Ontario Review Board
Re: John G. Porter
ORB File No: 8442
Hearing held on: Wednesday, April 2, 2025
Place of Hearing: Royal Ottawa Mental Health Centre
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. C. Finley
Members: Dr. S. Lessard
Dr. S. Wiseman
Mr. D. Sandor
Ms. N. Lemieux-McKinnon
Parties Appearing:
Accused: John G. Porter
Counsel: Ms. L. Konarowski
Person in charge of the hospital: Representative Dr. A. Sandhu
Attorney-General of Ontario: Counsel: Ms. M. Dufort
REASONS FOR DISPOSITION
(Dated May 5, 2025)
Introduction:
On December 8, 2023, John Porter was found not criminally responsible on account of mental disorder on a charge of aggravated assault, contrary to the Criminal Code of Canada. He is currently subject to a detention order of the Ontario Review Board (ORB/the Board), dated March 27, 2024, detaining him at the Forensic Assessment Unit or the Forensic Rehabilitation Unit at the Royal Ottawa Mental Health Centre (ROH/the hospital), with the ability to exercise indirectly supervised passes in the community.
On April 2, 2025, the Board convened to conduct the annual review of Mr. Porter’s disposition pursuant to s.672.81(1) of the Criminal Code. Mr. Porter was present and accompanied by his counsel, Ms. Konarowski who was appointed pursuant to s.672.5(8) of the Criminal Code.
At the outset of the proceedings, all parties were canvassed as to their initial positions on the issues to be determined by the Board: whether Mr. Porter continues to represent a significant threat to the safety of the public, and if so, the necessary and appropriate disposition having regard to the criteria set out in s.672.54 of the Criminal Code.
Dr. Sandhu, on behalf of the hospital, submitted that Mr. Porter remains a significant threat to the safety of the public and the necessary and appropriate disposition is a detention order with the ability to reside in approved accommodation. Ms. Dufort, on behalf of the Ministry of the Attorney General, and Ms. Konarowski concurred in the hospital’s positions. Thus, a joint position was put before the Board.
Findings
- For the reasons that follow, the Board finds that Mr. Porter continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition is a detention order with the ability to reside in approved accommodations.
The Evidence
- The evidence at the hearing consisted of the Hospital Report dated March 23, 2025 (ex. 1), and the viva voce evidence of Dr Sandhu, Mr. Porter’s treating psychiatrist.
The Index Offence
- On April 18, 2023, Mr. Porter and his brother James were in their home at 1185 Merivale Road when an argument broke out between them about sleep deprivation. James asked his brother to leave the unit. He escorted Mr. Porter to the door. He then grabbed Mr. Porter by the arm and tried to push him out of the apartment. Mr. Porter was holding a knife at the time and he used it to stab his brother in his lower abdomen. James called police. Mr. Porter was arrested.
Background Information
The Hospital Report contains details about Mr. Porter’s background and psychiatric history and need not be reviewed beyond the following material details. Mr. Porter is a 59-year-old-man who, together with his two brothers, was born and raised in Sault Ste. Marie. After the death of their father, their mother remarried. According to Mr. Porter’s mother, Mr. Porter struggled following the death of his father. He had difficulty in high school and was frequently truant. He eventually left before completing high school.
The family moved to Ottawa in 1986 when Mr. Porter was 19 years of age. Mr. Porter and his brother James initially resided with their mother until she entered a nursing home. They have lived together in an apartment in Ottawa ever since. Mr. Porter currently is supported by the Ontario Disability Support Program (ODSP).
Mr. Porter has a criminal history with convictions between 1983 and 1991 including theft under $200, mischief, possession of a weapon, obstructing a peace officer, causing a disturbance, and failure to attend court.
Mr. Porter’s first psychiatric admission was in May 1994. He was diagnosed with schizophrenia and prescribed Risperidone. It was noted that his older brother, James, had been diagnosed with schizophrenia and was treated with Haloperidol with good response. Although initially compliant, Mr. Porter stopped taking his medication sometime between 2007 and 2010. His brother noted that he started carrying knives because of his fears about other people.
In December 2021, Mr. Porter attended the Emergency Department at the Ottawa Hospital. Mr. Porter had called police because he “saw someone outside his window holding a gun”. Mr. Porter said that he had become increasingly frightened. He was hearing “whispers”, although he was vague about their content. He had stopped leaving the house because of fear of being harmed. He thought that there were people following him or carrying a gun. He was afraid and ran to the home of a neighbour, a retired RCMP officer. When police attended his home to investigate, they found several full pill bottles of the antipsychotic Risperidone. Mr. Porter’s mother reported that Mr. Porter had been anxious and having difficulty sleeping because he was worried people were trying to break into his house. A few weeks earlier, he broke his television and cellphone during a bout of psychosis. He had also begun sleeping on the floor. Mr. Porter was not willing to remain in hospital but did agree to try the antipsychotic medication Paliperidone.
Following his arrest on the index offence, Mr. Porter was detained at the Ottawa Carleton Detention Centre. He refused all antipsychotic medications offered to him. He was transferred to the ROH on June 10, 2024. When initially assessed regarding hearing voices he became increasingly aggressive. He denied having schizophrenia and did not want medications. He continued to respond to internal stimuli and demonstrated disorganized thoughts which were largely incoherent. Mr. Porter was assessed as incapable to make treatment decisions with respect to schizophrenia. The Public Guardian and Trustee became his Substitute Decision Maker (SDM).
Course Since the Last Disposition
Mr. Porter’s current diagnoses are Schizophrenia, multiple episodes, currently in partial remission and Alcohol Use Disorder, in remission in controlled environment.
In late June, Mr. Porter was verbally aggressive and intimidating towards co-patients in the context of severe hallucinations and persecutory delusions. On one occasion a Code White was required. After receiving his antipsychotic medication, he became more cooperative, settled, and re-directable. The staff noted that he became unsettled when around large groups of people.
As Mr. Porter became more settled on the unit he had less outbursts of aggression. He became more willing to take medications. His brother, James, and his mother both visited him on the unit. There were positive influences. Mr. Porter became increasingly engaged in recreational therapy groups; however, large groups continued to be stressful for him. He demonstrated that he could remove himself from these stressful situations and take a break in his room to re-regulate his emotions.
In November, Mr. Porter’s medications were further augmented. His aripiprazole injection was increased to every two weeks and a second long-acting injectable antipsychotic (zuclopenthixol) was added. He was compliant with his medication and reported no side effects. Mr. Porter continued to demonstrate improvement in his mood as he socialized with his brother during in person visits.
Mr. Porter was transferred on the Forensic Rehabilitation Unit on February 6, 2025. He has successfully exercised indirectly supervised passes on hospital grounds. Mr. Porter has not demonstrated any substance use while on those passes.
In the Hospital Report, Dr. Sandhu has indicated the need for a detention order to manage Mr. Porter’s risk to the safety of the public, at pps 29-30:
Mr. Porter requires the Form 49 over the next year to be able to rapidly bring him to the hospital to assess and manage his acute violence risk in situations where he would not meet Section 17 or Form 1/Form 2 criteria under the Mental Health Act of Ontario. His risk of future decompensation of schizophrenia is linked to his medication adherence and relapses of substance use, and he has a substantial history of difficulties managing both of these key factors. These risk factors have been addressed through long-acting injectable antipsychotic medication and Mr. Porter’s ongoing engagement in substance use teaching in the group setting. The Form 49 is needed to be able to admit him to hospital and keep him hospitalized for a sufficient period to manage his violence risk, even when he is not certifiable.
Dr. Sandhu testified before the Board. He reported that over the nine months that Mr. Porter has been in hospital, he has had an overall positive trajectory. He has been compliant with medication and not exhibited any physical aggression. Mr. Porter has developed a positive rapport with the treatment team and openly identifies and discusses incidents that cause him stress or anxiety. He has developed coping mechanisms such as removing himself from the area and returning to his room. Colouring is an activity that he finds helpful.
Mr. Porter is currently exercising indirectly supervised passes on hospital grounds and accompanied passes in the community. There have been no concerns and all urine drug screens have been negative.
Dr. Sandhu testified that Mr. Porter is currently undergoing a functional assessment that will assist the team in identifying what, if any, supports Mr. Porter may require when residing in the community. That assessment will also factor in whether the one bedroom apartment that he shared with his brother is appropriate. James Porter is a positive influence on Mr. Porter. James is insightful as he too lives with schizophrenia. He is supported by an Assertive Community Treatment (ACT) team and shares with his brother the positives that come with antipsychotic medication. James Porter has participated in case conferences dealing with his brother’s care.
In response to questions from the panel, Dr. Sandhu indicated that Mr. Porter’s insight has improved. He is able to identify that the voices that he is hearing are symptoms of his mental illness. Mr. Porter also is able to recognize that when he drank alcohol, he became more impulsive. Of note, Mr. Porter has heard from his brother how different he is when he is on medication. This has contributed to Mr. Porter’s improvement in insight.
All parties maintained the joint submission.
Analysis and Conclusion
The Board has carefully considered the Hospital Report and the evidence of Dr. Sandhu and unanimously concludes that Mr. Porter continues to represent a significant threat to the safety of the public. Mr. Porter’s risk stems from his diagnosis of schizophrenia. He has a long history of not being compliant with treatment. When untreated, Mr. Porter experiences psychotic symptoms such as severe hallucinations and persecutory delusions. He often demonstrates hostility when experiencing these symptoms. At times, he has carried a knife to protect himself. Without the supervision of the ORB through the hospital and treatment team, Mr. Porter would stop taking medication and experience a deterioration in his mental status similar to the time of the index offence.
Having found that Mr. Porter continues to represent a significant threat to the safety of the public, the panel must consider the necessary and appropriate disposition taking into consideration the criteria set out in s. 672.54 of the Criminal Code, which includes the need to protect the public from dangerous persons, the mental condition of the accused, the integration of the accused into society and the other needs of the accused.
The Board unanimously agrees that the necessary and appropriate disposition is a detention order. Mr. Porter is currently residing on the Forensic Rehabilitation Unit and exercising accompanied passes in the community. Assuming he continues to successfully exercise these passes, he will gradually move to entering the community in the company of an Approved Person and then indirectly supervised. The functional assessment that is currently underway will assist the team to identify where in the community Mr. Porter will be best supported. As such the hospital requires the ability to approve his accommodation.
The Board also accepts Dr. Sandhu’s expert opinion that the Mental Health Act may not be sufficient to rapidly bring Mr. Porter to hospital should he exhibit signs of a deterioration in his mental status, or keep him in hospital until he is stabilized.
By all accounts, Mr. Porter has had a successful nine months. He has been compliant with treatment including medication that has been optimized. He is developing skills to manage stressful occasions to good effect. Mr. Porter is on a positive trajectory
Accordingly, the Board orders that Mr. Porter be subject to a detention order with the same terms and conditions as his existing disposition with the added privilege of residing in the community in approved accommodation. When residing in the community, he shall report no less than once a week.
DATED this 5th day of May 2025, at the City of Toronto, in the Toronto Region.
Ms. C. Finley
Alternate Chairperson
Office of the Registrar
Ontario Review Board