Ontario Review Board
Re: Giuliano Varlese
ORB File No: 8251
Hearing held on: Tuesday, June 24, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Section 672.81(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: Giuliano Varlese Counsel: Ms. S. Feldman
The person in charge of hospital: Representative: Dr. R. McMaster
Attorney General of Ontario: Counsel: Mr. J. Canton
REASONS FOR DISPOSITION
(Dated August 19, 2025)
Introduction
On March 7, 2023, Giuliano Varlese was found not criminally responsible on account of mental disorder (NCR) on charges of Assault Causing Bodily Harm, Forcible Entry, and Mischief, all contrary to the Criminal Code of Canada.
Mr. Varlese is currently subject to a disposition of the Ontario Review Board (the “Board”) dated July 29, 2024, that orders his detention at the Forensic Service of the Centre for Addiction and Mental Health (“CAMH” or “the hospital”) and grants him privileges, the most liberal of which allows him to live in the community in accommodation approved by the Person in Charge.
On June 24, 2025, the Board convened at CAMH for a hearing to make a Disposition further to s. 672.81(1) of the Criminal Code. Mr. Varlese was present at the hearing along with his counsel, Ms. Feldman. Mr. Varlese’s parents attended the hearing as observers in support of Mr. Varlese.
The issues to be determined at the hearing are whether Mr. Varlese 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.
For the reasons set out below and based on the expert evidence and opinions before it, the Board concluded that Mr. Varlese continues to represent a significant threat to the safety of the public. The necessary and appropriate Disposition is a continuation of the existing Detention Order Disposition, with the inclusion of the ability to travel internationally with an Approved Person with an itinerary approved in advance by the Person in Charge.
A Hospital Report dated June 10, 2025 (the “Hospital Report”) was entered as Exhibit 1.
Background
The Hospital Report contains very detailed information regarding Mr. Varlese which need not be repeated.
Briefly, Mr. Varlese was born in Toronto, Ontario. He is 24 years of age, unmarried, and has no children. He lived with his parents up to the time of his arrest with the exception of a short time in University residence after graduating from a private high school. He is unemployed with minimal employment history, and he is financially supported by his parents.
Mr. Varlese started drinking alcohol and using cannabis when he was 12 years old. By the time he began University, he reported that he was drinking six to seven beers per night four to five times per week. He stated that he sometimes experienced paranoia and visual and auditory misperceptions when using cannabis. He reported drinking alcohol and using cannabis at the time of the index offences.
Mr. Varlese had no criminal record prior to the index offences. Mr. Varlese had been treated for mental health issues since approximately 2017 and had been doing well from March until September 2020, at which time he stopped taking his medications. Mr. Varlese was involuntarily admitted to hospital several times during 2021 and early 2022 for paranoid and bizarre or violent behaviour, including violence against his parents.
Following the index offences, Mr. Varlese was incarcerated from September to December 2022, then was released on conditions into an inpatient rehabilitation facility for a 90-day program. Following completion of the program, he moved directly into a private 24-hour supervised sober living facility. Both Mr. Varlese and his parents wished for him eventually to move into the family home from the treatment facility.
In October 2024 Mr. Varlese was evicted from the sober living facility due to a positive urine drug screen for cannabis. He got into a motor vehicle collision and fled the scene. He was charged with impaired operation careless driving, and failure to remain, for which he received a conditional sentence with 12 months’ probation. His license was revoked. After residing for a week at his parents’ residence, he returned to an inpatient rehabilitation program. After a few weeks in the program, he returned to his parents’ residence for two months, then moved to TRHP2 24-hour high support housing.
His current diagnoses are Schizophrenia, Cannabis Use Disorder Severe (early remission), and Alcohol Use Disorder Moderate (early remission). Mr. Varlese has been presumed capable of consenting to treatment and capable of managing his financial affairs.
Evidence at the Hearing
- Dr. McMaster testified on behalf of the hospital and adopted the contents of the Hospital Report. Dr. McMaster testified as follows:
During the reporting year Mr. Varlese transitioned into TRHP2 housing, and Dr. McMaster described this as a good transition.
The treatment team’s focus is on Mr. Varlese’s activities of daily living, but the goal is to progress toward more educational activities.
A main goal is also to work on the salient risk factors including substance use.
In response to questions from counsel for the Attorney General, Dr. McMaster stated that with reference to page 43 of the Hospital Report, the PCL-R test is standard and an evidence-based assessment of psychopathy. It was used for Mr. Varlese’s assessment.
In response to questions from counsel for Mr. Varlese, Dr. McMaster testified:
When Mr. Varlese relapsed to substance use, he immediately contacted the treatment team and expressed remorse.
Mr. Varlese is internally motivated with respect to substance use programming and attends weekly AA meetings.
Mr. Varlese transitioned to TRHP2 housing in January of 2025. This is transitional housing with 24-hour, seven-day-a-week supervision.
For the next reporting year, Mr. Varlese is expected to work on his independent living skills, including preparing meals, shopping, etc. He continues to require high support to do so.
Mr. Varlese is working well with the treatment team.
There was a change to Mr. Varlese’s ADHD medication in March. The treatment team will consider changes in medication for Mr. Varlese after the hearing, but they did not want to make changes abruptly when there were potential stressors such as the upcoming ORB hearing.
With respect to use of Seroquel, Mr. Varlese reports insomnia and increased energy. The treatment team may refer him for a sleep study.
Mr. Varlese says he has difficulty following through with tasks, medication and appointments due to his ADHD.
Both pharmaceutical and non-pharmaceutical approaches will assist Mr. Varlese.
Programming can be accommodated in light of his ADHD, for example, meeting with a FORCAT worker for a walking session rather than sitting. When Mr. Varlese applies to school, they will look into accommodations for him and support him in that regard.
He is currently completing a FORCAT program that has stated he has an interest in beginning psychotherapy. Psychotherapy programming is available for him.
If Mr. Varlese has a good year, discharge planning could begin within six to 12 months.
TRHP2 is an 18-month program. The length of the program varies depending on how well people are doing. At this point, it appears that Mr. Varlese would be discharged back to the family home. Mr. Varlese has used weekend passes to visit his family and home visits have gone well.
Mr. Varlese’s father has recently become an Approved Person.
As there have been no issues with respect to the weekend passes for visiting his family, the hospital is comfortable recommending travel passes with Approved Persons for the upcoming year.
Mr. Varlese requires significant support with respect to his finances, and he is currently working with his case worker for this.
Success in the upcoming year would include ongoing recovery in terms of his mental health, including adherence to medication and abstinence from substances. The hospital wishes to ensure that Mr. Varlese is able to engage in more programming as well as to see an increase in his independent living skills. Mr. Varlese would need to work well with the treatment team and achieve goals that he has set for himself. He has indicated an interest in returning to school which will be a focus, or efforts toward vocational activities.
Mr. Varlese continues to require reminders to take medication for his ADHD, but there has never been an issue with respect to his monthly antipsychotic injection, no issue with missed appointments, and to his credit, he has good insight into the need for his long-acting injectable medication.
- In response to questions from the panel, Dr. McMaster testified that:
The risk assessment was completed prior to this year’s criminal charge. The HCR-20 assessment, however, was updated in June, which post-dated Mr. Varlese’s Highway Traffic Act conviction.
The Hospital Report notes at page 47 that Mr. Varlese’s cannabis and alcohol use disorder is in sustained remission, however, it is more correctly in early remission.
Mr. Varlese’s use of cannabis led to his eviction from the Sober Living facility and also to the index offence charges. Mr. Varlese has impaired insight into the impact of cannabis on his mental health symptoms. In Dr. McMaster’s opinion it was somewhat of a wake-up call for Mr. Varlese that even small amounts of cannabis can lead to significant negative outcomes, and the criminal charge was helpful for his insight.
The hospital supports Mr. Varlese returning to live with his family because they provide prosocial support for him. If Mr. Varlese returns to school, this will be stressful for him. Living with his parents could be a continuation toward living more independently.
A full evaluation has not yet been done in terms of next steps for living, but it appears as though Mr. Varlese will need some forms of support.
There are potential downsides to Mr. Varlese’s parental support, in that it may be preventing Mr. Varlese from becoming more independent. In addition, Mr. Varlese’s father was the victim of an index offence.
The treatment team will continue to discuss with his parents the need for Mr. Varlese to become more independent.
At the TRHP housing, the treatment team will continue to assess if Mr. Varlese is able to live independently and if there is appropriate housing, then they will look to that as well instead of him returning to his parents’ home after discharge. It is still early days.
In terms of use of his travel passes, Mr. Varlese has only travelled within Ontario this year. There is a plan for Mr. Varlese to attend his brother’s wedding this summer on the east coast with his family and there is a possibility that he may travel to Chicago or Italy with his family, which would necessitate the permission to travel internationally. Appropriateness of travel would be evaluated with respect to his mental health as well as an approved itinerary.
The long-acting injectable medication is very protective in terms of major mental illness, and support of his family has been important for Mr. Varlese.
Mr. Varlese has demonstrated consistent stability in terms of no positive symptoms of his illness for quite a while. If there were any indication of change, the treatment team would not approve travel.
Mr. Varlese has expressed insight into his mental illness, and this has been sustained in conversations with the treatment team and the doctor.
The treatment team was not aware that Mr. Varlese was using cannabis prior to the incident which led to him being evicted from the Sober Living facility. There is now a flag for the treatment team, and they are reviewing urine drug screens.
- No further evidence was called, and the parties confirmed their positions that the joint submission was still in place.
Analysis and Conclusions
Having heard and considered the entirety of the evidence, as well as the submissions from the parties, the Board finds that Mr. Varlese remains a significant threat to the safety of the public.
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. McMaster, in addition to the documentary evidence before us.
In particular, the Board relies on the Re-offence Scenario and the Composite Assessment of Risk, set out in the Hospital Report:
Re-offence Scenario
“In risk assessment, one of the best predictors is a patient’s history. Mr. Varlese’s index offences were violent and occurred in the context of psychotic symptoms and substance use. When unwell, he resisted psychiatric assessment and hospitalization, and presented with poor insight into his illness, the risks of substance use, and his likelihood of violence.
If Mr. Varlese were to re-offend, it would likely be in the context of suboptimal supervision, medication non-compliance and/or cannabis use. If Mr. Varlese were to resume the use of cannabis or discontinue his medications, he would become increasingly unwell, with persecutory delusions, agitation, and impulsivity, and would be at heightened risk of acting out violently towards others, as was the case during the index offences.”
Composite Assessment of Risk
“It is the clinical team’s opinion that Mr. Varlese continues to represent a significant risk to the safety of the public. Mr. Varlese has a history of repeated serious violence and aggression in the context of medication non-compliance and substance use. In the absence of the external controls of the ORB, he has historically demonstrated a pattern of repeated disengagement from treatment and escalation in destabilizing substance use.
When weighing the pertinent risk and protective factors, Mr. Varlese’s risk of violent reoffending was deemed to be Moderate in the context of a Conditional Discharge and Moderate-High should he be granted an Absolute Discharge at this time. The risk of serious physical harm would e moderate-high, while the risk of psychological harm would be high. Importantly, absent a detention order disposition, there would be limited tools available to intervene should Mr. Varlese return to substance use, a factor known to be destabilizing even in the context of medication adherence.
In contrast, should Mr. Varlese remain subject to a Detention Order with the provision for community living, his risk of future violence was deemed Low.”
Mr. Varlese is in the early stages of remission, he has had variable success in less structured and less supportive environments, and the risk of relapse remains real in light of the relapse that led to his eviction from the Sober Living facility and a criminal conviction.
Having determined the issue of significant threat, the Board finds that the necessary and appropriate Disposition remains a Detention Order with the addition of the privilege of international travel as noted in the formal Disposition. The Board finds that the evidence before it supports the conclusion that Mr. Varlese continues to require close supervision and that the Board requires the authority to approve accommodation and to return Mr. Varlese to hospital promptly should he show signs of relapse. For this reason, a Conditional Discharge would not be appropriate.
The addition of more liberal travel passes in Mr. Varlese’s Disposition will allow him to travel with his family if the hospital determines that he is mentally well enough to do so. The increase in passes will enable Mr. Varlese to enhance his relationship with his family, which is one of Mr. Varlese’s most important protective factors. Mr. Varlese’s long-acting injectable medication also provides a protective factor for his stability in case of travel.
In consideration of all the evidence, submission of the parties, and the criteria set forth in s. 672.54, the paramount consideration being the safety of the public, Mr. Varlese’s community reintegration, his mental condition, and his other needs, the current Disposition should be continued with the addition of travel passes as noted in the formal Disposition.
The Board commends Mr. Varlese for his progress this year and notes that staff observe that he is friendly towards his care team and co-residents. He is cooperative although his challenges with organization limit his capacity to engage with his care team. He demonstrates a willingness to take directions from staff, and his family support will continue to be important over the upcoming year while he increases his skills in order to become more independent.
DATED this 19th day of August, 2025, at the City of Toronto, in the Region of Toronto.
Ms. M. den Haan Legal Member
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Office of the Registrar Ontario Review Board