Ontario Review Board
Re: Brian Tran
ORB File No: 6469
Hearing held on: Wednesday, May 21, 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. S. Kert Members: Dr. P. Prendergast Dr. M. Mamak Hon. B. Allen Mr. A. Bouvier
Parties Appearing:
Accused: Brian Tran Counsel: Ms. L. Choi
The person in charge of hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Ms. L. Earle
REASONS FOR DISPOSITION
(Dated July 8, 2025)
Overview
On January 7, 2014, Brian Tran was found not criminally responsible on account of mental disorder (NCR) on a Criminal Code charge of mischief. Since the finding of NCR and the initial disposition, Mr. Tran has remained subject to dispositions of the Ontario Review Board, most recently a disposition dated May 29, 2024, discharging him on conditions.
On May 21, 2025, this panel of the Review Board convened at CAMH to hold an in-person hearing to review that disposition. Mr. Tran was present and represented by his counsel, Ms. Choi. Members of Mr. Tran’s family were also in attendance to show their support of him.
The issues to be decided at this hearing were whether Mr. Tran continues to meet the threshold test of posing a significant threat to the safety of the public, and, if so, what is the necessary and appropriate disposition to be imposed, considering the four factors in s. 672.54 of the Criminal Code.
The position of CAMH and the Crown was that Mr. Tran continues meet the significant threat test, and that the necessary and appropriate disposition is one discharging him on the same conditions. Mr. Tran’s position was that as he is no longer a significant threat, he should receive an absolute discharge.
Having considered all of the evidence and the submissions of counsel, and after deliberating, we find that the threshold test for significant threat continues to be met, and that the current conditional discharge (unchanged) remains necessary and appropriate in the circumstances. These are our reasons.
Background
The circumstances surrounding the index offence, the details of Mr. Tran’s personal history and his clinical course while under the jurisdiction of the Board are set out in the hospital report which was marked an exhibit at the hearing. In summary, Mr. Tran is 44 years of age. He was born in Vietnam and has lived in Canada since he was five years old. He finished high school and attended some college courses, though it is not clear if he graduated.
In November 2004, Mr. Tran was charged with criminal harassment and uttering threats. At the time he had no criminal record and no previous admissions to a psychiatric facility. The victim and Mr. Tran had been classmates at college and exchanged email addresses. When the victim blocked him from contacting her, Mr. Tran became upset and sent multiple emails to her, many of a threatening or sexual nature. Mr. Tran said that he believed that the victim and others had been harassing him and that he became so upset over the behaviour of the victim and her group, he left school and felt that he had to defend himself against her statements.
After a 30-day inpatient assessment at CAMH (where he presented as paranoid and endorsed visual and auditory hallucinations), Mr. Tran was diagnosed with schizophrenia. He was found NCR in respect of the criminal harassment and uttering threat charges in November 2005. After an initial ORB hearing in December 2005, he was discharged on conditions and returned to live with his parents. He was compliant with antipsychotic medication and became connected with the Hong Fook Mental Health Association in March 2006.
According to Mr. Tran’s father, sometime in 2005 Mr. Tran began dating another woman that he met in college. Six months later that woman moved into the family home with Mr. Tran and his parents and became part of the family. She was supportive of Mr. Tran receiving treatment and attended with Mr. Tran at his appointments with Hong Fook.
In the fall of 2007, Mr. Tran received an absolute discharge from the Review Board. He continued to receive mental health care and services from Hong Fook until August 2009, when the services were terminated by mutual agreement. It appears that Mr. Tran continued to take his prescribed antipsychotic medication for about another six months, then stopped.
According to his father, Mr. Tran appeared to continue to do well without psychiatric medication until he and his girlfriend broke up in November 2012. After that Mr. Tran became more delusional and isolated and began talking to himself. He refused medication and would not see a psychiatrist. His delusions increased to the extent that a month prior to the current index offence, Mr. Tran’s father attempted to surreptitiously give him psychiatric medication.
Mr. Tran was arrested in respect of the current index offence in late September/early October 2013, after a woman complained to police that on September 9, 2013, as she was walking her children to middle school, she observed a suspicious male watching the children walking to school from across the street. She said that she had heard the man either whistle or “catcall” at some of the young female students and when she confronted the male he said he worked for social services. She did not believe him given the way he was dressed and reported the interaction to the police.
After being found NCR on the charge of mischief on January 7, 2014, Mr. Tran was released on bail to live with his parents, on conditions. He was charged with failing to comply with a condition of his bail on January 21, 2014, when he did not attend an assessment at CAMH as required. On March 7, 2014, he was admitted to the ATU at CAMH for a risk assessment. On the ATU he adamantly denied having a mental illness and refused medication. He was declared incapable of making treatment decisions, a finding that was subsequently upheld by the Consent and Capacity Board.
On admission to CAMH, Mr. Tran presented as acutely psychotic. After eloping from the ATU he was detained on a secure unit at CAMH. Despite treatment with aripiprazole his mental state began to deteriorate. Starting in August 2014, he refused contact with his parents, saying that they were imposters.
With the initiation of treatment with olanzapine, Mr. Tran’s mental state improved. In March 2015 he was transferred to a general forensic unit at CAMH. A trial of clozapine was started in the fall of 2015, and in early 2016 he was discharged to live with his parents at the family home.
Since then, Mr. Tran has not required readmission to hospital. He has been compliant with medication under the substitute consent of his father, and his clozapine levels have remained therapeutic. For the most part treatment with clozapine has assisted in attenuating his positive psychotic symptoms, although he continues to experience residual negative symptoms, including amotivation.
In the community Mr. Tran has remained relatively isolated and does not participate in any educational, vocational, volunteer or organized social activities. Mr. Tran did re-engage with Hong Fook at some point in 2019, but was apparently discharged from the care of his psychiatrist at Hong Fook in April 2022, as the facility clearly stated that they were not able to provide longer term care for him. While it seems that Mr. Tran did continue to see a mental health worker at Hong Fook for some period of time, that person left the agency this year and Mr. Tran has yet to be reassigned to any individual at Hong Fook. Further, there has been no concrete information from Hong Fook that they intend to reassign Mr. Tran to a mental health worker.
Clinical Course Since the Last Hearing
At the time of his last ORB hearing in May 2024, Mr. Tran had been recently referred to the CMHA – Peel for case management and psychiatric follow-up, but had yet to be picked up by that agency.
At the current hearing we received evidence in the form of an updated hospital report, as well as the oral testimony of Dr. Ugwunze, Mr. Tran’s attending psychiatrist for the past number of years. That evidence revealed as follows: Over the course of the past clinical year, Mr. Tran continued to live with his parents in the family home, as he has done since his discharge from CAMH in 2016. With the support and oversight of the treatment team and his parents, Mr. Tran remained compliant with treatment with clozapine and there was no significant deterioration in his mental state. He was followed by his CAMH FOPS case manager who saw him at least once per month (or more if needed) and was seen by Dr. Ugwunze approximately once each month.
Mr. Tran’s main social supports remain his parents and extended family. He is always with at least one of his parents. He attends the gym daily with his father and goes to Dynacare in Brampton accompanied by one parent. Although he drives he does not go anywhere on his own but helps his mom with errands and drives her to various places. He also attends with his mother at his grandmother’s house every few days, where his mother assists his grandmother with her personal care. His father has reported that Mr. Tran helps out with some chores around the family home but does not engage in any structured activities.
The primary focus for the clinical team over the past year has been their attempts to secure psychiatric follow-up care for Mr. Tran in preparation for transitioning him away from forensic services. A variety of potential resources/agencies were contacted but none proved to be a good fit. For the most part the agencies that might be appropriate in the Brampton area (where Mr. Tran lives) provide only short-term psychiatric consultation and mental health treatment (Mr. Tran requires longer-term care), or provide a sufficient level of treatment but only to those individuals who fall within their catchment area, which Mr. Tran does not. As described in the hospital report, the challenge with the resources available relates to Mr. Tran residing in Brampton and being out of the catchment area of the service, or the service provided being only available on a short-term basis.
In describing the concerns around transferring Mr. Tran’s to a non-forensic service, Dr. Ugwunze acknowledged that despite their efforts the team has not been successful in finding appropriate psychiatric follow-up care for Mr. Tran. In the past Mr. Tran was involved with Hong Fook but his relationship with the psychiatrist there ended in 2022, and Hong Fook is not prepared to take him on for the long term. Dr. Ugwunze described that Mr. Tran needs at least a psychiatrist to monitor his clozapine, ideally a physician who is associated with a complimentary team. Dr. Ugwunze noted that treatment with clozapine is crucial to ensure that Mr. Tran’s stability is maintained. While his parents have been instrumental in supporting his adherence with clozapine, given Mr. Tran’s limited insight into the benefits of medication for the long term, as well as his history of non-adherence, it will be essential to have external monitoring by mental health professionals to ensure his compliance going forward. A private psychiatrist (alone) would not be sufficient, given the level of care and supervision that Mr. Tran needs.
When asked his opinion as to what would occur were Mr. Tran to be granted an absolute discharge, Dr. Ugwunze said that he would anticipate that Mr. Tran would shortly fall away from treatment as he does not believe he requires it. This would be in keeping with his history. Once discharged from the jurisdiction of the Review Board and without the assistance of the FOPS team or any other mental health service, Mr. Tran would fairly quickly fall away from treatment as he does not believe he requires it, similar to what occurred after his relationship ended with his psychiatrist at Hong Fook. If non-adherent with treatment, Mr. Tran would experience a decompensation in his mental state fairly rapidly and his risk for engaging in criminal activities, such as those he engaged in at the time of both sets of index offences, would increase exponentially.
When asked whether without supervision or support Mr. Tran would take medication of his own accord, Dr. Ugwunze said that Mr. Tran would not. Rather, his history suggests that it is likely that he would fall away from treatment as occurred in the past.
Analysis and Conclusion
As described by his counsel, Mr. Tran has been able to live without incident in the community since his discharge from CAMH in 2016. He has maintained compliance with medication and psychiatric follow-up and has been relatively stable on medication for several years. However, we accept the evidence of Dr. Ugwunze that Mr. Tran’s compliance with treatment is almost entirely externally motivated. He continues to demonstrate limited insight into his mental disorder or his need for treatment and psychiatric follow-up. Despite medication adherence, he is unable to fully articulate the benefits of clozapine, stating only vaguely that it helps. As has been the case for many years, he is unable to identify any signs or symptoms of relapse of his mental illness or any therapeutic benefit of his medication. He is passively compliant with clozapine (the medication that keeps him well) through oversight by his parents, consent from his SDM and significant support from his FOPS case manager provided under the current conditional discharge disposition.
After being absolutely discharged by the Board in respect of his earlier offences, Mr. Tran eventually ended his relationship with Hong Fook and then stopped his recommended antipsychotic medication. He refused to see a psychiatrist, became very unwell and engaged in the problematic and criminal behaviour underlying the current index offence.
Given Mr. Tran’s ongoing lack of insight, we accept that a similar trajectory would likely follow were he to receive an absolute discharge at this time. As described by counsel for the hospital, Mr. Tran’s history provides a sense of what is necessary to ensure his long-term success in the community. Not only does support from his parents and other family members remain important, but also the ongoing involvement of a mental health team to ensure his compliance with treatment and follow-up. Without the presence of the Review Board disposition, there must be an outpatient/community team ready and willing to take over his care when the forensic team steps back and the Board is no longer involved. Despite the efforts of the clinical team, currently Mr. Tran has no psychiatric follow-up in place. As such, we find that the threshold test for significant threat continues to be met.
We also agree that, considering public safety (which is paramount), as well as Mr. Tran’s mental condition, his reintegration into the community and his other needs, the current conditional discharge remains the necessary and appropriate disposition, which is also the least onerous and least restrictive disposition in the circumstances.
Finally, while we recognize the efforts of the CAMH outpatient team to secure appropriate psychiatric follow-up and care for Mr. Tran, we want to emphasize the importance and necessity of the team continuing and expanding those efforts this year, so that Mr. Tran can ultimately be transitioned out of the forensic system.
DATED this 8th day of July, 2025, at the City of Toronto, in the Toronto Region.
Ms. S. Kert Alternate Chairperson
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Office of the Registrar Ontario Review Board