Tyler Cousineau (Re), 2026 CanLII 18272

Ontario Review Board

Re: Tyler Cousineau

ORB File No: 7442

Hearing held on: Friday, January 16, 2026

Place of hearing: Waypoint Centre for Mental Health Care

Pursuant to: Section 672.81(1) of the Criminal Code

Before:

Alternate Chairperson: Mr. J. Weinstein

Members: Dr. R. Kunjukrishnan

Dr. R.W. Hill

Mr. P. Capelle

Mr. J. Cyr

Parties Appearing:

Accused: Tyler Cousineau

Counsel: Ms. A. Szigeti

Person in charge of Hospital: Counsel: Ms. J. Lefebvre

Attorney General of Ontario: Counsel: Ms. S. Curry

REASONS FOR DISPOSITION

(Dated March 2, 2026)

Introduction

1. On October 15, 2018, Tyler Cousineau was found not criminally responsible on account of mental disorder (“NCR”) on charges of two counts of second-degree murder, contrary to the Criminal Code of Canada (the "Criminal Code"). The Court also designated Mr. Cousineau a high-risk offender (“HRO”), pursuant to s. 672.54 of the Criminal Code.

2. Mr. Cousineau is currently subject to a Disposition of the Ontario Review Board, dated May 30, 2024, ordering him detained at the Waypoint Centre for Mental Health Care – High Secure Provincial Forensic Programs Division (“Waypoint”/“the Hospital”), with privileges up to and including hospital and grounds privileges, escorted by staff.

3. On January 16, 2026, a panel of the Ontario Review Board (“the ORB” or “the Board”) convened a hearing pursuant to s. 672.81(1) of the Criminal Code of Canada (“the Code”). Mr. Cousineau was in attendance and represented by his counsel, Ms. Szigeti. Also in attendance were Ms. Lefebvre for the Hospital and Ms. Curry for the Attorney General.

Without Prejudice Position of the Parties

4. Ms. Lefebvre stated that a transfer to Ontario Shores Centre for Mental Health Sciences (“Ontario Shores”) was recommended with no changes to the current Disposition.

5. Ms. Curry advised she was likely to support that recommendation but would first want to hear evidence.

6. Ms. Szigeti indicated that her client supports a transfer to Ontario Shores as well as the recommended privileges following a transfer. Ms. Szigeti added that while ongoing significant threat to the public threat is conceded, Mr. Cousineau is contesting the High-Risk Offender designation and requesting that the designation be referred back to a Superior Court Judge for removal, per s. 672.84(1) of the Code.

7. Therefore, for the purposes of Mr. Cousineau’s annual review, the hearing proceeded by way of a joint position. Following the evidentiary portion of the hearing, the Hospital revised its recommendation. The updated recommendation was consistent with Dr. Mishra's testimony and the terms and conditions described in the Updated Recommendation Regarding Disposition, dated January 15, 2026, entered as Exhibit 4. This recommendation was joined by both Ms. Curry and by Ms. Szigeti. Therefore, if Mr. Cousineau was to be ordered transferred to Ontario Shores, the following terms and conditions were jointly requested:

a) to attend within or outside of the hospital for necessary medical, dental, legal, or compassionate purposes;

b) hospital and grounds privileges, escorted by staff;

c) hospital and grounds privileges, accompanied by staff;

d) passes for up to six hours to enter the community within a 150-kilometre radius of Ontario Shores Centre for Mental Health Sciences, escorted by staff;

e) abstain absolutely from the non-medical use of alcohol or drugs or any other intoxicant;

f) submit samples of his urine and/or breath to the person in charge of the Ontario Shores Centre for Mental Health Sciences, or his or her designate for the purpose of analyzing whether the accused has ingested alcohol, drugs, or any other intoxicant;

g) refrain from having in his possession any firearm, ammunition, or other offensive weapon, or being in the company of any person possessing a firearm other than a peace officer.

8. No changes were recommended to the residual terms and conditions applicable to Mr. Cousineau pending his transfer to Ontario Shores. These are nevertheless reproduced below for ease of reference:

a) abstain absolutely from the non-medical use of alcohol or drugs or any other intoxicant;

b) submit samples of his urine and/or breath to the person in charge of the Waypoint Centre for Mental Health Care, or his or her designate for the purpose of analyzing whether the accused has ingested alcohol, drugs, or any other intoxicant;

c) refrain from having in his possession any firearm, ammunition, or other offensive weapon, or being in the company of any person possessing a firearm other than a peace officer.

Index Offences

9. The circumstances of the index offences are taken from last year's Reasons for Disposition, as follows:

"In the early morning hours of March 7, 2017, Mr. Cousineau broke into the home of Carol-Lynn and Orville Affleck in Fort Frances. He used a knife to kill 77-year-old Orville in the bedroom and then broke into the bathroom and used a knife to kill 66-year-old Carol-Lynn. After the police arrived at the scene and investigated, they located Mr. Cousineau in his home across the street. When interviewed, Mr. Cousineau recounted a series of paranoid delusions that included allegations that the victims had broken into his house, poisoned his milk and food, and broken his bones with ultra-sonic waves. A physician who saw Mr. Cousineau two days later described him as 'floridly psychotic'."

Evidence at Hearing

10. Ms. Lefebvre called Dr. Mishra to testify on behalf of the Hospital. He has been Mr. Cousineau's attending psychiatrist for the past five years and meets with him monthly.

11. Dr. Mishra opined that Mr. Cousineau continues to represent a significant threat to public safety. Absent oversight, if allowed to come off treatment and supervision, he also presents a substantial likelihood of causing serious harm. Mr. Cousineau was admitted to the Thunder Bay Regional Health Science Centre (“TBRHSC”) when found NCR and HRO in 2018. Thereafter, he was transferred to Waypoint because it is a larger facility, with a secure perimeter and more patient amenities. While Waypoint has significantly reduced Mr. Cousineau's risk, he still remains a significant threat to the safety of the public and therefore must be detained at a forensic facility to manage his risk to public safety. Dr. Mishra added, that at this time, Mr. Cousineau would be properly placed at a medium secure forensic facility, notwithstanding that he would gain greater access to substances.

12. Dr. Mishra advised that Mr. Cousineau can safely be permitted accompanied hospital grounds privileges at Waypoint where he requires a staffing ratio of 3:1 because of his HRO status. Dr. Mishra added that Mr. Cousineau would be fine with a 2:1 staffing ratio at Waypoint when exercising this privilege.

13. Over the past six to seven months, Dr. Mishra has concluded that in the course of the 2026/2027 reporting year, Mr. Cousineau could appropriately access the community of Ontario Shores if escorted by staff, as recommended in the January 15, 2026, Updated Recommendation Regarding Disposition. Putting aside the HRO designation, Dr. Mishra envisions that if transferred to Ontario Shores, Mr. Cousineau could continue to progress, as would any forensic patient. A transfer to Ontario Shores would also facilitate visits from Mr. Cousineau's family as that facility is significantly closer to them than Waypoint. Dr. Mishra is prepared to leave the determination of the patient/staff ratio for hospital grounds privileges to the discretion of the person in charge at Ontario Shores. In Dr. Mishra's opinion, Mr. Cousineau’s risk could be adequately managed if escorted/accompanied by just one staff member.

14. Mr. Cousineau's insight regarding his illness, associated symptoms, need for treatment and the index offences has improved with medication compliance and forensic oversight at Waypoint. Questioned by Ms. Curry, Dr. Mishra stated that there remains room for his overall insight to continue to improve/develop. Asked if Mr. Cousineau's insight regarding the use of cannabis has improved, the doctor responded that substance use was a factor in Mr. Cousineau's current and previous NCR finding. Within Waypoint, a substance free facility, he has displayed stability. He is also now older and more mature. Dr. Mishra believes this risk is significantly reduced. Therefore, access to hospital grounds, either accompanied or escorted by staff at Ontario Shores, should be sufficient to ensure he does not access cannabis.

15. Ms. Lefebvre asked Dr. Mishra about Mr. Cousineau's decision to stop attending Waypoint's vocational wood shop. The doctor responded that the wood shop's therapeutic value is in providing opportunities for engagement, concentration, and motivation testing. Mr. Cousineau did very well in the vocational woodworking program. He previously held a high skilled job as an electrician. Therefore, ending his engagement with the woodworking shop should not be a barrier to his moving forward and does not impact his risk. Mr. Cousineau has exhibited prosocial behaviour at Waypoint and exercised the highest privilege level (C5), since 2019.

16. Asked why Mr. Cousineau wants to transfer to Ontario Shores at this juncture, Dr. Mishra responded that this is a natural progression as well as a motivating factor. Mr. Cousineau believes he will have greater access to programming and to an improved quality of life. Mr. Cousineau's progression has plateaued at Waypoint. He has completed all available therapy groups, some of which addressed substance use. Individual Cognitive Behavioural Therapy (“CBT”), which began in December 2025, can continue at another hospital.

17. During the last seven to eight years at Waypoint, Mr. Cousineau has been provided meaningful opportunities for treatment and medication to address his mental disorder. He no longer exhibits positive symptoms of schizophrenia. Dr. Mishra reiterated that there is no need to switch Mr. Cousineau to an intramuscular antipsychotic at present. His blood levels can be tested on an ongoing basis to ensure he remains medication compliant via pills.

18. Responding to questions from the panel, it was noted that paragraph 21 of the most recent Reasons for Disposition, dated July 31, 2024, indicate that Mr. Cousineau stated he was cured and would not relapse if he stopped taking antipsychotic medications. Dr. Mishra responded that this is no longer the case, and the change is attributable to all the programming Mr. Cousineau has engaged in at Waypoint. At paragraph 21 of the aforementioned Reasons for Disposition, Dr. Mishra is reported to have opined that if Mr. Cousineau’s symptoms returned, he would not seek assistance. Dr. Mishra testified in reply that Mr. Cousineau's relapse signature is deterioration over weeks and months. With safeguards in place, a future deterioration should therefore be identified early on by his treatment team.

19. Another Panel Member inquired why indirectly supervised community privileges were not recommended as part of the transfer recommendation to Ontario Shores. Dr. Mishra responded that this is because the scope of privileges available at Waypoint are very limited and do not allow for indirectly supervised community privileges. Untested, it is premature to assess how Mr. Cousineau would react to that increased level of freedom.

20. Dr. Mishra agreed with the suggestion that because Mr. Cousineau had previously been detained at Ontario Shores, it should be less stressful for him to be transferred there, rather than to another medium secure forensic facility. Waypoint's recommendation regarding community access for Mr. Cousineau at Ontario Shores is that he be escorted by staff. As Mr. Cousineau has been at Waypoint for a number of years, largely absent this privilege, if and when appropriate, it should be enabled gradually.

21. Yet another Panel Member inquired why subparagraph 2(b): hospital and grounds privileges, escorted by staff does not specify the number of staff required. Dr. Mishra responded that the HRO designation requirement of being accompanied by three staff is not connected to clinical status at the time the pass is exercised.

22. It was noted that some three years prior to this hearing, Mr. Cousineau discontinued his intramuscular antipsychotic medication, believing that his illness was in remission. Dr. Mishra was asked if Mr. Cousineau currently believes he is cured of the symptoms of his mental illness, or if Mr. Cousineau now believes the symptoms are controlled with medication. The doctor reiterated his opinion that Mr. Cousineau has recently developed an understanding that treatment is helpful. Therefore, Mr. Cousineau is now internally motivated vis-à-vis recognition of his illness, his need for treatment, and the need to abstain from substances. This progression will be tested over time. The doctor added a note of caution, stating “people learn what to tell you.”

23. Dr. Mishra agreed that the Hospital's recommendation is premised on how a forensic patient would be assessed, rather than an HRO designated patient. The only functional difference at Waypoint is that, when exercising hospital grounds privileges, an increased staff ratio of 3:1 rather than 2:1 is required. Dr. Mishra also agreed with the hypothetical that, assuming Mr. Cousineau can never have indirectly supervised community passes or reside in community due to the HRO designation, it is difficult to determine if he may be suitable for an Absolute Discharge. This is because privileges need to be given and assessed in a stepwise manner.

24. Responding to questions from Ms. Szigeti, Dr. Mishra stated that he would not object to the inclusion of accompanied community passes within Mr. Cousineau's 2026/2027 Disposition. That opinion is formed absent consideration of Mr. Cousineau's HRO status, in conjunction with the inability to test community access while at Waypoint.

25. Finally, Ms. Szigeti requested that Mr. Cousineau's sister's letter and email exchange with a Waypoint Social Worker be considered evidence, as she did not propose to call her to testify.

Closing Observations

Submissions on the Annual Review

Submissions of Ms. Lefebvre:

26. Ms. Lefebvre stated that she was content to rely on the evidence.

Submissions of Ms. Curry:

27. Ms. Curry advised that the Attorney General supports the transfer request to Ontario Shores with the additional privileges identified. Ms. Curry submitted that the inclusion of community passes at Ontario Shores is premature, regardless of Mr. Cousineau's HRO designation.

Submissions of Ms. Szigeti:

28. Ms. Szigeti noted that a panel Member raised the possibility of broadening the envelope of recommended privileges to include indirectly supervised community passes, and that Dr. Mishra stated he would not oppose this.

29. Referencing the decision in Sookram (Re), 2024 ONCA 823, Ms. Szigeti observed that the refusal to include a community living provision within a Disposition was deemed unreasonable even with no reasonable prospect of that occurring in the upcoming clinical year. She analogized that it would therefore be proactive for Mr. Cousineau to move forward, notwithstanding his HRO designation.

30. On balance, Mr. Cousineau would prefer the inclusion of indirectly supervised passes into the community but recognizes that passes up to escorted/accompanied on hospital grounds is a good start.

Submissions regarding the appropriateness of the HRO Designation to be referred back to a Superior Court Judge for removal

Submissions of Ms. Szigeti:

31. Ms. Szigeti submitted that consistent with the scheme for all NCR accused and looking at Mr. Cousineau's trajectory under the ORB, it does become appropriate to refer his HRO designation back to the Superior Court. Absent the HRO designation, it can be anticipated, that if all goes well for Mr. Cousineau at Ontario Shores, he will not have to wait a year to enable the next natural step in his progression, that being community access either with an approved person, such as his sister, accompanied community access, or via indirectly supervised community passes.

32. The ORB's mandate is to maximize liberties, while safeguarding the public. The Board in Grant (Re), 2024 CarswellOnt 18804, articulated its understanding of the Cousineau (Re), 2021 ONCA 760, judgment to preclude the referral of an HRO designation back to Superior Court unless an Absolute Discharge has been granted. Ms. Szigeti submitted that this cannot be a Constitutional approach because the HRO designation is not a designation that is capable of being removed by the Board and the Board must make appropriate and Charter compliant orders. Ms. Szigeti therefore urged the panel to ignore the Ontario Court of Appeal’s decision in Cousineau.

33. Reflecting on Dr. Mishra's evidence, Ms. Szigeti submitted that her client poses a lower level of risk than he did in 2018 when initially found NCR and given the HRO designation. Mr. Cousineau is not asking to be absolutely discharged. If his risk is reduced to the level of significant threat, which is below the HRO threshold of significant likelihood, the HRO designation can properly be referred back to the Superior Court. Ms. Szigeti submitted that the difference between the two standards is one of likelihood.

34. Ms. Szigeti referenced the Board's 2025.11.04 Reasons for Charter Ruling in Tyler H. Edgar (Re) as helpful, vis-à-vis its analysis of the Board's jurisdiction. More specifically, the Edgar decision addresses instances when the Board can properly decide not to apply the Charter.

35. Ms. Szigeti recognized that two HRO cases are currently before the Ontario Court of Appeal. While she is hopeful that they will be heard together, there is no reliable timeline when this will take place. As a result, Mr. Cousineau is prejudiced if a decision is not taken by this panel. But for the HRO designation, Mr. Cousineau would not be blocked from community access with staff. Therefore, the HRO designation limits his progress. Absent the HRO designation, Mr. Cousineau could progress, as would any NCR accused. Mr. Cousineau's progress at Waypoint entitles him to removal of the HRO designation, notwithstanding that the significant threat threshold applicable to an NCR accused continues to be met.

Submissions of Ms. Curry:

36. Ms. Curry submitted that it is inappropriate to seek the removal of Mr. Cousineau's HRO designation via a referral back to the Superior Court.

37. Progress has been seen during the last review period in that Mr. Cousineau has productively used his time by engaging in all available programming. This has resulted in a positive change in insight and behaviour and why a move to Ontario Shores is now appropriate. This transfer can occur notwithstanding that the HRO finding remains in place.

38. Referencing paragraphs 18 to 21 of the Attorney General’s Reply to Notice of Application/Constitutional Question, Ms. Curry further submitted that the Cousineau decision is applicable to the circumstances of this case. The Attorney General relies on all of its written materials, and more specifically paragraph 29 and onward of the Attorney General's Reply to Notice of Application/Constitutional Question as to why Mr. Cousineau’s request that his HRO status be referred back to a Superior Court Judge for removal, per s. 672.84(1) of the Code is premature.

39. Ms. Curry submits that Mr. Cousineau is simply not ready for anything more than what is recommended at today's hearing. She noted that Mr. Cousineau met the HRO designation in 2021 and continues to because of the nature of the index offences and his history of falling away from treatment. It is also possible that he could decompensate, even if medication compliant. In an ill state, Mr. Cousineau would not recognize that he was decompensating, as seen after his first Absolute Discharge when he fell away from treatment. At that time, his family was unable to intervene and have him admitted to hospital prior to the commission of the subject index offences.

40. Referencing paragraph 37 of the Reply to Notice of Application/Constitutional Question, Ms. Curry reiterated that Mr. Cousineau is not yet at a level wherein he can access unescorted/unaccompanied access to the community. Ms. Curry referenced the Board’s decision in Pestill (Re), 2025 CanLII 81153 (ON RB), which speaks to the appropriateness of unescorted/unaccompanied community passes for a patient coming from the high secure environment of Waypoint to a medium secure forensic facility, where escorted or accompanied passes are tried prior to granting indirectly supervised community access.

41. Ms. Curry submitted that the nature of the HRO regime limits the Board's jurisdiction to consider Constitutional questions, notwithstanding the Edgar Reasons for Charter Ruling and the application of certain Criminal Code sections. Therefore, if the Board decides to review the HRO designation, specifically in relation to Mr. Cousineau, it should not find breaches of ss. 7, 12 or 15, and in the alternative, that any breach would be upheld by s. 1 of the Charter.

Submissions of Ms. Lefebvre:

42. Following the lunch break, Ms. Lefebvre clarified that Dr. Mishra, on behalf of the hospital, supports indirectly supervised privileges for Mr. Cousineau within the hospital building.

43. Ms. Lefebvre submitted that Dr. Mishra's evidence is that Mr. Tyler Cousineau would meet the HRO threshold if oversight of the Ontario Review Board was removed. The decision in Grant (Re) suggests that the HRO designation ought not to prevent progress, or increase restriction, without a rational connection to actual clinical risk. Thus, when considering a breach of s. 7 of the Charter, actual clinical risk should be considered in determining whether Mr. Cousineau should be more restricted. While that doesn't necessarily apply to the s. 672.84(1) referral request to a Superior Court Judge, it should be considered when the Board makes Dispositions that may be restricted by terms of the HRO.

44. Ms. Szigeti was asked by a Panel Member if her Charter application was premature. More specifically, if the panel determines that the necessary and appropriate Disposition is limited to indirectly supervised passes on hospital grounds, then how are Mr. Cousineau's Charter rights breached if indirectly supervised community passes are outside the scope of his level of his privileges? Responding, Ms. Szigeti noted that Ms. Curry's written materials suggest that Mr. Cousineau may not have maximized his privileges at Waypoint. Ms. Szigeti added that Dispositions are always forward looking over the upcoming reporting year. She submitted that if Mr. Cousineau was an “ordinary NCR,” he would no longer be at Waypoint. If Mr. Cousineau was an “ordinary NCR” in the course of the 2026/2027 reporting year at Ontario Shores, it is unlikely that Mr. Cousineau would be limited to staff accompanied access into the community.

45. Ms. Szigeti submitted that it is reasonable to anticipate that if Mr. Cousineau's HRO designation was referred back to the Superior Court, a determination to remove the designation would not occur the day after this hearing. Therefore, including indirectly supervised community access in his Ontario Shores Disposition is appropriate so that this privilege can be exercised when the clinical criteria allowing for it have been met.

46. There is a risk, according to Ms. Szigeti, that due to conflicting ORB decisions Grant and Pestill, that Mr. Cousineau may not receive as liberal a Disposition in next year's annual review, unless he is no longer deemed an HRO. While the HRO designation may have been appropriate at the time it was imposed, the safeguard is that it can be removed if he no longer meets the more onerous threshold. While no hearing date has been fixed by the Court of Appeal, it is anticipated both Grant and Pestill will be heard together. Ms. Szigeti noted that no Charter issues were raised in either case at the Board level. Ms. Szigeti submitted that this panel cannot conclude that because of the aforementioned pending appeals, it does not wish to decide what ultimately may not matter. Fairness necessitates a decision by the panel.

47. Ms. Szigeti challenges the applicability of the HRO designation, as interpreted subsequent to the Pestill and Cousineau decisions. She requests that this panel state that the Cousineau decision violates her client’s Charter rights because the HRO designation cannot be removed until such time as her client is ready for an Absolute Discharge. While her client requires ongoing Board supervision and detention, his level of risk no longer satisfies the HRO threshold.

Analysis and Decision

(a) Significant Threat

48. Ongoing significant threat to the safety of the public cannot be speculative. It must entail a real risk of serious physical or psychological harm arising from conduct that is both serious and criminal in nature.

49. In determining whether Mr. Cousineau continues to represent a significant threat to the safety of the public, the Board carefully analyzed the evidence as it relates to the Supreme Court of Canada decision in Winko, 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625.

50. The Board unanimously finds that Mr. Cousineau continues to pose a significant threat to the safety of the public. In arriving at this determination, the Board considered the joint position of the parties and accepted the uncontroverted evidence of Dr. Mishra that Mr. Cousineau continues to pose a significant threat. The Board further relies on the Hospital Report and the Re-offence Scenario contained therein at page 73, reproduced below for ease of reference:

Future problems with Mr. Cousineau’s treatment or response to supervision can be anticipated. He has been compliant with treatment while in hospital under strict supervision. Without this structure and support, compliance with treatment will not be sustained, as is evident from history. Without active supervision and support, he will be at high risk to disengage from therapeutic support and medication compliance, which will lead to psychotic decompensation, substance use and the increased likelihood of serious physical harm to others. The risk of serious physical harm to others, including the use of weapons, should he become ill again, is high.

51. The Board therefore accepts that absent an ORB Disposition, Mr. Cousineau would likely become non-compliant with prescribed medications which would lead to decompensation, the use of substances and the re-emergence of behaviours similar to those seen at the time of the index offences. We are satisfied that absent an ORB Disposition, it is likely that Mr. Cousineau will cause serious physical or psychological harm to members of the public and such conduct will likely be criminal in nature.

(b) Disposition

52. Flowing from the Board’s finding that Mr. Cousineau continues to pose a significant threat to the safety of the public, it must shape a Disposition for the year ahead. Its paramount consideration in doing so must be the safety of the public while also considering Mr. Cousineau’s needs pursuant to s. 672.54 of the Criminal Code.

53. The necessary and appropriate Disposition for Mr. Cousineau provides him as much freedom as possible without subjecting the community to a real risk of dangerous behaviour.

54. In considering Mr. Cousineau’s needs, the Board was attentive to the Hospital’s recommendation, joined by both the Attorney General Representative and patient’s counsel that Mr. Cousineau be transferred to Ontario Shores with the following subparagraph included in his Detention Disposition:

1(d) passes for up to six hours to enter the community within a 150-kilometre radius of Ontario Shores Centre for Mental Health Sciences, escorted by staff;

55. This term may be outside the envelope of the privileges he will be permitted to exercise during the upcoming clinical year. Ms. Szigeti conceded that the inclusion of escorted or accompanied passes on hospital grounds would be a “good start” for her client at Ontario Shores.

56. Inclusion of terms within a Disposition that may not be attained within the clinical year is not unusual. For example, terms at times are inserted for motivational purposes, such as leaves of absence to spend overnight or weekend visits with family, decrease the level of supervision required while residing in a group home, travel abroad with an approved person to visit family, or the inclusion of a community living term to enable a patient’s placement on a housing wait list despite the absence of a reasonable prospect of discharge during the clinical year.

57. The panel notes that despite the progress seen at Waypoint, in particular during the past clinical year, there remains room for Mr. Cousineau’s insight to develop and improve. While cannabis use was implicated in his previous and current NCR finding, he has matured and exhibited stability within Waypoint’s substance free environment. Nonetheless, it is widely accepted that cannabis is easily available on hospital grounds as well as within the walls of all of this province’s medium secure forensic facilities. Therefore, Mr. Cousineau, like any patient transitioning from Waypoint to Ontario Shores, will be continually tested and assessed vis-à-vis his abstinence from substances and suitability to continue to progress towards the upper echelons of freedoms that his Disposition allows. Once transferred to Ontario Shores, it can be anticipated that Mr. Cousineau’s newly assigned psychiatrist and treatment team will exercise caution prior to augmenting the highest, albeit still restrictive, privilege level Mr. Cousineau has been permitted to exercise at Waypoint since 2019. This approach is in keeping with the primary obligation of protecting the public from individuals who pose a significant threat to the public’s safety and in Mr. Cousineau’s case, “individuals who pose a substantial likelihood of causing serious harm.”

58. Mr. Cousineau will hopefully continue to progress at Ontario Shores by accessing programing unavailable at Waypoint targeted towards his insight in all spheres in tandem with ongoing CBT, medication compliance, abstinence from cannabis and forensic oversight. No expert evidence was presented at this hearing which speaks to the likelihood of Mr. Cousineau realistically achieving, let alone maximizing, the full extent of the privileges included within subparagraph 1(d) as referenced above. This is most liberal and aspirational of the terms within Mr. Cousineau’s Ontario Shores Disposition for the clinical year ahead. He was largely untested at Waypoint vis-à-vis the exercise of any level of passes into the community since 2018. Dr. Mishra’s uncontroverted evidence was that this privilege level, “if and when appropriate,” should be carefully and gradually accorded. It is therefore speculative to presume that Mr. Cousineau will be stymied in his rehabilitation/community reintegration at Ontario Shores if he does not achieve this threshold. He has not been consistently tested vis-à-vis the exercise of any level of passes into the community during his time at Waypoint. Nevertheless, recognizing the progress Mr. Cousineau has achieved, the panel is prepared to grant him the additional privilege of indirectly supervised passes on hospital grounds.

(c) HRO designation

s. 672.84 (1) of the Code directs:

672.84 (1) If a Review Board holds a hearing under section 672.81 or 672.82 in respect of a high-risk accused, it shall, on the basis of any relevant information, including disposition information as defined in subsection 672.51(1) and an assessment report made under an assessment ordered under paragraph 672.121(c), if it is satisfied that there is not a substantial likelihood that the accused  — whether found to be a high-risk accused under paragraph 672.64(1)(a) or (b)  —  will use violence that could endanger the life or safety of another person, refer the finding for review to the superior court of criminal jurisdiction.

59. Having considered the evidence as well the submissions of the parties, this panel finds that the threshold required to refer Mr. Cousineau’s high-risk designation to the District Court for reconsideration has not been met. This is because his progress to date within Ontario’s forensic system has not been significantly impeded by the designation he received in 2018 in tandem with his second NCR finding.

60. Dr. Mishra’s evidence at this year’s hearing speaks to a marked improvement in his patient’s overall insight as compared to 2024 because of continued medication adherence in conjunction with continued forensic programming and oversight. As a result, Mr. Cousineau no longer voices that he is cured of mental illness or that non-compliance with his prescribed antipsychotic medication would not precipitate a relapse. Additionally, if Mr. Cousineau was to fall away from treatment, his relapse signature reveals a history of a slow deterioration, stretching over weeks/ months, which is easily identifiable by a forensically trained treatment team. In light of Dr. Mishra’s evidence with regard to Mr. Cousineau’s progress since his last 672.81(1) hearing on May 17^th, 2024, this panel does not accept Ms. Szigeti’s contention that if Mr. Cousineau was an ordinary NCR, he would no longer be at Waypoint or limited to staff accompanied access into the community. The progression enabling the Hospital’s transfer recommendation relies on improvements consolidated and reported upon subsequent to May 17^th, 2024. Therefore, it cannot be said that his progress to date has been prejudiced by the HRO designation but for the requirement that he be escorted by three rather than two staff at Waypoint when exercising hospital and grounds privileges, beyond the secure perimeter, escorted by staff.

61. Once transferred to Ontario Shores, it is anticipated that Mr. Cousineau, like any other NCR accused, will be gradually introduced to, and tested with, increased privileges as determined by the scope of his Disposition to ascertain the extent of privileges that can be exercised while managing his risk to public safety. Whereas an envelope of necessary and appropriate privileges is provided within a Disposition, the Hospital retains the discretion to determine to what extent a patient may be allowed to exercise some or all of those privileges.

62. Inclusion of a privilege that has yet to be exercised within a Disposition addresses the possibility of sufficient improvement during the upcoming reporting year that a patient may exercise the privilege without the need for an early hearing. Additionally, this panel is well aware that at times the inclusion of certain privileges within a Disposition can be aspirational or motivational for a patient with minimal likelihood of being exercised.

63. Dr. Mishra’s view that his patient is now appropriate for transfer to a medium secure forensic hospital began to take shape midway through the past reporting year. To Mr. Cousineau’s credit, he has completed all available therapy groups at Waypoint and is expected to continue with CBT at Ontario Shores. Notwithstanding his recent progress, which was the impetus for the transfer recommendation, Dr. Mishra testified that community access at Ontario Shores will require gradual implementation. Mr. Cousineau has been largely restricted to Waypoint’s secure perimeter absent the ready exposure to substances he will be faced with at Ontario Shores.

64. The panel accepts that an HRO designation ought not to prevent progress, or increase restriction, without a rational connection to actual clinical risk. We therefore reject the suggestion that, absent his HRO designation, if all goes well for Mr. Cousineau, he will not have to wait a year to be permitted community access. Ongoing assessments of Mr. Cousineau’s mental state at Ontario Shores as provided by his attending psychiatrist and treatment team will determine the extent of any privilege within his Disposition he can exercise. In the event his clinical progression is restricted by the terms or conditions of his Disposition, an early hearing can be requested. These future determinations are speculative and dependent upon variables yet unknown. For example, how Mr. Cousineau will react to the initial restriction of his liberties within a smaller facility that lacks the physical amenities available to the most highly privileged patients at Waypoint. This provides the rationale why Mr. Cousineau’s progression as a forensic patient has yet to be impeded by his HRO designation

65. Community access is at the upper echelon of the privileges within Mr. Cousineau’s Ontario Shores Detention Disposition and only provides for staff escorted six-hour passes. It remains uncertain and aspirational as to whether he will be deemed appropriate to exercise additional community privileges over and above those set out in his Disposition before the conclusion of the 2026/2027 reporting year. If this was to occur, an early hearing could be called and a referral made to the Court to request removal of his HRO designation. However, if Mr. Cousineau remains unable to exercise the full latitude of privileges described in his Ontario Shores Disposition, it cannot be said that he has been held back in his rehabilitation and community reintegration by the HRO designation. This is because the clinical progress that enabled the recommendation for his transfer to Ontario Shores only occurred within the last clinical year. There is therefore no rationale justifying a referral back to the Court to request removal of the HRO designation absent a decision to the contrary from the Ontario Court of Appeal when at some future date, Grant and Pestill are heard.

Conclusion

66. In making this Disposition, the Board carefully considered the positions and submissions of the parties and the evidence of Dr. Mishra and is satisfied that this determination is both necessary and appropriate. The Board reviewed the provisions of s. 672.54 of the Criminal Code and carefully considered the need to protect the public from dangerous persons, Mr. Cousineau’s mental condition, his reintegration into society and his other needs.

DATED this 2nd day of March 2026, at the City of Toronto, in the Toronto Region.

Mr. P. Capelle

Alternate Chairperson

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Office of the Registrar

Ontario Review Board