Re: Deryk R. Keeash
ORB File No: 6450
Hearing held on: Monday, January 19, 2026
Place of hearing: Thunder Bay Regional Health Sciences Centre
Pursuant to: Sections 672.48(1) & 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. J. Weinstein
Members: Dr. K. Hand Dr. J. C. Rose Hon. E. Kruzick Mr. R. Rainboth
Parties Appearing:
Accused: Deryk R. Keeash Counsel: Mr. U. Agostino
The Person in charge of Hospital: Representative: Dr. E. Leinonen
Attorney General of Ontario: Counsel: Ms. P. Pasloski
REASONS FOR DISPOSITION
(Dated February 9, 2026)
Introduction:
On December 3, 2013, Mr. Keeash was found unfit to stand trial on two charges of assault, both contrary to the Criminal Code of Canada (“Criminal Code”). Mr. Keeash is subject to a disposition of the Ontario Review Board (“the Board”), dated January 29, 2025, which ordered that he be detained at the Secure Forensic Unit of the Thunder Bay Regional Health Sciences Centre (“TBRHSC”). This Disposition grants Mr. Keeash permission to live in the community in supervised accommodation approved by the person in charge as well as other terms and conditions as set out therein.
On January 19, 2026, the Board convened a hearing at TBRHSC to conduct the annual review of the current Disposition.
Mr. Keeash was present and was represented by his counsel, Mr. U. Agostino.
A Hospital Report (“the Hospital Report”), dated January 13, 2026, was entered as Exhibit 1.
In accordance with s. 672.48(1) of the Criminal Code, the Board must decide whether Mr. Keeash is fit to stand trial on the day of the hearing, within the meaning of s. 2 of the Criminal Code. Specifically, is Mr. Keeash unable, on account of mental disorder, to understand the possible consequences of the proceedings and to communicate with counsel? The other issues before the Board were whether Mr. Keeash is permanently unfit, and if so, whether he remains a significant threat to the safety of the public.
If Mr. Keeash is found fit, he must be sent back to court. If he is found unfit, but not permanently so, the Board must make a Disposition that is necessary and appropriate, considering the criteria set forth in s. 672.54 of the Criminal Code. Similarly, if he is found to be both permanently unfit and a significant threat, the Board must determine the appropriate Disposition. If he is not found to pose a significant threat to public safety, he must be returned to the court.
For the reasons set out below, and based on the evidence before us, this Board has concluded that Mr. Keeash is unfit to stand trial. The Board further found that Mr. Keeash is not permanently unfit. The Board also found that the necessary and appropriate Disposition required to manage the threat posed to the public by Mr. Keeash is a continuation of the existing Detention Order Disposition.
Outstanding Charges:
At the last O.R.B. hearing held on January 20, 2025, the Board was advised that Mr. Keeash’s charges of Indecent Act (two counts), which occurred in 2012 and resulted in his initial finding of Unfit, were stayed by the court in Kenora, Ontario.
The circumstances of the remaining allegations against Mr. Keeash are excerpted from last year’s Board reasons as follows (with redactions of the victims’ names):
“On October 24, 2013, at approximately 1803 hours, Constable Berube #738 in company of Constable Brayden Beck #757 had been dispatched to 116-120 Cumberland Street South for an assault in progress. Information was received that male tenant and patient of Brain Injury Services Northwestern Ontario (BISNO) Derek Keeash had earlier left and returned to confront staff as to what he had done wrong. During his presence, he attacked two female rehabilitation support workers, RK and SB, as they had contacted police due to him leaving the premises. Keeash got upset with staff resulting with Keeash attacking SB, choking her, using both hands and began pulling her hair. Keeash then dug his fingernail into her right eye using his index finger while laughing. Kelly intervened attempting to separate Keeash from SB resulting with Keeash turning his attention at RK and he forcefully squeezed both of RK’s upper arms. RK was able to forcefully push Keeash out of the kitchen area closing and locking the door. Constable Berube and Constable Beck arrived on scene. RK allowed police into the secured apartment. Constable Berube observed SB crying and had redness below her right eye. RK was upset and frantic, advising police what had transpired leading to Keeash being arrested at 1809 hours in front of room 116 of 120 Cumberland Street South. Keeash uttered, “I didn’t do anything; they got in car crash.” Keeash was escorted out of the building and read his rights to counsel and caution at 1815 hours. Ambulance attended the scene and transported RB to the Thunder Bay Regional Health Sciences Centre for treatment. Keeash was escorted to the Thunder Bay Police Service where a message was left for L N at 1856 hours upon request.”
Course Since Last Disposition:
- Mr. Keeash’s course since his last Disposition is set out in detail in the Hospital Report. The following extracted paragraphs are relevant to this hearing:
“His overall mental status remains largely unchanged over the past year.
He frequently paces the unit hallways in a repetitive, patterned route; when others impede his path, he comes impatient and may shout ‘move.’
Mr. Keeash’s verbal communication is limited, typically consisting of brief interactions using single-word questions or responses. He minimally engaged socially with peers. He is occasionally observed laughing to himself, though he denies hallucinations, delusional thinking, or other perceptual disturbances. He consistently reports his mood as ‘good’ without further elaboration.”
Current Privilege Level:
Supervised Hospital Access
Supervised Community Access – including workers.
4 hour passes with mother, Lizzie
Other Agency Involvement:
Developmental Services of Ontario – Mr. Keeash remains on the waitlist for Supportive Housing. DSO is unable to provide details in terms of his priority within this waitlist. Mr. Keeash remains on the waitlist for Agency-Based Community Participation Supports since 2020. Mr. Keeash is approved for $25,691.50 in Passport funding per year.
Best Care Canada – Mr. Keeash attends weekly Passport outings with his Best Care Canada worker, Robin.
Northern Caribou Lake First Nation Band Office – This band office has been providing funds to assist with Mr. Keeash’s outings with Best Care Canada as well as personal needs items.
Brain Injury Services of Northwestern Ontario – Mr. Keeash remains on the waitlist for a rehab support worker with BISNO since November 16, 2018.
Norwest Community Health Centre – Mr. Keeash’s primary healthcare provider is a Nurse Practitioner, Richard McKenzie.
Current River Family Dental – A referral was made to Dr. Wilson for teeth extraction as well as Dr. Mason for a sedated hygiene appointment. Mr. Keeash is currently on the waitlist to have these procedures done in the hospital operating room.”
Housing:
Mr. Keeash remains on the waitlist for Supportive Housing in Thunder Bay through Developmental Services Ontario (DSO).
Mr. Keeash remains on the waitlist for BISNO supporting housing as of November 16, 20168”
Position of the Parties:
Dr. Leinonen, on behalf of the Hospital and as the most responsible physician, and both counsel for the Attorney General and for Mr. Keeash all agreed that Mr. Keeash is unfit to stand trial but not permanently unfit.
Dr. Leinonen and counsel for the Attorney General advised that it was their position that the necessary and appropriate Disposition in the circumstances is a continuation of the existing Detention Order Disposition.
Counsel for Mr. Keeash advised that he was unable to obtain instructions as to the necessary and appropriate Disposition.
Evidence at the Hearing:
The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Leinonen.
Dr. Leinonen testified that Mr. Keeash:
a) is unfit to stand trial, however, there has been some improvement in his fitness compared to his previous reporting year, which is promising
b) has been working with one of the treatment team nurses who does fitness teaching and education sessions with Mr. Keeash
c) has been able to verbalize some understanding of the roles and procedures of the court
d) is still unable to meaningfully participate in the proceedings, due in part to his limited communication style, and
e) continues to require a high degree of support for the safety of himself as well as others. Without the support and supervision, he receives from the treatment team, his risk to the safety of the public would increase.
- In response to questions from counsel for Mr. Keeash, Dr. Leinonen testified that.
a) the new facility that the doctor referred to in last year’s reasons for disposition that were anticipated for construction in Thunder Bay and known as DD-TRHP did not materialize, and
b) Mr. Keeash remains on the waitlist for housing with the Brain Injury Services of Northern Ontario (BISNO).
- In response to questions from the panel, Dr. Leinonen testified that:
a) Mr. Keeash’s fitness education sessions are provided on a monthly basis. In response to the suggestion that this frequency is not sufficient for someone with cognitive delays, the doctor agreed that this was likely the case, given Mr. Keeash’s cognitive issues. He added that while increasing the frequency could be considered, if approached too often, Mr. Keeash might refuse to engage and become frustrated,
b) Mr. Keeash’s communication barriers and his learning style, such as auditory versus visual memory, have not been assessed. He agreed that understanding Mr. Keeash’s memory profile could help tailor the fitness education; however, , this information is lacking and could be an area for further assessment. When it was suggested to him that the possibility of a neuropsychological consult would also help the treatment team better understand Mr. Keeash’s learning profile and adapt coaching strategies accordingly, he did not disagree.
c) He would not consider Mr. Keeash permanently unfit as the treatment team have seen some improvement in Mr. Keeash’s ability to answer certain questions regarding the roles and the nature and the object of a criminal proceeding,
d) The treatment team did try to obtain a detailed neuropsychological assessment virtually with CAMH and other facilities but unfortunately, this did not happen.
e) Mr. Keeash does participate in programs that he enjoys.
f) In the past few months, Mr. Keeash has been able to indicate that he understands his charges and verbalize some understanding of the roles and procedures of a court, as well as understanding some of the basic potential outcomes. Previously, this was something he was unable to do,
g) The doctor agreed that the following paragraph from last year’s reasons for disposition is still true to today:
“The doctor noted that Mr. Keeash requires a very high degree of supervision, and that the support and supervision in the new facility will be comparable to the support and supervision that Mr. Keeash receives in the Forensic Unit at the hospital.”
h) Mr. Keeash needs supervised accommodation in order to monitor his behavioral dysregulation as well as for the supervision of his medication regimen.
i) while the Box B criteria of the Mental Health Act might be available to bring Mr. Keeash back to hospital, he doubts Mr. Keeash would remain in hospital.
He also doubts that should Mr. Keeash be returned to a hospital other than a forensic hospital, a different hospital would consider Mr. Keesh’s cognitive limitations as not sufficient enough to keep Mr. Keeash in hospital under the Mental Health Act,
j) while Mr. Keeash is from time to time able to understand the nature and object of the proceedings and understand the possible consequences of these proceedings, Mr. Keeash cannot meaningfully communicate with counsel nor meaningfully participate or instruct counsel in criminal proceedings, and
k) Mr. Keeash’s mental disorder does compromise his ability to conduct a defence and impairs his understanding of reality and in communicating rational decisions in his defence.
Analysis and Conclusions:
Fitness to Stand Trial
- The first issue for the Board to decide is whether Mr. Keeash remains unfit to stand trial.
Applicable Law
- The Supreme Court of Canada addressed the fitness test, most recently in R v Bharwani, 2025 SCC 26 (“Bharwani”). In this decision, the Supreme Court emphasized the following with respect to the fitness test:
a) Fitness to stand trial does not require an accused to make decisions in their best interests. Instead, “it requires making decisions based on an understanding of reality that is not overwhelmed by delusions, hallucinations, or other symptoms of their mental disorder.”1
b) The accused is fit to stand trial if they can: “make and communicate reality-based decisions in the conduct of their defence or instruct counsel to do so”2 and: “intelligibly communicate these decisions to counsel or the court.”3
c) Conducting a defence involves: “making decisions that an accused must always make personally and those which relate to the exercise of their right to full answer and defence, such as decisions about pleas, the mode of trial, selection of counsel, whether to testify, whether to call or cross-examine witnesses, and closing submissions, among others.”4
d) The “capacity” required to make these decisions includes: “a reality-based understanding of the nature or object of the proceedings and their possible consequences, an ability to understand the available options and their consequences, and an ability to select between those options when making decisions.”5
e) “Transient” mental health symptoms do not necessarily compromise an accused’s ability to conduct a defence. The focus is: “always on assessing the extent to which an accused’s mental disorder impairs their understanding of reality when making and communicating decisions in their defence.”6
f) The fitness to stand trial test is “contextual,” and the inquiry: “focuses on the decisions that form part of an accused’s defence in a specific case, and not in the abstract.”7
g) The same test for fitness to stand trial applies to all accused, whether they are represented by counsel or not.8
The Court further stated at paragraph 67 in Bharwani the following:
“The text of the statutory definition of “unfit to stand trial” provides some guidance on the requisite capacity threshold that an accused must possess. The definition notes “in particular” that an accused is unfit if they are unable to (1) understand the nature or object of the proceedings, (2) understand the possible consequences of the proceedings, or (3) communicate with counsel. The use of “or” between these requirements suggests that if the court is satisfied that the accused is unable to meet one of them, they are unfit to stand trial, as they lack the capacity to “conduct” a defence.”
Determination on Fitness
Having heard and considered all the evidence and submissions from the parties, the Board agrees with the joint submissions of the parties: Mr. Keeash is unfit to stand trial. Due to Mr. Keeash’s cognitive impairment and related communication limitations (i.e., he speaks in one or two words), it is challenging to determine the degree to which he understands the concepts of the Taylor test questions with respect to differentiating between a plea and a verdict and the roles of the various parties to a criminal proceeding. Although he can voice some understanding of the roles of the parties and the available plea options, the concern remains that his cognitive impairments would prevent him from being able to meaningfully participate in his defence.
The doctor’s uncontroverted evidence was that Mr. Keeash cannot communicate meaningfully with counsel nor meaningfully participate or instruct counsel in a criminal proceeding. Further, Mr. Keeash’s mental health disorder does compromise his ability to conduct a defence and would impair his understanding of reality when making or communicating decisions in his defence.
Necessary and Appropriate Disposition:
The Board cannot find that Mr. Keeash is permanently unfit as he has shown improvement in responding to the Taylor-type questions in the past reporting year. The Board notes that it would be helpful for Mr. Keeash to not only undergo more frequent fitness teaching as a result of his cognitive limitations, but also to ascertain which learning style is more appropriate for Mr. Keeash. A neuropsychological consultation would help the treatment team better adapt their assessment and teaching in the hope that they can build upon his improvement in the last reporting period.
In particular, the Board relies on the following extracted paragraph from the Hospital Report:
“It is the position of the hospital that Mr. Keeash continues to represent a significant threat to public safety. Although Mr. Keeash is generally calm and cooperative, this has been in the context of being maintained on a secure forensic unit where his medications are monitored, and the staff and co-patients know him very well. Even in this setting, Mr. Keeash has continued to display some intermittent anger and irritability. On one occasion he was physically aggressive towards a co-patient. There have been some sexually inappropriate behaviours that the nursing staff have needed to manage. Mr. Keeash lacks insight regarding his mental health and cognitive limitations. Without constant supervision, he would likely not engage with treatment, stop his medications, and become more acutely unwell, which would lead to increased risk to public safety.”
- 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 mental condition of Mr. Keeash, his reintegration into society and his other needs, the necessary and appropriate Disposition a Detention Order.
DATED this 9th day of February 2026, at the City of Toronto, in the Toronto Region.
Mr. J. Weinstein
Alternate Chairperson
Office of the Registrar
Ontario Review Board