Ontario Review Board
Re: Richard Carangay
ORB File No: 6935
Hearing held on: Monday, July 21, 2025
Place of hearing: St. Joseph's Healthcare Hamilton West 5th Campus, 100 West 5th Street
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Ms. T. Mann Members: Dr. A. Park Dr. G. Kerry Mr. D. D’Intino Ms. C. Plyley
Parties Appearing: Accused: Richard Carangay Counsel: Mr. R.W. Browne
The Person in Charge of Hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Mr. B. Adsett
REASONS FOR DISPOSITION
(Dated September 23, 2025)
Introduction:
On March 23, 2016, Richard Carangay was found not criminally responsible on account of mental disorder (NCR) on a charge of possession of a weapon for a purpose dangerous to the public peace, contrary to the Criminal Code. He is currently subject to a disposition of the Ontario Review Board (the Board) dated July 29, 2024, ordering his detention at the Forensic Psychiatry Program of St. Joseph’s Healthcare Hamilton (SJHH or the Hospital) with privileges up to and including residence in the community of Southern Ontario in accommodation approved by the person in charge.
On Monday, July 21, 2025, the Board convened a hearing to conduct the annual review of Mr. Carangay’s disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. Carangay was present at the hearing and represented by Counsel, Mr. R. Browne.
The issues to be determined at the hearing were whether Mr. Carangay represented a significant threat to the safety of the public as defined in s. 672.5401 of the Criminal Code and, if so, the necessary and appropriate disposition which was also the least onerous and least restrictive, taking into account the factors set out in s. 672.54 of the Criminal Code.
Positions of the Parties:
- At the commencement of the hearing the parties were invited to provide their recommendations with respect to the issues before the Board. Counsel for the Hospital posited that Mr. Carangay continued to represent a significant threat to the safety of the public and that the necessary and appropriate disposition was a continuation of the terms and conditions of the current detention order. Counsel for the Attorney General concurred with the Hospital. Counsel for Mr. Carangay advised his client would not take issue with the Hospital’s recommendations. Thus, in effect, the Board was presented with a joint submission as to the issue of significant threat and the necessary and appropriate disposition.
Index Offence:
- The circumstances of the index offence are taken from last year’s Reasons for Disposition as follows:
“For reasons that are unclear, Mr. Carangay became angry with his next door neighbor. On November 28, 2014, Mr. Carangay went to his neighbour’s home, armed with a baseball bat. He was screaming and yelling and swinging the baseball bat around. He uttered a threat to cause bodily harm to his female neighbour, and when her husband appeared, Mr. Carangay tried twice (unsuccessfully) to hit his male neighbour in the head with a baseball bat. Mr. Carangay then returned to his own home. When the police arrived shortly after, Mr. Carangay appeared on the porch of his home with a large butcher knife and began swinging it in the direction of the police. Mr. Carangay went back to his home and came out sometime later. He was unarmed but charged at the police. He was taken down and arrested.”
Background Information Regarding the Accused:
Mr. Carangay is currently 56 years old. He was born in the Philippines and immigrated to Canada with his family when he was seven. As a youth, Mr. Carangay excelled at sports, particularly baseball and hockey. He was a very social individual who had a lot of friends.
Mr. Carangay did well in school until grade 12 when he began to have difficulties academically and started to use substances on a regular basis. He was expelled from school that year after being found in possession of and distributing illicit substances. He attempted to complete grade 12 at another school but was unable to do so. He enrolled as a mature student at George Brown College in 1991 to study business information systems but was unable to complete this program as well.
Mr. Carangay has a limited employment history. He worked as a kitchen installer for Ikea in the late 1980s with his brother. He also worked for about a year in the factory at Carleton Cards in the late 1990s. Mr. Carangay has been receiving ODSP since 1994.
Mr. Carangay has a significant history of substance use, criminal offending and contact with psychiatric services commencing at a young age. Mr. Carangay reports that he began using cannabis when he was in grade 12. He continued to use cannabis on a regular basis, smoking up to 1g per day, except when incarcerated, until the time of the index offence in November 2014. He was introduced to crack cocaine in 1989 and became addicted.
Mr. Carangay’s first involvement in the criminal justice system was at 17 when he was found guilty of theft. He has further convictions for assault and weapons offences and reportedly was incarcerated from 1989 to 1990 and again between 1991 and 1994.
On April 4, 2015, Mr. Carangay had an altercation with police that left him with bruising and a bloody, swollen face. He has suffered multiple fractures as a result of various altercations with police.
In terms of family support, Mr. Carangay enjoys a close relationship with his brother and his mother, both of whom have supported him throughout his many difficulties over the years. Mr. Carangay and his mother are regular church goers and Mr. Carangay’s religious faith remains a positive, motivating force in his life. Mr. Carangay’s brother moved to Toronto from Niagara Falls this year. Mr. Carangay is not married and has no children.
Psychiatric History:
Mr. Carangay reports that he first began hearing voices in 1993 and had his first involvement in the mental health system in 1994 when he was sent for assessment at the Centre for Addiction and Mental Health (CAMH) while incarcerated at the Guelph Correctional Centre. His mother reports that he was diagnosed with bipolar disorder and began seeing a psychiatrist after his release from custody. Between 1994 and the NCR finding in 2016, Mr. Carangay was admitted to hospital on approximately 12 occasions with respect to mental health issues. Many of the admissions involved police bringing him to hospital after finding him behaving in a bizarre and aggressive manner in public. Upon admission, Mr. Carangay frequently exhibited delusions, hallucinations, paranoia and aggression.
Mr. Carangay’s current diagnoses are bipolar disorder and cannabis use disorder (in remission in a controlled environment). He is capable to consent to treatment with psychiatric medication.
Following the finding of NCR in March 2016, Mr. Carangay was detained on a general forensic unit at SJHH where he remained until his November 2020 annual review, at which time he was discharged to reside with his mother in the Niagara Falls area. Since then, he has been readmitted to hospital on several occasions due to breaches of his disposition and/or decompensation of his mental health in the community. His last readmission was on April 22, 2025, when he was readmitted due to changes in his baseline mental status and behaviours.
In general, Mr. Carangay’s progress while under the jurisdiction of the Board can best be described as positive overall, but inconsistent at times. Strict adherence to medication and abstinence from cannabis are two of the most significant factors contributing to Mr. Carangay’s ability to safely reside in the community. When these mainstays of his stability fall away, Mr. Carangay deteriorates precipitously.
Mr. Carangay remains in need of a high degree of extrinsic support from forensic and community-based mental health professionals. Since his discharge to the community, Mr. Carangay’s risk to the safety of the public has been well-managed by successive detention dispositions which have enabled his prompt re-admission to hospital for assessment and stabilization.
More generally, Mr. Carangay’s mental health is fragile, and he is sensitive to the impact of cannabis on his mental state. Due to that fragility, he tends to decompensate rapidly. When this occurs there is a significant likelihood that he will cease taking oral antipsychotic medication which negatively impacts his mental stability. When less mentally well, Mr. Carangay quickly becomes floridly psychotic, agitated and loses insight into his mental health, particularly his need for medication and abstinence. He can be aggressive to the point where physical and chemical restraints are necessary to control his behaviour.
When at his baseline, Mr. Carangay is a pleasant individual who readily engages and cooperates with others, including members of his treatment team and those comprising his community-based psychiatric supports.
On July 8, 2025, the Board held a hearing at SJHH to review the decision of the Hospital to significantly increase the restrictions on Mr. Carangay’s liberty. The Board determined the ROL commencing March 12, 2025 and lasting until April 7, 2025, and a second ROL from April 22, 2025, ongoing as of the date of the July 8th hearing, were both found to be necessary and appropriate to manage Mr. Carangay’s risk to the safety of the public.
Currently, Mr. Carangay remains in hospital. Mr. Carangay has been followed by Dr. O. Kolawole for the last eight years. Mr. Carangay is followed in the community by the Forensic Outpatient Clinic as well as the Niagara Region ACT team.
Evidence at the Hearing:
The Board had available to it background information in the form of the hearing documents, including the Notice of Hearing dated December 17, 2024, Disposition dated July 29, 2024, the Reasons for Disposition dated August 20, 2024, as well as Reasons for Decision dated July 25, 2025. A Hospital Report dated July 8, 2025, was marked and filed as Exhibit 1 at the hearing.
In addition, the Board had the benefit of oral evidence from Dr. O. Lee. Dr. Lee is a PGY-6 Fellow (Resident), working under the supervision of Dr. O. Kolawole. Dr. Lee has been involved in Mr. Carangay’s care since mid-March 2025 when he was admitted to hospital in connection with the first of two restrictions of liberty occurring in the spring of this year. Dr. Lee gave oral evidence to update and supplement the information contained in the Hospital Report, which she endorsed, including the analysis of significant threat.
Dr. Lee described Mr. Carangay has having a variable year overall; he spent most of this reporting year in hospital. As noted above, he required several readmissions to hospital, mainly for decompensation in his mental health secondary to cannabis use, social stressors and/or physical health issues. He had a number of unwitnessed falls (at a skating rink, down the stairs at home, among others) that he did not disclose to his mother or clinical staff. Subsequent testing did not reveal any adverse physical consequences from these events. A falls risk assessment was conducted in hospital by Occupational Therapy and a number of factors contributing to Mr. Carangay’s risk of falling were identified and risk-reducing strategies implemented. Notably, Mr. Carangay’s risk of falling has decreased apace with increased mental stability.
Mr. Carangay’s longstanding vulnerability to the destabilizing effects of cannabis continues to be a concern. On July 27, 2024, Mr. Carangay tested positive for cannabis. The treatment team decided to ask him to come to the Hospital for assessment. After several unsuccessful attempts to contact him and his mother, an “escape custody package” was activated and Mr. Carangay was brought to the Hospital by police.
Mr. Carangay admitted to using cannabis as a means of managing the stress and anxiety he was experiencing as to his behaviour during his ORB hearing. He later admitted to nursing staff that he had been consuming cannabis on the weekends following his scheduled bloodwork. Dr. Lee indicated that to Mr. Carangay’s credit, he has not tested positive for cannabis since, as demonstrated by negative urine/drug screens (UDS).
During this same admission, Mr. Carangay disclosed intentional non-compliance with some of his psychiatric medications at the direction of his mother, who was concerned about the effects of medication on his liver. She later admitted to replacing his medication with nutritional supplements. This occurred notwithstanding daily contact with the ACT team.
Dr. Lee indicated that to support Mr. Carangay’s suitability for discharge from hospital, a number of issues still need to be sorted out. Medication adjustments are ongoing, particularly with respect to his mood stabilization medication, lithium. When Mr. Carangay was re-admitted to Hospital in March 2025, his serum lithium was at a toxic level, raising the concern that he had ingested his medication all at once, to compensate for prior non-adherence.
According to Dr. Lee, Mr. Carangay’s mental status remains fragile. He will need a longer period of time in hospital before he is able to be discharged from hospital. Because of the number of falls Mr. Carangay has suffered, the treatment team will assess Mr. Carangay’s home to ensure that it is safe for him. Dr. Lee confirmed that the ACT team is still available to support Mr. Carangay in the community. The treatment team would like to discuss with ACT more intense involvement on their part, perhaps “eyes on” medication administration. The doctor is hoping that Mr. Carangay’s ACT team can provide more supervision with respect to Mr. Carangay’s self-administration of oral medication.
Dr. Lee touched on the issue of significant threat. Dr. Lee indicated that when Mr. Carangay is, mentally unwell, he becomes paranoid, disengages from supports and is physically aggressive. He also suffers from physical health issues which contribute to his risk of falling and concomitant deterioration in his mental status. Mr. Carangay decompensates quite rapidly, particularly if he does not take his medication or takes it other than in accordance with the prescribed dosing schedule. Cannabis use is a known destabilizer for Mr. Carangay which heightens his risk considerably.
Dr. Lee added that when Mr. Carangay’s symptoms are well managed, he engages quite satisfactorily with ACT team members and enjoys a positive relationship with them. The ACT team is aware that disengagement with others is a sign that Mr. Carangay is not doing well and if they cannot reach him, will turn to the FOP team for assistance.
In terms of Mr. Carangay’s insight, Dr. Lee characterized it as superficial; that is, Mr. Carangay understands that he should not be using substances and can identify that using substances is bad, but he lacks an understanding of how destabilizing substance use can be to his mental health. Health teaching in this regard is ongoing.
Dr. Lee confirmed that Mr. Carangay takes a long-acting injectable antipsychotic medication (Aripiprazole) intramuscularly every 28 days. Due to the fragility of Mr. Carangay’s mental state, he would likely decompensate in a matter of days to weeks, as was seen recently in the circumstances giving rise to his readmissions to hospital.
Dr. Lee indicated that overall Mr. Carangay’s relationship with his mother is quite strong and she has been a significant source of emotional and practical support to him. However, she struggles at times to appreciate the degree of his vulnerability to stress and his need to take his psychiatric medication. The treatment team is aware of this and will continue to provide on-going health teaching to Mr. Carangay’s mother as to the necessity for him to take his medication as prescribed.
In response to questions by Mr. Browne, Dr. Lee confirmed that Mr. Carangay has chronic back pain and that he requires medication to address this. Dr. Lee had not discussed with Mr. Carangay whether his periodic use of cannabis could have been a means of self-managing his chronic pain. Dr. Lee felt Mr. Carangay’s cannabis use was more likely due to the stress of the Review Board hearing which occurred around that time.
In terms of proactively managing stressors, Dr. Lee indicated that Mr. Carangay has been encouraged to reach out to staff or his outpatient team for help when experiencing stress. Dr. Lee said that should Mr. Carangay express an interest in talk therapy, a forensic psychologist could be made available to him and that Mr. Carangay’s family doctor could be approached about referring him to a community-based psychologist. Mr. Carangay would be amenable to participate in substance use programming in or out of hospital but has been too ill to participate in recent months.
Dr. Lee agreed that Mr. Carangay’s brother has been a strong source of support for him, particularly when the brother lived in the home. However, Mr. Carangay’s brother no longer lives in Niagara Falls and is unable to provide day-to-day support. This, along with Mr. Carangay’s mother’s advancing age, may be contributing to the difficulty Mr. Carangay has been having in terms of maintaining stability in the community.
In response to questions from the Board, Dr. Lee advised that Mr. Carangay does not wish to consider moving from his mother’s home to supportive housing. In fact, Mr. Carangay insists he would rather stay in hospital if he cannot live with his mother. The doctor further indicated that this – Mr. Carangay’s potential need for supportive housing – is an ongoing discussion.
Dr. Lee described the profound impact cannabis use has on Mr. Carangay’s mental state. When under the destabilizing influence of cannabis, Mr. Carangay’s pattern is to become increasingly paranoid, difficult for the team to engage, disorganized, confused and guarded. When unstable and manic, Mr. Carangay becomes disinhibited and sexually inappropriate, as happened during his most recent admission and during other admissions as well.
Currently, Mr. Carangay is doing much better. He is less irritable and less verbally aggressive. His sleep has improved. He is using his passes appropriately and looking forward to returning home.
Dr. Lee agreed that the provisions of the Mental Health Act would not be sufficient to manage Mr. Carangay’s risk to the safety of the public. It was not successful in the past. In Dr. Lee’s view, the structure of a forensic/ORB detention disposition provides the most appropriate legal framework within which to mitigate Mr. Carangay’s risk.
In response to an additional question from the Attorney General, Dr. Lee confirmed that Mr. Carangay would be unlikely to return to hospital voluntarily and that the incident of July 27, 2024, illustrated this when he had to be brought back to the Hospital by police.
Dr. Lee described the most likely re-offence scenario as consisting of the following elements: if Mr. Carangay were to discontinue his psychiatric medications, he would decompensate, grow increasingly paranoid, confused and disorganized. He would barricade himself and become physically and verbally threatening to others. He is likely to misinterpret the actions of others and to act on those misinterpretations. Should Mr. Carangay become paranoid and psychotic, there is a significant likelihood he would return to the behaviour giving rise to the index offence.
Submissions:
All counsel maintained the positions they had taken at the outset of the hearing. Hospital counsel underlined the fluctuating nature of Mr. Carangay’s major mental illness, which has required him to be in and out of hospital over the last 12 months or so, notwithstanding attempts by the treatment team to discharge him to his mother’s home in Niagara Falls. Hospital counsel described Mr. Carangay’s family as supportive and interested in his well-being; however, their help has been insufficient to maintain Mr. Carangay in the community. At this time, the treatment team is not going to rush returning Mr. Carangay back to his mother’s home. The existing disposition allows for the Hospital to respond nimbly, when necessary, to return Mr. Carangay quickly to hospital in the event of decompensation.
The Crown adopted the Hospital’s submissions.
Mr. Browne emphasized that Mr. Carangay was grateful to have a game plan which will ultimately lead to his discharge from hospital in the relatively near future and hopefully lead to his progressing to an absolute discharge over the longer term. Counsel noted Mr. Carangay continues to be very appreciative of the assistance of the treatment team. He now has a deeper understanding of his need to abstain from cannabis even while in the community, and to take such additional programming as may be available to support continued abstinence.
Analysis and Conclusion:
Having heard and considered all of the evidence and the submissions from the parties, the Board agrees with the joint submission that Mr. Carangay represents a significant threat to the safety of the public. However, apart from the joint submission, the Board has no difficulty coming to an independent conclusion that Mr. Carangay’s current constellation of symptoms and behaviours supports a finding that he poses a significant threat to the safety of the public as defined by the Supreme Court of Canada in Winko.
Mr. Carangay’s risk flows from his major mental illnesses, bipolar disorder and cannabis use disorder, which working together and separately, make him highly vulnerable to acting out in serious, criminal and violent ways when mentally decompensated and/or under the influence of cannabis.
In this regard, the Board adopts in its entirety and relies upon the psychological risk assessment carried out in 2022. At that time, Mr. Carangay’s risk for violent re-offending was considerate moderate to high while managed pursuant to a detention order disposition. along with the clinical risk summary as set out at pages 64 to 65 of the Hospital Report. On the evidence before it, the Board finds that Mr. Carangay’s risk to public safety is unchanged.
Over the past review period, there have been three attempts to discharge Mr. Carangay into the community. The longest period over which he has been able to reside in the community was between January 28-March 12, 2025. The Board finds that in the absence of the appropriate level of support, supervision and a positive therapeutic alliance, Mr. Carangay would with a high degree of certainty discontinue taking medication, become increasingly paranoid and fixated on perceived grievances about his treatment at the hands of others (misinterpretations), relapse to the use of cannabis and return to the state of mind that engendered the index offences, which were criminal in nature and serious.
Mr. Carangay’s mental status clearly remains fragile. It is easily destabilized by physical injury, stress, medication non-compliance and substance use. To Mr. Carangay’s credit, there have been no positive urine drug screens since July 27, 2024. While Mr. Carangay is compliant with his medication under the supervision of a structured environment, he struggles to take his medication properly in the community, even with the close oversight of the Forensic Outpatient Team and the Niagara Assertive Community Treatment Team. Mr. Carangay’s history of multiple hospital admissions, criminal offending, substance abuse and disengagement from psychiatric services is significant. Taken together with his manic/psychotic symptoms, affective instability, non-adherence with treatment, poor insight, poor impulse control and prior supervision failure, this Board finds that there is a real risk of mental decompensation and harm to others in the absence of forensic oversight.
This said, it is to Mr. Carangay’s great credit that he engages readily with clinical staff when his symptoms abate.
The Board carefully considered whether Mr. Carangay’s risk to public safety could be managed by the terms of a conditional discharge and concluded it could not. As noted above, Mr. Carangay’s illness is brittle, and he remains stress-vulnerable. The Mental Health Act is insufficient to meet the safety of the public. Mr. Carangay can deteriorate quite quickly. While he would likely meet the civil commitment criteria for admission to hospital when symptomatic, the concern is that Mr. Carangay will act inappropriately while decompensating and the Mental Health Act would not allow the Hospital to pro-actively intervene to prevent him from harming others. Thus, the Board finds that Mr. Carangay’s risk to public safety necessitates that it be managed by rapid re-admission to hospital, as has occurred several times over the review period. This is only possible under the terms of a detention disposition.
It is readily apparent from the evidence before the Board that Mr. Carangay’s return to the community must be handled using a cautious, measured approach that allows the Hospital to quickly intervene and readmit him to hospital if necessary to protect public safety. Thus, the Board finds there is no “air of reality” to a conditional discharge at this time and that the necessary and appropriate, least onerous and restrictive disposition is a continuation of the terms and conditions of the existing disposition.
The Board recommends that Mr. Carangay’s sexual disinhibition, which is an established feature of his presentation when decompensated, be assessed to determine whether there may be a diagnosis apart from his bipolar disorder that accounts for it. This will better inform Mr. Carangay’s treatment plan going forward, so that this aspect of his behaviour and the risk it poses to the public, including clinical staff, can be mitigated.
In addition, the Board supports the recommendations set out in the Reasons for Decision dated July 25, 20251. Specifically, consideration should be given to referring Mr. Carangay to a neuropsychologist for a comprehensive neuropsychological assessment including his memory and level of cognitive functioning. This is important given the many falls Mr. Carangay has experienced and the close association between his physical well-being and mental status.
The Board concurs with the finding that Mr. Carangay will require a well-considered individualized discharge plan that addresses his need for additional supports in the home especially regarding the administration of his medication. The Board agrees that ACT team support should be increased, if possible.
The Board wishes Mr. Carangay well over the coming year and urges him to continue to work cooperatively with his treatment team so that he can be discharged home when it is safe and appropriate.
In making this disposition, the Board has considered the criteria set out in s. 672.54 of the Criminal Code, which are the safety of the public, being the paramount consideration, the mental condition of Mr. Carangay, the reintegration of Mr. Carangay into society and his other needs.
DATED this 23rd day of September 2025, at the City of Toronto, in the Toronto Region.
Ms. T. Mann Alternate Chairperson Office of the Registrar Ontario Review Board
Footnotes
- The Reasons for Decision in connection with the two ROLs in March and April 2025 were not available until after Mr. Carangay’s hearing. The Board considers that the recommendations of the ROL panel are well supported by the evidence before it in the annual review and have incorporated them into the within Reasons for Disposition.