Re: Adam Alishaw
ORB File No: 7568
Hearing held on: Friday, January 30, 2026
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: Mr. J. Weinstein
Members: Dr. K. Hand Dr. A. Kerry Hon. A. Sosna Mr. A. Mete
Parties Appearing:
Accused: Adam Alishaw Counsel: Mr. S. Proudlove
The person in charge of hospital: Counsel: Mr. S. O'Brien
Attorney General of Ontario: Counsel: Mr. B. Adsett
REASONS FOR DISPOSITION
(Dated March 3, 2026)
Introduction:
On July 3, 2019, Mr. Adam Alishaw was found not criminally responsible on account of mental disorder on a charge of second-degree murder, contrary to the Criminal Code of Canada.
Mr. Alishaw is subject to a Disposition of the Ontario Review Board, ("the Board"), dated January 30, 2025, which ordered that he be detained at the Forensic Psychiatric Program of St. Joseph's Hamilton Health Care, West 5th Campus ("St. Joseph's").
On January 30, 2026, the Board convened a hearing at St. Joseph's to conduct the annual review of the current Disposition.
Mr. Alishaw was present at the hearing and was represented by his counsel, Mr. Proudlove. His aunt attended by videoconference.
A Hospital Report, dated January 5, 2026, (the "Hospital Report"), was entered as Exhibit 1.
The issues of the hearing were whether Mr. Alishaw is a significant threat to public safety, as defined in s. 672.5401 of the Criminal Code, and, 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.
For the reasons set out below and based on the expert evidence and opinions before us, the Board concluded that Mr. Alishaw continues to represent a significant threat to the safety of the public. The Board found that the necessary and appropriate Disposition in the circumstances is the continuation of the existing Detention Order.
Current Psychiatric Diagnoses:
- Schizophrenia Substance use Disorder.
Index Offence:
- On May 3, 2018, Mr. Alishaw beat his father with a hammer, causing his death. He called the police to advise that he had just killed someone.
Background:
- Mr. Alishaw's background and history are outlined in the Hospital Report, and they are accurately summarized in last year's Reasons:
"His parents separated when he was 11 years of age, and he then resided with both his mother and maternal grandmother. In his early teenage years, Mr. Alishaw began to experiment with street drugs; and his behaviour became more oppositional and belligerent. At 13 years of age, he lived with his father, but returned to live with his mother after one year.
The Report notes that in 2014, a paternal aunt lived with Mr. Alishaw and his father. She became afraid of Mr. Alishaw and moved out of the home.
Mr. Alishaw was a good student in his early years in school, but became more oppositional in grade 7. He was expelled from High School for pushing the principal.
He did not complete High School, and has a modest work history. He is not married and does not have children.
Mr. Alishaw has had limited involvement with the criminal justice system, but does have convictions as both a youth and as an adult.
He has a significant history of drug abuse. He started using marijuana at the age of 13, and started using methylenedioxymethamphetamine (MDMA) at 17. He used crystal methamphetamine and marijuana regularly until 2017. He also reported experimenting with ecstasy, cocaine, psilocybin, dextromethorphan, Tylenol 3, oxycontin, and LSD. His alcohol consumption is described as occasional.
In 2010, Mr. Alishaw attempted suicide; and in 2011, he was admitted to the Child and Adolescent Inpatient Program at Grand River Hospital pursuant to a form 1 under the Mental Health Act due to suicidal ideation.
In 2014, he required emergency room care after a drug overdose and seizure. He discharged himself from hospital against medical advice.
In February 2016, Mr. Alishaw was admitted to the Forensic Assessment Unit of St. Joseph’s for an assessment of his fitness to stand trial on charges of uttering a threat to destroy property, assault with a weapon, breach probation, and fail to comply with recognizance. His behaviour in the hospital was described as bizarre. He appeared to be responding to internal stimuli, and laughing to himself. Seclusion and a chemical restraint were required on one occasion. Even with medication, his delusions and suspicions remained. He was diagnosed with schizophrenia and substance abuse. He was ultimately found fit to stand trial and returned to court.
In March 2016, Mr. Alishaw was brought to the emergency department by the police on a form 1. He was acutely psychotic and becoming a danger to himself and others. He reported having stopped taking his antipsychotic medication. He had chronic delusions of being poisoned by his father and others. At the time of discharge, he refused to take his medication by injection which was recommended by his treating physician.
In November of that same year, he was brought to the hospital suffering an acute psychotic episode. He believed his neighbours had poisoned him.
In 2017, he was brought to the hospital on 3 occasions. He had not been compliant with his medication and continued to believe that he was being poisoned.
Mr. Alishaw was again hospitalized on two occasions in 2018. The first admission resulted from him accidentally starting a fire at his father’s place of business. He suffered burns to his hand when he tried to extinguish the fire. He was observed to be talking to himself and laughing inappropriately. The second admission followed a complaint of command hallucinations.
On the day of the Index Offence, Mr. Alishaw experienced a massive overdose and was admitted to hospital. He told the staff that “voices made me do it.”"
Position of the Parties
Counsel for the hospital, the Attorney General and Mr. Alishaw advised that this was a joint submission; all were adopting the hospital's recommendation for the continuation of the existing Detention Order.
Counsel for Mr. Alishaw advised that the issue of significant threat was not in dispute for purposes of this hearing.
Course Since Last Disposition
- Mr. Alishaw's course since his last Disposition is set out in detail in the Hospital Report. The following extracted paragraphs are relevant to this hearing:
"This report covers the period of September 19th, 2024, to November 7th, 2025, during which Mr. Alishaw was an inpatient on Mountain 2.
During this reporting period, he has been placed on constant observation (1:1) to mitigate the risk of self-harm.
Mr. Alishaw has displayed remorse for the index offense and the death of his father. However, Mr. Alishaw doesn’t have a clear understanding of the severity of the index offense. Mr. Alishaw demonstrates limited insight into the need for medications and the risk he may pose to the public without antipsychotic medication. Mr. Alishaw doesn’t appreciate the negative effects that substances have on him. During this reporting period, Mr. Alishaw frequently displayed defiance toward nursing staff regarding taking his medications and refused on numerous occasions, despite extensive health teaching."
"His urine drug screens have all come back negative for substances since October of 2024. Mr. Alishaw is on daily urine drug screening for monitoring of substance use and as a deterrence. Mr. Alishaw usually adheres to unit and hospital rules; however, there have been several incidents where he has broken the unit and hospital rules.”
"Mr. Alishaw is highly engaged in Occupational Therapy (OT) services. He is generally pleasant and cooperative during all interactions with OT, and regularly seeks OT out for therapeutic support and/or to update on events in his life. His participation in programming can be restricted at times due to substance use and/or cravings to use substances. On the occasions Mr. Alishaw has used substances, he often presents with a change in mental status which involves refusal of his psychiatric medications and an increase in suicidal thoughts"
"Mr. Alishaw has completed 15 out of 15 group sessions, and all individual sessions offered. Mr. Alishaw arrived on time and was engaged with therapy regardless of the modality."
- The Hospital Report sets out 16 notable incidents from September 28, 2024, to October 28, 2025. Full details are set out in the Hospital Report and do not need to be repeated here.
Evidence at the Hearing
- The Board had available to it the evidence and documents forming the record, the exhibits, and oral evidence from Dr. Naidoo. Dr. Naidoo co-authored the Hospital Report, and he is Mr. Alishaw's treating psychiatrist. He testified as follows:
a) He has worked with Mr. Alishaw for approximately three years.
b) He adopts the contents of the Hospital Report.
c) Mr. Alishaw has had a relatively successful year. He is preparing to start culinary school at Mohawk College. Mr. Alishaw has worked with a vocational counsellor to defer tuition at Mohawk College, and he is now ready to restart this program, which aligns with his passion for food and his future goals. This is a significant milestone, especially given his past challenges with remaining abstinent from substances.
d) Mr. Alishaw has twice completed a trauma-focused cognitive processing therapy group (a grief group addressing healing and forgiveness). He has shown improvement in managing his stress in relation to anniversaries and has engaged less in self-defeating behaviours that are linked to trauma from the Index Offence.
e) Mr. Alishaw has very positive family engagement. He frequently reaches out to his aunts and his cousins for support, especially while experiencing cravings for substances or frustration. Mr. Alishaw has also engaged in spiritual care, with a Chaplin and community church involvement, which has also been a source of support for him.
f) Mr. Alishaw remains on Clozapine and adjunctive medications, which have effectively managed his psychosis to the point that it is now in remission. He regularly meets with the treatment team, including psychologists, and occupational therapy services, social work, and vocational therapist, all who provide ongoing support and skill development to deal with intense cravings when they arise as well as support for attending culinary school and adaptive skills for future independence.
g) The treatment team has observed gradual gains in Mr. Alishaw’s ability to tolerate stress and to adhere to rules, although ongoing support is still required for both.
h) As set out in the Hospital Report, the hospital maintains that Mr. Alishaw remains a significant threat to the safety of the public. Use of substances, especially methamphetamines, cannabis and alcohol, is a very high risk factor. Mr. Alishaw has a long history of addiction, and he continues to experience fluctuating cravings, but he has been able to manage these cravings with support, and the skills that he has been taught.
i) Triggers for Mr. Alishaw's cravings include negative peer affiliation, grief, frustration with the treatment team, and anniversaries of significant events. While the treatment team has seen some improvement in his response to these triggers, Mr. Alishaw still requires ongoing work and support.
j) The treatment team hopes that, in the coming reporting year, Mr. Alishaw will complete his culinary program, remain abstinent from substances, adhere to rules, communicate his frustrations with the treatment team appropriately, and maintain a positive relationship with his family and supports.
k) The treatment team will provide intensive support and monitoring to Mr. Alishaw in the coming reporting year, especially during his time in the community and particularly while he is attending the culinary school.
- In response to questions from counsel for the Attorney General, Dr. Naidoo testified:
a) Currently Mr. Alishaw's hallucinations are very infrequent, and he has not experienced any fixed delusional beliefs. Mild auditory delusions have diminished since the start of the reporting period.
b) The primary triggers for Mr. Alishaw's cravings for substance use are a result of Mr. Alishaw still experiencing trauma from the Index Offence, as well as disagreements or frustrations with staff. Additionally, negative peer affiliation, reactions to anniversaries, such as birthday or the Index Offence date, and observing others using substances, also increase his cravings. Mr. Alishaw's triggers for substances are complex and multifactorial.
c) Mr. Alishaw's insight into his need for medication and the impact that substances have on his mental stability still remains limited and requires further development.
d) Frustration that Mr. Alishaw experiences with the treatment team sometimes leads Mr. Alishaw to request medication changes or reductions, which Dr. Naidoo would described as being impulsive and self-destructive. Mr. Alishaw occasionally minimizes the impact of substance use on psychosis, believing he can use substances without adverse effects. This struggle with insight is quite common among patients with similar profiles.
- In response to questions from the panel, Dr. Naidoo testified as follows:
a) The treatment team does recognize that Mr. Alishaw returning to attending culinary school after being in a forensic unit can be quite stressful, especially as Mr. Alishaw may be prone to social anxiety and shame with respect to his Index Offence history.
b) The treatment team plans to support Mr. Alishaw in managing these social and emotional challenges, including navigating relationships and maintaining boundaries. The treatment team recognizes that the academic demands of a full-time culinary program are significant.
c) To Mr. Alishaw's credit, he has previously succeeded academically. He is confident that Mr. Alishaw would seek assistance for most challenges he faces while attending school, although there is a concern that Mr. Alishaw might conceal issues related to shame or substance use. The treatment team is aware of these issues and will remain vigilant and proactive in monitoring these areas of concern.
d) Mr. Alishaw will be tested for substance use every time he leaves and returns to the unit. Mr. Alishaw has been exposed to substances in the hospital, and attending university will be no different in the level of exposure he has to substances , whether on hospital and grounds or at the university. The treatment team will continue to provide Mr. Alishaw with strategies for managing negative influences and to remain abstinent from substances.
e) While Mr. Alishaw has shown remorse and has experienced trauma in relation to the Index Offence, Mr. Alishaw's actions, such as non-adherence to treatment, sometimes indicates a lack of full appreciation for the seriousness of the Index Offence and the importance of avoiding future risk enhancing behaviours.
f) Mr. Alishaw has been involved in peer support and advocacy for patients. These roles are extremely rewarding for Mr. Alishaw, helping him foster connection in the community, as well as spiritual wellness and do serve as protective factors against substance use.
g) The hospital needs the ability to retain authority to approve of Mr. Alishaw's housing, as it is essential to monitor Mr. Alishaw's medication adherence and ability to remain abstinent for substances in order to protect the safety of the public. The Mental Health Act would be insufficient to protect public safety, as it would not allow the hospital treatment team to respond quickly enough, should he engage in the use of substances or have re-emergence of any symptoms of his mental disorder. Continued detention is recommended for the protection of the safety of the public.
- No other evidence was called.
Analysis and Conclusions
Having heard and considered the entirety of the evidence, as well as submissions from the parties, the Board agrees with the joint submission: Mr. Alishaw 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 in this matter, the Board relies on the uncontroverted expert evidence of Dr. Naidoo, in addition to the documentary evidence before us.
During this reporting period, Mr. Alishaw was placed on constant observation 1:1, to mitigate the risk of self-harm.
Mr. Alishaw demonstrates limited insight into his need for antipsychotic medication, and the risk he may pose to the public without it. He does not fully appreciate the negative effects that substances have on him. During this reporting period, Mr. Alishaw was frequently defiant toward nursing staff about taking his medication, refusing it outright on numerous occasions, despite extensive health teaching. To his credit, however, all his urine drug screens since October 2024 have come back negative for substance use.
In particular, the Board relies on the Clinical Risk Summary, set out in the Hospital Report:
"Overall, Mr. Alishaw had a variable reporting period. He had been able to sustainably complete most of his activities of daily living. He continued to reside on the inpatient forensic psychiatric unit where he benefited from staff support for medication administration, financial management and maintaining a tidy living space. He often required prompting to sustainably complete those activities. He had engaged in a number of therapeutic programs including group CPT which contributed to an improvement in his ability to tolerate distress during death anniversaries. He also completed substance use treatment and relied upon behavioral strategies to cope with cravings. In addition, he attended and completed Peer Support Core Essentials Training and regularly attended recreational programming. Mr. Alishaw was able to maintain positive supportive relationships with his aunts and with his cousin, whom he frequently turned to for advice and admiration and he developed positive friendships with peers on the unit. Mr. Alishaw’s symptoms of psychosis were generally fully managed with treatment and he was not violent or aggressive during the prior reporting period.
Despite those positive factors, the team had a number of ongoing concerns about Mr. Alishaw’s risk. He had lapsed onto cannabis in July 2025 and later had told staff he had used cocaine. While both substances were not present on routine urine drug screen, his initial attempts to hide use created concern about his risk for further relapse. Mr. Alishaw frequently described intense cravings for substances, particularly during times of distress when he tends to verbalize self-destructive and oppositional attitudes. His oppositional attitudes at times lead to rule non-adherence including lending money to peers to purchase him items, not following staff direction on passes, smoking in the hospital and bringing contraband onto the unit. Mr. Alishaw’s attitude was generally defiant toward staff in response to pass cancellation, suggesting he continued to struggle with distress tolerance, and his general response to supervision. Mr. Alishaw’s insight into his need to remain on treatment and to avoid substances remains in development and as such he would be at extremely high risk for treatment discontinuation and substance use absent his current supports. As a result of his ongoing dynamic risk factors, Mr. Alishaw’s risk factors Historically, Mr. Alishaw has a diagnosis of Schizophrenia and Substance Use Disorder. He has a past history of violence, limited employment or relationship stability, antisocial behavior and a history of trauma during the index offence from which he continues to struggle with guilt and episodic stress that increases his future risk for substance use.
Overall, the treatment team is of the view that Mr. Alishaw continues to represent a significant threat to public safety. It is highly likely that absent an ORB Detention Order, that Mr. Alishaw would disengage with psychiatric care, relapse onto drugs and under those circumstances exhibit symptoms of psychosis. Under those circumstances, it is highly likely that he would develop persecutory delusional beliefs about those around him, including delusional misidentification, hallucinations command in nature and further impaired insight. It is highly likely that he would engage in violent action with a weapon, blunt force, in response to his delusional belief system and psychotic as well as drug-related disinhibition. Targets of violence would most likely be those whom he has close connection with, who are critical of his substance use and of criminal action, such as his aunts or his cousin. Strangers are also possible targets if involved in his delusional belief system."
In light of the Board's finding that Mr. Alishaw represents a significant threat to the safety of the public, it must shape a disposition that is necessary and appropriate for the coming reporting year. The doctor's uncontroverted evidence is that the hospital needs to retain the ability to approve his housing, to monitor his adherence to medication and his ability to resist cravings and abstain from substances. Mr. Alishaw continues to have significant cravings. In addition, the Board agrees with the doctor's evidence that the Mental Health Act would not be sufficient to protect the safety of the public; the Act is more reactive than proactive, and the use of substances would not allow the treatment team to use it appropriately to manage Mr. Alishaw's 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. Alishaw, his reintegration into society and his other needs, the necessary and appropriate Disposition is to continue with the existing Detention Order.
DATED this 3rd day of March 2026, at the City of Toronto, in the Region of Toronto.
Mr. J. Weinstein Alternate Chairperson Office of the Registrar Ontario Review Board