Re: Alexander Chang, 2025 CanLII 72927

Ontario Review Board

Re: Alexander Chang

ORB File No: 8279

Hearing held on: Tuesday, June 10, 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: Mr. J. Goldenberg Members: Dr. R. W. Hill Dr. L. O. Lightfoot Ms. L. Banks Mr. J. Cyr

Parties Appearing:

Accused: Alexander Chang Counsel: Mr. A. Rai

The person in charge of hospital: Counsel: Ms. S. Rosales-Zelaya

Attorney General of Ontario: Counsel: Ms. V. Culp

REASONS FOR DISPOSITION

(Dated July 22, 2025)

Introduction:

1On January 30, 2023, Mr. Chang was found not criminally responsible on account of mental disorder (“NCR”) on charges of sexual assault (x2) and criminal harassment (x4), contrary to the Criminal Code of Canada. Mr. Chang is currently subject to a Disposition of the Ontario Review Board (“ORB” or the Board) dated June 19, 2024, ordering his detention at the Forensic Service of the Centre for Addiction and Mental Health (“CAMH” or the “hospital”) with privileges up to and including a community living privilege in accommodation approved by the person in charge of the hospital.

2On June 10, 2025, the ORB convened a hearing at CAMH for the annual review of Mr. Chang’s Disposition pursuant to s.672.81(1) of the Criminal Code. Mr. Chang attended his hearing and was represented by counsel, Mr. Rai.

3The issues to be determined at this hearing are whether Mr. Chang poses a significant threat to the safety of the public, and if so, the necessary and appropriate Disposition to manage that risk having regard to the criteria set out in s. 672.54 of the Criminal Code.

4For the reasons that follow, the Board finds that Mr. Chang continues to represent a significant threat to the safety of the public and that the necessary and appropriate Disposition is a continuation of his current Detention Order save and except for a change in detention level to specifically identify that Mr. Chang be detained within a General Forensic Unit at the hospital.

Index Offences:

5The circumstances of the index offences are extracted from last year’s ORB Reasons, as follows:

“October 17, 2019: Sexual Assault x 1 and Criminal Harassment x 4

On the evening of October 17th, 2019, two women, EM [victim 1] and JG [victim 2], boarded the #602 Kingston City Transit bus at the Kingston General Hospital bus stop, making their way to Fort Henry to attend Fort Fright at Fort Henry, in the City of Kingston. While on the bus they were approached by Mr. Chang who sat beside EM. Neither EM or JG had seen Mr. Chang prior to this incident, and they stated that they were complete strangers to Mr. Chang. While on the bus, Mr. Chang began to make repeated requests for sex from the two women [the victims], causing them discomfort and feeling harassed. The women asked that Mr. Chang stop his behaviour. Mr. Chang proceeded to lean up against EM and placed his right hand on EM’s left thigh. Coupled with the sexual comments, the unwanted touching was deemed to be sexual in nature (Charge 1: Sexual Assault). EM and JG repeatedly asked Mr. Chang to stop communicating with them, and he failed to comply with their requests. Mr. Chang followed EM and JG as they got off the bus at the stop on Highway 2. At the bus stop, Mr. Chang continued to approach and follow the two women, making requests of a sexual nature.

Fearing for their safety, the two women ran into traffic to hail aid from a passerby despite the risk of being hit by a vehicle, as they were unfamiliar with the area and did not know where else to seek safety. (Criminal Harassment by Following x 2; Criminal Harassment by Threatening Conduct x 2). EM and JG were assisted by three passersby who helped to keep Mr. Chang at bay while the two women were secured in a random passerby's vehicle. Despite these parties’ assistance, Mr. Chang continued his unwanted advances and harassment of the two women.

At 19:49 hrs., police were dispatched to the scene. When police arrived, they witnessed Mr. Chang being separated from EM and JG by two males (Russell and McCabe). Police spoke to the victims who informed that an assault had taken place and harassment had occurred. Due to the erratic and increasing aggressive and agitated behaviour of Mr. Chang, police became concerned for his mental well-being and believed that he was in a possible state of psychosis requiring emergent medical attention. Police apprehended Mr. Chang under the auspicious [sic] of the Mental Health Act for assessment. Mr. Chang was taken to Kingston General Hospital where medical staff detained him for evaluation.

October 19, 2019: Sexual Assault x 1

On October 19, 2019, police received a call regarding a mental issue. Information from dispatch advised that there was a male [Mr. Chang] who was being physically aggressive towards his roommate. He was trying to start fights and seemed to the roommate as though he was manic. Police entered the residence and located Mr. Chang who was sitting on the stairs. Mr. Chang would not answer police questions and advised that he "was not leaving until Donald Trump shows up." Police advised Mr. Chang that they would be taking him to Kingston General Hospital (KGH) to speak with a doctor. Mr. Chang looked the female officer [victim] and began referring to her as "Sabrina." The victim advised Mr. Chang that her name was not "Sabrina," and he advised that it was. Mr. Chang stuck his tongue out and advised, “big tongue eh.” Police supported him by his arms to stand up. Once standing, Mr. Chang refused to move his feet and leaned forward. Mr. Chang then leaned toward the victim's face and advised, "I love you Sabrina" He proceeded to lick the left side of the victim’s face with his tongue. Police stabilized Mr. Chang so that he did not fall down the stairs. At the bottom of the stairwell, police walked Mr. Chang outside and handcuffed him. He was advised of his apprehension under Section 17 of the Mental Health Act. Mr. Chang continued to make statements regarding the arrival of "Donald Trump" and "Sabrina." He was taken to KGH for assessment.”

Positions of the Parties:

6At the outset of the proceedings, all parties were asked for their positions on the issues to be determined by the Board: whether Mr. Chang continues to represent a significant threat to the safety of the public; and if so, the necessary and appropriate Disposition.

7Counsel for the hospital recommended that the necessary and appropriate Disposition is a continuation of the current Detention Order. In response to a question posed by the Alternate Chair, the hospital’s counsel suggested that the appropriate level of security of Mr. Chang’s detention is in a General Forensic Unit.

8Counsel on behalf of the Ministry of the Attorney General concurred with the hospital’s recommendation in all respects.

9Mr. Rai agreed with the hospital’s proposed Disposition and advised that the issue of significant threat was conceded for the purposes of this hearing. Counsel agreed that the appropriate level of security for his client’s detention is a General Forensic Unit.

10All parties maintained their joint recommendation to the Board in closing submissions.

Background Information:

11The Hospital Report dated May 27, 2025 (the “Hospital Report”) contains a significant amount of information pertaining to Mr. Chang’s background and psychiatric history and need not be reviewed in detail. In addition, last year’s ORB Reasons summarize Mr. Chang’s history and have been relied on heavily herein. Briefly stated, Mr. Chang is a 26-year-old single man with no dependents. Both his parents are working in Canada although Mr. Chang’s father had previously divided his time between living in Toronto and in New York where he had been employed.

12Mr. Chang did well in both elementary and high school and there were no indications of childhood behavioural issues.

13Mr. Chang was in a relationship with a girl when he was 14 and 15 and his mother reports that when the relationship ended, he was adversely emotionally affected. She noted that he received some counselling to help him cope but that afterwards he appeared to “shut down” emotionally and did not want to make friends. She also noted that he never expressed any further interest in dating again after the breakup.

14After graduating from high school, Mr. Chang enrolled in the linguistics program at Queen’s University and reportedly performed well in his first year earning all As. His marks dropped to Bs in his second year and, shortly after beginning his third year, the index offences occurred.

15Mr. Chang reports that he first experimented with cannabis during his senior year of high school but did not use again until his second year in university (late 2018) when he began to use on a daily basis. He reported that cannabis made him feel energetic and uplifted and helped him to be more social. Subsequent to the index offences, Mr. Chang continued to use cannabis regularly. Mr. Chang has previously reported that cannabis use improved his mood and reduced his symptoms of mania. He was unable to identify any negative effects from cannabis at that time.

Legal History:

16Mr. Chang has no charges or convictions prior to the index offences.

Psychiatric History

17Mr. Chang has no documented psychiatric history prior to the index offences.

18Following the index offences, Mr. Chang was brought to Kingston General Hospital emergency department by police on October 19, 2019. On admission, Mr. Chang was disorganized, was observed responding to internal stimuli and exhibited pressured speech. He expressed bizarre and delusional thoughts in addition to paranoid beliefs. He was treated with lurasidone. On discharge, he was described as much improved, and his discharge diagnosis was substance-induced psychotic disorder.

19On October 29, 2019. Mr. Chang presented voluntarily at the Mount Sinai Hospital emergency department in Toronto. He was held under a Mental Health Act (“MHA”) Form 1 and transferred to CAMH for assessment. On admission, he was irritable, dismissive, paranoid, grandiose and had poor sleep. He was assessed as incapable of consenting to treatment. He responded well to lithium and, by the time of his discharge, his symptoms were in remission. His diagnoses at discharge on November 21, 2019, were Bipolar I Disorder (current episode hypomanic, in full remission) and Cannabis Use Disorder.

20Two days following his discharge, on November 23, 2019, Mr. Chang voluntarily attended the hospital accompanied by his father reporting symptoms of panic attacks. After speaking to staff, he agreed to return home. The following day, he again attended at the emergency department reporting panic attacks that cause him to experience suicidal ideation. He was subsequently seen by CAMH outpatient psychiatry until the end of January 2020 when after attending a hospital group in a manic state and displaying “hypersexual, grandiose and disorganized speech”, he was admitted to hospital. During admission he was overtly psychotic with grandiose religious beliefs including that he was Jesus. With treatment, his thinking became more organized, and reality based, and he was discharged on February 13, 2020.

21From March 2020 to March 2022, Mr. Chang was followed at the CAMH’s Slaight Centre Early Intervention Service (“SCEIS”) but was discharged from that program due to his non-adherence to prescribed medication.

22At Mr. Chang’s initial Board hearing in August 2023, he was ordered detained in hospital without the privilege of community living. A few days later, he was brought to hospital by police on a Warrant of Committal pursuant to the Board’s Disposition. Mr. Chang has remained in the hospital since that time.

23On April 4, 2024, the Ontario Court of Appeal allowed an appeal by Mr. Chang from his previous Disposition to the extent that it directed that the Disposition be amended to include a privilege of residence in the community in approved accommodation.

Current Diagnoses:

24Mr. Chang’s current diagnoses are:

Bipolar Affective Disorder, Type 1; and Cannabis Use Disorder, in remission within a controlled environment.

Evidence at the Hearing:

25Dr. O’Sullivan, who has been Mr. Chang’s inpatient psychiatrist since December 2024, testified at the hearing to supplement the documentary evidence before the Board, including the Hospital Report.

26Dr. O’Sullivan stated that Mr. Chang is assessed as capable to consent to his psychiatric treatment, but he has declined treatment with any psychotropic medication. In the treatment team’s opinion, medication would reduce both the likelihood and severity of a relapse to symptoms of Mr. Chang’s illness.

27Mr. Chang’s mental state has remained stable over the year. He has consistently denied experiencing any psychotic symptoms and none have been observed. There were no acute risk indicators in relation to harm to self or others. At times, his affect was somewhat blunted. Overall, his presentation was free of psychotic features.

28Mr. Chang has remained on FGUB, a general forensic unit. He was previously under the care of Dr. H. Meng until his care was transferred to Dr. O’Sullivan. Mr. Chang has not experienced any relapses or significant decompensations in his presentation or behaviour over the year in review and there have been no incidents of violence. Mr. Chang does not present as a management challenge. He is calm, polite and demonstrates several strengths including independence, intelligence, and organization skills.

29Dr. O’Sullivan commented that since Mr. Chang’s admission to hospital, he has not used cannabis. His positive urine drug screens (“UDS”) in November and December 2023, were attributable to his long-standing cannabis use and not on-going use. All of Mr. Chang’s UDSs over the past reporting year have returned negative for the presence of alcohol, cannabis and other intoxicants. His UDSs are administered on a randomized basis.

30Mr. Chang is able to identify his diagnosis and some of the past symptoms he has experienced but overall, his insight remains “superficial”. He has continued to decline medication, citing side effects in the past and the fact that he has remained stable, and its absence. He is aware there is evidence that medication can reduce his risk of relapse risk; however, he prefers to employ positive sleep hygiene, keeping a structured schedule and avoiding stress as ways to reduce his risk of relapse.

31Mr. Chang has demonstrated underdeveloped insight with regard to the harmful effects of cannabis and he has frequently minimized the connection between his mental illness, cannabis use and his risk of offending. In his view, cannabis has not been harmful for him. He has stated that he plans to use cannabis in the future although he does accept that it may increase his risk of relapse to illness. He has not engaged in substance use programming over the year in review and has declined engagement. These issues are being discussed in his individual therapy sessions.

32Mr. Chang has shown limited engagement in therapeutic rehabilitative programming (i.e., mental health and substance misuse). The Hospital Report indicates that he attended WRAP (x3) and a single session of CBT. He attended the discharge readiness group (x8). In addition, Mr. Chang has attended a variety of recreational and creative groups and has participated in various unit outings. He has not engaged in substance-related group programming.

33From February to November 2024, Mr. Chang attended individual psychology sessions with Dr. Cripps. The focus of those sessions was on CBT for psychosis and DBT skills. In January 2025, individual therapy sessions with a social worker were discontinued due to Mr. Chang’s limited engagement. They have resumed.

34Over the year in review, an assessment by the Forensic Consultation and Assessment Team was completed. Among other things, it identified that Mr. Chang may present with Schizoid Personality Disorder. The doctor stated that this has not yet been adopted as a formal diagnosis. The Hospital Report states “Schizoid personality disorder is characterized by a pervasive pattern of detachment from and general disinterest in social relationships and a limited range of emotions in interpersonal relationships.” It is recommended that Mr. Chang engage in individual therapy with his social worker to focus on improving his interpersonal communication skills, emotional expression, insight development, and augmentation of his coping skills. In response to a question raised by a panel member, Dr. O’Sullivan stated that he is cautious about adding the formal Schizoid personality disorder as a diagnosis at the present time, but its assessment will continue.

35For three months during the fall and early winter of 2024, Mr. Chang worked as a door-to-door fundraiser on behalf of SickKids hospital. In so doing, he utilized indirectly supervised community passes for up to 10 hours at that time. Mr. Chang also briefly worked for Elections Ontario. Additionally, since January 2025, he has volunteered one day a week at Trinity Square Café. That position has been discontinued as of this week, but Mr. Chang is now volunteering one day a week with the TTC Rider program. The Hospital Report indicates that Mr. Chang’s motivation to engage in these vocational and volunteer activities is likely externally motivated so that he can pursue his Pokemon Go hobby, which is his real passion.

36Mr. Chang most frequently uses his community passes to attend Pokemon Go recreational and social activities. At times over the review period, his access to these passes has been suspended due to his poor pass usage for rehabilitative activities. Overall, the doctor stated that the team is supportive of Mr. Chang’s hobby and is hopeful that Mr. Chang might be able to marry his engagement in that area possibly with a potential vocational endeavour.

37In terms of discharge planning, Dr. O’Sullivan advised that Mr. Chang was granted ODSP funding following a successful appeal. Further, an Occupational Therapy assessment was completed regarding his housing support level needs. The doctor noted that Mr. Chang is independent in attending to his activities of daily living. The assessment indicated that he is best suited in independent subsidized housing, however, there are financial barriers. In the alternative, the team is seeking out low-support housing, such as TRHP-1 or TRHP-2 or possibly LOFT housing. Of note, an application was made to a housing opportunity at 901 O’Connor in May 2025 but there has been no response to date. As soon as any housing vacancy arises, the doctor advised that the hospital will submit an application on Mr. Chang’s behalf.

38The doctor advised that Mr. Chang has consistently stated that he is not interested in being discharged to his family home given his relationship with his father. Dr. O’Sullivan stated that he does not believe that Mr. Chang’s parents reside together; however, he understands that Mr. Chang’s father frequently visits at the mother’s residence. The doctor reiterated that alternative independent living or subsidized housing continue to be sought out.

39Dr. O’Sullivan stated that a Conditional Discharge is premature at this juncture. The doctor stated that it would not allow for Mr. Chang’s swift and speedy return to the hospital for an extended detention, if necessary. In 2019, when admitted under the MHA, the civil mental health legislation was inadequate to keep Mr. Chang in the hospital. The doctor noted that the Box B criteria of the MHA are not available as Mr. Chang remains capable to make treatment decisions. As well, the treatment team considers it necessary that they have oversight in regards to his placement in the community on discharge for appropriate risk management.

40Mr. Chang is fortunate to have positive relations with his peers and family members, although his relationship with his father has remained strained. His mother has been an important support; she has applied to become an Approved Person.

41The Hospital Report identifies Mr. Chang’s historical risk factors, including:

• a history of violence;
• substance use;
• major mental disorder;
• traumatic experiences; and
• treatment or supervision response.

Clinical risk factors identified included:

• limited insight, and
• treatment/supervision response.

42Overall, the Hospital Report indicates, “When considering the combination of static and dynamic risk factors identified and those deemed most relevant in understanding his risk, Mr. Chang presents a low risk of serious physical harm and low risk of imminent violence.” Dr. O’Sullivan stated that it is the unanimous opinion of the treatment team that Mr. Chang remains a significant threat to the safety of the public and that the existing Disposition is both necessary and appropriate.

43No further evidence was called by the parties.

Analysis and Conclusion

44The Board has carefully considered the Hospital Report and the viva voce evidence of Dr. O’Sullivan and we find that Mr. Chang continues to represent a significant threat to the safety of the public. Mr. Chang suffers from Bipolar Affective Disorder, Type 1. During acute episodes of his illness, he has presented with behavioural disturbance (aggression, sexual disinhibition), affective disturbance (including depressed mood and mania), psychosis, and impaired insight and judgment. The index offences occurred during an acute phase of his illness. We are mindful of the fact that Mr. Chang remains untreated in terms of medication for his mental illness. This renders him vulnerable to rapid decompensation should he experience symptoms of his illness. In the absence of medication, the possibility of a relapse to his illness is higher than if he were treated. When unwell, he has the capacity to act out aggressively resulting in possible physical and/or psychological harm to members of the public.

45Additionally, we note that Mr. Chang is diagnosed with Cannabis Use Disorder, presently in remission within a controlled environment. Although he has been abstinent of substances for many years, Mr. Chang minimizes the harmful effects of cannabis and expresses suboptimal insight in connecting his offending history and future risk with cannabis use. He has expressed an intention to resume cannabis use in the future. Accordingly, there remains a significant risk of him relapsing to cannabis use with the likely consequent increase in the symptoms of his illness and a corresponding increase in his risk to the safety of the public.

46The Hospital Report indicates that “If Mr. Chang were to reoffend, it would likely occur in association with such acute phase symptoms. In these circumstances, Mr. Chang would likely begin to exhibit delusional thought including grandiosity, paranoia and perceptual disturbances. To cope with this stress, Mr. Chang may engage in further substance use, which would likely exacerbate his symptoms. This may lead him to misperceive social interactions, exhibit behavioural dysregulation and act in a manner that others perceive as aggressive. He may also misinterpret cues from the environment as threats to his safety, and subsequently act in a disorganized, impulsive and aggressive manner.”

47Having come to the conclusion that Mr. Chang satisfies the threshold of posing a significant risk threat to the safety of the public, the Board is tasked with crafting a Disposition that is necessary and appropriate, as well as least restrictive and least onerous.

48In our opinion, based on the evidence before us and the submissions of the parties, the hospital continues to require the risk management tools afforded by a Detention Order. Specifically, the hospital must be able to approve his accommodation in the community to ensure that Mr. Chang is provided with the appropriate degree of monitoring, supervision and support to adequately manage his risk. On discharge, Mr. Chang will face stressors associated with his reintegration in the community and enhanced opportunities to use substances. Absent an appropriate level of support and monitoring, in the context of no pharmacological treatment, Mr. Chang will be at risk of a return of symptoms, likely resulting in an increase of danger to the public.

49The Board also accepts the opinion of the treatment team that the civil mental health system would not adequately address risk and that the hospital requires the ability to readmit Mr. Chang expeditiously and at an early juncture should he experience any decompensation in his mental state, whether, as a result of symptoms of his illness, relapse to substance use, or otherwise. In that context, the hospital must be able to readmit him quickly and keep him in hospital until he is fully re-stabilized. A Conditional Discharge Disposition and the provisions of the MHA would be insufficient. Further, it is uncertain in that context whether or not Mr. Chang would be cooperative with a voluntary readmission and potentially lengthier readmission, if requested.

50Mr. Chang has demonstrated a prolonged period of stability and abstinence and he has progressed up the privileges ladder. The treatment team is actively engaged in discharge planning and it is hoped that appropriate housing will be available in the near future.

51For all of the reasons articulated above, the Board unanimously agrees that the necessary and appropriate Disposition is a continuation of his existing Detention Order save for an amendment to identify that his detention occur within a General Forensic Unit.

52In arriving at our decision, the Board has considered the paramount factor of the safety of the public, Mr. Chang’s community reintegration, his mental condition and his other needs, as required by s. 672.5 of the Criminal Code.