Re: Perfect Adison
ORB File No: 7921
Hearing held on: Tuesday, February 18, 2025
Place of hearing: Centre for Addiction and Mental Health, Toronto
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. M. Segal
Members: The Hon. B. Allen Dr. B. Bordoff Dr. J. Kis Mr. J. Cyr
Parties Appearing:
Accused: Perfect Adison Counsel: Ms. S. Dubb
The Person in charge of Hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Mr. M. Feindel
REASONS FOR DISPOSITION
(Dated April 10, 2025)
Introduction
1On July 15, 2021 Mr. Perfect Adison was charged with attempting to disarm a police officer (x 2), assaulting a police officer causing bodily harm, assaulting a police officer and uttering a threat contrary to the Criminal Code and was found not criminally responsible on account of mental disorder.
2A panel of the Ontario Review Board (the Board) was convened, under s. 672.81(1) of the Criminal Code, on February 18, 2025 at the Centre for Addiction and Mental Health (CAMH or the Hospital) to review Mr. Adison’s existing disposition as to his risk to public safety. His existing disposition dated February 28, 2024 orders that he be detained at CAMH with privileges up to living in the community in approved accommodation with a minimum reporting requirement of once every two weeks.
3At the start of the hearing the parties indicated they were of the unanimous position that Mr. Adison remained a significant risk to public safety and that he should be subject to a conditional discharge with appropriate conditions. The parties maintained their positions at the completion of the evidence.
Disposition
4For the reasons set out below the Board concludes that Mr. Adison continues to pose a significant threat to public safety under s. 672.54 of the Criminal Code and that the necessary and appropriate disposition is a conditional discharge with appropriate conditions including a stipulation of Mr. Adison’s housing address as 96 Dowling Street, Toronto, Ontario and adding a weapons prohibition.
Evidence Before the Board
5Before the Board is the Hospital Report dated January 31, 2025, authored by Dr. Hanna Meng, which contains a description of Mr. Adison’s personal and medical histories, the details of which need not be repeated in detail here.
Index Offences
6A summary of the index offence is as follows:
7On July 28, 2020 Mr. Adison entered his mother’s residence naked. He left the residence and returned shortly afterwards wearing underwear and no pants. His mother became concerned for Mr. Adison’s state of mind and contacted the police.
8The police attended the address and located Mr. Adison in his mother's apartment. Officers entered the unit and engaged in a conversation with him. Mr. Adison was showing the officers some family photos in the living room. Within seconds he ran towards the kitchen and became agitated talking about Jesus and saying that nothing was making any sense. When the officers attempted to contain Mr. Adison, who was trying to leave, he suddenly threatened one of the officers that he would take the officer's gun and kill him (charge #1). Mr. Adison quickly became aggressive and attempted to take the officer's firearm. However he got hold of the officer's radio located directly above his firearm and removed it from his vest (charge #2). He then reached for the other officer's taser. But he failed to grab it. (charge #3). Mr. Adison was combative and head-butted the first officer's head. (charge #4). He then immediately turned to the second officer and head-butted him as well as striking the second officer on his head. (charge #5). He then turned to the first officer and head-butted him a second time striking him on his forehead.
9The officers called for backup because they could not control Mr. Adison. Additional officers arrived on scene and Mr. Adison was arrested and handcuffed. He was transported to the hospital to be medically cleared. He was placed on a Form 1 under the Mental Health Act and subsequently charged accordingly.
Current Diagnosis
10Mr. Adison’s current diagnosis is schizophrenia.
Criminal History
11Mr. Adison denied any involvement with the criminal justice system before the index offence. He reported that he had taken someone’s laptop in the past because of voices telling him to take it, but never got arrested or charged because he gave it back. This happened almost six years ago. He denied other stealing or criminal behaviour.
Mr. Adison’s Personal and Psychiatric History
Before the Current Reporting Year
Personal History
12Mr. Adison is a 29-year-old male born in Zimbabwe who immigrated to Canada in 2017 and became a Canadian Citizen in 2024. He is Shona-speaking with English being his second language. Mr. Adison is financially supported by ODSP and has worked odd jobs “under the table”. He is not married and has no children. He reported being in a relationship with a female partner who resides in Montreal.
13Mr. Adison never knew his father. His mother moved to New York City when he was age five. He communicated with his mother by phone. He and his sister were raised by their grandmother. In 2007 Mr. Adison's mother moved to Toronto with a son by a subsequent marriage and sponsored Mr. Adison to come to Canada where he first met his half-brother. Shortly after arriving in Canada in 2017 Mr. Adison moved from his mother's home because he felt it was too small for all the family members. He rented an apartment for some time and then when he lost his job he became homeless living in shelters and his car. Mr. Adison remains in touch with his mother a few times a month.
14Mr. Adison completed grade 10 in Zimbabwe. In Canada he completed a six months training program in 2017 to obtain a security guard license. Mr. Adison worked as a security guard in Toronto from 2017 to 2019 for two different companies. He reported that he liked the jobs and schedules. He was fired from the first company after six months for being found sleeping while on duty. Mr. Adison left his job at the second company after about a year saying it was because of voices telling him to "quit because it was not good there." He also briefly had a job as a carpet installer. During the period leading up to the not criminally responsible finding Mr. Adison received ODSP.
Psychiatric History
15In terms of Mr. Adison's psychiatric history, he reported first experiencing mental health issues in Zimbabwe but did not see a doctor at the time. Before finishing high school in Zimbabwe he started hearing the voices of different people, sometimes people he met previously, telling him to remove his clothes or to run away from school. He also occasionally had concerns about demons. He reported this to his grandmother; however no services were available to them in Zimbabwe and they could not afford a psychiatrist. He indicated he had no hospitalizations in Zimbabwe.
16Mr. Adison was first assessed for mental health issues in Canada in 2017 or 2018 when he received medications he does not recall. He is aware that in 2020 he was diagnosed with schizophrenia and accepts the diagnosis and acknowledges that his medications minimize the voices. Mr. Adison's mother, Ms. Makombese, became his substitute decision-maker.
17Mr. Adison indicated that he had attempted suicide three to four times when voices “told me to do that.” The first attempt was in 2017, the second was in 2019 when he quit his job and the third was in 2020. His first attempts involved trying to jump off a bridge which he obviously did not do. His last attempt was trying to eat glass. Mr. Adison was apprehended by the police and brought to the hospital.
18As noted earlier Mr. Adison’s initial Board hearing was held on December 3, 2021 at which time he received a conditional discharge and was on a Community Treatment Order (CTO) at the time. From December 2021 to November 2022 he was first followed by the Forensic Out Patient Service (FOPS) and later during that period was admitted to a general forensic unit at CAMH.
19Mr. Adison reported auditory hallucinations approximately every day before receiving medication. He had limited insight regarding his mental illness and the need for medication. During that period he received long-acting intramuscular injections every three months with the consent of his mother as his substitute decision-maker.
20In May 2022 Mr. Adison attended the FOPS clinic in a dishevelled state. His case manager was aware that he left a shelter the previous weekend and was not in contact with his mother, case manager or brother. He told his case manager he had been homeless for a week. Mr. Adison agreed to be admitted to CAMH voluntarily. He did well while admitted but chose to leave in June 2022 and stayed at the Scott Mission until July 2022.
21However Mr. Adison left Scott Mission on July 18, 2022 without advising where he could be located. Despite many attempts to locate him Mr. Adison could not be found for some time. On September 3, 2022 he called his mother informing her that he was staying in the Sherbourne-Dundas area. His mother located him near Sherbourne St., dishevelled. She offered to take him home but he declined. She called the police however he refused to be brought into CAMH.
22Mr. Adison was found by Toronto Police Services on October 3, 2022 wandering in a school playground and was taken to CAMH. Mr. Adison reported having used crack cocaine and having auditory hallucinations. He was admitted as an inpatient under a Form 3 and continued in the Hospital under a Form 4 which expired on November 16, 2022. During the inpatient stay he acknowledged he had a mental illness but documentation showed he had poor insight into his mental illness and the need for treatment. He refused to take his medications due to the unwanted side effects of jaw movements. He indicated he did not want to stay in the Hospital because he did not need it.
23Mr. Adison indicated he remained in touch with his mother and brother and had reconnected regularly with his girlfriend who resided in Montreal, with all of whom he had good supportive relationships.
24Following Mr. Adison’s February 17, 2023 Board hearing he received a new detention order disposition. He was admitted to a general forensic unit at CAMH. Initially he declined to attend programs saying he was not interested in advancing in his passes. By April 2023, with encouragement, he began to attend substance relapse prevention, mindfulness and open gym programs. In May 2023 Mr. Adison began individual psychotherapy with Dr. Cripps in the Forensic Consultation and Assessment Team (FORCAT) program.
25In July 2023 Mr. Adison was accepted for 24-hour high support housing accommodation provided by Regeneration Community Services. To support discharge planning his passes were expedited to community indirectly supervised outings. Mr. Adison used the passes positively. On August 8, 2023 he was discharged to the community.
26Psychological testing revealed poor intellectual performance. The clinical team felt it was important to consider that Mr. Adison's general problem-solving skills and emotional regulation were likely negatively impacted by his poor intellectual functioning affecting such factors as goal-setting, planning, understanding concepts, perspective-taking and anticipatory problem-solving moving forward.
27On August 8, 2023 Mr. Adison was discharged to 96 Dowling Avenue, a 24-hour supervised high-support shared accommodation operated by Regeneration Community Services. The residence had a nightly curfew and forbade overnight visitors. There were two staff on-site at all times. Mr. Adison was described as a "model resident" by housing staff. He maintained his room and personal hygiene well and was compliant with housing rules.
28During this period Mr. Adison showed considerable progress, for instance: his attendances with FOPS were gradually decreased as his stability improved; he continued to be involved in CAMH programs; his mental state and presentation remained stable; he was consistently on time and well-groomed for appointments; he reported the voices were “almost gone”, hearing them only emerging briefly on two occasions since discharge; and he showed better yet still limited insight into the adverse effects of substance use on his mental state.
29There remained areas of concern with Mr. Adison, for example: he rejected the possibility that he may re-offend should he discontinue treatment and consistently indicated that he would stop taking his anti-psychotic medication once he was no longer under the Board's jurisdiction; his appreciation of the adverse effects of crack cocaine on his mental state was more limited; he continued to externalize responsibility for his previous supervision breaches; he remained resistant to psycho-education and feedback; he consistently expressed discontent with his high support housing because he believed this prevented him from having his "freedom".
Current Reporting Year - February 2024 to January 2025
30Mr. Adison had a stable and productive reporting year. He continued to reside at 96 Dowling Ave.
31Mr. Adison made progress in the following important areas: there were no rule violations or management concerns; he was compliant with his reporting obligations, medications and urine drug monitoring; there were no indications of substance use; weekly FOPS reporting was reduced to once every two weeks; his urine samples were negative for prohibited substances; his schizophrenia was well-controlled with some ongoing residual positive symptoms that did not significantly impact his functioning; he made productive use of his time through educational and other prosocial activities; there were no concerns reported by either housing or Mr. Adison’s mother during her visits; and staff opinion was that he was “amazing to have as a resident”.
32Mr. Adison obtained his Canadian citizenship in 2024 and expressed an interest in moving to a residence with parking so that he could get a car in the future, preferring a residence with no restrictions or curfews. Regarding functional capacity Mr. Adison's score was near the high range suggesting an ability to manage with less support than he currently receives at his residence. He displayed many skills required for independent living in the community but still benefited from support to develop further skills for independence. Mr. Adison scored from moderate to high on home management, transportation, finances, health and safety and problem-solving.
33Mr. Adison was deemed a suitable candidate for the Regeneration Community Services’ Step-Up Program which provides a permanent, independent, subsidized unit with staff available on-site to support daily activities as needed. However it was felt that fully independent housing would likely not adequately support his functional needs. The Hospital Report concludes that Mr. Adison’s risk of future violence under a conditional discharge would be low-moderate. And if granted an absolute discharge the risk of future violence would be high.
34Regarding the prospect of a conditional discharge the Hospital Report observes:
The availability of a residency clause would ensure that he remains in appropriate housing. With the ongoing stabilizing influences of appropriate housing and regular structured activities, Mr. Adison is likely able to remain compliant with treatment and refrain from substance use or contact with antisocial peers. While he may exhibit some increased resistance to treatment recommendations absent the controls of a detention order, his motivation to progress through the ORB, and his demonstrated ability to persist in his productive goals suggest that he would likely remain compliant with the most important risk management interventions (i.e., housing, reporting, substance abstinence, and medication adherence). [at page 30].
35In conclusion the clinical team is of the unanimous opinion that a discharge subject to conditions is the necessary and appropriate, least onerous and least restrictive, recommendation at this time. The recommended conditions are that Mr. Adison: reside in a 24-hour supervised, high-support accommodation; report to the Hospital no less than every two weeks; not leave the residence for more than 24 hours at a time without Hospital approval; on consent, comply with prescribed treatment and medication; attend for psychiatric assessments on request; remain in Ontario except for travel outside of Ontario for up to two weeks at a time, subject to an itinerary approved by the Hospital; and refrain from contact with the victims of the index offence.
Dr. Hanna Meng’s Evidence
36Dr. Meng testified at the hearing and indicated there were no significant updates to the Hospital Report. She advised the Board that Mr. Adison initially indicated he disagreed or was ambivalent about remaining in the 24-hour highly supervised housing environment. But he has, since the date of the Hospital Report, changed his mind about this. He has become accepting of his housing.
37Dr. Meng addressed the significant progress Mr. Adison has attained during the current reporting year: he has a reputation of being an “amazing resident” in the housing; has used no substances; has obtained his Canadian citizenship; has obtained a driver’s licence and his security guard licence.
38Dr. Meng spoke to Mr. Adison's ambivalence about the restrictiveness of his current housing and his preference for less controlled housing. However she indicated that he is agreeable to undergoing an assessment of his needs. Dr. Meng indicated there were no anticipated changes in Mr. Adison's housing and that because the Regeneration Community Services' Step-Up Program accepts patients straight from a hospital, there are no real prospects for Mr. Adison entering that program.
39Dr. Meng indicated that although Mr. Adison has had a stable year, he still requires high support and supervision. To support that opinion she referred to Mr. Adison's decompensation into drug use, homelessness and disorganization when he received a conditional discharge with no support in 2021.
40Mr. Adison's goal to travel to Zimbabwe alone was a point of some concern with the parties and the Board. Dr. Meng indicated that the clinical team favoured adding to the disposition that he be permitted to travel to Zimbabwe. In answer to questions about risk, Dr. Meng referred to the significant progress Mr. Adison has made during the current reporting year: his medication compliance; the improvement in his judgment; his abstention from substance use; the consistency with his reporting requirement so much so that his reporting requirement was decreased; and his enrolment in English and adult education classes.
41Concerning travel planning Dr. Meng emphasized that for such travel to be allowed the clinical team would have to ensure: that there is an approved itinerary and travel plan; that arrangements are made for Mr. Adison to be in contact with the treatment team while away; that his medications are coordinated with his time away; that his place of residence is suitable; that he will have appropriate supervision; that he abstain from substance use; and that he attend a medical facility in the event of decompensation.
42Questions were also raised about the recency of the psychotic symptoms which emerged during the previous reporting year, that being his intermittent auditory hallucinations which he denied were distressing or command in nature and his guardedness about his internal state. Dr. Meng explained that this was a transient perceptual disturbance that happened only in church during which time, Dr. Meng stated, Mr. Adison's overall judgment was preserved. Dr. Meng indicated that Mr. Adison has experienced no further perceptual disturbances, but rather only intrusive thoughts mainly related to church and not referable to people around him.
43In answer to a question about the sufficiency of the Mental Health Act system, if Mr. Adison decompensates, Dr. Meng indicated that to Mr. Adison's credit he has previously volunteered for admission to the hospital. So that system would be sufficient to address the eventuality of any decompensation.
The Parties’ Submissions
44The Crown and defence counsel maintained their joint position with the Hospital that the necessary and appropriate, least onerous and least restrictive disposition, to manage Mr. Adison’s risk in the community is a conditional discharge with a requirement to reside in the community at a 24-hour, high-support housing accommodation. The parties agreed with the added requirement that housing should be stipulated as 96 Dowling Avenue, Toronto, Ontario. The parties were satisfied with the other conditions recommended by the treatment team.
The Board’s Conclusion
45While mindful of the parties’ joint position the Board is required to come to an independent determination.
46Based on the evidence before us, the Board unanimously accepts the recommendations in the Hospital Report that Mr. Adison remains a significant threat to public safety as contemplated under s. 672.54 of the Criminal Code, within the criteria outlined in Winko, and as defined in s. 672.5401. The Board considered the criteria, as set out in s. 672.54, namely, the paramount criterion of the safety of the public and Mr. Adison’s community re-integration, his mental condition and his other needs.
47The Board accepts that the disposition that is necessary and appropriate in the circumstances is a conditional discharge to a 24-hour supervised, high-support accommodation specifically 96 Dowling Avenue in Toronto.
48The Board is cognizant of the significant progress Mr. Adison has made in critical areas of his mental health and behaviour. Again, his mental stability, improved judgment, amiable disposition and great reputation as a tenant, compliance with medication and the prohibition against substance use, consistency with reporting and positive functional assessment, all bode well for Mr. Adison's chance of gaining a less restrictive disposition in the future.
49The Board accepts that for the time being Mr. Adison requires the support and supervision offered at his current residence. We find that for Mr. Adison to continue on his positive trajectory he requires supervision of his medication and monitoring for substance use particularly given his past decompensation into drug use and homelessness when he was unsupported on his previous conditional discharge in 2021.
50Mr. Adison requires structure to positively occupy his time which to his credit he has addressed with his participation in some of the social activities and structured therapeutic programs recommended by the clinical team. Also positive in this regard is that he has enrolled in adult learning classes to advance his education and has obtained his security guard licence to enhance his employment opportunities. Mr. Adison has also achieved Canadian citizenship in the past year.
51The Board finds Mr. Adison's housing arrangement appropriate for his needs at this time and agrees that his housing should be stipulated as 96 Dowling Street, Toronto, Ontario. Mr. Adison appears to have adjusted quite well there and, as Dr. Meng has indicated, has changed his view on restrictive supervision.
52The Board is concerned about the absence of a weapons prohibition in the clinical team's recommendations particularly due to Mr. Adison's attempt to disarm a police officer and his threat to kill the officer during the index offence. The Board is of the view that a weapons prohibition should be added as a term of the conditional discharge.
53The Board also raised some concerns about Mr. Adison’s goal to travel to Zimbabwe unaccompanied. While acknowledging his significant gains during the current reporting year, the Board is concerned about possible decompensation in Mr. Adison’s mental status if he becomes medication non-compliant and violates the prohibition against drug use particularly because he will be unaccompanied by an approved person.
54The Board recognizes that the Hospital’s approval is required for the trip to materialize and that approval will be contingent upon Mr. Adison’s circumstances at the time and upon achieving the necessary pre-travel requirements as outlined by Dr. Meng. We find that the success of the travel depends on satisfying all aspects of the plan especially satisfaction with Mr. Adison’s supervision and living arrangements while in Zimbabwe and his regular contact with the CAMH treatment team.
55Regarding possible medical care in Zimbabwe the Board notes that the Hospital Report indicates that before Mr. Adison moved to Canada in 2017, his family could not afford psychiatric care for him. It will be crucial that the accessibility of psychiatric care in Zimbabwe be explored before a trip to proactively prepare for Mr. Adison’s possible need for psychiatric care if he travels to Zimbabwe.
56In conclusion the Board accepts the opinion of Dr. Meng and determines, under s. 672.54 of the Criminal Code, that the necessary and appropriate disposition in the circumstances is a conditional discharge on the conditions recommended by the treatment team with the following additions. The high support housing shall be stipulated as 96 Dowling Street, Toronto Ontario and there shall also be a weapons prohibition.
57In keeping with the Criminal Code’s s. 672.5401 criteria the existing detention order provides for public safety given the many supports and the 24-hour high level of supervision with Regeneration Community Services. In the event of decompensation, because of his proximity to supervision and monitoring, the Hospital can promptly intervene and re-admit Mr. Adison to the hospital to avoid potential violence to others and to address his needs. Mr. Adison's integration into the community is well satisfied by Mr. Adison's proactive social engagement in the housing space and the community and his participation in social and therapeutic programs recommended by the treatment team.
DATED this 10th day of April, 2025, at the City of Toronto, in the Toronto Region.
The Hon. B. Allen Legal Member
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Office of the Registrar Ontario Review Board