Re: Kabeesan Sivapalasingham
ORB File No: 8875
Hearing held on: Monday, December 15, 2025
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Sections 672.47(1) and 672.48(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: Kabeesan Sivapalasingham Counsel: Ms. S. Dubb
The person in charge of hospital: Counsel: Mr. D. Blumenkrans
Attorney General of Ontario: Counsel: Ms. S. Cressman
REASONS FOR DISPOSITION
(Dated February 4, 2026)
On August 2, 2025, Kabeesan Sivapalasingham was charged with aggravated assault arising out of an incident in which he is alleged to have punched and struck his mother, dislocated one of her fingers and bit off the top of another finger when she intervened during an argument between him and his sister. Mr. Sivapalasingham was living with his parents and younger sister in the family home at the time.
Following his arrest, Mr. Sivapalasingham was detained in custody at the Toronto East Detention Centre. On September 10, 2025, he was admitted to CAMH pursuant to an assessment order regarding his fitness to stand trial. In hospital, his cognitive ability was noted to be significantly limited – he communicated with one-word responses, was largely unable to add or subtract, and was disoriented to season, month and day of the week. This was consistent with his documented history of severe autism spectrum disorder and intellectual disability. Aripiprazole, which had previously been prescribed by his outpatient psychiatrist to address his worsening behavioural problems in the community, was restarted in jail and continued in hospital at CAMH on the substitute consent of his parents.
On October 7, 2025, Mr. Sivapalasingham returned to court for a hearing on the question of fitness, accompanied by an assessment report authored by Dr. Eid. In her report, Dr. Eid expressed the opinion that Mr. Sivapalasingham was unfit to stand trial, stating:
His profound limitations in language and communication substantially interfere with his ability to engage in meaningful discussion with the assessing team. Given his severe cognitive and adaptive limitations, Mr. Sivapalasingham likely does not possess the cognitive capacity required to participate meaningfully in the court proceedings and communicate with counsel and the court.
Based on Dr. Eid’s assessment, Mr. Sivapalasingham was found unfit to stand trial on October 7th and returned to CAMH on a Warrant of Committal. He has continued to be detained as an in-patient at CAMH since that time.
On December 15, 2025, this panel of the Review Board convened an in-person hearing at CAMH. Mr. Sivapalasingham was present and was represented by counsel, Ms. Dubb. A staff member sat next to Mr. Sivapalasingham at the hearing and kept him occupied with colouring. He remained calm and engaged in coloring throughout the hearing Mr. Sivapalasingham's parents and sister were also present to support him.
The questions for the Board are whether Mr. Sivapalasingham is unfit to stand trial, and what disposition is necessary and appropriate in the circumstances. The parties jointly submitted that Mr. Sivapalasingham remains unfit and that a disposition detaining him on a general forensic unit at CAMH with privileges up to community living should be imposed by the Board. The sole issue was whether the community living provision should include a requirement that Mr. Sivapalasingham reside in supervised accommodation (as submitted by the Crown), or whether approved accommodation will suffice to address safety concerns about him returning to live at the family home.
Based on the evidence we agree with the parties that Mr. Sivapalasingham continues to be unfit. We find that the necessary and appropriate disposition, which is also the least onerous and least restrictive disposition (including conditions attached to the disposition) is one detaining him on a general forensic unit at CAMH with privileges up to community living in approved accommodation. As this was a first hearing, we did not address the issue of permanent unfitness.
Background
Mr. Sivapalasingham turned 21 on the day of the hearing. Following psychological and/or developmental assessments at the Shoniker Clinic in 2007 (at the age of 3), he received a diagnosis of autism spectrum disorder, with marked impairment in his social interactions and communication. A further psychological assessment in 2010 (through the TDSB) showed limited cognitive abilities, all within the first percentile. He also had limited adaptive functioning and limited expressive and receptive language. He was placed in a special needs class during elementary and high school.
Mr. Sivapalasingham was subsequently assessed and followed by an outpatient psychiatrist, Dr. Flood, who also diagnosed him with ADHD. Dr. Flood trialed Mr. Sivapalasingham on stimulant medications for ADHD, but these were discontinued due to aggressive behaviour. Mr. Sivapalasingham had a brief trial of antipsychotic medication (risperidone, for 2 or 3 days), which was stopped due to concerns about involuntary tongue twisting.
Dr. Flood stopped following Mr. Sivapalasingham in 2012. Mr. Sivapalasingham reportedly had eight years of stability after that time. However, beginning in October 2020, Mr. Sivapalasingham’s parents noticed an increase in his aggressive behaviour. They attributed this to a decrease in his daily structure and supports during the COVID-19 pandemic, and to isolating at home, which was distressing for him. His aggressive episodes (for the most part toward family members) typically included poking, scratching, kicking, and hair pulling. His parents found it challenging to identify typical triggers for his aggression, although lack of sleep was noted be a potential trigger.
Although Mr. Sivapalasingham had no criminal history predating his arrest on the outstanding charge of aggravated assault, he did have some history of psychiatric contacts associated with his aggressive behaviour. In July 2021, he was brought to the Rouge Valley hospital by his mother due his increasingly aggressive behaviour since October 2020. In the week before his attendance, Mr. Sivapalasingham reportedly hit his mother in the eye and bit her on the arm, then bit his sister’s finger when she tried to intervene (though similar in nature, this predates the episode for which Mr. Sivapalasingham is currently charged). In the emergency department he was aggressive with his mother and pulled her hair. His mother attributed Mr. Sivapalasingham’s increased aggression to the disruption of his routine as a result of the pandemic. He was prescribed aripiprazole and given an urgent referral for outpatient follow-up.
The following month (in August 2021), Mr. Sivapalasingham was seen by Dr. Parveen, an outpatient psychiatrist at the Rouge Valley Outpatient Mental Health Clinic. His parents had been giving him oral aripiprazole since attending the emergency department in July, with good effect, but had discontinued the medication two days earlier due to concerns about side effects. Dr. Parveen advised them to continue the aripiprazole daily and arranged for follow-up.
In January 2023, Mr. Sivapalasingham was seen in follow-up by Dr. Parveen for “worsening behaviour problems leading to physical aggression towards his peers,” assumedly at school. Dr. Parveen advised Mr. Sivapalasingham’s parents to increase the aripiprazole to manage his escalating behavioural problems. According to the hospital report, at the same time Dr. Parveen also “arranged follow-up and provided Mr. Sivapalasingham’s family with additional resources for psychosocial and behavioural interventions.”
The hospital report and the other hearing documents before us do not indicate whether Mr. Sivapalasingham continued in follow-up or accessed the recommended resources thereafter, or whether there were other aggressive episodes before August 2025. This information will likely be helpful to the treatment team and to ORB panels going forward for the purpose of assessing risk, care planning and potential community placement.
What is known is that at some point in 2022 or 2023, Mr. Sivapalasingham returned to in-person classes at school. He graduated high school in June 2025, and was arrested in respect of the outstanding charge weeks later, on August 2nd.
Fitness to Stand Trial
In oral testimony, Dr. Eid, Mr. Sivapalasingham’s treating psychiatrist, confirmed her view and that of the treatment team that he remains unfit to stand trial.
We accept that view. As described by Dr. Eid, Mr. Sivapalasingham has the mental age of a young child. In keeping with his diagnoses of severe autism spectrum disorder and intellectual disability, he has severe cognitive and developmental limitations. He struggles with slow processing, concrete thinking and an inability to engage in meaningful conversation. Even if he was to learn the answers to the Taylor-type questions (which is unlikely), there is little likelihood that he could apply those concepts to his own situation, follow and participate meaningfully in any court proceedings, or understand and instruct counsel regarding his legal options. Additionally, although the issue was not before us at this initial hearing, it is worth noting Dr. Eid’s view that given Mr. Sivapalasingham’s significant cognitive deficits and the static nature of his disability, coaching and support is unlikely to make him fit to stand trial in the future.
The Necessary and Appropriate Disposition
Since his admission to CAMH in September, Mr. Sivapalasingham has generally presented as calm, pleasant and co-operative with staff, to the best of his ability. Despite being told what to do by staff on a regular basis, there have been no episodes of aggression and no management concerns. He spends much of his time colouring, plays games with staff and co-patients and enjoys visits with his family. As he has gotten more familiar with the members of his treatment team, he has been attending for assessment discussions.
We agree with the treatment team and the parties that in order to build on the behavioural progress that Mr. Sivapalasingham has displayed to date, any community reintegration must occur in a gradual, developmentally appropriate way. As outlined in the hospital report, the clinical team needs an adequate further period of hospitalization to identify Mr. Sivapalasingham’s triggers to violence and what can be done to intervene early before he escalates. Similarly, the team must be able to assess and identify potential warning signs for future aggression, so that a suitable safety and behavioural plan can be put into place. In order for this to occur, a detention disposition is necessary.
The evidence is that Mr. Sivapalasingham is likely to do much better if he is detained on a high support general forensic unit than on a secure unit – as described by Dr. Eid, there are more acutely unwell patients on the secure units and more violence there. In contrast, a high support general forensic unit will have less clients and more staff to help manage any problematic or inappropriate behaviours. As a result, we have specified that Mr. Sivapalasingham be detained on a general forensic unit.
To allow Mr. Sivapalasingham to begin the process of community reintegration, we have included graduated passes off of the unit. Initially his passes will be escorted or accompanied by security or unit staff on the hospital grounds or in the community, likely focused on structured leisure activities. This will allow the team to monitor closely for triggers off of the unit, particularly as Mr. Sivapalasingham receives increasing privileges. Subsequent passes may occur with an approved person (possibly a family member, depending on approval) if the initial passes are successful. Dr. Eid said that Mr. Sivapalasingham may or may not be able to go on indirectly supervised passes this year, but suggested allowing for up to indirectly supervised community passes as it is possible that with appropriate support and training, he could go to the Tim Horton’s on Queen Street. As a result, we have included those passes too, though it may be appropriate for the Board to reconsider indirectly supervised community passes in future depending on Mr. Sivapalasingham’s actual ability to use them.
Finally, we have included the possibility of community living over the next year, approved by the person in charge. It is very important that the treatment team have the ability to approve Mr. Sivapalasingham’s housing prior to discharge, to ensure adequate supports and supervision at his residence to manage his behaviour and cater to his specific developmental needs. The people providing oversight at any housing must be able to recognize triggers and signs of triggers to violence and respond appropriately to reduce his risk of aggression. Building prosocial connections with others will also be an important aspect of his care. Specialized support for persons with autism would be particularly helpful, possibly through the DSO. While Mr. Sivapalasingham may not be in a position to transition to community living for many months, given the very significant waitlists for housing, it is essential that he has a community living clause in his disposition to allow him to be placed on an appropriate housing list.
Although the Crown suggested specifying “supervised accommodation” to ensure that Mr. Sivapalasingham is not permitted to return home to live with his family without the Board receiving further information as to how he is doing, we have instead allowed for approved accommodation. In so doing we are not suggesting that Mr. Sivapalasingham should be discharged to his family home, particularly as his family members have been the primary victims of his aggression and violence in the past. Rather, we are allowing for the potential of a wider range of appropriate housing options available to him in the future.
DATED this 4th day of February, 2026, at the City of Toronto, in the Toronto Region.
Ms. S. Kert Alternate Chairperson
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Office of the Registrar Ontario Review Board