Ontario Review Board
Re: Jeffrey Sinclair
ORB File No: 7602
Hearing held on: Wednesday, March 12, 2025
Place of hearing: Centre for Addiction & Mental Health
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: Jeffrey Sinclair Counsel: Mr. J. Louch
The Person in charge of Hospital: Representative: Dr. P.L. Darby
Attorney General of Ontario: Counsel: Mr. I. Sunderland
REASONS FOR DISPOSITION
(Dated May 6, 2025)
Introduction:
1On September 11, 2019, Jeffrey Sinclair was found not criminally responsible by way of mental disorder on a charge of aggravated assault, contrary to the Criminal Code of Canada. He is subject to a disposition of the Ontario Review Board, dated April 9, 2024, detaining him at the General Forensic Unit at the Centre for Addiction and Mental Health, Toronto (hereinafter referred to as "CAMH" or "the Hospital") with privileges up to and including that of living in the community in supervised accommodation approved by the person in charge of the Hospital. That disposition also subjects him to certain conditions, including that of abstaining absolutely from the non-medical use of alcohol or drugs or any other intoxicant and that of submitting samples for the purpose of monitoring his compliance with the abstention condition.
2On March 12, 2025, a panel of the Ontario Review Board convened a hearing to review that disposition pursuant to section 672.81(1) of the Criminal Code. Mr. Sinclair was present for the hearing, represented by his lawyer, Mr. Louch.
3The record for the hearing consisted of the Notice of Hearing dated September 11, 2024, the most recent Disposition (as mentioned, dated April 9, 2024) and the Reasons for that Disposition dated May 8, 2024. On the consent of all parties, a Hospital Report, dated February 27, 2025, was entered into evidence as an exhibit.
4The parties were canvassed for initial positions. Dr. Darby, Mr. Sinclair's treating psychiatrist, spoke for the Hospital. He expressed the position that Mr. Sinclair continued to represent a significant risk to the safety of the public as that term has been defined by the Supreme Court of Canada in Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625. He also expressed the position that it was necessary and appropriate, having regard to the objectives set out in section 672.54 of the Criminal Code, for Mr. Sinclair to be discharged on conditions largely similar to those found in the detention disposition under review.
5The representative of the Attorney General agreed with the position that Mr. Sinclair continued to represent a significant threat to the safety of the public, but took the position that a continued detention order, without change from the one under review, was necessary, having regard to the primary objective of assuring the safety of the public, and appropriate having regard to the other objectives of ensuring that Mr. Sinclair's mental health and other needs are met, including the ultimate objective of reintegration into the community.
6Counsel for Mr. Sinclair joined with the Hospital on all issues. Accordingly, the Board benefitted from a joint submission on the threshold issue of significant threat, and a contested issue on disposition.
7For the following reasons, the Board accepts and finds that Mr. Sinclair continues to represent a significant threat to the safety of the public. It has further concluded that the necessary and appropriate disposition, having regard to the primary objective of assuring the safety of the public, together with the other objectives set out in section 672.54 of the Criminal Code, and applying the principle of minimal intrusion, is that of a conditional discharge, with terms and conditions mirroring in effect those of the detention disposition under review.
Evidence at the hearing
8The evidence for the hearing came from two sources – the Hospital Report mentioned, and the live testimony and update offered by Dr. Darby.
9Turning first to the Hospital Report, it explains that Mr. Sinclair was previously under the Board's jurisdiction beginning in 2006 after being found not criminally responsible on the charges of sexual assault (x3), sexual interference, failing to comply with a recognizance and obstructing a police officer. He received an absolute discharge in 2012 and was followed by an outpatient psychiatrist at Humber River Hospital until the 2019 NCR finding that has brought him again under the ORB's jurisdiction.
10The index offence is also described in the Hospital Report as it has been set out in previous Reasons for Disposition.
On September 7, 2018, at approximately 9:56 pm, the victim, Ms. W.M., and her cousin, Ms. J., arrived at 33 King Street in Toronto, and went to the apartment building's mail room to retrieve their mail. When they arrived there, Mr. Sinclair quickly approached from behind, holding a knife in his right hand. Once he was close to the victim, he stabbed her multiple times about her head and shoulders, causing her to fall to the ground. While she was on the ground, he continued to stab her a few more times. He placed the knife in his pocket and casually walked away and waited in the lobby until the elevator came down. The assault took place in the close presence of another woman and her infant and young child.
Police were called and attended the scene. Shortly after, Mr. Sinclair was located and placed under arrest for Attempted Murder. He disclosed to police that he had stabbed the victim and directed them to the knife. The victim sustained stab wounds to her right and left temple (1cm), the left side of her head (1cm), and right shoulder. The victim received numerous steri-strips for her injuries.
11The Hospital Report also provides significant details associated with Mr. Sinclair's personal history and course while under the jurisdiction of the Ontario Review Board. Briefly put, Mr. Sinclair is of Jamaican heritage and came to Canada when he was 10 years old. He has no childhood abuse history and there is no reported family history of psychiatric illness or substance use problems.
12In terms of education, Mr. Sinclair had some difficulties with behaviour starting in Grade 11. From age 17 to 23, he became a member of a gang, sold drugs, shoplifted, fought with rivals, and engaged in other criminal activities. He has indicated that it was when he began withdrawing from "gang life" that he started experiencing psychotic symptoms. Mr. Sinclair did not complete high school as an adolescent but he did obtain some additional credits as a mature student and was enrolled in a one-year business administration program at the Academy of Learning College in Toronto. This seems to have been disrupted, however, by the emergence of further psychotic symptoms that included auditory hallucinations, delusions of reference, mind reading and paranoia.
13In terms of employment, Mr. Sinclair has held various entry-level jobs, working in factories and stores. He has said, however, that his mental illness interfered with these as well as he often became stressed and sick, experiencing symptoms of paranoia directed towards work colleagues. He has been an ODSP recipient since 2000.
14Regarding substance use, the Hospital Report says that Mr. Sinclair smoked cannabis almost daily at the time of the previous index offences (in 2005 and 2006). To his credit, he consistently tested negative for substances from 2006 to 2012 as he found himself for the first time under the ORB's jurisdiction. He then returned to sporadic use, the last of which according to him was in 2018. There have been no further positive drug tests and Mr. Sinclair appears to have good insight into the impact of cannabis on his psychotic symptoms. Historically, cannabis has been significantly decompensating leading to rapid exacerbation of his psychotic symptoms.
15Mr. Sinclair has a long history of psychiatric illness and hospitalizations. He first came into contact with mental health services in 1999. His symptoms have consistently included paranoid and other types of delusions, auditory hallucinations, disorganized thought and behaviour, affective instability, disinhibition, agitation, and negative symptoms of psychosis. He also has a significant history of noncompliance with psychiatric treatment that has led to severe decompensations in his mental state. This has occurred when he was using substances, and when he was both adhering to treatment and abstaining from substances. Historically, Mr. Sinclair has been inconsistent in disclosing his psychotic symptoms to clinicians.
16Mr. Sinclair's current diagnoses are:
- Schizophrenia
- Cannabis Use Disorder (said at page 35 of the Hospital Report to be "in remission")
- Conduct Disorder, Adolescent-Onset
- Personality Disorder, Not Specified (Antisocial Traits)
17The Hospital Report's update begins at page 28. It explains that Mr. Sinclair has been compliant with medications throughout this review period and has voiced no adverse reactions. His mental state has improved over this past year. In terms of insight, while it is somewhat limited, he has acknowledged a diagnosis of schizophrenia and has understood that he takes medication to treat "an illness." But his insight into some of the paranoid ideation and perceptual disturbances has fluctuated. His ability to question the reality of these experiences has been inconsistent. He has continued to experience auditory hallucinations and paranoid ideation when in the community. Early in the reporting period he spoke with some intensity about these positive symptoms of his psychosis. It seems, however, that this intensity has decreased somewhat. While he still has occasional feelings that people are making comments about him, his presentation is generally stable, and he is demonstrating a good response to medication.
18The Hospital Report identifies stability of symptoms as being one of Mr. Sinclair's most relevant considerations. His treatment team has noted that his relapses of psychotic symptoms are quick and unpredictable in spite of the fact that he has been relatively stable for the past year and has, in fact, nearly fully progressed across all recovery domains. He has been pro-social and has not posed any behavioural concerns. He has reported fewer instances where he has experienced positive symptoms. He has reported not having paranoid thoughts and has been medication compliant when visiting with friends and family. Recurring overnight passes to his parents' home have been used without any incidents. He is independent and exercises good self-care and personal hygiene. He attends appointments reliably and has a positive attitude towards staff and authority.
19Over the course of his testimony, Dr. Darby adopted the contents of the Hospital Report and confirmed that Mr. Sinclair has now been in the community for 3 ½ years with no readmissions to the Hospital. He resides in closely supervised housing that he appreciates and cannot, nor does he wish to, change. Dr. Darby explained that substances are not a concern at this stage, nor is medication compliance. He said that Mr. Sinclair has a good relationship with himself and the case manager. He described Mr. Sinclair as polite, pleasant, and respectful. He gave an important update relative of insight, saying that there has been "significant progress" in the last year in terms of Mr. Sinclair's insight into both his major mental illness and need for medication. Dr. Darby described this as a "key change" from the situation at the time of the last hearing in 2024. He indicated that this factor was a key consideration for the Hospital when formulating its position on the recommended disposition following this annual review.
20Dr. Darby did say that Mr. Sinclair's insight was not total with regard to symptoms of his illness but added that Mr. Sinclair acknowledges his diagnoses and what it drove him to do in the past. Mr. Sinclair acknowledges that his life is much better now than it has been in the past.
21Dr. Darby gave further information with regard to programming completed by Mr. Sinclair. These included culturally-appropriate cognitive behavioural therapy. He explained that Mr. Sinclair has overall done well. He said that, if there was a decompensation, Mr. Sinclair would return voluntarily to the Hospital given his relationship with the treatment team. Dr. Darby also expressed confidence that he would be able to obtain a Form 1 or Form 3 pursuant to the provisions of the Mental Health Act, given Mr. Sinclair's history.
22In response to questions from the representative of the Attorney General, Dr. Darby explained that, on those occasions in 2023-24 when Mr. Sinclair showed some inconsistency in reporting symptoms of his major mental illness, this was not due to any intention on his part to minimize or hide paranoia being experienced. Dr. Darby explained that these experiences for Mr. Sinclair were fluctuating and infrequent and occurred with lower intensity. As such, Mr. Sinclair had difficulties being precise when trying to detail with precision the frequency or duration of what he had been experiencing. Dr. Darby said that Mr. Sinclair's paranoid delusions were less intense and continued to be infrequently experienced. He explained that Mr. Sinclair was able to often identify them as being part of his mental illness. He said that the paranoid delusions, when experienced, did not cause Mr. Sinclair the same level of distress as they had a year ago. He explained that Mr. Sinclair has not been reporting feeling threatened, nor has he been expressing any need to retaliate.
23In response to questions from counsel for Mr. Sinclair, Dr. Darby said that Mr. Sinclair enjoys a close relationship with his sister and has strong support from other family members, including his parents. Dr. Darby expressed confidence that if Mr. Sinclair were to experience early signs of decompensation, the family would contact and work with the Hospital. He explained that the family has formed a good relationship with Mr. Sinclair's case manager. He highlighted that while Mr. Sinclair has a troubling history, he has done well for 3 ½ years in the community. It has been close to 7 years since the index offence and Mr. Sinclair has not committed any further offences since that time.
24In response to questions from the panel, Dr. Darby explained that Mr. Sinclair's medication regimen has been fairly standard over the course of a number of years. He indicated that gradual improvement such as that seen with Mr. Sinclair is not uncommon where there is stability in medications and regular engagement with programming such as Mr. Sinclair has done. He indicated that he did not see a need for a treatment clause in the context of a conditional discharge because Mr. Sinclair has a sustained history of medication compliance both in and out of the Hospital.
25Dr. Darby addressed the fact that Mr. Sinclair was before the ORB in 2012 and received an absolute discharge, only to go on to commit the index offences that have brought him under the Board's jurisdiction again. He explained that this was an important piece of history accounted for when forming Mr. Sinclair's risk profile. Mr. Sinclair has a significant criminal record. That being said, Dr. Darby explained that Mr. Sinclair has not shown any evidence of anti-social behaviour in the last 3 ½ years in the community. Mr. Sinclair expresses understanding that he ceased his meds following his last absolute discharge. Dr. Darby explained that his view is that Mr. Sinclair's recognition of how much better he is now that he is treated for his major mental illness. Dr. Darby explained that from August 2024 to January 2025, Mr. Sinclair has been involved with Culturally Adaptive Cognitive Behavioural Therapy. He engaged with this program meaningfully and he has been utilizing skills and techniques gained to identify feelings associated with paranoia as either being "real, believed real, or identified as not real." This has been in the context of improved insight into his symptoms and decreased frequency and intensity of symptoms.
26Dr. Darby discussed Mr. Sinclair's transition from a long-acting injectable medication to oral medications. He explained that he has been on oral medications full time since being in the community. He has been assiduous and has the support of his family. He has been compliant with his oral medications both in his own accommodations and when visiting family.
27The issue of international travel was discussed with Dr. Darby. Mr. Sinclair has not been to Jamaica with his family but is working on saving for that purpose.
28The primary concern expressed by Dr. Darby again in his responses to questions from the panel dealt with the nature of Mr. Sinclair's relapses into paranoid delusions. Dr. Darby explained again that Mr. Sinclair's relapses are quick and unpredictable. That being said, he expressed confidence in the level of supervision Mr. Sinclair receives in his residence and by virtue of his daily contact with the treatment team and his case manager.
29This is confirmed in the violence risk assessment found in the Hospital Report, beginning at page 31. That assessment notes that clinical risk items include problems with insight, symptoms of major mental disorder, violent ideation, instability and problems with treatment and supervision response. It explains that Mr. Sinclair continues to exhibit significant psychotic symptomatology such as that which was present at the time of the index offence. These symptoms are present despite receiving treatment. When decompensation occurs, Mr. Sinclair becomes threatening and irritable and demonstrates poor appreciation of his mental condition, attributing his violent actions around persecutory beliefs. The risk assessment goes on to state, at page 33-34 that:
Absent the jurisdiction of the ORB, Mr. Sinclair would be expected to have significant difficulties with maintaining professional services and reasonable plans (as he has in the past and which ultimately led to his re-offending violently and the second finding of NCR). He would be expected to have an unstable living situation. His family supports would be limited as a result of his significant likelihood of becoming psychotic and using drugs, and he would be expected to do poorly with treatment and supervision in keeping with his history of non-compliance. He would have ongoing and heightened difficulties with stress and coping as he has in the past.
30This, however, is coupled with the following statement under the subheading "Strengths":
Mr. Sinclair has demonstrated some ability to follow treatment care plans, including adhering to long-acting injectable antipsychotic medication and taking PRN medications for his side effects. Further, he has shown improved insight into his mental illness. He is independent in managing his finances and in completing activities of daily living. He continues to receive support from his family. He is engaged in treatment in his residence. He presents as pleasant and cooperative with staff and co-patients during group activities.
Submissions
31At the end of the hearing, the parties renewed their submissions as stated at the hearing's outset. Dr. Darby, speaking for the Hospital, maintained the position that Mr. Sinclair continued to represent a significant threat to the safety of the public based on his troubling history. In this regard, he highlighted Mr. Sinclair's previous course under the Review Board's jurisdiction, his significant history of aggression, his criminal record and historic lack of compliance with treatment recommendations. He took the position, however, that Mr. Sinclair's risk could be managed under the provisions of a conditional discharge. He emphasized that this has been another good year for Mr. Sinclair, making 3 ½ years of stability while living in the community. He argued that the evidence showed an increase of insight that would support the conclusion that Mr. Sinclair would return to the Hospital were he asked to do so. He took the position that this was a key difference compared to previous years.
32The representative of the Attorney General agreed that Mr. Sinclair continued to represent a significant threat to the safety of the public but took the position that a detention disposition was necessary and appropriate to manage his risk, having regard to the s. 672.54 objectives, the primary of which is the assurance of the safety of the public. He specifically referenced page 28 of the Hospital Report. Here, it is explained that Mr. Sinclair's insight has improved but is still limited. He pointed to fluctuations in Mr. Sinclair's paranoia and suspicions and took the panel to page 30 of the Hospital Report where it is pointed out that Mr. Sinclair's relapses can be quick and unpredictable.
33Counsel for Mr. Sinclair was ad idem with the Hospital. While he conceded that the threshold of significant threat had been met based on the factors set out by Dr. Darby in his submission, he argued that a further year of stability in the community, together with Mr. Sinclair's ongoing compliance with treatment recommendations since coming under the Board's jurisdiction on the subject index offences, supported the granting of a conditional discharge.
Analysis and Conclusion
34As stated above, the panel had no difficulty accepting the joint submission that Mr. Sinclair represents a significant threat to the safety of the public. In doing so, the panel considered the following factors in arriving at its conclusion:
- Mr. Sinclair suffers from a major mental illness that figured prominently in the commission of a serious index offence.
- Mr. Sinclair has a significant criminal record, history of aggression, and was previously under the jurisdiction of the Ontario Review Board for acts of sexual aggression and other offences, all driven by his psychosis.
- Mr. Sinclair's insight, while improving, remains partial. What is more, while he continues to be assiduous with antipsychotic medications, his symptoms return unexpectedly. When this takes place, he becomes oppositional, aggressive, and irritable.
Looking at his history of aggressivity when suffering the primary symptoms of his psychosis, the risk Mr. Sinclair poses to the public is one of serious physical harm. Applying the direction provided by the Supreme Court of Canada in Winko, Mr. Sinclair's re-offence scenario as described above in paragraph 29 sets out a clear threat that, absent a disposition, he is likely to experience unpredictable relapse into paranoid delusions similar to those experienced at the time of the commission of the index offence, and that there is a resultant risk that the public will suffer serious physical harm. The risk, in his situation, is both significant in terms of likelihood and in terms of seriousness of harm.
Turning then to the issue of disposition, the Board is mindful of the provisions of section 672.54 of the Criminal Code and of its primary objective to assure the safety of the public. It is also mindful of the important consideration and balancing of the other objectives pertaining to ensuring that Mr. Sinclair's mental health and other needs are met, including the ultimate objective of reintegration into the community. In this regard, the Board was mindful of the principle of minimal intrusion and actively considered the question: "Can Mr. Sinclair's risk be managed under a lesser form of disposition than that of a detention order?"
In the Board's view, it can, while assuring the safety of the public. This is owing to several protective factors. Firstly, he lives in highly supervised housing in the community. Mr. Sinclair likes his residence and has not expressed any intention of changing it nor could he given housing shortage and limited funds that he is trying to save for a trip with family to his place of heritage (Jamaica). His family is highly supportive, and he has frequent contact with them. The evidence is that in the event of decompensation, they would contact the Hospital and work cooperatively with the treatment team to address Mr. Sinclair's emergent needs. Mr. Sinclair maintains a positive relationship with both staff at his place of residence and at the Hospital. Mr. Sinclair has improved insight and with the combination of both his medication and the skills and techniques learned through the Culturally Adaptive Cognitive Behavioural Therapy program, been able to identify paranoid delusions as "believed real" and "not real." These delusions themselves are of lesser frequency and intensity, and Mr. Sinclair has a lengthy history of working cooperatively with the treatment team, Dr. Darby, and his case manager when symptoms arise. Mr. Sinclair has been treatment compliant while in the community for over 3 ½ years and expresses appreciation for his oral anti-psychotic medication.
The Board considered the fact that Mr. Sinclair has continued to experience fluctuating and unpredictable periods of relapse of his paranoid delusions. While this is a concern associated with the safety of the public, the question is whether a conditional discharge with terms that, in effect, mirror those of his reigning detention disposition, are sufficient to manage the threat. In our view, it can. The nature of Mr. Sinclair's major mental illness is that symptoms are subject to unpredictable return whether he is under a detention disposition or a conditional discharge. Both forms of disposition would have him living in the community in highly supervised housing with the support of family and a treatment team with whom Mr. Sinclair shares a strong therapeutic alliance. The evidence is that Mr. Sinclair has never resisted requests that he attend at the Hospital and that he would likely attend as requested. The involvement of staff at his place of residence and his family gives confidence that early signs of decompensation will be brought to the Hospital's attention if Mr. Sinclair himself does not disclose them. It is notable that Mr. Sinclair has been open in any event with his symptoms when they have been experienced. This makes it difficult to ascertain how a detention disposition will contribute to the safety of the public beyond what a conditional discharge may in his circumstances. In his situation, we are not dealing with rapid decompensation but rather an unpredictable possibility of decompensation.
Applying the principle of minimal intrusion, the Board is of the view that a conditional discharge, with terms matching those found in the reigning order, albeit amended so as to be appropriate to the context of a conditional discharge, is the necessary and appropriate disposition having regard to the objectives set out in s. 672.54 of the Criminal Code. An order will issue accordingly. Mr. Sinclair's housing is key to his risk management therefore a residence clause will be included in the Disposition, together with a condition that he report to the Hospital not less than once per week.
The Board thanks all those who participated in this hearing and wishes Mr. Sinclair the best over the course of the next review period.
DATED this 6^th^ day of May, 2025 at the City of Toronto, in the Toronto Region.
Mr. D. Sandor Legal Member
__________________
Office of the Registrar Ontario Review Board