Re: Joshua Levesque, 2025 CanLII 39403

Ontario Review Board

Re: Joshua Levesque

ORB File No: 8232

Hearing held on: Wednesday, March 26, 2025

Place of hearing: St. Joseph's Healthcare Hamilton West 5th Campus, 100 West 5th Street

Pursuant to: Section 672.81(1) of the Criminal Code

Before:

Alternate Chairperson: Mr. M.D. Segal

Members: Dr. B. Sheppard Dr. G. Stones Mr. K. McKenna Ms. M. McKinnon

Parties Appearing:

Accused: Joshua Levesque Counsel: Ms. M. Perez

The person in charge of hospital: Counsel: Ms. L. Barney

Attorney General of Ontario: Counsel: Ms. K. Malkovich

REASONS FOR DISPOSITION

(Dated April 28, 2025)

Introduction

1. Joshua Levesque, age 22, was found not criminally responsible by reason of mental disorder on February 13, 2023, on charges of assaulting a peace officer, mischief endangering life, assault (x3), utter a threat to cause death or bodily harm, possession of a weapon for a dangerous purpose, carrying a concealed weapon, discharge air gun or pistol with intent, discharge firearm being reckless as to the life and safety and assault causing bodily harm, all contrary to the Criminal Code.

2. Mr. Levesque was on a Disposition dated April 2, 2024, detaining him at St. Joseph's Healthcare Hamilton (the “hospital”) with privileges up to and including living in the community of Southern Ontario in accommodation approved by the person in charge.

3. On March 26, 2025, Mr. Levesque's annual review was held. The patient was not present but was represented by counsel, fully instructed, who requested that the matter proceed in his absence. The panel made an order permitting the hearing to proceed in his absence. The patient's mother was present in person. The Board had before it as Exhibit 1, the Hospital Report dated March 12, 2025, as well as the most recent Disposition and most recent Reasons for Disposition.

4. In preliminary positions, the hospital advanced that a Detention Order should be maintained with the current conditions being modified to amend paragraph 2(f) to read: “to enter the community of Southern Ontario, accompanied by staff or a person approved by the person in charge; and to add a condition: “to enter the community of Southern Ontario, indirectly supervised”. Crown counsel wished to reserve on the addition of indirectly supervised privileges. Mr. Levesque’s counsel was requesting an Absolute Discharge.

5. After considering the evidence, both oral and written, and the submissions of all counsel, the panel concluded that significant risk to public safety continued to be made out, that a Conditional Discharge would not be appropriate in all the circumstances and that the least restrictive and least onerous disposition that protected the public while giving regard to the patient’s progress and rehabilitation was a continuation of the current Disposition with the two amendments that the hospital outlined.

Diagnoses

6. • Schizophrenia

• Polysubstance Abuse Disorder, in remission in a controlled environment

7. Mr. Levesque is treatment capable.

Index Offences

8. The facts are outlined in last year’s Reasons, as follows:

“On June 12, 2022, Mr. Levesque threw a rock off a bridge onto the Queen Elizabeth Highway, shattering the windshield of a passing car. The rock then smashed the dashboard and steering wheel, narrowly missed the driver and smashed the back windshield. The driver was not hit but was showered with glass and swerved his vehicle to avoid being hit. Mr. Levesque then spit saliva and blood into the face of the officer who arrested him.

On August 3, 2021, Mr. Levesque, while an inpatient in the psychiatric intensive care unit, (PICU) of St. Catharines General Hospital, punched a nurse in the neck. He was pinned down by other staff and a sedative was administered. The security guard was last to leave, and Mr. Levesque got up and punched her behind her ear. When staff returned to physically restrain Mr. Levesque by strapping him to the bed he spit at another nurse.

Mr. Levesque was subject to an undertaking to an officer in charge when he purchased an airsoft piston and less than one hour later went to the parking lot of a nightclub on his bicycle with the air pistol in his waistband. He shot 4 or 5 BB pellets into the car breaking out the windows and hitting the occupant in the head with one of the BBs which had to been medically removed. He hid the air pistol and rode away. This occurred on July 9, 2022.

On July 12, 2022, Mr. Levesque went to a convenience store. When the manager asked him to turn off the loud, offensive music he was playing he threatened to kill her."

Background

9. The background is found in the Hospital Report:

“Mr. Joshua Levesque was residing with his parents and siblings in Niagara Falls, Ontario at the time of the index offences. He was not formally employed, and he was taking online academic courses. Mr. Levesque was supported by the Niagara Region Mental Health Early Psychosis Intervention Team. According to health records, Mr. Levesque was attending monthly appointments with his outpatient psychiatrist, however, in February 2021, it was agreed that Mr. Levesque was psychiatrically stable, and he was scheduled to follow-up every three months.

June 2021 Index Offences:

Mr. Levesque’s mother, Ms. Tamara Levesque, reported a decline in her son’s mental health in June 2021. She advised he had not been taking his prescribed medication; he had ongoing bizarre behaviour and a decline in symptomatology in the two weeks leading to the index offences. She asserted that he was not using alcohol or substances during this time. Ms. Levesque observed that her son was not sleeping or eating properly, he was religiously preoccupied, talking nonsensically, not attending to his hygiene and was dressed inappropriately for the weather. She further reported that he was speaking in other languages and accents, identifying as Jewish, and focused on making business deals and investing in the stock market. Ms. Levesque advised there were several police incidences prior to the index offences, where her son called 911, accusing his father of being involved in a gang and hiding weapons and illicit substances in the home. She advised she had attempted to have her son hospitalized following these events, however, there was no action taken by police.

August 2021 Index Offences:

Ms. Levesque reported that she believed her son was over-medicated during his admission to the Niagara Health System, St. Catharines General Site. According to health records, Mr. Levesque was re-admitted to hospital one day after he was discharged, after reports that he was having thoughts of harming others and acting bizarrely. Records indicated he was religiously preoccupied and rambling incoherently, stating he “needed Jesus to rescue him”. Upon admission to hospital, Mr. Levesque was maintained as an involuntary patient.

July 2022 Index Offences:

Following his August 2021 admission to hospital, Mr. Levesque was maintained on a long-acting injectable antipsychotic medication. He attended monthly appointments with his outpatient psychiatrist and was compliant with his medication. Mr. Levesque obtained full-time employment at a furniture warehouse, and he was on track to pursuing post-secondary studies on a scholarship. According to health records, in November 2021, Mr. Levesque’s long-acting injectable antipsychotic medication dose was lowered due to a remission in his psychotic symptoms. The health records indicated Mr. Levesque began using cannabis and alcohol, but he was able to maintain his employment. Ms. Levesque reported her son began experiencing auditory hallucinations while at work in December 2021, and he began missing work as a result. Health records indicated by January 2022, the dose of his medication was re-optimized. However, his mother reported that he elected to discontinue his long-acting injectable medication by mid-February, and he quit his full-time job in April. Ms. Levesque reported an increase in her son’s cannabis and alcohol use, which caused ongoing upset and discord in the family. By June 2022, Ms. Levesque reported her son became increasingly verbally abusive, he was not attending to his hygiene, he was delusional with the belief he was a Jewish lawyer, and he became focused on selling stocks to strangers in affluent neighbourhoods. She reported additional police incidents due to his bizarre behaviour in the community.

10. Mr. Levesque is the first in a sibline of three brothers. His brothers are now 17 and 13. His parents and the family reside in Niagara Falls. His parents are approved persons.

“Mr. Levesque was raised in Niagara Falls, Ontario. From a young age, he was involved in sports, including soccer and hockey, playing in a house league and a select hockey league. He also enjoyed attending summer camp and music programs during his childhood. Ms. Levesque reported that her son had many friends throughout his childhood and had no issues with socialization at school. It is understood that Mr. Levesque began school and there were no issues during his elementary school studies.

Mr. Levesque’s mother recalled a change in her son when he entered high school. She reported he began associating with a negative peer group, experimenting with substances, and engaging in thefts and stealing. According to Ms. Levesque, her son was suspended from school several times for stealing during school hours. Ms. Levesque reported her son was stealing property from stores, vehicles, neighbours’ homes, and from his family. Mr. Levesque sustained a serious concussion while playing hockey in early 2018, and his mother reported that he endured difficulties at school as a result, and he missed school while recovering from the concussion. She indicated that he continued to experiment with and use substances, and he had accidental overdoses requiring medical attention. She recalled that he became more isolative from the family, and he began experiencing mental health issues because of his substance use. Ms. Levesque recalled her son’s behaviour was uncontrollable, and he has had several interactions with police because of his mental health and behaviour.

Ms. Levesque recalled that her son was ultimately expelled from high school in October 2018, following bomb threats he made to the school. It is understood that Mr. Levesque was sent to G.R. Force, a youth open custody detention facility, and to D.S. Horne, a supportive reintegration housing residential facility for youth with involvement in the Youth Criminal Justice system. He resided at the group home for approximately one year until his family made the decision to bring him back to their home.

Mr. Levesque continued to experience mental health and substance use issues. He was hospitalized on several occasions due to substance use, psychotic symptoms, and suicidal ideation. In August 2020, Mr. Levesque was hospitalized for a serious intentional overdose, after ingesting approximately seven bottles of Tylenol and Aspirin. He was transferred to Sick Kids Hospital in Toronto due to acute liver failure, and it was felt initially that he may require a liver transplant, however his liver function improved. Following this admission, he was returned to Hamilton for a psychiatric admission. Upon discharge, Mr. Levesque returned to the family home.

Ms. Levesque reported her son’s mental health, substance use, and behavioural difficulties continued. She noted that upon discharge from the hospital, he did not follow any recommendations set out by his treatment team. Although he was followed by an outpatient mental health team, he made several adjustments to his medications, ultimately discontinuing them by February 2022.

Abuse and Trauma History

11. “Mr. Levesque denied experiencing verbal, emotional, physical, or sexual abuse. His mother reported the family experienced the loss of her father when her son was in grade eight. She indicated her sons were close to her father and they did not have the ability to say their goodbyes prior to his passing. Ms. Levesque reported that the family has had several Family and Child Services (FACS) interactions due to physical altercations between her son and his father, and her son’s behavioural difficulties. Ms. Levesque reported these instances were short-lived, as FACS determined there were no protection issues. According to health records, Mr. Levesque engaged in dialectical behaviour therapy (DBT) in the past, however, he has never engaged in trauma-informed therapy.”

Education

12. “Mr. Levesque began school at age four. He attended Orchard Park Elementary School until Grade 4. His mother reported he excelled in his academic studies, however, he struggled with English and math and received regular tutoring. She advised that her son has never been diagnosed with a learning disability, nor was he enrolled in a special education class, or had an Individualized Education Plan (IEP). It is understood he transferred schools in Grade 5 to enter a French immersion program, and he attended Prince Philip School until Grade 8. Mr. Levesque began Grade 9 and attended high school at A.N. Meyer Secondary School until Grade 11. According to Ms. Levesque, her son began associating with negative peer influences, and she noted changes in his behaviour. Ms. Levesque reported he began using substances, was truant from class, and he failed some of his classes. She advised that her son was suspended on several occasions due to altercations with peers, and thefts which occurred during school hours. It is understood that Mr. Levesque was ultimately expelled from high school in Grade 11, following a threat made to the school. Following his expulsion from high school, Mr. Levesque completed the remainder of his high school credits while at an open custody youth facility. He attended an alternative education program while residing in a transitional group home and completed online credits at E.L. Crossley Secondary School. Following the completion of his high school diploma, Mr. Levesque received a scholarship to Brock University and Niagara College to enroll in a business program, however, because of his mental health issues, he was unable to attend.”

Employment History

13. “During his adolescence, Mr. Levesque held a few employment positions. He reported he has volunteered at a soup kitchen, and worked as a soccer referee, in a kitchen as a dishwasher at a golf club, and as a warehouse worker at a furniture warehouse. Both Mr. Levesque and his mother reported he missed work often due to psychotic symptoms and negative side effects from medication. Ms. Levesque reported her son ultimately quit his job at the furniture warehouse, despite accommodation offered by the employer.

14. Mr. Levesque is financially supported by Ontario Disability Support Program (ODSP) benefits.”

Substance Use and Criminal History

15. “Mr. Levesque began experimenting with substances during his adolescence. He reported experimenting with cannabis and alcohol prior to high school, and health records indicated he has also experimented with LSD, Psilocybin (magic mushrooms), MDMA, and cocaine. His mother reported that he has stolen prescription medications from neighbours, cough syrup (dextromethorphan) and other over-the-counter drugs from the drug store. In addition, Ms. Levesque reported her son has experimented with non-conventional substances including nutmeg and cinnamon. As reported, Mr. Levesque has experienced intentional and accidental overdoses because of his substance use, at times requiring medical attention. According to health records, Mr. Levesque also has had issues with online gambling, resulting in significant debt. He has engaged with outpatient addiction counselling in the past. It is understood that he has been referred for inpatient residential treatment, however, he has never attended, nor has he engaged with detoxification services.

16. The following is quoted from the Niagara Regional Police Service, CR2 Criminal Record – Level II, Occurrence # 21-84804, generated date August 5, 2021:

Date Sentenced

Offence

Sentence/Status

2019-05-23

St. Catharines, ON

(Youth Justice Court)

Uttering Threats,

Sec 264.1(1)(b) CC

Conditional discharge for

18 mos

17. Mr. Levesque was referred for a psychological assessment under Section 34 of the Youth Criminal Justice Act (YCJA) in 2019 following charges of Utter Threats and Property Damage. He was assessed by Dr. Jeffrey Wong, Psychologist. The psychological assessment findings supported past diagnoses of Polysubstance Abuse Disorder, and he met criteria for Pervasive Depressive Disorder, Oppositional Defiant Disorder and rule out Conduct Disorder. Based on the assessment findings, it was recommended that he would benefit from a probation order, residing in a transitional housing program and engage in residential substance abuse treatment. Additionally, he was recommended for individual counselling to address aggressive and violent attitudes and behaviours, poly-substance misuse, his relationships with parents, siblings, and peers, and coping strategies to address feelings and anger. Lastly, it was recommended that Mr. Levesque engage in family counselling, continue working towards his high school diploma and engage in prosocial recreational activities, and refrain from associating with negative peer influences.

18. Health records indicated that Mr. Levesque was engaged with a youth court support worker and a high-risk therapist at Pathstone Mental Health Services while involved with the youth criminal justice system.”

Psychiatric History

19. The Hospital Report notes numerous attendances or admissions at emergency or in hospital from May 2018 into February 2022. The index offences occurred in June of 2021, August of 2021 and July of 2022. Mr. Levesque was extremely unwell as noted on pages six to seven of the Hospital Report.

20. A psychological assessment conducted in January 2023 states:

“Based on the information provided by Mr. Levesque and his mother, along with his clinical presentation during the treatment order, there is little doubt that Mr. Levesque suffers from a serious major mental disorder, namely Schizophrenia. It is also clear that Mr. Levesque has engaged in problematic drug and alcohol use and has demonstrated substance dependency. While he has demonstrated decompensation absent substances, it is suspected the use of substances serves to hasten decompensation and in turn, aggravate his experience of symptoms. When actively symptomatic, Mr. Levesque will often take on the identity of certain professions (lawyer, stockbroker, businessman) and/or will take on different religious or gender identities (will state that he is Jewish, will identify as a woman). While symptomatic, Mr. Levesque will also develop beliefs related to injustice and the need to obtain justice or stop injustices from happening. He becomes increasingly emotionally dysregulated, and he will readily lash out towards family members and others. His behaviour, thought processes, and speech can also become disorganized when unwell.

In examining each of the index offences, it does appear that across the four separate incidents, Mr. Levesque was actively symptomatic. He was not taking medications during each of the four offence clusters and was said to be increasingly agitated, engaging in bizarre behaviour, was identifying as someone from the Jewish faith, was referring to himself as a stockbroker or lawyer, and was expressing beliefs about injustices. After Mr. Levesque’s admission to hospital in July and August, following the incident on the bridge and the assault of staff at the hospital, Mr. Levesque did demonstrate a period of stability after being prescribed an intramuscular medication (Invega). However, soon after his release from hospital in August 2021, he asked for the dose to be reduced and by February 2021, he discontinued his medications. In turn, he suffered a decline in his mental status and over time, he again became symptomatic, resulting in further contacts with police and the laying of additional criminal charges.

In terms of criminal responsibility, it is the undersigned’s opinion that although Mr. Levesque would have likely been aware of the nature and quality of his actions on all counts and he was also likely aware of the legal wrongfulness of his actions, the extent of his symptoms would have impaired his ability to know that his behaviour was morally wrong. Given the same, it is opined that the plea of not criminally responsible should be made available to Mr. Levesque on all counts.”

21. Mr. Levesque first came into hospital September 1, 2022, to determine his fitness to stand trial. He was found not criminally responsible on February 13, 2023. His initial hearing was on March 30, 2023. He was on an Invega Sustenna injection every 28 days. His initial months in hospital were rough. The Hospital Report notes his progress over time. The hospital notes a risk assessment from last year's reporting period that states:

“Mr. Levesque continues to make good progress toward his rehabilitation goals. There is no recent evidence of psychosis or mood disturbance. Overall, his insight has improved but continues to develop. He has not demonstrated any recent aggressive or self-harmful behaviour, and he has generally used passes and privileges appropriately. He is engaged in several therapeutic and recreational programs both individually and in groups. He continues to receive a high level of support from his family, particularly his mother.

Notwithstanding the progress which he has demonstrated, particularly in recent months, Mr. Levesque’s history of substance use, aggression and emotional instability must continue to be considered when assessing his risk. He has on several occasions been less than truthful with the clinical team, which has been a cause for concern. Furthermore, Mr. Levesque has yet to engage in any meaningful educational or vocational activities and it is the team’s view that such engagement would be protective for him. Finally, his improvement has been relatively recent, and he remains to be tested in less closely monitored environments. It is our opinion that Mr. Levesque continues to pose a significant threat to the safety of the community. However, we believe that Mr. Levesque’s risk can be safely managed under the authority of an order with the following conditions, which are necessary and appropriate.”

22. For the current hearing a previous diagnosis of antisocial personality disorder was omitted.

23. The Hospital Report notes paranoid thoughts about his brother during a home visit where the patient indicated he thought the brother had spiked his soft drink with poison.

24. There is still limited insight into his mental illness and his current situation with the Board.

25. The Hospital Report notes a random test in August of 2024. Mr. Levesque tested positive for the presence of ethanol. On confirmation it showed positive for methamphetamine. Mr. Levesque denied using substances. Since that incident, all tests have been negative.

26. Mr. Levesque has been taking DBT therapy and is actively working on occupational therapy such as a cooking group and a life skills group. He has been meeting with the occupational therapist in individualized appointments on a regular basis to assist him with navigating his overnight passes to stay with his family. He was assessed as of April 2024 as not having the necessary skills to live independently. There were concerns about money management with collectors calling the hospital unit. There were concerns about his judgment in money matters and him being taken advantage of in that respect. In November 2024, Mr. Levesque started volunteering for two hours a week at his uncle's church.

27. Mr. Levesque indicated that he had anxiety in the community when near a liquor or cannabis store. He is now spending up to four days at his parents’ house a week.

28. Mr. Levesque’s mother is strongly active in her son’s supervision and treatment progress and is in regular communication with the forensic team. Mr. Levesque’s mother speaks every day to her son by telephone. Mr. Levesque’s mother quit her job to deal with her son’s challenges.

29. The Hospital Report notes that both the patient and his mother want him to live at home once released. Mr. Levesque is on a waitlist for a transitional rehabilitation housing program in Hamilton, but the waitlist is a very long one and Mr. Levesque would also have to show that he could be able to live independently.

Evidence at Hearing

30. Dr. S. Prat, the patient’s psychiatrist since May of 2024, testified. Dr. Prat described the patient's overall goal to enter back into the community - to move on. There have been no overt psychotic symptoms in this reporting period. However, the patient is deficient in coping skills.

31. Dr. Prat pointed to several concerning incidents in the reporting period including:

• The positive test for methamphetamine which was denied.
• Sponsoring or helping to organize a party in Niagara that involved posters inviting guests to bring their own cannabis.
• An incident in January when the patient, who smokes cigarettes, was vaping to such an extent it induced vomiting.
• The patient self-pierced his nose during a home visit.
• In February there was a random discovery that Mr. Levesque was purchasing cannabis for other forensic patients which included a patient who was vulnerable to relapse because of substances. This conduct had apparently been going on for some time. It is totally contrary to hospital rules, a fact that was known to the patient. His motive was ostensively raising money.
• Approximately a month or so prior to the hearing Mr. Levesque added a new tattoo of an AK47 machine gun on his forehead. Mr. Levesque admires rappers, including their music and their manner of adorning themselves with tattoos. Mr. Levesque enjoys music. He has recorded much music. Mr. Levesque struggled with understanding the negative impact of such a tattoo but ultimately appreciated the problem and now applies makeup to hide his tattoo in public settings where that might not be appreciated, such as at his uncle's church.
• Mr. Levesque recently raised the possibility of him having ADHD. The doctor was doubting the sincerity of the patient raising the issue noting that the traditional treatment for it was the administration of stimulants. A neurocognitive test indicated the diagnosis was not warranted.
• Mr. Levesque continues to require significant management.
• The hospital continues to be aware of several risk factors. Mr. Levesque lacks adequate coping mechanisms.
• There are no non-forensic professional supports in the community that have been explored.
• Mr. Levesque continues to be vulnerable to others.

32. On the positive side, Mr. Levesque has several things going for him including a supportive family. His activities of daily living have shown improvement. There have been noticeable improvements in his ability to attend to hygiene which has been a challenge in the past. He is taking DBT individually and in group. While he was initially reluctant to share information with his therapist, Dr. Moulden, the relationship is now on a solid plain.

33. In Dr. Prat’s view, if granted an Absolute Discharge the patient would take his medications, however, he does not fully understand the importance of them or the full nature of his mental health status.

34. Mr. Levesque has a vulnerability to others. He has difficulty saying no. He may seek out ADHD medication that could impact his medical state. He does not now possess the skills to make friends or other connections.

35. Following each one of the various incidents in the past year, Mr. Levesque had his privileges withheld and had to earn them back. The lapses in judgment were not initially apparent to him and the restriction of privileges was not initially welcome. However, following each incident with teaching, he eventually understood the ramifications of his actions and the need for withholding privileges.

36. A history of noncompliance with medication and use of substances is concerning to the doctor. Dr. Prat does not now endorse the diagnosis of antisocial personality disorder. It would be difficult to assess, and the doctor is concerned that such a diagnosis may negatively impact on the patient.

37. At present, the family home is the only available housing in the community, but the doctor indicates that work must be done on the family dynamic for that option to be viable.

38. If an Absolute Discharge were granted the doctor is very concerned about resort to substances without the current extensive support to cope with stressors. On a few home visits, Mr. Levesque asked to be taken back early because of how he was feeling. The background behind the additional privileges sought by the hospital, if in fact both are not already covered in the current Disposition, is that it will explicitly permit the patient's mother some relief. She accompanies her son everywhere including on vacations and trips to Northern Ontario where the family has a property and enjoys camping. The slight extension of privileges may permit the patient to meet up with his mother thereby mitigating the burden on her.

39. Dr. Prat is concerned with the state of the patient’s vocational activity and the scarcity of psychiatric services in the Niagara area. The doctor would like to reserve the ability to hospitalize quickly in the event of signs of decompensation. The doctor also believes that the Mental Health Act is inadequate to keep him in hospital to achieve baseline. The hospital believes it is important to approve accommodation.

40. When previously discharged in the lead-up to the index offences, Mr. Levesque stopped his medication and resorted to substances. There are still breakthrough symptoms such as auditory hallucinations, but the doctor agrees that they could be residual positive symptoms or merely the patient describing what he feels when stressed. The paranoid belief regarding his brother could possibly be attributed to stress.

41. There are stressors at home. There is some merit, according to the doctor, to address the family’s needs.

42. The doctor noted that Mr. Levesque was relatively new to the ORB forensic system. It was early days of rehabilitation, and the index offences were very serious. Someone could have got killed.

43. Mr. Levesque has impulsivity that also makes it premature to consider an Absolute Discharge or a Conditional Discharge. An example would be the tattoo of the AK47 on his face.

44. Some of Mr. Levesque’s songs are quite violent and disrespectful of others. On the other hand, Mr. Levesque appears to be very kind and generous toward others. He professes not to want to glamorize violence. On a day-to-day basis, he does not come across as antisocial. Ms. Perez for the patient stressed Mr. Levesque’s youth pointing out that his immaturity is not that different from any 22-year-old. Regarding the party where cannabis was welcome, Mr. Levesque talked to his then psychiatrist. Despite being advised against the idea, he went ahead. Ms. Perez notes that her client is now working with a skilled therapist. There are minor issues at home. The patient may have pressured his parents to fund unwise purchases. He is now getting along with his brother. He volunteers at a food bank at the church. There have been no instances of alcohol or cannabis consumption. He has had access to cannabis but is not partaking. According to Ms. Perez, her client wishes to get ahead. Overall, Ms. Perez notes that it has been a good year without violence or aggression. There have been extensive passes to the family home.

45. In answer to Board questions, Dr. Prat noted that Mr. Levesque may be now open to living in Hamilton. Dr. Prat's current view is that an Absolute Discharge and release to the house in Niagara would be a “disaster”. Dr. Prat believes that there would be attachment to problematic peers, and substance consumption. Dr. Prat was also very concerned about the provision of cannabis to fellow patients which had been going on for some time. Without adequate and active supervision, Mr. Levesque would decompensate. If Mr. Levesque consumes substances, that would produce psychosis and a reappearance of the extremely violent behaviours in the recent past.

46. Mr. Levesque is prone to frequent periods of anxiety and uses PRNs in those circumstances. Mr. Levesque’s insight is underdeveloped.

47. In final submissions Ms. Perez stressed that it is has been a good year. There have been no incidents of violence or aggression. Generally, there has been adherence to conditions. Mr. Levesque has been medication compliant. The Board should take into account that we are dealing with a 22-year-old and not everything he does should be viewed in a sinister fashion. Mr. Levesque has strong family support and wants to progress. In the alternative, the Board should consider a Conditional Discharge.

Analysis

48. Mr. Levesque’s index offences were frightening. As Dr. Prat noted, someone could have been killed. They happened very recently. Mr. Levesque has a serious mental health condition. There had been multiple admissions prior to the index offences. Medication was stopped and substances started. While it is correct that there have been no incidents of violence or aggression in the current reporting period under the hospital’s supervision as part of an ORB Disposition, there continue to be signs that additional treatment is required. He is relatively new to the ORB system. There is a significant history of violence for someone so young. Mr. Levesque is on a positive trajectory. He has not integrated yet into the community. There are no concrete plans at present that would protect both the safety of the public and deal with his needs. That is all provided at present by the hospital with the authority of a detention order.

49. There are issues regarding whether the family house is ideal. Mr. Levesque is now open to supervised housing in the Hamilton area as well. The hospital is of two minds about the best residential placement.

50. Mr. Levesque is in early days of treatment. He is taking some positive steps but there continue to remain issues regarding coping, stressors, impulsivity, judgment, substances and relationships.

51. A Conditional Discharge is not appropriate given the need to act quickly in the event of signs of dysregulation, and to permit him to stay in hospital long enough to achieve baseline. The hospital is of the view that it is important to approve housing and so does the panel. In all the circumstances, the current disposition is the least onerous and least restrictive that balances public safety and the rehabilitative needs of the patient. The additional privileges suggested by the hospital are approved.

DATED this 28^th^ day of April 2025, at the City of Toronto, in the Region of Toronto.

Mr. M.D. Segal Alternate Chairperson

____________________________

Office of the Registrar Ontario Review Board