Ontario Review Board
Re: F. (N.)
ORB File No: 7806
Hearing held on: Tuesday, May 6, 2025
Place of hearing: Waypoint Centre for Mental Health Care 500 Church Street, Penetanguishene
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Mr. M. Segal Members: Dr. K. Hand Dr. L.O. Lightfoot Ms. M. Chamberlain Mr. J. Cyr
Parties Appearing: Accused: F. (N.) Counsel: Ms. C. Francis
The person in charge of hospital: Representative: Ms. T. Newman
Attorney General of Ontario: Counsel: Ms. S. Curry
REASONS FOR DISPOSITION
(Dated August 5, 2025)
On November 26, 2020, Mr. F. (N.) was found not criminally responsible on account of mental disorder on a charge of assault causing bodily harm, contrary to the Criminal Code of Canada (the "Criminal Code").
Mr. F. (N.) is currently subject to a Disposition of the Ontario Review Board dated May 29, 2024, discharging him on various terms and conditions.
On Tuesday, May 6, 2025, the Ontario Review Board convened a hearing at Waypoint pursuant to s. 672.81(1) of the Criminal Code. Mr. F. (N.) was in attendance and was represented by his counsel, Ms. Francis.
Position of the Parties
Ms. Newman, on behalf of the hospital, submitted that Mr. F. (N.) remained a significant threat to the safety of the public. The Hospital recommended a continuation of the current conditional discharge with the removal of the clause allowing Waypoint to maintain open communication with the Early Psychosis Intervention team at the Canadian Mental Health Association as Mr. F. (N.) was no longer connected to this program. The Hospital was also requesting an increase to Mr. F. (N.)’s reporting to not less than once every two weeks instead of once per month. This position was supported by Ms. Curry, on behalf of the Attorney General.
Ms. Francis informed the Board that her client was also in agreement with the Hospital. Mr. F. (N.) is happy with the job that his treatment team is doing and wants to keep moving forward with them.
Background and Index Offences:
Mr. F. (N.) was born in Toronto. He was raised from birth by his maternal grandparents because his biological mother, Stephanie, was 19 years old at the time of his birth. His biological father died when Mr. F. (N.) was 6 years old from Marfan’s syndrome.
Mr. F. (N.) described his childhood as positive; however, by the sixth grade, Mr. F. (N.) began using cannabis and became angry and depressed. Mr. F. (N.) went on to abuse stimulant medication and ecstasy before progressing with other substances.
Mr. F. (N.) first left his family home in Grade 9 or 10 and went to live with a friend for a month. He attempted suicide while living at the friend’s house. Around this same time, he was expelled for making a video of skateboarding through his high school.
Mr. F. (N.) then attended another high school which he left in grade 11 after confrontations with the principal. At the time, he was selling cocaine and other drugs. He then attended alternative school for 1 week and did not go back.
Mr. F. (N.)’s current psychiatric diagnoses are:
- Schizophrenia
- Cannabis Use Disorder, in remission
- Opioid Use Disorder, in remission
- The circumstances of the index offences are taken from the most recent Reasons for Disposition, as follows:
“According to the agreed statement of facts, Mr. F. (N.) was residing in the basement suite that contained three apartments. He had been living in this home for approximately two months. On June 20th, 2019 at 500 hrs, Mr. F. (N.) kicked open the door to his co- tenant’s room and began stabbing the victim in the neck with a butter knife. The victim managed to disarm Mr. F. (N.) who then obtained a metal spoon and that was the victim in the neck and the eyes. The victim eventually broke free and escaped to a neighbour’s home.
The attack was described as unprovoked. The victim was 68 years old at the time and had little prior contact with Mr. F. (N.).”
Evidence at Hearing:
The evidence at the hearing consisted of the Hospital Report dated March 24, 2025, and the testimony of Dr. Ismail.
Mr. F. (N.)’s progress since his last annual review is summarized in the Hospital Report as follows:
“Mr. F. (N.) continues to reside at the home of his parents, and is supported by the Mobile Treatment and Support Team (MTST) and Dr. P. Ismail. Mr. F. (N.)’s mental state has been relatively stable and he is forthcoming about his symptoms with the MTST clinicians. In October 2024, Mr. F. (N.) reported experiencing auditory hallucinations after returning home from a karaoke bar. He described hearing the voices of his parents and said “I almost felt like someone drugged me. I went to RVH [Royal Victoria Hospital] and asked for tests for it”. According to MTST, there were no illicit substances detected in his system. On another occasion, Mr. F. (N.) reported thoughts of his girlfriend’s infidelity. Mr. F. (N.) has experienced paranoia related to infidelity in previous relationships in 2021 and 2023. Mr. F. (N.) denied any other perceptual disturbances during the review period. The MTST clinicians have not observed any perceptual disturbance or thought disorder. “
Ms. Newman called Dr. Ismail to give evidence on behalf of the Hospital. The doctor agreed with the contents of the Hospital Report as well as the recommendation contained therein.
Dr. Ismail provided an update since the date of the Hospital Report. Mr. F. (N.) had recently obtained his own residence in Barrie and has a new full-time job as a marketing representative with CMHA.
At his last interaction with his treatment team at the end of April, Mr. F. (N.) informed staff that his urine sample might be positive for alcohol and cannabis. Dr. Ismail stated that the Hospital appreciated Mr. F. (N.)’s honesty in reporting this usage. The Hospital takes this recent substance usage seriously, especially given that cannabis played a role in the index offence. Dr. Ismail noted that Mr. F. (N.) was also taking it seriously and had agreed to participate in one-on-one substance use counselling.
The doctor noted that Mr. F. (N.) has had previous positive urine screens for alcohol but not cannabis. He explained that cannabis use can have negative impact on one’s mental health, especially where one has a baseline paranoia as Mr. F. (N.) does.
As a result of this recent usage, the Hospital has changed their recommendation to the Board and is now seeking an increase in Mr. F. (N.)’s reporting requirements. Dr. Ismail stated that this was the least restrictive move that the Hospital could make to deal with the increased concern of substance use. He noted that the treatment team wanted to keep the positive therapeutic relationship with Mr. F. (N.) and also wanted to recognize that he had been forthcoming about his usage. Dr. Ismail felt that if Mr. F. (N.) reported to the Hospital more often, then the team could see if there was a deterioration in his mental status. Dr. Ismail did note that Mr. F. (N.)’s mental state has remained stable throughout the reporting period. The Hospital would bring him back in if there was a concern that he was deteriorating.
Dr. Ismail noted that recently, Mr. F. (N.) had been more open with the team in discussing his issues.
The Hospital Report indicates that Mr. F. (N.) has tested positive for cocaine metabolites in August of 2024. Mr. F. (N.) denied using cocaine and suggested that the positive result must be due to being in the presence of others who were using cocaine. This explanation has not been accepted by the Hospital. Mr. F. (N.) has also tested positive for alcohol on a few occasions. He has been open about his alcohol usage with the treatment team.
Dr. Ismail noted that Mr. F. (N.) has discontinued his Wellbutrin medication. The doctor had agreed to look at discontinuing this medication as Mr. F. (N.) did not seem to be suffering from depression. After seeing that Mr. F. (N.) was using alcohol, Dr. Ismail decided that it might be best to remain on this drug to counteract any depressive effects of the alcohol use. Mr. F. (N.) decided to stop using the Wellbutrin on his own and has not experienced depression since this time. Dr. Ismail acknowledged that he may have been being conservative in his position to continue the Wellbutrin. Mr. F. (N.) has maintained compliance with his anti-psychotic medication as he understands the need to take it.
Mr. F. (N.) is on the waitlist for Cognitive Behavioural Therapy for Psychosis (CBT-P) to assist with psychosis. He has also agreed to take substance use counselling. Mr. F. (N.) finds group therapy triggering for him and therefore one-to-one CBT-P counselling is best for him. In the past, he did not qualify for one-on-one counselling as he was not using substances but now that he has admitted to substance use, he will qualify. The Hospital will make the referral soon and counselling should start in the next few months. It is expected that Mr. F. (N.) will be able to complete this counselling in the next review period.
The doctor stated that CBT can teach Mr. F. (N.) other coping mechanisms other than substance use. It can also provide him with ways to deal with cravings, and how to say no. This form of counselling should also increase his insight into risks of use.
Dr. Ismail agreed with Ms. Francis that Mr. F. (N.)’s honesty about his use will help him be able to move forward. He stated that the Hospital did not want to penalize him for his honesty. The Hospital wants to work with Mr. F. (N.) on this issue and hopes that he will be successful. Dr. Ismail felt that an increase in Mr. F. (N.)’s reporting into the Hospital will allow the team to observe his mental status more closely. In addition, the counselling and CBT-P that Mr. F. (N.) has agreed to will also add a protective factor in the coming year. The Hospital will ensure that Mr. F. (N.) has access to resources while waiting for these programs.
A Board member noted that Mr. F. (N.) had had six positive urine screens this year. While most positive screens were for alcohol, there had also been evidence of cocaine use. Mr. F. (N.) was honest about his alcohol use but not the cocaine use. The doctor added that the Hospital is not solely relying on self-reporting but are also conducting random testing twice each month. The positive screens are also the reason that the Hospital is increasing the reporting requirement. Dr. Ismail posited that Mr. F. (N.) may become more truthful about his use now that he sees that the Hospital is willing to support him to become abstinent.
The Board also noted that that Mr. F. (N.) had a previous period of abstinence and queried why he might be using now. The doctor stated that he has always asked to drink alcohol but had not done so. Dr. Ismail felt that Mr. F. (N.) had not been aware that the abstinence clause had been removed and seemed to be testing the water a bit once he learned that it was no longer a requirement. Mr. F. (N.) is aware that if his mental health were to deteriorate, the Hospital may request that an abstinence clause be reinstated.
The Board asked Dr. Ismail if Mr. F. (N.) had been offered therapy to deal with his sexual abuse as a child. The doctor stated that the focus during the last review period has been Mr. F. (N.)’s substance use. It is hoped that this issue will come up when he is engaging in the counselling that will occur in the next year.
In response to questions from the Board, Dr. Ismail noted that no PCLR assessment had been conducted on Mr. F. (N.) in the past year but agreed that this would still be worth doing.
Final Submissions:
In closing, Ms. Newman noted the joint position of the parties that the existing conditional discharge should continue. She commended Mr. F. (N.) on his engagement with the treatment team. She stated that, while he is very open, he still has some reservation about communicating with the Hospital. The requested increase in reporting will support Mr. F. (N.) and his relationship with his service team as well as allow the Hospital to monitor his mental health more closely.
Counsel for the Crown adopted the Hospital’s submissions. Mr. F. (N.)’s counsel stated that her client wanted his treatment team to know how much he appreciates their support. He is hoping to move foreword in the coming year with their support.
Findings of the Board:
The Board accepts the joint position of the parties that Mr. F. (N.) continues to pose a significant threat to the safety of the public. In arriving at this determination, the Board accepted the uncontroverted evidence of Dr. Ismail as well as the Hospital Report. It is clear that Mr. F. (N.) is becoming more open with the treatment team; however, the positive results for alcohol, cannabis and cocaine during the past year are concerning and will require ongoing monitoring.
The Board, therefore, accepts that Mr. F. (N.) continues to require the oversight of the Board and unanimously determines that the necessary and appropriate Disposition required to manage the threat Mr. F. (N.) poses to the safety of the public while still meeting their needs, is a continuation of his existing conditional discharge.
The Board agrees with the recommended changes to Mr. F. (N.)’s current disposition:
- removal of 1(i) which allows permission for Waypoint to maintain open communication with the Early Psychosis Intervention team at the Canadian Mental Health Association. Mr. F. (N.) is not currently affiliated with this program.
- An increase in Mr. F. (N.)’s reporting requirement so that he reports to the Hospital not less than once every two weeks.
- In making this Disposition, the Board carefully considered the positions and submissions of the parties and the evidence of Dr. Ismail and is satisfied that this determination is both necessary and appropriate. The Board reviewed the provisions of s. 672.54 of the Criminal Code and carefully considered the need to protect the public from dangerous persons, Mr. F. (N.)’s mental condition, their reintegration into society and their other needs. The Board wishes Mr. F. (N.) well in the coming year.
DATED this 5th day of August 2025, at the City of Toronto, in the Toronto Region.
Ms. M. Chamberlain Legal Member Office of the Registrar Ontario Review Board