Re: Nathan Clarke
ORB File No: 3945
Hearing held on: Tuesday, December 16, 2025
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Kert
Members: Dr. T. Verny
Dr. G. Nexhipi
Hon. C. Nelson
Mr. W. Apted
Parties Appearing:
Accused: Nathan Clarke
Counsel: Mr. A. Rai
The person in charge of hospital: Counsel: Mr. D. Blumenkrans
Attorney General of Ontario: Counsel: Mr. J. Canton
REASONS FOR DISPOSITION
(Dated February 4, 2026)
Overview
On March 4, 2004, Nathan Clarke was found not criminally responsible on account of mental disorder on a charge of attempt murder. That charge arose from an incident on December 27, 2003, when Mr. Clarke stabbed his father in the back of the head with a paring knife. At the time, Mr. Clarke was living with his parents in the family home. He had stopped taking his prescribed antipsychotic medication, believing it was poisonous, and had developed paranoid beliefs about his father wanting to harm him.
Mr. Clarke is currently subject to a disposition of the Ontario Review Board that detains him on a general forensic unit at CAMH, with privileges extending to living in the community in accommodation approved by the person in charge.
On December 16, 2025, this panel of the Review Board convened a hearing at CAMH for the annual review of Mr. Clarke’s disposition. At the time, Mr. Clarke continued to reside on a general unit at CAMH. Mr. Rai, counsel for Mr. Clarke, asked that the hearing proceed in his client’s absence. He advised that he had met with Mr. Clarke earlier that morning, that Mr. Clarke did not want to attend his hearing and that he had provided instructions to allow Mr. Rai to act for him. All parties agreed, as did we, that in the circumstances Mr. Clarke could be absent and the hearing should proceed: s. 672.5(10) of the Criminal Code.
The issues for the Board to decide are whether Mr. Clarke remains a significant threat to public safety and, if so, what is the necessary and appropriate disposition for the coming year, considering the four factors in s. 672.54 of the Criminal Code.
None of the parties contested a finding of significant threat, and the parties jointly submitted that the current disposition remains necessary and appropriate in the circumstances. We agree. These are our reasons.
Background
Mr. Clarke is 42 years of age. He has remained under the jurisdiction of the Review Board for approximately 21 years.
After coming under the jurisdiction of the ORB in 2004, Mr. Clarke remained an in-patient at CAMH until 2015, when he was discharged to the Harbour Light residential treatment program, and subsequently moved to LOFT high support housing in 2016. In the community there were periods when outpatient staff had trouble connecting with Mr. Clarke due his level of guardedness and avoidance. He also provided some positive urine screens and there were episodes of inappropriate sexual comments toward treatment team members.
Despite this, for a number of years Mr. Clarke was able to live without significant incident at LOFT, with follow-up by the CAMH EFOPS team. However, in February 2019, he was readmitted to CAMH after a period of disengagement from his clinical team. He subsequently advised that he had stopped his medication in December 2018 (feeling that he no longer needed it) and had been using cannabis occasionally. In hospital he was sexually inappropriate with nursing staff, leading to periods of seclusion. Once clozapine treatment was restarted in May 2019 (with the consent of his SDM), his symptoms and problematic behaviours significantly diminished.
After an extended admission, Mr. Clarke was discharged back to his LOFT housing in March 2020. Thereafter, his random urine drugs screens were often positive for marijuana. There were further admissions in November 2020 (after Mr. Clarke experienced an acute decompensation, likely the result of medication non-adherence) and in May 2021 (after he described new psychotic symptoms and distress). In July 2021, he was readmitted after reporting increasing auditory and visual hallucinations and testing positive for cannabis. He has remained an inpatient at CAMH since that time.
Mr. Clarke’s course in hospital has been variable. Over time he progressed up the privilege ladder but remained reluctant to engage in many structured activities. By early June 2023, he was adamant he wished to reduce, if not completely discontinue, clozapine treatment and he intermittently declined his medication. In late June 2023, he went AWOL while on an indirectly supervised pass. After police returned him to the hospital the following day, he admitted alcohol and cannabis use while AWOL, was actively psychotic and refused his medication. In July 2023, he threatened to kill a staff member and attempted to grope a female staff on the unit. The following month he sexually assaulted a female staff on the unit.
Course Since Last Hearing
At Mr. Clarke’s last hearing, the panel heard evidence that over the 2023-2024 clinical year, he exhibited ongoing symptoms of his psychotic disorder (including delusional thought content) and demonstrated limited insight into the need for medication. At various times he abruptly stopped taking clozapine, though usually for no more than a few hours.
At the current hearing we received evidence in the form of an updated hospital report, as well as the oral testimony of Dr. Darani. That evidence indicated as follows: Over the course of the past year, Mr. Clarke’s mental status remained relatively unchanged. He exhibited ongoing symptoms of his psychotic disorder (auditory hallucinations; delusional ideation), which Dr. Darani attributed to a combination of Mr. Clarke’s treatment resistant illness and his occasional non-adherence with clozapine. At baseline Mr. Clarke expresses the view that he does not believe that he needs antipsychotic medication and/or that the voice of God or his father told him not to take the medication.
Mr. Clarke experienced periods of deterioration in his mental status (possibly due to his intermittent non-adherence), but there was no aggression or significant behavioural concerns this year. Though reluctant to move up the privilege ladder, Mr. Clarke did attend some recreational and therapeutic programming, exercised some indirectly supervised grounds passes and also used accompanied passes into the community. While he occasionally acknowledged cravings for substances (alcohol or cannabis), he consistently denied plans to use substances and all of his UDS results were negative.
Analysis and Conclusions
Based on the evidence, the threshold test for significant threat is met. Mr. Clarke has a lengthy history of experiencing the symptoms of his major mental illness, schizophrenia. He also carries diagnoses of substance abuse disorder and personality disorder NOS. Historically, when experiencing symptoms of psychosis (including auditory hallucinations and delusions of persecution), Mr. Clarke has engaged in aggressive or violent behaviour, notably at the time of the index offence, and later toward staff in hospital. Mr. Clarke's current level of stability has been achieved through consistent compliance with medication and abstinence from illicit substances. However, this has only been accomplished through ongoing supervision by the treatment team within the hospital environment.
In the past, without supervision after discharge from hospital, Mr. Clarke was non-adherent with medication and used street drugs and alcohol. Currently, his insight remains limited and his adherence with medication is externally motivated. Without ongoing supervision, it is highly likely he would discontinue clozapine treatment as: i) he does not view it as necessary to maintain his mental status and keep him well; and ii) even under supervision in hospital he is episodically non-adherent. Absent treatment his mental state would quickly decompensate, he would become more psychotic, and he is likely to act on his delusional ideation in ways that would place others at risk of serious harm, either physical or psychological.
We are also satisfied the current detention disposition remains necessary and appropriate to allow Mr. Clarke to move forward in the coming year. Although the treatment team has been working to progress Mr. Clarke up the privilege ladder (so that he can demonstrate appropriate use of indirectly supervised passes, including in the community), he appears unmotivated to do so. The reasons for this are complex, but include his suspected institutionalization and related ambivalence about being discharged. His reports of occasional concerns/paranoia about persons in the community may also play a role.
Dr. Darani agreed that in order to address these issues, the team will have to be creative in its approach to moving Mr. Clarke up the privilege ladder and reintegrating him back into the community. To that end, the team has discussed appropriate care planning and pass planning for Mr. Clarke. Additionally, given the length of time it can take to find the kind of residence that Mr. Clarke will require upon discharge (high support housing with, in particular, supervision of medication), Mr. Clarke has been placed on a waitlist for housing with the Mental Health and Justice Housing Program. The current disposition will allow the hospital to approve housing for Mr. Clarke to ensure an appropriate level of support and supervision upon discharge.
Accordingly, considering public safety, which is paramount, as well as Mr. Clarke’s mental condition, his reintegration into society and his other needs, we order that the current detention disposition continue unchanged.
DATED this 4th day of February, 2026, at the City of Toronto, in the Region of Toronto.
Ms. S. Kert
Alternate Chairperson
Office of the Registrar
Ontario Review Board