Re Anthony D. Heinekamp, 2025 CanLII 59122

Ontario Review Board

Re: Anthony D. Heinekamp

ORB File No: 3746

Hearing held on: Monday, June 2, 2025

Place of hearing: Ontario Shores Centre for Mental Health Sciences

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

Before:

Alternate Chairperson: Ms. L. Banks

Members: Dr. P. Prendergast Dr. M. Kalia Ms. C. Murray Mr. S. Duffy

Parties Appearing:

Accused: Anthony D. Heinekamp Counsel: Ms. J. Boissonnault

The person in charge of hospital: Representative: Dr. J. Pytyck

Attorney General of Ontario: Counsel: Ms. N. MacDonald

REASONS FOR DISPOSITION

(Dated June 19, 2025)

Introduction:

1. On March 24, 2003, Anthony Heinekamp was found not criminally responsible on account of mental disorder (“NCR”) on charges of possession of weapon, uttering death threat, and assault with a weapon, all contrary to the Criminal Code.

2. Mr. Heinekamp is currently subject to a Disposition of the Ontario Review Board (“the Board” or “ORB”) dated June 5, 2024, whereby he is detained at the Forensic Program of the Ontario Shores for Mental Health Sciences (“Ontario Shores” or the “hospital”) with privileges up to and including community living in accommodation approved by the person in charge.

3. On June 2, 2025, a panel of the Board convened to conduct Mr. Heinekamp’s annual review pursuant to section 672.81(1) of the Criminal Code. Mr. Heinekamp attended the hearing and was represented by counsel, Ms. J. Boissonneault.

4. The issues to be decided at the hearing were whether Mr. Heinekamp continues to meet the test of posing a significant threat to the safety of the public and, if so, what is the necessary and appropriate Disposition, bearing in mind the four factors in section 672.54 of the Criminal Code.

Positions of the Parties:

5. The parties made a joint recommendation to the panel that Mr. Heinekamp meets the significant threat threshold and that a continuation of his existing Detention Disposition was appropriate and necessary. All parties supported the addition of a term allowing Mr. Heinekamp to attend a residential treatment program for up to three months within Southern Ontario subject to prior approval of the person in charge of the hospital.

6. The parties maintained their positions with respect to the joint recommendation during closing submissions.

Index Offences:

7. The index offences were summarized in last year’s Reasons for Disposition, as follows:

“On January 21, 2003, Mr. H, attended at the apartment of his girlfriend in an intoxicated condition. His girlfriend was not at home at the time, and Mr. Heinekamp began causing a disturbance by banging, kicking and swearing. The police were called, and when the two officers arrived, they found Mr. Heinekamp and his girlfriend standing in the doorway of her apartment. When the officers walked up the stairs and approached Mr. H, he came out of the apartment and yelled at the officers, "Get the fuck out of here! You are not fucking coming in here! You are not fucking coming in here!”

When one of the officers took hold of Mr. Heinekamp’s left forearm, Mr. Heinekamp produced a knife in his right hand and held it above his head. The second officer drew her gun and demanded that the accused drop the knife, and he complied.

The officers then walk to Mr. Heinekamp to their police cruiser. He struggled when they attempted to handcuff him, and banged his head on the cruiser door when they searched him. During this process he repeatedly made statements such as, “I’ll kill you fuckers! I’ll do my 20 years. I’ve already done 10 years for murder. I’ll kill one of you guys right in front of your family.”

8. In fact, in 1993, Mr. Heinekamp had been convicted of manslaughter and sentenced to ten years imprisonment. The sentence was reduced to eight years on appeal. He had become involved in an argument with a guest in his home that escalated into violence. Mr. Heinekamp knocked the victim to the floor and killed him by kneeing him about the head and upper chest area.

Personal Background:

9. Mr. Heinekamp’s personal and psychiatric history are set out in the Hospital Report to the ORB dated May 17, 2025 (the “Hospital Report”), which was marked as an Exhibit, and will not be repeated in detail here. In summary, Mr. Heinekamp is a 54-year-old man who is single with no dependents. He was born in Nova Scotia and has two brothers. He reported that his father was extremely abusive, and his mother left his father as a result. Mr. Heinekamp’s father passed away in 2002. He remains in contact with his mother.

10. Mr. Heinekamp completed grade 10 but missed a lot of school. He reported employment in carpentry, house painting, construction, and landscaping in Toronto and Ottawa. He reported living in rental apartments prior to the index offences.

11. Mr. Heinekamp reported that he began using alcohol at age 17, and alcohol was his drug of choice.

Criminal History:

12. As stated above, Mr. Heinekamp was convicted of manslaughter in 1993 and served a custodial sentence in penitentiary. The underlying charge stemmed from a violent, physical altercation with a person with whom Mr. Heinekamp had been drinking. Mr. Heinekamp qualified for and was granted a statutory release in 2001.

13. Following the NCR finding in March 2003, Mr. Heinekamp was admitted to Brockville hospital. While detained in hospital in 2005, under the Board’s jurisdiction, Mr. Heinekamp violently assaulted a co-patient causing multiple injuries. He was charged and pleaded guilty to assault causing bodily harm. The offence occurred within two months of Mr. Heinekamp having discontinued some of his antipsychotic medications, whereupon he began to exhibit angry outbursts, threatening and assaultive behaviour.

Psychiatric History:

14. Mr. Heinekamp began hearing voices at the age of thirteen but received no psychiatric treatment prior to the index offences. Mr. Heinekamp has been under the Board’s jurisdiction for over 20 years.

15. He was initially detained in Brockville and Oak Ridge/Waypoint, and has been at Ontario Shores since September 2011. Mr. Heinekamp exhibited somatic delusions, paranoia, auditory hallucinations, and assaultive behaviours. He was variously compliant with prescribed medication, and denied that he had a mental illness for many years. He was transferred to Ontario Shores after showing some improvement; however, while at Ontario Shores, he regularly used alcohol on passes, eloped in 2014, 2017, and 2023, and there were numerous notable incidents over the years.

Current Diagnoses:

16. Mr. Heinekamp’s current diagnoses are:

Schizophrenia,

Alcohol Use Disorder, severe, in remission in a controlled environment,

Amphetamine-type Substance Use Disorder, moderate,

Cocaine Use Disorder, moderate, and

Antisocial Personality Disorder.

Evidence at the Hearing:

17. Dr. J. Pytyck who has acted as Mr. Heinekamp’s attending psychiatrist over the past year testified at the hearing to supplement the documentary evidence before the Board. The doctor advised that she has known Mr. Heinekamp and been involved with his care on and off over the past ten years.

18. The Hospital Report stated that Mr. Heinekamp is capable of consenting to treatment of his mental illness. He is treated with a long-acting (“LAI”) antipsychotic medication which he receives every 10 days.

19. Over the year in review, he continued to reside in the hospital He continues to reside on the general Forensic Transitional Unit (“FTU”). He presents with poor hygiene and he spends most of his day in his room. He often avoids his daytime meals only snacking in the evenings. He is appropriate in his interactions with co-patients. However, on January 22, 2025, Mr. Heinekamp got into verbal altercation with a male co-peer which was likely to have escalated to physical violence but for the quick intervention of staff on site.

20. Unfortunately, he continues to have difficulty controlling his anger and he often becomes verbally threatening toward members of the clinical team. On January 28, 2025, his privileges were put on hold because of his explicit verbal threats and physical intimidation towards Dr. Hartfeil. Mr. Heinekamp struggles with impulse control, becoming easily agitated and will react by punching a wall or throwing an object.

21. Due to his frequent relapses to substance use and his behavioural outbursts, Mr. Heinekamp’s indirectly supervised privileges were often put on hold for various periods of time over the year in review. Mr. Heinekamp does not have an Approved Person.

22. In terms of his mental state, Mr. Heinekamp has denied experiencing hallucinations over the year in review. He has also denied suicidal or homicidal ideation despite the fact he has made many specific threats to harm or kill staff. He rationalizes and minimizes his behaviour by explaining that this is simply how he manages his anger. The Hospital Report indicates that he “…has presented as more paranoid and suspicious of members of his treatment team in the context of his recent substance use.”

23. Dr. Pytyck testified that from approximately August 2024 to November 2024, Mr. Heinekamp participated in a three-month pilot program that was incentive based and intended to reward patients who remained abstinent. Urine drug screens (“UDS”) were conducted daily on participating patients and when the rapid response indicated a negative result, the patient was rewarded with a voucher for a future lottery. During the pilot program, Mr. Heinekamp tested negative throughout. However, when the program was terminated, he relapsed to crystal methamphetamine and presented with increased paranoia, and impulsivity.

24. Over the past reporting period, Mr. Heinekamp has tested positive for illicit drugs and substances on many occasions (see Hospital Report pages 72-75). To his credit, he is generally forthcoming about his illicit substance use. On some occasions, he has refused to provide a urine sample for drug testing. Often, his privileges were put on hold in response to this refusal. Mr. Heinekamp reports that he periodically craves crystal methamphetamine.

25. Of note, over the past six weeks, Mr. Heinekamp’s UDS have returned negative and his presentation is more behaviourally settled. In the doctor’s opinion, substance use clearly elevates Mr. Heinekamp’s risk of harm to the public.

26. Of note, the doctor testified that on April 26, 2025, a mouthwash bottle containing urine was found in Mr. Heinekamp’s room and his privileges were put on a temporary hold. Mr. Heinekamp was asked to provide a fresh urine sample but he declined on April 28 and May 1, 2025, unless the team agreed to immediately reinstate his privileges. Finally, on May 14, 2025, he agreed to provide a fresh urine sample and his privileges were reinstated that day given the stability in his mental state. The UDS returned clear days later.

27. At the present time, Mr. Heinekamp is able to exercise indirectly supervised privileges for up to 1 hour, five times daily. He does not yet have access to community privileges.

28. In terms of programming, Mr. Heinekamp attended a six-week group dealing with anger management challenges. The Hospital Report indicates that “If Mr. Heinekamp were amenable, he could also benefit from CBTp or a referral for psychological services to address assumptions and core beliefs in order to foster the development of more adaptive coping skills. This could further enhance his capability to address stressors, frustrations, and/or insight-related limitations as he works towards a transition back to the community with the FOS.”

29. Mr. Heinekamp’s insight has deteriorated from previous years. He minimizes the impact of substance use on his mental state and he has continued to use both crystal methamphetamine and cocaine intermittently. His insight into the need for ongoing treatment remains underdeveloped and he has requested reductions in the dosing of his medication, complaining of side effects of over-sedation. Dr. Pytyck advised there will be no further reduction in his dosage until he can demonstrate sustained absence from substance use.

30. Mr. Heinekamp was on the Canadian Mental Health Association Collaborative Residents Enabling Assisted Transitional Engagement (CMHA CREATE) housing waitlist; however, he was removed from the active waitlist by CMHA in May 2025 due to continued substance use concerns and lack of progress in controlling his anger and irritability. Mr. Heinekamp is eligible to be placed again on their “active” list if he is able to show sustained abstinence.

31. Mr. Heinekamp is close to his mother and maintains regular telephone communication with her (she lives in Cape Breton). Mr. Heinekamp maintains regular contact with his girlfriend.

32. The Empirically-Based and Clinical Assessment of Risk set forth in the Hospital Report indicates that Mr. Heinekamp’s risk for violent reoffending is in the “low-moderate” range when considering a continuation of a Detention Order. Under a Conditional Discharge, his risk would rise to a “moderate” or higher range.

33. The Clinical Assessment of Risk section of the Hospital Report identifies the following risk factors:

• psychiatric and behavioural instability;

• verbal and environmental aggression in the context of decompensation due to substance use;

• numerous relapses to psychotogenic substances (crystal methamphetamines, cocaine);

• problems with treatment or supervision response;

• deteriorated insight into his major mental illness, the need for medication, and the impact of his substance use;

34. Dr. Pytyck highlighted the fact that Mr. Heinekamp does not appear to appreciate the heightened risk for worsened breakthrough symptoms in the context of his ongoing use of cocaine and crystal methamphetamine, particularly if his LAI antipsychotic medication were to be reduced as he has asked.

35. Dr. Pytyck stated that the hospital endorsed the inclusion of a term allowing for Mr. Heinekamp to attend a residential treatment program within Southern Ontario for up to 90 days upon prior approval of the person in charge of the hospital. It is hopeful that this intensive treatment modality will assist with Mr. Heinekamp’s addiction challenges.

36. Ms. Boissonneault posed a series of questions to Dr. Pytyck relating to the state of the doctor’s therapeutic relationship with Mr. Heinekamp. Dr. Pytyck acknowledged that there are times when her client refuses to speak with her but overall, she did not believe they had reached a therapeutic impasse. When Ms. Boissonneault suggested that her client might benefit from a transfer to a new treating psychiatrist, Dr. Pytyck stated that she did not oppose that; however, much would depend on bed availability and professional resources.

37. Dr. Pytyck stated that the treatment team is of the unanimous opinion that Mr. Heinekamp can only be safely managed under his existing Detention Order at this time. The Hospital Report indicates that “Mr. Heinekamp requires ongoing monitoring and treatment in an inpatient setting before he can be safely transitioned back to the community. At this time, he has not demonstrated the ability or the motivation to return to abstinence from substances, which will be a requirement for him before his risk can be managed in an outpatient setting. Once he has demonstrated a period of psychiatric stability and abstinence, the hospital will require the authority to approve his housing to ensure that it offers sufficient structure and oversight. Once he is discharged, the hospital will require the ability to readmit Mr. Heinekamp if he should relapse to substances or decompensate in response to stress, substance use, or other factors.”

38. No further evidence was called by the parties.

Analysis and Conclusions:

39. Based on the Hospital Report and the evidence of Dr. Pytyck, the panel found that Mr. Heinekamp represents a significant threat to the safety of the public, and that a continuation of a Detention Order is the necessary and appropriate Disposition. Mr. Heinekamp’s relevant risk factors include his major mental illness, in conjunction with his substance use disorder and antisocial personality disorder, as well as his limited insight into the importance of ongoing medication adherence, abstinence from illicit substance use and past history of violence. He also continues to minimize his past history of violence, as well as his future risk to the public. Over the year in review, Mr. Heinekamp has engaged in considerable verbal aggression and threats of harm as well as aggression to property. He struggles with appropriate anger management. Further, over the year in review, Mr. Heinekamp has engaged in episodes of cocaine and methamphetamine use.

40. He continues to require an inpatient admission until his condition stabilizes and he is able to demonstrate a prolonged period of stability with medication compliance, the absence of aggressive behaviours and an absence of relapses to illicit substances.

41. When Mr. Heinekamp is ultimately ready for community placement, the hospital will require the ability to carefully monitor Mr. Heinekamp’s housing transition, and have the ability to rapidly return him to the hospital if he deteriorates as a result of medication noncompliance, substance use, or other reasons. The Mental Health Act is not sufficient at this juncture to manage his risk to public safety.

42. We find that Mr. Heinekamp’s frequent relapses to substance use has impeded his use of privileges and general progress under the Board. We concur with the joint recommendation of the parties that Mr. Heinekamp’s Disposition should be amended to include a term allowing him to attend a residential treatment program for up to three months within Southern Ontario subject to prior approval of person in charge of the hospital. We are hopeful that the hospital will find an appropriate residential treatment facility to provide him with intensive supports and strategies to assist him with his addiction challenges.

43. In making this Disposition, the panel reviewed the provisions of section 672.54 of the Criminal Code and carefully considered the need to protect the public from dangerous persons, Mr. Heinekamp’s mental condition, his reintegration into society, and his other needs. The panel concluded that this was also the least onerous and least restrictive Disposition for Mr. Heinekamp at this time.

DATED this 19^th day of June 2025, at the City of Toronto, in the Toronto Region.

Ms. L. Banks

Alternate Chairperson

Office of the Registrar

Ontario Review Board