Ontario Review Board
Re: John Proudfoot
ORB File No: 7733
Hearing held on: Friday, June 20, 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: John Proudfoot Counsel: Ms. M. Murphy
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Ms. K. Dalrymple
REASONS FOR DISPOSITION
(Dated July 22, 2025)
Introduction
On May 12, 2020, John Proudfoot, then 26 years old, was found not criminally responsible on account of mental disorder (“NCR”) on a charge of aggravated assault, contrary to the Criminal Code of Canada. He was most recently subject to a Disposition of the Ontario Review Board (“ORB” or “the Board”) dated July 5, 2024, detaining him at the Southwest Centre for Forensic Mental Health Care, St. Joseph's Health Care London (“Southwest Centre” or “the Hospital”) with privileges up to and including 72-hour accompanied community passes and indirectly supervised community access.
Mr. Proudfoot was present at the hearing and was represented by his counsel, Ms. Murphy. The issues at the hearing were to determine whether Mr. Proudfoot represents a significant threat to the safety of the public and, if so, to determine the necessary and appropriate Disposition, having regard to the criteria in s. 672.54 of the Criminal Code.
The parties were canvassed as to their initial positions. Ms. Zamprogna stated the Hospital’s position, that Mr. Proudfoot remains a significant threat to the safety of the public and should be continued on his current Detention Order with the addition of living in the community of Elgin or Middlesex Counties in supervised accommodation approved by the person in charge of the Hospital, and the requirement to report not less than four times per month. Ms. Dalrymple for the Attorney General joined the Hospital position. Ms. Murphy indicated that the issue of significant threat was not contested, and that she joined with the Hospital’s recommendations.
The parties maintained their initial positions and the Board had before it a joint recommendation.
The documentary evidence at the hearing consisted of the Hospital Report dated April 30, 2025 (Exhibit 1). Dr. Jason Quinn testified for the Hospital.
Following its deliberations, the panel found that Mr. Proudfoot continues to represent a significant threat to the safety of the public as that term is defined in s. 672.5401 of the Criminal Code. The panel further found that the necessary and appropriate Disposition is a Detention Order containing the terms and conditions found in the previous Disposition, with the modifications proposed by the parties in their joint recommendation.
Index Offence
- The circumstances of the index offence are summarized as follows:
On the evening of July 14, 2019, the victim was sitting alone on a TTC streetcar talking on his cell phone. The accused boarded the streetcar and sat behind the victim. The victim and the accused were strangers to each other. For approximately ten minutes the accused sat calmly on the TTC streetcar. He did not speak to anyone. At one point he took out a sandwich and ate it. At no point while the accused was seated behind the victim did the victim turn to look at the accused or speak to the accused. The accused stood up. He pulled a knife out of his pocket, screamed “fuck you motherfucker” and began stabbing the victim in the neck, arm and shoulder. After the stabbing ended the victim got to his feet and turned to face the accused. The accused silently stood face to face with the victim for about one minute and then walked off the streetcar at the next stop.
Mr. Proudfoot’s background, criminal history and psychiatric history are set out in detail in the Hospital Report and need not be summarized in these Reasons except for the matters noted below. The following background information is taken, with slight modifications, from last year’s Reasons.
Mr. Proudfoot lived with his parents until they separated when he was young and thereafter with his mother until approximately the age of 20. His father currently lives in Ireland and his mother continues to live in Ontario. From at least 2018 up to the time of the index offence in July of 2019, Mr. Proudfoot lived in and out of shelters. Mr. Proudfoot reportedly did well in school but to date, he has not held any significant employment.
Mr. Proudfoot began using cannabis in high school, but over time also used illicit drugs including amphetamines, crystal methamphetamine and crack cocaine. However, his drug of choice has always been cannabis. He reported that he had “probably” smoked cannabis on the day of the index offence as it was something that he did “pretty much every day.”
Mr. Proudfoot’s mental health history reportedly began in 2012, when he was 18 years old. From that point to February of 2019, he was seen and treated in multiple hospitals for a variety of conditions including depression, anxiety, suicidal thoughts, auditory hallucinations and paranoia. He was prescribed several antidepressants and antipsychotic medications and was referred at least three times to Crisis Intervention Teams. He reported experiencing visual and auditory hallucinations for at least two months prior to the index offence and was having visual hallucinations while seated on the bus just before the index offence.
Between 2017 and 2019, Mr. Proudfoot was charged with various offences. All charges were withdrawn, one of which was withdrawn when Mr. Proudfoot entered into a peace bond for 12 months. Reportedly, none of the charges involved the actual use of physical violence. The most recent charges were withdrawn at the time of the NCR verdict.
Mr. Proudfoot’s current diagnoses are listed in the Hospital Report as: schizophrenia and substance use disorder, in remission in a supervised setting. He suffers from a treatment-refractory form of schizophrenia.
Following the NCR verdict, Mr. Proudfoot was admitted to the Provincial Forensic Programs at the Waypoint Centre for Mental Health Care (“Waypoint”). He was treated with clozapine at Waypoint starting in 2020 but continued to experience active positive and negative symptoms of his illness despite medication adherence. He was eventually admitted to the Southwest Centre on March 28, 2022, where he initially came under the care of Dr. N. Mokhber.
In February of 2023, Dr. Mokhber was able to start treating Mr. Proudfoot with Amisulpride, a medication not conventionally available in Canada. The start of this new medication correlated with a positive change in Mr. Proudfoot’s presentation. While he continued to experience auditory and visual hallucinations, the frequency of these hallucinations was considerably less than in previous reporting periods. He stated that his symptoms were “manageable” and he requested as-needed medications when they became difficult to tolerate. Nevertheless, Mr. Proudfoot continued to express paranoid thoughts, believing that his peers did not like him, that people were saying that he liked young children, and once accused a peer of threatening to harm him.
Evidence from the Hospital Report
Mr. Proudfoot continued to experience positive symptoms of his mental illness this reporting year, including persecutory delusions, visual and auditory hallucinations, with occasional tactile and somatic hallucinations.
He was generally forthcoming about his symptoms but, at times, believed that the voices were of utility to him. Occasionally he recognized these hallucinations as symptoms of his mental illness. When his hallucinations became unmanageable, he requested PRNs, which appeared to help with his symptoms.
Mr. Proudfoot began electroconvulsive treatment (ECT) in June 2024, which was used intermittently throughout the reporting year. Positive changes noted following ECT treatment included appearing more visible on the unit and demonstrating significant improvement in posture and speech clarity. Instead of a slouched-over posture, he walked upright and displayed a sense of humor. Mr. Proudfoot reported relief from hearing voices and that things were quieter. He was more engaged in activities. He went to the local library daily, and completed his high school diploma.
Following several medical complications and resultant anxiety about ECT treatment and potential complications, Mr. Proudfoot decided to stop ECT treatment altogether. The treatment team decided to treat him with medication which included increasing clozapine and initiating lamotrigine to decrease myoclonic side effects from clozapine.
The dose of clozapine was increased but this caused other side effects, e.g., unsteady gait and decreased motivation. His treatment team continues to assess treatment interventions and aims to engage Mr. Proudfoot in CBT for psychosis (upcoming) and one-on-one psychoeducation or therapy.
Mr. Proudfoot continued with monthly drug and alcohol screening and all results have been negative. His substance use triggers have appeared to decrease over the reporting year.
Mr. Proudfoot shared with staff that he would not engage in substance use again, although he still experiences the rare craving for marijuana and an occasional celebratory drink, despite it being contraindicated with some of his medications. Upon discussing the risks associated with alcohol and medication interactions, he reflected on the potential consequences, an improvement from previous reporting periods.
Mr. Proudfoot remains capable of making decisions related to his treatment of his mental illness. He is compliant with his medication under supervision despite several medication changes this reporting period.
Testimony of Dr. Quinn
Dr. Quinn told the panel that Mr. Proudfoot experienced periods of improvement this year. The doctor commended Mr. Proudfoot for completing his high school diploma and for volunteering with an environmental group.
However, Mr. Proudfoot’s wellness fluctuated over the year. He continues to experience the types of hallucinations and persecutory thinking that were present at the time of the index offence, although to a lesser degree. At the time of the hearing, Mr. Proudfoot was experiencing a relatively low mood, with increased symptoms of depression.
Mr. Proudfoot has insight into the symptoms of schizophrenia much of the time, and can identify the symptoms, the illness and his medications. He is forthcoming about his symptoms when asked, except with respect to suicidal ideation, which he often only discloses after the fact. However, Mr. Proudfoot loses insight in the moment, e.g. when hearing voices, he thinks they are true, but he is able to recognize they are not real relatively quickly.
The treatment team is still working to optimize medications, having recently switched anti-convulsant medication to valproic acid, which has improved some symptoms. The hope is that this will enable Mr. Proudfoot to tolerate a higher dose of clozapine. The clozapine has not yet been increased.
The doctor commented that Mr. Proudfoot showed significant improvement with the ECT treatments. ECT treatment is not sustainable at the present time, but Dr. Quinn did not rule out the possibility that Mr. Proudfoot might be able to tolerate ECT at some point in the future.
Mr. Proudfoot believes that the medications benefit him. Due to his level of disorganization, which is a symptom of schizophrenia, he needs support (not supervision) to manage compliance with his complicated treatment regimen.
Mr. Proudfoot is vulnerable to substance use, but as noted in the Hospital Report, his insight into the risks of substance use has improved this year. He has not attempted to use substances.
Dr. Quinn pointed out that Mr. Proudfoot does have protective factors, including his positive attitude to authority, and the active support and assistance of his mother. In addition, Mr. Proudfoot has a good relationship with the treatment team. He takes medications and is willing to try new medications when requested by the treatment team.
Mr. Proudfoot uses his indirectly supervised passes appropriately, although the treatment team encourages him to make more frequent use of the passes. When Mr. Proudfoot enters the community more, he is brighter and “stands taller”. However, his use of passes fluctuates with his wellness. He uses the passes more when he is well, and his wellness improves when he uses the passes.
Given his current mental status, community living is not indicated. However, Dr. Quinn commented that “Mr. Proudfoot does well when he is well”. Community living is a long-term goal.
The hope of the treatment team is that with a good treatment plan in place to address his symptoms and to support his improvement to the same or similar degree that Mr. Proudfoot experienced with the ECT treatment, community living is realistic. The treatment team plans to look for a placement in a local group home with adequate support, which will assist Mr. Proudfoot with his medication regimen. The group home needs to be local to permit the treatment team to monitor Mr. Proudfoot’s symptoms, especially suicidal ideation and worsening paranoia.
Analysis and Conclusions
The panel finds that Mr. Proudfoot continues to represent a significant threat to the safety of the public. Mr. Proudfoot lives with a treatment refractory major mental illness, schizophrenia. He continues to experience positive and negative symptoms similar to those present at the time of the index offence. This illness is exacerbated by a substance use disorder. Mr. Proudfoot has remained abstinent from substances but continues to experience cravings for marijuana, albeit rarely. Mr. Proudfoot’s insight into his illness diminishes when he is unwell. Mr. Proudfoot’s insight into his substance use and risk of violence are still developing. While Mr. Proudfoot has experienced periods of wellness during the reporting period, this wellness fluctuates significantly. His treatment has not yet been optimized. In addition, the index offence was extremely serious.
The panel adopts the Hospital’s reoffence scenario, set out on page 45 of the Hospital Report as a very realistic description of the likely consequences of Mr. Proudfoot’s course in the absence of the Board’s oversight. In these circumstances, there exists a very real likelihood of Mr. Proudfoot again engaging in criminal conduct that has the potential to cause serious physical or psychological harm.
The panel finds that the appropriate and necessary Disposition is a continuation of the current Detention Order with the changes recommended by the parties. The panel considered that there was no air of reality to a conditional discharge. Mr. Proudfoot’s risk to the safety of the public cannot be managed under a less restrictive disposition than a Detention Order. Mr. Proudfoot’s mental stability and ability to remain abstinent and adherent with medication has not yet been assessed outside of the Hospital environment. The Hospital requires the ability to approve Mr. Proudfoot’s accommodation, and to return him to the Hospital quickly if he decompensates while living in the community.
While community living is not immediately realistic given Mr. Proudfoot’s symptoms at the time of the hearing, during the past year Mr. Proudfoot experienced periods of wellness when community living (with appropriate supports) would have been realistic. With proper treatment, the Hospital is optimistic that community living will again be a realistic goal. The Hospital needs time to identify appropriate accommodation, and to place Mr. Proudfoot on the applicable waitlist(s) in anticipation of the goal of community living.
Reporting requirements are necessary to ensure that the treatment team can support Mr. Proudfoot and monitor his symptoms.
The panel finds that the addition of the community living and reporting clauses recommended by the parties to the Detention Disposition represents the least onerous and least restrictive disposition.
For all these reasons, the panel finds that the necessary and appropriate Disposition is a continuation of the Detention Order, with the changes unanimously recommended by the parties. We do so in recognition of the primary factor of protection of the public and in consideration of Mr. Proudfoot’s mental health, his reintegration into the community and his other needs.
The panel commends Mr. Proudfoot for his continued abstinence from substances, his good rapport with the treatment team, and the significant achievement of completing his high school diploma this year.
DATED this 22^nd^ day of July 2025, at the City of Toronto, in the Region of Toronto.
Ms. K. Tomaszewski Legal Member
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Office of the Registrar Ontario Review Board