Re: Andrew Metatawabin
ORB File No: 7744/8029
Hearing held on: Monday, June 23, 2025
Place of hearing: Providence Care Hospital,
Pursuant to: Sections 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. J. Hanbidge
Members: Ms. K. Weisbaum
Dr. S. J. Hucker
Dr. W. Loza
Ms. K. Brisson
Parties Appearing:
Accused: Andrew Metatawabin
Counsel: Ms. E. Holder
The person in charge of hospital: Counsel: Ms. T. Tom
Attorney General of Ontario: Counsel: Ms. J. Ferguson
REASONS FOR DISPOSITION
(Dated August 19, 2025)
Introduction:
On June 5, 2020, Andrew Metatawabin was found not criminally responsible (“NCR”) on account of mental disorder on charges of attempt to choke or strangle to commission of offence, assault causing bodily harm, and utter threat to cause death or bodily harm, all contrary to the Criminal Code of Canada (ORB File No. 7744). On February 24, 2022, Andrew Metatawabin was also found NCR on account of mental disorder on charges of aggravated assault and possession of weapon for dangerous purposes, all contrary to the Criminal Code (ORB File No. 8029). Both NCR matters were being dealt with together at the review hearing.
Mr. Metatawabin is currently subject to a Disposition of the Ontario Review Board (the “Board” or “ORB”), dated July 24, 2024 and with amending Orders, dated July 24 and 26, 2025, which requires Mr. Metatawabin to be detained at the Secure Forensic Unit of the Providence Care Hospital (the “Hospital” or “PCH”), Kingston, Ontario, with the ability to live in the community in supervised accommodation approved by the person in charge.
On June 23, 2025, a panel of the Board convened Mr. Metatawabin’s annual “in person” review hearing at PCH pursuant to sections 672.81(1) of the Criminal Code. Mr. Metatawabin was in attendance and was represented by legal counsel, Ms. Erin Holder. Also appearing were Ms. Tina Tom, legal counsel representing the interests of the Hospital, as well as Ms. Jennifer Ferguson, Crown counsel, appearing for the Attorney-General of Ontario.
The issues to be determined at the hearing were whether Mr. Metatawabin continues to represent a significant threat to the safety of the public as defined in section 672.5401 of the Criminal Code and if so, what is the necessary and appropriate Disposition which is also the least onerous and least restrictive taking into account the factors set out in section 672.54 of the Criminal Code.
Position of the Parties
- At the commencement of the hearing the parties were requested to provide their initial, without prejudice, positions with respect to the issue before the Board in order to narrow any issues. Ms. Tom, on behalf of the Hospital, submitted that Mr. Metatawabin continued to represent a significant threat to the safety of the public. Ms. Tom further submitted that, on behalf of the Hospital, the necessary and appropriate Disposition ought to be the continuation of Mr. Metatawabin’s current Detention Order, with its same conditions and privileges. Ms. Ferguson, on behalf of the Attorney-General, agreed with the Hospital’s position. Ms. Holder, on behalf of Mr. Metatawabin, also agreed with the position taken by Hospital counsel, without exception.
Evidence at the Hearing
- The evidence at the hearing consisted of the oral testimony of Dr. Zoe Selhi, Mr. Metatawabin’s current treating psychiatrist, as well as the Hospital Report, dated May 28, 2025, and a Victim Impact Statement (“VIS”), dated May 12, 2025, both entered as exhibits at the hearing
Findings:
- For the reasons that follow, the panel of the Board concluded that Mr. Metatawabin continues to represent a significant threat to the safety of the public, and, therefore, the necessary and appropriate Disposition which is also the least onerous and least restrictive to Mr. Metatawabin is a Detention Order with the conditions and privileges as set out in the Board’s formal Disposition Order.
Index Offence Charges:
- The allegations giving rise to the index offences are set out in the Reasons for Disposition, dated June 7, 2023, and are as follows:
The index offences that are the subject of ORB File No. 7744 occurred at the Toronto South Detention Centre (“TSDC”) on June 15, 2018, and are set out in the Hospital Report as follows:
On Friday, June 15, 2018, at approximately 0100 hours, the accused and the Victim #1 were the only two individuals inside the locked Medical – B unit, Cell #11.
Within a few minutes of the accused being placed in the cell-room with the Victim #1, unprovoked and without any motive, the accused [viciously] attacked the Victim #1, who was resting in his own bed, by punching [and] kicking and, using his hands, the accused choked the Victim #1 to the point of the Victim #1 being unconscious (Charges #1 and #2).
Corrections officers immediately attended on scene and separated the accused from the Victim #1.
Emergency Medical Services (EMS) attended and Victim #1 was transported to St. Joe’s Hospital for immediate medical attention.
The accused was secured and in direct supervision of the Corrections personnel; he was escorted and transferred to the Segregation-B unit at TSDC.
Further, [on] Friday, June 15, 2018, at approximately 1713 hours, the accused was held in Segregation-B unit, cell #12 at TSDC.
The TSDC Corrections Officer, Victim #2, was conducting the routine duties at Segregation – B unit at TSDC and he attempted to serve the scheduled meal to the accused; the accused directly threatened to cause bodily harm to the Victim #2 by saying that: “I will break your fucking neck and stab you just like him.” (Charge #3)
The index offences that are the subject of ORB File No. 8029 occurred at Michael Garron Hospital on June 5, 2018, and are set out in the Hospital Report as follows:
On June 1st 2018, the accused attended Michael Garron Hospital in relation to cocaine use and Acute Kidney Injury. He was admitted into the hospital and placed in the MSSU – Medical Short Stay Unit, room #44. On June 4th, 2018, the victim was place[d] in the MSSU, room #45. The accused and the victim do not know each other.
On Tuesday June 5th 2018, at approximately 1400 hours, the accused, located in room #44 in the MSSU, walked over to the victim’s room in room #45 in the MSSU. The accused produced a silver butter knife, and said “prepare to die” before he plunged the knife into the victim’s right eye. As hospital staff entered room #45, the accused fled the MSSU and exited the hospital via the emergency exit, butter knife in hand.
Officers arrived on scene and searched the area for the accused but were unable to locate him.
Background Information Regarding the Accused:
Mr. Metatawabin’s personal and psychiatric history are set out in the Hospital Report, as well as the Reasons for Disposition, dated June 7, 2023, as follows: In summary, Mr. Metatawabin is a 38-year-old Indigenous man who was born in Moose Factory and grew up in Attawapiskat. He has multiple siblings and was raised primarily by his maternal grandparents after being separated from his parents when he was 1 year old. At age 9, Mr. Metatawabin moved in with his mother and stepfather, but this was an abusive relationship which significantly impacted him. The Children’s Aid Society intervened, and Mr. Metatawabin became a Crown ward. He lived in foster homes, group homes, young offender facilities, and jails.
Mr. Metatawabin exhibited a number of conduct-disordered behaviors between the ages of 10 and 12, and he demonstrated violent tendencies at school. He quit or was expelled from school at age 16, but eventually completed sufficient credits to obtain Grade 10.
Mr. Metatawabin has a long history of substance abuse (alcohol, cannabis, cocaine, and other street drugs) starting in his teenage years. His use led to serious physical issues, serious legal charges, multiple hospitalizations, and significant disruptions in his social and employment life. Mr. Metatawabin held jobs as a landscaper, mover, and general labourer, but was unable to maintain any stable employment as a result of his substance abuse. He has been supported by ODSP since he was approximately 18 years old.
Mr. Metatawabin is single with no dependents. He has maintained some contact with his mother. He has lived in Sudbury, Timmins, and Sault Ste. Marie. He moved to Toronto around 2012 and considers it home. Mr. Metatawabin reportedly had his own apartment at one time, but also experienced periods of homelessness.
Mr. Metatawabin has an extensive criminal offence history as outlined in the Hospital Report. His history of violent behaviours began at age 13, and he has more than fifteen assault charges and two attempt murder charges in his criminal record. He has also had charges for threatening bodily harm, carrying weapons, break and enter, and theft. There were also multiple incidents of unpredictable/violent aggressive behaviours in the community.
Mr. Metatawabin has an extensive psychiatric history which is also set out in the Hospital Report. He was diagnosed with schizophrenia at age 16, and was hallucinating, feeling paranoid, and having black outs. Mr. Metatawabin had numerous psychiatric hospitalizations between 2006 and 2017 where he presented with psychosis, agitation, and aggression. He was treated with antipsychotic medications and was discharged but was frequently noncompliant with prescribed medication leading to deterioration and subsequent admissions to hospital. There was also at least one period where Mr. Metatawabin was assessed and treated while incarcerated.
Following the index offences, Mr. Metatawabin was treated at the Centre for Addiction and Mental Health (“CAMH”) and the TSDC.
Victim impact Statement
- The Board also acknowledges its review of the contents of the VIS of the victim of the stabbing that caused a significant eye injury, with lasting and profound consequences, as detailed in the VIS.
Updated Psychiatric and Medical Diagnoses:
- Mr. Metatawabin is currently diagnosed with:
-Schizophrenia by history, in remission
-Substance abuse disorder(s) in remission (cannabis, alcohol & stimulants)
-ADHD by history
Course in Hospital from May 2024 to May 2025
According to the Hospital Report, Mr. Metatawabin continued to show psychiatric stability as a forensic inpatient at PCH. He showed some mood changes in early 2025 following his grandfather’s death, though no psychotic symptoms presented themselves. He had no seclusions or restraints over the reporting period.
In May 2024, Mr. Metatawabin was referred to psychology for concern over auto-asphyxiation behaviour. Since that time, he has been engaged in psychotherapy on a weekly basis. Other significant group involvement included completion of a dialectical behavioural therapy (“DBT”) program for addictions in February 2025.
While Mr. Metatawabin continues to engage in numerous recreational groups, indigenous activities, and outings into the community with staff, he became less motivated to initiate activities outside of the unit during the latter half of the reporting period. He also requested a transfer back to Waypoint on several occasions during periods of stress.
Mr. Metatawabin had no significant medication changes over the reporting period. He is complaint with his medication regimen. Mr. Metatawabin’s presentation in interviews suggests that his medication has been optimized. Staff have not observed any symptoms suggestive of a psychotic process during the current reporting period. Documentation indicates that Mr. Metatawabin’s mental status has been stable. Mr. Metatawabin did not endorse any psychotic symptoms during an interview for the current assessment. Additionally, his presentation was unremarkable, with no overt evidence of symptoms of a major mental illness.
Mr. Metatawabin has been engaged in Occupational Therapy services provided on the Forensics Mental Health unit at PCH over the course of the past year. This has mainly involved supporting Mr. Metatawabin in exploring engagement in community-based occupations as well as various unit program offerings, including helping him establish a daily routine in the community, supporting him with obtaining a bus pass and gym and library memberships, attending art hive and the Sweat Lodge in the hospital, as well as engaging in various indigenous practices. He has also been connecting with a local elder on weekends and continues to maintain contact with his mother who he enjoys spending time with, as well as his sister.
The treatment team is in the early stages of planning Mr. Metatawabin’s community transition. The team is currently considering Mr. Metatawabin’s placement at the Transitional Rehabilitation Housing Program (“TRHP”) pending waitlist and bed availability concerns. This setting would provide 24/7 staff support which Mr. Metatawabin does acknowledge may be helpful in terms of providing a starting point to develop his confidence living in the community and to abstain from substances as he has expressed concern about the potential for relapse with members of the team.
It is important to highlight that Mr. Metatawabin does possess good functional abilities and attends to all activities of daily living (“ADLs”) and instrumental activities of daily living (“IADLs”) independently. The TRHP setting would primarily serve to support Mr. Metatawabin manage his substance use issues and provide him with related ongoing skills teaching and educating within a highly structured environment, in preparation for living independently in accommodation in the community thereafter.
Mr. Metatawabin has also participated in 36 psychotherapy sessions to date, with an overarching goal of relapse prevention (inclusive of schizophrenia and substance use). Mr. Metatawabin’s attendance has been described as excellent, with consistent engagement. He has diligently completed all homework. His mental state has remained stable, with no evidence of psychosis. Mr. Metatawabin has also developed an increased awareness of both internal and external triggers for substance use. At this time, he appears to be in an action/maintenance stage of change regarding substance use, and in the preparation/action stage of change for auto-asphyxiation.
Risk Formulation
As noted in the Hospital Report, Mr. Metatawabin reported that he would likely reoffend if he stopped his medications. He shared that stopping his medication would lead to a return of his psychotic symptoms and that a lot of his prior violence was committed when he was not taking his prescribed medications. His paranoia had led to unprovoked assault behaviour, as referenced in one of the index offences.
Mr. Metatawabin also acknowledged a history of substance and alcohol use dating back to his teens which he noted were used during times when he committed criminal offence. He also acknowledged that ongoing use of substances interfered with his medication compliance, which then affected his psychotic symptoms.
The Hospital Report, at page 95, references several public safety risk factors applicable to Mr. Metatawabin’s particular circumstances, as stated as follows:
“Several risk factors warrant consideration when looking at potential pathways to offending behaviour. The intergenerational effects of colonization and personal experience of trauma are vulnerability factors that likely contributed to the development of difficulties with substance use and mistrust of authority and systems. History of trauma and substance use also represent vulnerability factors for the development of psychosis. In Mr. Metatawabin’s case, psychosis is considered to be an important destabilizing factor as it affects his ability to monitor and control his decision making. In the context of untreated psychotic symptoms, persecutory delusional beliefs have been a precipitating factor that has triggered specific incidents of violence. File information notes instances where Mr. Metatawabin has engaged in violence to protect himself from a threat that is not reality based. Use of substances is judged to have a disinhibiting effect for both general and violent recidivism. In terms of general recidivism, Mr. Metatawabin has acknowledged engaging in property offences in order to secure funds to purchase substances. From the perspective of violence recidivism, substance use becomes a barrier to compliance with medications as Mr. Metatawabin has reported that he becomes so fixated on substances that he forgets to take his medication. In addition, on-going substance use is likely to contribute to a relapse of and/or exacerbation of psychotic symptoms. Lack of compliance with psychiatric treatment and conditions of supervising agencies serves to perpetuate challenges with psychotic symptoms and substance use. File information also suggests that Mr. Metatawabin’s level of insight and symptom severity have also served as barriers to compliance. Although it is not confirmed, potential mistrust of White-dominated systems may also play a role in his openness to complying with past recommendations. An underdeveloped repertoire of coping strategies, disruption/separation from personal supports, and dislocation from his culture have also played a role in the maintenance of substance use and indirectly increases vulnerability to a relapse of psychotic symptoms.”
The Hospital Report notes that Mr. Metatawabin currently presents as psychiatrically stable. Following his transfer to PCH from Waypoint in October 2023, his adjustment to the medium secure unit at PCH has gone well, and he continues to demonstrate insight and therapeutic engagement. However, given the complex relationship between Mr. Metatawabin’s history of violence, mental health, cognitive difficulties (including but not limited to ADHD) and his well-documented history of trauma with ongoing issues related to self-injurious behavior, the Hospital and the treatment team remain of the opinion that Mr. Metatawabin remains a significant risk to the safety of the public.
The Treatment team and Hospital are of the opinion that Mr. Metatawabin is not manageable in the context of an Absolute Discharge Disposition given that Mr. Metatawabin continues to require forensic oversight and risk management strategies. As well, a Conditional Discharge Disposition is considered to be premature and also insufficient to manage his risk. The rationale for not making this recommended Disposition to the Board was noted in the Hospital Report at page 96 as follows:
“…. Mr. Metatawabin has not had indirect community access in many years. In the past, he has voiced concerns about the increased access to substances associated with community access. While he continues to develop his confidence in his ability to remain abstinent from substances, he would benefit from additional interventions to build his repertoire of coping strategies. It is imperative that this includes culturally specific interventions and opportunities to engage in his culture. Additionally, it is important for the hospital to have the ability to approve Mr. Metatawabin’s housing. File information indicates that association with antisocial peers may have a destabilizing effect on Mr. Metatawabin with respect to substance use. His past difficulties with adhering to risk management strategies and psychiatric treatment also underscores the value of an initial period of supervised housing, prior to more independent living.”
- Accordingly, the treatment team and Hospital were recommending both at the time of preparation of the Hospital Report and at the time of the hearing that Mr. Metatawabin continue to be subject to a Detention Order Disposition with the same terms as contained in last year’s Order, with an increase in privileges up to and including community living. The Hospital Report notes as follows at page 96:
“…. Under this management plan, [Mr. Metatawabin’s] risk is judged to be low. A continuation of the detention order allows the treatment team to implement a gradual re-integration plan that includes a high degree of monitoring as Mr. Metatawabin works towards exercising indirect community privileges. This gradual plan is essential given his history of non-compliance with conditions set be supervising agencies, inconsistent follow-up with mental health services, and periods of medication non-compliance. File information also notes that Mr. Metatawabin has also expressed reservations when given more privileges due to concerns about his ability to be successful. A gradual re-integration plan will also assist Mr. Metatawabin in building his confidence.”
- The Hospital Report further notes that Mr. Metatawabin had another successful year as an inpatient at PCH, with notable progress in the areas of individual psychotherapy and accessing the community independently. However, as a cautionary note, the Hospital Report also notes at page 96:
“Notwithstanding the above, Mr. Metatawabin may need more time managing and initiating activities independently prior to moving into the community. While stable and compliant, he is extremely driven and reliant on the structured setting of PCH to provide this stability. Likewise, he appears to use avoidant and/or distracting behaviours to process difficult emotions. Both of these factors may result in him becoming vulnerable to substances use when released into a less secure setting.”
- While Mr. Metatawabin remains a significant risk to public safety, nevertheless, Mr. Metatawabin’s progress since arriving at PCH from Waypoint has been considered excellent according to the treatment team, and, as such, he will be considered for the TRHP once he is deemed suitable to live in the community. It is anticipated that this transition will occur over the next reporting period.
Oral Testimony of Dr. Selhi
In her oral testimony before the Board, Dr. Selhi advised that she had assumed carriage of Mr. Metatawabin’s psychiatric care as of October 2023 when he arrived at PCH from Waypoint.
Dr. Selhi confirmed that Mr. Metatawabin remains a significant risk to public safety, and, as noted at page 96 of the Hospital Report, she adopted the recommendations concerning the appropriate Disposition for Mr. Metatawabin for the upcoming reporting period.
Dr. Selhi referenced the various factors leading to the finding that Mr. Metatawabin continued to remain a significant risk to public safety, including his violent index offences, his criminal record history, Mr. Metatawabin’s diagnosed major mental illness condition, his substance abuse history, his continued residence in an inpatient psychiatric hospital unit, as well as his reliance on the external structure of the hospital for control of his risk.
During the past year, Dr. Selhi testified that Mr. Metatawabin’s focus had been spending more time independently outside the hospital setting, as well as engaging in weekly psychotherapy sessions with Dr. Douglas, the hospital clinical psychologist, as well as participating in indigenous cultural activities, and connecting with family members.
There was only one issue that arose when Mr. Metatawabin was not at the location, he was expected to be according to his itinerary, namely, finding himself at the nearby cafeteria when he was supposed to be at the gym.
Dr. Selhi advised that it was anticipated that Mr. Metatawabin would be transitioned to the community in the next year. Initially, during an expected six-month period, Mr. Metatawabin would be monitored for his time participating in the various activities and programming at the structured residence known as the Transitional Rehabilitation Housing Program (“TRHP”), a 24/7 supervised housing facility in the community of Kingston. Thereafter, if the results are favourable, Mr. Metatawabin would be placed on the waiting list for placement at the TRHP facility.
Dr. Selhi also noted that Mr. Metatawabin maintains contact with his family, with his mother expected in the near future to become one of Mr. Metatawabin’s “approved persons”.
It is expected that, with the Disposition’s current terms and conditions, Mr. Metatawabin is expected to exercise his pass privileges to attend his mother’s wedding ceremony in June 2026.
In response to questions posed by Ms. Ferguson, on behalf of the Attorney General, Dr. Selhi testified that Mr. Metatawabin’s anticipated placement at the TRHP housing complex would not be impacted by Mr. Metatawabin’s ORB Disposition.
Dr. Selhi noted that Mr. Metatawabin has accessed additional substance use counselling interventions to assist with his ability to maintain his abstinence from substances, including indigenous cultural activities, attending AA sessions, and completing the Dialectical Behaviour Therapy (“DBT”) group sessions for addictions in February 2025.
Mr. Metatawabin is expected to increase his independent activities as he becomes more comfortable with his expected community access and presence.
In response to questions posed by Ms. Holder, on behalf of Mr. Metatawabin, Dr. Selhi testified that Mr. Metatawabin was expected to move into TRHP housing by the end of the upcoming reporting period.
In response to questions posed by some panel members, Dr. Selhi testified that Mr. Metatawabin remained capable to consent to treatment, and has a positive view and is compliant with, his currently prescribed medication regimen.
As noted in last year’s Reasons for Disposition, reference was made of Mr. Metatawabin’s reported observation that he would likely reoffend if he stopped his medication. Dr. Selhi testified that Mr. Metatawabin stated this observation in the context that he valued his medication and his need to take same. Mr. Metatawabin is aware that if he stopped taking his medication, it would be very problematic.
The granting of a five-day pass was in anticipation of Mr. Metatawabin attending his mother’s wedding, expected to take place now in June 2026. Dr. Selhi added that Mr. Metatawabin will require a separate “approved person” (other than his mother) be put in place in advance in order for Mr. Metatawabin to be permitted to attend that ceremony.
No further evidence was presented at the hearing by the parties.
Final Submissions
- All counsel agreed that Mr. Metatawabin continues to represent a significant threat to the safety of the public, and that the necessary and appropriate Disposition ought to be a Detention Order with the same conditions and privileges as detailed in last year’s Order.
Analysis and Finding of Necessary and Appropriate Disposition
Based on the Hospital Report, the VIS, and the evidence of Dr. Selhi, the panel found that Mr. Metatawabin represents a significant threat to the safety of the public. While Mr. Metatawabin has made significant progress, and is currently not exhibiting symptoms of psychosis, his ability to abstain from substances at the current time outside of a maximum secure facility has not yet been tested. Mr. Metatawabin himself had at one point shared these concerns. The evidence is clear that the combination of Mr. Metatawabin’s major mental disorder and substance use results in an increased propensity for violence. The index offences were very serious. The panel noted that while Mr. Metatawabin has undergoing substance abuse treatment at the Hospital, as well as participating in other programs and activities to address his addictions, he has not yet been exposed to an environment where substances are likely to be available.
The Board agrees with Dr. Selhi’s professional opinion that Mr. Metatawabin remains a significant risk to the safety of the public given that he has not been tested while living outside his very structured setting in hospital, coupled with his mental health condition (currently stable with medication treatment) and outstanding substance abuse disorder issues. These factors mandate that a very cautious approach be taken in granting Mr. Metatawabin privileges towards more extensive community access.
The panel agreed with the clinical team’s opinion that Mr. Metatawabin is stable from a mental health perspective, is responding well to treatment for substance cravings, has been working hard to develop internal controls with respect to substances, is motivated to continue his recovery, and has consistently engaged well with the treatment team and the team’s recommended treatment programs.
The Board has concluded that the necessary and appropriate Disposition which is also the least onerous and least restrictive to Mr. Metatawabin is a continuation of a Detention Order, with the same conditions and privileges as noted in last year’s Disposition, as well as now being set out in the Board’s current formal Disposition Order.
The Board also concludes that a Conditional Discharge Disposition would be inappropriate given the requirement to return Mr. Metatawabin to hospital quickly if he became unwell and the inadequacy of the MHA alone to manage his risk as its provisions for involuntary admission would be insufficient to readmit him in a timely way, as well as the ability of the Hospital to approve Mr. Metatawabin’s housing.
He is also encouraged to continue to be open with staff about his thoughts and urges to use substances. He is also commended for his on-going medication compliance and the improvements in insight that he has demonstrated. The Board wishes Mr. Metatawabin every success concerning his recovery in the upcoming year, with the hopeful expectation of his successful transition to community living at the Kingston TRHP facility, if available, within the next reporting period.
In making this Disposition, the Board carefully considered the joint position of the parties, the evidence of Dr. Selhi and the contents of the Hospital Report and VIS entered as exhibits at the hearing and is satisfied that this determination is both necessary and appropriate. The Board reviewed the provisions of sections 672.54 and 672.5401 of the Criminal Code and carefully considered the need to protect the public from dangerous persons (with the public’s safety being the Board’s paramount consideration), Mr. Metatawabin’s mental condition and his reintegration into society and other needs.
DATED this 19th day of August 2025, at the City of Toronto, in the Toronto Region.
Mr. J. Hanbidge
Alternate Chairperson
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Office of the Registrar
Ontario Review Board