Ontario Review Board
Re: T. (D.)
ORB File No: 8195
Hearing held on: Friday, March 7, 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: T. (D.) Counsel: Mr. C.P. Dobson
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Ms. K. Dalrymple
REASONS FOR DISPOSITION
(Dated April 14, 2025)
Introduction:
On December 7, 2022, Mr. T. (D.) was found not criminally responsible on account of mental disorder, on charges of sexual assault and sexual interference with a person under 16, both contrary to the Criminal Code of Canada (“Criminal Code”).
Mr. T. (D.) is currently subject to the terms and conditions of a Disposition of the Ontario Review Board (the “Board”), dated February 6, 2024. Pursuant to this Disposition, he is detained at the Southwest Centre for Forensic Mental Health Care, St. Joseph's Health Care London (“Southwest”). This Disposition provides him with certain privileges, the highest level being to enter the communities of Elgin County or Middlesex County, accompanied by staff or by a person approved by the person in charge.
On March 7, 2025, the Board convened a hearing at Southwest to conduct the annual review of the current Disposition.
Mr. T. (D.) was present at the hearing and was represented by counsel, Mr. Christopher Dobson.
A Hospital Report, dated December 11, 2024 (the "Hospital Report"), was entered as Exhibit 1.
As the Index Offences as enumerated are sexual offences, an order is made, pursuant to s. 672.501of the Criminal Code, restricting publication of any information that could identify the victims.
The issue at this hearing is whether Mr. T. (D.) is a significant threat to public safety, as defined in s. 672.5401 of the Criminal Code. If so, the necessary, and appropriate, Disposition in the circumstances must be determined, bearing in mind the factors enunciated in s. 672.54 of the Criminal Code.
For the reasons set out below and based on the expert evidence and opinions before us, the Board concluded that Mr. T. (D.) continues to present a significant threat to the safety of the public. It determined that a Detention Disposition, with changes set out in our formal Disposition, and as agreed to by all parties, is the necessary and appropriate Disposition in the circumstances.
Current Psychiatric Diagnoses:
- Schizophrenia
Cannabis Use Disorder
Index Offences:
- The circumstances giving rise to the Index Offences are extracted from last year’s Board Reasons, (with names of victims deleted), as follows:
“The following information is from the Charge Sheet from the London Police Service dated May 14, 2022:
The accused in this matter is T. (D.) (1990-01-05) and the victims in this matter are victim 1 and 2. All parties are not known to one another prior to this incident.
On the 13th of May 2022 at approximately 6:12pm victim 1 and her friend victim 2 were out front of the Pet Smart located at Northland Mall, 1275 Highbury Avenue London Ontario.
At this time the two were approach by the accused who subsequently reached out and started squeezing victim 1‘s buttocks. Victim 1 immediately shouted and backed away. The accused then walked further down the plaza.
At approximately 6:15 pm the accused then approached victim 2. He reached out and started rubbing her stomach and breast area. Victim 2 backed away and the accused turned and attempted to flee the area.
While fleeing the area the accused was caught and grounded by Micheal Kubicki, a good Samaritan that had watched everything transpire. Kubicki also called police.
At 6:18pm police arrived on scene and arrested the accused. The accused was provided with his rights to counsel and cautioned to which he advised he understood. The accused identity was confirmed via London Police mug shot.
At 6:46 pm the accused was transported to cells.
At 7:01 pm the accused was booked into cells by Sgt O’Brien.
As a result the accused is being charged with 2 counts of sexual assault contrary to section 271 of the Criminal Code of Canada.”
Background:
- Mr. T. (D.)’s relevant background information is accurately summarized in last year’s Board Reasons, as follows:
“Mr. T. (D.) is treatment capable for psychiatric decisions. While Mr. T. (D.) was residing in the community with his parents, prior to the commission of the index offences, his parents handled his finances. There is currently no formal arrangement regarding a substitute decision maker for finances.
Mr. T. (D.) was born in Fredericton, New Brunswick and moved to London, Ontario in grade one with his family. He has two sisters and one brother, and he is the middle sibling. Mr. T. (D.)’s parents and family are a strong source of support for him. His childhood was described as happy and fulfilled with pleasant family times.
Mr. T. (D.) has a substance use history which involves significant cannabis use in his twenties. He also experimented briefly with cocaine and crack cocaine during this period.
The drug use worsened Mr. T. (D.)’s auditory hallucinations. He only drinks alcohol on special occasions and only in moderation.
Mr. T. (D.) has a psychiatric history that dates to his teenage years. He was seen by the Prevention and Early Intervention Program for Psychoses (PEPP) in 2010. He was followed by a psychiatrist with PEPP. He was also assigned a case manager and received psychotherapy. His case manager was female and due to inappropriate sexual behaviours, a male case manager was reassigned to him. He exhibited aggressive behaviours while associated with PEPP.
Mr. T. (D.) had multiple admissions to hospital over several years due to decompensation in his mental status. In August 2017, he was admitted to hospital under police escort after he assaulted a pregnant woman. He was psychotic at the time and on admission was aggressive towards staff. He continued to struggle with his mental health in his twenties. He was intermittently hearing voices. His health records noted at least three mental health admissions to London Health Sciences Centre in 2017, 2019, and 2020.
Mr. T. (D.) has been under the care of a psychiatrist, Dr. Ngungu, since 2017. He was maintained in the community for a long period, but he continued to experience symptoms of his illness. He responded to internal stimuli, was labile, and difficult to understand and disorganized.
Mr. T. (D.) attended elementary school. He used cannabis in grade eight. He described his high school years as “pretty good” and said he had grades between 70 and 80 percent. The family moved to the Ottawa area when Mr. T. (D.) was in grade 11 and he found the transition difficult. In his late teens he obtained his grade 12 education through online classes with the support of his mother.
Mr. T. (D.) does not have an employment history of note. He worked odd jobs in high school but since his early 20s he has been supported by the Ontario Disability Support Program benefits (ODSP). He may have also worked some construction jobs in his 20s.
Mr. T. (D.) has a criminal record which includes two sexual assault convictions in 2021. Mr. T. (D.) received a suspended sentence and probation for 12 months for these offences. He also has a finding of guilt for assault in May 2013, receiving a conditional discharge. Mr. T. (D.) is registered with the sex offender registry, both for the 2021 convictions and the index offences.
Mr. T. (D.) was admitted to the assessment unit at the hospital on May 30, 2022, pursuant to treatment order after being found unfit to stand trial on May 18, 2022, just five days after the commission of the index offences. He returned to court on July 13, 2022, and was found fit to stand trial after a successful course of treatment. Mr. T. (D.) was then assessed for criminal responsibility pursuant to an assessment order of the court dated July 20, 2022. As mentioned, he was admitted to the hospital on September 8, 2022, for this assessment and has been an inpatient since that date.”
Position of the Parties:
Counsel for the hospital, the Attorney General and Mr. T. (D.) advised that this was a joint submission. The parties recommended a continuation of the Detention Order, with the following changes: expand the geographical area of indirectly supervised passes, from the County of Elgin to both the County of Elgin and Middlesex County and remove all restrictions on the number of passes for 72 hours.
Counsel for Mr. T. (D.) advised that significant threat would not be in dispute for purposes of this hearing.
Course Since Last Disposition:
- Mr. T. (D.)’s course since his last Disposition is set out in detail in the Hospital Report. The following extracted paragraphs are relevant to this hearing:
“Mr. T. (D.) remained on the Treatment Uni B2 for the entire reporting period and remained under the care of Dr. Mokhber.
Mr. T. (D.) remained impacted by his psychotic symptoms, continuing to endorse auditory hallucinations.
Over the reporting period, Mr. T. (D.) experienced worsening OCD traits that caused him significant stress. He experienced periods where he became quite dysregulated from his obsessive paranoid thoughts.
In July 2024, Mr. T. (D.) began having weekly meetings with Occupational Therapy and Social Work. These meetings were initiated to provide Cognitive Behavioural Therapy (CBT) to address his OCD.
Mr. T. (D.) accepted an invitation to join the Dialectical Behaviour Therapy (DBT) for Distress Tolerance group.
His OCD symptoms notably have a tactile and sensory component to them.”
Evidence at the Hearing:
- The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Mokhber. Dr. Mokhber co-authored the Hospital Report and testified as follows:
a) She has been Mr. T. (D.)’s treating psychiatrist for over two years.
b) Mr. T. (D.) continues to experience active symptoms of his major mental illness, including hallucinations and delusions.
c) The treatment team has continued to try to optimize Mr. T. (D.)’s medication regimen. They have tried different adjunct medications to help with Mr. T. (D.)’s mental status, but nothing has resolved his active symptoms to-date.
d) The treatment team had hoped to bring in a new medication from France, which has been successful in treating schizophrenia in certain patients. However, it is no longer available to the treatment team.
e) Mr. T. (D.) is very sensitive to any changes in his medications. When his clozapine levels are not at their therapeutic level, or when it is close to the time for his four-week IM medication, they notice a drastic deterioration in his mental stability.
f) As a result of Mr. T. (D.)’s sensitivity to his medication regimen, the treatment team pays close attention to the timing of the administration of his clozapine . They have also increased the frequency of his injectable medication, from once every four weeks to once every three weeks.
g) Despite Mr. T. (D.)’s fluctuating mental status, he is doing very well. He has not engaged in any violence nor any inappropriate sexual behaviour.
h) Mr. T. (D.) had sexual assessments at both Southwest and at a sexual clinic at Victoria Hospital. Neither assessment uncovered any signs or symptoms suggesting that Mr. T. (D.) suffers from a paraphilic disorder. It is her opinion that Mr. T. (D.)’s criminal behaviour, both at the time of the Index Offences and before, was a result of his cannabis use exacerbating his major mental disorder. The use of cannabis caused Mr. T. (D.) to engage in uninhibited sexual behaviour.
i) Mr. T. (D.) has been successful in abstaining from drugs over the last two years in hospital, despite their availability on the unit.
j) Mr. T. (D.) is working with a psychologist on his trauma.
k) The psychotherapist has noticed mild-to-moderate improvement, but progress will be slow, due to Mr. T. (D.)’s psychotic symptoms and difficulty concentrating on any topic for very long.
l) The treatment team is tailoring Mr. T. (D.)’s involvement in psychological programs, so that he is seen on a 1:1 basis.
m) Mr. T. (D.)’s ability to remain abstinent from substances has not yet been assessed in a less supervised setting.
n) Mr. T. (D.)’s medication regimen includes SSRIs to control his OCD and to suppress his sexual desires.
o) Mr. T. (D.) is working as well with their behaviour analyst, who is educating him about self-care.
p) One of the difficulties the treatment team encounters is that Mr. T. (D.)’s mother is against him using psychotropic medication. His father is also against the use of psychotropic medication but does not actively object or attempt to prevent Mr. T. (D.) from taking his medication.
q) She adopts the list of risk factors set out on page 37 of the Hospital Report, as well the results of the HCR-20 on page 33, which explain why the treatment team considers Mr. T. (D.) to be a significant threat to public safety.
r) Mr. T. (D.)’s father is an approved person, and the approved passes have all gone well.
s) The treatment team does not believe that any further assessments of Mr. T. (D.) are required to rule out a diagnosis of paraphilic disorder.
t) Mr. T. (D.) is capable of making treatment decisions, and he understands his symptoms. However, when he is experiencing a decompensation, he is not able to appreciate that it is part of his major mental illness.
u) Mr. T. (D.) has insight into his diagnoses of schizophrenia and OCD and into how substance use adversely affects his mental status. He understands his need for medication and agrees that it helps him.
v) The treatment team has considered ECT for Mr. T. (D.), but he is not agreeable to it.
w) The recommended changes to the Disposition are meant to prepare Mr. T. (D.) for eventual transfer from the treatment unit to the rehabilitation unit. He should do well in a group home that is supervised, but he does not need 24/7 supervised accommodation.
- In response to questions from counsel for Mr. T. (D.), Dr. Mokhber testified:
a) Mr. T. (D.)’s smoking is not a concern; he only smokes one or two cigarettes while on passes with his father, which is not enough to affect his clozapine levels below the therapeutic threshold. He does have the insight to understand the impact that cigarette smoking could have on his levels. He does not smoke inside the hospital.
b) The reasons Mr. T. (D.) is a significant threat are set out in the Re-Offence Scenario, on page 36 of the Hospital Report. Without adequate supervision, he would likely become non-adherent to his medication regimen. His symptoms would intensify, causing his to become aggressive and to exhibit the same sexual behaviours as at the time of the Index Offences.
c) Mr. T. (D.) is now on the Sex Offender Registry.
- No other evidence was given.
Analysis and Conclusions:
Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board agrees with the joint submission: Mr. T. (D.) remains a significant threat to the safety of the public. Moreover, the Board has no difficulty coming to an independent conclusion that Mr. T. (D.)’s current constellation of symptoms and behaviours support a finding that he continues to pose a significant threat, as defined by the Supreme Court of Canada, in Winko. The Board makes this finding based on Dr. Mokhber’s testimony and documentary evidence available at the hearing.
In particular, the Board relies on the Re-Offence Scenario and the Overall Clinical Assessment of Risk, as set out in the Hospital Report:
“Re-Offence Scenario:
Without psychiatric supervision and treatment, Mr. T. (D.) would likely return to not taking his prescribed medication, resulting in his symptoms intensifying further. Given his fragile mental health, his judgment would likely become impaired, and he would likely violently reoffend similar to the time of the index offence.
Overall Clinical Assessment of Risk
It is the opinion of the treatment team that Mr. T. (D.) continues to pose a risk of serious physical or psychological harm to members of the public. The hospital believes that a detention order is necessary and appropriate to protect public safety while facilitating his rehabilitation and safe community reintegration. The following evidence supports this opinion:
Mr. T. (D.) has a major mental illness namely schizophrenia. During this reporting period, he continued to be impacted by auditory hallucinations, and OCD traits, which were noted to cycle roughly every six weeks. These symptoms impacted him daily, affecting all areas of his life, most notably with his activities of daily living;
Mr. T. (D.) has remained medication adherent; however, he continued to experience symptoms of his illness. He showed some resistance when medication changes were made and required supervision to maintain his adherence;
Mr. T. (D.)’s insight into his mental illness and his risk for violence continue to develop. He remains unable to recognize how his mental illness impacted him at the time of the index offence;
Mr. T. (D.) has a history of substance use and he has yet to participate in any addiction programming due to being highly impacted by symptoms of his illness; and
Mr. T. (D.) has limited professional supports outside his current inpatient treatment team.
The Board also agrees that the recommended changes to the Disposition are necessary for Mr. T. (D.)’s reintegration into society and his other needs, as it is hoped that he will be able to transition into a group home.
In consideration of all the evidence, submissions of the parties and taking into consideration the criteria set forth in s. 672.54, the paramount consideration being the safety of the public, in addition to the mental condition of Mr. T. (D.), his reintegration into society and his other needs, the necessary, and appropriate, Disposition is to continue with the Detention Order, with the changes agreed to by all the parties, and as set out in our formal Disposition.
DATED this 14^th^ day of April 2025, at the City of Toronto, in the Region of Toronto.
Mr. J. Weinstein
Alternate Chairperson
Office of the Registrar
Ontario Review Board