Ontario Review Board
Re: Michael James
ORB File No: 7834
Hearing held on: Wednesday, March 5, 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: Michael James Counsel: Mr. S.F. Gehl
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. D. Rows
REASONS FOR DISPOSITION
(Dated April 14, 2025)
Introduction
On January 12, 2021, Michael James was found not criminally responsible on account of mental disorder (“NCR”) on two charges of assault and threatening bodily harm, contrary to the Criminal Code of Canada (the “Criminal Code”).
Mr. James is currently subject to a disposition of the Ontario Review Board (the “Board”), dated May 24, 2024, detaining him at the Southwest Centre for Forensic Mental Health Care, St. Thomas (“Southwest” or the “Hospital”), with privileges up to and including the ability to live in the communities of Elgin and/or Middlesex Counties in accommodation approved by the person in charge.
On March 5, 2025, a panel of the Board convened to review Mr. James’ Disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. James was present for his hearing and was represented by counsel throughout the proceedings.
A Hospital Report dated January 6, 2025, was entered into evidence as Exhibit 1 (the “Hospital Report”).
The issues to be determined are whether Mr. James continues to represent a significant threat to the safety of the public and, if so, the necessary and appropriate disposition to manage that risk having regard to the criteria set out in s. 672.54 of the Criminal Code.
At the commencement of the hearing, counsel for the Hospital submitted that Mr. James continues to represent a significant threat to the safety of the public and a detention disposition is necessary and appropriate with amendments to the 2024 Disposition as follows: add indirectly supervised travel to clause 2 (f); and increase the 24 hour passes to 72 hours in clause 2(g).
Counsel for the Attorney-General adopted the Hospital’s position.
Counsel for Mr. James conceded for the purposes of this hearing that Mr. James continues to pose a significant threat to the safety of the public and agreed with the detention disposition and the changes recommended by the Hospital. However, counsel for Mr. James took the position that Mr. James be permitted to exercise the 72-hour passes on an indirectly supervised basis, as well as on an accompanied basis.
In closing submissions, counsel for both the Hospital and the Attorney-General agreed with the position of counsel for Mr. James and provided a joint submission to continue the Detention Order with changes to terms (as they appear in the Board’s formal Disposition), which includes indirectly supervised 72-hour passes.
For the reasons set out below and based on the evidence and opinions before us, the Board concludes that Mr. James continues to represent a significant threat to the safety of the public. The Board finds that a Detention Disposition is the necessary and appropriate Order on the terms set out in our formal Disposition having regard to the safety of the public, which is the paramount concern, and also having regard for Mr. James’ mental health and other needs.
Current Psychiatric Diagnoses
- Mr. James is currently diagnosed with schizophrenia; substance use disorder; ADHD; antisocial personality disorder; and intellectual disability.
Index Offences
- The circumstances of the index offences are excerpted from last year’s Reasons for Disposition and are as follows:
On August 5, 2020, Mr. James and his partner were involved in a domestic dispute. At that time Mr. James and his partner had been in a relationship for approximately five years. They were living together in Mr. James’ apartment even though Mr. James was subject to a two-year probation order prohibiting him from communicating with his partner or being within 100 meters of anywhere that he knew her to live or work. On August 5, 2020, Mr. James became enraged as he was hearing voices in his head. He ran towards his partner and pushed her into the front door. She hit her head on the door. She ran to the bedroom, barricaded the door with a dresser and she called 9-1-1. Mr. James then tried to enter the bedroom by pushing the door open and yelling, “I’m going to cave your face in.” A security guard for the community housing where Mr. James and his partner were living, heard the screaming and yelling. She attended at the apartment and knocked on the door and Mr. James exited the apartment and charged toward her. Fearing for her safety, the security guard drew her baton and ordered Mr. James to stop. He continued running toward her in an aggressive manner, yelling, “Do it, I dare you,” before returning to his unit. When the police arrived, Mr. James and his partner were both in the apartment. His partner had a bump on the back of her head but declined medical attention. Mr. James was arrested. The police described him as very escalated and exhibiting signs of significant mental health issues.
Background Information
- The Hospital Report contains detailed information regarding Mr. James’ history, background and psychiatric history, the entirety of which need not be repeated here in detail. However, this information was accurately and briefly summarized in last year’s Reasons for Disposition as follows:
In brief, Mr. James is 41 (now 43 as of the date of the current hearing). Mr. James’ mother left the family home when he was approximately six months old. He lived together with his father and two older brothers until he was 9 years old when he was placed into foster care. Mr. James reconnected with his mother when he was 12 years old. She passed away in 2013.
Mr. James left school in grade 10. He worked at a window factory for several months, then in various manual labour jobs for five years. Mr. James has been receiving ODSP since 2004.
Mr. James started drinking alcohol and using cannabis in his mid to late teens. Mr. James self-reports that he did not need to take substances, when he was taking his prescribed ADHD medication (Adderall). When not available to him he would resort to using crystal methamphetamine.
Prior to the index offences, Mr. James had a criminal record which commenced in 2008 and which includes convictions for assault, assault peace officer, forcible entry, harassing phone calls, criminal harassment, mischief and failing to comply with court orders, some of which occurred in a domestic context.
Mr. James also has a significant psychiatric history, with multiple contacts beginning in October 2011. Mr. James is currently diagnosed as suffering from schizophrenia, substance use disorder, antisocial personality disorder by history and attention deficit hyperactivity disorder (ADHD) by history.
Course Since Last Disposition
- The following excerpts from the Hospital Report summarize Mr. James’ course since the last Disposition. Mr. James had a very positive year:
On May 15, 2024, Mr. James began the reporting period on a leave of absence (LOA) to Chester Residence, a 24/7 supervised Community Homes for Opportunity (CHO) group home in St. Thomas, Ontario. Mr. James shared a room with one roommate. On July 17, 2024, he was discharged from the inpatient unit to the forensic outreach team under the psychiatric care of Dr. Arun Prakash. Since his LOA began, Mr. James remained in the community with no readmissions to hospital.
Upon transitioning to the group home, Mr. James expressed dissatisfaction due to feeling disconnected with the residents (many of the residents were more significantly affected by their illness), was having interpersonal issues with two residents, he didn't like the food, and the group home was larger compared to smaller homes and not centrally located to transportation or downtown.
In both scenarios [of the two residents who were difficult], he demonstrated appropriate coping strategies which included ignoring/walking away. Mr. James identified that some of his peers were not well in the home and that he would alert the group home manager, if needed. He was able to engage in dialogue with his team around stressors and coping strategies. He identified that leaving the group home to engage in activities alleviated his symptoms [of hallucinations].
Group home staff consistently had positive remarks to share about Mr. James’s tenancy. He exemplified generosity, for example, he purchased fruit for all the residents in the home to share. He was friends with his roommate and was working on making friends outside of his home. He noted that he did not have much in common with the other residents, but should “give them a chance.” He continued to explore ways to make personal connections.
He continued to state that he would like to move to independent living in London. …He believed that because he had lived independently in the past, then he would be able to manage his housing needs. When prompted to think about navigating budgeting or transportation in a larger city, Mr. James admitted that those aspects would be more difficult. In continued conversation, Mr. James understood that there would need to be some stability in his current placement, and assessments completed before considering independent living. At the time of this writing, Mr. James does not want to transfer homes, but desires to move on his own in London in the future. The treatment team opine that Mr. James would not be able to coordinate or maintain housing independently at this time and that he would likely not be able to problem-solve due to his cognitive limitations.
Mr. James continued to experience positive symptoms of schizophrenia, specifically auditory hallucinations. His symptoms fluctuated in severity and intensity.
Adjustments to his antipsychotic medication, clozapine, were made during this time, with effect.
Generally, his thought process was logical and goal-oriented and there was no evidence of paranoia or delusional thinking. There was also no evidence of his antisocial personality disorder during this reporting period.
Mr. James’s sources of stress centered around his lack of family support and connection, as well as his auditory hallucinations. At times, these stressors resulted in decreased energy and low mood and were congruent to the situation. Mr. James would self-isolate and would become reclusive to his room.
At times, Mr. James presented with blunted or restricted affect but brightened on approach. He was open to meeting with his treatment team and transparent in conversations about stressors, his illness, trauma, and grief.
Mr. James demonstrated challenges with concentration, attention, and memory which aligned with his overall cognitive functioning and limitations.
Mr. James was approved for Passport funding (monies for community integration) through eligibility from Developmental Services Ontario prior to transitioning into the community. Mr. James met with his treatment team several times to review and complete the process to independently submit receipts for reimbursement.
Mr. James was motivated and demonstrated appropriate follow-through when organizing his day. His leisure was organized for him by his treatment team and community partners (e.g. obtaining a YMCA membership, submitting the receipts to Passport, CHO activities were organized and run by CHO staff). When he was not accompanied by staff, he required prompts to attend activities with scheduled start times. He attended the YMCA independently, (approximately 4-5 times/week) and consistently named this to be his most important coping strategy. He described how good he felt mentally and physically after exercising. He required significant support with organizing his activities as he would become confused with the details or would not understand the purpose. He regularly attended Talbot House (CMHA leisure and program centre) and was increasing his engagement with peers. Mr. James also attended programs run by the group home and attended the library occasionally. In October 2024, Mr. James began attending Harvest Hands (food distribution bank) with an occupational therapist assistant. He was working towards independent attendance. With support, he continued to structure his day and was able to identify that his routine helped maintain his wellness.
On November 20, 2024, Mr. James completed an intake with Changing Ways (an organization that focuses on alternatives and responsibility of abusive behaviour), to begin a 12-week group centered around understanding abuse and healthy relationships. He completed two sessions and then missed two sessions. On December 4, 2024, Mr. James stated that he no longer wanted to attend due to anxiety in groups. With treatment team support and encouragement, he agreed to continue participating. He required support in phoning Changing Ways, connecting with the group facilitator to explain his absences, and asking to be re-admitted. At the time of this writing, he attended another session. Mr. James has stated that after this group concludes, he would like to initiate psychotherapy to address past traumas.
Evidence at the Hearing
The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Arun Prakash, Mr. James’ treating psychiatrist.
Dr. Prakash testified that Mr. James had a very positive year in the community, and briefly summarized the evidence excerpted above from the Hospital Report.
Dr. Prakash emphasized that Mr. James is now settled and happy in his current accommodations and does not want to move. He structures his days with exercise, activities at Talbot House and in his residence, and attends Changing Ways regularly. Mr. James is now comfortable with the Changing Ways group setting and can express whether he understands the materials. He has been losing weight as a result of diet and exercise and expresses how good exercise makes him feel.
Mr. James continues to work on developing relationships. He now has a good friend who is going through the process to become an Approved Person. This friend lives in the Kitchener-Waterloo area. The purpose of the Hospital’s recommendation to add indirectly supervised travel, and to change the 24-hour passes to 72-hour passes is to facilitate visits with this friend.
Dr. Prakash indicated that he has no concerns about including indirectly supervised passes for up to 72 hours as requested by counsel for Mr. James. The treatment team will use a stepwise approach with these passes, beginning with shorter passes and passes on which the Approved Person accompanies Mr. James to travel to and from the Kitchener-Waterloo area.
Mr. James is hoping to connect with his 18-year-old son, but this relationship has not developed yet.
Mr. James has not used substances during the reporting period although he is exposed to substances in the group home. While he has only been in the community for six to seven months, Dr. Prakash stated that remaining abstinent in the group home has been a “great achievement”, and he hopes that Mr. James will continue to remain abstinent.
Mr. James has not yet attended a residential treatment program. He feels he has learned enough and is reluctant to attend. Dr. Prakash wonders if Mr. James’ cognitive difficulties with the group setting is part of the reason for his hesitation to attend the program. Dr. Prakash indicated, however, that he understands Mr. James’ concern and that addiction services will assess what type of programing would be most suitable for him. Dr. Prakash also indicated that if the treatment team recommends a program, Mr. James will accept it.
Dr. Prakash told the Board that the short-term goal is for Mr. James to continue to live at the Chester Street residence, and to adjust his medications. Mr. James continues to pose a significant threat to the safety of the public.
Dr. Prakash agreed that the following paragraphs from the Board’s Reasons for Disposition last year continue to be true:
“Mr. James has clear limitations in his insight in all domains.
Mr. James needs a detention order at this time. When he is ill, his tendency toward violence is unpredictable.
The risk of violence is moderate to high if Mr. James is not on a detention order. If he did not have the support of the Forensic system he would seek his own accommodation, which would be stressful for him. In the context of stress, he would become non-adherent with treatment. In that context his hallucinations and delusions would increase, and he would likely become violent. He requires some level of supervision and support wherever he lives.”
- No other evidence was called.
Analysis and Conclusion
In Winko the Supreme Court outlined that, in coming to the conclusion on the issue of significant risk, a Review Board should closely examine a range of evidence, including: the circumstances of the original offence; the past and expected course of the accused’s treatment; the present state of the NCR accused’s medical condition; the NCR accused’s own plans for the future; the support existing for the NCR accused in the community; and most importantly, the recommendations provided by experts who examined the NCR accused. In coming to our conclusion in this matter, the Board relies on the expert evidence of Dr. Prakash in addition to the documentary evidence before us.
In particular, the Board relies on the following excerpts of the Assessment of Risk and Re-Offence Scenario within the hospital report:
“Mr. James continues to present with active symptoms of schizophrenia, symptoms of which have historically led to violent behaviours. Mr. James has complied with his medication regimen in the controlled and supervised setting of his group home, he would not be able to manage this on his own due to his cognitive limitations. Mr. James's insight into the index offence, his illness, treatment, and risk for violence remains underdeveloped. Mr. James has been abstinent from substance use, but has not connected with community-based substance use programming; and Mr. James’s professional supports are currently limited to the forensic outreach team. He continues to have no personal supports despite his desire to reconnect with his family.”
“Absent forensic supervision and support, Mr. James would attempt to live in London, Ontario and attempt to live independently. He would struggle with the increased stressors of attempting living independently, which would lead to worsened psychotic symptoms and potential other risk-enhancing coping, including substance use. He would likely fall away from treatment and become nonadherent with medication. His auditory hallucinations and persecutory delusions would intensify and overwhelm his limited frustration tolerance. Psychotic symptoms and substance use would further disinhibit underlying aggressive impulses; he would become physically violent, as in the past.”
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. James remains a significant threat to the safety of the public.
The Board accepts the opinion of the treatment team as stated in the Hospital Report that the necessary and appropriate disposition is a detention disposition and not a conditional discharge:
The treatment team considered a less restrictive disposition, however, opined that it would not be sufficient to manage upcoming possible destabilizing risk factors, such as the increase of his positive symptoms. Mr. James wants to live independently, but has yet to be tested in independent housing, and the transition and lack of personal and professional supports could destabilize him. In addition, he is not connected to professional mental health services. Mr. James’s symptoms and medication are supervised by CHO staff. Should he decompensate, the team would require return him to the hospital expeditiously.
The Board adopts the joint submission with respect to the expansion of Mr. James’ passes. As noted by Dr. Prakash, this will enable the treatment team to assess Mr. James’ mental stability, and his ability to remain abstinent, as he integrates into the community while exposed to cannabis in the group home and while dealing with the demands of travel. This is the least onerous and least restrictive disposition.
In making the disposition the Board took into consideration all the evidence and submissions, and the criteria set forth in s. 672.54, the paramount consideration being the safety of the public, the mental condition of Mr. James, his reintegration into society and other needs of the accused.
The Board finds that Mr. James continues to represent a significant threat to the public and that the necessary and appropriate Disposition is the continuation of the Detention Order upon the terms set out in our formal Disposition.
The Board congratulates Mr. James on his successful adjustment to living in the community and encourages him to continue to participate in the programming recommended to him by the treatment team.
DATED this 14th day of April 2025, at the City of Toronto, in the Region of Toronto.
Ms. K. Tomaszewski Legal Member
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Office of the Registrar Ontario Review Board