Re Troy M. Simpson, 2025 CanLII 84085

Re: Troy M. Simpson

ORB File No: 5094

Hearing held on: Thursday, July 17, 2025

Place of hearing: Waypoint Centre for Mental Health Care

Pursuant to: Section 672.81(1) of the Criminal Code

Before: Alternate Chairperson: Ms. C. Finley Members: Dr. J.C. Ferencz Dr. B. Bordoff Ms. A. La Viola Mr. A. Bouvier

Parties Appearing: Accused: Troy M. Simpson Counsel: Mr. A. Rastgou The person in charge of hospital: Representative: Ms. T. Newman Attorney General of Ontario: Counsel: Ms. J. Armenise

REASONS FOR DISPOSITION

(Dated August 21, 2025)

Introduction

1On June 5, 2008, Troy Simpson was found not criminally responsible on account of mental disorder (“NCR”) on a charge of assault, contrary to the Criminal Code of Canada. He is currently subject to a disposition of the Ontario Review Board (“ORB”/the “Board”), dated July 23, 2024, detaining him at the Waypoint Centre for Mental Health Care - High Secure Provincial Forensic Programs (“Waypoint”/the “hospital”) with hospital grounds privileges, beyond the secure perimeter, escorted by staff.

2On May 29, 2025, the hospital sent a letter to Dr. Coleman at the Ontario Shores Centre for Mental Health Sciences (“Ontario Shores”) providing notice pursuant to Rule 13 that the hospital would be recommending a transfer of Mr. Simpson’s care to Ontario Shores.

3On July 17, 2025, the Board convened a hearing pursuant to s. 672.81(1) of the Criminal Code. Mr. Simpson was present and represented by his counsel, Mr. Rastgou.

4At the outset of the proceedings, all counsel were canvassed as to their positions on the issues to be determined by the Board: whether Mr. Simpson continues to represent a significant threat to the safety of the public and if so, the necessary and appropriate disposition having regard to the criteria set out in s. 672.54 of the Criminal Code, including which forensic facility.

5Ms. Newman, on behalf of the hospital, submitted that Mr. Simpson remains a significant threat to the safety of the public and that a detention order is the necessary and appropriate disposition. In her submission, Mr. Simpson no longer requires the support and structure of the High Secure Provincial Forensic Program at Waypoint, and his risk could be managed at a less secure facility. In her submission, Ontario Shores is the appropriate facility to manage Mr. Simpson’s care with privileges up to and including the ability to enter the catchment area of Ontario Shores accompanied by staff or an approved person. Ms. Armenise and Mr. Rastgou ultimately concurred in the hospital’s positions. Thus, a joint position was put before the Board.

Findings

6For the reasons that follow, the Board finds that Mr. Simpson continues to represent a significant threat to the safety of the public and the necessary and appropriate disposition is a detention order. Further, the Board finds that Mr. Simpson no longer requires the high secure facility and that a transfer to Ontario Shores is necessary and appropriate and represents the least restrictive and least intrusive disposition while managing his risk to the public.

The Evidence

7The evidence at the hearing consisted of the Hospital Report, dated June 26, 2025 (ex. 1), The Rule 13 response from Ontario Shores, dated July 16, 2025 (ex. 2), and the viva voce evidence of Dr. Bouskill, Mr. Simpson’s treating psychiatrist.

The Index Offence

8The circumstances of the index offence have been taken from the previous Reasons for Disposition:

“In summary, from the Hospital Report: On March 3, 2008, while at Waypoint's Regional Forensic Services Program on a 30-day NCR assessment order, Mr. Simpson was participating in a weekly addictions counselling group session conducted by social worker, 'Ms. M.' He was sitting in a chair next to Ms. M. and seemed calm and relaxed. In the introductions at the start of the session, Mr. Simpson said his week had been good, and Ms. M. asked him what "good" meant for him. He then, 'like flash', stood up, hit her with open hands on both sides of her face, and pushed her, causing her chair to fall backwards, and her head to hit the floor. She did not lose consciousness and was taken to hospital to be assessed for injuries. Mr. Simpson was placed in a seclusion room and police were called.”

Background Information

9The Hospital Report contains information as to Mr. Simpson’s personal background and psychiatric history and need not be reviewed here beyond the following material facts. Mr. Simpson is a 38-year-old man who was born in Quebec and moved to Ontario with his mother and two sisters. He was placed in foster care at the age of 12 after a serious incident with his mother that resulted in both being charged with assault. He resided in a number of foster homes before being sent to a Young Offender facility after throwing a chair and punching a wall in school.

10Mr. Simpson demonstrated significant behavioural issues before the age of 15, including assaults, substance abuse, thefts, fire setting and various rule violations. An assessment conducted through the Kawartha Family Court Assessment Service concluded that Mr. Simpson was functioning in the mild range of mental retardation and functionally illiterate with an overall IQ of 58. A subsequent assessment confirmed these findings and found that Mr. Simpson was functioning intellectually in the extremely low range. He committed numerous assaults when in school against his peers and, on one occasion, against an education worker.

11Mr. Simpson has a significant criminal record that is included in the Hospital Report at p. 3-4. Between 2002 and 2008 he incurred multiple convictions for violence and failing to comply with court orders. At some point, it was felt that Mr. Simpson’s difficulties were related to being in group homes with other youth and he would be better off living alone. He was supported by the Community Living Association South Simcoe (CLASS) who assisted him in finding accommodation in the community when he was not in custody. CLASS did not believe that Mr. Simpson could be placed in another group home given his violent behaviour and his risk to vulnerable people.

12Mr. Simpson became involved with drugs, was accused of serious fights, and destroyed his apartment. He was evicted from his apartment in September of 2006. CLASS referred Mr. Simpson to the Mental Health Centre Bayview Dual Diagnosis Program for outreach support and a psychiatric consultation. In July of 2007, Mr. Simpson was placed at the Cumberland group home with extensive support and individual anger management counseling. He continued to be followed by the Bayview Dual Diagnosis Community Team.

13Mr. Simpson stated that he drank 15 beers daily or “unlimited Bacardi if he could get it”. Mr. Simpson stated that he began smoking marijuana at age 12, and smoking crack cocaine at age 19, daily.

14Mr. Simpson had several admissions to the Royal Victoria Hospital in Barrie in 2006. On one occasion, he was admitted pursuant to a Form 1 under the Mental Health Act. His neighbour had reported to police that Mr. Simpson was acting strangely, tearing apart his behaviour and becoming agitated about some of his neighbours. In November 2006, he was admitted to the Regional Forensic Services Program at Waypoint on a court-ordered assessment. His diagnoses on discharge were “Mild Mental Retardation, Mixed Personality Disorder, Borderline and Explosive Features, Polysubstance Abuse”. He was referred back to the Bayview Dual Diagnosis Program.

15Following his initial disposition under the Board, Mr. Simpson was detained at Ontario Shores where he remained until 2017. With treatment with clozapine he developed insight and his behaviour slowly stabilized. He was discharged into the community, adhered to his medication, abstained from substance use, reconnected with his mother, and was in a stable relationship. In 2019 his disposition under the ORB was a discharge with conditions.

16Unfortunately, a series of events led to a deterioration in Mr. Simpson’s mental status. He broke up with his girlfriend, his mother died, and he relapsed into cannabis and alcohol use. Further, he became noncompliant with his medication. He was readmitted to Ontario Shores in 2021 after assaulting a co-resident at his group home and absconding from the residence. During this readmission, Mr. Simpson continued to be physically aggressive towards co-patients and staff. The hospital experienced challenges trying to manage his behaviour. His attending psychiatrist at the time felt that his behaviour mainly resulted from his cluster B personality traits.

17Following his annual review in March 2023, Mr. Simpson was ordered detained at St. Joseph’s Healthcare Hamilton. While awaiting that transfer, he continued to be aggressive. As a result, Ontario Shores requested an early hearing which resulted in Mr. Simpson being subject to a disposition detaining him at the High Secure Provincial Forensic Program at Waypoint.

18Mr. Simpson was admitted to Waypoint on October 19, 2023. Initially, Mr. Simpson was noncompliant with medication and aggressive, and required seclusion. He was noted to have difficulty adhering to social norms, including inappropriate sexual comments and behaviour, and would react impulsively to perceived provocation. Early staff intervention was required to avoid escalation of his behaviour and seclusion was required on occasion. On the positive side, Mr. Simpson was compliant with the administration of clozapine and valproic acid. He was able to progress through the privilege ladder, achieving the highest level of security, that allowed for up to 4 hours off unit access, and in April 2024, became the unit ward worker, before he became subject to a seclusion order.

Course Since the Last Disposition

19Mr. Simpson’s current diagnoses are:

• Schizophrenia
• Intellectual Developmental Disorder, Mild
• Unspecified Personality Disorder (Cluster B, anti-social and borderline traits)

20Over the past year, Mr. Simpson has remained compliant with his medication. In June 2024, he was transferred to the Beausoleil Program, which is the least structured unit within the High Secure Program. There have been no observation or reports from Mr. Simpson of the presence of any positive psychotic symptoms. His mental state has remained stable, and, unlike previous years, he has not displayed aggressive or explosive behaviour.

21Mr. Simpson’s insight into his mental health is good and he has an appreciation of the risk he presents to others should he become acutely unwell. However, his insight into substance misuse, and how that leads to a deterioration in his mental state and associated risk, remains undeveloped.

22Mr. Simpson continues to have difficulty with social norms and interpersonal interactions. He seeks significant reassurances from staff and has been able to walk away from situations that he has found difficult. He required a brief period of seclusion in November 2024. He swore at staff, became irritable and punched his fist into his palm. On another occasion he was subject to a seclusion order following an altercation with a co-patient. A review of the incident found that Mr. Simpson had not been the aggressor and had only pushed the aggressor in self-defense.

23Mr. Simpson has engaged in weekly counselling with an addiction counsellor, focusing on impulse control and effective problem-solving skills. He receives Passport Funding from Developmental Services Ontario which he uses to purchases games.

24Mr. Simpson also receives significant support from his cousin and his aunt. They are supportive of his treatment and commitment to abstaining from substances. Mr. Simpson has stated an intention to reside with his cousin once he is discharged into the community.

25In the Hospital Report, Dr. Bouskill indicates that Mr. Simpson remains a significant threat to the safety of the public should he no longer be subject to a disposition of the ORB in the following paragraph found at p. 94:

“The most likely risk scenario would include Mr. Simpson stopping his antipsychotic medication or returning to substance use. Both behaviours have historically resulted in decompensation and a resurgence in psychotic symptoms, which for Mr. Simpson include a worsening of executive function, emotional dysregulation, and impulse control difficulties as well as paranoia, hypervigilance, and perceptual disturbances such as command auditory hallucinations. He is likely to misinterpret environmental and social cues, and to become agitated and impulsive. In this state, he is likely to act on his delusions and in response to emotional distress with verbal and physical violence, as he has in the past.”

26Dr. Coleman, from Ontario Shores, responded to the Rule 13 request (ex. 2). She referenced Mr. Simpson’s previous behaviour while at Ontario Shores and noted in particular, that his behaviour was not related to psychosis or substance use but rather his personality issues. His acting, at times, had been as a result of frustration with being detained at Ontario Shores. In Dr. Coleman’s opinion, Mr. Simpson’s “risk of harm to others is only expected to increase on a transfer to conditions of lesser security given the increased opportunity to access substances, and a history of antisocial connections.” Dr. Coleman further reports that “there continue to be patients and staff at Ontario Shores that have experienced trauma as a result of Mr. Simpson’s violent behaviour”. She respectfully opposes a transfer to Ontario Shores at this time and feels that a longer period of stability without seclusion is required.

27Dr. Bouskill testified before the Board. She testified that Mr. Simpson is now accepting clozapine in tablet form. His serum levels have remained at a therapeutic range, confirming compliance. Dr. Bouskill reported that Mr. Simpson’s insight into the importance of medication is fairly good as he is able to appreciate that previous non-compliance with medication when in the community led to a deterioration in his mental status. He endorses the need for long-term compliance.

28Dr. Bouskill reported that Mr. Simpson continues to participate in one-on-one therapy with an addiction counsellor. The doctor noted that he tends to focus on “higher-level”, more abstract motivations such as his desire to progress through the ORB system, gain more independence and reside in the community. He is mindful of “what is on the line”. However, he otherwise has not developed more specific coping mechanisms.

29Dr. Bouskill testified that, over time, Mr. Simpson has demonstrated some improvement in his ability to control his impulsive behaviour and limit an escalation in his response in some conflicts. Lately he has walked away and/or sought out staff for support. He has remained on Beausoleil throughout the last year and has achieved the highest level of autonomy within the High Secure Program. Mr. Simpson is in discussions with an Occupational Therapist about how his Passport Funding could be used for vocational services. He has participated in a kitchen orientation and a Circles Program, focusing on healthy relationships.

30In response to some of the concerns raised by Dr. Coleman, Dr. Bouskill indicated that Mr. Simpson’s only seclusion was in November 2024 and that since his move to Beausoleil in October, he has been able to exercise better behavioural control and limit the escalation in terms of interpersonal conflict. Compliance with medication has led to a decrease in his agitation and paranoia. With respect to Dr. Coleman’s concerns with respect to an increased risk to accessing substances, Dr. Bouskill indicated that that concern is not unique to Mr. Simpson. Access to substances will always have to be carefully monitored in cases where someone with a history of problematic substance use transfers to a less secure facility.

31Dr. Bouskill testified that Mr. Simpson requested a transfer to Ontario Shores because it is familiar, and he believes that it is a good place, and he has faith that it would provide him with good care. He acknowledged the difficult relationship he had with some of the members of his treatment team in the past, but that he had got along with most staff. He no longer believes that will be the case as he is older, calmer and is cognizant that this is the next step in his road to independence. He has done well at Waypoint and is proud of his ability to avoid conflict. Further, Mr. Simpson indicated that there was one staff member at Ontario Shores that he would specifically like to be able to apologize to for his previous behaviour.

32Dr. Bouskill indicated that the waiting list for a transfer to Ontario Shores is long, likely a matter of months if not a year. Mr. Simpson has been engaged in many of the risk-mitigating strategies that the treatment team has recommended, particularly in the past few months. These have included working with an addiction counsellor, vocational services support and working with an occupational therapist. The delay in any transfer would provide an opportunity for Mr. Simpson to continue to demonstrate stability and continued engagement with those supports.

33In response to questions from Ms. Armenise, Dr. Bouskill testified that she has had many discussions with Mr. Simpson about Ontario Shores and the behaviours that he exhibited when he was a patient there. Knowing the environment, the staff and some of the patients at Ontario Shores provides some comfort for Mr. Simpson. Also, his aunt and cousin are positive influences and reinforce the need for Mr. Simpson to maintain good relationships with people. They are also adamantly opposed to him using substances in any way. Finally, Mr. Simpson’s irritability and more severe violent behaviour was driven primarily by his psychotic symptoms. At present those symptoms have been well managed.

34All parties maintained the joint submission.

Analysis and Conclusion

35The Board has carefully considered the Hospital Report, the letter from Dr. Coleman and the evidence of Dr. Bouskill and unanimously finds that Mr. Simpson remains a significant threat to the safety of the public. Mr. Simpson suffers from schizophrenia. He has a long history of violence, impulsive behaviour, and problematic substance use. When noncompliant with medication, he experiences increased irritability and paranoia, delusions, and auditory hallucinations. The Board accepts Dr. Bouskill’s expert opinion that, without the supervision of the Board, Mr. Simpson would cease taking his antipsychotic medication, return to substance use and would present similar to when he committed the index offence and when he was readmitted to hospital from the community in 2021. He would misinterpret other’s actions and respond with violence.

36Having found that Mr. Simpson remains a significant threat to the safety of the public, the Board must consider the necessary and appropriate disposition taking into consideration the criteria set out in s. 672.54 of the Criminal Code, which includes the need to protect the public from dangerous persons, the mental condition of the accused, the integration of the accused into society and the other needs of the accused.

37The Board unanimously finds that the necessary and appropriate disposition is a detention order at Ontario Shores. A detention order is required as Mr. Simpson is not ready to be discharged into the community. He has made considerable progress over the current year in review. He has been transferred to the Beausoleil program, the least secure unit with the High-Risk Program. He has enjoyed the maximum level of privileges while on that unit and regularly exercises those off-unit passes. He has been compliant with medication and has engaged with an addiction counsellor and an occupational therapist. In short, Mr. Simpson has begun to address his risk factors in a meaningful way.

38Mr. Simpson is fortunate in that he has supportive family members who encourage him to maintain good relationships with his treatment team and co-patients and discourage him from returning to substance use. These supports will continue when he is transferred to Ontario Shores.

39The Board recognizes and appreciates Dr. Coleman’s concerns. At the latter part of his admission at Ontario Shores, Mr. Simpson was violent, aggressive, and extremely difficult for his treatment team to manage. He has not exhibited this behaviour over the last year while at Waypoint. The Board accepts that Mr. Simpson recognizes his problematic behaviour at that time and is committed to having a more positive relationship with his treatment team. Mr. Simpson’s commitment to taking steps to address his risk factors is relatively recent. He will have an opportunity to continue to demonstrate that commitment pending his transfer to Ontario Shores.

40In conclusion, the Board finds that the necessary and appropriate disposition is a detention order at Ontario Shores with the terms and conditions as recommended by the hospital and agreed to by the parties.