Ontario Review Board
Re: Dinel Amankwah Dene (a.k.a. Daniel Dene)
ORB File No: 7812
Hearing held on: Monday, March 10, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Clapp
Members: Dr. R. Sheppard Dr. S. Lessard Mr. D. Sandor Mr. J. Cyr
Parties Appearing:
Accused: Dinel Amankwah Dene Counsel: Mr. T. Whillier
The person in charge of hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Mr. J. Rinaldi
REASONS FOR DISPOSITION
(Dated April 30, 2025)
Introduction:
On December 3, 2020, Dinel Amankwah Dene was found not criminally responsible on account of mental disorder (“NCR”) on charges of assault (x2), assault with a weapon (x2), assault causing bodily harm, and mischief not exceeding $5,000 (x2), all contrary to the Criminal Code. Mr. Dene is currently subject to a Disposition of the Ontario Review Board (“ORB” or the “Board”) dated March 19, 2024, whereby he is detained at the General Forensic Unit of the Centre for Addition and Mental Health (“CAMH” or the “hospital”) with privileges up to and including community living in Southern Ontario in accommodation approved by the person in charge. The Disposition also includes a weapons prohibition and no contact provisions.
On March 10, 2025, a panel of the Board convened at CAMH to conduct Mr. Dene’s annual review pursuant to section 672.81(1) of the Criminal Code. Mr. Dene attended the hearing and was represented by counsel.
The Hospital Report dated February 21, 2025, was marked as Exhibit 1 at the hearing. In addition to the documentary evidence, Mr. Dene’s attending psychiatrist, Dr. D. Jaiswal, gave evidence.
The issues to be decided at the hearing were whether Mr. Dene continues to meet the test of posing a significant threat to the safety of the public and if so, what is the necessary and appropriate Disposition, bearing in mind the four factors in section 672.54 of the Criminal Code.
Position of the Parties:
- At the outset of the hearing, the parties were asked for their initial without prejudice positions. On behalf of the hospital, Ms. Warner took the position that Mr. Dene remains a significant threat to the safety of the public and there should be no change to the current Detention Order Disposition. Mr. Rinaldi supported the hospital’s position on behalf of the Attorney General. Mr. Whillier stated that Mr. Dene was seeking an Absolute Discharge.
Findings:
- For the reasons that follow, the panel found that Mr. Dene continues to pose a significant threat to public safety. The panel concluded that the necessary and appropriate Disposition, which is also the least onerous and least restrictive in the circumstances, is a continuation of the existing Detention Order.
Index Offences:
- The circumstances giving rise to the index offences are stated as follows in the Hospital Report (at pages 8-9):
“(a) December 20, 2018: Mr. Dene was on a TTC bus. As he went to exit the bus at Humber College, he grabbed an overhead handrail and swung with both feet and kicked a seated woman in the head. He then left the bus and fled the scene. The victim suffered redness and soreness to her head, but medical assistance was not sought.
(b) December 26, 2018: The female victim was exiting a store on Albion Rd. in an Etobicoke mall. She held the door open for Mr. Dene, assuming he was about to enter the store. When Mr. Dene did not enter, after a few moments, she let the door close. Mr. Dene struck her in the face with a closed fist, then walked away. The victim experienced soreness to her neck, likening it to “whiplash”, but no medical treatment was sought.
(c) December 29, 2018: Mr. Dene was in a Dollarama store in the same mall on Albion Rd. As he approached the cash register, without provocation, he threw a 398 ml. can of fruit at the cashier, striking her in the head and causing her to lose consciousness. It is not known whether medical treatment was required.
(d) January 25, 2019: Mr. Dene was in a grocery store at 1701 Martin Grove Rd. in Etobicoke. He approached the cashier and threw two canned food items, one at a time, at the cashier. The first can hit the victim in his arm, and the second narrowly missed his head. Mr. Dene again walked away.
(e) January 25, 2019: A woman was sitting in her car, parked in a designated parking spot in the rear lot of an apartment building at 1905 Martin Grove Rd. in Etobicoke. Mr. Dene approached the car, produced a bladed weapon, and slashed the tires on the driver side of her car. Later that day in the evening, Mr. Dene is seen on video approaching the same vehicle parked in the rear parking lot of the apartment where he lived. This time, he slashed the tires on the passenger side of the same car, then used a blunt object to smash the vehicle’s windows before walking away.
The owner of the vehicle had never met Mr. Dene and had no idea what had provoked the vandalism of her car. Damage to the motor vehicle was estimated at approximately $2500."
- Mr. Dene has either denied or stated that he cannot remember details of the index offences. However, he has said that some of the victims “said something to him” or gave him a “bad vibe.”
Background:
- Mr. Dene’s personal background and history are set out in detail in the Hospital Report and will not be repeated here. Briefly summarized, Mr. Dene is a 36-year-old single man with no children. His parents separated when he was approximately ten years old and he lived with his mother and older sister. He continued to visit his father regularly. Mr. Dene left high school in grade 11 and worked in general labour jobs and restaurants. He is currently supported by the Ontario Disability Support Program.
Criminal History:
- Mr. Dene has a significant criminal record which is outlined in the Hospital Report. He has convictions for drug trafficking and possession for the purpose of trafficking in 2007, wherein he received a 12-month conditional sentence (concurrent) for each offence. In 2010, he was convicted of several firearm offences in Hamilton and was sentenced to 13 years in the federal penitentiary (Joyceville Penitentiary). He received statutory release two years later, but was recommitted within a year for violating the terms of his release.
Psychiatric History:
Mr. Dene had a limited psychiatric history prior to the index offences. Documentation from the time that he was at Joyceville Penitentiary described Mr. Dene as “guarded and non-communicative.” There were no concerns about substance use or aggression noted at that time.
The Hospital Report referenced two psychiatric consultations at the Etobicoke General Hospital in December 2016. On both occasions, Mr. Dene attended at the hospital voluntarily and complained about hearing voices and “unwanted thoughts.” He received diagnoses of psychosis unspecified, query OCD, schizophreniform disorder, and schizoid traits with a low intelligent quotient.
Following the NCR finding, Mr. Dene was detained at Waypoint Centre for Mental Health Care (“Waypoint”) from December 2020 to July 2021, and then St. Joseph’s Healthcare Hamilton (“SJHCH”) from July 2021 to November 2023. While at Waypoint, Mr. Dene denied having a mental illness and was described as “difficult to engage and his responses were brief and limited.” Early on in his time at SJHCH, Mr. Dene spontaneously punched a co-patient in response to auditory hallucinations. He was then described as reclusive to his room with minimal engagement. He followed the rules, but presented as guarded, and offered only monosyllabic responses to questions. Mr. Dene used indirect privileges to the community without incident and all urine drug screens tested negative. He demonstrated low engagement and socialization in therapeutic groups.
The Hospital Report stated that Mr. Dene underwent an Independent Living Skills (ILS) assessment at SJHCH in 2022, and he attained low scores in the categories of managing money, home/transportation, and health and safety. As a result, it was noted that he required “intensive supervision and support to be successful in the community.”
Mr. Dene was transferred to CAMH on November 16, 2023, in order to be closer to his mother, however, it appears she only visited him once in November 2023 before travelling to Jamaica. Upon arrival at CAMH, some adjustments were made to Mr. Dene’s medication in an effort to address his internal preoccupation and to have him on monotherapy of a long-acting injectable antipsychotic medication. During this time, Mr. Dene hit two different co-patients. These incidents were unprovoked and appeared to be a result of auditory hallucinations. Oral olanzapine was subsequently reintroduced to Mr. Dene’s medication regimen.
The Hospital Report stated that Mr. Dene’s current diagnosis is Schizophrenia.
Mr. Dene is capable of consenting to treatment and capable of managing his finances.
Evidence at the Hearing:
The Hospital Report stated that Mr. Dene maintained clinical stability over the reporting year, with no concerns pertaining to aggression or substance use. He attended a number of psychotherapeutic programs and attended a work-readiness program. Mr. Dene was then employed as a kitchenette cleaner on the unit. He also volunteered at the Trinity Square Café on a weekly basis. Mr. Dene attained Level 8 privileges which allowed for indirectly supervised access to the community, which he used appropriately. Dr. Jaiswal testified that Mr. Dene does not go very far or for very long on these passes.
Some medication changes were made such that Mr. Dene currently receives only one antipsychotic medication in long-acting injectable form every 12 weeks.
Mr. Dene was referred to the forensic dual diagnosis support service to explore the possible presence of an intellectual disability. This service concluded that the raw scores and results from psychological testing done at SJHCH counted as evidence against the possibility of an intellectual disability. Mr. Dene would therefore not be entitled to any funding or services offered by Developmental Services Ontario (DSO).
Another ILS assessment was completed at CAMH in May 2024 and Mr. Dene scored as overall low functioning. The Hospital Report stated that this included low scores in the areas of memory/orientation, managing money, managing home and transportation, and health and safety. Although Mr. Dene has worked on his cooking skills and showed significant improvement in this area, the treatment team is recommending a supervised setting for Mr. Dene’s initial transition to the community in order to mitigate stress stemming from such a transition.
The Hospital Report stated that Mr. Dene’s insight was most recently explored on February 10, 2025. At that time, Mr. Dene acknowledged that auditory hallucinations were present at the time of the index offences, but he did not remember the content of them or how they influenced his actions. The following was also stated (at page 16):
“Mr. Dene acknowledged that antipsychotic medications were prescribed for “the voices” and that he could re-experience auditory hallucinations if the medication was to be stopped. Despite this response, Mr. Dene reported that he would “eventually” stop treatment in the context of an absolute discharge. When asked if he would follow-up for mental health care supports in the context of an absolute discharge, he responded, “I don’t know.”
- The Hospital Report stated that absent ORB involvement, and in the context of an Absolute Discharge, Mr. Dene’s risk for violent re-offending falls in the high range. It also stated the following under the heading “Re-offence Scenario/Composite Assessment of Risk” (at page 20):
“Absent ORB involvement, Mr. Dene is likely to migrate to insufficient housing, receive [in]adequate1 support, be exposed to stressors, and/or fall away from treatment. These factors independently or in combination are likely to lead to mental state decompensation. In this context, based on past behaviours, it is likely that he will engage in violence towards a member of the public. This includes unprovoked violence towards strangers. Hence, on a balance of probabilities, Mr. Dene represents a significant threat to public safety.”
Dr. Jaiswal testified that the treatment team is applying for 24-hour supervised housing for Mr. Dene given the ILS results and Mr. Dene’s historical challenges with transitions. They are hopeful that Mr. Dene will be accepted to a facility, but there is no guarantee. Dr. Jaiswal explained that Mr. Dene will likely require support with his activities of daily living in order to reduce any stressors. Mr. Dene has been susceptible to stressors in the past and this led to instability in his mental state, which then led to violence. Dr. Jaiswal referred to two incidents in the 2023-2024 reporting year where Mr. Dene engaged in unprovoked violence against co-patients in response to a change in the patient milieu and related stressors. As such, a supervised and supported residence is important for risk management.
When asked about Mr. Dene’s insight, and the paragraph from the Hospital Report cited above, Dr. Jaiswal stated that Mr. Dene’s insight is “rudimentary” or “partial” and not robust. While Mr. Dene is able to recognize that he heard voices and medication might help with that, he is unable to make the link between his psychotic symptoms and his behaviours at the time of the index offences. Although Mr. Dene has been compliant with both oral and injectable antipsychotic medication while under the ORB, Dr. Jaiswal was of the opinion that Mr. Dene would stop taking medication, and not follow-up with a treatment team, in the event that he received an Absolute Discharge. He did not think that Mr. Dene had changed his mind since their discussion about this on February 10, 2025, and noted that Mr. Dene stated the same thing last year. Further, Dr. Jaiswal testified that Mr. Dene does not have any psychiatric supports in the community at the present time. Therefore, if Mr. Dene was granted an Absolute Discharge, it was Dr. Jaiswal’s opinion that Mr. Dene was likely to migrate to insufficient housing, encounter stressors, experience a decompensation in his mental state, and engage in violence as he did in the past.
Dr. Jaiswal also stated that Mr. Dene does not have social supports in the community. The treatment team has had no contact with Mr. Dene’s mother, and they tried to reach out to his sister to encourage her to visit and/or become an Approved Person. Mr. Dene tends to be withdrawn, and the treatment team encourages him to engage in leisure activities, volunteer, and attend groups.
In response to a question from Mr. Whillier, Dr. Jaiswal acknowledged that Mr. Dene had presented to Etobicoke General Hospital voluntarily in the past when he was experiencing voices, however, Dr. Jaiswal did not think that Mr. Dene would reliably seek out help during the early stages of decompensation, or if he was experiencing active symptoms and having difficulty coping.
Dr. Jaiswal testified that Mr. Dene told him that he would try to find a one-bedroom apartment in Scarborough if he received an Absolute Discharge; however, he did not have a housing worker or any specific ideas about location or availability.
Dr. Jaiswal testified that the hospital requires the tools of a Detention Order to support Mr. Dene and to protect public safety. Specifically, he stated that the hospital requires the ability to approve Mr. Dene’s housing in order to maintain his clinical stability since transitions appear to have a destabilizing effect on him. They also need the ability to bring Mr. Dene back to the hospital in the event of any signs of decompensation. Dr. Jaiswal testified that Mr. Dene has engaged in unprovoked violence, and his clinical instability is difficult to predict. Dr. Jaiswal was of the opinion that the Mental Health Act (“MHA”) is insufficient to mitigate this risk to the public. He also did not think that it was likely that Mr. Dene would agree to a voluntary admission.
A member of the panel asked Dr. Jaiswal about Mr. Dene’s history of antisocial behaviour. He responded that they did not have a lot of information about the circumstances of Mr. Dene’s criminal history, but he noted that the convictions in 2007 and 2010 occurred when Mr. Dene was 19 and 22 years old. Dr. Jaiswal stated that Mr. Dene has not exhibited antisocial traits since he has been at CAMH, so he has an index of suspicion that Mr. Dene’s behaviours at that time may have been related to his association with criminogenic peers. Dr. Jaiswal agreed that Mr. Dene is easily influenced by his surroundings, and stated that a supervised setting will help to monitor and mitigate that risk.
Dr. Jaiswal was also asked about Mr. Dene’s history of being reclusive and withdrawn, and whether that affected the treatment team’s ability to evaluate his risk. Dr. Jaiswal stated that Mr. Dene has improved in this regard and is “more out of his shell” now. He engaged in cognitive adaptive training and has developed more of a therapeutic rapport with the treatment team. Dr. Jaiswal stated that over time, they will be better able to predict his pattern of decompensation.
Finally, Dr. Jaiswal was asked what the treatment team would like to see from Mr. Dene before recommending an Absolute Discharge. Dr. Jaiswal responded that Mr. Dene would need to demonstrate a durable period of clinical stability in the community, an enduring shift in his insight, a proactive approach to maintaining wellness, a commitment to indefinite medication compliance, and engagement in treatment and programs.
Submissions:
Ms. Warner maintained the hospital’s position that Mr. Dene remains a significant threat to the safety of the public and that the necessary and appropriate Disposition is a continuation of the current Detention Order. Ms. Warner acknowledged Mr. Dene’s positive year and progress through the ORB system, noting his successful use of Level 8 passes, his cooperation with assessments, and compliance with medication. However, Mr. Dene is at an important juncture in his recovery as he moves toward community living. Ms. Warner submitted that there are a number of reasons to discharge Mr. Dene to the community under the supervision of the ORB. She noted key factors including Mr. Dene’s lack of insight into the need for ongoing medication and follow-up with a psychiatrist, his vulnerability to stressors and transitions, and the likelihood that he will need support with independent living. Ms. Warner submitted that a Detention Order gives the hospital the tools it needs in order to set Mr. Dene up for success and to keep the public safe.
Mr. Rinaldi adopted the submissions of Ms. Warner, and stated that the Attorney General was “absolutely opposed” to an Absolute Discharge. Mr. Rinaldi stated that a “jump” to an Absolute Discharge was premature and would put public safety at risk, especially in light of Mr. Dene’s statements over the last two years that he would not take medication if he received an Absolute Discharge.
Mr. Whillier reminded the panel that if there is any doubt as to whether Mr. Dene meets the threshold of significant threat, we are required by law to grant him an Absolute Discharge. Mr. Whillier submitted that the evidence that Mr. Dene remained a significant threat to the safety of the public was speculative and insufficient.
Analysis and Conclusion:
The panel found that the Hospital Report and the evidence of Dr. Jaiswal clearly demonstrated that Mr. Dene continues to represent a significant threat to the safety of the public. Mr. Dene has a serious criminal history as well as a history of unprovoked assaults both to members of the public and co-patients. His decompensation and assaultive behaviours have been unpredictable, even in the hospital environment. Although Mr. Dene has responded well to treatment with antipsychotic medication, he remains somewhat withdrawn, his insight is described as rudimentary, and he has not yet been tested in the community. Mr. Dene is unable to link his mental illness with the index offences and the harm he caused to others, and he maintains that he will not take medication or engage in any follow-up if he were to receive an Absolute Discharge. If this were to occur, the panel accepted that the re-offence scenario contained in the Hospital Report (and included above) is more than likely to occur, and members of the public would be at risk.
The panel found that a continuation of the existing Detention Order is the necessary and appropriate, and least onerous and least restrictive, Disposition for Mr. Dene at this time. Mr. Dene has progressed to the point where the treatment team believes he is ready for discharge into supervised and supported housing in the community. This is a big step for Mr. Dene, and has the potential for destabilization of his mental state given his historical challenges with transitions, his low scores on the ILS assessments, and the fact that he is easily influenced by his surroundings and his peers. It is clear that the hospital requires the ability to approve Mr. Dene’s housing as it will be a significant factor in his stability and recovery going forward. It will also be important for Mr. Dene’s medication compliance to be supervised given his rudimentary insight into the need for medication long term.
The hospital also requires the ability to bring Mr. Dene back to hospital quickly in the event that there are any signs of decompensation during his transition to community living. It is unlikely that the MHA would be sufficient to manage the risk that Mr. Dene poses to the public in light of the unpredictability of his clinical instability and his guardedness.
Mr. Dene is encouraged to continue his good work and engagement with the treatment team during this next step in his reintegration into the community and his recovery.
DATED this 30th day of April 2025, at the City of Toronto, in the Toronto Region.
Ms. S. Clapp Alternate Chairperson
__________________ Office of the Registrar Ontario Review Board