Re: Erik Knight, 2025 CanLII 45816

Ontario Review Board

Re: Erik Knight

ORB File No: 8030

Hearing held on: Tuesday, April 1, 2025

Place of Hearing: Brockville Mental Health Centre

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

Before: Alternate Chairperson: Ms. T. Mann Members: Dr. R. Kunjukrishnan Dr. A. Gibas Ms. M. den Haan Mr. M. Hajek

Parties Appearing: Accused: Erik Knight Counsel: Mr. M. Bird Person in charge of the hospital: Representative Dr. E. Carefoot Attorney-General of Ontario: Counsel: Ms. J. Masse

REASONS FOR DISPOSITION

(Dated May 12, 2025)

Introduction:

1On March 7, 2022, the accused, Eric Knight was found not criminally responsible on account of mental disorder on one count of arson – reckless disregard for human life contrary to the Criminal Code of Canada (“Criminal Code”). Mr. Knight is currently subject to a Disposition of the Ontario Review Board (“ORB” or “the Board”) dated March 27, 2024 which detains him in the Forensic Treatment Unit of the Brockville Mental Health Centre with privileges up to and including to live in the community in accommodation approved by the person in charge.

2On April 1, 2025 the Board convened a hearing at the Brockville Mental Health Centre, (hereinafter referred to as “the Hospital”), to review Mr. Knight’s disposition pursuant to s. 672.81(1) of the Criminal Code.

3Mr. Knight attended the hearing and was represented by his counsel, Mr. M. Bird. A Hospital Report dated March 10, 2025 was marked and filed as Exhibit 1 in the hearing and a CPIC Report dated March 17, 2025 was marked and filed as Exhibit 2.

4The issues for this hearing are whether Mr. Knight continues to meet the threshold of significant threat to the safety of the public and, if so, to determine the disposition that is necessary and appropriate in the circumstances.

Position of the Parties

5At the commencement of the hearing the parties were asked to provide their initial without prejudice recommendations with respect to the issues before the Board. The Hospital, through their representative, Dr. E. Carefoot, recommended Mr. Knight be found to represent a significant threat of harm to the safety of the public and that the terms and conditions of the current detention disposition be continued, with one slight change, as it remained the least onerous, least restrictive way of managing Mr. Knight’s risk. Dr. Carefoot asked that Mr. Knight be granted the privilege of entering the community within 500km of the Hospital, indirectly supervised, for the purpose of visiting family members other than his mother.

6Ms. Masse on behalf of the Attorney General supported the Hospital’s recommendations as to significant threat and the necessary and appropriate disposition.

7Mr. Bird advised that his client would like to explore the suitability of a conditional discharge. If this panel should find a detention disposition were to continue, Mr. Knight was in support of the Hospital’s recommendations. Although the issue of significant threat was not specific conceded, Mr. Bird confirmed that his client was more intent on exploring aspects of the necessary and appropriate disposition.

Index Offences:

8The circumstances giving rise to the alleged index offences are extracted from last year’s Reasons for Disposition, as follows:

"On November 25th 2021 at approximately 4:53 am, a fire was reported at 864 Eighth Concession in North Crosby Township.

The complainant and homeowner, Deborah KNIGHT, reported to police that her nephew, 23-year-old Erik KNIGHT, had started a fire in the furnace room of the residence. She claimed he was unstable. She explained that there were a total of five family members (accused's grandmother, aunt (complainant), father and brother) within the residence at the time the fire was started by Knight.

Ambulance and the Fire Department both responded to the call. No persons died from this incident, however multiple [persons] were checked by ambulance as a precaution. There are approximately $30,000 in damages and the Fire Marshall's Office has invoked their mandate.

Knight fled the scene prior to police arrival. He was found nearby and placed under arrest for Arson - Disregard for Human Life. He was visibly suffering from severe mental health issues, likely caused by continuous drug use. Within the cruiser enroute to Brockville General Hospital, Knight began hitting his head against the inside of the cruiser (metal); he also attempted to wrap the seat belt around his neck.

Knight was transported to BGH by ambulance, in police custody, where he now awaits his over-the-phone bail hearing. He was at first extremely uncooperative with police and medical staff, but has since calmed down."

Background

9Mr. Knight is currently 26 years old. The Hospital Report dated March 10, 2025 sets out, in considerable detail, his psychosocial and legal history as well as his progress through the forensic system during his tenure under the jurisdiction of the Board and will not be repeated in detail here. Of note are Mr. Knight’s current diagnoses, being Schizophrenia, Other Specified Depressive Disorder, Generalized Anxiety Disorder – in remission, Cannabis Use Disorder – in remission and Seizure Disorder.

10Also of note is Mr. Knight’s psychiatric history commencing from a young age. He was diagnosed with ADHD and anxiety when he was eight years old. He presented with oppositional and defiant behaviours in his youth. His involvement in the criminal justice system was brief but significant in that it involved intimate partner violence against his former girlfriend. Assault and forcible confinement are two of the counts contained in Mr. Knight’s CPIC report, filed at the hearing. The Hospital Report details a significant history of anger management difficulties. For a variety of reasons, including attention difficulties, conflictual interpersonal relationships, cannabis use and truancy, he did not complete secondary school.

11In approximately Grade 11, Mr. Knight began seeing a counsellor or a psychiatrist and a behavioural assessment was completed, indicating “social deviance” and a lack of empathy towards others. Mr. Knight suffered on and off throughout his adolescence and young adult life with anxiety and depression. His mother suspected he suffered from a body dysmorphic disorder. He also had an eating disorder, which was thought to relate to paranoia in connection with food. Notwithstanding these difficulties, apart from some fleeting contact with counselors as a youth, and hospital attendances for mental health assessment, Mr. Knight does not seem to have had significant involvement with mental health professionals as an adult.

12Mr. Knight attempted suicide on two known occasions. He was prescribed anti- depressant medication. Additionally, Mr. Knight was diagnosed with epilepsy in 2020 and had a significant history of seizures. He took medication to alleviate these symptoms but had a poor reaction to one of his medications, becoming withdrawn, despondent and acting oddly. His mood and behaviour began to deteriorate. The index offence occurred soon thereafter.

13It appears in hindsight that Mr. Knight suffered a rare side effect of his seizure medication, which resulted in psychotic symptoms. While involuntarily detained in hospital, his seizure medication was changed and antipsychotic medication started. This led to improvement in his physical and mental health.

14Mr. Knight also has a significant history of substance abuse. He began using cannabis around the age of fourteen and alcohol roughly a year later. He described himself as addicted to both cannabis and tobacco. His use of cannabis grew steadily to the point that he was using it in significant quantities several times a day. He has experimented with psilocybin but has no apparent history of abusing prescription medications.

15Mr. Knight’s use of substances, non-adherence to medication, florid psychosis including paranoid and persecutory ideation, auditory command hallucinations, suicidality and sub-optimally treated seizure disorder all played a role in the events giving rise to the index offences (see, for example, the narrative of events at pp 2 – 4 of the Hospital Report).

Evidence at the Hearing

16The Board had available to it the information in the documents forming the Record, the Hospital Report (Exhibit 1), Mr. Knight’s CPIC Report dated March 17, 2025 (Exhibit 2) and the oral evidence of Mr. Knight’s attending psychiatrist, Dr. Esther Carefoot. Dr. Carefoot endorsed the contents of the Hospital Report, including the analysis of significant threat contained within. The doctor then provided the Board with a brief update to the Hospital Report and summarized Mr. Knight’s progress during the period under review.

17In terms of updated information, Dr. Carefoot advised that on March 17, 2025, Mr. Knight moved to an independent apartment in Brockville where he is the only tenant. He pays his rent through a combination of ODSP, a small forensic subsidy available to patients who reside in Leeds-Grenville and his employment at a local hotel. Thus far, he appears to enjoy living on his own, but it is still early days. On the evening of March 26, 2025 he did not call in to the treatment team as required. (This was in the context of staff having some difficulty connecting with him by phone prior to this date.) Staff went to his apartment and knocked on his door but there was no response. The situation was sufficiently serious that the treatment team considered issuing a Form 49 to help locate Mr. Knight and secure his return to hospital. Fortunately, staff located Mr. Knight the following day, at work. The explanation he offered for this incident was that his phone is not reliable and that he did not hear staff at his door. He did not appear to appreciate the team’s concerns as to public safety. There have been no further instances of Mr. Knight being difficult to reach or failing to check in with the team as required by his care plan.

18More generally, Mr. Knight has had a good year overall in the sense that he has not engaged in any aggressive behaviour. He takes his medication as prescribed, is mostly cooperative with his treatment team, and maintains gainful employment. He was doing well enough that the team followed through with plans to permit him to reside in the community.

19However, Mr. Knight’s mental status has fluctuated. In June 2024, he experienced an acute exacerbation of his depressive disorder which manifested as low mood, increased anxiety and a return of suicidal ideation. He later told Dr. Carefoot that he went to some nearby railroad tracks and laid his head down on them “to see what it would feel like”. He also disclosed a re-emergence of auditory hallucinations and increased cravings for cannabis such that he purchased some at a legal cannabis dispensary but ultimately decided against using it. In her oral evidence, Dr. Carefoot said it was difficult to identify a triggering event for his decompensation, but suspected it was due to a combination of increased stress at his employment related to having to work more hours and a dosage decrease in his antipsychotic medication (olanzapine).

20The doctor found it concerning that Mr. Knight did not proactively reach out to his treatment team to seek help for his difficulties, possibly because he did not recognize them as illness symptoms or that he did recognize them and was afraid he would be re-admitted to hospital. Fortunately, group home staff noted the change in his presentation and reported it to the treatment team. Dr. Carefoot and the treatment team have been working with Mr. Knight to help him understand that reporting symptoms does not automatically result in re-admission to hospital. Building trust with Mr. Knight remains a work in progress. He is resistive to engaging in counseling because he experiences it as “patronizing” and “demeaning”, and also because he did not want to prioritize therapy over his employment. Moreover, he was not a good fit with the individual to whom he was referred for this. However, there are glimmers of hope in that Mr. Knight seems to be establishing trust with a particular staff member on his treatment team, “Chris”, and has also quite recently reached out to Mr. G. Tremblay, a hospital employee with whom Mr. Knight previously enjoyed a positive therapeutic rapport, for counseling.

21Mr. Knight’s insight into his illness, its connection to his index offence and his need for medication is partial. He does not believe he has schizophrenia and has expressed a desire to reduce his antipsychotic medication, including within one day of moving to his apartment in the community. He views psychiatric issues requiring medication as important to address but does not accord the same priority to psychiatric issues requiring counseling. He believes that the index offence/s were not solely his fault and that his father’s actions heightened his paranoia which contributed to his behaviour at the time. He feels “it wouldn’t have gotten that bad” had his father not made those comments. Although Mr. Knight is amenable to taking his medication, he does not feel he really needs it. He sometimes forgets to take it or takes too much. Dr. Carefoot expressed the hope that Mr. Knight’s participation in counseling will lead to increased insight, greater ability to manage mood and anxiety and help him to process the impact of being under the jurisdiction of the ORB.

22As for the proposed change in passes to include indirectly supervised privileges, Dr. Carefoot explained that Mr. Knight has done well during visits to the Kitchener-Waterloo area, but the terms of his current disposition require that he be accompanied by an approved person – in this case, his mother. The treatment team would like Mr. Knight to be able to build relationships with other family members – cousins, for example – without his mother needing to be present.

23Lastly, Mr. Knight has been referred to a neurologist for an assessment of his seizure disorder and its impact on his mental health, but he remains on the waitlist for this with no date yet identified for an initial appointment.

24An issue raised in last year’s Reasons for Disposition was the need for clarity around Mr. Knight’s diagnoses, as this would inform his treatment plan going forward, whether in the Hospital or in the community. Dr. Carefoot believes that Mr. Knight’s primary diagnosis is schizophrenia and there is also a mood component to his presentation due to his struggles with depression. He does not experience hypomania. Dr. Carefoot noted that there remains some room to optimize his medications in that he responds well to antipsychotic medications but less so the medications prescribed to regulate mood. The doctor added that some of Mr. Knight’s ambivalence in terms of decision-making and lack of follow-through may be due to negative symptoms of schizophrenia, or underlying personality issues. This, too, could be explored in therapy provided Mr. Knight is ready to participate in it. Dr. Carefoot has also referred Mr. Knight for a formal psychological risk assessment with a psychometric component which may shed some light on the extent to which Mr. Knight’s personality traits might be impacting his presentation. He remains on the waitlist for this as well.

25Turning to the issue of significant threat, Dr. Carefoot described the most likely risk scenario would arise from Mr. Knight not prioritizing his mental health and failing to engage regularly with his treatment team. This would lead to decompensation of his mood and re-emergence of the positive symptoms of his schizophrenia. The doctor noted that Mr. Knight’s decompensation last summer presented as very similar to the state of mind giving rise to the index offence.

26In describing the timeframe within which Mr. Knight could experience decompensation in his mental state, Dr. Carefoot indicated if it occurred in the context of substance use, it would be “quite quickly” and if solely due to medication non-compliance, symptoms would likely emerge more slowly, i.e. within a few days.

27Dr. Carefoot stated that neither she nor the treatment team were in support of Mr. Knight being granted a conditional discharge. Factors considered by the treatment team included his lack of insight into, and acceptance of, his diagnoses, his interest in reducing his medication, and his delayed disclosure of his symptoms to his treatment team last June. The doctor is of the opinion that Mr. Knight’s risk could not be managed if his situation were governed by the Mental Health Act. Dr. Carefoot worries that triggering the application of the Mental Health Act would require Mr. Knight to pose an imminent risk of harm to others. In the time it would take for Mr. Knight to reach this threshold, harm to others or himself is likely to have already occurred. In this regard, the Hospital needs the ability to return Mr. Knight to hospital to prevent this state of affairs from developing.

28Neither the Attorney General nor Mr. Knight adduced evidence.

Analysis, Conclusion and Disposition

29Having heard and considered all of the evidence presented at the hearing, and submissions from the parties, the Board finds that Mr. Knight continues to pose a significant threat to the safety of the public. Mr. Knight’s risk flows from his major mental illness, Schizophrenia, as well as his other diagnoses relating to depression, anxiety, cannabis use and seizures which, operating independently and together, render him highly vulnerable to acting out in serious and criminal ways when mentally unwell. The index offence of arson – disregard for human life was particularly serious. The Board accepts in its entirety the risk assessment set out at pp 28 – 29 of the Hospital Report, and in particular the following summation:

“Under the supervision of the outpatient forensic rehabilitation team with the current detention order Mr. Knight’s risk of future violence, serious physical harm and imminent violence is low-moderate. However, without the support of the team and the detention order Mr. Knight’s risk is likely to become elevated to the moderate risk category as he is likely to have significant concerns in all risk management categories”.

30The Board was struck by the similarity between the psychotic and mood symptoms Mr. Knight experienced at the time of his decompensation in June 2024 and those which were present at the time of the index offences (i.e. hearing birds talking to him, depression, anxiety and thoughts of self-harm). His decision to purchase cannabis is of particular concern in view of his history of addiction and active use of it in the days and weeks leading up to the index offences. Given the overall fragility of Mr. Knight’s mental state, partial insight into his index offences, diagnoses and need for medication, ongoing vulnerability to stress and reluctance to participate in recommended psychotherapeutic initiatives (eg counseling, relapse prevention support), the Board has no doubt whatsoever that Mr. Knight’s current constellation of symptoms and behaviours are such that he continues to pose a significant threat to the safety of the public.

31Turning now to the issue of fashioning the necessary and appropriate, least onerous and least restrictive disposition, currently Mr. Knight is passively compliant with his psychiatric and seizure disorder medications. He has been agreeable with suggested changes in his medication regimen. To his great credit, despite the return of cravings during the decompensation he experienced in June 2024, he has remained abstinent from cannabis. Also to his credit is his participation in gainful employment which adds structure and accountability to his day. These factors, along with the benefit of the support and supervision he receives from his treatment team, have resulted in the attenuation of the positive symptoms of his schizophrenic illness, mood stabilization and control of his seizure disorder. He is now living in the community with no imminent plans to move. As such, the Board agrees that a conditional discharge disposition has an “air of reality” about it. Consequently, the Board carefully considered whether Mr. Knight’s consent to treatment pursuant to s. 672.55(1), together with the civil commitment mechanisms available under the Mental Health Act would be sufficient to protect public safety, maintain his mental stability in the community and ensure his expeditious return to hospital in the event of noncompliance or decompensation and concluded that they would not.

32The Board agrees with the Hospital’s position that there is a need to be able to quickly intervene and readmit Mr. Knight to hospital in the event of a decompensation or threatened decompensation in his mental state. The provisions of the Mental Health Act, which are retrospective in nature, are insufficient to accomplish this, particularly given the rapidity with which Mr. Knight is likely to decompensate. If Mr. Knight were to decline treatment with psychiatric medication, or relapse to use of cannabis or experience an increase in illness symptoms, whether caused by stress or otherwise, the Mental Health Act would not allow the Hospital to intervene sufficiently quickly so as to ensure public safety.

33The Board notes that Mr. Knight’s tenure in the community has been relatively brief – nine (9) days. The day after he moved to his apartment, he asked whether his medication could be reduced, based on his perception that he does not suffer from Schizophrenia. On March 26, 2025, he failed to report as required by his treatment plan and did not answer his door when staff attended his apartment. This incident was sufficiently alarming that the Hospital considered activating a warrant to locate and return him to hospital. These early supervision response difficulties bear close monitoring, particularly in view of the complexity and multiplicity of Mr. Knight’s risk factors and his history.

34While Mr. Knight is on a positive trajectory overall and is moving fairly quickly through the forensic system, the Board finds that there remains a need for Mr. Knight to demonstrate stability within the community for a further period of time before a conditional discharge can become a viable disposition. Mr. Knight continues to be in need of supervision, structure and support to manage his complex mental health needs and ensure the safety of the public and himself. This is best accomplished within the legal framework of a detention disposition order. In Mr. Knight’s case, forward progress is best accomplished slowly and incrementally to avoid overwhelming his fragile coping mechanisms.

35The Board concurs with the Hospital’s recommendation that Mr. Knight’s passes to enter the community should be liberalized to facilitate the development of various familial connections in his home community and thus adds the additional privilege of 7-day passes, to enter the community within a 500km radius of the Hospital, indirectly supervised and upon first obtaining approval of his itinerary from the person in charge. This will enhance Mr. Knight’s recovery and rehabilitation in a manner that is not contrary to the safety of public but is consistent with the maximization of his liberty interests. Further, in an effort to provide further extrinsic support to Mr. Knight, the Board wishes to make explicit reference to cannabis in the disposition term prohibiting him from consuming intoxicants, as per Dr. Carefoot’s recommendation.

36Having considered the four factors set out in s. 672.54 of the Criminal Code, namely the protection of the public which is the paramount consideration, the mental condition of the accused, his reintegration into society and his other needs, the Board is of the view that a detention disposition on the terms set out in its formal disposition is the least onerous and restrictive disposition that is necessary and appropriate in the circumstances to manage his risk and his care.

37The Board wishes Mr. Knight well in his recovery journey over the coming year.