Re: Kieran Appleby
ORB File No: 7498/7506/7539
Hearing held on: Friday, May 2, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. C. Finley Members: Dr. P.E. Cook Dr. H. Moulden Mr. B. Garrow Mr. S. Duffy
Parties Appearing:
Accused: Kieran Appleby Counsel: Ms. M. Addie
The person in charge of hospital: Counsel: Ms. A. Marshall
Attorney General of Ontario: Counsel: Mr. K. Simpson
REASONS FOR DISPOSITION
(Dated June 6, 2025)
Introduction
On January 31, 2019, Kieran Appleby was found not criminally responsible (“NCR”) on account of mental disorder on charges of assault with a weapon, theft not exceeding $5000, being unlawfully in a dwelling house, uttering threats to cause death or bodily harm, and mischief not exceeding $5000. He was also found NCR on March 1, 2019, and April 25, 2019 on charges of assault, and assault with a weapon, respectively, all charges being, contrary to the Criminal Code, (the “Code”).
Mr. Appleby is detained at the General Forensic Unit of the Centre for Addiction and Mental Health (“CAMH” and/or the “hospital”), under the terms of a Disposition dated May 1, 2024 with certain discretionary privileges up to and including living in the community in accommodation, in the approved by the person in charge.
On May 2, 2025, the Board convened a hearing, pursuant to s. 672.81(1) of the Code to conduct the annual review of the current Disposition. Mr. Appleby was present and represented by counsel. Mr. Appleby’s parents also attended the hearing.
The issues before the Board are whether Mr. Appleby continues to pose a significant risk to the safety of the public, and if so, what is the necessary and appropriate disposition to manage that risk having regard to the criteria set out in s. 672.54 of the Code.
The parties jointly submitted that there be no change to Mr. Appleby’s current Disposition. Counsel for Mr. Appleby conceded that her client continues to poses a significant threat to the safety of the public.
For the reasons that follow the Board finds that Mr. Appleby continues to pose a significant threat to the safety of the public and that his care should continue on the same terms as his current Disposition.
Evidentiary Record
- Dr. McMaster co-authored the Hospital Report dated April 16, 2025, Exhibit 1, and testified on behalf of the hospital. No further evidence was adduced at the hearing.
Background
Mr. Appleby’s personal and psychiatric history, including the details of his mental disorder and treatment since being found NCR, are described in detail in the Hospital Report. Briefly, Mr. Appleby is 37 years of age, single with no dependents. He has been living in the community since December 2023, in CMHA-THRP2, 24 hour supervised high support housing.1 Since being discharged he has frequently attended at the CAMH emergency department (“ER”), and had many brief admissions to hospital due to persistent psychotic symptoms. His most recent ER attendance was on April 20, 2025.
Mr. Appleby completed high school and attended university but did not complete his degree. Mr. Appleby is currently unemployed and financially supported by Ontario Disability Support Program (ODSP). He is capable of consenting to psychiatric treatment and managing his financial affairs. He is followed by the Expanded FOPS team under the care of Dr. McMaster. Mr. Appleby’s mother is very involved in his care and maintains regular contact with him.
Mr. Appleby’s current diagnoses are Schizophrenia, and Attention Deficit Hyperactivity Disorder, by history. He is currently treated with clozapine and various antidepressants.
The circumstances surrounding the index offence are fully described in the Hospital Report. Briefly, they occurred over a 15-month period beginning in April 2017. The initial charges involved altercations with Mr. Appleby’s mother and stepfather from whom he was estranged. In November 2017, he physically assaulted a passenger on the TTC subway, injuring her. In July 2018 he assaulted (spat upon), an employee at a Tim Horton’s, and in August 2018 he assaulted an individual with a metal crutch.
As noted in the Hospital Report, Mr. Appleby’s first psychiatric admission occurred in 2014, as a result of suicidal ideation. Over the next three years he had multiple assessments and consultations at CAMH.
In 2017, one month prior to the events culminating in the initial index offences, Mr. Appleby was brought to St. Joseph’s Health Centre ER by police following a physical assault on his stepfather. In the period following his arrest, and before being found NCR, he was admitted to the Ontario Shores Centre for Mental Health Sciences, pursuant to a treatment order, for a fitness assessment, and subsequently readmitted to St. Joseph’s for an assessment of his criminal responsibility. Mr. Appleby was uncooperative and his aggressive behaviour continued. He was subsequently treated with antipsychotic medications which resulted in a gradual reduction in his physical aggression.
Course Since Last Annual Review
Mr. Appleby suffers from treatment resistant schizophrenia with low grade psychotic symptoms. He has had a good response to clozapine. While his mental state was generally stable over the reporting period, he volunteered that he occasionally entertained violent thoughts. However, there were no observed physical aggression or critical incidents. He continued to experience somatic symptoms, but at a decreased frequency compared to the last reporting year. Common symptoms experienced by Mr. Appleby include nausea, dizziness and headache.
As in the past, Mr. Appleby was often preoccupied with medication optimization. He remains fixated on the narrative that most of his mental health symptoms can be attributed to medication management issues. Fluctuations in his symptoms often led to him requesting that the dosage be reduced. However, more recently he has shown a willingness to considering other possibilities, such as the impact of general life stressors and past trauma on his fluctuating presentation.
Early in the new year Mr. Appleby reported that his mood was “up and down” but that his psychotic symptoms had improved. On or about January 20, he reported passive suicidal ideation. Wellbutrin, an antidepressant, was added to his medication but he stopped taking it at the end of February due to negative side effects. Prozac was initiated on or about April 1. Initially Mr. Appleby reported an improvement in his mood. On Sunday April 20, he was in distress and presented at CAMH’s ER. He was concerned that Prozac, was causing his distress. When seen by Dr. McMaster on the following Tuesday, his mood had stabilized and he had settled.
Mr. Appleby manages appointments with his psychiatrist and case worker independently. He has a good therapeutic relationship with the clinical team and the staff at THRP2. He has remained compliant with his medication. Currently, he is working with the staff at THRP2 to increase his independence with medication monitoring, in preparation for his eventual transition to independent living. He has also abstained from the use of substances. He is pro social and gets along well with his co-residents.
Mr. Appleby has good insight into his mental illness and his past behaviour. He appreciates that he was delusional at the time he committed the index offences. He also recognizes that his current referential beliefs are delusional. But, there is a gap in his thought process as evidenced by his belief that his reoccurring symptoms and somatic physical complaints are attributable to changes to his medication. In Dr. McMaster’s opinion, Mr. Appleby over values the effect of medications on his experiences. Efforts will continue to optimize his response to psychiatric treatment. Other treatment options may be considered; bearing in mind that the clinical team does not want to reinforce his beliefs on the negative aspects of medication. Mr. Appleby agrees that clozapine is the mainstay of his treatment, and he is committed to taking the antipsychotic in order to optimize his mental stability.
Mr. Appleby is able to manage his activities of daily living independently including self-care. He handles his personal transportation needs and consistently signed in on time for curfew. He completed a cooking assessment in May and demonstrated good independent cooking skills and kitchen safety skills. He engaged in more physical activities in the summer such a swimming and biking. He manages his finances and also started a jewelry design business on line. He pursued opportunities to sell his jewelry at some local arts and crafts fairs around the holiday season as well as online.
Mr. Appleby maintains a strong relationship with his family. He visits his mother and stepfather approximately once a week and speaks on the phone to them throughout the week. In December 2024, he successfully used his first overnight pass since living in the community to visit his aunt. He was accompanied by his mother, who is an approved person.
In view of Mr. Appleby’s progress, the clinical team has initiated a request for his transfer to THRP1 housing, which provides supportive housing 24/7 support, including case management focusing on skill building and risk management. It is stepping stone to living independently in the community in permanent housing, with appropriate supports.
Given the treatment resistant nature of his illness, his history of aggression, the fragility of his mental state with ongoing fluctuating symptoms of psychosis, and his difficulty managing stress, the clinical team believes that he continues to represent a significant threat to the public. The clinical team is unanimous in its opinion that, given Mr. Appleby’s ongoing struggles with the symptoms of his illness, he continues to require a high level of mental health support as provided for under his current Disposition.
If Mr. Appleby is to re-offend it would likely transpire while he is experiencing an exacerbation of psychotic symptoms or through inadequate response of his psychotic symptom intervention. In either event he is likely to behave in a similar way to that at the time the index offenses. Should he decompensate he would need to be rapidly readmitted to hospital.
Dr. McMaster stated that in order to be considered for a conditional discharge the clinical team needs to see more stability and consistency in Mr. Appleby’s overall mental state. The team must also be confident that Mr. Appleby is able to self-administer and monitor his medications while he is living independently. The concern at the moment is the rapid fluctuations in his mental state that are difficult to predict. Dr. McMaster also stated that Mr. Appleby is on the right path to attaining a conditional discharge in the future.
Analysis and Conclusions
Having considered all of the evidence and the joint submission presented by the parties the Board finds that Mr. Appleby continues to pose a significant threat to the safety of the public. We also conclude that his care should continue on the same terms as his current Disposition.
In coming to these conclusions, the Board has considered its responsibility pursuant to s. 672.54 of the Code to make a disposition that is necessary and appropriate in the circumstances, taking in to account the safety of the public, which is the paramount consideration, the mental condition of the accused, his reintegration into society, and his other needs.
DATED this 6th day of June, 2025, at the City of Toronto, in the Region of Toronto.
Mr. B. Garrow Legal Member
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Office of the Registrar Ontario Review Board