Re: Trevaun Brown
ORB File No: 7268
Hearing held on: Thursday, May 29, 2025
Place of hearing: St. Joseph’s Healthcare Hamilton, West 5th Campus Hamilton, Ontario
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Clapp
Members: Dr. M. Attia Dr. T. Stirpe Mr. E. Siebenmorgen Ms. R. Chopra
Parties Appearing:
Accused: Trevaun Brown Counsel: Ms. C. Francis
The person in charge of hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Ms. C. Gzik
REASONS FOR DISPOSITION
(Dated July 4, 2025)
Introduction:
On December 1, 2017, Trevaun Brown was found not criminally responsible on account of mental disorder (“NCR”) on charges of utter a threat to cause death or bodily harm (x2), contrary to the Criminal Code. He is currently subject to a Disposition of the Ontario Review Board (“ORB” or the “Board”) dated March 19, 2024, whereby he is detained at St. Joseph’s Healthcare Hamilton, West 5th Campus (“SJHCH” or the “hospital”) with privileges up to and including escorted entry into the community of Hamilton. He is also required to abstain from substance use, refrain from possessing weapons, and refrain from contacting certain individuals.
On May 29, 2025, a panel of the Board convened at SJHCH to conduct Mr. Brown’s annual review pursuant to section 672.81(1) of the Criminal Code. Mr. Brown attended the hearing and was represented by counsel, Ms. Francis, who attended by video.
The Hospital Report dated April 23, 2025, was marked as Exhibit 1. In addition to the documentary evidence, Mr. Brown’s attending psychiatrist, Dr. Wesley Sutton, gave evidence.
The issues to be decided at the hearing were whether Mr. Brown continues to meet the test of posing a significant threat to the safety of the public as set out in section 672.5401 of the Criminal Code, and if so, what is the necessary and appropriate Disposition, taking into account the four factors set out in section 672.54 of the Criminal Code.
Position of the Parties:
At the outset of the hearing, the parties were asked for their initial without prejudice positions. On behalf of the hospital, Mr. O’Brien took the position that Mr. Brown continues to represent a significant threat to the safety of the public, and that a Detention Order remained necessary and appropriate. However, the hospital was recommending the addition of indirectly supervised hospital and grounds privileges, as well as privileges to enter the community of Hamilton accompanied by staff or an Approved Person. It was also noted that since Mr. Brown was transferred to SJHCH from the Waypoint Centre for Mental Health Care (“Waypoint”) on December 17, 2024, all references to Waypoint in the Disposition should be removed.
Ms. Gzik agreed with the position of the hospital on behalf of the Attorney General. Ms. Francis stated that the issue of significant threat was conceded, and that it was a joint submission. She also advised that it was her understanding that Mr. Brown’s mother may be interested in becoming an Approved Person.
Findings:
- For the reasons that follow, the panel found that Mr. Brown continues to pose a significant threat to public safety. The panel concluded that the necessary and appropriate Disposition, which is also the least onerous and least restrictive in the circumstances, is a continuation of the Detention Order, with the two additional provisions as recommended by the hospital.
Index Offences:
- The circumstances of the index offences are set out in the Hospital Report at pages 2-3 as follows:
“The victim in this matter is the physician in charge of the accused’s care at Parkwood Hospital. On the 17th of August, 2017 at 9:59 a.m., [the female physician] called the mobile phone number that she has for the accused, Trevaun Brown. [The physician] identified herself to the accused and she recognized his voice from previous dealings. [The physician] was calling to see if Brown would be attending his 11:00 a.m. appointment, as there was a problem at his last visit.
During the phone conversation, Brown stated, “It should have been you”. [The physician] asked him to clarify and he said, “That should have been you”. [The physician] was aware that the accused had attended the hospital [on] August 14, 2017, and had assaulted and threatened another staff member. [The physician] asked if Brown wanted to hurt her, to which he replied, “Of course, I want to hit you”. [The physician] asked, “Why would you say that?” to which he replied, “Look what you guys did to me” and “I want to kill one of you guys”.
[The physician] is afraid of Brown and believes he is capable of carrying out his threats.
As a result of Brown’s threats, St. Joseph’s Parkwood Hospital has been put into a state of lockdown. During the day, people are generally able to come and go from the building freely but now the front door is locked and Security has to allow people into the building. Numerous police officers were utilized in an attempt to locate Brown on the 17th of August. Brown was last seen leaving [street address], his residence, in the morning. Brown is also wanted in relation to another investigation. As a result, a warrant application is being applied for Brown in relation to two counts of Uttering Threats, contrary to Section 264.1(1)(a) of the Criminal Code.”
Background:
Mr. Brown’s personal history is outlined in the Hospital Report in detail and will not be repeated here. In summary, Mr. Brown is a 31-year-old single man who was born in Jamaica. He is the second child in a sibline of four. Mr. Brown was raised primarily by his grandmother. He came to Canada with his father when he was approximately nine years old, and lived in Toronto and then London, Ontario. Mr. Brown struggled in school and is two credits short of his high school diploma. He used marijuana daily since he was a teenager. He has no work experience, and is supported by the Ontario Disability Support Program.
At the time of the index offences, Mr. Brown was living independently in London, Ontario. Mr. Brown’s mother currently lives in Florida. His father lives in London. Mr. Brown’s father reported that his son was aggressive and started “acting weird” around age 17.
Criminal History:
- Mr. Brown’s criminal history is set out in the Hospital Report at pages 3-6. It includes a 2010 robbery conviction in Youth Court, as well as 2016 convictions for robbery with violence, possession of weapon for dangerous purposes, and theft and dangerous operation of a motor vehicle. Mr. Brown was also convicted on charges of assault and utter threat to cause death which were incurred three days before the index offences. The victims of those offences were Mr. Brown’s caseworker and a security guard at Parkwood Hospital.
Psychiatric History:
The Hospital Report outlines Mr. Brown’s psychiatric history prior to the index offences. It includes multiple admissions between 2012 and 2016 to London Health Sciences Centre (“LHSC”) and the Southwest Centre for Forensic Mental Health Care (“Southwest”). His first admission was precipitated by violence toward his father and lasted two months. Mr. Brown exhibited poverty of thought, profoundly disorganized thinking, and endorsed hearing voices. Mr. Brown’s general level of intellectual functioning measured in the extremely low range, and an occupational therapy assessment demonstrated that he was in the low range for independent functioning. Mr. Brown’s symptoms improved with treatment and supportive housing was recommended upon discharge.
Mr. Brown was involved in the Prevention and Early Intervention Program for Psychosis at LHSC between May 2012 and July 2014. It was noted that he refused medications and exhibited negative symptoms.
Mr. Brown was admitted to Southwest in 2015 on a Treatment Order and spent two weeks in seclusion as a result of aggressive and unpredictable behaviour. He was treated with medication and his symptoms improved. He was admitted to Southwest again from June 2015 to January 2016 for an assessment of fitness to stand trial related to charges of robbery with violence, possession of weapon for dangerous purposes, and theft and dangerous operation of a motor vehicle. He was found fit to stand trial, and the diagnoses were “Psychosis, not otherwise specified; Possible Drug-induced Psychosis, unlikely schizophrenia; Antisocial Personality Disorder, by history (could not be ruled out); Substance Use Disorder, marijuana; Borderline Intelligence; and Malingering.”
Mr. Brown was re-admitted to Southwest in 2016 under another Treatment Order. He was thought disordered, guarded, paranoid, belligerent, threatening, and was responding to internal stimuli. Mr. Brown assaulted two co-patients and was transferred to Waypoint. He required seclusion and was uncooperative with oral medication and combative with injectable medication. Mr. Brown improved with treatment and was able to actively engage in discharge planning. He was discharged to the community on a Community Treatment Order to be followed by the Adult Mental Health Team at LHSC.
Following the NCR finding, Mr. Brown was detained at Waypoint. He had many periods of seclusion, denied he had a mental illness, and refused medications. He was found incapable of consenting to treatment in December 2017, and requested reviews of this finding before the Consent and Capacity Board multiple times over the years (the incapacity finding was consistently confirmed).
The following excerpt from the Psychosocial Assessment Update in the 2017 Hospital Report describes Mr. Brown’s challenging and assaultive behaviours (at page 17):
“Over the past several years, Mr. Brown has been accumulating a history of serious assaults while in hospital and he has made some very serious threats against caregivers and patients. These assaults and threats have occurred at Southwest Centre for Mental Health Care, Parkwood Mental Health Institute and Waypoint Centre for Mental Health Care, and have resulted in changes as to how and who will provide psychiatric care for Mr. Brown in the community. There appears to be a consistent theme of paranoia, in that he has described misperceived actions against him (i.e. accusing a co-patient of following him; being fed bad food; being poisoned, etc.). His assaults are unpredictable and have resulted in personal injury to the victims. Non-compliance with medication, anger towards treatment plans (i.e. Community Treatment Orders and Probation Orders), poor coping strategies, poor communication, and psychotic symptoms have all been attributed as a precipitant to his violent behaviours. Diagnostically, it appears undisputed that Mr. Brown has a diagnosis of schizophrenia. His behaviour, however, is often seen as a result of a broader Antisocial Personality Disorder.”
Mr. Brown’s assaultive and threatening behaviours continued at Waypoint, and he also engaged in property damage and sexually inappropriate behaviours. He continued to require frequent seclusion as a result of these behaviours.
The Clinical Risk Assessment completed by Dr. P. Ismail at Waypoint in January 2024 indicated that Mr. Brown’s mental status, along with episodes of agitation and aggression, reflected a complex clinical presentation marked by mood instability, responsiveness to internal stimuli, and a fluctuating pattern of behaviour ranging from cooperation to aggression. His lack of insight into his mental health was evident through his denial of the severity of his symptoms and the impact they have on himself and others. He also minimized his aggressive acts and failed to understand the personal, interpersonal, and contextual factors contributing to his violent behaviour. Dr. Ismail also stated that Mr. Brown’s engagement in therapeutic activities, albeit inconsistent, pointed to a potential for positive engagement in a rehabilitative environment. His participation in selected activities, along with a noted improvement in behaviour over review periods, suggested that with the right support and intervention strategies, further rehabilitation could be achievable. While Mr. Brown remained a high-risk individual, Dr. Ismail recommended a transition to a less secure facility, and stated the following (at page 84):
“A less secure setting could provide Mr. Brown with more opportunities for social interaction and engagement in therapeutic activities, potentially facilitating further improvement in his behavior and overall mental health. This environment could also help in addressing his needs for autonomy and dignity, fostering a sense of responsibility and self-awareness that might be constrained in a high-security context. However, this transition should be underpinned by a detailed and individualized plan that ensures continuous monitoring, ready access to mental health services, and strategies to manage potential escalations in risk behaviors.”
The Board ordered Mr. Brown’s transfer to SJHCH in its March 9, 2023 Disposition, and this transfer occurred on December 17, 2024.
A restriction of liberty hearing was held on July 9, 2024 at Waypoint following Mr. Brown’s 10 day seclusion in April 2024. Mr. Brown had spat on a staff member when his needs were not met to his satisfaction. The Board concluded that the restriction of liberty was the least onerous and least restrictive intervention available in the circumstances and was warranted for public safety.
Mr. Brown’s current diagnoses are: Schizophrenia; Mild Intellectual Disability; Stimulant Use Disorder, in sustained remission in a controlled environment; and Antisocial Personality Disorder. Mr. Brown is incapable of consenting to treatment and his mother is his substitute decision-maker. He is capable of managing his finances.
Evidence at the Hearing:
The Hospital Report stated that since Mr. Brown was admitted to SJHCH his mental status has been generally stable, with no evidence of residual psychosis. He is typically calm and settled but can become quickly irritable and angered when his requests are denied or he perceives that staff are treating him unfairly or discriminating against him. He was secluded once for a period of five days in the context of becoming verbally threatening, and not responding to redirection from staff. However, he has not acted out in a physically aggressive manner while at SJHCH.
The Hospital Report stated that Mr. Brown remained incapable of consenting to treatment and requested that changes be made to his medications on a near daily basis. A care plan was developed to help manage these behaviours. There have been instances where he has refused his injection, but he will eventually take it with repeated prompting and education. It was specifically noted that Mr. Brown’s lack of insight remains a significant concern.
Mr. Brown speaks to his mother on the telephone quite regularly and she is his main support. Mr. Brown’s father reached out to the team on one occasion and requested that phone calls to him be limited. Mr. Brown has not consented to the sharing of information with his father.
A Psychological Risk Assessment was conducted at SJHCH in March 2025 and concluded that Mr. Brown’s risk to act out violently falls in the moderate to moderate-high range under his current Detention Order with the support of the forensic program. His risk to act out violently would be increased during limit setting or periods of stress.
The Hospital Report included the following comments about the issue of significant threat in the Clinical Risk Summary (at page 92):
“The team is unanimously of the opinion that Mr. Brown continues to represent a significant threat to the safety of the public. Mr. Brown has a confirmed diagnosis of Schizophrenia, Intellectual Disability and Antisocial Personality Disorder. When unwell he has acted out violently on a number of occasions, both physically, and also by way of verbal threats, including at the time of the Index Offence. His insight into his illness, associated risk, and need for treatment is quite limited. Mr. Brown frequently challenges staff and his physician about the necessity of continuing with his injectable antipsychotic medication, as he does not feel he requires ongoing treatment. He has mentioned to staff that he would stop his antipsychotic treatment if the opportunity presented itself. What is more, Mr. Brown struggles with emotional regulation in general, and his frustration tolerance is very limited. During his stay in our facility, Mr. Brown has required brief periods in seclusion in response to difficulties in managing his emotions, particularly when he feels his needs are not being immediately met. During these times Mr. Brown becomes verbally threatening and intimidating.”
- The Clinical Risk Summary also included the following comments regarding next steps for Mr. Brown, and the reasoning behind the recommendation for increased privileges (at pages 92-93):
“Mr. Brown’s privileges over the last few years have been limited to staff accompanied and escorted on hospital grounds, and escorted in the community. To his credit, he has demonstrated appropriate use of hospital accompanied passes thus far. As he is yet to be tested with indirectly supervised passes, the logical next step from the clinical team’s perspective would be to increase Mr. Brown’s privilege allotment to allow for indirectly supervised passes on hospital grounds, and accompanied passes into the community. Given the aforementioned risk management concerns, and the fact Mr. Brown has not exercised any indirect passes to date, the clinical team feels it would be premature to recommend community living at this time. In the event that Mr. Brown is able to demonstrate effective use of indirect passes over a period of several months, we would likely be in a position to advocate for an early hearing to suggest the addition of community living.”
Dr. Sutton testified that he had been Mr. Brown’s attending psychiatrist since his transfer to SJHCH in December 2024. Dr. Sutton reiterated that Mr. Brown had settled in fairly well, with some challenges related to somatic complaints, demands of the staff, frustration tolerance, and anger management. He required an additional period of seclusion for three days this month, but went into seclusion on his own and settled fairly quickly. Mr. Brown also appealed the finding of treatment incapacity again, and it was upheld by the Consent and Capacity Board in April of this year.
In terms of granting increased privileges, Dr. Sutton stated that Mr. Brown would first be tested using indirectly supervised passes on the secure side of the hospital, and if they went well it would be extended to hospital grounds. In terms of community passes, they would start with escorted passes (staff to patient ratio of 1:1) and eventually move to accompanied passes (staff to patient ratio of 1:3). Dr. Sutton testified that in light of Mr. Brown’s significant history of violence, his residual symptoms of mental illness, his intellectual challenges and personality pathology, any progression of increased liberties will have to be taken cautiously.
Dr. Sutton believed that Mr. Brown was optimally treated, stating that he is the “best he has been” with both behavioural and symptom control.
Ms. Francis informed Dr. Sutton that Mr. Brown told her that he is the best doctor he has ever had. Dr. Sutton responded that Mr. Brown has done quite well with the transition from Waypoint and had “earned the opportunity to increase his liberties.”
In response to a question about Mr. Brown’s goals to complete grade 12 and get a job, Dr. Sutton stated that the team can absolutely help him with his academic pursuits, but he would need indirectly supervised community passes in order to pursue work outside of the hospital. Dr. Sutton added that there are sometimes opportunities to do grounds work at the hospital and the team would support Mr. Brown with that if it was something he wanted to pursue.
Analysis and Conclusions:
Based on the Hospital Report and the evidence of Dr. Sutton, the panel concluded that there was clear evidence that Mr. Brown remains a significant threat to public safety. Mr. Brown has a persistent mental illness as well as an intellectual disability and a personality disorder. He has a long history of disruptive and criminal activities in the community and while a patient in numerous hospitals over the years. He lacks insight into his mental illness and his potential for violence, and has a low frustration tolerance. The panel accepted that Mr. Brown requires the highly structured and supportive inpatient environment to maintain clinical stability. Without clinical support and supervision, he would rapidly succumb to the effects of stress, his mental state would decompensate, and this would be exacerbated by medication noncompliance and a return to substance use. This would likely lead to physical violence to members of the public, co-patients, and hospital staff, as has happened in the past. The panel noted that Mr. Brown’s risk of violence under a Detention Order was found to be moderate to moderately-high. This would undoubtedly increase if he were not subject to forensic oversight.
The panel accepted the joint submission that a continuation of a Detention Order was necessary and appropriate, and the least onerous and least restrictive Disposition for Mr. Brown at this time. Given Mr. Brown’s modest but encouraging progress at SJHCH so far, the panel also accepted that it was appropriate to add additional privileges for Mr. Brown, specifically, indirectly supervised passes on hospital grounds, and accompanied passes into the community. While Mr. Brown’s improvements are relatively recent, the panel was of the view that it is important to continue this positive momentum and motivation for Mr. Brown going forward. As Dr. Sutton stated, these increased liberties will be granted cautiously and slowly so as to ensure the safety of the public, including staff and co-patients. But they will provide Mr. Brown with an opportunity to progress in the forensic system, and hopefully move towards reintegration into the community in the future.
While it was not discussed at the hearing, the panel agreed with the hospital’s position that it was premature to include community living in Mr. Brown’s Disposition at this time, as he will only be beginning to use indirectly supervised privileges in the hospital.
Finally, the panel appreciated Ms. Francis’ comment that Mr. Brown has typically not attended his Board hearings as he has found them stressful. The panel agreed that this was a big step for Mr. Brown, and appreciated his attendance and attention.
DATED this 4th day of July 2025, at the City of Toronto, in the Toronto Region.
Suzanne Clapp
Alternate Chair
Office of the Registrar
Ontario Review Board