Re: F. (N.)
ORB File No: 7806
Hearing held on: Wednesday, August 20, 2025
Place of hearing: Waypoint Centre for Mental Health Care
Pursuant to: Section 672.81(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: F. (N.) (by Zoom)
Counsel: Ms. C. Francis (by Zoom)
The person in charge of hospital: Counsel: Ms. J. Lefebvre
Attorney General of Ontario: Counsel: Ms. S. Curry
REASONS FOR DISPOSITION
(Dated September 4, 2025)
Introduction
On November 26, 2020, Mr. F. (N.) was found not criminally responsible on account of mental disorder on a charge of assault causing bodily harm, contrary to the Criminal Code of Canada (the "Criminal Code").
F. (N.) is currently subject to a Disposition of the Ontario Review Board dated May 28, 2025, discharging him on various terms and conditions.
By letter dated July 28, 2025, the Waypoint Centre for Mental Health Care (“Waypoint” or the “Hospital”) requested an early hearing for the following reasons: “Mr. F. (N.) has been using substances regularly and there is suspected non-compliance with medication which may lead to anticipated breach of his terms of ORB disposition.”
On Wednesday, August 20, 2025, the Ontario Review Board convened an early hearing at Waypoint pursuant to s. 672.81(1) of the Criminal Code. F. (N.) was in attendance by Zoom, and was represented by his counsel, Ms. Francis, who also attended by Zoom.
The Board had before it a Hospital Report dated August 10, 2025; a Progress Note dated August 14, 2025, and the oral evidence of Dr. P. Ismail, who gave evidence on behalf of the Hospital.
Position of the Parties
The parties informed the Board that this is an early hearing, and that this early hearing did not replace F. (N.)’s annual hearing.
Ms. Lefebvre, on behalf of the Hospital, submitted that F. (N.) remained a significant threat to the safety of the public. The Hospital recommended that F. (N.) be subject to a detention order to the Brébeuf Program for Regional Forensic Services (“Brébeuf”) at Waypoint, with privileges up to living in the community in approved accommodation, and a requirement that he abstain absolutely from the non-medical use of alcohol or drugs or any other intoxicant, as set out at pages 48-49 of the Hospital Report. This position was supported by Ms. Curry, on behalf of the Attorney General.
Ms. Francis informed the Board that F. (N.) agreed with the Hospital’s position, and that the issue of significant threat was not in dispute.
The Board had before it a joint position. All parties maintained their positions throughout the hearing.
Background and Index Offences
F. (N.) was raised from birth by his maternal grandparents because his biological mother was 19 years old at the time of his birth. His biological father died when F. (N.) was 6 years old from Marfan’s syndrome.
F. (N.) described his childhood as positive; however, by the sixth grade, F. (N.) began using cannabis and became angry and depressed. F. (N.) went on to abuse stimulant medication and ecstasy before progressing to other substances.
F. (N.) first left his family home in Grade 9 or 10 and went to live with a friend for a month. He attempted suicide while living at the friend’s house. Around this same time, he was expelled for making a video of skateboarding through his high school. F. (N.) then attended another high school which he left in grade 11 after confrontations with the principal. At the time, he was selling cocaine and other drugs. He then attended alternative school for 1 week and did not go back.
F. (N.)’s current diagnoses are:
Schizophrenia
Cannabis Use Disorder, in remission
Cocaine Use Disorder, moderate
Alcohol Use Disorder, moderate
- The circumstances of the index offences are taken from the most recent Reasons for Disposition, dated August 5, 2025, as follows:
According to the agreed statement of facts, F. (N.) was residing in the basement suite that contained three apartments. He had been living in this home for approximately two months. On June 20th, 2019, at 500 hrs, F. (N.) kicked open the door to his co-tenant’s room and began stabbing the victim in the neck with a butter knife. The victim managed to disarm F. (N.), who then obtained a metal spoon and that was the victim in the neck and the eyes. The victim eventually broke free and escaped to a neighbour’s home. The attack was described as unprovoked. The victim was 68 years old at the time and had little prior contact with F. (N.).
Evidence at the Hearing
- Dr. Ismail adopted the contents of the Hospital Report. The Hospital Report sets out the circumstances which prompted the Hospital to request an early hearing. Those circumstances are described in the following edited excerpts from the Hospital Report:
Since F. (N.)’s annual hearing in May 2025, F. (N.) has moved from the stable living environment in his parents’ home to a boarding house; progressed in his substance use; [is alleged to have disclosed sexually inappropriate comments that prompted a police wellness check]; and has been admitted to Waypoint under the Mental Health Act.
In April 2025, F. (N.) moved from his parents’ home to a boarding house. His rationale for the move was that he was living in a room in their basement and had limited contact with his parents. He did not discuss his plans to move with Dr. Ismail or the FMSTS clinicians beforehand. According to his clinical team, the boarding house has a reputation for substance use, raising concerns about its suitability for his recovery. F. (N.) pays approximately $800.00 a month in rent and has access to a kitchenette and shared bathroom facilities. F. (N.) described being behind in his rent.
F. (N.) left his employment at the Canadian Mental Health Association due to limited hours. He recently began working Monday to Friday for an irrigation or landscape company. He has missed some days from work without explanation to the FMTST, which is unusual. F. (N.) has experienced some financial stress. He was having difficulty making the high-interest payments and insurance on his vehicle.
F. (N.) had a legal requirement for abstinence from substance use from April 9, 2021, to June 7, 2023. During this period, F. (N.)’s urine drug screens all yielded negative results, and he expressed minimal to no interest in alcohol use. However, shortly after F. (N.) understood he was no longer under a legal obligation to abstain, he resumed alcohol use. In November 2024, he was consuming alcohol weekly, primarily on weekends. Between October and December 2024, F. (N.) had three positive toxicology results for cocaine and/or cocaine metabolites, yet he repeatedly denied using cocaine.
Since F. (N.)’s annual ORB hearing, toxicology reports from April 30, May 23, June 2, and June 19, 2025, all yielded positive results for ethylglucuronide and benzoylecgonine, a cocaine metabolite. The July 10, 2025, sample was also positive for cocaine and cocaethylene. F. (N.) told the FMTST clinician when providing the sample on July 10, 2025, “It will probably be positive, may not be for cocaine, but it might be for G”.
(GHB or G) is a depressant drug known to cause a euphoric high that can also cause unusual and disturbing thoughts, depression, and hallucinations. Withdrawal symptoms include anxiety, paranoia, and hallucinations. F. (N.)’s July 21, 2025, sample was also positive for cocaine. The change from testing positive for cocaine metabolites to cocaine suggests an increase in use.
When F. (N.) met with FMTST on July 17, 2025, he admitted to using cocaine in the last week and informed them that the Barrie Police conducted a wellness check because of some concerns reported by [his] addiction counsellor but said he did not know what the concerns were.
During a virtual consultation with the FMTST clinicians and Dr. Ismail on July 21, 2025, F. (N.) described his mood as good and denied experiencing any psychotic symptoms. Dr. Ismail noted F. (N.) was disheveled, unkempt, and without any upper garments. He appeared quite anxious; his speech was somewhat rapid, and he was constantly vaping throughout the assessment. His presentation was out of character.
It was determined that a more fulsome assessment was necessary, and a Form 1 was issued. The Barrie Police were contacted to enact the Form 1, as the clinical team did not anticipate F. (N.) would cooperate. F. (N.) was taken to the general hospital in Midland for medical clearance.
F. (N.) was admitted to the Swing unit at Waypoint on July 23, 2025. According to Dr. Kaggwa’s Mental Health Assessment, F. (N.) presented disheveled and unkempt, with poor grooming and hygiene. His attire was inappropriate for the clinical setting, and he carried a bag of candy and Skittles, which he clutched throughout the intake process.
Medication compliance was questioned as the pharmacist discovered that, based on F. (N.)’s last fill date on June 2, 2025, he would have run out of medications by early July. When asked about this by Dr. Kaggwa on July 25, 2025, F. (N.) said he had a surplus of medication from changing pharmacies. He knew that he required ongoing medications to avoid worsening of his schizophrenia. He agreed to his medications being dispensed in weekly blister packs and to return any unused medicines to the pharmacy. According to the Outpatient Pre-Board Conference Report, F. (N.) reported on June 2, 2025, that he missed a couple of doses of his medication on the weekend as he did not request a refill on time.
By July 25, 2025, F. (N.)’s grooming was improved. He was calm, his mood stable, and he appeared to be at his psychiatric baseline. His thoughts were goal-directed, yet his insight into substance use remained limited. His accounts of cocaine use were inconsistent, and when challenged with this, F. (N.) became defensive but did not offer clarification. He acknowledged regular alcohol use with “no plans of stopping alcohol. However, I want to slow down on the cocaine.”
When assessed by Dr. Ismail on July 25, 2025, F. (N.) expressed some frustration about the Form 1 and minimized Dr. Ismail’s concerns. F. (N.)’s mental state was good, and he reported getting more sleep while in the hospital. He continued to deny cocaine use, blaming positive urine drug screens on being around people who were using. He said he had been compliant with his medication by taking the medication he had stockpiled. He also told Dr. Ismail that the addiction counsellor had misunderstood what he had said.
Dr. Ismail’s recommendation was for F. (N.) to remain in the hospital for treatment and engage in substance use programming, but F. (N.) was adamant that he wanted to be discharged.
On July 27, 2025, F. (N.) was discharged against medical advice. He had been stable during the admission, engaged with the staff and other patients, consistently denying psychotic symptoms, and wanting to be discharged.
Dr. Ismail was asked about the link between substance use and increased risk to the public, and the need for an abstain clause. Dr. Ismail indicated that with a diagnosis of schizophrenia, no use of substances or alcohol is safe. In F. (N.)’s case, the index offences occurred in the context of untreated schizophrenia and substance use. F. (N.) has a pattern of using alcohol with a slow increase in substance use, which gradually escalates. If he does not take his medications as prescribed, his risk of violence increases.
Asked specifically about the impact of GHB, Dr. Ismail testified that the drug could cause significant delusions and hallucinations, even without a diagnosis of schizophrenia, and can induce and exacerbate delusions and hallucinations in persons with a diagnosis of schizophrenia.
In F. (N.)’s case, there is evidence that the abstain clause is effective in providing the external motivation F. (N.) requires to abstain from alcohol and substances. In his first year under the Board’s jurisdiction, his disposition contained an abstain clause, and all urine drug screen tests were negative for alcohol and substances. When it was removed in the second year, F. (N.) was not aware of its removal, and the urine drug screens remained negative for alcohol and substances. As soon as he was made aware of the removal of the abstain clause, urine drug screens yielded positive results for the presence of alcohol and substances.
Dr. Ismail told the Board that in the last part of 2024, the treatment team tried to work with F. (N.) in the hope that an abstain clause, or a detention order would not be required to manage the risk of continued substance and alcohol use. To his credit, F. (N.) began one-on-one counselling sessions with an addiction counsellor.
Each time a urine drug screen tested positive for substances, the treatment team would try to see F. (N.) as soon as possible, however this was difficult because of F. (N.)’s work schedule. Dr. Ismail told the Board that during the two weeks that elapsed between taking the urine sample, obtaining the test results, and being able to see F. (N.), the effects of the substance/alcohol use dissipate, and F. (N.) is no longer certifiable under the Mental Health Act. (“MHA”)
F. (N.) is capable to make treatment decisions, so the Box B criteria under the MHA are not available, and it is difficult to support an involuntary admission to the hospital under Box A.
Dr. Ismail told the panel that, to his credit, F. (N.) “does amazing to get jobs.” He has a very good relationship with the treatment team and wants to do well. During his first two years under the ORB’s jurisdiction, Dr. Ismail had been extremely impressed by F. (N.)’s abstinence.
When asked about housing, Dr. Ismail indicated that they were working with F. (N.) to obtain more suitable housing, since substance use is prevalent in the current boarding house. Dr. Ismail agreed that F. (N.) poses a risk to the public in this setting and noted that the victim of the index offence was a fellow resident of a boarding house.
Dr. Ismail indicated that it is necessary for the Hospital to approve housing to ensure that F. (N.) lives in accommodation where F. (N.) can safely recover and practice abstinence.
Dr. Ismail indicated that the treatment team plans to work with F. (N.), to keep him living in the community for as long as his risk to the public does not increase.
When asked what he hopes to see between now and the next annual hearing, Dr. Ismail testified that he hopes F. (N.) will develop internal motivation to abstain from substances and alcohol. The doctor stated that F. (N.) has partial insight into his substance use issues, and that he currently needs external structure to support abstinence. The detention order will enable the Hospital to intervene in a timely manner, if necessary. F. (N.) is agreeable to counselling, and the doctor has hopes that a different type of therapy (other than CBT-based therapy) will help F. (N.) to develop insight and internal motivation to remain abstinent.
No other evidence was adduced by the parties.
In closing submissions, the parties maintained their initial positions. Ms. Francis noted that it is very unusual for someone to agree to a change from a conditional discharge to a detention order, and that this reflects how seriously F. (N.) is taking this turn in events. Ms. Francis noted that F. (N.) has great respect for Mr. Don Childs, his worker, and wants to show how well he can do in the upcoming year. To his credit, F. (N.) plans to complete his grade 12 equivalency in the fall to support career-type employment. He gave up his car in recognition of the financial burden and is looking for more suitable accommodation. Ms. Francis encouraged F. (N.) to continue in a positive trajectory.
Analysis and Conclusion
Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board agrees with the joint submission: F. (N.) 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 on this matter, the Board relies on the uncontroverted expert evidence of Dr. Ismail, in addition to the documentary evidence before us.
Flowing from the Board’s finding that F. (N.) 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 shaping the disposition must be the safety of the public while also considering F. (N.)’s needs pursuant to s. 672.54 of the Criminal Code.
The necessary and appropriate disposition for F. (N.) provides him with as much freedom as possible without subjecting the community to a real risk of dangerous behaviour.
The Board notes that the proposed detention order includes a broad range of passes which allow F. (N.) extensive freedom to live and work the community, with Hospital supervision and approval.
The Board agrees with the joint recommendation of the parties that a detention order is the necessary and appropriate disposition. Dr. Ismail’s evidence was clear that the MHA was not sufficient to manage the potential risk to the public of F. (N.)’s substance use. Substances are a risk factor for F. (N.). He has partial insight in that he understands that substance use is bad, but he does not relate it to the risk of violence or psychotic symptoms. He wants to use substances in small quantities, believing that a small amount is not harmful. He has a history of complying with an abstain clause but then using substances once he is aware that the abstain clause has been removed, thus demonstrating the need for external motivation to remain abstinent.
F. (N.) decompensates gradually with the use of substances, making it difficult under the MHA for the Hospital to disrupt substance use by bringing F. (N.) to the Hospital before his risk to the public becomes unacceptably high.
The evidence also supports the conclusion that F. (N.) did not always take his medication as prescribed.
In coming to our decision, the Board relies on the following excerpts from the Clinical and Composite Assessment of Risk:
Since his annual hearing in May 2025, F. (N.)’s presentation and circumstances have deteriorated significantly, creating an elevated and unacceptable risk to public safety that cannot be managed under his current conditional discharge. In the short span since that hearing, he has moved from the stability of his parents’ home to a boarding house known for substance use, without prior discussion with his treatment team. This transition has coincided with a clear escalation in substance use, from regular alcohol consumption to repeated cocaine use, with toxicology reports in April, May, June, and July 2025 consistently positive for cocaine and its metabolites. Despite overwhelming evidence, F. (N.) has provided implausible explanations—such as contamination from shared water bottles or second-hand exposure—and has minimized the role substances play in his illness, stating openly that he has “no plans” to stop drinking and intends only to “slow down” cocaine use. This lack of insight is particularly alarming given his well-established history of psychotic relapse in the context of substance use and the documented link between intoxication and the sexualized delusional content present at the time of his index offence.
The cumulative effect of these factors—escalating substance use, poor insight, sexualized disclosures, treatment noncompliance, and social destabilization—creates an intermediate to long-term risk profile that cannot be adequately mitigated with the Mental Health Act. The current conditional discharge is insufficient to address these risks, particularly given the inevitable delays between substance use, toxicology confirmation, and the ability to intervene clinically. These delays provide dangerous windows in which F. (N.) can continue using substances and potentially re-engage in harmful behaviours without timely detection. A detention order is therefore necessary to ensure continuous monitoring, structured delivery of substance use interventions, and comprehensive assessment of his current sexualized ideation. Furthermore, an abstinence clause is essential, as periods of mandated abstinence have historically coincided with stable toxicology results and reduced risk behaviours, whereas the removal of this condition immediately preceded rapid relapse into use. Such a clause would directly reduce the likelihood of psychiatric decompensation and recurrence of high-risk behaviours, thereby protecting public safety. In summary, F. (N.)’s current presentation represents a substantial and unmanaged threat to the community, and only a detention order with a strict prohibition on alcohol and illicit substances can adequately address the risks he poses.
The Board notes an emergent concern of maladaptive sexual preoccupation, referenced on pages 45, 46, and 48 of the Hospital Report. The Board suggests that it would be appropriate going forward to have this issue more formally and comprehensively assessed.
In consideration of all the evidence, submissions of the parties and criteria set forth in s. 672.54, the paramount consideration being the safety of the public, in addition to the other needs, the necessary and appropriate Disposition is the Detention Order, with the clauses as recommended by the Hospital, agreed to by all the parties, and set out in our formal Disposition.
The Board encourages F. (N.) to participate in programs which will support abstinence from alcohol and substances and wishes him success as he upgrades his education.
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