoint. His psychiatric treatment and care involves the necessary level of supervision, evaluation, and adjustment to manage his risk level. Without the forensic treatment team, and their interventions and support, his recovery path would most certainly decline.
We find that even though he has made good progress, including positive vocational engagement and abstinence from illicit substances, the risk of recurrence remains high without close monitoring. We note that his recent decision to discontinue medication for his opioid use disorder highlights the potential for poor treatment decisions if he is not carefully managed. Together these factors underscore the necessity of continued close monitoring to mitigate his risk to public safety. These are early days under the Board's oversight, and Mr. Caines' transition to a less-secure environment must be approached cautiously, and methodically. At Waypoint, the high-secure program provides Mr. Caines' with the necessary structure, oversight, and controlled environment that has facilitated his current stability. Maintaining this level of care is critical to mitigating the substantial risk he poses should his mental state deteriorate, ensuring both his recovery trajectory, while protecting public safety.
We conclude on the evidence before us that the most necessary and appropriate outcome for Mr. Caines is to continue his recovery and rehabilitative trajectory under the supervision and authority of the Ontario Review Board, in accordance with a Detention Order, with no change to the disposition at this time. We wish Mr. Caines continued recovery progress in the upcoming year.
DATED this 11th day of April 2025, at the City of Toronto, in the Toronto Region.
Ms. A. La Viola Legal Member
Office of the Registrar Ontario Review Board