Ontario Review Board
Re: Timothy J. Iwamoto
ORB File No: 4640
Hearing held on: Thursday, February 27, 2025
Place of hearing: Waypoint Centre for Mental Health Care 500 Church Street, Penetanguishene, Ontario
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. C. MacIntyre, KC Members: Dr. C. Krasnik Dr. G. Stones Ms. A. La Viola Mr. D. Smith
Parties Appearing:
Accused: Timothy J. Iwamoto Counsel: Mr. D. Northcott
The person in charge of hospital: Counsel: Ms. T. Newman
Attorney General of Ontario: Counsel: Ms. S. Curry
REASONS FOR DISPOSITION
(Dated April 11, 2025)
OVERVIEW
- On December 21, 2006, Timothy J. Iwamoto was found not criminally responsible on account of mental disorder of assault with a weapon, possession of a weapon for dangerous purpose and forcible confinement, contrary to the Criminal Code. Mr. Iwamoto’s last annual review was held on February 27, 2024. He is currently subject to a disposition of the Ontario Review Board also dated March 18, 2024, detaining him at the Waypoint Centre for Mental Health Care – High Secure Provincial Forensic Programs, permitting him access to the hospital grounds, beyond the secure perimeter, escorted by staff. On February 27, 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. Iwamoto had been transferred from the Beausoleil Program to the Awenda Program, where he has been housed since October 2024. Of note, the Board received notice1 from Waypoint of its intention to recommend Mr. Iwamoto's transfer and detention to St. Joseph's Healthcare Hamilton. On February 25,2025, the Board received a response to the transfer request, opposing the transfer in that Mr. Iwamoto was not manageable at their facility at this time.
ISSUES
The issue before the Board was to determine whether Mr. Iwamoto continues to pose a significant threat to the safety of the public and, accordingly, to determine the necessary and appropriate disposition for him consistent with the factors set out in s. 672.54 of the Criminal Code. Mr. Iwamoto attended the hearing in person, along with his Counsel, Mr. Northcott.
The Hospital asked the Board to conclude that Mr. Iwamoto 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, regardless of the previous recommendation that he be transferred to St. Joseph's. Counsel for the Attorney General initially deferred its position but ultimately agreed with the Hospital’s recommendation. Counsel, Mr. Northcott, conceded the issue of 'significant threat', however, he submitted that notwithstanding the recent change in the Hospital's position, Mr. Iwamoto would like a transfer to St. Joseph's.
FINDINGS
- After reviewing the evidence, the Board found that Mr. Iwamoto continues to pose a significant threat to the safety of the public and is not entitled to be discharged absolutely. Despite some improvement in his presentation, Mr. Iwamoto continues to display limited insight into his illness and ongoing difficulties with medication adherence, along with rapid decompensation, persistent psychotic symptoms, and intrusive behaviour toward others, all of which demonstrates that his stability remains fragile and heavily reliant on close supervision and structured clinical support. His current treatment plan, including a medication watch and the intensive oversight provided, remains necessary to manage his risk. For the reasons that follow in more detail below, the Board concluded that there be no change to the Detention Order at this time.
PERSONAL BACKGROUND
The Hospital Report dated January 24, 2025, was entered as an exhibit at the hearing. The following background information, including the events surrounding the 2006 index offence, has been taken from the Report, summarized here as follows.
On July 29, 2006, shortly after being discharged from a psychiatric admission, Mr. Iwamoto was at home with his parents when the alleged offence occurred. Earlier that day, he had reported receiving disturbing messages from the television and experiencing 'negative thoughts'. During dinner, he asked to be taken to the hospital but was told to finish his meal. Shortly after, while his parents were in the living room, Mr. Iwamoto emerged from the kitchen holding a steak knife and made threatening motions toward his mother without speaking. His father later recalled Mr. Iwamoto stating that voices were telling him to kill someone. His mother fled the house and called police. Mr. Iwamoto's behaviour and statements suggested that he was experiencing significant psychological distress.
Mr. Iwamoto is 44 years old, born in Barrie to older parents (14 years after having their third child). His early childhood was reportedly stable, with no major developmental concerns. He performed well academically in elementary school, maintained friendships, and even participated in a year-long exchange program in Japan at age 12. However, adolescence marked the onset of familial conflict, particularly with his parents, who were seen as overly strict. Due to ongoing tension at home, he moved in with his brother. During this period, signs of his mental illness emerged, leading to hospitalization. With these challenges, he completed high school and remained in Oakville with his brother, after the family relocated. Academically, Mr. Iwamoto excelled but found school uninspiring, but he showed strong artistic talent and pursued post-secondary education, though his illness impeded completion. As well, he struggled to maintain employment due to the effects of his psychiatric condition.
Notably, Mr. Iwamoto’s family history includes significant mental health concerns. Both of Mr. Iwamoto’s parents are now deceased. His sister was diagnosed with severe mental disorder in her teens and resides in a group home. His brothers maintain contact with him. Mr. Iwamoto has no history of alcohol or illicit drug use, as confirmed by both his family and clinical records. Mr. Iwamoto has not had lasting intimate relationships and has experienced ongoing difficulties with peer interactions since high school due to poor social judgement, including inappropriate behaviour. His adult life has been significantly affected by his psychiatric symptoms.
A records check of the Canadian Police Information Centre database showed that Mr. Iwamoto has criminal convictions for uttering forged documents and possession of property obtained by crime in 2004 (the uttering threats charge was withdrawn). He received a suspended sentence with three years probation.
PSYCHIATRIC BACKGROUND
The psychiatric background information is contained in the Hospital Report. Mr. Iwamoto's mental health issues began to surface at age 18, with his first psychiatric admission occurring in 1999. He was subsequently hospitalized multiple times between 2002 and 2006, with several incidents leading to admissions at RVH in Barrie, where he was assessed and later discharged as an outpatient for follow up care. His psychiatric history includes several inpatient stays related to behavioural incidents and family conflict. He received follow up from community based services, including intensive support to help manage his condition and daily functioning.
In 2006, Mr. Iwamoto was admitted to the Mental Health Centre Penetanguishene (now known as Waypoint) for assessments related to criminal proceedings and was subsequently found 'not criminally responsible'. He remained an inpatient until July 2014, when he was discharged to a supervised group home after a period of gradual transition. Subsequent readmissions occurred in 2014 and 2015 due to treatment related complications and symptom relapse.
Efforts have been ongoing to support his transition to community living, specifically, a placement at Jennings Lodge Homes for Special Care. He enjoys and values contact with his family, particularly visits from his brother and his family, which continue to be a source of encouragement and emotional support.
Mr. Iwamoto’s current psychiatric diagnosis is Paranoid Schizophrenia. Mr. Iwamoto has been found incapable of making decisions about his medical treatment, and he is also incapable of managing his finances independently. His substitute decision maker for consent to psychiatric treatment is his brother, and the Public Guardian and Trustee has been appointed to manage his finances. He receives financial assistance from the Ontario Disability Support Program.
EVIDENCE AT THE HEARING
Mr. Iwamoto’s clinical course for this reviewing year is documented in the Hospital Report. In attendance at the hearing was his current attending psychiatrist Dr. A. Mishra (having taken over from Dr. M. Muraven), Dr. P. Ismail (observing by video conferencing) and Dr. M. Kaggwa, who gave evidence at the hearing.
Dr. Kaggwa stated that he is not currently the most responsible physician, though he remains actively involved in Mr. Iwamoto's care. Dr. Kaggwa also indicated that he consulted with Dr. Mishra and attended Mr. Iwamoto's pre-board conference. He reviewed the Hospital Report and agreed with its contents, aside from the recent change in recommendation.
On January 30, 2025, Mr. Iwamoto was involved in an incident of aggression toward another individual, followed by self harming behaviour. Since then, he has been closely monitored and continues to experience persistent persecutory delusions.
Despite medication adjustments, his symptoms remain problematic. He continues to express beliefs that his food is being poisoned and that he is being monitored, which has led him to isolate during meals. These ongoing beliefs, combined with a pattern of sudden, unprovoked aggression, are of particular concern. A significant reduction in medication levels between December and February was observed, likely due to longstanding issues with compliance. As a result, he remains under close medication monitoring.
While there had been a period of relative stability prior to the January incident, including indirect passes within the secure perimeter, that stability has not been sustained. He continues to inconsistently engage in therapeutic activities, likely due to both environmental stressors and ongoing symptoms. Although he understands the consequences of acting on his beliefs, they remain present, and his current restraint appears to be driven more by awareness of consequences than actual symptom improvement. A change to a different medication form has been initiated to improve compliance, and more frequent monitoring has resumed.
The expected timeline for restoring Mr. Iwamoto's clozapine levels to previous therapeutic levels is within the next six months. Regarding insight into his illness and treatment needs – it is limited. He believes certain medications, particularly olanzapine, are more effective for him, although this has not been supported by clinical observations. He does not have full insight into his illness. While the hope is to restore him to his 'pre-incident' baseline, a full return to the point of readiness for transfer to a medium secure facility within the coming year is unlikely.
The reduction in clozapine levels is thought to be related to medication noncompliance. In response, the medication is being changed from crushed to liquid form to reduce the possibility of cheeking. Monthly monitoring has been reinstated to allow quicker response to fluctuations. The team is aware that Mr. Iwamoto is not in agreement with this treatment and may attempt to interfere with its effectiveness. In the past, after subtherapeutic dosing in the community, it took over eight months for him to return to baseline. This informs the expectation for a longer stabilization period required now.
Side effects have influenced his preference for olanzapine over clozapine. He finds the latter unpleasant and is more willing to accept the former, which he perceives to cause fewer side effects. Following the January incident, he disclosed long standing delusional thoughts that he had not previously shared. These beliefs fluctuate, but their presence has been consistent. Self-induced vomiting has occurred in the past and may still be ongoing, potentially affecting medication levels. Additional medications are being used to enhance symptom control, and there is cautious optimism that, with ongoing optimization, Mr. Iwamoto may achieve greater stability and insight over time.
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. This determination requires a careful assessment of risk factors, including Mr. Iwamoto's current mental state, insight, and response to treatment. We have considered the evidence presented during this review period and make the following findings.
Based on the evidence contained in the Hospital Report (including reports by Dr. Muraven and Dr. Mishra), together with the evidence provided by Dr. Kaggwa at the hearing, we find that Mr. Iwamoto continues to pose a significant threat to the safety of the public.
Throughout the review period, Mr. Iwamoto exhibited poor insight into his mental illness, inconsistent engagement in treatment, and persistent non-adherence to medication. He remains on a medication watch due to his history of spitting out, purging and avoiding medication administration. Despite adjustments to his medication regimen, his psychotic symptoms have not been adequately controlled. Mr. Iwamoto’s recent behavioural issues further supports this finding. He has displayed intrusive, inappropriate, and occasionally provocative conduct towards staff and patients, including inappropriate comments and invading personal space. These behaviours, combined with evidence of ongoing psychotic symptoms – such as responding to internal stimuli and acting out in response to auditory hallucinations – demonstrate continued cognitive and behavioural disorganization. His frequent disregard for rules and difficulty following directions led to multiple reductions in his security level prior to stabilization in late September 2024.
While there has been some recent improvement in Mr. Iwamoto’s presentation, his progress remains tenuous. He continues to minimize his symptoms, resists individualized programming, and fails to fully engage in available treatment options. His current stability is contingent on intensive monitoring and structured supervision, including medication watch. The evidence demonstrates that when these supports are reduced, Mr. Iwamoto rapidly decompensates. Without the appropriate level of oversight, there is a clear risk of further deterioration, which could result in conduct that poses a serious risk of harm to the safety of others. Together these factors underscore the necessity of continued close monitoring, to mitigate his risk to public safety.
(b) Necessary and Appropriate
Based on the above, we find that at this time, a move to a less secure setting is not appropriate and would not address Mr. Iwamoto's specific needs. We note that the treatment team's focus remains on improving compliance and optimizing his treatment plan. Although he has declined electroconvulsive therapy, discussions have occurred and may be revisited. With sustained treatment and monitoring, it is hoped he may return to a more stable baseline within six months, and this is challenging because he currently lacks full insight into his illness or the need for ongoing treatment. The decompensation observed earlier in the year, despite outward signs of stability, underscores the unpredictability of his condition and the continued risk he poses if supervision is prematurely reduced.
Mr. Iwamoto’s current disposition is appropriate and necessary to address the level of supervision required to manage his risk. The plan of care in place remains focused on improving medication adherence and functional recovery. The treatment team continues to provide essential support through medication watch, group therapy, and structured programming. This intensive level of oversight is not viable in a less secure environment. Without this framework, there is a significant risk that Mr. Iwamoto’s condition would deteriorate, especially in light of his history of nonadherence to treatment, ongoing psychotic symptoms, and failure to recognize early signs of decompensation.
While Mr. Iwamoto has adjusted relatively well to the Awenda Program at Waypoint, we do not find there is a sufficient foundation to support transfer to a less secure facility at this time. The risks associated with reducing supervision are too great, particularly given his persistent challenges with medication compliance, social functioning, and lack of insight. While he is engaging in some aspects of his treatment plan, he continues to demonstrate behaviours that could escalate without appropriate monitoring and supervision. A Conditional Discharge, or transfer to a medium secure hospital setting has no air of reality at this time, given the need for continued support within a high secure hospital setting.
We conclude that the current Detention Order remains the most necessary and appropriate disposition for Mr. Iwamoto. The Awenda Program allows for the level of structure, supervision, and clinical intervention required to manage his risk and support his ongoing treatment needs. Any reduction in the current level of supervision would be premature and potentially detrimental to both his recovery process and to public safety. We wish Mr. Iwamoto stability and wellness in his recovery process.
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