Ontario Review Board
Re: Li Kai Li
ORB File No: 8688
Hearing held on: Monday, January 26, 2026
Place of hearing: Ontario Shores Centre for Mental Health Sciences
700 Gordon Street, Whitby
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. J. Goldenberg
Members: Dr. M. Attia
Dr. M. Kalia
Ms. J. Ferguson
Mr. J. Cyr
Parties Appearing:
Accused: Li Kai Li
Counsel: Mr. A. Paas
The person in charge of hospital: Counsel: Mr. K. Dow
Attorney General of Ontario: Counsel: Ms. N. MacDonald
REASONS FOR DISPOSITION
(Dated March 6, 2026)
Introduction:
On December 11, 2024, Mr. Li Kai Li was found not criminally responsible (NCR) on account of mental disorder, on charges of attempt to murder by stabbing (x2) and assault, both contrary to the Criminal Code of Canada ("Criminal Code"). That finding was based on an assessment, and related report, of Dr. Hartfeil, dated April 2, 2024.
The court did not make a Disposition and ordered, pursuant to s. 672.81(1) of the Criminal Code, that Mr. Li be detained at the Central East Correction Centre – Ontario Shores Centre for Mental Health Sciences ("Ontario Shores"), pending a Disposition of the Ontario Review Board (the "Board").
An Initial Disposition was made on February 25, 2025 and on January 26, 2026, the Board convened a hearing at Ontario Shores for Mr. Li's annual NCR review.
Mr. Li was present and was represented by his counsel, Mr. A. Paas.
A Hospital Report, dated January 12, 2026 (the "Hospital Report"), was entered as Exhibit 1. Dr. F. Alioglu Karayilan, a Clinical Fellow at Ontario Shores, gave oral evidence.
The issue at this hearing is whether Mr. Li 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.
For the reasons set out below and based on the expert evidence and opinions before it, the Board concluded that Mr. Li represents a significant threat to the safety of the public. The Board further concluded that his risk can be properly managed with a Detention Order at Ontario Shores, on the terms and conditions set out in our formal Disposition. The Board allowed that the highest level of privileges accorded to Mr. Li shall be to live in the community, in accommodation approved by the person in charge. The Board concluded that the above is the necessary and appropriate Disposition, and the least restrictive and least onerous Disposition taking into consideration all of the circumstances.
Current Psychiatric Diagnoses:
- Schizophrenia
Cannabis Use Disorder, moderate, in remission, in a controlled environment
Index Offences:
- The circumstances giving rise to the Index Offences are extracted from the Reasons for Judgment of Justice A.A. Ghosh, released on December 18, 2024, as follows:
"The stabbing occurred inside the "Li" family home in Markham. Mr. Li lived there with his mother and two adult sisters. He failed to complete high school and had been unemployed for years. Mr. Li apparently suffered from undiagnosed mental health issues, and he regularly smoked cannabis. The women in the home paid the bills and supported Mr. Li.
On June 10, 2023, the sisters agreed to go to different rooms in the home to logon and play videogames together. Cindy Li heard their mother screaming for help, and she went to the main floor to investigate.
Cindy observed their mother laid out on the ground in a pool of her own blood. Mr. Li was standing over her and striking her. Cindy observed a wooden stick with a metal piece on the end laying across their mother. She yelled at Mr. Li for him to stop hitting their mother. He stopped.
Mr. Li stated that their mother had a "chip implanted in her brain" and was "not well
as a result. Alissa Li then entered the room. Both women told Mr. Li that he was the one who was unwell, enraging Mr. Li.
He took on a fighting stance, and then struck Cindy in the face 3-5 times, causing bruising around her eye and a small cut. Alissa tried to physically intervene, and Mr. Li began to strike her too. Their mother yelled at the women to call the police.
Mr. Li left for the kitchen, and returned holding two large kitchen knives. He began swinging them at Alissa, causing her to fall back onto the ground. He then began to "hack" her on top of her head. She held her hands over her head protectively.
Cindy ran out of the house with their mother's cell phone. She called the police. Police attended and arrested Mr. Li at gunpoint. Both the mother and Alissa suffered permanent loss of mobility and functionality in their hands due to the nerve damage caused by the attack. Alissa has a large scar on her face. Cindy did not suffer any lasting injuries.
In acknowledging the facts, counsel submitted that Mr. Li did not have any memory of the key events, but accepted that he committed the acts alleged."
Legal History:
- Mr. Li has no prior arrests, charges, or convictions.
Psychiatric History:
- Mr. Li had never seen a psychiatrist, nor was he ever admitted to hospital for psychiatric reasons.
Substance Use History:
- Mr. Li's substance use history is set out in detail in the Hospital Report:
"Mr. Li did not smoke cigarettes. He drank alcohol occasionally, approximately one or two shots once per week. He vaped cannabis about three times per week in relatively small quantities. He reported that this occasionally made him paranoid for 'about five minutes' in that he would feel that others were looking at him. He did not enjoy this feeling, and so he tended not to use larger quantities of cannabis. He denied any paranoia when not using cannabis. He denied any other substance use."
Background Information:
- Mr. Li's background information is set out in detail in the Hospital Report and in last year's Reasons. It does not have to be repeated here in detail, but the following passages are relevant.
"At the age of eight, Mr. Li immigrated to Canada with his mother and sisters and his father remained in China.
Mr. Li reported that after finishing tenth grade he visited his father in China for two years before returning to Canada in 2010.
Prior to his arrest, and since he last worked, Mr. Li spent much of his time working out and playing games on his computer. He enjoyed "shooting games" such as Call of Duty.
Mr. Li previously attended Markville Secondary High School until dropping out in Grade 11. Mr. Li never completed his GED or obtained his high school diploma."
Course Prior to Not Criminally Responsible Finding:
Mr. Li was admitted to the Forensic Assessment Unit ("FAU") on February 2, 2024, for a criminal responsibility assessment.
Mr. Li was able to move out of the psychiatric intensive care area ("PICA"), into the general milieu of the unit, a few days after admission. He did not require locked seclusion, mechanical restraint, chemical restraint, or as-needed medication during this admission. He did not engage in any overtly threatening, aggressive, or violent behaviour.
Mr. Li did demonstrate bizarre and disorganized behaviour and behaviour suggestive of a perceptual disturbance.
Position of the Parties:
Counsel for the hospital advised that its position is that a continuation of the current Detention Order is the least onerous and least restrictive and is both necessary and the most appropriate order in the circumstances. Counsel further suggested that the hospital would agree to the Disposition specifying that Mr. Li be detained on a general forensic unit.
Counsel for the Crown agrees with the position of the hospital, including a provision specifying a general forensic unit.
Mr. Paas conceded significant threat and anticipated agreeing with the hospital but reserved his final submission until he had heard the evidence.
Evidence at the Hearing:
The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Alioglu Karayilan who is a Clinical Fellow working under the supervision of Dr. Pytyck. She has been one of Mr. Li's treating psychiatrists since his admission to Ontario Shores, in December 2024.
Dr. Alioglu Karayilan authored the Hospital Report and adopted its contents. She had no updates.
Dr. Alioglu Karayilan testified that Mr. Li remains at a general forensic unit and there have been no issues and no elopements. For the past month, Mr. Li has been volunteering at the boutique one hour per week, organizing teams, opening boxes, and taking care of the boutique.
Dr. Alioglu Karayilan testified that the biggest clinical concern for the treatment team is Mr. Li's insight, which remains poor. According to Dr. Alioglu Karayilan, Mr. Li has agreed to and is receiving long-acting injectable medication, despite his primary deficit, which is his inability to accept his diagnosis.
Dr. Aligolu Karayilan gave evidence that Mr. Li has been observed responding to internal stimuli, which resulted in a change in his treatment, which change appears to be responsible for the team now reporting that they do not observe him responding to internal stimuli.
Dr. Aligolu Karayilan testified that in her opinion, as set out on pages 23 & 24 of the Hospital Report, Mr. Li remains a significant threat to safety of public at this time.
When asked why the treatment team was recommending no changes to the current detention order, Dr. Aligolu Karayilan replied that Mr. Li remains mostly stable, exercises his privileges appropriately, and is adherent to his medication regime. However, the doctor added that the team is still trying to address Mr. Li's issues by getting him involved in some type of education group and stated that he is currently on the waiting list for the Cognitive Behavioural Therapy ("CBT") for psychosis.
Dr. Alioglu Karayilan opined that Mr. Li's risk would not be manageable if he was granted a conditional discharge given that he still requires constant support, has not maximized the privileges available to him, and would not remain abstinent without support and supervision from staff.
In response to a question as to what is the plan for the upcoming year apart from trying to obtain housing in the community for Mr. Li, Dr. Alioglu Karayilan testified that CBT for psychosis is planned for Mr. Li and he is currently on the wait list for this therapy. Another goal is the improvement of Mr. Li's insight, and Dr. Alioglu Karayilan testified that Mr. Li is currently working with a group in pursuance of this goal.
In response to a question from Ms. MacDonald, Dr. Alioglu Karayilan testified that, as set out in the Hospital Report, Mr. Li is ready to move into the community into a 24-hour supervised setting, and is on the wait list for McKay House, which is such a setting. Dr. Alioglu Karayilan testified that a detention order is necessary in order to bring Mr. Li back to hospital quickly if anything happens in the community.
Dr. Alioglu Karayilan gave evidence that, although Mr. Li is a rule follower, he hasn't internalized the fact that he has a major mental illness, and he takes his medication because the treatment team tells him to. However, without the supervision of the Board, Mr. Li has told her that he would stop taking medication and wouldn't see his doctors. Dr. Alioglu Karayilan opined that Mr. Li is seeing his doctors solely because he is under the supervision of the ORB.
In response to a question from Mr. Paas, Dr. Alioglu Karayilan confirmed that Mr. Li is on the wait list for McKay House, and that the treatment team hasn't been able to find other suitable housing, but are still looking. Dr. Alioglu Karayilan confirmed that Mr. Li definitely needs a 24-hour supervised setting.
Dr. Alioglu Karayilan testified that Mr. Li has exercised all of his privileges, including passes into community for up to six hours, and has been as far away from the hospital as Pickering.
Dr. Alioglu Karayilan testified that Mr. Li is tested regularly for substances and that there are no issues with substance use. Dr. Alioglu Karayilan gave evidence that Mr. Li has said that he wants to follow the Disposition but still thinks its unnecessary.
In response to a question about the CBT for psychosis program, Dr. Alioglu Karayilan testified that Mr. Li has been cooperative in terms of doing programming, that he is near the top of the list for CBT for psychosis programming, and that he should be starting the program within a month.
With respect to a question about insight-based programming, Dr. Alioglu Karayilan testified that Mr. Li is already participating in such a program.
In response to a question about Mr. Li following the rules, Dr. Alioglu Karayilan opined that generally, Mr. Li follows rules because he wants an absolute discharge and he knows he must follow the rules to get one. When asked if Mr. Li would follow rules under a conditional discharge, Dr. Alioglu Karayilan responded that Mr. Li says he doesn't think he needs his medication, and wouldn't take them if he didn't have to, and, of course he wouldn't have to take his medication if he received an absolute discharge. In addition, Dr. Alioglu Karayilan stated that if granted an Absolute Discharge, the hospital wouldn't have the ability to bring Mr. Li back to hospital if required, which ability she felt was necessary given his history of substance use and of decompensating quickly when he uses substances.
When further questioned as to whether Mr. Li would take his medications if granted a conditional discharge, Dr. Alioglu Karayilan reiterated that she expected he would not, as he currently needs his medications given to him, and she believes he only takes them because he is being supervised.
In response to a question from the Board, Dr. Alioglu Karayilan testified that, in her clinical opinion, Mr. Li is marginally capable with respect to his treatment, and the issue of his capacity is still under review, but that Mr. Li does recognize that he benefits from taking medication by experiencing less anxiety and by being less symptomatic.
In response to a question as to whether Mr. Li is externally motivated, Dr. Alioglu Karayilan testified that it is possible, but the treatment team hasn't had the chance to fully assess him with respect to this issue.
Dr. Alioglu Karayilan testified that Mr. Li is guarded about his symptoms and doesn't want to engage. Dr. Alioglu Karayilan added that recently, Mr. Li says he doesn't believe there is a chip in his mother's and sisters' brains and that he never thought that, although such belief is well documented. Dr. Alioglu Karayilan testified that Mr. Li may be hiding his symptoms.
Dr. Alioglu Karayilan testified that the treatment team has seen Mr. Li responding to internal stimuli but that after his medication change, his symptoms seem to have decreased, and progress is being made. Dr. Alioglu Karayilan gave evidence that Mr. Li's presentation has changed over time and especially since the previous year; however, he remains very guarded.
When asked whether it was possible that the delusion regarding the implant has disappeared, Dr. Alioglu Karayilan testified that she is not sure, but that Mr. Li is more stable and relaxed since being in contact with his mother. Dr. Alioglu Karayilan added that at first, Mr. Li didn't want to talk about his mother, but now he does and that is progress. Dr. Alioglu Karayilan gave evidence that Mr. Li's mother has visited him three times, and he says that he is in daily phone contact with her.
No other evidence was called.
Final Submissions:
Counsel for the hospital submitted that a continuation of current Disposition is the least onerous, least restrictive and the necessary and most appropriate order. Counsel submitted that Mr. Li hasn't reached the outer envelope of privileges and the hospital needs the ability to choose his housing. Counsel added that Mr. Li needs more inpatient time in order to make significant improvements with respect to his insight. Of particular concern is the fact that Mr. Li doesn't believe he has a mental illness and intends to cease taking his medications if granted an absolute discharge. He added that Mr. Li requires supervision to take his medication and is not doing this independently; therefore, Mr. Li needs the more robust guardrails of a Detention Order. Further, Mr. Li doesn't have community housing at this time and the plan for what he would do in the community is bare bones. A Conditional Discharge would increase the risk to the public.
Ms. MacDonald, on behalf of the Crown, adopted the hospital's position. She was of the view that it was too early for Mr. Li to be discharged conditionally, and that we need to see him doing well and remaining free of cannabis while living in the community under a detention order. She also took the position that it is necessary to be able to get Mr. Li back in hospital quickly if he decompensates while in the community, and a Detention Order facilitates that.
Mr. Paas, on behalf of Mr. Li, conceded the issue of significant threat and submitted that he would leave the issue of a Conditional Discharge to the Board. Nonetheless, Mr. Paas submitted that a Conditional Discharge, with conditions that could include residing at McKay House when it becomes available, would be the most appropriate and least onerous and least restrictive Disposition. Mr. Paas pointed out that Mr. Li is a rule-follower and submitted that Mr. Li would continue to follow the rules if granted a Conditional Discharge.
Analysis and Conclusions:
Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board finds that Mr. Li 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. Alioglu Karayilan, in addition to the documentary evidence before us.
Mr. Li has made progress this reporting year. However, his insight into his illness remains extremely limited and he has stated that he does not believe he needs to take medication. Mr. Li requires constant support and supervision, and the evidence suggests that he follows the rules and takes his medication because he wants an absolute discharge, and understands that he must do so in order to obtain one. The Board also takes into consideration the extremely serious nature of the index offences, that Mr. Li is only marginally capable, remains very guarded with respect to engaging with the treatment team, would likely start using cannabis and stop taking his medication if not closely supervised and subject to the oversight of the Board, would decompensate quickly if he stopped taking his medication and would need to be returned to hospital quickly in order to safeguard the public in the event of such decompensation. Mr. Li is also in need to further assessment and programming, especially with respect to his limited insight and his psychosis.
In particular, the Board relies on the following excerpts from the Hospital Report:
"Insight and Symptoms of Major Mental Illness, both of which inform his risk of violence. During the clinical interview, Mr. Li expressed disagreement with his diagnosis of schizophrenia and reported a belief that medication is unnecessary. While he expressed an intention to adhere to his current disposition to facilitate an Absolute Discharge, he openly shared that he intends to immediately stop all medication and rely on cannabis as a primary coping mechanism if granted autonomy. He denied the negative effects of cannabis use and inquired about removing the substance use prohibition from his disposition. In addition to limited insight, records indicate on-going residual symptoms of psychosis. For example, nursing notes highlight incidents suggestive of responding to internal. When canvassed as part of this assessment, Mr. Li denied experiencing any symptoms of schizophrenia at any point in his life. This self-report is contradicted by collateral reports from the treatment team, which document numerous incidents of Mr. Li denying symptoms as they are being observed by staff.
"On the Risk Management items, when considering a Conditional Discharge, there is evidence of potential problems with Stress and Coping, Professional Services and Plans, Living Situation, Personal Support, and Treatment or Supervision Response. Based on these factors, a Detention Order is clinically indicated at this time, as there appears to be significant gaps in his discharge plan. Mr. Li would like to reside in an apartment owned by his mother and work cleaning apartments. He denied the need for professional services (e.g. psychiatrist follow-up), and shared that he is not easily distressed or dysregulated. When asked about future stress, he was unable to identify stressors that could destabilize him or hamper his ability to utilize coping skills. Even when presented with hypothetical situations (e.g., financial stress or consequence of stopping medication or engaging in substance use), Mr. Li demonstrated no explicit or well-formed plans aimed at supporting his reintegration.
"Primary Re-Offence Scenario of Future Violence: The most likely re-offence scenario for Mr. Li involves psychiatric destabilization precipitated by substance use and non-adherence to medication. In such a state, limited insight would hamper his ability to implement coping strategies. Environmental stressors may precipitate delusional beliefs and paranoia, potentially leading to an aggressive response. Potential victims would include those with whom he is closest, such as peers, family members, and neighbours. Violence may initially manifest as environmental aggression or verbal altercations but could escalate to threats or actual physical harm. Based on his history, this may take the form of striking others and/or the use of weapons.
"Summary and Management Plan: The primary concern during this reporting period remains Mr. Li's limited insight into his mental health diagnosis as well as limited insight among the relationship between environmental stressors, psychiatric stability, substance use, and the risk for violence.
"Without improved insight into these risk factors, unstructured autonomy is contraindicated. Overall, Mr. Li's risk for violence is categorized as Moderate within the context of a Conditional Discharge. It is opined that a continuation of his current disposition is necessary to mitigate and manage this level of risk effectively.
"To assist Mr. Li in the upcoming year and manage the aforementioned risk factors, the following interventions are recommended:
Individual Psychological Intervention: While Mr. Li participates in a variety of groups, individual therapy is recommended to allow for targeted interventions. Individual work should focus on shifting his orientation from a pre-contemplative to a more active stage of change regarding his diagnosis and treatment needs.
Insight-Based Programming: Engagement in therapeutic activities aimed at fostering supporting relationships and developing intrinsic motivation for change is essential. Until Mr. Li develops an internal awareness of his risk factors, he will continue to require external supervision and support.
Structured Prosocial Activity: Mr. Li reports that a lack of structure and boredom increases his cravings for cannabis. To date, he has successfully abstained from substance use while under supervision. He should be supported in seeking structured activities, such as employment or community volunteering, to foster a sense of purpose and encourage a prosocial and substance-free lifestyle.
External Support Systems: The continued involvement of external support and oversight is necessary to monitor for signs of psychiatric destabilization and to provide a framework for community reintegration when clinically appropriate.
"Clinical Assessment of Risk
Mr. Li's historical risk factors for violent recidivism, as outlined by the HCR-20V3, continue to include clear evidence for historical problems with Violence and Major Mental Disorder. There is also partial evidence for historical problems with Employment, Substance Use, and Traumatic Experiences. The most relevant historical risk factors for Mr. Li continue to be his history of violence, major mental illness, and substance use.
Clinically, over the past reporting year, Mr. Li has demonstrated clear evidence of ongoing problems with insight and active symptoms of a major mental illness. He continues to experience auditory hallucinations and was not forthcoming about these symptoms, has denied even clearly observed psychopathology. This pattern suggests a broader tendency to minimize the severity and impact of his symptoms.
Mr. Li continues to lack meaningful insight into his major mental disorder. Although he has been taking antipsychotic medication following medical recommendation, this adherence does not reflect an internalized understanding or acceptance of his illness or the need for ongoing treatment. He does not believe that he has a psychiatric disorder, nor does he believe that psychotropic medication is necessary. He has stated that his current medication use is primarily motivated by the requirements associated with hospitalization and Ontario Review Board oversight, and that he would be unlikely to continue medication if no longer subject to supervision.
Similarly, Mr. Li does not acknowledge the adverse impact of cannabis use on his mental state. He has denied the role of cannabis in past psychiatric destabilizations and has indicated that, if supervision were lifted or a substance prohibition were removed, he would wish to resume cannabis use. In this context, he demonstrates no meaningful insight into a cannabis use disorder or into the relationship between substance use and the exacerbation of psychotic symptoms. In the absence of supervision, relapse of substance use would be highly likely.
Absent an ORB Disposition, Mr. Li would almost certainly disengage from psychiatric treatment and supervision, resume cannabis use, and discontinue medication. In this context, he would be expected to deteriorate rapidly and would be at high risk of engaging in violent behaviour with the potential to cause serious harm to others, driven by paranoia, auditory hallucinations, substance use, and disorganization of thought and behaviour."
Given the Board's finding of significant threat, the Board is unanimous in agreeing that the necessary and appropriate and the least restrictive and least onerous Disposition to manage Mr. Li's risk is a continuation of a Detention Order with a change to specify the "General" Forensic Unit" instead of simply referring to the Forensic Service.
Given the severity of Mr. Li's Index Offences, his guardedness, and his underdeveloped insight, it will be necessary for the hospital to intervene quickly should he become unwell in the community in order to prevent another incident which may include severe violence.
As set out in the Hospital Report, it is critical for Mr. Li to remain abstinent from substances, and he needs to be closely monitored to ensure he takes his medications and remains abstinent. When Mr. Li's mental state becomes destabilized, he needs to be returned to hospital quickly. In the opinion of the Board, the Mental Health Act would not be sufficient to protect the safety of the public. In addition, Mr. Li will require a 24-hour supervised setting when he moves into the community and the treatment team will need to approve Mr. Li's housing in the community.
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. Li, his reintegration into society and his other needs, the necessary, and appropriate, Disposition is a Detention Order, upon the terms set out in our formal Disposition.
DATED this 6th day of March 2026, at the City of Toronto, in the Region of Toronto.
Ms. J. Ferguson
Legal Member
Office of the Registrar Ontario Review Board