Ontario Review Board
Re: Ankurbhai Patel
ORB File No: 7805
Hearing held on: Wednesday, May 7, 2025
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. L. Banks
Members: Dr. T. Verny Dr. G. Nexhipi Mr. K. McKenna Mr. W. Apted
Parties Appearing:
Accused: Ankurbhai Patel Counsel: Ms. R. Levin
The person in charge of hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Mr. M. Feindel
REASONS FOR DISPOSITION
(Dated June 18, 2025)
Introduction:
On November 10, 2020, Ankurbhai Patel was found not guilty by reason of mental disorder of charges of possession of weapon for a dangerous purpose, utter threat, assault with a weapon, and assault causing bodily harm, contrary to the Criminal Code.
Mr. Patel is currently subject to a Disposition of the ORB dated June 7, 2024, which discharges him subject to a variety of terms and conditions, including that he reside at a specified address and that he report to the person in charge of the Centre for Addiction and Mental Health (“CAMH” or the “hospital”) not less than twice per month. The Disposition also contains a condition that he take treatment as prescribed in accordance with s.672.55 (1) of the Criminal Code. There is also a condition prohibiting Mr. Patel from contacting or communicating, or residing with, Nilamben Patel, except with her written revocable consent.
On May 7, 2025, a panel of the Ontario Review Board (“ORB or the “Board”) convened an annual hearing to review Mr. Patel’s Disposition pursuant to s.672.81 of the Criminal Code. Mr. Patel attended the hearing and was represented by his counsel, Ms. Levin. He was assisted at the hearing by a Gujarti interpreter, who provided interpretation on an as-needed basis. Mr. Patel’s wife was also present at the hearing.
The issues to be decided at this hearing were whether Mr. Patel continues to meet the test for significant risk to the safety of the public and, if so, a decision as to the least onerous and least restrictive disposition to be made in the circumstances of this accused, including any conditions to be attached to that Disposition, bearing in mind the four factors set out in s. 672.54 of the Criminal Code.
For the reasons set out below, the Board was in unanimous agreement that the test for significant threat continued to be met and that the least onerous and least restrictive Disposition necessary to manage the risk posed to the public by Mr. Patel is that he remains subject to his Conditional Discharge, with one amendment thereto being the removal of the prohibition on his contacting, or living with, his wife.
Positions of the Parties:
At the commencement of the hearing, all parties were canvassed as to their position. The hospital’s representative recommended that Mr. Patel continues to represent a significant threat to public safety and that he should remain bound by the terms of his existing Disposition, with one amendment thereto being the removal of the prohibition on his contacting, or living with, his wife.
Counsel for the Attorney General supported the hospital’s recommendation for the continuation of the Conditional Discharge but stated that he wished to canvas the issue of the removal of the no-contact prohibition.
Counsel for Mr. Patel indicated her client was supportive of the hospital’s recommendation and she confirmed Mr. Patel’s consent to the treatment condition.
At the conclusion of the evidence, Mr. Feindel indicated his support of the hospital’s position resulting in the Board being presented with a joint recommendation.
Personal History:
Mr. Patel is a 39-year-old man who is a permanent resident of Canada. He migrated from India in 2014. Since October 8, 2021, he has lived with his wife, the victim of the index offences. He works full time for his brother-in-law in a factory. There are no children. The index offences occurred December 24, 2019. He was granted bail on February 11, 2020. He lived with his sister, brother-in-law, their two children until October 8, 2021, when he was permitted to live with his wife subject to her consent as provided in his Disposition.
Mr. Patel has a history of heavy alcohol use since moving to Canada in 2012. He reports being abstinent since the index offences.
Current Diagnoses:
- Mr. Patel’s current diagnoses are:
Schizophrenia; and
Alcohol Use Disorder, in remission.
Query/Rule out mild intellectual disability vs unspecified mild neurocognitive disorder.
Index Offences:
- The facts surrounding the index offences are set out in last year’s ORB Reasons dated June 20, 2024, as follows:
“According to the police report, on December 21, 2019, Mr. Patel was watching television with the victim, his wife Ms. Nilamben Patel, at their shared apartment residence in Toronto. Without warning, Mr. Patel demanded for the victim to surrender all of her “black cards” in her wallet as he feared that unknown persons were using them to track the victim’s whereabouts. Without allowing the victim any time to react, Mr. Patel attempted to stab her in the stomach with a recently purchased knife. The knife was still enveloped by plastic sheathe, which prevented the victim from sustaining severe injuries. The victim fell onto her back and Mr. Patel again attempted to stab her. The victim sustained multiple lacerations to her forearms. Mr. Patel then chased the victim with the knife and threatened kill her if she did not give him her “black cards”. The victim was able to grab the knife blade and wrestle it from him. She fled to a relative’s residence in the area and contacted the police. Mr. Patel was apprehended and charged with Assault with Weapon, Assault Cause Bodily Harm, Possession of a Weapon, and Uttering Threat.”
Evidence at the Hearing:
Dr. A. Igoumenou, Mr. Patel’s out-patient psychiatrist since January 21, 2025, testified at the hearing to supplement the documentary information available to the Board. She adopted the contents of the Hospital report, and advised there were no material updates thereto.
Mr. Patel is assessed as capable to consent to his psychiatric treatment and he self-administers an oral dose of the antipsychotic medication, risperidone, nightly, monitored by his wife. His mental state has been stable and he denies experiencing any psychotic symptoms, including hallucinations or other disturbances. There have not been any concerns raised by Mr. Patel’s wife regarding his medication adherence.
Mr. Patel continues to decline treatment by a long-acting injection (“LAI”) and explains his reluctance as attributable to a fear of needles. The doctor stated that if he were treated with a LAI, it would be preferable as it would be easier to ensure compliance and therefore, improve risk management. In all respects however, his illness is considered to be in remission due to his medication adherence and his abstinence from alcohol and drugs. Of note, Mr. Patel has expressed experiencing sexual side effects from his medication. He has sought help from his family doctor and the situation has been addressed.
Mr. Patel continues to reside in an apartment in Toronto with his wife who is a very strong support. In February 2025, Mr. Patel’s in-laws moved from India to stay with his wife and him for three years. Mr. Patel and his wife have expressed that they are happy with this situation and grateful for the support. The team has had regular contact with Ms. Patel and she reports that her husband has been mentally stable and their relationship has been positive.
Over the past year in June 2024, Mr. Patel’s risperidone levels were quite low. It was not confirmed whether or not he had missed a dose but as a risk management plan going forward, it was decided that Mr. Patel’s wife would supervise his medication. She has been doing this daily.
Mr. Patel has been living with his wife for the past three and a half years without issue and the doctor stated that the treatment team believes that the no-contact provision is no longer necessary or appropriate.
Mr. Patel is followed in the community by the Forensic Outpatient Service (“FOPS”) team and he has reliably attended all appointments, which are typically every two weeks. As Mr. Patel works full-time, many of his appointments were virtual. Often his case manager met him at his place of work to provide him with more flexibility for reporting. A Hindi or Gujurati interpreter was made available for all of Mr. Patel’s meetings as his English is limited. Mr. Patel sees his psychiatrist at least monthly.
The doctor advised that Mr. Patel has been referred for psychological therapy to address psychoeducation regarding his illness, its treatment and substance abuse challenges. As well, the therapy will focus on cognitive adaptive training and strategies. This will be done as an out-patient and Mr. Patel is receptive to the team’s recommendation.
There have been no incidents relating to violence, self-harm, or threats of harm.
There were no readmissions or visits to the emergency department.
All of Mr. Patel’s urine drug screens during the reporting period have returned negative for substances of abuse.
Mr. Patel is gainfully employed, working five days a week with his brother-in-law in a company where his brother-in-law is a partner, making doors.
Mr. Patel reported that not being able to speak English proficiently has been the biggest barrier to increased independence; however, he has declined to enroll in ESL courses as he states he is too busy with work.
The doctor reminded the panel that psychological assessments conducted in 2020 and 2022 revealed that Mr. Patel has enduring cognitive deficits even when his psychosis was in remission. The Hospital Report indicates “Results from his 2022 psychological assessment suggested that his cognitive deficits likely reflected a mixture of his premorbid intellectual functioning and residual symptoms of schizophrenia.”
Dr. Igoumenou stated that Mr. Patel’s presentation is complex but that it is likely that both his mental illness of Schizophrenia and his intellectual disability are driving factors. The doctor stated that is why the team recommends he engage in ongoing individual therapy.
According to the Hospital Report, the clinical factors most relevant for Mr. Patel include:
History of violence influenced by delusional beliefs
Limitations on insight into treatment
Tendency to minimize stressors and psychotic symptoms when unwell
History of alcohol misuse
- The re-offence scenario contemplated in the Hospital Report indicates:
“If Mr. Patel were to re-offend, this will likely transpire in the following manner: Mr. Patel would experience a relapse of psychotic symptoms, as a result of medication non-adherence, substance use, spurred on by stress, or occur spontaneously without obvious triggers. In such a scenario, he will progressively become more fixated on acquiring his father’s property in India and other ways to make money quickly. His delusions will likely progress to developing paranoid beliefs that others are tracking or following him, with concerns about “black money” or “black cards”. He is likely to experience referential delusions such as receiving specific messages from the TV or from strangers, which would likely intensify his paranoia, and he would act out violently. The victims most likely to be harmed are individuals in Mr. Patel’s proximity, such as family members.”
When asked what would occur should Mr. Patel suffer a decompensation in his mental state due to medication non-adherence, relapse to alcohol or substance use, and/or breakthrough symptoms, the doctor stated that Mr. Patel has assured the clinical team that he would cooperate in a return to hospital if requested. The clinical team is also confident that they would be assisted by his wife who is insightful regarding her husband’s illness and who has indicated that she would contact the team with any concerns with Mr. Patel’s mental health, as she has done in the past.
No further evidence was called by the parties.
Analysis and Conclusions:
The Board finds that the test for significant threat is made out in this case. Mr. Patel has a history of psychosis and of assaultive behaviour flowing from delusional thoughts when unwell. His delusions, when active, are very expansive. Mr. Patel’s insight into his mental illness and need for treatment, and his delusions, when active, are so extensive that it removes him from appreciating the reality of his situation, increasing his level of risk to others. Absent external controls, medication, supervision and support, Mr. Patel is at risk of decompensation and the violence he exhibited in 2017.
Having come to a finding of significant threat, we must craft a Disposition that is necessary and appropriate, as well as least restrictive, and least onerous. We find that the Mental Health Act is sufficient to manage his risk to public safety together with Mr. Patel’s existing Conditional Discharge, subject to the removal of the prohibition on his contacting or living with his wife.
In our assessment, this prohibition is no longer necessary, appropriate, least restrictive, or least onerous. Mr. Patel has resided successfully with his wife in the community for the past approximate 3 1/2 years without issue. She is an important support for him and she is well aware of his mental health challenges and, in fact, plays an important role in supporting him. Their relationship is reported to be supportive and stable. Ms. N. Patel has reached out to the FOS in the past when she had concerns about her husband’s presentation and would be expected to do so in the future should concerns arise.
In making this Disposition, the Board has reviewed the provisions of s. 672.54 of the Criminal Code and has carefully considered the need to protect the public from dangerous persons, Mr. Patel’s mental condition, his reintegration into society and his other needs.
DATED this 18th day of June, 2025, at the City of Toronto, in the Region of Toronto.
Ms. L. Banks
Alternate Chairperson
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Office of the Registrar
Ontario Review Board