Ontario Review Board
Re: Dr. Alf Breitwieser
ORB File No: 3912
Hearing held on: Tuesday, January 26, 2026
Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. R. Bigelow
Members: Dr. J. M. Bradford Dr. L. O. Lightfoot Ms. K. Tomaszewski Ms. B. Little
Parties Appearing:
Accused: Dr. Alf Breitwieser Counsel: Mr. R. Cunningham
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Ms. K. Dalrymple
REASONS FOR DISPOSITION
(Dated February 26, 2026)
Introduction
On January 28, 2004, Dr. Alf Breitwieser was found not criminally responsible on account of mental disorder, on charges of utter threat to cause bodily harm and fail to comply with probation order, both contrary to the Criminal Code of Canada (“Criminal Code”).
Dr. Breitwieser is currently subject to the terms and conditions of a Disposition of the Ontario Review Board (the “Board”), dated February 6, 2025. Pursuant to this Disposition, he is detained at the Southwest Centre for Forensic Mental Health Care, St. Joseph's Health Care London (“Southwest” or the “hospital”). This Disposition provides him with various privileges, including living in the communities of Elgin County and Middlesex County, in accommodation approved by the person in charge.
The Board convened a hearing at Southwest on January 26, 2026, to conduct the annual review of the current Disposition. Dr. Breitwieser was present at the hearing and was represented by his counsel, Mr. R. Cunningham.
A Hospital Report (“Hospital Report”), dated November 20, 2025, was entered as Exhibit 1. Dr. Arun Prakash, Dr. Breitwieser’s attending psychiatrist, adopted the Hospital Report, with the exception of the recommendations with respect to the necessary and appropriate Disposition (which recommended a Detention Disposition), and gave oral evidence on behalf of the hospital.
The issue at this hearing is whether Dr. Breitwieser is a significant threat to public safety, as defined in s. 672.5401 of the Criminal Code. If so, the necessary, and appropriate, Disposition in the circumstances must be determined, bearing in mind the factors enunciated in s. 672.54 of the Criminal Code.
At the outset of the hearing the parties were canvassed for their initial positions. Ms. Zamprogna indicated that the hospital took the position that Dr. Breitwieser continues to pose a significant threat to the safety of the public, and that the necessary and appropriate disposition is a conditional discharge, with conditions including: a specified address; reporting to the hospital no less than two times per month; a weapons prohibition clause; a consent to treatment clause under s. 672.55 of the Criminal Code; and a requirement to attend the hospital for assessment (a “Young” clause).
Mr. Cuningham indicated that Dr. Breitweiser consented to the treatment clause under s. 672.55 of the Criminal Code. Mr. Cunningham also agreed with the hospital’s position. Ms. Dalrymple, acting for the Attorney General, also supported the hospital’s position. The Board had before it a joint submission.
For the reasons set out below and based on the expert evidence and opinions before us, the Board concluded that Dr. Breitwieser continues to represent a significant threat to the safety of the public. The Board ordered that the conditional discharge, as recommended by the hospital at the hearing, is the least restrictive, necessary, and appropriate, Disposition in the circumstances.
Current Psychiatric Diagnosis
- Schizoaffective Disorder, Bipolar Type
Index Offences
- The circumstances giving rise to the Index Offences are extracted from last year’s Board Reasons, as follows:
“On June 26, 2003, Dr. Breitwieser entered into a probation order, a condition of which was to keep the peace and be of good behaviour. On July 31, 2003, there was an incident at Dr. Breitwieser's apartment where the victim was concerned for Dr. Breitwieser's safety and police were let into his apartment. Dr. Breitwieser was very upset that police were allowed into his apartment. On August 1, 2003, Dr. Breitwieser called the victim (his case manager) at home and also called him twice at work between the hours of 10:30 and 11:30 am. He was accusing the victim of breaking and entering and letting the police into his apartment. At approximately 11:15, Dr. Breitwieser entered the office of the victim, Walter Friesen, and threatened him by stating "I'll bite your fucking cocksucking head off" and left the building. Mr. Friesen, who had been Dr. Breitwieser's caseworker for approximately twelve years, was fearful for his safety because of Dr. Breitwieser's history of violent behaviour. On August 4, 2003, police were called to a restaurant in Waterloo to ask Dr. Breitwieser for the third time to leave the property. Police discovered an outstanding charge and arrested Dr. Breitwieser.”
Issue # 1: Significant Threat
Evidence
The Board had available to it the evidence and documents forming the Record, the Exhibit, and oral evidence from Dr. Arun Prakash.
Dr. Prakash testified that Dr. Breitwieser has done exceptionally well this year. He has been stable with no symptoms of schizoaffective disorder. Dr. Prakash characterized the past 1 ½ years of stability as the longest period of stability for Dr. Breitwieser since he entered the forensic system, and perhaps prior to this as well.
Dr. Breitwieser continues to be happy with his residence. He likes his private room, the group home, the people in the home, and his books. He is compliant with his medications and has not experienced any episodes of mental decompensation since moving to the group home in June of 2024.
He is getting along well with the staff and other residents of the home, and there have been no reported issues with respect to his mental state or his residence.
Pharmacologically, the mood stabilizer has kept him stable, and he has not had any manic episodes, delusions or pressured speech. Dr. Prakash noted that the mood stabilizer is taken orally.
When Dr. Breitwieser is well, he has good insight into his illness, but when he decompensates, Dr. Breitwieser does not want his medications; is paranoid others will harm him; and he becomes irritable over minor issues. He has a history of non-compliance with medications and decompensation and has had many failed attempts at community living in the past. When he is unwell, Dr. Breitwieser exhibits similar symptoms to those surrounding the index offences.
Historically when he decompensates, Dr. Breitwieser experiences paranoia, hypersexuality, and he decompensates very rapidly.
The evidence before the Board indicated the following as signs of decompensation: isolative behaviour; sleeping in his chair; anger; paranoia. The team and staff of the group home have not seen any of these signs since Dr. Breitwieser moved into the group home.
Dr. Prakash attributes this stability primarily to one external factor: Dr. Breitwieser’s current living conditions. Dr. Breitwieser really likes this home. It is a new building where every resident has their own room. The home provides 24/7 supervision and has a CHO worker and recreation programming onsite.
Despite Dr. Breitwieser’s stability throughout this reporting period, in Dr. Prakash’s opinion, Dr. Breitwieser remains a significant threat to the safety of the public.
While Dr. Breitwieser’s mental status has been stable, his physical health continues to decline. During the reporting period Dr. Breitwieser experienced two falls, and in October 2025, Dr. Breitwieser experienced weakness and fatigue following a vaccination, resulting in a three-week admission to a hospital medical ward. Dr. Prakash told the Board that Dr. Breitwieser has not yet recovered his original energy. He now ambulates using a walker and has had no falls since November 2025.
Dr. Prakash explained that because of Dr. Breitwieser’s declining physical health, it is likely that long-term care (“LTC”) may become necessary if Dr. Breitwieser’s current home is unable to continue to provide adequate care for his physical needs.
Dr. Prakash explained that the changes resulting from a move to an LTC with a new place and new people would likely be destabilizing for Dr. Breitwieser, potentially resulting in rapid deterioration as has occurred in the past. The combination of rapid deterioration and loss of insight indicates that while Dr. Breitwieser is stable in his current living situation, he remains a significant risk to the public in the context of a potential move to LTC.
Historically, as outlined in the Hospital Report, Dr. Breitwieser has had many failed attempts at community living. The current home is the only living situation which has provided stability to Dr. Breitwieser. It is likely that a change in homes will result in instability and increased risk to the public as has happened several times in the past.
Analysis
Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board agrees that Dr. Breitwieser remains a significant threat to the safety of the public for the following reasons.
In Winko, the Supreme Court outlined that, in coming to the conclusion on the issue of significant risk, a Review Board should closely examine a range of evidence, including: the circumstances of the original offence; the past and expected course of the accused’s treatment; the present state of the NCR accused’s medical condition; the NCR accused’s own plans for the future; the support existing for the NCR accused in the community; and most importantly, the recommendations provided by experts who examined the NCR accused. In coming to our conclusion in this matter, the Board relies on the uncontroverted expert evidence of Dr. Prakash, in addition to the documentary evidence before us.
Dr. Breitwieser suffers from a major mental illness, Schizoaffective Disorder, bipolar type. He decompensates rapidly. When he experiences decompensation, he loses his insight and does not understand his need for medication. When he does decompensate, he engages in threatening behaviours similar to the index offences.
Dr. Breitwieser is likely to have future problems with his living situation. Given his physical health status, it is uncertain if his group home will be able to manage his physical health as they are currently doing or if a referral to LTC will be needed. This change in living situation will likely destabilize him, especially since Dr. Prakash largely attributes Dr. Breitwieser’s current stability to his current living situation.
While positive, this stability has been of relatively short duration (1 ½ years) and is a marked change from Dr. Breitwieser’s historical difficulty maintaining stability in the community. The most significant factor in this stability is his current living situation. If this changes, as a result for example of the need to transition to an LTC, instability is likely.
The Board relies on the Reoffence Scenario set out on page 271 of the Hospital Report:
Absent forensic supervision, Dr. Breitwieser would likely experience decompensation either spontaneously or due to noncompliance with prescribed medications. As a result, he would quickly deteriorate, becoming manic and increasingly paranoid and delusional which would result in the re-emergence of aggressive and threatening behaviours towards innocent stimuli in his environment, similar to those seen at the time of the index offences and as evidenced in this reporting period.
- The Board also relies on the Current Clinical Assessment of Significant Risk, set out on page 272 of the Hospital Report:
Current Clinical Assessment of Significant Risk
It is the opinion of the treatment team that Dr. Breitwieser continues to pose a risk of serious physical or psychological harm to members of the public. The following evidence supports this opinion:
Dr. Breitwieser is diagnosed with schizoaffective disorder, bipolar type. Dr. Breitwieser has a lengthy psychiatric history with many relapses and re-hospitalizations, secondary to noncompliance with medication and absconding. Though he has had a reporting period of mental health stability, his physical health may destabilize him. Most recently, he was discharged form hospital due to his health, and continued monitoring is required to determine how this will affect his mental wellness as historically he has deteriorated quickly;
Dr. Breitwieser’s insight into his risk for violence is not fully developed;
Dr. Breitwieser would likely not take his medications if left to his own devices, in particular when decompensated. Given his risk for non-compliance with his oral medications, and the nature of his mental disorder, he requires ongoing monitoring and supervision to remain treatment-compliant and stable while living the community; and
Dr. Breitwieser has no community professional mental health supports outside of the forensic system.
Issue # 2: Necessary and Appropriate Disposition
Evidence
In the Hospital Report dated November 2025, the hospital recommended a continuation of the current Detention Order. At the time of the hearing, the hospital recommended a Conditional Discharge Disposition, with the conditions noted above in these Reasons.
Dr. Prakash explained that the hospital’s recommendation had changed for two basic reasons: Dr. Breitwieser’s risk to the public can now be safely managed under a less restrictive Disposition; and a conditional discharge will support Dr. Breitwieser’s integration to the community by facilitating access to a broader range of mental health support services in the community.
Dr. Prakash testified that having considered the Court of Appeal’s decision in Ramos (Re), 2025 ONCA 820, it is his opinion that if the hospital asks Dr. Breitwieser to attend the hospital for examination, he will do so. Dr. Prakash also opined that Dr. Breitwieser will remain in the hospital if so requested, since he has done so in the past.
Dr. Breitwieser is incapable of consenting to treatment, and his niece is his substitute decision maker. Box B criteria would be available to admit Dr. Breitwieser involuntarily under the Mental Health Act given his historical pattern of rapid mental deterioration when destabilized. Dr. Prakash stated that he doubted that it would be necessary to use the Mental Health Act, but that it would be available to readmit Dr. Breitwieser should an involuntary admission become necessary.
Dr. Breitwieser is happy, stable, and settled into his current residence. The staff there have “eyes on him” and will report any early signs of decompensation to the hospital.
Unless LTC is required, there is no reason to believe that Dr. Breitwieser will want to change residences. This would also be difficult for him, since the Public Guardian & Trustee manages Dr. Breitwieser’s finances, and any change in residence would come to their attention quickly.
Dr. Prakash told the Board that although Dr. Breitwieser shows no signs of wanting to move, because much of Dr. Breitwieser’s current stability is a result of his current living situation, it is necessary to ensure that he remains in this housing.
Dr. Prakash stated that for these reasons a named residence condition is necessary to manage Dr. Breitwieser’s risk to the public.
Dr. Breitwieser’s medications are oral. If he destabilizes, he is likely to refuse medications, causing mental deterioration and risk to the public. Dr. Breitwieser has consented to the inclusion of a treatment clause under s.672.55 of the Criminal Code.
Dr. Prakash expects that Dr. Breitwieser will return voluntarily to the hospital if requested to do so, but the inclusion of a Young clause in the Disposition will further reduce the risk that he will not return to the hospital.
In the upcoming year, the treatment team anticipates referrals to community mental health support services. Depending on Dr. Breitwieser’s stability in the upcoming year, the team is considering a referral to either a geriatric outreach team, or an ACT Team. In either case, it is anticipated that Dr. Breitwieser will be made subject to a Community Treatment Order to support his transition from the forensic system to the community.
Dr. Prakash testified that in his experience, most community mental health support teams consider that a conditional discharge is evidence that the person is ready to transition to their support services. A conditional discharge makes successful referrals to community support teams more likely.
Analysis
For the reasons which follow, the Board accepts the parties’ joint recommendation that the necessary and appropriate as well as least restrictive Disposition is a conditional discharge, with the conditions proposed by the hospital.
It was the undisputed evidence of Dr. Prakash that Dr. Breitwieser is likely to return to the hospital voluntarily and remain in hospital should the need arise. If Dr. Breitwieser is not willing to return or remain voluntarily, the Mental Health Act is sufficient to bring Dr. Breitwieser into the hospital and to admit him. In addition, the Disposition contains a Young clause, making the enforcement provisions of the Criminal Code available.
The Board finds that a Warrant of Committal is not necessary to bring Dr. Breitwieser to the hospital expeditiously. Although Dr. Breitwieser destabilizes rapidly, the staff at Dr. Breitwieser’s current residence can detect early warning signs of decompensation and will inform the hospital. The evidence supports the conclusion that Dr. Breitweiser’s risk to the public can be adequately managed under the Mental Health Act.
Because Dr. Breitwieser’s continued stability depends in large part on his current living situation, a named residence clause is necessary and appropriate to protect the public and reduce the likelihood of destabilization. If Dr. Breitwieser needs to move to LTC, an early Board review can be requested.
The requirement to report not less than two times per month is necessary and appropriate. The staff at Dr. Breitwieser’s residence provide 24/7 supervision and they are aware of the early warning signs of decompensation, but because Dr. Breitwieser can deteriorate rapidly, it is necessary that the Treatment Team maintain this level of contact with him.
Dr. Breitwieser consents to a treatment condition under s. 672.55 of the Criminal Code. The Board finds that this condition is reasonable and necessary and in the interests of Dr. Breitwieser. Dr. Breitwieser’s medications are oral. When he destabilizes, he begins to refuse his medications, leading to mental deterioration. The evidence supports the conclusion that Dr. Breitwieser is capable to understand the information relating to the operation of this condition and the reasonably foreseeable consequences of agreeing to the condition.
The Disposition recommended by the hospital and adopted by all parties contains a weapons prohibition, continued from his current Disposition. The parties did not address this condition in their submissions. The Board adopts the reasoning as set out in last year’s Reasons for including this condition in the Disposition:
The Board carefully considered Dr. Breitwieser’s history as set out in the hospital report, and noted that pages 3, 5, 131, 182, and 240 contain references to Dr. Breitwieser threatening the use of weapons or using weapons (e.g. described as an excellent shooter or marksman; threatened to shoot someone with a gun in 2001; threatened to put a bullet in the head of staff; 1987 – tried to get into a person’s car with a knife; spat on someone; threw a cup of tea; threw food at a peer; flipped over a table, threw papers and poured soap all over the floor).
The Board notes that the current period of stability is encouraging in the context of Dr. Breitwieser’s previous history but is objectively a relatively short period of time. Dr. Breitwieser decompensates quickly and becomes aggressive abruptly. While he does not tend to go out of the group home unescorted, he is free to do so.
Dr. Prakash agreed that most of Dr. Breitwieser’s aggression is focused on the staff around him, and that further evaluation of his stability and his actions this year before removing the weapons prohibition would be appropriate to protect the public safety.
The Board adopts the submissions of Mr. Rows that while the risk of acquiring a firearm is low, Dr. Breitwieser decompensates rapidly, and it is not in the interest of the safety of the public to “test” whether Dr. Breitwieser will refrain from the use of weapons. Mr. Rows submitted that there would be no benefit to Dr. Breitwieser to remove the clause, and that the clause is important to protect the safety of the public.
- In consideration of all the evidence, submissions of the parties and taking into consideration the criteria set forth in s. 672.54 of the Code, the paramount consideration being the safety of the public, in addition to the mental condition of Dr. Breitwieser, his reintegration into society and his other needs, the necessary, and appropriate, Disposition is a Conditional Discharge Disposition, with the conditions discussed above.
DATED this 26th day of February 2026, at the City of Toronto, in the Region of Toronto.
Ms. K. Tomaszewski Legal Member
Office of the Registrar Ontario Review Board