Re Lancelot Murphy, 2025 CanLII 78497

Ontario Review Board

Re: Lancelot Murphy

ORB File No: 4066

Hearing held on: Friday, June 27, 2025

Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto

Pursuant to: Sections 672.81(1) and 672.81(2.1) of the Criminal Code

Before:

Alternate Chairperson: Mr. J. Weinstein Members: Dr. L.E. Cappe Dr. L.O. Lightfoot Ms. M. den Haan Mr. A. Mete

Parties Appearing:

Accused: Lancelot Murphy Counsel: Mr. T. Whillier

The person in charge of hospital: Counsel: Ms. A. Marshall

Attorney General of Ontario: Counsel: Ms. S. Cressman

REASONS FOR DECISION AND DISPOSITION

(Dated August 6, 2025)

Introduction

1. On October 29, 2004, Mr. Lancelot Murphy was found not criminally responsible on account of mental disorder, on a charge of cause a disturbance, contrary to the Criminal Code of Canada (“Criminal Code”).

2. Mr. Murphy is subject to the terms of a Disposition of the Ontario Review Board (the “Board”), dated May 21, 2024, which orders that he be detained at the Forensic Service of the Centre for Addiction and Mental Health, Toronto (“CAMH”).

3. Pursuant to s. 672.56(2) of the Criminal Code, CAMH notified the Board, by letter dated April 17, 2025, that Mr. Murphy’s liberty had been restricted; Mr. Murphy had been residing on a Forensic General Unit A (“FGUA”) and was transferred to a Forensic Secure Unit A (“FSUA”).

4. On June 27, 2025, the Board convened a hearing at CAMH to conduct the annual review of the current Disposition and to conduct a restriction of liberty hearing (“ROL”).

5. Mr. Murphy was represented by his counsel, Mr. Thomas Whillier. Mr. Whillier advised that his client did not wish to attend this hearing and that he had instructions to proceed in his absence. On the consent of all the parties, an order permitting Mr. Murphy to be absent from his hearing was made, pursuant section 672.5(10) (a).

6. When a hospital significantly restricts the liberty of an accused for more than seven days, it has an obligation to provide notice to the Board, as soon as practicable, under s. 672.56(2)(b) of the Criminal Code. Under s. 672.81(2.1), the Board is then required to convene an ROL hearing to review the hospital’s decision, also as soon as practicable. Since Mr. Murphy’s annual hearing was scheduled for June 27, 2025, it was agreed that his annual review and the ROL would happen concurrently.

7. A Hospital Report and a Restriction of Liberty Report (the “Hospital Report”), dated June 14, 2025, was entered as Exhibit 1.

8. For the ROL, the issues at this hearing are:

a) Was the decision made by the person in charge, to significantly increase the restrictions of liberty on Mr. Murphy, warranted and necessary, and was it the least onerous, and least restrictive, option in the circumstances, at the time of its onset, on April 9, 2025?

b) Does it continue to be so?

9. For Mr. Murphy’s annual review, the issue is whether Mr. Murphy continues to be a significant threat to public safety, as defined in s. 672.5401 of the Criminal Code. If so, the necessary and appropriate Disposition in the circumstances must be determined, bearing in mind the factors enunciated in s. 672.54 of the Criminal Code.

10. For the reasons set out below and based on the expert evidence and opinions before it, the Board concluded that the initial restriction of liberty was warranted, necessary and appropriate, as is the ongoing restriction of liberty. The Board found that these restrictions were necessary for public safety, and they represented the least onerous, and least restrictive, interventions available.

11. For the reasons set out below and based on the expert evidence and opinions before it, the Board also concluded that Mr. Murphy continues to present a significant threat to the safety of the public. The Board ordered that the continuation of the existing Detention Order, is the appropriate Disposition in the circumstances.

Current Psychiatric Diagnosis

12. Schizophrenia

Substance Use Disorder

Other Specified Personality Disorder

Major Neurocognitive Disorder

Index Offence

13. The circumstances giving rise to the Index Offence are extracted from last year’s Board Reasons, as follows:

“According to the Police synopsis and record of arrest, on August 24, 2004, at approximately 12:10 pm, the accused was observed by officers in the area of Bloor Street and Bellair Street in the City of Toronto. Officers were in the area, apparently responding to calls from numerous citizens, regarding a male party who was acting in a disorderly manner. A short time later, the accused appeared and was identified by a complainant as the same male. The officers observed the accused running in and out of traffic, yelling and screaming obscenities to everyone who passed his location. A large crowd gathered within minutes during this busy lunch hour period. Police officers approached the accused to investigate the above and were met with further screaming and swearing. The accused was cautioned about this behaviour, at which time, he reportedly told the police officers, "fuck off, you're no police officer". At that time, the accused was placed under arrest and transported to 53 Division."

Reasons for Restriction of Liberty

14. The Hospital Report sets out the reason for Mr. Murphy’s transfer from FGUA to FSUA, as follows:

“A second case conference with the Office of the Person-in-Charge took place on April 8, 2025. Concerns around Mr. Murphy’s non-adherence to medication, unpredictable behaviour (including unprovoked aggression towards co-client and exit-seeking behaviour), and suitability to return to his housing were discussed. It was noted that Mr. Murphy’s non-adherence to treatment in the community had resulted in multiple trips to the emergency room, and his current non-adherence to treatment while in hospital indicated that he needed a more secure environment to ensure his stabilization of his mental state. It was determined that transfer to a secure forensic unit would provide him with more support while in hospital while mitigating his risk of aggression towards others.

It was also determined that more supportive housing will need to be arranged for Mr. Murphy when he is suitable for discharge given his deteriorated mental status. It is evident that his housing is not appropriate for him given his high frequency of re-admissions to hospital. Despite a consistent medication cheeking protocol, Mr. Murphy has been able to cheek his medications while residing in the community. The housing also had an "opt-in" service for meals and Mr. Murphy does not eat appropriately while residing in the community; hence, rapid weight loss when he is discharged to the community, and weight gain when he is in hospital. His housing location was also in an area known for high substance use; Mr. Murphy has been known to deal drugs in that area and has frequently tested positive for prohibited substances on UDS..

Mr. Murphy was transferred to Forensic Secure Unit A (FSUA) on April 9, 2025.”

Course Since Last Disposition

15. Mr. Murphy’s course since his last Disposition is set out in detail in the Hospital Report. The following extracted paragraphs are relevant to this hearing:

“Mr. Murphy had another challenging reporting period with three re-admissions to hospital and while in hospital, he had to be transferred from a general forensic unit to a secure forensic unit. Mr. Murphy initially resided in the community in high support housing supported by LOFT at Sherbourne St. until his re-admission to hospital on September 2, 2024. Mr. Murphy has also tested positive for cocaine metabolites on urine drug screen (UDS) this year.

While on FSUA, he continued to have concerns about food and water, asserting that he felt that the food had been contaminated, probably by kitchen staff. He also mentioned that he was fearful of HIV and reported that he might get it from the food. He continued to completely lack insight on his mental illness and need for treatment. His clozapine adherence remained poor and it was ultimately discontinued in April. After he was transferred to FSUA, the clinical team on FGUA found towels of vomit in Mr. Murphy’s old room, suspecting that he had been purging after medication administration during his time in hospital on the general forensic unit.

Mr. Murphy refused to take his scheduled paliperidone injection in April 2025. His SDM provided consent to administer the long-acting injectable medications in restraints if necessary. Although Mr. Murphy resisted taking the injection, and security needed to be called, physical restraints were not necessary.

On May 19, 2025, Mr. Murphy triggered a Code White (i.e. violent emergency). It was noted that he was yelling in the yard, and demanding that staff give him a ripe pear. Then he threw the pear aggressively, almost hitting staff.

On April 3, 2025, Mr. Murphy had a verbal altercation with a transfemale co-client on the unit, which was unprovoked. The co-client was having a conversation with another client when Mr. Murphy became hostile towards her and was verbally aggressive. He took an aggressive stance towards staff when they tried to intervene. He made transphobic and threatening comments such as “That thing has been getting on my nerves all day” and “if I were outside, I would beat that drag queen up.”:”

Position of the Parties

16. At the outset of the hearing, the parties were canvassed for their positions on both the annual review and the restriction of liberty. Counsel for the hospital and the for the Attorney General submitted that the initial restriction of liberty was warranted, necessary and appropriate, as is the ongoing restriction of liberty.

17. Counsel for Mr. Murphy took no position on either the initial restriction of liberty or the ongoing restriction of liberty.

18. Counsel for the hospital and for the Attorney General recommended a continuation of the existing Detention Order Disposition.

19. Counsel for Mr. Murphy advised that his client’s position is that he does not meet the test to be found a significant threat to public safety, and he should, therefore, be absolutely discharged. No alternative position was given.

Evidence at the Hearing

20. The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Van. Dr. Van co-authored the Hospital Report and testified as follows:

a) She was Mr. Murphy’s outpatient psychiatrist from July 2022 to July 2024. She was his inpatient psychiatrist from November 2024 to April 2025, while he was on the FGUA, until he was transferred to the FSUA.

b) She adopts the contents of the Hospital Report.

c) Mr. Murphy is currently using level 1 passes, which allow him to go out on hospital and grounds with security present.

d) Mr. Murphy continues to exhibit irritability and volatile behaviour while on the FSUA.

e) Mr. Murphy requires the presence of security in order to administer his injectable antipsychotic medication. Without security present, Mr. Murphy will not accept his antipsychotic injection.

f) If Mr. Murphy were to be absolutely discharged, he would have no place to live in the community. He would end up living on the street, and he would become medication non-adherent.

g) When Mr. Murphy was living in the community, it appeared he was rapidly losing weight, which caused the hospital some concern that he might be suffering from a serious physical ailment. It also became apparent that he was not adherent to his oral clozapine medication.

h) Mr. Murphy is not optimally treated. When he is adherent to his medication regimen of oral clozapine, his symptoms become attenuated, which allows him to reside in the community.

i) Mr. Murphy has required several readmissions to hospital as a result of using illicit substances or for non-adherence to his oral clozapine. He cannot remain in the community without the extensive monitoring provided to him by the treatment team.

j) Mr. Murphy is incapable to consent to treatment. When he becomes non-adherent to his medication regimen, the team notices an increase in his irritability, paranoia and disorganized behaviours, including sexually inappropriate comments towards female staff. Mr. Murphy also claims to be receiving messages from God about his daughter.

k) She believes the following paragraph from the Hospital Report is still true today:

“Overall the case prioritization for violence risk management was deemed to be high (while on a detention order), given his non-adherence to treatment this year. Risk of serious physical harm is high and imminent violence is medium.”

l) The treatment team could not allow Mr. Murphy to remain on the FGUA, as he threatened a patient while on that unit.

m) The treatment team felt that Mr. Murphy’s non-adherence to medication caused him to target, and threaten a co-patient, completely unprovoked. Accordingly, it was no longer safe for Mr. Murphy to remain on the FGUA, where the staff-to-patient ratio is insufficient to protect the safety of co-patients.

n) The team has noticed that Mr. Murphy is experiencing increased cognitive difficulties, and his memory is worsening.

o) Mr. Murphy needs constant reminders to attend his appointments and programs.

p) Mr. Murphy’s memory has declined so significantly that he now believes that he has already been granted an Absolute Discharge.

q) Until Mr. Murphy’s mental status has been stabilized, the treatment team will not perform any assessments for neurocognitive disorders.

r) Going forward, Mr. Murphy will need 24/7 secure housing, to stop him from wandering into the community.

s) The team recommendations, as set out on page 56 of the Hospital Report, are still appropriate today.

21. In response to questions from counsel for the Attorney General, Dr. Van testified:

a) Mr. Murphy has an extensive criminal record, as set out on pages 10 and 11 of the Hospital Report. There appear to have been approximately 11 convictions for offences of violence, as well as numerous convictions for drug- and property-related offences. Should Mr. Murphy receive an Absolute Discharge from the Board, his expected course of action would be a repetition of those acts of violence, as set out in his criminal history.

b) Mr. Murphy’s recent violent, threatening behaviour to co-patients, which required intervention of staff, supports the belief that he would engage in violent behaviour, if he were granted an Absolute Discharge.

c) Mr. Murphy suffers from a treatment refractory form of schizophrenia. Clozapine appears to be the best antipsychotic medication to reduce his violent impulses.

22. In response to questions from counsel for Mr. Murphy, Dr. Van testified:

a) Mr. Murphy has no personal or professional supports in the community; he would most likely end up living on the streets, should he be discharged absolutely. He does have an elderly mother living in the Greater Toronto Area, but she has dementia.

b) As set out on page 52 of the Hospital Report, Mr. Murphy has poor insight into his diagnosis of schizophrenia, the impact that substance use has on his mental state, and the importance of medication to manage the active symptoms of his psychosis and to prevent, decompensation.

c) Mr. Murphy has indicated that he would use crack cocaine and other substances, should he be absolutely discharged. He does not believe that their use would cause him to harm members of the community.

d) Mr. Murphy’s last MoCA assessment was September 2024, in which he scored 17 out of 30. If he were re-assessed today, he would probably score 17 or lower.

e) The last time that Mr. Murphy engaged in any act of violence was back in 2016; however, this improved behaviour is solely the result of the intensive monitoring he receives from his outpatient team. It is only the ability of the treatment team to readmit Mr. Murphy rapidly, pursuant to a Detention Order, that prevented him from engaging in assaultive behaviours in the community.

23. In response to questions from the panel, Dr. Van testified:

a) Mr. Murphy has refrained from violence for many years only because he is on a Detention Order and under the auspices of the Board. Should he become non-adherent to his medication, he would engage in behaviour of a serious criminal nature. Her opinion of Mr. Murphy’s risk to public safety, if he became non-adherent to medication, is real and not speculative. If granted an Absolute Discharge, his risk is real, foreseeable and substantial, and it would result in serious psychological, or physical, harm to members of the public.

b) Mr. Murphy does not have any non-forensic supports in the community on which he could rely, should he receive an Absolute Discharge. He has had several readmissions to hospital while under the Board, to prevent him from engaging in criminal, or violent, acts against members of the public.

c) Mr. Murphy would not return to hospital voluntarily, should his mental state decompensate.

d) Mr. Murphy’s lack of insight does represent a real risk of safety to the public.

e) ECT would not be appropriate treatment for Mr. Murphy, as it would negatively impact his memory. He would also be unwilling to participate in ECT, and neither his SDM, nor the treatment team, would be willing to administer it against his will.

24. No other evidence was called.

Analysis and Conclusions

A. Annual Review

25. Having heard and considered the entirety of the evidence, as well as the submissions from the parties, the Board agrees with the joint submission: Mr. Murphy remains a significant threat to the safety of the public.

26. In Winko, the Supreme Court outlined that, in coming to the conclusion on the issue of significant risk, a Review Board should closely examine a range of evidence, including: the circumstances of the original offence; the past and expected course of the accused’s treatment; the present state of the NCR accused’s medical condition; the NCR accused’s own plans for the future; the support existing for the NCR accused in the community; and most importantly, the recommendations provided by experts who examined the NCR accused. In coming to our conclusion in this matter, the Board relies on the uncontroverted expert evidence of Dr. Van, in addition to the documentary evidence before us.

27. The evidence is quite clear, as outlined in paragraphs 22(a) to (d) of these Reasons, that Mr. Murphy meets all the criteria to be found a significant threat to the safety of the public. In addition, the Board considered Mr. Murphy’s extensive criminal history. Dr. Van testified that, if Mr. Murphy were absolutely discharged, his risk to public safety would be real and not speculative. Mr. Murphy indicated that he would become non-adherent to his medication regimen. There is a clear connection between his treatment with antipsychotics, his risks of decompensation, and his risk to public safety.

28. The Board has no difficulty in coming to the decision that Mr. Murphy satisfies the test set out in Marmolejo (Re), 2021 ONCA 130, in which Justice Tulloch reviewed the relevant test, in paragraph 37:

"The threshold for significant risk is “onerous”: Carrick (Re), 2015 ONCA 866, 128 O.R. (3d) 209, at para. 17. A significant threat to the safety of the public means a foreseeable and substantial risk of physical or psychological harm to members of the public: R. v. Ferguson, 2010 ONCA 810, at para. 8. The conduct must be of a serious criminal nature. A very small risk of grave harm will not suffice, nor will a high risk of trivial harm: Ferguson, at para. 8. The threat must be more than speculative in nature; it must be supported by evidence: Winko, at p. 665; Pellett (Re), 2017 ONCA 753, at para. 21."

29. Mr. Murphy continues to engage in aggressive and threatening behaviour. As set out in the Hospital Report, he had an unprovoked verbal altercation with a co-patient in the unit, as recently as April 3, 2025, in which he became threatening and aggressive.

30. The evidence before us conclusively demonstrates that Mr. Murphy represents a foreseeable, substantial risk of physical, or psychological, harm to members of the public. His conduct would be of a serious criminal nature. The risk is neither small nor speculative, as outlined in his history.

31. The Court of Appeal, in Osawe (Re), 2020 ONCA 715 (paragraph 18), in upholding the Board's finding that significant threat was real in the circumstances, found that:

"The Board’s conclusion on significant risk is grounded in the expert testimony of Mr. Osawe’s treating psychiatrist that a less structured living situation in which Mr. Osawe will enjoy a decreased level of support will increase his risk to the public safety.”

The evidence before us is that Mr. Murphy can only be safely managed in the community while detained in 24/7 secure housing. The treatment team is not prepared to let him live independently in the community. Should Mr. Murphy be discharged absolutely, he would have no place to live. He needs the extensive structure and supervision currently provided to him while under a Detention Order.

32. In Mott (Re), 2019 ONCA 568, at para. 10, the Court of Appeal indicated that the absence of offending behaviour alone is not determinative of whether there is a significant threat to the safety of the public. This absence must be considered in the context of other factors.

The other factor we considered is Mr. Murphy’s lack of insight into his need to both abstain from substances and to remain adherent to his medication regimen.

33. Mr. Murphy’s score on the PCL-R was 25.6 which would indicate a moderately high presence of psychopathic traits.

34. An HCR-20 V3 was rated in April 2025, by Mr. Murphy’s clinical team. This assessment indicated that the following clinical items were present and highly relevant: recent problems with insight, violent ideation of intent, symptoms of a major mental disorder, instability, and treatment or supervision response.

35. In particular, the Board relies on the Clinical Risk Factors/Reoffence Scenario set out in the Hospital Report:

“Criminogenic Risk Factors Include:

a) Lack of Insight:

Mr. Murphy demonstrated poor insight into his diagnosis of schizophrenia, the impact of his substance use and the importance of medication to manage and prevent more active symptoms of psychosis or decompensation. This lack of insight resulted in episodes of non-adherence with clozapine even during this predicate year. Mr. Murphy continues to endorse that he does not need medication and he will stop taking medication if he is no longer under the auspices of the ORB. He has also expressed a desire and will to use prohibited substances (namely crack cocaine) despite potential risks to his mental and physical health.

b) Symptoms of a Major Mental Illness:

Mr. Murphy generally evidenced stable mood and no apparent positive symptoms of psychosis when he is on treatment and his clozapine levels are therapeutic. However, when Mr. Murphy is non-adherent with clozapine, he has a history of mental decompensation, with increased agitation, paranoid delusions, disorganized speech and behaviour. He demonstrated some negative symptoms, including amotivation.

c) Cognitive Limitations:

Psychological testing performed in 2004, 2012, 2022 and 2024, demonstrated that Mr. Murphy’s cognitive functioning had been adversely affected by the chronic nature of his mental illness. Mr. Murphy’s ability to problem solve in an effective and pro-social fashion continues to demonstrate likely impairment. Additionally, Mr. Murphy is likely to act impulsively and experience difficulty predicting the consequences of his actions. Mr. Murphy has consistently had psychoeducation provided with respect to the impact of substance use and medication nonadherence on managing his symptoms; his ability to understand, integrate and apply this information to himself remains limited.

d) Substance Use Disorder:

Mr. Murphy has demonstrated positive drug screens during this reporting period and he is typically not forthcoming with regards to use. Mr. Murphy requires close supervision and monitoring to assist him with minimizing his use of crack cocaine.

Re-offence Scenario:

Mr. Murphy demonstrates an ongoing lack of insight into his mental illness. Mr. Murphy refutes his diagnosis of schizophrenia, the need for medication adherence and abstinence from substances. This continues to place Mr. Murphy at significant risk for re-offending absent external supervision. If Mr. Murphy was no longer under auspices of the Ontario Review Board, he would likely discontinue medications and resume regular crack cocaine use. Medication noncompliance and substance use would lead to acute psychotic decompensation. Mr. Murphy would likely experience perceptual disturbances in the form of auditory hallucinations, as well as religious and grandiose delusions. In the event of worsening psychotic symptomatology, Mr. Murphy is likely to act in an impulsive disorganized fashion and would thus be at high risk of causing physical or psychological harm to a member of the public.”

B. Analysis of Restriction of Liberty

36. The Board agrees that a restriction of liberty has taken place, pursuant to the decision of the Ontario Court of Appeal, in R vs M.L.C. (2010 ONCA 843) and in Regina v. Campbell (2018 ONCA 140). The Board has also concluded, based on the evidence before us, that the hospital’s decision to significantly restrict Mr. Murphy’s liberty, by transferring him from the FGUA to FSUA on April 9, 2025, and his ongoing restriction, were warranted and necessary.

37. The Board agrees that Mr. Murphy’s non-adherence to his treatment in the community, and his current non-adherence to treatment while in hospital, indicated that he needed a more secure environment, to ensure stabilization of his mental state as well as the safety of others. The Board agrees that the transfer to a Secure Forensic Unit was necessary to provide him with more support while in hospital, while mitigating his risk of aggression towards others.

38. Mr. Murphy quickly developed symptoms of psychosis with non-adherence to his clozapine this year, exhibiting mood instability, auditory hallucinations, paranoia, and disorganized behaviour. The Board agrees that the hospital had no other recourse than to transfer him to the SFUA. This transfer was warranted, as is his ongoing detention on the SFUA, and both remain the least onerous, and least restrictive, decisions available to the hospital.

39. In consideration of all the evidence, submissions of the parties and the criteria set forth in s. 672.54, the paramount consideration being the safety of the public, in addition to the mental condition of Mr. Murphy, his reintegration into society and his other needs, the necessary, and appropriate, Disposition is to continue with a Detention Order.

DATED this 6th day of August, 2025, at the City of Toronto, in the Region of Toronto.

Mr. J. Weinstein Alternate Chairperson

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Office of the Registrar Ontario Review Board