Ontario Review Board
Re: Grant Fowler
ORB File No: 5531/5951
Hearing held on: Tuesday, May 20, 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. S. Hucker Dr. M. Mamak Hon. B. Allen Mr. A. Bouvier
Parties Appearing: Accused: Grant Fowler Counsel: Mr. C. Hynes
The person in charge of hospital: Counsel: Ms. S. Zelaya
Attorney General of Ontario: Counsel: Ms. L. Earle
REASONS FOR DISPOSITION
(Dated July 7, 2025)
Overview
On January 15, 2010, and subsequently on September 8, 2011, Grant Fowler was found not criminally responsible on account of mental disorder (NCR) on Criminal Code charges, including: mischief over $5,000, prowl by night, possession of property obtained by crime, assault, assault with a weapon, aggravated assault and possession of a weapon for a dangerous purpose.
Since September 2010, Mr. Fowler has remained subject to dispositions of the Ontario Review Board, most recently a disposition dated June 17, 2024, detaining him at the General Forensic Unit of CAMH, with privileges extending to living in the Greater Toronto Area in accommodation approved by the person in charge.
On May 20, 2025, this panel of the Review Board convened in-person at CAMH to hold a hearing to review that disposition. Mr. Fowler was present and represented by his counsel, Mr. Hynes.
The issues to be decided at this hearing were whether Mr. Fowler remains a significant threat and, if so, what disposition is necessary and appropriate. Both at the outset and at the conclusion of the hearing, the parties jointly submitted that the test for significant threat continues to be met, and that the current detention disposition (unchanged) remains necessary and appropriate in the circumstances.
After hearing the evidence, the submissions and deliberating, we agree with the parties on the issues of significant threat and disposition. These are our reasons.
Background and Index Offences
Mr. Fowler was 57 years old at the time of the hearing. He was born in Kitchener, one of four siblings. He finished grade 13 and was employed as a chemical technician before completing a Bachelor of Science degree in 1999. He worked in the field as a prospector through a mining company which he started in 1998. That company eventually failed after Mr. Fowler ran out of investment capital.
Mr. Fowler’s first psychiatric admission occurred in 2002, when he was 35 years old and experienced his first manic episode. He was hospitalized for three weeks and prescribed olanzapine. After discharge he saw a psychiatrist at the Toronto General Hospital but was non-adherent with prescribed medications. He was admitted and detained at the Homewood Health Centre under the Mental Health Act for seven weeks in 2003. Further admissions to Homewood and CAMH took place in 2004 and 2006.
Mr. Fowler has no history of criminal convictions. There is some information (provided by Mr. Fowler) that he used alcohol and cannabis in the past. His medical records suggest that he intermittently acknowledged light to moderate drinking in the years of his index offences, though he has indicated that the offences were not related to alcohol or cannabis consumption.
The index offences which led to the first finding of NCR occurred over a series of dates between December 2007 and June 2009. On December 22, 2007, Mr. Fowler was charged with mischief and prowl by night after: i) police responded to a call from a female homeowner who advised that a male (Mr. Fowler) was outside her home, was trying to get into the house, and had used a brick to break several windows; ii) Mr. Fowler used a brick to hit the hoods of three vehicles parked in the lot of a Mercedes dealership, causing dents and scratches to the hoods of the vehicles; and iii) Mr. Fowler was found in possession of a sign that had been forcibly removed from a parking lot. Just over a year later, on December 30, 2008, Mr. Fowler was charged with mischief after Via Rail employees saw him kick the glass in a door at the entrance of Union Station, shattering the door.
In April 2009, Mr. Fowler was assessed for, and accepted into the Mental Health Diversion Program at Old City Hall in respect of his outstanding charges. However, in early May 2009, he was charged with assault and assault with a weapon after he struck a volunteer litter collector with a “karate chop” to the shoulder, and assaulted the same person the following day with a shovel, telling him to “get out of my hood.” On June 4, 2009, upon seeing the same person again outside of a local Starbuck’s, Mr. Fowler approached the individual, told him "I'll get you out of my hood!", then swung the box cutter he was holding, striking the victim on the left thigh. The injury required 7 internal and 13 external stitches to repair it. On the same day, Mr. Fowler walked up to a person on the street, pulled out a knife and stated, "Don't make me cut you".
After being found NCR in January 2010, Mr. Fowler was released on conditions pending his initial ORB hearing. He was admitted to CAMH in February 2010 pursuant to an assessment order made by the ORB, and released into the community on the expiry of the order a month later. He returned to his previous residence (a boarding home), discontinued psychiatric medications and follow-up, and isolated himself from family, friends and health care providers. By August 2010, he had not taken any medications for about 5 months and had not been sleeping well.
Mr. Fowler’s second NCR verdict involved mischief, assault and weapons offences that he committed while he remained in the community. On August 5, 2010, Mr. Fowler was arrested after he kicked the car of a motorist who had stopped to let him cross the road, causing a dent to the vehicle. When the driver exited his vehicle, Mr. Fowler grabbed him by the throat, punched him in the face and threw him to the ground. Following his arrest, further investigation revealed that five days earlier (on July 31, 2010), Mr. Fowler had approached a co-resident at his boarding home, began shouting at the co-resident, hit him in the head with some sort of club, then left the room.
In September 2010, following his initial ORB hearing in respect of his original charges, Mr. Fowler was ordered detained at CAMH. In January 2012, he was discharged to live in transitional housing in the community after presenting as “non-psychotic, cooperative, compliant with his medications, and utiliz[ing] his hospital and community privileges appropriately.” (p. 22 of the hospital report). In November 2012, he moved to an apartment at Mainstay Housing, which was staffed during the day and had off-site support on a 24-hour basis. He remained in the community volunteering at the food bank (for a time) and looking for employment. He was also compliant with medication.
In February 2016, Mr. Fowler was readmitted to hospital after an exacerbation of his delusional ideas. He returned to the community in May 2016. There was a further brief admission in August 2018. Despite adherence with medication on discharge, between August 2019 and March 2020, Mr. Fowler experienced some deterioration in his mental state. He was increasingly preoccupied with and expressed various delusional beliefs. He also resumed contact with several authorities by email. On the recommendation of his treating psychiatrist, Mr. Fowler agreed to restart his monthly Invega injection. He experienced an attenuation of his symptoms and was able to remain an outpatient, receiving his treatment through the FOPS clinic. He continued to reside in an independent apartment managed by Mainstay, as he had since 2012.
On November 16, 2022, Mr. Fowler was readmitted to CAMH after concerns were raised that he was experiencing psychotic symptoms and he evidenced some agitation. After he refused to report to his case manager and did not follow up with his psychiatrist, the decision was made to admit him to hospital. He has remained an inpatient at CAMH since that time.
At Mr. Fowler’s last annual ORB hearing in June 2024, Dr. Meng, his then attending psychiatrist, advised the Board that Mr. Fowler had been designated Alternate Level of Care (ALC) in November 2023, and was therefore deemed appropriate for discharge should appropriate housing become available. Mr. Fowler’s discharge was slowed by his ongoing fixed beliefs that he had access to his own market rent accommodations, and his view that the proposed hospital approved alternatives would be dangerous for him. At that hearing, the position of the treatment team and the Hospital administration was that it was essential that the CAMH be able to approve Mr. Fowler’s accommodation to ensure adequate support for him, without which his ability to remain in the community could be precarious. The Board agreed with that position and continued the detention disposition.
Course Since Last Hearing
At the current hearing we received evidence in the form of an updated hospital report, as well as the oral testimony of Dr. Valoo, Mr. Fowler’s attending psychiatrist. That evidence revealed as follows: Over the past clinical year, Mr. Fowler remained an inpatient on a general forensic unit at CAMH. Overall he had an uneventful year. His mental status remained stable, and he generally presented as pleasant and friendly, but overtly delusional with paranoid and grandiose delusional beliefs. He remained incapable with regards to antipsychotic treatment and continued to receive treatment with oral clozapine and depot paliperidone on the substitute consent of his sister, his SDM. Although he occasionally exhibited some resistance to taking the medication, he always eventually cooperated after encouragement from nursing staff.
During the year, Mr. Fowler was able to maintain his use of level 8 privileges, which allowed him indirect passes into the community for extended periods for the purpose of recreation and/or socialization. All of his passes occurred without incident and his urine drug screens were negative for recreational substances. In fact, Mr. Fowler’s last known positive test for substance use occurred in October 2022, when his urine drug screen was positive for cannabis.
Despite medication adherence Mr. Fowler continued to present with overt psychotic symptoms, most prominently delusional beliefs with no insight at all into his psychotic illness. He also endorsed some hallucinatory experiences.
To address Mr. Fowler’s ongoing symptoms, in April 2025 Dr. Valoo spoke to Mr. Fowler’s sister about a trial of electro-convulsive therapy (ECT) to optimize his antipsychotic treatment. Ultimately, both she and Mr. Fowler agreed that he would start a course of ECT, and by the time of the hearing he had completed six ECT sessions. While significant changes in Mr. Fowler’s presentation had yet to be observed, Dr. Valoo was clear that this was to be expected given the chronicity of his illness. However, the team remains optimistic regarding the potential impact of ECT going forward.
The primary focus for the treatment team over past year has been discharge planning for Mr. Fowler. For much of the time he remained very resistant to discharge. This was due to his persistent delusional beliefs that he owned multiple homes of his own and was being prohibited from using these due to nefarious activities. He repeatedly said that he would be able to access housing units that he owned at any time and did not want to consider going anywhere else. When pushed about his reluctance around discharge, he also said that he was comfortable in the hospital, where all of his needs were being met.
In January 2025, when Mr. Fowler expressed a willingness to consider other housing, staff submitted an application on his behalf to CMHA, which was ultimately unsuccessful. In April 2025, he declined to consider a vacancy at LOFT supportive housing because of ongoing grandiose delusions. However, at the hearing Dr. Valoo reported that Mr. Fowler had recently agreed to an application being submitted for housing through LOFT, and that application remained outstanding.
Dr. Valoo described that the team is hopeful that as treatment with ECT continues they will see some improvement in Mr. Fowler’s mental state, that he will engage in recreational programming, and that he can make further progress toward community living. Dr. Valoo reiterated the importance of the Hospital being able to approve where Mr. Fowler resides to ensure that there is some level of onsite supervision, including around compliance with medication.
Analysis and Conclusion
None of the parties contested the finding of significant threat, and the parties jointly submitted that the current detention disposition remains necessary and appropriate in the circumstances. We agree.
We recognize that Mr. Fowler had a largely uneventful and stable clinical year. He remained compliant with treatment, did not engage in any aggression, generally presented as pleasant and friendly, and had no difficulty with using his passes. He is also working with the treatment team to address his residual symptoms through the use of ECT. All of this is positive.
Unfortunately, despite his adherence with recommended treatment, Mr. Fowler remains overtly psychotic, with paranoid and grandiose delusional beliefs. His understanding of his psychotic illness (schizoaffective disorder) and the benefits of medication, remains limited. He has a long history of non-adherence with medication, and engaged in aggression related to his delusional belief system at the time of the index offences. His mental illness is brittle and sensitive to the destabilizing effects of medication non-adherence and stressors. Absent the support, supervision and monitoring provided under his current detention disposition, there is a real likelihood that Mr. Fowler would fall away from treatment with a consequent increase in the severity of the symptoms that he is currently experiencing, resulting in an escalation of his risk for violence. As such, the test for significant threat is met.
We are also satisfied that the current detention disposition, which allows Mr. Fowler to continue to move forward and back into the community, remains necessary and appropriate. Mr. Fowler has been designated ALC since the fall of 2023, but for various reasons he has been unable or resistant to considering housing approved by the treatment team. More recently he agreed to consider LOFT housing, and his application is under review. We join counsel and the team in the hope that not only will Mr. Fowler’s application be accepted by the LOFT program, but also that he will agree to LOFT housing so that he can begin the process of further community reintegration. In the meantime, it remains essential for the treatment team and the Hospital to be able to approve any accommodation in which Mr. Fowler resides to ensure the level of structure, support and supervision that he needs, and a smooth transition to community living.
Accordingly, considering the four factors in s. 672.54 of the Code, we agree that the current detention disposition should continue for the coming year, and so order.
DATED this 7^th^ day of July, 2025, at the City of Toronto, in the Toronto Region.
Ms. S. Kert Alternate Chairperson
__________________
Office of the Registrar Ontario Review Board