Re: Alexander Venneman
ORB File No: 6417
Hearing held on: Thursday, February 20, 2025
Place of hearing: Centre for Addiction and Mental Health, Toronto
Pursuant to: Section and 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. M. Segal
Members: The Hon. B. Allen Dr. B. Bordoff Dr. J. Kis Mr. J. Cyr
Parties Appearing:
Accused: Alexander Venneman Counsel: Mr. P. Valli
The Person in charge of Hospital: Counsel: Mr. M. Warner
Attorney General of Ontario: Counsel: Mr. M. Feindel
REASONS FOR DISPOSITION
(Dated April 14, 2025)
Introduction
On October 4, 2013 Mr. Alexander Venneman was found not criminally responsible by reason of mental disorder on a charge of attempting to commit murder contrary to the Criminal Code.
Under s. 672.81(1) of the Criminal Code a panel of the Ontario Review Board (the Board) was convened on February 20, 2025 at the Centre for Addiction and Mental Health (CAMH or the Hospital) to review Mr. Venneman’s risk to public safety and the appropriate disposition under s. 672.54 of the Criminal Code.
Mr. Venneman’s existing disposition dated March 18, 2024 orders a conditional discharge on condition among others that he reside at 1302 King Street West, Unit 303, Toronto, ON, M6K 1G8.
At the start of the hearing the parties provided the Board with their respective positions on disposition and significant risk. The parties advanced the joint position that a continuation of Mr. Venneman’s existing disposition of a conditional discharge subject to the existing conditions remains the necessary and appropriate, least onerous and least restrictive recommendation to ensure the safety of the public. The parties maintained their positions at the close of the evidence.
Disposition
- For the reasons set out below the Board concludes, under s. 672.54 of the Criminal Code, that Mr. Venneman continues to pose a significant risk to public safety and that the necessary and appropriate disposition, that is the least onerous and the least restrictive to mitigate risk to public safety, is a conditional discharge subject to the existing conditions.
Current Diagnoses
- Mr. Venneman’s current diagnoses are schizophrenia and cannabis use disorder in sustained remission.
The Evidence
- The Board has before it the Hospital Report dated February 5, 2025 which contains an account of Mr. Venneman’s personal and psychiatric background which needs not be repeated in detail here. The Board also has the oral evidence of Dr. Hanna Meng, the author of the Hospital Report.
Index Offence
The circumstances of the index offence are described in the Hospital Report and are summarized as follows:
The index offence of attempted murder occurred on July 15, 2013. The victim was his mother. She reported that when she returned home Mr. Venneman jumped out of a hiding spot, said, "die bitch die" and stabbed her repeatedly. Mr. Venneman called 911 and reported that he killed his mother. He was calm and cooperative and was taken into custody without incident. He told the police that he stabbed his mother because she was "gang stalking him" and that she had been about to kill him so he killed her. He believed his whole family was "gang stalking" him and planned to kill him. His mother survived multiple stab wounds to her face, head and upper torso. She had surgeries to remove what was thought to be the tip of the knife from her head and to repair tendons in her hand.
Current Diagnoses
- Mr. Venneman’s current diagnoses are schizophrenia and substance use disorder in remission.
Criminal History
- Mr. Venneman reports that he was caught shoplifting at the age of 18 and that this was addressed by way of diversion.
Substance Use
- Mr. Venneman stated that he first smoked marijuana at age 13 and that by age 16 he was smoking about two grams daily. This was his drug of choice and he used it daily until a few months before his index offence. His normal state was to "be high all the time". He would only use other substances including opioids, MDMA and cocaine when in the company of others. Mr. Venneman indicated that he started using alcohol at age 15, binge-drinking on weekends until he was 17 when he abruptly stopped consuming alcohol because he did not enjoy it.
Mr. Venneman’s Personal History and Psychiatric
Before the Current Reporting Year
Personal History
Mr. Venneman is 37 years old. He was born in Etobicoke and raised by his father and mother until their separation when Mr. Venneman was age 12. His father was diagnosed with "bipolar disorder with schizophrenic tendencies" and his children described him as being volatile at times because he was non-adherent with prescribed treatment. His father died in 2010. Mr. Venneman has a sister who resides in Guelph and a half-sister both of whom are older than him.
Mr. Venneman completed Grade 10 and some Grade 11 courses. He dropped out of high school due to social anxiety. Mr. Venneman has had an intermittent employment history with long periods of unemployment. He obtained employment at Canadian Tire and started to work there full-time in 2017.
By age 15 Mr. Venneman identified as homosexual. He reported having various sexual relationships before age 18. At age 18 he had a brief relationship in which both parties used drugs including cocaine. He reported that since then he had mostly casual sexual encounters with individuals he met online. Mr. Venneman stated that he has close relationships with his mother and both of his sisters.
Psychiatric History
Mr. Venneman did not seek psychiatric help before he committed the index offence. From July 2013 to December 2014 he was admitted to Waypoint Centre for Mental Health Care (Waypoint). He was subsequently transferred to CAMH from December 2014 to October 2019 when he was conditionally discharged to community housing.
Mr. Venneman reported that in 2013 he began experiencing recurrent suicidal ideation. He estimated that his mental illness started at age 19 with a depressed mood and an intense desire to withdraw from everyone. He started to experience auditory hallucinations at age 20. Mr. Venneman stated that he was smoking marijuana daily when he started experiencing auditory hallucinations which he stopped during the months leading up to the index offence because of his fear and preoccupation with gangster stalkers.
On July 31, 2013 Mr. Venneman was admitted to the forensic assessment program at Waypoint to be assessed for criminal responsibility for his index offence. He reported experiencing bizarre and paranoid delusions in which he believed “gangster stalkers” had targeted him for elimination and that he had been “electroshocked” while he slept. Mr. Venneman complained that the gangster stalkers, by sabotaging him and causing him anxiety, were trying to force him to commit suicide and commit mass murder. He endorsed ongoing auditory hallucinations.
Mr. Venneman was found incapable of knowing the wrongfulness of his actions at the time of the index offence due to psychosis and on October 4, 2013 he was assigned a not criminally responsible designation.
Mr. Venneman was not a management problem during his admission to Waypoint and had achieved level 6 privileges by October 2013. There was no clinical need for a “no contact order” for Mr. Venneman’s mother as she understood his illness was the motivation for the attack. His mother was in regular contact by phone. Mr. Venneman continued to believe the gangster stalkers were real.
As of December 2014 Mr. Venneman was administered anti-psychotic medication and he denied hearing voices but was seen talking to himself. He reported believing that the lyrics in songs by certain music artists were directed at him which caused his psychotic symptoms to be triggered. Mr. Venneman remained cooperative and compliant with his medication. He stated that he would "definitely" stay on his medication when released from the hospital.
Mr. Venneman attended five of six sessions of the Anger Management Group and a Solutions for Wellness Nutrition Group. Also on the positive side, Mr. Venneman maintained a positive relationship with his two sisters and mother who visited him regularly.
Mr. Venneman's Board disposition dated November 19, 2014 provided for secure detention at CAMH. He arrived at CAMH on December 24, 2014 and was placed in a secure forensic unit until January 2, 2016 when he was transferred to a general forensic unit.
While on the secure unit at CAMH he was cooperative with unit rules and expectations but required prompting to attend his groups on time and to complete his activities of daily living, such as regular hygiene. There were some modifications to his medication but he continued to exhibit residual psychotic symptoms of auditory hallucinations - ideas of reference such as music lyrics being about him and paranoia believing that "gangster stalkers" were monitoring all of his utterances. Mr. Venneman had superficial insight into his illness, the index offence and the need for life-long medications. He seemed to appreciate the risk of potential serious violence with decompensation and the need to abstain from substances.
Throughout his time in the secure unit Mr. Venneman continued to complain about being “electroshocked” by the “gangster stalkers” and about hearing voices for days that were laughing at him. He was able to take advantage of passes and attend groups despite his symptoms. Mr. Venneman sometimes required prompting to participate when he attended programming including therapeutic sessions.
As noted Mr. Venneman was transferred from a secure forensic unit at CAMH to a general forensic unit January 16, 2016.
Mr. Venneman’s circumstances improved from the beginning of his time in the general forensic unit, for instance: he was compliant with ward rules and expectations; there were no behavioural or management concerns; he remained generally pleasant; he attained a good understanding of his mental illness and the need for treatment and acknowledged his illness as schizophrenia; regarding the index offence he took responsibility for his actions; he used his indirectly supervised passes appropriately; he set goals of completing high school and obtaining employment which he succeeded at by obtaining employment at Canadian Tire in 2017; he continued to participate in some therapy sessions and group activities; he assumed control over his finances; his social anxiety around strangers began to abate; and he worked with unit staff to secure community accommodations.
On October 20, 2017 Mr. Venneman was discharged from a general forensic unit to Harbour Light Transitional Housing where he transitioned well. He remained in the community under a psychiatrist and the Forensic Out Patient Services (FOPS). Due to his compliance progress, his reporting requirement was reduced from daily to once a week. There were no periods of instability evidenced in Mr. Venneman’s mental state over the year. He did not exhibit periods of deterioration or psychotic symptoms. Mr. Venneman continued to display good insight into the role of treatment and complied with his medication regimen. He consistently showed an appreciation of the role that his mental illness played in his criminal acts and took responsibility for maintaining his stability to prevent future dangerous conduct.
Given his successful transition at Harbour Light, on September 18, 2018, Mr. Venneman secured a one-bedroom apartment in the North Toronto area. He had success with independent living. He had full-time employment at Canadian Tire. He attained more independence from external oversight. He continued to display avoidance and minimizing behaviours to cope with anxiety and was receptive to treatment to explore the underlying causes of his anxiety. He maintained compliance with his medications, reporting to FOPS and attending meetings with his treating psychiatrist. Mr. Venneman's insight into his mental illness, need for treatment and ongoing substance abstinence remained intact.
On January 27, 2019, Mr Venneman independently reported to the emergency department at CAMH suffering from a panic attack. Thinking the emergency department would inform the clinical team he did not mention this until his next reporting session. He at first attempted to minimize the incident but when encouraged to elaborate, he disclosed that this panic attack had been in the context of re-emergent psychotic symptoms. He heard “noises, sounds” leading to increasing anxiety and eventual paranoid ideation that “it involved people again.” This triggered fear that he was experiencing a relapse. He was open about his chronic underlying fear of relapse and his fear of a catastrophic outcome.
In November 2019 a new conditional discharge disposition was in place which decreased the reporting requirement. Mr. Venneman began toward the end of 2020 to have increasing difficulty managing his reporting obligations and coping with stressors. In August 2020 he missed psychiatric appointments for two consecutive weeks. There were also concerns about reliable medication compliance which required increased supervision. However despite increased supervision and support, Mr. Venneman continued to struggle in the latter half of the reporting year. His engagement with the team deteriorated and he became increasingly defensive and resistant to feedback.
Mr. Venneman continued to deny problems with managing his obligations and insisted that he was doing well. The deterioration in his condition became obvious in late October 2020 when he was terminated from his position at Canadian Tire due to performance concerns. Since the loss of his employment, his FOPS reporting was increased to three times weekly to provide him assistance with external structure. The clinical team believed that the deterioration in Mr. Venneman’s organization, self-management and motivation in 2020 was likely owing to his new conditional discharge disposition and the provision of greater independence with less external oversight. Mr. Venneman’s performance did not improve by the end of 2020.
At this point Mr. Venneman was exhibiting fair insight into his schizophrenia, the need for ongoing treatment and the importance of substance abstinence. However he appeared to overestimate his ability to cope and minimized the destabilizing effects of stressors. He was generally dismissive of recommendations for psycho-social interventions and structure. Despite his recent challenges in 2019/2020, Mr. Venneman continued to insist he was doing very well.
On September 26, 2021 Mr. Venneman was re-admitted to a general forensic unit at CAMH due to his significant instability and functional deficits over 2021. There were several periods of psychotic destabilization with increased paranoia and thought disorder, including a period in August 2021 that was characterized by overt delusional thinking, behavioural changes and suspected perceptual disturbances.
There were concerns about possible inadvertent medication non-compliance which likely heightened his difficulties. Mr. Venneman continued to minimize any concerns but he went to the hospital on September 26, 2021 complaining of anxiety. He remained vague about his difficulties but his aunt reported that he was coping poorly at his residence and that his apartment was in disarray. Mr. Venneman remained a voluntary patient in a general forensic unit. At this point there was a very high probability that he would be formally accepted into the Regeneration House Step-Up supported housing program.
Mr. Venneman appeared to accommodate well with the increased supports and structure in the Hospital. He was cooperative with medication changes. The treatment team's opinion was that the combination of supervised medication administration, further dose optimization and ongoing structure and support meaningfully stabilized his mental state. Mr. Venneman regularly attended weekly sessions such as Illness Management and Recovery, Cognitive Behavioural Therapy (CBT), Stress and Coping, MoneyWise and occasional cooking groups on the unit. He also met one-on-one with the Forensic Consultation and Assessment Team (FORCAT) psychologist, Dr. Pauls, for individual CBT for anxiety. Mr. Venneman utilized shorter, indirectly supervised passes to the community for behavioural activation and he scheduled longer passes to attend errands with his mother or his FOPS team.
Mr. Venneman owned the house in Guelph where his sister resided. With the help of family he sold that house with a closing date in early January 2022. The proceeds of the sale would support him pending finality on his application for ODSP. Mr. Venneman was presented to the Step-Up program at Regeneration House located closer to CAMH. The program agreed to hold a spot for him until the formal closure of his house sale in January 2022.
At this residence he would have his own apartment and kitchen. There would be staff on site for 12 hours a day until 8:00 p.m. to assist with medication administration. The program provided daily groups and activities for external structure and support and required Mr. Venneman to attend FOPS programs and maintain his individual CBT therapy with Dr. Pauls.
On January 20, 2022 Mr. Venneman was discharged to the Regeneration House Step-Up Program. This supportive housing allowed for interventions when needed, closer physical proximity to CAMH and increased clinical contacts with the FOPS team. Mr. Venneman did not display any symptoms of active schizophrenia, was better able to cope and manage stress and to follow through on stated goals.
The increased support in his new residence and increased contacts with FOPS resulted in meaningful improvement in Mr. Venneman's clinical stability. There was no evidence of psychosis and his anxiety was much improved. He showed continued improvement in his hygiene and grooming and utilized his time more constructively.
Mr. Venneman continued to exhibit fair to good insight into his schizophrenia, the need for ongoing treatment and the importance of substance abstinence. When queried however Mr. Venneman continued to minimize his significant instability over the previous reporting period and the benefits associated with an increase in his medication. He was evasive and dismissive when queried about the impact of stress and his coping difficulties before his last admission to CAMH. Despite his reluctance to acknowledge the difficulties, he consistently expressed an appreciation for his new supported housing.
During the December 2022 to February 2024 reporting period Mr. Venneman’s situation was, in general, stable, except for a period of decline in 2023. He continued to reside in supportive housing provided by Regeneration House (Step-Up Program) and enjoyed the benefits of the supervised environment. There were no signs of overt psychosis during the period. He regularly attended courses through the Adult Learning Centre and successfully obtained his GED equivalency. Mr. Venneman continued to report weekly to FOPS as his principal source of external structure and received ongoing Cognitive Adaptation Training (CAT) interventions at his residence to support his independent living skills.
By mid-September 2023 it became obvious that Mr. Venneman’s functioning began deteriorating again. He exhibited subtle changes in his mental status including increased cognitive rigidity and distractibility during interactions. He repeatedly failed to follow through on his stated goals of registering with employment programs. Mr. Venneman missed appointments with FOPS and FORCAT and was slow to respond to the clinical team’s communications. Mr. Venneman’s case manager noted that he was taking his anti-psychotic medications at progressively later times sometimes past midnight. He initially resisted returning to supervised medication administration but eventually relented.
From January 2024 Mr. Venneman functioned well re-establishing a routine with the ongoing support, encouragement and oversight of his forensic clinical team. In February 2024 his case manager tried to provide him with more independence in organizing his schedule and commitments. But Mr. Venneman immediately began to miss appointments again and was unable to proactively coordinate his activities.
Current Reporting Year – March 2024 to February 2025
Mr. Venneman continued to reside in supportive housing provided by Regeneration House (Step-Up Program). There were no significant incidents of concern as he was compliant with the conditions of his disposition. There were no incidents of aggression or substance use. His oral medications were supervised by housing staff. His circumstances were not remarkable in any way. Mr. Venneman made little progress in his identified productive goals. His external structure was principally comprised of weekly reporting to FOPS and the activities facilitated by his case managers. Mr. Venneman’s overall stability remained highly predicated on external sources such as management interventions and the external controls of the Board.
Unknown to the clinical team Mr. Venneman began to experience periods of intense anxiety distress with associated vague paranoid ideations after the discontinuation of his anti-depressant medication sertraline. He consistently denied these concerns to his case manager. Mr. Venneman developed intrusive negative thoughts believing that the housing staff and his clinical team did not want him to succeed and that forensic co-patients tried to prevent him from receiving inpatient care. He believed that co-patients looked at him on the Hospital grounds which made him feel like they were negatively judging him.
After sharing these concerns Mr. Venneman reluctantly agreed to increase the anti-depressant escitalopram between October and November 2024. His mother reported that her son’s anxiety appeared reduced and that in their phone calls he was no longer reporting the same concerns about panic attacks and paranoid distress. Mr. Venneman continued his appointments with FORCAT and appointments and outings with FOPS. However he regularly missed appointments and had to be reminded. He eventually ceased participating in the FOPS events complaining of illness. There was a lack of structure to his time.
Mr. Venneman began to gradually drop out of or be removed from programs he enrolled in, for instance, the Woodgreen Work Initiative Network (WIN) Program for vocational preparation which involved virtual classes twice weekly and meetings with his employment counsellor once weekly. He was removed from the program due to failed attendance. Between January and March 2024 he attended swim lessons at the YMCA. He reported that gym attendance would comprise a significant component of his weekly structure. However his attendance became increasingly sporadic over the year. By January 2025 he conceded that he had not attended the lessons for some time.
On May 29, 2024 Mr. Venneman attended the CAMH emergency department requesting a one-week admission for a “tune-up.” This visit occurred shortly after his removal from the WIN Program. He had problems connecting his hospital admission-seeking with this recent stressor. His mental state appeared at baseline, but he was kept overnight for observation as a precaution and then assessed as suitable to be discharged. His main concern was “stress/low mood.” He was reluctant to return home which the clinical team saw as an attempt to avoid the cause of his stress. His mother was concerned that he was lonely and that he did not like being alone in his apartment.
The Hospital Report addressed the factors that could underlie a potential re-offence scenario:
Mr. Venneman's most likely reoffence scenario would be through psychotic decompensation resulting from non-compliance with antipsychotic medication, even inadvertently or intermittently (i.e., occasional missed doses). His risk of psychotic decompensation would be heightened by either a return to his previous pattern of substance use and/or extended exposure to an unmanageable level of stress. On his own, he has difficulty appraising potential stressors or coping through effective means. Due to his tendency to overestimate coping abilities and minimize difficulties, he is anticipated to experience a progressive increase in his exposure to destabilizers over time. When confronted with stressors that overwhelm his avoidant coping style, he is susceptible to exacerbation of his psychotic illness and reduced consistency in medication compliance. While he has demonstrated some ability to proactively seek care when in crisis, he continues to minimize the nature of his symptoms and the presence of stressors, thus making it difficult to detect early signs of decline without close monitoring. Should his mental state start to deteriorate, his judgment and organizational abilities would correspondingly decline, increasing the likelihood of further treatment non-compliance and mental state deterioration. [at pages 52 and 53].
- On the question of the risk presented by Mr. Venneman, if granted an absolute discharge as compared to his existing conditional discharge, the Hospital Report states the following:
Taken together, when weighing Mr. Venneman’s pertinent risk and protective factors, his risk of future violence, including serious physical harm akin to the index offence, would be Low-Moderate in the context of a premature Absolute Discharge. In contrast, should he remain subject to his current Conditional Discharge disposition, his risk of any future violence would be Low.
[at page 51].
- The clinical team unanimously recommends that a continuation of Mr. Venneman’s current disposition of a discharge subject to the existing conditions remains the necessary and appropriate, least onerous and least restrictive recommendation to ensure the safety of the public.
Oral Evidence of Dr. Hanna Meng
Dr. Meng testified at the hearing. She provided the update that since the date of the Hospital Report Mr. Venneman has attended an information session at George Brown College for a construction course scheduled to start in May 2025.
Dr. Meng testified the clinical team believes that once Mr. Venneman adjusts to the program, attending George Brown full-time will be a good use of his time. She pointed out that the progress he previously achieved, for instance with employment at Canadian Tire, has stalled during this reporting year.
Dr. Meng stated that the rehabilitative goal for the upcoming year is to get Mr. Venneman out of his current rut and into a structured routine of organized activity to reduce his anxiety and foster less dependence on the external supports he relies on heavily at this time. He meets with the treatment time once a week requiring him to leave his home and get outside. Mr. Venneman gets support with adopting measures for mitigating his anxiety and stress about future success. The treatment team hopes this plan will reduce Mr. Venneman’s anticipatory anxiety and regenerate the confidence he lost over the past year. He is being encouraged to seek therapeutic approaches to addressing his stress and anxiety through programs providing behavioural training and education.
Dr. Meng opined that a conditional discharge with the level of support and supervision currently in place is the optimal arrangement for Mr. Venneman at this juncture. On the positive side, he voluntarily seeks hospital support when he decompensates although he tends to minimize the reason for his decline and attempts to cope with stress through avoidance behaviours.
The Parties’ Positions
- The parties maintain their joint position that Mr. Venneman continues to be a significant risk to the safety of the public and that the least onerous and least restrictive disposition, that is necessary and appropriate in the circumstances, is a conditional discharge on the same conditions as the existing disposition.
The Board’s Conclusion
While mindful of the parties’ joint position the Board is required to come to an independent determination.
Based on the evidence before us, the Board unanimously accepts the opinion, as stated in the Hospital Report, that Mr. Venneman remains a significant threat to public safety within the criteria outlined in Winko and as defined in s. 672.5401 of the Criminal Code. The Board considered the criteria, as set out in s. 672.54, namely, the paramount criterion of the safety of the public and Mr. Venneman’s community re-integration, his mental condition and his other needs.
The Board agrees with the parties and accepts, pursuant to s. 672.54 of the Criminal Code, that the least onerous and least restrictive disposition is a conditional discharge on the same conditions as the existing disposition.
The Board arrives at that decision for the following reasons.
The Board finds from the evidence in the Hospital Report and the testimony of Dr. Meng that a conditional discharge on the existing conditions is necessary to manage Mr. Venneman’s risk. The clinical team has set in motion a rehabilitation plan to help Mr. Venneman regain the progress and confidence he lost since the previous reporting year. The Board finds that the treatment team’s plan to encourage activities like attending school and therapeutic programming is a constructive one.
In view of Mr. Venneman’s use of a knife during the index offence the Board considered a weapons prohibition but unanimously determined its was not necessary. Our view is influenced by the clinical team’s finding that his risk of violence is low on a supervised conditional discharge when medication-complaint and abstinent from the use of substances. During the hearing the parties agreed with this view.
The aim is to eventually reduce Mr. Venneman's dependence on external supports to lay the groundwork for helping get him back on track to a productive lifestyle. In the meantime, a conditional discharge with significant support and monitoring is necessary as a starting point to improve Mr. Venneman's ability to achieve success in the community and to reduce the possibility of danger to the community if his mental status were to decline.
In keeping with the Criminal Code’s s. 672.5401 criteria, the existing conditional discharge allows Mr. Venneman to maintain his integration into the community and provides for public safety given the supervision the Hospital retains over his medication compliance and mental status.
Based on the evidence in the Hospital Report and the oral evidence added by Dr. Meng the Board finds, under s. 672.54 of the Criminal Code, that Mr. Venneman remains a significant threat to public safety and that currently the necessary and appropriate disposition, that is the least onerous and the least restrictive to mitigate risk to public safety, is to maintain his conditional discharge on the existing conditions.
The Board wants to acknowledge the importance of Mr. Venneman's plan to enrol in school and attend a college program in an area in which he has some experience. We encourage Mr. Venneman to continue with his plan to be more engaged in housing programs, pursue his educational plan and, participate in other activities outside his home to lift himself out of the stagnancy he has recently found himself in.
DATED this 14th day of April, 2025, at the City of Toronto, in the Toronto Region.
The Hon. B. Allen Legal Member
__________________ Office of the Registrar Ontario Review Board