Ontario Review Board
Re: Shevon Guthrie-Cahns
ORB File No: 8402
Hearing held on: February 21, 2025
Place of hearing: Ontario Shores Centre for Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Ms. L. Banks (by Zoom videoconference) Members: Dr. R. Kunjukrishnan (by Zoom videoconference) Dr. G. Nexhipi (by Zoom videoconference) Ms. C. Murray Mr. A. Mete
Parties Appearing: Accused: Shevon Guthrie-Cahns Counsel: Ms. J. Boissonneault
The person in charge of hospital: Counsel: Ms. J. Szabo
Attorney General of Ontario: Counsel: Mr. T. Hewitt
REASONS FOR DISPOSITION
(Dated April 24, 2025)
Introduction:
1On September 29, 2023, Shevon Guthrie-Cahns was found not criminally responsible (“NCR”) on one count of aggravated assault, contrary to the Criminal Code. On the same date, the Crown withdrew charges of assault with a weapon and possession of a weapon for a purpose dangerous to the public peace. Following his NCR finding, an initial hearing was held before the Ontario Review Board (“ORB” or the “Board”) and a Disposition dated November 14, 2023 was issued detaining Mr. Guthrie-Cahns at the Forensic Program of the Ontario Shores Centre for Mental Health Sciences (“Ontario Shores” or the “hospital”). Pursuant to the terms of his Disposition, Mr. Guthrie-Cahns’ most liberal privilege allows for passes for up to 12 hours to enter the community within a 150 km radius of the Ontario Shores, indirectly supervised.
2On February 21, 2025, a panel of the ORB convened for the purposes of conducting an annual review of Mr. Guthrie-Cahns’ Disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. Guthrie-Cahns was present at the hearing and was represented by his counsel, Ms. J. Boissonneault. Several members of Mr. Guthrie-Cahns’ family were in attendance at the hearing to support him. The victim of the index offence, Ms. P. Mitchell, and several of her family members were also in attendance at the hearing.
3The issues considered at this hearing were whether Mr. Guthrie-Cahns is a significant threat to the safety of the public as defined in s. 672.5401 of the Criminal Code and, if found to be a significant threat to the community, the determination of the necessary and appropriate Disposition in the circumstances bearing in mind the factors enunciated in s. 672.54 of the Criminal Code.
4For the reasons set out below, this Board concluded that Mr. Guthrie-Cahns continues to represent a significant threat to the safety of the public. The Board also determined that the necessary and appropriate Disposition is that Mr. Guthrie-Cahns continue to be subject to the terms of his existing Detention Order with the addition of the following terms:
passes for up to 7 days to enter the community, within a 150-kilometre radius of Ontario Shores, accompanied by staff or a person(s) approved by the person in charge (“PIC”);
passes for up to 7 days to enter the community, within a 150-kilometre radius of Ontario Shores, indirectly supervised;
an international travel pass for up to 14 days, accompanied by a person(s) approved by the PIC on an itinerary approved in advance by the PIC;
to live in the community in accommodation approved by the PIC;
while living in the community, he shall report to the PIC or his/her designate, not less than once every two weeks, or as required.
Index Offence:
5The circumstances of the index offence are set forth in the Board’s Reasons for Disposition dated November 29, 2023, as follows:
“The Accused and Victim, (Pamela MITCHELL) were neighbors but unknown to each other apart from casual acquaintances within the neighborhood. The accused lived with his mother and sister. The accused suffers from what appears to be schizoaffective disorder with catatonic features.
On May 7, 2023 the victim was on her porch having a cigarette when the accused approached her, unprovoked, and stabbed her approximately 12-15 times. The injuries were to her left arm, chest, abdomen and lips but on her right lower leg the stab wound was deeper and was bleeding profusely. After attacking Ms. Mitchell the accused fled back to his residence. The victim’s daughter, Kimberly HOVEN was at the residence at the time along with her 5 year old daughter Malia. Kimberly Hoven and Malia heard their mother/grandmother screaming. They saw the accused running back to his residence. The victim was in critical conditions but was stabilized through medical intervention by paramedics and medical staff at Sunnybrook Hospital. While at the hospital, the hospital Ms. Mitchell was able to tell police about the event.
Police set up containment in the front and rear of [the] accused’s residence. The accused was eventually arrested by the tactical unit at approx. 1:28 am May 8, 2023. The arresting officer described the accused to be emotionless the entire time in police custody and exhibited no remorse.
A search warrant of the Accused’s residence was authorized on May 8, 2023 by Justice of the Peace L. Smith. The accused’s clothing he had been wearing at time of the offence was seized (most of which contained blood). The knife used was located in a kitchen drawer. That knife was seized and there was also a blood drip on a second smaller knife which was also seized. The victim’s clothing was seized as well, and included a T-shirt, jeans, socks and jacket, which all had blood on them.
SOCO photos were taken of the accused’s clothing, his hands (left palm had dried blood on it – which was swabbed) of the scene at the victim’s residence, the accused’s residence and knives. SOCO photos were also taken of the victim’s injuries once she was released from hospital, which show all the locations of stitches, staples, and bruising. Her right arm was bandaged, the officer noted that she had difficulty standing for the photos and rotating/lifting her left arm.
At the time of the offence the accused was prescribed medication for his mental health issues, but he was not regularly taking all of his medication. His family described his mental health as deteriorating in the days leading up to the offence.”
Personal History:
6Mr. Guthrie-Cahns’ personal history is set out in detail in the Hospital Report to the ORB dated November 13, 2024 (the “Hospital Report”) which was filed as an exhibit at the hearing and need not be repeated here. These Reasons adopt the background information from the ORB Reasons of November 29, 2023, edited as set forth below.
7Mr. Guthrie-Cahns was born in Toronto and moved to Ajax with his parents and older sister when he was seven years old. His parents separated in 2016. He is a 28-year-old single man with no dependents. He was living at home with his mother and sister at the time of the index offence.
8He graduated high school in 2014 and attended the Architectural Technology program at George Brown College in 2015. He suffered a serious hand injury while playing basketball in 2016 and began to experience deterioration in his mental health following this incident. He returned to George Brown College in 2017, completing his second year, though he found it more challenging due to his hand injury, emerging symptoms of mental illness, and having to work part-time due to financial stressors. He tried to return for his third year in both 2019 and 2021 but had to withdraw on each occasion due to his physical and mental health issues.
Legal History:
9He has no prior criminal convictions.
Psychiatric History:
10Mr. Guthrie-Cahns’ mental health issues began after surgery following an injury to his hand in 2016. By October of 2017, Mr. Guthrie-Cahns’ behaviour had changed significantly and he often presented as verbally nonresponsive, would laugh inappropriately, and would remain in bed all day. He stopped socializing with his friends and began to drink alcohol and use marijuana.
11His mother reported that in January 2018, he had begun sleeping with a bread knife in his possession as he believed that people were watching his family in their home. He was also observed at times talking to himself.
12Mr. Guthrie-Cahns’ mother reported that he had previously harmed her physically and in April 2018, she expressed that she did not feel safe with him in the home. Initially on admission to hospital in April 2018, Mr. Guthrie-Cahns was not verbally responsive, presented with a flat affect, and appeared to be responding to internal stimuli.
13During his hospital admission from April to May 2018, Mr. Guthrie-Cahns reported that he believed that a “chip had been implanted in his hand” during his hand surgery and that this chip resulted in him experiencing negative effects. He had a second surgery on his hand in 2017 but said that this did not help. He reported delusions of reference, thought insertion, and paranoid delusions that individuals were watching him through cameras. Mr. Guthrie-Cahns was maintained on a Form 1 under the Mental Health Act (“MHA”) until his admission to the Early Psychosis Unit at the Centre for Addiction and Mental Health (“CAMH”).
14Mr. Guthrie-Cahns’ symptoms improved following a trial on Abilify. He was encouraged to remain in hospital as a voluntary patient while his medication was optimized but declined to do so. He declined injectable medication and was discharged to his mother’s home on oral medication, with outpatient psychiatric support.
15Mr. Guthrie-Cahns experienced further hospital admissions for stabilization of worsening symptoms in October of 2018 and February of 2019, to Mount Sinai Hospital and to CAMH, respectively. On the first occasion, he escaped from the hospital by stealing a staff member’s name tag and fob after learning that he had been certified under a MHA Form 1. He similarly attempted to escape from CAMH by trying twice to steal staff badges and was placed in seclusion due to his AWOL risk. On each occasion, his condition improved while in hospital, but he had difficulty remaining adherent to his medication after being discharged to his mother’s home.
16Mr. Guthrie-Cahns’ symptoms included both paranoid delusions and hallucinations, including command hallucinations directing him to kill himself. He reported that he had walked around with a knife in his hand one night because he “saw a ghost”. He had also been knocking on his mother and sister’s door at night. They feared for their safety and had hidden the knives in the house. Mr. Guthrie-Cahns was not sleeping well, and his behaviour was disorganized.
17Mr. Guthrie-Cahns was admitted to Lakeridge Health in Oshawa from August 28 to September 3, 2020. He was brought to hospital by police due to his bizarre presentation. It was suspected that he had become non-compliant with his medication. While in the waiting room at the hospital, Mr. Guthrie-Cahns committed an unprovoked attack on two men. The first victim was a 91-year-old who was in a wheelchair. The second victim was the 69-year-old son who attempted to come to the aid of his father. Following the assaults, Mr. Guthrie-Cahns ran out of the hospital to downtown Oshawa and tried to enter a car driven by a woman who was stopped at a red light. Mr. Guthrie-Cahns was arrested but the charges were diverted through the Durham Mental Health Court Diversion Program.
18Dr. Harrigan’s criminal responsibility report includes additional details about Mr. Guthrie-Cahns’ mental health history prior to the commission of the index offence. We note that he had been connected to the Durham Amaze Early Psychosis Intervention program for approximately two years before being discharged from this program in 2020. Mr. Guthrie-Cahns was no longer being followed by a psychiatrist after his discharge. He was placed on a waitlist to see a community psychiatrist. Between 2020 and 2023, Mr. Guthrie-Cahns was being prescribed psychiatric medications by his family doctor but he did not consistently adhere to his prescribed medications.
19According to Mr. Guthrie-Cahns’ mother’s report, Mr. Guthrie-Cahns had presented with indicators of decline in January 2023. He appeared depressed and was spending less time with family and friends. In March 2023, his mother tried to have him hospitalized under a MHA Form 1 but was unsuccessful.
20By early May of 2023, Mr. Guthrie-Cahns continued to show subtle signs of deterioration and, in an incident that was out of character for him, he reportedly screamed at his sister in a disrespectful manner on May 4, three days before the index offence. The next day, while being spoken to by his father about the previous day’s incident with his sister, Mr. Guthrie-Cahns “suddenly became mute”. The next day, on May 6, 2023, Mr. Guthrie-Cahns was non-communicative with both parents. When he responded to something his mother said, he answered “like a robot”. She suspected that he was hearing voices, though he denied this. The index offence occurred the following day.
Current Diagnosis:
21Mr. Guthrie-Cahns’ current diagnosis is Schizoaffective Disorder with Catatonic Features.
Positions of the Parties:
22At the outset of the hearing, all parties were canvassed as to their initial recommendations to the Board. Counsel for the hospital submitted that Mr. Guthrie-Cahns remained a significant threat to public safety and that the necessary and appropriate Disposition was his existing Detention Order with the addition of the following terms:
passes for up to 7 days to enter the community, within a 150-kilometre radius of Ontario Shores, accompanied by staff or a person(s) approved by the person in charge (“PIC”);
passes for up to 7 days to enter the community, within a 150-kilometre radius of Ontario Shores, indirectly supervised;
an international travel pass for up to 7 days, accompanied by a person(s) approved by the PIC, on an itinerary approved in advance by the PIC;
to live in the community in accommodation approved by the PIC; and
while living in the community, he shall report to the PIC, or his/her designate, not less than once every two weeks, or as required.
23Counsel for the Attorney General of Ontario supported the recommendation of the hospital.
24Counsel for Mr. Guthrie-Cahns conceded the issue of significant threat but was recommending that her client be granted a Conditional Discharge Disposition with terms to include:
a residency condition stipulating that Mr. Guthrie-Cahns reside at 80 Alton Towers Circle, Unit 612, in Scarborough, Ontario (which is his grandmother’s home);
a s.672.55 Criminal Code consent to treatment provision;
a condition mandating that he abstain from the non-medical use of alcohol, drugs or any other intoxicant;
a condition requiring that he submit samples of his urine and/or breath to the PIC for the purpose of analyzing whether he has ingested alcohol, drugs or any other intoxicant;
a weapons’ prohibition; and
a condition prohibiting him from attending within 200 metres of 31 Torr Lane, Ajax, Ontario (the victim’s residence).
25Ms. Boissonneault’s alternative position, if the Board were to conclude that the necessary and appropriate position was a Detention Order, was to recommend that the international travel pass be extended to up to 14 days, together with the additional terms recommended by the hospital.
26All parties maintained their respective positions in closing submissions.
Evidence at the Hearing:
27The evidence at the hearing consisted of the viva voce testimony of Dr. C. Harrigan, the Record, which among other entries, included the Victim Impact Statements of Ms. P. Mitchell and Ms. K. Hoven, and several other documents that were entered as Exhibits, including:
the Hospital Report;
the Occupational Therapy Assessment dated December 20, 2024;
Telephone Contact Report dated September 26, 2024;
Inpatient Progress Report dated November 22, 2024;
4 letters of support from Mr. Guthrie-Cahns’ family members; and
a letter of support authored by Ms. Anderson of K.I.D.S. Community Health Services Ltd. dated January 23, 2025.
28Dr. Harrigan stated that she has been involved as Mr. Guthrie-Cahns’ attending psychiatrist since his admission to the hospital. She advised that she is the co-author of the Hospital Report and she adopted its contents and advised there were no material updates thereto.
29Mr. Guthrie-Cahns continues to be assessed as capable of consenting to treatment with antipsychotic medication and receives a long-acting injection (“LAI”) of the antipsychotic medication, Invega Sustenna every three weeks together with a daily dose of an oral antidepressant medication.
30Mr. Guthrie-Cahns’ mental state has been stable over the year in review. The doctor advised that Mr. Guthrie-Cahns is optimally treated at the present time. She commented that his mental illness is stable now and in full remission, and that he has had a robust response to continuous treatment with antipsychotic medication since July 2023.
31Dr. Harrigan testified that when Mr. Guthrie-Cahns is psychiatrically well, he presents with a high baseline level of functioning. She noted that he is educated and quite intelligent and presents as cooperative and rule abiding. He is pro-social, insightful and works well with his treatment team.
32Dr. Harrigan testified that when unwell, Mr. Guthrie-Cahns presents with prominent symptoms of psychosis and/or catatonia as well as a prominent mood component including symptoms of mania and/or depression. His psychotic symptoms have included: command auditory hallucinations and paranoid delusions. Features of his catatonia may include: depression, becoming socially withdrawn, flat affect, mutism, and psychomotor slowing (to the point of presenting as robotic). The doctor commented that early warning signs of his catatonia can be quite subtle and are easy to evade detection.
33In terms of Mr. Guthrie-Cahns’ insight into his illness and the need for continuous treatment with antipsychotic medication, the doctor agreed that Mr. Guthrie-Cahns identifies that one of his goals is to remain compliant with his LAI. The doctor stated that when he is psychiatrically well, Mr. Guthrie-Cahns’ expresses “good insight with respect to treatment benefits” but she noted that he is also externally motivated to remain treatment adherent in order to progress quickly through the forensic system. The doctor also commented that when Mr. Guthrie-Cahns becomes unwell, he presents with underdeveloped insight across all domains.
34In response to whether or not Mr. Guthrie-Cahns has expressed remorse regarding the index offence’s impact on the victim, the doctor stated that he has underdeveloped insight and has no memory of his actions at that time. Dr. Harrigan stated that Mr. Guthrie-Cahns’ limited insight in this regard may never improve. The Hospital Report indicates that Mr. Guthrie-Cahns hoped to have the “no contact” order with the victim removed from his Disposition so that he would be able to reside at his mother’s residence. The Risk Assessment contained in the Hospital Report indicates that “Mr. Guthrie-Cahns presents as not fully appreciative of the severity and impact of his past aggressive acts; this can, inadvertently, impress as a degree of insensitivity towards his victims.”
35Dr. Harrigan adopted her testimony from last year’s ORB hearing wherein she indicated that “…if his [Mr. G] symptoms are under control, he is unlikely to be violent.” The doctor expanded by stating that Mr. Guthrie-Cahns has no history of violent conduct when he has been optimally medicated.
36Dr. Harrigan testified that Mr. Guthrie-Cahns had attended and participated meaningfully in a wide variety of therapeutic and recreational programming all as set forth on pages 22 to 26 of the Hospital Report. In particular, the doctor noted that Mr. Guthrie-Cahn’s mother, grandmother and his sister all participated in Family Intervention Therapy (“FIT”) from April to July, 2024. The doctor testified that FIT programming provides family members with education about a patient’s mental illness, its signs and symptoms, the importance of medication, and how to respond to early warning signs of illness. Dr. Harrigan stated that Mr. Guthrie-Cahns’ family members we’re meaningfully engaged in FRT sessions and even attended extra sessions. Overall, Dr. Harrigan stated that Mr. Guthrie-Cahns’ family members are both strong and important supports for him.
37The Hospital Report also indicates that Mr. Guthrie-Cahns attended weekly individual therapy sessions from October 2023 to August 2024 and meaningfully engaged in same.
38Dr. Harrigan stated that Mr. Guthrie-Cahns currently exercises indirectly supervised community privileges for up to 10 hours, daily (with a phone check-in at 5 hours). On Saturdays, these privileges are extended to 12 hours (with a phone check-in at 6 hours) to allow him to attend church. Mr. Guthrie-Cahns has exercised his privileges appropriately, without incident.
39Dr. Harrigan testified that Mr. Guthrie-Cahns and his family continue to utilise out-of- hospital care providers with regard to services related primarily to the repercussions of his motor vehicle accident. While this, in itself, is not problematic, the doctor did state that many of the services he receives outside of the hospital are available in the hospital as well (ex. physiotherapy and access to dieticians). The doctor commented that in her opinion, there has not been full disclosure with the treatment team of the external services Mr. Guthrie-Cahns receives and this is potentially problematic. The Hospital Report indicates, “On January 22, 2024, Ms. Guthrie-Cahns called the unit. She informed staff that she had forgotten to provide her son with medication that she had filled at an outside community pharmacy. Ms. Guthrie-Cahns was reminded that any community medications needed to be verified by the hospital pharmacy in order to ensure that there would be no negative drug interactions, and to ensure that the treatment team was aware of what medications he was taking.”
40Dr. Harrigan testified that there must be a collaborative and consolidated approach to Mr. Guthrie-Cahns’ care. She stated that the hospital’s forensic team is responsible for the safe management of Mr. Guthrie-Cahns’ risk to public safety and that his outside care providers do not have expertise in risk management for forensic patients.
41When discussing the role of Mr. Guthrie-Cahns’ family, the doctor testified that they have been very supportive of Mr. Guthrie-Cahns and have engaged meaningfully in FIT. However, Dr. Harrigan also commented that Mr. Guthrie-Cahns’ family have high expectations that the forensic process ought to be expedited, whereas the hospital’s approach is to proceed with Mr. Guthrie-Cahns’ rehabilitation in a cautious and graduated manner. The doctor noted that the different approaches to Mr. Guthrie-Cahns’ care and rehabilitation can present somewhat of a challenge for Mr. Guthrie-Cahns as the messaging he receives from his family, as opposed to the treatment team, can be quite disparate. As well, the doctor stated that it has been quite challenging for the treatment team to manage Mr. Guthrie-Cahns’ family’s expectations. Dr. Harrigan stated that in anticipation of Mr. Guthrie-Cahns’ ultimate discharge to community living, there will have to be meetings held with Mr. Guthrie-Cahns’ family members to manage their expectations and to essentially ensure that Mr. Guthrie-Cahns receives similar messaging from all of his professional and social care supports.
42When asked whether the team considered Mr. Guthrie-Cahns to be a candidate for discharge to the community, the doctor indicated that discharge planning will be initiated if the ORB grants a community living privilege in his Disposition. The doctor advised that Mr. Guthrie-Cahns has expressed a desire to return to live at his mother’s home but, given that home’s proximity to the residence of the victim of the index offence, the treatment team does not consider a discharge to his mother’s home appropriate.
43In the alternative, Mr. Guthrie-Cahns has also indicated that he would like to live with his grandmother. Dr. Harrigan stated that an Occupational Assessment of Mr. Guthrie-Cahns’ independent living skills has been conducted and the Occupational Therapy Report dated December 20, 2024 concluded that he exhibits the skills required to live independently notwithstanding the fact that he has never lived independently. The report also indicates that Mr. Guthrie-Cahns is open to living with his grandmother as he has re-engaged in schooling and residing with her would be a more financially feasible option for him. Dr. Harrigan stated that the team has not yet conducted an assessment of his grandmother’s home or her suitability. The Occupational Therapy Report notes: “Residing with grandmother requires further assessment and discussion at the treatment team level given concerns surrounding the lack of transparency from Mr. Guthrie-Cahns’ family.”
44Dr. Harrigan testified that the treatment team needs to meet with Mr. Guthrie-Cahns’ grandmother to conduct a fulsome assessment of her understanding of Mr. Guthrie-Cahns’ mental illness, his symptoms, and her receptiveness to working collaboratively and transparently with Mr. Guthrie-Cahns’ clinical team in order to safely manage his risk of harm to others when he is discharged to community living. The team will assess Mr. Guthrie-Cahns’ grandmother’s insight regarding his symptoms and whether or not she would be likely to reach out to appropriate resources should Mr. Guthrie-Cahns evidence signs of decompensation when in the community. Dr. Harrigan acknowledged that Mr. Guthrie-Cahn’s grandmother has already completed FIT programming.
45Dr. Harrigan testified that in the possible event that the treatment team considers it inappropriate for Mr. Guthrie-Cahns to reside at his grandmother’s home then another form of housing, likely independent subsidized housing, will be considered.
46In response to questions posed by Ms. Boissonneault, Dr. Harrigan acknowledged that when using his privileges, Mr. Guthrie-Cahns typically attends at his grandmother’s home 4 to 5 days a week for approximately 8 to 10 hours per day. When using these privileges, there have not been reports of any concerning behaviours. He has not been able to exercise any overnight privileges as that is not afforded to him under his current Disposition.
47When addressing the hospital’s recommendation for the inclusion of an international travel privilege for up to one week in duration on an itinerary approved by the PIC, the doctor stated that this privilege would not be likely to be granted to Mr. Guthrie-Cahns until such time as he was living in the community and had evidenced stability for several months. The doctor stated that the travel privilege was to facilitate visiting extended family members oversees, likely accompanied by other family members. Dr. Harrigan guesstimated that possibly Mr. Guthrie-Cahns might be able to exercise such a travel pass towards the end of the upcoming year provided he remained on his positive trajectory and remained clinically stable, compliant with his medications, abstinent substances and incident-free.
48According to the Hospital Report, the clinical risk factors pertinent in informing Mr. Guthrie-Cahns’ risk to public safety are:
when suffering from symptoms of his major mental illness, he presents with paranoid delusions, hallucinations, agitation, mood disturbances and behavioural dyscontrol that have resulted in him posing a real risk of unprovoked, unpredictable physical and psychological harm;
in addition to a very serious index offence Mr. Guthrie-Cahns has committed prior acts of assaultive behaviour against vulnerable victims and has posed a risk of harm to family members;
he has a history of medication non-compliance when living in the community;
his history of non-compliance and resistance to psychiatric treatment and services;
Mr. Guthrie-Cahns has a history of alcohol and cannabis use;
when unwell, he has impaired insight into his illness, the need for treatment with medication, the impact of substance use on his mental state and other factors that increase his risk for violence/reoffence; and
even when optimally treated, Mr. Guthrie-Cahns’ insight into the psychological and physical harm to the victim of the index offence and her family members remains underdeveloped.
49In the doctor’s assessment and that of the treatment team, Mr. Guthrie-Cahns continues to meet the threshold of posing a significant threat to public safety.
50The doctor testified that although Mr. Guthrie-Cahns has had a very positive tenure under the ORB, his history of violence, the severity of the index offence, and his history of non-compliance with prescribed medications when living in the community, necessitate a cautious progression through the forensic health system. As well, Dr. Harrigan commented that although Mr. Guthrie-Cahns has done very well over the year in review, this has occurred while living within the highly structured environment of the hospital where he is able to be closely monitored and supervised.
51The doctor noted that Mr. Guthrie-Cahns is clearly vulnerable to psychosocial stressors and she noted that he has high expectations for himself and that his family also has high expectations for him to progress expeditiously through the forensic system. Overall, the doctor noted that both internal and external stressors have the potential to contribute to an exacerbation in the symptoms of his illness, as has occurred in the past.
52Dr. Harrigan commended Mr. Guthrie-Cahns for his many successes over the past reporting year. She noted that he has remained compliant with his prescribed medications, evidenced sustained abstinence from substances of abuse, used his privileges appropriately and without incident, engaged in recommended therapeutic programming, not presented as a management challenge, and has been cooperative with the treatment team. Further, Mr. Guthrie-Cahns has not engaged in any incidents of property aggression, threats of harm, or incidents of physical aggression. He has not required the use of seclusion or physical or mechanical restraints.
53In response to a question from hospital counsel as to why the treatment team was recommending the continuation of a Detention Order, as opposed to a more liberal Conditional Discharge Disposition, the doctor responded that:
Mr. Guthrie-Cahns has only been under the jurisdiction of the ORB for a relatively short period of time (since July 2023) and he has progressed rather quickly;
the hospital continues to require the authority to approve his accommodation in the community when he is ready for discharge to ensure that it provides him with an appropriate level of support, monitoring, and supervision to safely manage his risk; and
when Mr. Guthrie-Cahns has decompensated and become unwell, the symptoms of his illness have presented as quite subtle and, in the past, have evaded detection, until the point that he has become acutely psychotic and engaged in extreme violence. As a result, the doctor advised that the hospital requires the ability to rapidly, and at an early juncture, intervene to effect Mr. Guthrie-Cahns’ prompt readmission to the hospital should he be living in the community, whether or not he would satisfy MHA criteria for an involuntary hospitalization.
54Dr. Harrigan testified that if Mr. Guthrie-Cahns were to experience signs of decompensation while living in the community, she anticipated that he would be reluctant to disclose same to his treatment team because he has already expressed frustration about the slow pace with which he believes he has progressed through the forensic system. In the treatment team’s assessment, Mr. Guthrie-Cahns would also be unlikely to voluntarily agree to a hospital readmission or to remain in hospital voluntarily. In the past, it has been necessary to admit him to the hospital as an involuntary patient under the MHA and once admitted, he has attempted on more than one occasion to abscond against medical advice. The doctor also commented that historically, when family members have raised concerns that Mr. Guthrie-Cahns was presenting with signs of psychosis and was at risk of harming others, the MHA had been insufficient to manage his risk.
55When addressing the utility of a Conditional Discharge containing a s. 672.55 Criminal Code treatment condition, Dr. Harrigan stated that such a provision would allow the hospital to return Mr. Guthrie-Cahns to the hospital should he become non-compliant with his prescribed treatment. However, the doctor stated that if, on assessment, Mr. Guthrie-Cahns did not meet criteria under Box A of the MHA, then he could not be maintained in the hospital unless he agreed to remain as a voluntary patient. In such a scenario, the team would have to wait for Mr. Guthrie-Cahns to further decompensate until he met criteria for an involuntary admission, or, alternatively, call for an early ORB hearing to recommend a Detention Order.
56The doctor reiterated her expert opinion that at the present juncture, a Detention Order remains necessary and appropriate as it provides two key risk management features. First, it allows the hospital to retain authority over Mr. Guthrie-Cahns’ accommodation in the community when he is ready for discharge. She commented that the treatment team will need to carefully assess Mr. Guthrie-Cahns’ placement in the community to determine its appropriateness for him.
57Additionally, the doctor commented that the hospital must have the ability to readmit Mr. Guthrie-Cahns expeditiously if necessary and at an early juncture, should he evidence any early warning signs of decompensation, whether as a result of medication noncompliance, relapse to substance use, his response to psychosocial stressors, or otherwise. In the treatment team’s opinion, a Conditional Discharge Disposition is insufficient to safely proactively manage Mr. Guthrie-Cahns’ risk to public safety.
58The Hospital Report indicates that, “Given Mr. Guthrie-Cahns’ historical minimization/guardedness of his symptom experience, paired with the potential for a return to catatonic symptoms (e.g., mutism, automatism), there is less certainty of the provisions of the Mental Health Act could obviate risk concerns with this nuanced presentation, despite this being delineated as a clear pathway to (significant) reactive violence.” In the treatment team’s assessment, to wait until such time as Mr. Guthrie-Cahns presented with more frank symptoms of his illness may result in an unacceptable level of risk to members of the public.
59In assessing Mr. Guthrie-Cahns’ level of risk, the Hospital Report indicates that: “Overall, given the currently available information and based on the PCL-R and HCR-20V3 herein, Mr. Guthrie-Cahns is opined to present as a Low risk to re-offend violently if he were to be awarded a Detention Order with the addition of a community living provision. His risk level is opined to increase under a standard Conditional Discharge to Moderate.”
60Ms. M. Anderson, Rehabilitation Nurse Case Manager with K.I.D.S. Community Health Services Ltd. also testified at the hearing to supplement her letter referred to in paragraph 27 above. She stated that her involvement is to assist Mr. Guthrie-Cahns with his physical and cognitive rehabilitation. She commented that she has been working with Mr. Guthrie-Cahns for the past approximate 8 months to provide services to address injuries he sustained in a motor vehicle accident in which he was assessed and deemed catastrophically injured on the basis of psychological/psychiatric findings. Ms. Anderson stated that her team’s approach has been to work collaboratively with Dr. Harrigan and the hospital’s team. Ms. Anderson stated that her team provides occupational therapy, exercise, physiotherapy, massage, transportation, and other services to assist in Mr. Guthrie-Cahns’ community integration. Her team augments the hospital’s resources and provides approximately 20 hours/week of services to Mr. Guthrie-Cahn.
61Ms. Anderson stated that her team has conducted a functional assessment of Mr. Guthrie-Cahns’ grandmother’s home. She further advised that members of her team were aware of Mr. Guthrie-Cahns’ psychiatric history as well as his involvement with the ORB. Ms. Anderson stated that she has probed Mr. Guthrie-Cahns’ insight with regard to his awareness of the symptoms of his illness and his commitment to medication compliance in order to ensure, among other things, that it is safe for members of her team to work with him. She advised that any changes in Mr. Guthrie-Cahns’ presentation or other concerns noted by any of her team members would be promptly reported to Ontario Shores.
62When asked by the Crown Attorney if she or any member of her team had any expertise in the management of a forensic patient’s risk to public safety, she responded in the negative. Ms. Anderson also acknowledged in response to a question posed by a panel member that Dr. Harrigan and the hospital’s treatment team were charged with the responsibility for the safe management of Mr. Guthrie-Cahns’ risk to members of the public.
63No further evidence was called by the parties.
Analysis and Disposition:
64The panel concurs with the joint position of the parties that Mr. Guthrie-Cahns continues to represent a significant threat to the safety of the public. In coming to this conclusion, the panel relies on the evidence of Dr. Harrigan and the documentary evidence before us. Mr. Guthrie-Cahns suffers from Schizoaffective Disorder with Catatonic Features. The expert evidence presented indicates that the early warning signs of his decompensations can be quite subtle in their presentation. However, once he becomes acutely unwell, he has presented with more intense symptoms including, auditory hallucinations, paranoid delusions, agitation, irritability, mood disturbances and behavioural dyscontrol. His illness has manifested itself in a serious, unprovoked and unpredictable knife attack upon his neighbour. The index offence caused extremely serious physical and psychological harm to the victim and her family members.
65We concur with the statements made in last year’s ORB Reasons which indicate, “As serious as the index offence is, it does not stand alone in Mr. Guthrie-Cahns’ history. On a previous occasion in 2020, after being brought to hospital because of his illness, he suddenly assaulted three other individuals, all total strangers, one of whom was a 91-year-old man. He had also assaulted his mother in the past and carried a knife with him in the house because of his paranoid delusions and or hallucinations. His violent behaviour appears to be completely impulsive and unpredictable.”
66The evidence before us indicates that when acutely unwell, Mr. Guthrie-Cahns presents with underdeveloped insight across all domains, and specifically with regard to the need for medication compliance, and the need for hospitalization. He is not able at these times to appreciate the symptoms of his illness or his risk to the safety of others.
67If no longer under an ORB Disposition, Mr. Guthrie-Cahns would be likely to return to his historical pattern of noncompliance with medication which would be highly likely to lead to emergence of psychosis and his resultant engagement in unpredictable violent behaviours. For all of the above reasons, the Board finds that Mr. Guthrie-Cahns currently represents a real risk of causing serious physical and psychological harm to members of the public.
68Having come to a finding of significant threat, we must determine the necessary and appropriate Disposition for Mr. Guthrie-Cahns which is also least restrictive and least onerous, bearing in mind the paramount concern of public safety.
69We are mindful that over the year in review, Mr. Guthrie-Cahns has remained on a very positive trajectory. He has remained medication compliant and his illness is in remission. He is clinically stable with no experience of residual symptoms. He has not engaged in any episodes of verbal or physical aggression and has not posed as a management challenge. Mr. Guthrie-Cahns has remained abstinent of substances of abuse and has progressed through the privilege ladder in an appropriate manner, without incident. As well, Mr. Guthrie-Cahns leads a very pro-social life and has engaged in educational pursuits as well as a wide variety of the hospital’s therapeutic programming. Mr. Guthrie-Cahns is fortunate to be extremely well supported by his many family members.
70The panel notes that Mr. Guthrie-Cahns’ progress has occurred within the highly structured and supervised setting of the hospital where Mr. Guthrie-Cahns is closely monitored and supported. The expert evidence before us indicates that Mr. Guthrie-Cahns has come very close to maximizing his use of privileges available under his existing Disposition. The treatment team is of the opinion that he is ready to begin the process of transitioning to community living. This is a significant step for him and it is important that he be well supported.
71At the present time, we find that the hospital continues to require the authority of a Detention Order for two critical risk management reasons. First, a Detention Order enables the hospital to retain oversight with regard to Mr. Guthrie-Cahns’ residence in the community to ensure that he is appropriately supported and monitored. This remains necessary for the safe management of his risk. The evidence before us indicates that if Mr. Guthrie-Cahns could choose his own residence in the community, he has stated that he would opt to live at his mother’s home which is in close proximity to the victim’s residence where the index offence occurred. We concur with the observations of the Hospital Report that “… the clinical team requires the ability to determine the most appropriate living accommodations that will support his independence and mental stability in the upcoming year, but that will also protect the mental, emotional, physical, and psychological safety of the victim of the Index Offence.”
72Further, if Mr. Guthrie-Cahns’ residence were stipulated as his grandmother’s residence under a Conditional Discharge Disposition as recommended by Ms. Boissonneault, that could potentially become problematic given the fact that neither the treatment team nor the PIC has determined that his grandmother would be appropriate person to reside with Mr. Guthrie-Cahns in the community. At this juncture, the panel finds it is premature to stipulate that Mr. Guthrie-Cahns reside at his grandmother’s home.
73The second risk management reason that supports a continuation of a Detention Order is that the hospital requires the authority of a Detention Order to intervene at an early juncture to readmit Mr. Guthrie-Cahns to the hospital should he suffer any decompensation in his mental status. We note that Mr. Guthrie-Cahns’ major mental illness may present with early warning signs that can be very subtle and difficult to detect. He is also prone to quite rapid and unpredictable deteriorations which have led to serious unprovoked physical harm to vulnerable victims. For these reasons, we consider it essential that the hospital maintain the authority to respond promptly and proactively to any change in Mr. Guthrie-Cahns’ presentation that could result in an increased risk of violent recidivism.
74We have carefully considered whether Mr. Guthrie-Cahns’ risk to public safety could be adequately managed under a less restrictive Conditional Discharge as proposed by Ms. Boissonneault. However, in our assessment, the Mental Health Act is not sufficient to safely manage Mr. Guthrie-Cahns’ risk of harm to the community at this juncture. In the event of a decompensation in his mental status while living in the community, the treatment team must have the ability to return him quickly to hospital for readmission rather than to wait until such time as he meets criteria for certification under the Mental Health Act. When unwell, Mr. Guthrie-Cahns has presented with unpredictable and unprovoked physical violence. Historically, the MHA has been insufficient to effect his admission to hospital, even at times when he has been acutely unwell and his family has advocated for admission to hospital to manage his risk.
75With regard to the panel’s decision to extend duration of the travel pass recommended by the hospital from 7 to 14 days, we note that the duration of the pass granted will be subject to an itinerary approved by the PIC. In accepting Mr. Guthrie-Cahns’ recommendation that the pass be extended to up to 14 days, we are mindful that his LAI administration occurs every three weeks. However, the Board reminds both Mr. Guthrie-Cahns and his family that the inclusion of privileges in a Disposition are in fact discretionary and not an entitlement. It will be up to the treatment team and the PIC to determine whether or not such privileges will be granted over the upcoming year.
76For all of these reasons, the panel is unanimous in agreeing that the necessary and appropriate Disposition is a continuation of the current Detention Order with the addition of the following terms:
passes for up to 7 days to enter the community, within a 150-kilometre radius of Ontario Shores, accompanied by staff or a person(s) approved by the person in charge (“PIC”);
passes for up to 7 days to enter the community, within a 150-kilometre radius of Ontario Shores, indirectly supervised;
an international travel pass for up to 14 days, accompanied by a person approved by the PIC, on an itinerary approved in advance by the PIC;
to live in the community in accommodation approved by the PIC;
while living in the community, he shall report to the PIC or his/her designate, not less than once every two weeks, or as required.
77In making this Disposition, the Board has reviewed the provisions of s. 672.54 of the Criminal Code and has carefully considered the need to protect the public from dangerous persons, Mr. Guthrie-Cahns’ mental condition, his reintegration into society and his other needs.
DATED this 24th day of April 2025, at the City of Toronto, in the Region of Toronto.
Ms. L. Banks Alternate Chairperson
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Office of the Registrar Ontario Review Board