Ontario Review Board
Re: Gabriel Kaltekis
ORB File No: 6703
Hearing held on: Tuesday, June 17, 2025
Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Ms. S. Kert Members: Dr. T. Verny Dr. J.C. Rose Ms. K. Tomaszewski Ms. C. Plyley
Parties Appearing: Accused: Gabriel Kaltekis Counsel: Ms. N. Circelli
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. D. Rows
REASONS FOR DISPOSITION
(Dated July 18, 2025)
Overview
On February 15, 2015, Gabriel Kaltekis was found not criminally responsible on account of mental disorder (NCR) on a charge of robbery. Mr. Kaltekis is currently subject to an Ontario Review Board disposition detaining him at the Southwest Centre for Forensic Mental Health Care (Southwest Centre), with privileges extending to living in the community of Elgin or Middlesex County in accommodation approved by the person in charge. He has been living with his family in London since his most recent discharge from hospital in March 2023.
On June 17, 2025, this panel of the Review Board convened at the Southwest Centre to hold a hearing and review that disposition. Mr. Kaltekis was present and was represented by counsel, Ms. N. Circelli. Mr. Kaltekis’ parents were also in attendance to show their support for their son.
The issues to be decided at this hearing are whether Mr. Kaltekis continues to pose a significant threat to the safety of the public and, if so, what is the necessary and appropriate disposition, having regard to the four factors in s. 672.54 of the Criminal Code.
The hearing proceeded on the basis of a joint submission in respect of both issues. None of the parties contested a finding of significant threat, and the parties submitted that the current detention disposition remains necessary and appropriate, with two changes: i) the removal of the abstention requirement and; ii) an associated increase in the frequency that Mr. Kaltekis is required to report to the person in charge of the Southwest Centre or their delegate.
Having had the opportunity to carefully consider the evidence, and bearing in mind the joint position of the parties, we agree with the parties both on the issue of significant threat and disposition. These are our reasons.
Background and Index Offences
At the time of the hearing Mr. Kaltekis was 43 years old. He is single and has no dependents. His current diagnoses are schizoaffective disorder (bipolar type); substance use disorder, in remission; Tourette’s syndrome; and ADHD (by history).
In elementary school, Mr. Kaltekis was described as a sweet, happy child, but his report cards suggested that he had difficulty focusing and engaging in group activities. He was assigned a special needs teacher between grades 3 and 8, who worked with him on an individual basis. In 1995, he was diagnosed with Tourette’s syndrome. In 2006, he received the ADHD diagnosis.
Mr. Kaltekis completed high school and obtained a college diploma in computer programming. He worked for a time at Canada Post, where both of his parents were employed. His employment ended with the onset of his mental illness. Two years later, with help from the postal union, he was re-hired on a part-time basis, but difficulties with focus and attendance resulted in him leaving in 2003. He received a significant settlement from his employer, but spent the money within 18 months.
In 2008, Mr. Kaltekis saw a community psychiatrist after his family expressed concerns about his deteriorating mental health. He was staying at home in the dark, not working and not taking care of his personal hygiene. On interview he was talkative and anxious but did not appear psychotic. He was diagnosed with adjustment disorder and Tourette's syndrome. In the years that followed he was treated with various antipsychotic medications (to address his Tourette’s), all with limited effectiveness. His primary request of clinicians was for stimulant medications. He abused stimulants and benzodiazepines in the past, taking amounts in excess of that prescribed and repeatedly seeking these medications. In fact, the index offence was related to this issue.
In July 2013, Mr. Kaltakis’ community psychiatrist referred him to the Schizophrenia Program at CAMH due to his newly emerging delusions, though there is no indication he attended for a consultation. Following a mental health admission to the Toronto East General Hospital in September 2013, Mr. Kaltekis was diagnosed with schizophrenia and ADHD and was prescribed Adderall, olanzapine and clonazepam.
On May 23, 2014, Mr. Kaltekis called a pharmacist at a Shopper’s Drug Mart in Toronto asking if Adderall and clonazepam were available. He was told that they were. Shortly after, he arrived at the store with his dog. He was wearing a shirt with “POLICE” across the front, a police badge hanging around his neck, face mask and gloves. He was also armed with an airsoft assault rifle. The store was open and other customers were in the store shopping. Mr. Kaltekis approached the pharmacy counter, pointed the rifle at the pharmacist and demanded 30 tablets of Adderall and 30 tablets of clonazepam from her. She complied with his demand. He left the pharmacy and returned to his apartment nearby, where police arrested him.
Within days of his arrest, Mr. Kaltekis was found unfit to stand trial and admitted on a treatment order to CAMH. He was described as acutely psychotic and suffering from grandiose and paranoid delusions. After treatment with medication and attenuation of his delusions, he was found fit to stand trial a month later, released on bail to live with his parents (in Toronto) and followed by CAMH’s out of custody treatment team who provided him with interim psychiatric care. He attended appointments accompanied by his mother, who also supervised him taking his prescribed medication. He often made requests regarding medications, specifically dosage increases of his stimulant medication.
Despite medication adjustments, Mr. Kaltekis continued to experience symptoms of psychosis in the form of delusions. His family described him as being reclusive and guarded at home and reported his reduced motivation, increased sleep and decreased activity.
Following the finding of NCR in February 2015, Mr. Kaltekis was continued on bail and lived with his parents until his first Review Board hearing. In June 2015, he received an initial disposition of a conditional discharge. He continued to live at home with his parents and used cannabis regularly, despite the abstention condition in his disposition.
Mr. Kaltekis was maintained on a conditional discharge and transferred to the care of the Southwest Centre in August 2016, after his parents moved to the London area. He continued to use cannabis in contravention of the terms of his disposition. His abstinence improved in the 2017 and 2018 reporting years.
In May 2019, Mr. Kaltekis was briefly admitted to the Southwest Centre after refusing his medications (in breach of his conditional discharge at the time). On admission he was found incapable with respect to treatment for his schizoaffective disorder and his mother became his SDM. Though he was aware that he been diagnosed with schizoaffective disorder, he disagreed with the diagnosis and said that he did not require medications. Ultimately, he was compliant with treatment in hospital.
Following Mr. Kaltekis’ annual hearing in 2020, the substance use prohibition was removed from his disposition. He had agreed to voluntarily abstain from cannabis use, but resumed consumption shortly after the abstention condition was removed. Around December 2020, he displayed a full relapse of his schizoaffective disorder (mixed mood and psychotic features), including extreme mood lability, ideas of reference, religious-themed delusions, and grandiose ideas about his abilities. By late December 2020, Mr. Kaltekis’ parents reported that their son was in “rough shape, and that they were avoiding bringing up anything confrontational with him “so as to not antagonize him or potentially provoke aggression.” Mr. Kaltekis initially agreed to a readmission in early January 2021 to stabilize his mental state, but was ultimately placed on Form 1 when he changed his mind.
Mr. Kaltekis was discharged home after a week. He continued living with his parents in London, and returned to cannabis use in the spring of 2021. He experienced some fluctuations in his mood and presentation during the early months of 2022. This was initially managed with the support of his parents and the outreach team, with increased monitoring at times.
In early March 2022, Mr. Kaltekis began refusing his long-acting injectable antipsychotic medication. Due to further decompensation in his mental state (including hyper-religiosity and grandiosity, and religious-themed delusions) and increasing difficulty managing him at home, Mr. Kaltekis was readmitted to the Southwest Centre on May 5, 2022, with the assistance of the police. Shortly after, the Board issued a detention disposition for him.
A month later, following further cannabis use and decompensation in his mental state, Mr. Kaltekis was again admitted to the hospital in July 2022. That admission was prolonged due to his refusal of his antipsychotic injection and his unstable mental status, requiring a new medication regimen. He remained an inpatient until early February 2023, when he was transitioned to the C.K. Clarke Centre, a 24/7 supportive and supervised group home. He stayed at the Clarke Centre for a month, and was discharged to his parents’ home in early March 2023. He has not required readmission since that time.
After Mr. Kaltekis returned to live with his parents, he found a local pet shelter where he began volunteering, something that he continues to do to date.
Course Since the Last Hearing
At Mr. Kaltekis’ last annual hearing (in June 2024), the Review Board panel heard evidence that in the weeks leading up to the hearing, Mr. Kaltekis had experienced brief periods of decompensation involving both psychotic and mood-related aspects of his illness. He demonstrated a lack of insight into the decompensation, believing that his experiences were a divine gift rather than symptoms of psychosis.
At the current hearing we received evidence in the form of an updated hospital report, as well as the oral testimony of Dr. Ajay Prakash, Mr. Kaltekis’ attending psychiatrist. That evidence revealed as follows: Over the past reporting year, Mr. Kaltekis continued to live at home with his parents in London. Over the course of the year he continued to experience residual chronic religious delusions, including hearing the voice of God, having visions from God and, at times, being the son of God. These symptoms continued despite his general adherence with medications which he receives under the substitute consent of his mother.
While Mr. Kaltekis has been adherent with medication, in discussions with the treatment team he said that he does so because he “has to” and is being “forced” to take the medication as a consequence of being under the jurisdiction of the Board. Mr. Kaltekis expressed the belief that all antipsychotic medications have an “emotionally flattening” impact on him, and left to his own devices he would not take the treatment. He continues to believe that his schizoaffective disorder was solely brought on by drug misuse and that if he remains abstinent from methamphetamines, there is no risk of recurrence. He also rejects the view that there is any benefit to the medication (in terms of treating his illness) and he attributes feeling better to “answer to prayers.”
In oral testimony, Dr. Prakash advised that Mr. Kaltekis’ mental condition continues to fluctuate. The challenge for the treatment team for a number of years has been trying to balance flattening Mr. Kaltekis’ mood, versus allowing him enjoyment of life. Dr. Prakash described this as a continuous assessment, noting that Mr. Kaltekis’ mental condition is fragile to changes in medication and substance use, including legal substances such as caffeine and nicotine. He described that the goal is to find a balance between ensuring Mr. Kaltekis’ enjoyment of life and his mental stability.
Dr. Prakash advised that over the past reporting year, Mr. Kaltekis continued to believe that the medications that he was receiving flattened him too much in terms of his mood, energy and ability to enjoy life. In an attempt to address the issue, Dr. Prakash worked with Mr. Kaltekis to trial a number of medications that could elevate his mood and alleviate his concerns. In the past this has included various antidepressant medications and ADHD medications. This year the trial involved Wellbutrin. While there has been some success with this medication, as described by Dr. Prakash, just below the surface Mr. Kaltekis still wants to “run free”, as at the base of it all he does not believe he has a major mental illness.
Despite this, Mr. Kaltekis is compliant with treatment under the substitute consent of his mother. There have been no reports or indications of substance use since July 2022. Though more recently Mr. Kaltekis has said that he does not want to use cannabis, it may be simply that he knows that use is frowned on by the treatment team, the Review Board and his parents.
The primary focus at this hearing was the recommendation of the treatment team that the abstention clause in Mr. Kaltekis’ disposition should be removed. Dr. Prakash described that the recommendation was made in furtherance of testing the delicate balance described above. He recognized that in the past the removal of the abstention condition was not successful and led to Mr. Kaltekis’ readmission to hospital. However, the hope of the treatment team is that through education over many years, Mr. Kaltekis now understands the importance of abstaining even without the requirement to do so, particularly as the team has clearly established that cannabis use (in particular) impacts his mental state.
Analysis and Conclusion
None of the parties contested a finding of significant threat, and we agree that the threshold test is met. As outlined in the re-offence scenario contained in the hospital report, given Mr. Kaltekis’ lack of insight into his mental illness, the benefits provided by his antipsychotic medication and the probability of decompensation were he to be nonadherent with treatment, absent forensic support and parental supervision, he would likely stop his antipsychotic medication. Indeed, he has said as much to members of the treatment team.
There is also the real risk of Mr. Kaltekis returning to substance use (particularly cannabis) without the oversight provided by a Review Board disposition. Mr. Kaltekis is diagnosed with a substance use disorder. While he has received considerable psychoeducation regarding the risks of cannabis use for him, and while he has indicated that he will not use it while under the auspices of the Review Board, his ability, or willingness, to remain abstinent for the long term remains uncertain. His non-compliance with treatment and a relapse to substance would, as in the past, inevitably result in a re-emergence of his psychotic symptoms. His impulsivity and irritability would exacerbate, increasing his risk for engaging in criminal activity which would, at a minimum, pose a significant risk of serious psychological harm to members of the public, as occurred at the time of his index offence.
The more difficult issue is the recommendation for the removal of the abstention condition. In describing the goal of the team in recommending the removal of the substance prohibition, Dr. Prakash said that the treatment team’s view is that the next step is to test Mr. Kaltekis’ internal motivation to abstain from cannabis and alcohol at a time when he is not prohibited from consumption.
In Mr. Kaltekis’ case, the requested “next step” has not gone well previously. Shortly after the substance prohibition was removed in 2020, and despite indicating that he would not do so, Mr. Kaltekis resumed his use of cannabis. Within months his mental state worsened, resulting in his readmission to hospital secondary to cannabis use. Not long after his discharge, he again relapsed to substance use. The same scenario again played out (twice), with the added risk of Mr. Kaltekis refusing his antipsychotic medication.
Mr. Kaltekis’ third and most recent readmission was much more prolonged - he remained in hospital for just over six months. He has not required readmission since his discharge in March 2023, more than two years ago, and has apparently remained abstinent since July 2022, in spite of easy access to cannabis in the community.
This has occurred while Mr. Kaltekis has remained subject to a disposition that mandates his abstinence. He knows that there is a real chance that he will be returned to the hospital if he uses cannabis or alcohol and decompensates, and has therefore been externally motivated to comply with his disposition. However, Mr. Kaltekis has not made any commitment to refraining from use without the authority and oversight of the Board. It remains unclear whether he has internalized the team’s view that substance use negatively impacts his mental state, and that abstention is necessary if he is to remain stable.
Having given it considerable thought, we agree with the treatment team that if Mr. Kaltekis is to be tested again in this regard, it should occur while he remains subject to a detention disposition. Mr. Kaltekis is currently living in approved accommodation, at home with his parents who are providing supervision for him, including observation of his oral medication compliance. His parents have a good relationship with the treatment team and have reached out to the team in the past when they had concerns that their son was using substances and/or decompensating. By history, Mr. Kaltekis’ decompensation with the use of cannabis happens over weeks to months (as opposed to days), and the team has exercised the warrant of committal to readmit him in a timely way to avoid any significant increase in his risk to public safety. Under a detention disposition, the same can occur going forward if Mr. Kaltekis relapses to substance use with the removal of the abstention clause.
Moreover, the plan of the treatment team is to increase the rate of Mr. Kaltekis’ reporting, so treatment team staff will have eyes on him more frequently. Specifically, the disposition will require Mr. Kaltekis to report not less than four times per month, and staff may ask him to report more frequently as necessary. Importantly, the disposition also continues to provide for testing for abstinence on a random basis. Over the past year, urine testing of Mr. Kaltekis has only been occurring once or twice a month and, of those, only some of the tests have been randomly conducted. Given Mr. Kaltekis’ history, we expect that with the removal of the abstention condition the treatment team will consider testing him for abstinence from substances of abuse more frequently and on a more random basis.
In the result, we agree with the joint position of the parties that the current detention disposition, with the removal of the abstention clause and the increase in reporting frequency, is necessary and appropriate in the circumstances considering public safety (which is paramount), Mr. Kaltekis’ mental condition, his reintegration into society and his other needs.
DATED this 18th day of July, 2025, at the City of Toronto, in the Region of Toronto.
Ms. S. Kert Alternate Chairperson
Office of the Registrar Ontario Review Board