Re: Kale Littlemoustache
ORB File No: 5752
Hearing held on: Friday, June 13, 2025
Place of hearing: St. Joseph’s Healthcare Hamilton, West 5^th^ Campus Hamilton, Ontario
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. L. Maunder
Members: Dr. P. Darby
Dr. G. Stones
Mr. R. Bigelow
Mr. A. Mete
Parties Appearing:
Accused: Kale Littlemoustache
Counsel: Mr. T. Whillier
The person in charge of hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Ms. S. Gzik
REASONS FOR DISPOSITION
(Dated: July 25, 2025)
Introduction
On November 22, 2010, Kale Littlemoustache was found not criminally responsible on Criminal Code charges of assault, utter threat, forcible entry, and fail to comply. At the time of the hearing, Mr. Littlemoustache was subject to an order detaining him at St. Joseph’s Healthcare Hamilton, with privileges up to and including living in the community in approved accommodation. On June 13, 2025, the Board convened to conduct an annual review of Mr. Littlemoustache’s disposition. Mr. Littlemoustache did not attend the hearing – we excused him pursuant to s.672.5(10)(a) of the Code.
The parties all agreed that the necessary and appropriate disposition was a continuation of the detention order under the same terms. Significant threat was conceded. For the reasons set out below, the panel found that the evidence established that Mr. Littlemoustache remained a significant threat and we agreed that a detention order remained necessary and appropriate under the same terms.
The Index Offences
On October 2, 2009, at 11:30 pm, Mr. Littlemoustache knocked on the door of a home and when the resident answered the door. Mr. Littlemoustache asked him if Britney Spears lived in the home. The man said no and asked Mr. Littlemoustache to leave. Mr. Littlemoustache said he needed to search the house. The man started to close the door but was prevented by Mr. Littlemoustache pushing the door with his shoulder. The push knocked the man to the ground. When other residents showed up in the entry (the man’s wife and daughter) Mr. Littlemoustache left the home. He was on probation at the time and required to “keep the peace and be of good behaviour.”
On April 14, 2010, Mr. Littlemoustache was living in a shared basement apartment. He went to his roommate’s room and accused him of filming him with his cell phone camera. They argued and then Mr. Littlemoustache grabbed his roommate by the neck and pushed him onto his bed before climbing on top of him, his hand still on his roommate’s neck. He threatened to break his roommate’s arms. They struggled and Mr. Littlemoustache punched his roommate on the side of the head. Mr. Littlemoustache then left the bedroom. When his roommate left the apartment, Mr. Littlemoustache followed him outside and there they argued some more before Mr. Littlemoustache punched his roommate on the side of the head again and then pushed him to the ground.
Background / Context
Mr. Littlemoustache is 41 years old. He is Indigenous and belongs to his mother’s band, the Peigan Blackfoot of Pincher Creek in Alberta.
Mr. Littlemoustache had a chaotic childhood. His mother left and he had a variety of caregivers. He was badly beaten when he was 14 years old and had to be hospitalized.
Mr. Littlemoustache spent most of his teenage years in youth custody and during that time was diagnosed with bipolar disorder and started on medication. After he turned 18, he lived in a series of group homes and worked occasionally doing odd jobs such as cutting grass, painting, and repairing things.
When Mr. Littlemoustache was about 22 years old, his father died and left him $9,000. Mr. Littlemoustache spent it within two weeks.
Mr. Littlemoustache moved to Ontario to be closer to his grandmother in 2007, when he was 23 years old. When he arrived, he had been non-adherent with his medication for seven months. His grandmother noted symptoms of mania and took him to hospital. He was admitted for a couple of days, restarted on medication, and discharged with follow up care arranged through a family doctor.
During the next two years, Mr. Littlemoustache struggled to remain adherent to medication and struggled to hang onto any of the various living arrangements put in place for him, despite support from his grandmother and the Canadian Mental Health Association. When non-adherent to medication, he was agitated, angry, grandiose, and delusional.
Mr. Littlemoustache has a history of using excessive amounts of caffeine (energy drinks) and cannabis.
Mr. Littlemoustache’s criminal record includes youth convictions for weapons, break and enter, utter threat and assault. As an adult he was convicted of uttering a threat in 2009. In 2015, he was convicted of assault bodily harm (discussed below).
Under the jurisdiction of the Board, Mr. Littlemoustache’s progress was, until quite recently, slow but steady. He was initially detained at Waypoint. Upon his arrival, he was threatening and intimidating and had to be restrained by several staff and put in locked seclusion. He remained at Waypoint while he stabilized, and his medications were adjusted, over a few years. His mental state improved but he continued to experience residual symptoms.
In December 2013, he punched a co-patient, causing swelling to the victim’s eye, a fractured nose and a cracked tooth. This incident was the basis for his 2015 conviction for assault bodily harm.
In 2014, Mr. Littlemoustache was transferred to a secure unit at the Centre for Addiction and Mental Health (CAMH). In 2015, he moved to a general unit. In 2016, he was transferred to St. Joseph’s.
Mr. Littlemoustache was first discharged to live in the community in 2018. After a month, he was returned to hospital – he had stopped taking his medication and had a recurrence of symptoms of mania and psychosis.
Mr. Littlemoustache was transitioned to community living again a year later. He has continued to live in the community ever since, although he has required short readmissions to hospital several times. In his first year, he was readmitted twice after testing positive for cocaine but returned to the community when his mental state remained stable. He denied using cocaine and said it was from being with those who were using it. Mr. Littlemoustache has not tested positive for substance use since.
At baseline, Mr. Littlemoustache experienced fluctuations in his mental state. He was usually grandiose and endorsed delusions. His insight into his need for medications also fluctuated – sometimes he would agree they were helpful and sometimes he would want off them. Nonetheless, for the next couple of years, his mental state remained stable enough that he did not need any admissions to hospital.
In September 2021, Mr. Littlemoustache was granted a conditional discharge. In September 2023, the substance prohibition was removed from his disposition.
In the spring of 2023, Mr. Littlemoustache appeared more paranoid. In the fall of 2023, the team became concerned about Mr. Littlemoustache’s medication adherence – his lithium levels were low, and his blister packs were not always as they should be. A urine sample tested negative for his medications. He was also demonstrating irritability, anger and defensiveness with the outpatient team and staff at his housing. The team also had concerns because he had a female friend staying with him frequently who had substances and drug paraphernalia in the apartment. Her consistent presence was also against the rules and put his housing situation at risk. The team began to monitor his morning medications, and to educate him about the negative impact of his energy drink consumption on his lithium levels.
Mr. Littlemoustache was admitted to hospital under the Mental Health Act in March 2024. He was asked to come to hospital, and he agreed to a voluntary admission. He left against medical advice two days later. Ten days later, he was suspicious of staff and was fiddling with a utility knife during their assessment of his mental state. His substance-using girlfriend was also in the apartment. He was asked to attend the outpatient clinic and was again admitted, this time as an involuntary patient. He was initially “angry, posturing, and loud in response to rule requests” such that he was secluded for a day. He was discharged eleven days later when his involuntary status was rescinded by the Consent and Capacity Board. The team implemented daily urine screens, assessments with two staff, and daily morning appointments so that he could be observed taking his morning lithium. By June 2024, his lithium levels were therapeutic for the first time in many months.
In June 2024, the Board ordered that Mr. Littlemoustache be detained and reinstituted the substance prohibition.
The Current Year
Dr. Y. Naidoo, Mr. Littlemoustache’s attending psychiatrist since approximately 2019, testified at the hearing. He had read and adopted the Hospital Report.
Mr. Littlemoustache’s current diagnosis is schizoaffective disorder, antisocial personality traits, cannabis use disorder, in sustained remission, in a controlled environment.
Dr. Naidoo testified that over the course of the year the team had seen some reduction in the variability of Mr. Littlemoustache’s mental state. He was relatively cooperative with the team. He remained abstinent from substances. Unfortunately, he continued to consume energy drinks and continued to have challenges with sleep hygiene.
At the recommendation of the team, Mr. Littlemoustache moved to Emmaus Place, housing with more staff support and medication supervision, in November 2024. He takes his medications under supervision but sometimes forgets or misses his medication time. His lithium levels are not always where they should be, likely impacted by excessive caffeine consumption – a longstanding problem.
Emmaus Place informed the team that Mr. Littlemoustache had been having guests without signing them in as required. One female guest also reported to staff that she saw children’s underwear in the apartment. The apartment was searched and the team found make-up, clothes of various sizes (including small enough for a child) and dolls, as well as drug paraphernalia. The security camera for the previous week showed one woman entering the apartment multiple times.
Mr. Littlemoustache was admitted to hospital for a couple of days while these concerns were investigated. The team went over the rules of Emmaus Place with him, and he was instructed that the woman he had been having in his apartment was not allowed back in. Despite this, Mr. Littlemoustache let her into his apartment several more times over a few weeks. Eventually, it seems Mr. Littlemoustache came to understand he was putting his housing at risk and if he lost it, he would have to return to hospital. His oppositional behaviour receded.
Dr. Naidoo testified that the team continued to work with Mr. Littlemoustache to encourage him to engage in structured activities but has not yet succeeded. In the past, when studying for his GED at the Hamilton Regional Indian Centre, for instance, he felt better and spent less time with concerning peers. They continue to encourage him to drink fewer energy drinks to keep his lithium levels therapeutic.
Dr. Naidoo noted that ultimately, Mr. Littlemoustache is entitled to allow people into his apartment, and the team and staff at Emmaus Place can only monitor him and control for so much. At the same time, as things stood, Mr. Littlemoustache continued to need strong support to stay stable in the community.
Significant Threat
- The panel was satisfied that Mr. Littlemoustache remained a significant threat to the safety of the public. We accepted the testimony of Dr. Naidoo that although Mr. Littlemoustache has been compliant with his medications, he was a high risk to stop taking his medications if granted an absolute discharge, due to his fluctuating and often poor insight. Dr. Naidoo opined that he would likely re-engage with substance use, particularly since he does not have structured activities and spends his time with peers who use substances. With substance use or non-adherence to medication, Mr. Littlemoustache would quickly show worsened symptoms of mania and psychosis, leading to violence as he has engaged in in the past. He remains a significant threat.
Necessary and Appropriate Disposition
The panel concluded that the necessary and appropriate disposition was a continuation of the detention order on the same terms as last year, as jointly recommended by the parties. Although Mr. Littlemoustache has been living in the community for many years, during the last two reporting years, he has demonstrated instability and been readmitted to hospital on three occasions. The Mental Health Act may be effective for admitting Mr. Littlemoustache to hospital when he begins to show signs of decompensating but would not be effective to keep him there because he is capable for treatment decisions. This was demonstrated in April 2024 when he challenged his involuntary status in hospital successfully.
The hospital also needs to be able to approve housing. Mr. Littlemoustache’s consistent adherence to medication has been assured through medication supervision. When the hospital recommended the move to Emmaus Place to facilitate this, Mr. Littlemoustache initially refused to make the move. Although he eventually agreed, we were satisfied that given the level of support and monitoring needed to ensure Mr. Littlemoustache remains stable (and thus not a risk to the safety of the public), it remains necessary for the hospital to approve his accommodation. It thus remains necessary and appropriate that he be on a detention order.
DATED this 25^th^ day of July 2025, at the City of Toronto, in the Toronto Region.
Leslie Maunder
Alternate Chairperson
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Office of the Registrar
Ontario Review Board