Re: Christopher Iannacchino
ORB File No: 8367
Hearing Held On: Friday, December 5, 2025
Place of Hearing: Waypoint Centre for Mental Health
Pursuant To: Section 672.48(1) and 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Ms. C. Finley Members: Dr. P. L. Darby Dr. G. Kerry Ms. A. La Viola Ms. D. Smith
Parties Appearing: Accused: Christopher Iannacchino Counsel: Mr. J. Kopman Person in charge of Hospital: Representative: Ms. T. Murdock Attorney-General of Ontario: Counsel: Ms. S. Curry
REASONS FOR DISPOSITION
(Dated January 28, 2026)
OVERVIEW
Christopher Iannacchino was found unfit to stand trial on account of mental disorder on August 3, 2023, on a charge of second degree murder, contrary to the Criminal Code. Mr. Iannacchino is currently subject to a disposition of the Ontario Review Board dated December 30, 2024, detaining him at the Waypoint Centre for Mental Health Care – Provincial Forensic Programs Division, Penetanguishene, Ontario. The terms of his detention order include hospital and grounds privileges, escorted by staff.
On October 20, 2025, the Board received notice from Waypoint under Rule 13 of the Rules of Procedure, recommending that Mr. Iannacchino be transferred and detained at St. Joseph’s Healthcare Hamilton’s Forensic Program.
ISSUES
On December 5, 2025, the Board convened at Waypoint for a hearing further to s. 672.81(1) of the Criminal Code to review the current disposition. The Board was asked to determine whether Mr. Iannacchino remained unfit to stand trial at the time of the hearing pursuant to s. 672.48(1) of the Criminal Code, and whether he is a significant threat to public safety, and further, what is the necessary and appropriate disposition in the circumstances for Mr. Iannacchino according to the factors set out in s. 672.54 of the Criminal Code.
At the outset of the hearing, Counsel for Mr. Iannacchino joined the Hospital’s position – Mr. Iannacchino remains unfit to stand trial, and he continues to represent a significant threat to the safety of the public. The necessary and appropriate disposition for Mr. Iannacchino is to be transferred to the less secure hospital environment at St. Joseph’s Health Care Hamilton. Counsel for the Attorney General agreed that Mr. Iannacchino remains unfit to stand trial and took the position that Mr. Iannacchino should remain at Waypoint, under the current disposition, with no change at this time.
FINDINGS
- The Board found Mr. Iannacchino continues to be unfit to stand trial, and given the seriousness of the index offence, major mental illness, communication deficits, past deterioration when unmedicated, and the absence of meaningful therapeutic engagement, he continues to pose a significant threat to the safety of the public. A detention order is necessary, and the Board concluded that the least onerous and least restrictive disposition is a transfer to St. Joseph’s (a secure forensic hospital), with initial privileges limited to hospital grounds, and no immediate community passes. Also, any amendment to the no-contact provision is subject to family confirmation, and their revocable written consent.
PERSONAL BACKGROUND
The Hospital Report dated November 3, 2025, was entered as an exhibit at the hearing. The following background information, including the allegations of the events surrounding the second degree murder charge has been taken from the Hospital Report, summarized here as follows.
On January 26, 2021, police were dispatched to a townhouse where they found the female victim with apparent blunt force trauma to her head. She was pronounced dead at the scene. Her son discovered her covered in blood after returning home from work, and he called 911. The accused, Christopher Iannacchino (the victim’s son and brother to the complainant), was not present when police arrived. It was learned that he had a history of schizophrenia and paranoia, and the victim was last known to be alive while alone with him on January 25, 2021. He returned to the scene with blood on his body and clothing, leading to his arrest. During police questioning, he admitted to punching his mother, stomping her face, and smashing her head into wood, claiming he acted in “pre-self-defence” during an argument over food. He left her on the floor before departing for a walk. Medical records indicated he had a history of not taking his prescribed anti-psychotic medication.
Mr. Iannacchino is 36 years old. As a child he reportedly had learning and social difficulties that required support. With assistance he appears to have completed high school and subsequently worked in manual labour roles until becoming unemployed in 2012.
Mr. Iannacchino was a frequent cannabis user before his illness onset and CAMH records indicate he ceased cannabis use in 2017. He had used both alcohol and cannabis, though frequency and quantities were not specified. His brother reported regular cannabis smoking and described him as an alcoholic, noting that after his psychotic break, he began to consume hard liquor.
Before the index offence Mr. Iannacchino resided with his mother and eldest brother, in a recently occupied home in Tottenham, Ontario. He has never lived independently outside the family home.
A check of the Canadian Police Information Centre database showed that Mr. Iannacchino has no criminal record and no other criminal charges, other than the events surrounding the second degree murder charge as outlined above, which forms the present charge before the court.
PSYCHIATRIC BACKGROUND
Mr. Iannacchino’s current psychiatric diagnoses are Schizophrenia, Autism Spectrum Disorder and Unspecified Obsessive Compulsive Disorder. He has been found incapable of making decisions about his medical treatment, but capable of managing his finances. The Office of the Public Guardian and Trustee has been designated as his substitute decision maker.
The first psychiatric admission appears to have been in May 2014. After several days without sleep and marked paranoia and bizarre behaviour, family members brought Mr. Iannacchino to Brampton Civic Hospital. He was diagnosed with schizophrenia and cannabis use disorder, initially reluctant to accept medication but, after psychoeducation, began prescribed treatment and showed gradual improvement. He was referred in 2017 to a first-episode psychosis service, though records of outcomes from that referral are not available.
After Mr. Iannachino’s arrest on January 26, 2021, and admission to Central North Correctional Centre, staff repeatedly noted disorientation, impairments in memory and insight, tangential and disorganized thinking, and a blunted or flat affect. Observations over the following months documented withdrawal from dayroom activities, frequent refusal of psychiatric medication, and variable agitation – at times yelling in court or making threatening remarks – though no sustained physical aggression was recorded. He was assessed multiple times by psychiatry and mental health staff.
The court ordered a fitness assessment, and Mr. Iannacchino was admitted to Waypoint in August 2021, where he was found unfit to stand trial. After further fitness training he was returned to court and found fit on March 23, 2022. He requested cessation of medications on November 23, 2022, after which his condition deteriorated, and he was found unfit on two subsequent court dates. Despite intensive fitness coaching in the Awenda Program at Waypoint, Mr. Iannacchino remained unfit to stand trial. He declined a recommended neuropsychological assessment, and he refused psychiatric medication for two months in 2023. Since October 2023, with substitute decision-maker approval, he has received monthly long-acting Invega Sustenna.
At last year’s annual hearing, the Board found Mr. Iannacchino remained unfit to stand trial. Although since that finding, his responses to the fitness questions have shown some improvement, that progress is tentative given his documented history of fluctuating fitness.
EVIDENCE AT THE HEARING
Mr. Iannacchino’s current course in hospital is detailed in the Hospital Report. His attending psychiatrist is Dr. P. Ismail. The treatment information for this reporting year is summarized here, along with updated information provided at the hearing.
Dr. Ismail testified that Mr. Iannacchino continues to demonstrate very poor communication skills related to negative symptoms of schizophrenia, and core features of autism spectrum disorder, particularly around social and communicative functioning. He stated that these deficits persist despite treatment of overt psychotic symptoms.
Dr. Ismail explained that Mr. Iannacchino is able to answer some fitness test questions with extensive fitness coaching, and that he remembers and recalls those answers for the time being, but that his responses are largely rote memory rather than true understanding. Dr. Ismail affirmed that, as time passes, Mr. Iannacchino is not able to repeat or retain the material and that his improvements are fragile and inconsistent. Additionally, Mr. Iannacchino does not have the communicative or social skills necessary to appreciate the object of the proceedings or to understand his index offence in a way that would permit meaningful decision-making about his case. Dr. Ismail concluded that Mr. Iannacchino cannot adequately communicate with or instruct counsel to participate meaningfully in a trial.
Dr. Ismail also confirmed that a number of accommodations would be required for Mr. Iannacchino to participate in proceedings, and that even with those accommodations, participation would be difficult and the feasibility of effective participation remained doubtful. Dr. Ismail stated that fitness coaching at Waypoint has been exhausted, and that further improvement is not evident.
After further inquiries, Dr. Ismail addressed treatment and risk, noting that Mr. Iannacchino will not take oral antipsychotic medication and that the only viable option has been long-acting injectable medication, which he is currently receiving at an adequate dose. Stopping medication in the past increased his risk, and unmedicated periods were associated with high levels of dissociation, with considerable risk to the safety of others.
In terms of Mr. Iannacchino’s behaviour during the review period, Dr. Ismail described it as largely self-isolated. He remains on a high security level (with the highest privilege levels available at Waypoint – C5 level) allowing him independent off-unit access to certain areas of the hospital for up to four hours every day. He attends the canteen briefly and returns to his room, does not participate in group or therapeutic activities, and engages minimally with staff and co-patients. Dr. Ismail testified that Mr. Iannacchino has not experienced any active symptoms of schizophrenia. He likes his isolation, which the doctor attributes to a feature of his autism spectrum disorder. Dr. Ismail confirmed that there were no seclusions, no use of chemical or physical restraints, and no incidents of sustained physical aggression during the review period.
In Dr. Ismail’s opinion, a transfer to a less secure forensic facility such as St. Joseph’s is appropriate because Mr. Iannacchino has not required high security interventions, his behaviour has been manageable in a less active environment, and his risk can be managed in a secure forensic setting. Dr. Ismail acknowledged that a transfer to a less secure hospital setting would not necessarily increase engagement and that it is unlikely Mr. Iannacchino would suddenly participate in programming, but he stated that a step-wise progression and inpatient assessment at the receiving facility would permit further decisions about community engagement.
Dr. Ismail explained that community passes are not being recommended at this time because Mr. Iannacchino does not engage with staff, or programming, which makes him difficult to assess. The doctor indicated that decisions about privileges should be left to the receiving facility. Dr. Ismail also confirmed the Hospital’s recommendation for continued no-contact conditions with named family members, while acknowledging that if family members later expressed willingness for contact the treatment team would consider a revocable written consent process beginning with telephone contact.
SUBMISSIONS
The Hospital maintained its initial position that Mr. Iannacchino is unfit to stand trial and that, based on the evidence provided, he is most appropriately and necessarily placed on the forensic programs of St. Joseph’s, together with the privileges and conditions noted in the Hospital Report. Mr. Iannacchino has remained at a C5 privilege level. There have been no seclusions during the review period and no aggressive or maladaptive behaviours. The Hospital requested that, on transfer, his privileges initially be restricted to hospital grounds only. With respect to the no-contact order, the Hospital had no objection to an amendment permitting the family’s revocable written consent. In the Hospital’s submission, a transfer to St. Joseph’s would represent the least onerous, least restrictive disposition.
Counsel for the Attorney General maintained their initial position. Mr. Iannacchino has been at Waypoint for just over two years. Clearly, he remains unfit, and he is most likely permanently unfit, while continuing to present a significant threat to public safety. He has not posed management difficulties at Waypoint during the review period. However, although there have been no seclusions or notable incidents, Mr. Iannacchino has not engaged with staff or co-patients, and he does not participate in therapeutic or recreational programming. At the time of the index offence, he was unmedicated, and so his current medication is therefore a significant positive factor, and his overt psychotic symptoms do not presently manifest. However, the lack of engagement and absence of rehabilitative progress otherwise mean his risk has been mitigated by medication only, and not by programming or functional gains. He remains socially isolated and largely unchanged from his pre-offence circumstances. In her submission, it would be premature to authorize a transfer to a less secure setting at this time.
Counsel for Mr. Iannacchino adopted the Hospital’s submissions regarding fitness and the transfer to St. Joseph’s. Addressing Counsel for the Attorney General’s position – Counsel stated that, given Mr. Iannacchino’s withdrawn and secluded presentation and the evidence provided by Dr. Ismail, there is nothing to suggest his level of risk would increase if he were moved to a less secure forensic unit. Non-engagement with programming is not evidence that risk cannot be managed in a less secure forensic setting or that the high-security environment is necessary to ensure public safety. Counsel submitted that the least onerous and least restrictive disposition is a transfer to a less secure forensic unit in lieu of continued placement at Waypoint, and that the availability of privileges at such a facility provides opportunities Mr. Iannacchino might reasonably aspire to, in order to engage with therapeutic, social and vocational programs.
ANALYSIS AND CONCLUSION
(a) Fitness to Stand Trial
The Board’s obligation under s. 672.48(1) of the Criminal Code is to determine whether the accused is fit to stand trial as of the day of the hearing, as defined under s. 2 of the Criminal Code. After a thorough review of the evidence presented at the hearing by Dr. Ismail, and the information contained in the Hospital Report, the Board has determined that Mr. Iannacchino does not meet the legal criteria for fitness to stand trial.
In reaching its conclusion, the Board applied the legal test for fitness to stand trial as clarified by the Supreme Court of Canada in R. v. Bharwani, 2025 SCC 26. The inquiry is whether Mr. Iannacchino presently possesses a basic, reality-based ability to understand the nature and object of the proceedings, to understand the possible consequences of the proceedings, and to communicate with counsel in a manner that permits instructing counsel and participating meaningfully in his defence.
With respect to the specific statutory criteria, the Board finds the following. First, Mr. Iannacchino does not possess a basic, reality-based understanding of the nature and object of the proceedings. He lacks appreciation of the purpose of the court process, and he has no reliable comprehension of the criminal charge he faces, routinely reporting an inability to recall the event, and showing no capacity to engage in factual or reflective discussion about it.
Second, he does not understand the possible consequences of the proceedings in any meaningful way. His answers to questions about outcomes are superficial, and there is no evidence that he can grasp or weigh the implications of guilty or not guilty findings, or the sentencing process. Of note, his presentation is dominated by marked social withdrawal, blunted affect, very limited engagement with staff and co-patients, and a pattern of rote or superficial responses rather than demonstrated understanding.
Third, he cannot communicate with counsel in a manner that would permit meaningful participation in his defence. Mr. Iannacchino’s answers to the fitness test questions are achieved only with extensive fitness coaching. They are largely rote, not retained over time, and lack the required underlying understanding. Overall, his communicative limitations render effective instruction and collaboration with counsel unlikely. The Board has also considered prospects for remediation. Intensive fitness coaching at Waypoint and the Awenda Program has been attempted and appear to have been exhausted. On that basis, the Board finds Mr. Iannacchino unfit to stand trial at this time.
(b) Significant Threat
Having determined that Mr. Iannacchino remains unfit to stand trial at this time, and in reviewing a disposition under s. 672.48(1) of the Criminal Code, we must now turn to the issue of whether Mr. Iannacchino continues to pose a significant threat to the safety of the public as defined in the seminal case of Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625. And for those purposes, we are mindful that a significant threat means a risk of serious physical or psychological harm to members of the public, resulting from conduct that is criminal in nature but not necessarily violent.
The most salient factors supporting a finding of significant threat is the nature and gravity of the offence, and the psychiatric and behavioural history that contextualizes that violent conduct. Mr. Iannacchino suffers from a longstanding psychotic disorder (Schizophrenia) with periods of non-adherence to treatment and prior inpatient commitment, together with core Autism Spectrum Disorder features, and communication deficits. Previous unmedicated periods – with marked deterioration and increased dissociation – expressly confirms that when unmedicated Mr. Iannacchino’s risk to others has increased in the past.
The Board also places weight on the pattern of medication non-compliance and fluctuating fitness. Mr. Iannacchino has a documented history of refusing oral antipsychotics, requiring long-acting injectable medication to achieve control of positive symptoms. Notably, in 2022, he requested cessation of medication followed by clinical decline, and court findings of unfitness, demonstrating that Mr. Iannacchino’s stability is medication-dependent, and that his risk profile can materially worsen if treatment adherence lapses.
Behavioural observations during the review period are relevant but must be read in context. While Waypoint staff reported no seclusions, no use of restraints and no sustained physical aggression during this review period, they also documented persistent self-isolation, minimal engagement with staff or co-patients, absence of participation in programming, blunt affect, and superficial/rote responses to fitness assessments. Those features indicate limited rehabilitative progress and make reliable risk appraisal more difficult because Mr. Iannacchino remains minimally interactive and therefore hard to assess in dynamic ways. The lack of engagement with therapeutic programming means that Mr. Iannacchino has not demonstrated functional improvements beyond medication-controlled reduction in positive symptoms.
Taken together, these considerations produce a risk profile characterized by a history of extremely violent, criminal conduct causing death, a major mental illness with autism that impairs communication and insight, documented instability and past deterioration during periods without medication, and dependence on long-acting injectable medication for control of positive symptoms, together with minimal engagement with rehabilitative programming. These factors, when weighed against the lack of recent aggressive incidents, nonetheless support a conclusion that Mr. Iannacchino poses ongoing risk of serious physical harm to members of the public.
(c) Necessary and Appropriate
The Board must next determine the disposition that is necessary and appropriate in the circumstances. The disposition must embrace the principle of ‘least onerous and least restrictive’ with due consideration given to Mr. Iannacchino’s liberty interests, which must also be consistently weighed together with concerns about public safety (the paramount concern), his mental condition, and his reintegration into society, as required by s. 672.54 of the Criminal Code.
The Board has determined that Mr. Iannacchino requires a detention order to manage his level of risk at this time. This decision is grounded in several key factors that highlight the appropriateness of transferring him to a less secure hospital environment.
Mr. Iannacchino’s current risk is primarily driven by a history of severe, unmedicated psychosis and that his positive symptoms are presently controlled by long-acting injectable antipsychotic medication. During the review period he has required no seclusions, no chemical or physical restraints, and has not exhibited sustained physical aggression. His behaviour has been characterized by marked social withdrawal and minimal engagement, rather than by active institutional management problems. Those objective observations indicate that, while the underlying risk remains serious if medication compliance or stability are lost, his current presentation is manageable in a less secure forensic environment.
The Board also finds that a transfer to St. Joseph’s does not represent a reduction in supervision to the community. Rather, it is a transfer to another secure forensic hospital program with the capacity to continue intensive inpatient management, to reassess needs in a different clinical setting, and to implement a progression for privileges and community contact only when clinically warranted, and supervised. The receiving hospital’s capacity to perform a fresh inpatient assessment, to tailor programming and security measures, and to expand or restrict privileges incrementally preserves public safety, while offering potential therapeutic benefits to Mr. Iannacchino that have not yet been realized.
In exercising its discretion to identify the least onerous and least restrictive disposition, the Board has also considered practical safeguards. The disposition limits initial privileges to hospital-grounds only, with no immediate community passes. Any modification of the ‘no-contact’ provision in the disposition would be subject to revocable written consent and confirmation from Mr. Iannacchino’s family. Ongoing adherence to long-acting injectable medication, supervision within a secure forensic unit, and continued clinical review at St. Joseph’s will ensure that public safety remains paramount, while permitting transfer to a setting that is less onerous in terms of security levels.
Balancing Mr. Iannacchino’s liberty interests against the paramount concern for public safety and having regard to his mental condition, and his prospects for reintegration, the Board concludes that a detention order with transfer to St. Joseph’s – subject to the restrictions and safeguards described above – is necessary and appropriate at this time. The transfer is the least onerous and least restrictive disposition that adequately manages the significant threat he poses while allowing for further clinical assessment and potential, incremental therapeutic engagement while he remains in a secure forensic setting. Until that transfer can be effected, Waypoint will maintain residual authority of Mr. Iannacchino’s care.
DATED this 28th day of January 2026, at the City of Toronto, in the Toronto Region.
Ms. A. La Viola Legal Member
Office of the Registrar Ontario Review Board