Ontario Review Board
Re: Michael B. Alexander
ORB File No: 7691
Hearing held on: Thursday, August 21, 2025
Place of hearing: Waypoint Centre for Mental Health Care
Pursuant to: Sections 672.81(1) and 672.81(2.1) of the Criminal Code
Before:
Alternate Chairperson: Mr. J. Weinstein
Members: Dr. S. Simpson
Dr. J. Cheston
Ms. K. Tomaszewski
Ms. D. Smith
Parties Appearing:
Accused: Michael B. Alexander
Counsel: Mr. M. Eaton-Kent
The person in charge of hospital: Counsel: Ms. J. Lefebvre
Attorney General of Ontario: Counsel: Ms. J. Armenise
REASONS FOR DECISION AND DISPOSITION
(Dated September 4, 2025)
Introduction
On January 31, 2020, Mr. Michael B. Alexander was found not criminally responsible on account of mental disorder, on charges of robbery and uttering threats to cause death or bodily harm, both contrary to the Criminal Code of Canada (“Criminal Code”).
Mr. Alexander is subject to the terms and conditions of a Decision and Disposition of the Ontario Review Board (the “Board”), dated February 14, 2024. Pursuant to this Disposition, he is detained at the Waypoint Centre for Mental Health Care, Provincial Forensic Programs Division, Penetanguishene (“Waypoint” or the “Hospital”).
On August 21, 2025, a panel of the Ontario Review Board (the "ORB" or the "Board") convened a hearing pursuant to ss. 672.81(1) and 672.81(2.1) of the Criminal Code of Canada. Prior to the hearing, the parties had agreed that the hearing agenda would consist of an annual hearing under s.672.81(1), and four Restriction of Liberty (“ROL”) hearings under s.672.81(2.1) to address seclusions from: January 4-14, 2025 (“ROL #1”); February 13-March 6, 2025 (“ROL #2”); April 29-May 6, 2025 (“ROL #3”); and May 29-June 6, 2025 (“ROL #4”). The parties had also agreed that additional hearings would be scheduled for a future hearing date for restrictions of liberty which occurred in July 2025.
Mr. Alexander was in attendance and was represented by his counsel, Mr. Eaton-Kent. Three hearing timeslots were reserved for the hearing. Mr. Alexander was provided with a lunch break, several comfort breaks, and opportunities to consult with his counsel, as requested by Mr. Alexander throughout the day.
By agreement of the parties, the first portion of the hearing day focused on the annual hearing, and the remaining portion of the hearing day focused on the four ROLs. The evidence for the four ROLs was heard together.
The Board had before it the Record, and three exhibits: ROL Report dated February 21, 2025 (Exhibit 1); Hospital Report dated February 6, 2025 (Exhibit 2); and a Hospital Report dated August 5, 2025 (Exhibit 3). Exhibit 3 contained the contents of Exhibit 2 and will be referred to in these Reasons as the “Hospital Report”.
The Board also had before it the oral evidence of Dr. Bouskill, who testified on behalf of the Hospital, and the oral evidence of Mr. Alexander. Mr. Alexander and Dr. Bouskill gave separate testimonies with respect to both the annual hearing, and the ROLs.
Without Prejudice Position of the Parties
The Hospital’s position, as submitted by Ms. Lefebvre, is that Mr. Alexander continues to present a significant threat to the safety of the public, and that the necessary and appropriate disposition is a detention order, with no changes requested to his current Disposition. The Hospital took the position that the four ROLs noted above were each warranted and remained the least onerous and least restrictive decisions until each ROL ended.
Counsel for the Attorney-General joined with the Hospital positions described above.
Mr. Eaton-Kent, on behalf of Mr. Alexander, for the purpose of the annual hearing did not dispute that Mr. Alexander continues to present a significant threat to the safety of the public. However, he submitted that a conditional discharge is the necessary and appropriate disposition in the circumstances. Mr. Eaton-Kent then advanced the position that none of the four ROLs under review were warranted or the least restrictive decisions available to the Hospital at their inception and while they were ongoing.
The parties agreed that the Hospital seclusion protocol applicable to all four ROLs is accurately described as follows:
At Waypoint, seclusion orders are reviewed daily. To ensure objectivity, secluded patients are seen by an independent psychiatrist (not the patient’s most responsible physician) for review and assessment at the 72-hour post-seclusion mark, seven days post-seclusion, and every 28 days thereafter. All seclusion consultations opined that Mr. Alexander’s seclusions were necessary to mitigate his risk.
Mr. Eaton-Kent indicated that he wished to hear evidence that this protocol was followed with respect to each ROL.
The parties maintained their initial positions throughout the hearings.
Index Offences
- The circumstances of the index offences are taken from last year’s Reasons for Decision and Disposition as follows:
“...on June 24, 2019, Mr. Alexander entered a bank in Toronto and proceeded toward the victim’s office at the rear of the branch, yelling and screaming in an irrational manner and disturbing staff and customers. He was carrying a potato sack, and when told by the victim to leave the bank he told her he was going to cut off her head and place it inside the sack. He was located and arrested on July 8, 2019.
On September 23, 2019, Mr. Alexander approached an outdoor dining patio in downtown Toronto. He leaned over the fence surrounding the patio and took a female’s purse. The victim grabbed back at her purse and the accused grabbed her right forearm, causing a fourteen-centimeter bruise along her arm. A brief struggle took place and caused the victim’s wallet to drop out of her purse. Mr. Alexander picked up her purse and ran westbound but was soon stopped by the victim and the struggle resumed. A passing police officer was flagged down and arrested the accused.”
Background
The following description of Mr. Alexander’s background is taken from last year’s Reasons for Decision and Disposition. Mr. Alexander is now forty-four years of age. Both his parents are described as having suffered from bipolar spectrum disorder. His father abused alcohol and drugs and was emotionally abusive to Mr. Alexander during the first decade of his life.
Mr. Alexander was diagnosed with a learning disability in elementary school and required assistance throughout his education. He has been supported by the Ontario Disability Support Program for many years, being unable to keep a job for any length of time. He has a long history of polysubstance abuse with many emergency room and hospital visits over the years, particularly to the Centre for Addiction and Mental Health.
Mr. Alexander reported a history of providing sexual favours for drugs, money, food, shelter, or safety. Over the years he had been placed in supportive housing but was evicted on at least three occasions, due to cocaine use and aggression towards staff.
In 2019 he was convicted of mischief under $5,000 and utter threat to cause death for which he received a conditional discharge and probation. At the time of his 2019 arrest for the index offences Mr. Alexander was essentially homeless. In 2020 he was convicted of theft under $5,000 and failure to comply with a recognizance.
Current Diagnoses
Schizoaffective Disorder, Bipolar Type;
Alcohol Use Disorder, in sustained remission in a controlled environment;
Cocaine Use Disorder, in sustained remission in a controlled environment;
Antisocial Personality Disorder.
Evidence at the Hearing
Necessary and Appropriate Disposition
Testimony of Dr. Bouskill
Dr. Bouskill testified on behalf of the Hospital and adopted the contents of the Hospital Report and the ROL Report dated February 21, 2025. Dr. Bouskill has been Mr. Alexander’s most responsible physician since she took over the care of Mr. Alexander in December 2024.
Dr. Bouskill confirmed the diagnoses set out in the Hospital Report. She noted that Dr. Muraven had been concerned about the possibility of a diagnosis of sexual sadism. A consultation report by Dr. Coleman of Ontario Shores indicated that Mr. Alexander’s symptoms are not in keeping with sexual sadism but are in keeping with a psychotic illness and anti-social personality disorder.
The report period began in the winter of 2024 when Mr. Alexander was untreated for his psychotic illness. He experienced an increase in emotional dysregulation and irritability, which was directed towards staff members. On March 27, 2024, Mr. Alexander was charged, arrested, and placed in jail for uttering death threats to staff.
While in jail, he remained untreated, and he decompensated. The correctional facility’s psychiatrist completed a Form 1 under the Mental Health Act (“MHA”) due to increasing disorganization, paranoia, and physical risk to himself. Mr. Alexander had been ingesting bodily fluids and feces, and the psychiatrist was concerned about the medical risks of consuming bodily fluids and feces. Mr. Alexander was assessed and cleared medically and returned to the jail the next day.
When Mr. Alexander was readmitted to the Hospital (from the jail) in June 2024, he was floridly psychotic, engaging in physical environmental aggression, disrobing, sexually abusive to staff, and making racialized comments to female staff. He was smearing feces in his environment and covered himself in feces to the point that staff had medical concerns about the risk of an eye infection due to feces in the eyes.
Mr. Alexander eventually agreed to start treatment with 300 mg of Abilify in July 2024, but this was not sufficient to manage his symptoms. He was found to be incapable to consent to treatment with antipsychotic medications. The Consent and Capacity Board (the “CCB”) upheld this finding in November 2024.
Mr. Alexander’s dose of Abilify was increased to 400 mg. in October and November 2024. Mr. Alexander showed improvements. He was more willing to talk with the team, engage in seclusion relief, and attend programming. He rarely spoke of his delusions; made fewer explicit threats to staff; did not ingest or cover himself with feces and no longer exposed himself to staff.
Mr. Alexander became concerned about side effects, including weight gain, brain damage, sexual dysfunction, and wanted to reduce the dose of his medications. Mr. Alexander appealed the CCB decision in December 2024 and advocated with his substitute decision maker (“SDM”), who is a close friend, to reduce the dose of Abilify to 300 mg. The SDM gave consent only for the 300 mg dose of Abilify, and as a result, Dr. Bouskill reduced the dose to 300 mg. Mr. Alexander has remained on the 300 mg dose of Abilify since December 2024. Mr. Alexander abandoned the appeal of the CCB decision in February 2024.
Since December 2024, Mr. Alexander has exhibited a slow and steady decline. He has become more tangential, more irritable, more hostile to staff, less trustful of staff, has engaged in increasing racial and verbal violence toward staff, is more sexually preoccupied (wanting access to pornography), and has had greater difficulty sleeping.
Mr. Alexander has become more disinhibited, has disrobed, and has fixated on the identities of staff. He is unwilling to consider the possibility that his concerns, e.g., that staff have been engaged in criminal activities, are not based on evidence but are part of his fixed delusions.
In May 2025, Mr. Alexander reported swallowing a battery, in an attempt to end his life.
Since December 2024, Dr. Bouskill has observed a decrease in Mr. Alexander’s overall level of insight. She reported that he does not believe he has a psychotic illness, or need treatment, and has been unwilling to discuss optimizing treatment to 400 mg of Abilify. He and his SDM have refused to consider other alternatives, including adding a mood stabilizer, switching to clozapine, and treatment with ECT. Although Mr. Alexander has been more open to the possibility of psychotherapy, he has been too unstable to engage fully in that type of treatment.
Since October 2024, the amount of time Mr. Alexander has spent in seclusion has decreased significantly. Dr. Bouskill attributed this to the interventions developed by the team over time. For example, the team meets regularly with the behavioural therapist to adjust Mr. Alexander’s care plan, and this has allowed Mr. Alexander to progress to more liberties. The plan has a specific directive to consider emergency care as needed. Mr. Alexander receives an additional dose of antipsychotic medication on the initiation of most seclusions, and this has contributed significantly to shorten the length of seclusions.
Dr. Bouskill stated that the decrease in the time spent in seclusion did not result from a change in or improvement of Mr. Alexander’s behaviour, but was solely a result of the efforts of a dedicated team, which includes regular unit staff, a social worker, a psychometrist, and a behaviour therapist who has followed him since his admission to the Hospital, and has been actively involved with adjusting the care plan on a regular basis.
Mr. Alexander is currently in the Beausoleil unit. Dr. Bouskill told the Board that Mr. Alexander is in this unit to give relief to the staff of other units, and not because he is ready to transition to community living. Mr. Alexander’s moves between units is described in the Hospital Report at pages 175 – 176 as follows:
Mr. Alexander began the review period on the Beckwith Program. On October 23, 2023, he transferred to the Forensic Assessment Program (FAP), Unit B as a means of respite for Beckwith staff. On March 21, 2024, he transferred to the FAPA unit in the context of significant death threats made to clinical staff on the B unit. On March 28, 2024, Mr. Alexander was discharged to the Central North Correctional Centre (CNCC) after being charged with Utter Threats (in relation to the aforementioned death threats made to staff). When readmitted to Waypoint on June 26, 2024 from CNCC, Mr. Alexander was again housed on FAPA. On October 3, 2024, he transferred to the Beausoleil A program after destroying several rooms on FAPA, rendering them unusable with no other appropriate rooms for him on that unit.
When not in seclusion, Mr. Alexander mostly keeps to himself but uses off-unit privileges appropriately. He has engaged in some substance use programing and has some increasing insight into the impact of substance use in his life. He has also completed some anger management programing. Although he has the ability to retain the content of this programing, he often does not put it into practice.
On August 13, 2025, Mr. Alexander was granted level C-5 privileges. Dr. Bouskill attributed this achievement to Mr. Alexander’s ability to do well when he can see that he is making progress. He has moved to a regular room outside the seclusion suite, which has been a long-standing goal. Mr. Alexander has more access to a wider range of electronics in this room. The staff have regular and ongoing discussions about expectations, and the staff have adjusted expectations with respect to Mr. Alexander’s baseline behaviour.
Recognizing that Mr. Alexander has difficulty stopping his impulse to protest limitations, staff have been more forgiving and also have been more able to recognize his individual needs and react quickly e.g., to offer PRN or other comfort measures.
A careful and frequently updated care plan has resulted in less frequent and less lengthy periods of seclusion.
In Dr. Bouskill’s opinion, a conditional discharge is not sufficient to manage the risk factors set out on pages 210-215 of the Hospital Report. Mr. Alexander currently manifests ongoing and worsening symptoms. He demonstrates decreasing insight and increased unwillingness to engage with the team with respect to adequate treatment with medication. Without the supervision of the ORB, he would not take medications. He often advocated with the team and his SDM to decrease his medications and is unlikely to take medications in the community.
Mr. Alexander is likely to use substances if exposed to them in the community, which would lead to a destabilization of his mental state.
He is likely to continue the impulsive behaviours displayed in the Hospital. Dr. Bouskill pointed out that even with intense team support and flexibility to support Mr. Alexander’s move through the privilege ladder, conflicts often arise where Mr. Alexander responds with threats because he perceives himself as a victim.
When asked what risks Mr. Alexander would pose to the public under a conditional discharge, Dr. Bouskill responded that she would expect sexual and racialized verbal violence when Mr. Alexander perceives he is slighted, along with disrobing, exposing himself, threats, and behaviours similar to the time of the index offences.
Mr. Alexander’s delusions with respect to staff members have transferred to staff in different units, and Dr. Bouskill stated that these delusions would transfer to anyone who imposes limits on what Mr. Alexander considers to be his autonomy and his rights. These delusions include the belief that many staff members have held positions in the sex industry and as workers in Niagara casinos, and that he has interacted with them prior to the index offences. Mr. Alexander believes these staff target him to sabotage his progress. This has contributed to verbal threats of violence, sexual threats, and throwing bodily fluids.
It is likely that these behaviours will result in psychological harm to staff members, their families, and members of the public under a conditional discharge.
Without the current level of external supports, Mr. Alexander will decompensate rapidly. It is only with rapid intervention by staff and a careful and frequently adjusted care plan that Mr. Alexander has experienced more rapid de-escalations and shorter seclusions.
In Dr. Bouskill’s opinion, the risk to the public will increase under a conditional discharge.
Dr. Bouskill confirmed that the Hospital needs to approve Mr. Alexander’s accommodation, but that at this point, given Mr. Alexander’s instability, there is no community housing available in the community that Dr. Bouskill would recommend. Mr. Alexander is suboptimally treated, is unstable, will pose a risk to the safety of the public and will be at risk for quickly losing housing accommodation because of his instability and his behaviours.
Mr. Alexander would not recognize his symptoms of decompensation and would not return voluntarily to the Hospital or stay voluntarily in the Hospital. The MHA is not sufficient to manage Mr. Alexander’s risk to the public. If he is living in the community, the Hospital will need the ability to quickly return him to the Hospital and keep him there before the risk to the public becomes unacceptably high. This is only possible under a detention disposition.
If Mr. Alexander is living in the community, it is likely, by his admission, that he will use substances, and he will experience a worsening of his mental illness and psychotic symptoms.
Testimony of Mr. Alexander
Mr. Alexander testified that he has achieved a C-5 level of privileges because of medication compliance and “putting up” with stressors in the Hospital. He described these stressors as including that there are other addicts from Queen Street and cocaine dealers in the Hospital. He said that 50% of the staff are not competent professionals.
When he returned to the Hospital from jail, he was put into seclusion, and not granted even A-0 privilege levels, just like he cannot enter the community now because of the accessibility of drugs.
Mr. Alexander stated that he agreed to start medications in June 2024 when he was in jail because he felt it would move him forward, since he was going nowhere in jail.
When asked to describe what it feels like to be back on medications, Mr. Alexander stated that it is punishing, with constant hunger and thirst, and he urinates a lot. With the injection, there are a couple of days of relief from mental symptoms. His maintained that his condition is complicated with a learning disability (from cocaine psychosis) so he improves the longer he is off the medications. Using drugs is a danger only to him and not to others. Being on a detention order means he is withheld from loved ones and his social network.
Mr. Alexander hoped that he could have a day trip to the community or a bit more incentive to take the 400 mg. instead of coercion and abuse to encourage him to take 400 mg., like today’s hearing which is hard to sit through.
He indicated that he wanted a lower dose because of weight gain, and he felt lethargic. He was in good shape in the jail and felt healthier and more attractive. He was starved in jail, so he turned to eating feces using the sink to wash it out– he has teeth that do not crunch properly – the doctor was concerned because he did not wash the feces properly and got it into his eyes.
Mr. Alexander was asked to describe his behaviour on 300 mg of Abilify.
Mr. Alexander stated that he agreed that his behaviour is difficult to put up with. He agreed he is quick to anger but stated that he is not a violent person who actually physically harms people. He is a good person, given the right type of people to talk to him. He stated, “I have good manners and am well liked in Toronto, Brampton, Mississauga.”
Mr. Alexander was asked by his counsel whether his behaviours are a response to hospital restrictions and whether he would behave differently in the community. Mr. Alexander answered “yes, especially the fear of coming back here would negate smearing feces etc. and would not threaten, expose myself, or act aggressively for fear of coming here.” “I think I would do better at a less secure facility for fear of coming here. I can’t take much more of this place. It is wearing on me. They would be able to bring me back here if I needed to be secluded again.”
Mr. Alexander stated that he has not done as much programming as he should have, but that he is never invited to join any programming.
He stated that he is “an aggressive chap when not myself” and that he tries to attend sports programs to quell his aggression.
With respect to the emergency protocol in his safety plan, Mr. Alexander commented that it is cowardly of staff when he is in a locked room to dress up in gear and threaten him with antipsychotics. He feels defensive and angry. “Just leave me alone, lock me in the room to sleep it off.”
When asked what a good strategy would be, Mr. Alexander stated, “lock me in the room.” If he threatened or caused environmental damage like he has in the past or banged on the door seclusion might be warranted, but it is not necessary to inject him especially since in the back room there is nothing to damage.
Mr. Alexander wants to live with more freedom to walk on the hospital grounds. He wants more freedom to see loved ones. He feels upset that with a C-5 level and being willing to take 400 mg. that the talk in the hearing is that he is a threat just because there are drugs in the community.
If he became upset in the community, he would practise deep breathing and put cold water on his face, and once he used these, he might meet someone he could trust to talk to. A fresh start would be beneficial.
To avoid substances, he would (in a less secure facility) identify drug addicts and stay away, stay away from mentally ill women, go for walks, talk to 3-4 friends who he could get hold of any time of day to discourage him from using drugs.
Mr. Alexander said that if he is in the community, he will only go to the library, the bank, and for walks in the park. He acknowledged he has a history of sneaking off from CAMH to get drugs, but that the fear of coming back to Waypoint will be a “100% deterrence” from drugs.
Mr. Alexander told the Board that he has a plan to get to the community as fast as possible, as his friends are getting older. He does not want to miss out on being with his friends just because of drugs, since it is not definite that he would use them.
In cross-examination, Mr. Alexander was asked if some of his behaviours could be the result of his mental illness. He responded, “very minutely, there are lots of awful coincidences.” When asked to explain, he stated, “because addicts know addicts and dealers and I still stick to my claim there are some workers here, who were sex workers, casino workers …involved in crime before. It is an awful coincidence that exacerbates the situation.”
Restrictions of Liberty
- Ms. Lefebvre stated that the Hospital was relying on the extensive details in the Hospital Report and ROL report and would ask Dr. Bouskill questions which would apply to all four ROLs. The following slightly edited excerpts from the ROL Report and the Hospital Report describe the circumstances of each ROL.
January 4 – 14, 2025 (ROL #1)
On January 4, 2025, Mr. Alexander walked past the care desk, and stated to a co-patient, "you're hogging the computer and the phone, you're an asshole!" He was provided with verbal redirection, however replied, "Whatever, fuck you"; staff requested that he return to his room. Mr. Alexander began walking toward his room and repeatedly called staff a “Nr lover” and “Nr.” Verbal redirection and limit setting was continuously provided. When entering his room, staff requested that he comply with being searched as per his CPP. Mr. Alexander became physically resistive, and the utilization of CPI techniques were required. It was discovered that Mr. Alexander had stuffed both pockets with items from the patient kitchen; these items were removed, as some (such as plastic cereal bowl) were not approved per his CPP. Mr. Alexander remained physically resistive and continued with verbal aggression and made comments such as "try and take it from me, you fat fucking bitch", and "you're too weak to take it from me." Once items were removed and he was in his room, Mr. Alexander continued to verbally berate staff, calling them "N****rs" and stating "come in here and fight me, I'll fuck you all up". He then stated, "I wasn't resisting. I have a really good lawyer. I am going to sue you all because you are infringing on my rights." Mr. Alexander was placed on 1:1 observation per hospital policy, and a seclusion order was obtained.
On January 5, 2025, Mr. Alexander was observed openly masturbating for over 2 hours. He requested a prn of diazepam and continued to masturbate after its administration.
On January 6th and 7th he was approached regarding seclusion relief, however declined to participate, indicating that he instead wanted to rest.
On January 9, 2025, Mr. Alexander was screaming and banging on his door, repeatedly yelling, "I want a prn!” When approached by staff about the prn, he immediately stopped the behaviours and instead indicated he wanted the phone. He was informed he could utilize the telephone when out for seclusion relief. Mr. Alexander became verbally aggressive stating, “I’m gonna piss and shit out the door you fucks” and voiced that he would attempt to set off the fire alarm and smash his window. He filled a sock with various items and began swinging it around his room, attempting to strike various objects. A STAT order was received for Loxapine 25mg IM and Lorazepam 2mg IM.
On January 10, 2025, Mr. Alexander was assessed and deemed appropriate for seclusion relief. He was initially calm and cooperative, and contracted to safety. However after showering, became irritable when asked to put on his shoes prior to entering the phone booth stating, "No. I'm not doing anything for you fucking people." Prior to returning to his room, he became verbally aggressive and made several statements to staff such as, "You've been a whore since 1994", "I'm going to shit on your front lawn", and "Find me in the parking lot, I'll kick your ass you fat fuck". He engaged in fixed staring and posturing, and he was returned to his room. Mr. Alexander requested and was administered Diazepam 10mg, however refused to pass out the spoon and medication cup afterward. Staff attempted to therapeutically engage him; however, he sat down nude, spread his legs and began slapping his genitals with the spoon.
From January 11-13, 2025, Mr. Alexander was assessed and engaged in seclusion relief without co-patients. He was calm, cooperative, and followed direction throughout.
On January 14, 2025, Mr. Alexander engaged in seclusion relief with the unit open. He presented as cooperative and followed direction. A team decision was made to discontinue the seclusion.
February 13 – March 6, 2025 (ROL #2)
On February 13, 2025, at approximately 1400 hours, Mr. Alexander was returning to his room, when staff requested that he empty the change out of his pocket. He refused stating, "No, I'm not doing it, you can empty my pockets yourself!" Mr. Alexander then threw his change onto the floor; staff accompanied him to the corridor outside his room and checked for contraband prior to re-entering his bedroom. Given his presentation - impulsivity, irritability, unwillingness to follow direction, and sensitivity to perceived provocation, a decision was made to put his privileges on hold for 24 hours, and to be reassessed the following day.
Once [in his room], Mr. Alexander began to bang loudly on the door and informed staff, "I am going to kill a male staff . . . Eugene, or Greg, or Gary . . . . I won't do anything while I'm here because you guys would jump me.” He would not elaborate on the reasons for his verbal threats, and instead continued to utter them. Mr. Alexander was offered a prn to help settle, however he refused and stated, “I am just going to jerk off.”
… Mr. Alexander continued to escalate, yelling threats from his room such as, “I'll kill you treacherous whores.” He began kicking his door and then placed an unknown hard object into a sweater and began repeatedly whipping the side of his sink. The duty doctor was contacted, and a seclusion order obtained.
… During his seclusion, Mr. Alexander has been assessed for seclusion relief daily; however, his participation in same has varied and has been dependent on his mental status and behavioural presentation. There were instances where he either refused or was assessed as inappropriate for seclusion relief due to an unstable mental status, verbal/environmental aggression, threats, and/or other maladaptive behaviour.
For example, on February 20, 2025: Mr. Alexander was heard pounding on his room door. Two staff approached and he was observed naked and demanded, "Go get my Diazepam 10mg!" He was administered the medication and then shouted, "Tell that fucking whore in the morning that I don't want her seclusion relief and fuck you!” After staff disengaged, Mr. Alexander could be seen on camera attempting to unscrew a steel electrical socket cover with an invisible screwdriver. Later he was observed scratching at the power outlet cover, and thereafter was fully naked, crawling back and forth on the floor. He eventually settled and the prn took effect.
On February 21, 2025, he was not offered seclusion relief due to ongoing agitation, verbal and environmental aggression, and the aforementioned behaviours from the day prior.
On February 22, 2025, he would not engage with staff so they could complete a mental status assessment, and so was not offered seclusion relief. He requested a prn and when staff provided this to him, he was agitated and responded, "I'll take it when I want to take it!" When staff attempted to redirect him, he responded, "fuck off.”
From February 23 - 24, 2025, Mr. Alexander successfully participated in seclusion relief and was appropriate throughout
On February 25, 2025, at the outset of a relief period, Mr. Alexander presented with some irritability and pressured speech and was offered seclusion relief absent co-patients due to the lability of his mood. Later that afternoon, as staff were completing rounds he stated, "You should take the needles you give all the deprived, desperate and decrepit homeless people and shove it up your mom’s ass." Limits were set, however he responded, "I don't give a fuck about appropriateness, why don't you make yourself useful and get me my food . . . you piece of shit."
On February 26, 2025, Mr. Alexander was banging and yelling from his room. When staff approached, he stated, "You know I'm still going to kill your entire family right?! I'm going to kill them and all of you pieces of shit whores!" He was unwilling to settle and continued screaming death threats about various staff; he was not appropriate for seclusion relief. Throughout the dinner hour he was striking his room door while screaming, “cowardly pieces of shit! Whores! I’ll kill you cowards!”
On February 28, 2025, while staff were speaking with a neighbouring co-patient, Mr. Alexander began repeatedly screaming out, "I want to use the phone to call my friends, I want my institutional snack you big fat cunt!". He continued to aggressively bang on his door, yelling profanities and verbal threats stating, "you're all pieces of shit, I'm going to murder you!" He was unable to settle or be redirected and was not appropriate for seclusion relief.
On March 1, 2025, Mr. Alexander began berating staff who were engaging with a neighbouring co-patient stating, "Fuck you whores. [Name of staff] is a whore who touched my pecker. You are all a bunch of faggot lovers. Fuck you, fucking Waypoint scum you can all rot in hell . . . You are all pieces of shit and will rot in hell. Fuck you, you fucking faggots you rainbow loving queers." He alternated between punching and slapping the hatch for approximately 40 minutes, and continued to berate staff members and threaten violence. Due to his unstable mental status and presentation, he was not deemed appropriate for seclusion relief.
On March 3 – 4, 2025, Mr. Alexander successfully engaged in seclusion relief without co-patients. He followed direction and was calm and cooperative. On March 5th he engaged in relief with the unit open to other co-patients.
On March 6, 2025, during seclusion relief Mr. Alexander presented as calm and co-operative, engaged with co-patients appropriately, and followed direction. A team decision as made to discontinue the seclusion.
April 29-May 6, 2025 (ROL #3)
On April 29, 2025, Mr. Alexander began demanding multiple items at the care desk in a demeaning tone. When limits were set, he replied "I don't fucking care, give me a pen now!" He remained unwilling to follow direction and continued to escalate; a unit lock-up was announced due to his increasing behaviours which were disrupting the unit milieu. Mr. Alexander continued with loud, verbally abusive remarks toward staff stating "you're an asshole, fuck you, you're a piece of shit asshole". He then kicked off his running shoes in the direction of staff (hitting the wall of the corridor) and began to disrobe, throwing his clothing on the floor. He continued with angry and abusive comments stating, "you're all a bunch of assholes, I hate you all, ugly fat bastards!" along with death threats stating, "I'm going to kill you all and all of your families...I'm going to do it myself when I get out of here and I won't forget, they'll all be dead I hate you!" He would not comply with direction to return to his room, requiring staff to utilize CPI techniques to escort him there. The duty doctor was contacted, and a seclusion order was obtained.
On May 1, 2025, he was urinating into the corridor, and later that day became argumentative, demanding, and verbally aggressive. He began scraping at the wall in his room that already had visible damage caused by him. Staff requested that he disengage from this behaviour and he stated, "Why don't you come and make me you dumb fuck. Come fight me, put the gear on and lets fucking go." He could not be redirected and so staff disengaged, however Mr. Alexander continued to threaten staff with violence stating, "Let’s go, lets fucking go get the gear and fucking fight me you pieces of shit."
On May 2, 2025, Mr. Alexander was assessed and deemed appropriate for seclusion relief. He successfully engaged in relief in wrist/waist restraints, without co-patients present.
On May 3rd and 4th, he again successfully participated in seclusion relief via the use of pinel restraints, and on May 5th, successfully engaged in relief absent the use of restraints.
On May 6, 2025, Mr. Alexander engaged in seclusion relief without restraints and with co-patients present. He socialized appropriately with both co-patients and staff, and a team decision was made to discontinue the seclusion.
May 29-June 6, 2025 (ROL #4)
On May 29, 2025, Mr. Alexander walked up to the care desk and asked about his code status asking, "am I a DNR, a Do Not Resuscitate"? After staff confirmed this he stated “good,” put the television remote on the desk and stated, "I swallowed the battery, I want to die". Mr. Alexander was escorted back to his room until further assessment could be completed. As staff were closing his door, he attempted to strike staff by whipping a safety blanket at them, and made verbal threats to "fuck up" staff should they attempt further intervention.
The duty doctor was contacted, and orders were received for STAT IM’s (due to his attempt to physically harm staff) and a seclusion order was obtained. Once staff explained the orders and that he would be transferred to general hospital, Mr. Alexander re-iterated that he intended to fight staff should these orders be carried out. Staff repeatedly approached Mr. Alexander and provided support, assurance, and health teaching regarding his present situation. Every reasonable effort was made to persuade him to allow for further medical assessment as a means to avoid escalating level of restraint required. Staff were required to don personal protective equipment and entered his room; while still verbally aggressive, he was not physically resistive to the medication administration of Lorazepam 2mg IM and Loxapine 50mg IM. After speaking with the duty doctor he agreed to attend the ED for medical care. He was transferred to the EMS stretcher and escorted to GBGH for assessment due to concerns of bowel perforation.
While at GBGH, Mr. Alexander repeatedly threatened to kill both Waypoint and GBGH staff, as well as making racial slurs to them. He also voiced intentions to cause harm with the hopes of going to jail, and tore off part of the hand sanitizer dispenser in his room. He was only able to settle after GBGH staff administered medication. An x-ray was completed, he was medically cleared, and was returned to Waypoint the same day.
On May 30, 2025, Mr. Alexander was whipping a weighted safety blanket against the door, defecated on the trap door ledge, and smeared feces on the walls/window. He began digging into his rectum with his hands, bent over with his buttocks in the air and screamed, “Whore!” and punched his door. He then began targeting the team leader with threats stating, "I'll kill you cowards", "I'll fucking kill you all". Mr. Alexander also attempted to remove the electrical socket cover, and knock down the room camera by whipping it with the weighted blanket. That same evening, he was loudly banging his door yelling, “Come here you pieces of shit! Fucking pieces of shit! . . . Get my medications, hurry the fuck up!” and was threatening staff stating, “. . .you fucking bitch, if I saw you in a parking lot I'd smash your head with a rock you fuck".
On June 2nd and 3rd, 2025, Mr. Alexander successfully participated in seclusion relief with the use of waist/wrist pinel restraints, absent the presence of co-patients. On June 4th he successfully participated in relief absent the use of restraints, and on June 5th again engaged in relief absent the use of restraints and with the unit open to co-patients. On June 6, 2025, Mr. Alexander successfully engaged in seclusion relief and a team decision was made to discontinue the seclusion.
Testimony of Dr. Bouskill
To place these seclusions in context, Mr. Alexander was secluded on 16 occasions during the reporting period. Not all of these resulted in restriction of liberty reviews.
Dr. Bouskill testified that across all four ROLs, risk of harm to others was indicated at the time when seclusion was initiated, until it was ended. The common themes included irritability, difficulty regulating emotions in the context of environmental stressors, unwillingness to follow instructions and/or engage in safety routines e.g. return to his room, conflict with staff or a co-patient, escalating threats of physical violence, threats to kill staff and their families, fashioning weapons to engage in property damage, and escalating property damage.
Dr. Bouskill pointed to the events in ROL #2 as examples of steps taken by staff to mitigate the situation before seclusion was initiated, including, offering PRN medication, encouraging Mr. Alexander to move away from the situation (e.g. go to his room), and using lesser consequences (e.g. hold on privileges for 24 hours) with clear expectations and limits of the privilege hold.
Dr. Bouskill pointed out that prior to the initiation of seclusion on February 13, 2025, there had been several incidents earlier in the day which could have merited seclusion, but the team tried to work with Mr. Alexander to avoid seclusion. The team strives to avoid seclusion, when possible, because they are aware of the negative impact of seclusion on Mr. Alexander.
The decision to initiate seclusion is always a team decision and is not made by one person. The team decision is based on the explicit expectations set out in the care plan.
Dr. Bouskill testified that, to the best of her knowledge, and based on the nursing notes for each ROL, the Waypoint seclusion policy was followed for each ROL, as set out on page 181 of the Hospital Report:
At Waypoint, seclusion orders are reviewed daily. To ensure objectivity, secluded patients are seen by an independent psychiatrist (not the patient’s most responsible physician) for review and assessment at the 72-hour post-seclusion mark, seven days post-seclusion, and every 28 days thereafter. All seclusion consultations opined that Mr. Alexander’s seclusions were necessary to mitigate his risk.
During the seclusion periods, Mr. Alexander was assessed near daily for seclusion relief; however, his participation in same varied and was dependent on his mental status and behavioural presentation. When he did participate in seclusion relief, there were some seclusion periods where seclusion relief was deemed unsuccessful due to his presentation and/or inability to follow direction. There were also numerable instances where he was assessed as inappropriate for seclusion relief due to an unstable mental status, verbal/environmental aggression, threats, and/or other maladaptive behaviour. During seclusion relief periods, Mr. Alexander engaged in activities such as, showering, watching television, attending courtyard, exercising, and/or using the telephone. He was also provided with recreational/leisure resources while in his room.
Mr. Alexander has a Crisis Prevention Plan (CPP) which outlines his behaviours (such as property destruction, attacks on objects, verbal abuse, racial abuse, threatening language), and mitigation strategies for same. The use of waist/wrist pinel restraints were also utilized through some seclusion relief periods. The CPP is a fluid document which has been updated as needed to address any new risks identified, as well as to support Mr. Alexander’s progression via the de-restraint process to work toward the discontinuation of seclusion.
During the course of these ROLs Mr. Alexander was assessed by 14 different psychiatrists, some forensic, some civil, working with both inpatient and outpatient psychiatry, who all determined that seclusion was warranted, and necessary on an ongoing basis.
The May seclusion (ROL #4) was different from the other ROLs in that Mr. Alexander disclosed a suicide attempt, refused medical attention, and threatened physical violence to staff by whipping a safety blanket at them. These actions flowed from acute dysregulation due to his mental illness. The on-call physician determined that Mr. Alexander required STAT medication.
The use of STAT medication has played a significant role in decreasing the length of seclusions. In the case of ROL #4, within one day, Mr. Alexander went from refusing relief to rapid progression out of seclusion. The use of STAT medication is part of his care plan.
In Dr. Bouskill’s opinion, Mr. Alexander’s psychotic symptoms cause dysregulation so that he can no longer control his emotional behaviour. Dr. Bouskill agreed with Mr. Alexander that at baseline, Mr. Alexander has some difficulty controlling his anger at restrictions. She did not agree that hospital routine causes Mr. Alexander’s emotional dysregulation. While Mr. Alexander often cites the hospital rules and routines as frustrating triggers, these are not the primary contributor, in the doctor’s opinion.
The staff regularly offer PRNs to Mr. Alexander. He has improved in his recognition of the benefits of PRNs, and for the most part, he uses them appropriately and at appropriate times.
Dr. Bouskill acknowledged the negative impact of seclusion on Mr. Alexander, who has a history of trauma, but indicated that acute risk to self or others takes priority in the decision to initiate/continue seclusion. She referred the Board to the Hospital Report, which provides many examples of the risk of harm to others.
Testimony of Mr. Alexander
Mr. Alexander testified that the general cause of seclusion is when he perceives difficult situations that he is not able to handle without someone talking to him in a caring way. He stated that the proper way to handle this is for the staff to de-escalate verbally with him rather than threatening seclusion, or a loss of privileges, or offering a PRN. He should be talked down before his privileges are taken away. This works if someone is nice and sympathizes with him to find out what went wrong. Mr. Alexander stated that if staff took that approach, there is a good chance he would calm down within 5 minutes.
The fact that injectable medications are part of the care plan makes him feel defensive. It makes him entertain the possibility of fighting because he does not want the injection. All he wants is to be talked to, cared for and spoken to like a friend to a friend.
Once in seclusion he feels 20% relieved from stress, and 80% stressed, especially when after 26 or 80 hours there is no review.
When asked to give examples of when he was not checked within 24 and 72 hours of the initiation of seclusion, Mr. Alexander testified that he didn’t remember but that “there is a general pattern” for the doctors to wait more than 24 hours to see him. He stated that despite documentation to the contrary, there have been many instances where the doctor does not come until after 28 hours instead of within 24 hours.
Mr. Alexander remarked several times that he feels abandoned in seclusion, especially when the doctor does not come to check on him in time. If the nurses do not check in on him, he feels more abandoned and then he gets attention by smearing feces, banging, yelling abusive things.
The parties adduced no additional evidence.
Analysis and Conclusion
Significant Threat and Disposition
Having heard and considered the entirety of the evidence, the Board agrees with the joint submission of the parties that Mr. Alexander 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. Bouskill, in addition to the documentary evidence before us.
The Board relies on the following summary of significant events, set out on page 179 of the Hospital Report:
Over the course of the review, Mr. Alexander engaged in a number of maladaptive behaviours. Documentation gathered from the unit Behavioural Support Specialist highlighted the following instances of such behaviours from the outset of the review period until July 8, 2025:
• 487 documented instances of verbally aggressive or assaultive behaviour. This included, but was not limited to, racial slurs, derogatory comments, swearing, and yelling.
• 13 documented instances of physically assaultive or attempted physical assault, including but not limited to, attempts to spit at others, resisting intramuscular injections resulting in physical restraint, and/or attempting to throw objects at others.
• 141 documented instances of sexually inappropriate or violent behaviour, including but not limited to, violent comments about rape and sexual torture, exposing himself, open masturbation and threats of sexual violence or harm.
• 193 documented occurrences of threatening behaviours, including but not limited to, threats of bodily harm or death, and threats of property destruction.
• 141 documented occurrences of environmental aggression, including but not limited to, destruction of or damage to hospital property including walls, toilets, and windows, kicking, and punching doors and walls. This also included using objects to engage in aggression or destruction of property.
• 91 documented occurrences of inappropriate urination/ defecation which included urinating outside of his toilet (primarily in attempt to hit staff with same), urinating outside of his door, smearing feces, throwing fluids (feces and urine), eating feces, and weaponizing or attempting to weaponize bodily fluids by attempting to throw them at staff.
- The Board relies in particular on the Clinical Assessment of Risk, summarized as follows in the Hospital Report at pages 210-213:
Mr. Alexander is a 44-year-old male with a history of severe and persistent mental illness (schizoaffective disorder) which is partially treated with his current medication regime. His presentation is further complicated by antisocial personality disorder and suspected mild intellectual disability. His current mental health struggles present on a background of concurrent substance use disorders, suggestive of longstanding executive dysfunction and impulse control deficits. Even in times of comparatively well-controlled psychotic symptoms, Mr. Alexander struggles to refrain from engaging in psychologically harmful behaviours and property destruction driven by emotional dysregulation.
Mr. Alexander has a history of engaging in repeated acts of violence resulting in police intervention. Over his admission here at Waypoint, a clear pattern of escalation in the severity of his aggression correlating with episodes of decompensated mental health has emerged. When experiencing an acute episode of psychosis, Mr. Alexander develops insomnia, racing thoughts, pressured speech, and mood lability. He has become increasingly sexually disinhibited and preoccupied. He has developed persecutory delusions and has often misidentified staff as having alternative identities and as meaning to do him harm. He has expressed fears for his safety, often related to sexual assault and to poisoning. Mr. Alexander’s behavior has become increasingly aggressive in response to his psychotic symptoms. He has been increasingly agitated and disorganized in his speech and behaviour. He has disrobed and engaged in explicit sexual acts. He has become more impulsive and will demonstrate unprovoked aggression seemingly against his own interests (i.e., In response to offers of otherwise welcome support or services such as food). He has attempted assault on numerous staff using bodily fluids. In his disorganized state he has not only smeared but also eaten his own feces and sodomized himself repeatedly. His physical health has been jeopardized by his actions, and he has required medical assessment for suspected harm caused to his vision due to covering himself in feces.
During acute episodes of psychosis, Mr. Alexander will engage in verbal aggression with increasing frequency, intensity, and severity. Though threats of physical harm to others and sexually inappropriate statements are common even when treated, in the throes of psychosis, Mr. Alexander will verbalize more specific threats of violence directed at staff and patients, and he becomes more intrusive and intimidating, with frequent use of racial slurs and targeting of women and minority members of staff. The sexual content he relays has become increasingly lude and violent, including threats of rape, and has made several death threats. In March of 2024, Mr. Alexander was charged as a result of one such instance of threatening death to a staff member.
In times when he is receiving more adequate pharmacological treatment, a distinct change in the quality of his interactions has been observed. He continues to make vague threats to kill people and will often provide a specific motivation for his statements. He is faster to settle following an episode of dysregulation and has frequently apologized after the fact. Albeit for short periods, he has been able to achieve the maximum level of privileges available at Waypoint. With effective treatment, Mr. Alexander has been able to engage meaningfully in groups and individual psychotherapeutic interventions.
Unfortunately, similar to the slow decompensation detailed in the 2021-2022 reporting period, Mr. Alexander experienced a resurgence in psychotic symptoms in the context of having discontinued his medication in August 2023 after being deemed capable of consenting to his own treatment. A slow decline in his mental state ensued, culminating in the eventual incurring charges of uttering death threats to a Waypoint staff member in March 2024. He remained untreated while in corrections and presented as floridly psychotic on his return. His presentation necessitated a prolonged period of seclusion, ending in late October 2024.
Mr. Alexander remains partially treated at this time, and continues to struggle with impulse control difficulties. His insight is globally deficient and he does not believe he has a psychotic illness requiring pharmacological treatment. He remains incapable to consent to treatment and has been explicit in his desire to discontinue his current treatment regime as soon as possible, often urging his SDM to revoke consent for treatment all together. More recently, he has begun reporting to staff his SDM is in agreement with his wishes to do so. In December of 2024, and in the context of a pending CCB decision appeal, Mr. Alexander successfully petitioned his SDM to revoke said consent for a higher dose of antipsychotic medication, citing unsubstantiated claims of side effects as his rationale. He remains at this lower dose of Abilify, and a slow decompensation described in detail above has resulted. Mr. Alexander has again started to make specific threats to harm or kill others, using racial slurs, disrobing, sexually preoccupied, and self-sodomizing for the purpose of feces smearing. He has become more openly paranoid, openly expressing his beliefs that he knows staff from previous times in his life, and that several staff members have either worked at the Niagara casino or in the sex industry. For example, Mr. Alexander has repeatedly identified the unit charge nurse as knowing him from a “rub-and-tug” he adamantly believes she had worked at. Whereas these ideas were previously loosely held and expressed only during periods of acute emotional dysregulation, they have become fixed and rigidly held. Mr. Alexander’s mood has become increasingly more labile, escalating in a suicide attempt as recently as May 29, 2025. It was only after receiving emergency treatment that Mr. Alexander consented to receive medical care following this incident.
If not for the oversight of the Ontario Review Board, Mr. Alexander is likely to face innumerous challenges related to maintaining his mental health, including an absence of housing, community support, treatment and return to substance use. He has stated that he will stop his medication. Medication non-compliance alone will likely result in a resurgence of psychotic symptoms, as it has in the past, including over this reporting period. Any use of substances is likely to accelerate a decline in Mr. Alexander’s mental state. When unwell, he is likely to become increasingly paranoid, disorganized, sexually preoccupied, disinhibited, and emotionally dysregulated. In this state, he is likely to struggle with impulsiveness and agitation, causing him to verbally aggress against individuals in his proximity. His threats of death and violent sexual assault are likely to worsen in severity, frequency, and intensity as they have in the past, resulting in severe psychological harm to others. When unwell, Mr. Alexander has historically engaged in physical violence towards himself and others, having as recently as 2023 struck a staff member in the arm. He has engaged in physical aggression against objects resulting in damage to property and placing himself and other patients at risk. For these reasons, it is the opinion of the clinical team that Mr. Alexander continues to represent a significant threat to the safety of the public.
The treatment team concurs with the overall opinions expressed in the updated Actuarial Risk Assessment in that Mr. Alexander’s risk of recidivism is ongoing, but mitigated in the current, well-supported environment, and would be elevated should he be granted a transfer to a lower secure facility.
Flowing from the Board’s finding that Mr. Alexander continues to pose a significant threat to the safety of the public it must shape a Disposition for the year ahead. Its paramount consideration in doing so must be the safety of the public while also considering Mr. Alexander’s needs pursuant to s. 672.54 of the Criminal Code.
The necessary and appropriate disposition for Mr. Alexander provides him with as much freedom as possible without subjecting the community to the real risk of dangerous behaviour.
In considering Mr. Alexander’s unique needs the Board was also attentive to his counsel’s submission that this patient is appropriate to be subject to a Conditional Discharge disposition as opposed to the Detention Disposition to which he is currently subject.
The Board finds that a Conditional Discharge is inappropriate in the circumstances. Both the documentary and viva voce evidence point to the need for elevated levels of supervision only attainable with a Detention Order.
Mr. Eaton-Kent submitted that Mr. Alexander will respond better with more freedoms because the regimented schedule and policies of the Hospital do not create the environment best suited for him. Mr. Eaton-Kent urged the Board to believe Mr. Alexander’s testimony that he would not have the same behaviours if he was living in the community.
Mr. Eaton-Kent also submitted that a conditional discharge could be crafted with terms that would mitigate Mr. Alexander’s risk to the safety of the public. However, Mr. Eaton-Kent did not provide the Board with any specific conditions that could protect the safety of the public, nor could we think of anyway to craft an appropriate conditional discharge disposition that would protect the safety of the public.
The Board relied on Dr. Bouskill’s evidence that at this time, she could not suggest any terms for a conditional discharge that would mitigate the risk to the public, nor could we think of any way to craft an appropriate conditional discharge disposition that would protect the safety of the public.
The Hospital needs to approve Mr. Alexander’s accommodations, but currently, there is no accommodation in the community suitable for Mr. Alexander’s current level of instability and risk to the public.
Mr. Alexander does not believe his behaviours flow from his mental illness, but rather that they flow from the fault of others or the environment e.g. the staff are not kind enough to him; the Hospital rules are too stressful; several of the staff are known to him to be sex workers, casino workers; he feels abandoned.
Although Mr. Alexander stated that he would agree to optimize his dose of Abilify to 400 mg., he stated this in the context of developing a plan to leave the Hospital. He currently lacks insight into his illness and need for medication. The Board accepts Dr. Bouskill’s evidence that Mr. Alexander is likely to stop taking medication if he lives in the community. He is currently sub-optimally treated, and his mental status has been declining gradually throughout the reporting period. This will likely continue in the community.
Added to this risk, it is likely that Mr. Alexander will struggle to remain abstinent from substances in the community, this increasing the risk that his mental state will deteriorate further.
The evidence strongly supports the conclusion that without the extensive supports in currently in place at Waypoint, Mr. Alexander’s mental condition will deteriorate, and his risk to the public will increase. From the summary of significant events noted above, it is clear that even within the secure environment of Waypoint, and under a detention order, Mr. Alexander presents a significant risk to the safety of the public. Any less restrictive disposition would increase the risk to the safety of the public.
There was no evidence to support the conclusion that in a less restrictive environment, Mr. Alexander will not engage in the types of dysregulated behaviours listed above as significant events.
Conclusion: Disposition
Therefore, the Board unanimously determines that the necessary and appropriate Disposition required to manage the threat Mr. Alexander poses to the safety of the public while still meeting his needs, is a renewal of his current Detention Disposition.
In making this Disposition, the Board carefully considered the positions and submissions of the parties and the evidence of Dr. Bouskill 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. Alexander’s mental condition, his reintegration into society and other needs.
Restrictions of Liberties
The Board carefully examined the circumstances surrounding each ROL. In each situation, the evidence supports the conclusion that the ROL was warranted at the time the seclusion was initiated, and that staff had attempted to de-escalate the situation before seclusion was initiated.
In ROL #1, Mr. Alexander was provided with verbal redirection and limit setting. When he was found with contraband Mr. Alexander remained physically resistive and verbally threatening to staff.
In ROL #2, Mr. Alexander was irritable, impulsive, unwilling to follow instructions and sensitive to perceived provocation. A decision was made to place his privileges on hold. He was offered a PRN. He continued to escalate, making threats to kill staff, and whipping an unknown object against the side of his sink.
In ROL #4, Mr. Alexander was escorted to his room after he disclosed that he had swallowed a battery. He then attempted to strike staff by whipping them with a safety blanket.
The Board carefully examined the circumstances surrounding the continuation and termination of each of the four ROLs. In each case, seclusion relief was offered on a regular basis, and Mr. Alexander was released from seclusion once he was able to safely tolerate seclusion relief.
The evidence supported the conclusion that with respect to each ROL, the Waypoint seclusion protocols were followed. Dr. Bouskill testified that 14 different psychiatrists had assessed Mr. Alexander and had agreed that he was suitable for seclusion or a continuation of seclusion. According to the nursing notes for each ROL, the protocols were followed.
Mr. Alexander offered vague evidence that doctors “often” did not check on him within the 24- and 72-hour periods, but by his own admission he could not remember which seclusions he was referring to.
The Board has no doubt that to Mr. Alexander it feels like the doctor did not check on him within the mandated time frames, but there is no credible evidence that the protocol was not followed during any of the four ROLs under review.
The Board acknowledges that Mr. Alexander often suffers from feelings of abandonment while he is secluded but is encouraged by Dr. Bouskill’s observations that seclusion periods have become shorter over time with the development of the safety plan and the refinement of staff intervention strategies.
Conclusion: Restrictions of Liberty
Mr. Alexander was assessed repeatedly while in seclusion. The Board has concluded that, based on the evidence before us, the Hospital’s decision to significantly restrict Mr. Alexander’s liberty, by placing him in seclusion from January 1-14, 2025 and from February 13 – March 6, 2025 and from April 29-May 6, 2025 and from May 29 – June 6, 2025 were each warranted and necessary. These four restrictions of liberty were the least onerous, least restrictive options, and they were warranted for the safety of the public.
The Board notes that Dr. Bouskill expressed optimism that if Mr. Alexander becomes optimally treated, both with Abilify and a mood stabilizer, and perhaps ECT, that he will be able to make progress toward his goal of progressing through the forensic system. The Board wishes Mr. Alexander every success in this upcoming year.
DATED this 4th day of September 2025, at the City of Toronto, in the Region of Toronto.
Ms. K. Tomaszewski
Legal Member
Office of the Registrar
Ontario Review Board