Re: Derek McPhee
ORB File No: 6620
Hearing held on: Thursday, December 11, 2025
Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Mr. J. Weinstein Members: Dr. L.O. Lightfoot Dr. R. Chandrasena Ms. C. Murray Ms. C. Plyley
Parties Appearing: Accused: Derek McPhee Counsel: Ms. N.C. Circelli
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. D. Rows
REASONS FOR DISPOSITION
(Dated January 13, 2026)
Introduction:
On October 9, 2014, Mr. Derek McPhee was found not criminally responsible on account of mental disorder (“NCR”) on charges of assault, mischief, and failing to comply with a probation order, all contrary to the Criminal Code of Canada (the “Criminal Code”).
On December 11, 2025, a panel of the Ontario Review Board (“Board” or “panel”) convened to review Mr. McPhee’s current Disposition pursuant to s. 672.81(1) of the Criminal Code. At the time of the hearing, Mr. McPhee was subject to a Detention Disposition with outer limits of privileges including living in the community of Southwestern Ontario in accommodation approved by the person in charge.
Mr. McPhee was present at the hearing. He was represented by counsel, Ms. Nicola Circelli, throughout the proceedings.
A Hospital Report dated October 1, 2025, was entered as Exhibit 1.
The issues to be determined are whether Mr. McPhee continues to represent a significant threat to the safety of the public, and if so, the necessary and appropriate Disposition to manage that risk having regard to the criteria set out in s. 672.54 of the Criminal Code.
For the reasons set out below and based on the evidence and opinions before us, the Board found that Mr. McPhee continues to represent a significant threat to the safety of the public. The Board finds that a Detention Disposition at the Southwest Centre for Forensic Mental Health Care (“Southwest” or “the hospital”), with amendments, is the necessary and appropriate Order having regard to the safety of the public, which is the paramount concern, and also having regard to Mr. McPhee’s mental health, reintegration into society, and his other needs.
Current Psychiatric Diagnoses
- Schizophrenia; and Substance Use Disorder, Cannabis and Alcohol, in remission in a controlled environment.
Index Offences
- The Hospital Report contains a detailed description of the index offences. The offences are briefly summarized as follows:
On July 4, 2014, Mr. McPhee was involved in a verbal altercation with his landlord. At one point during the dispute, Mr. McPhee pushed his landlord in the chest, then lunged forward and punched him in the head. Michael Hodges, who had worked with Mr. McPhee for over 10 years as a member of his ACT team, was also on the scene to give Mr. McPhee a ride. Mr. Hodges exited his vehicle to try to calm Mr. McPhee and stop the assault. Mr. McPhee threatened to bite Mr. Hodges’ hand, then kicked out the passenger window of Mr. Hodges’ car and broke the side mirror. Police attended and Mr. McPhee was charged with assault and mischief. As he was subject to a probation order (including a condition requiring that he keep the peace and be of good behaviour) at the time, Mr. McPhee was also charged with breach of probation.
Background and History
The Hospital Report contains extensive information regarding Mr. McPhee’s background and history, the entirety of which need not be repeated here in detail. Briefly, Mr. McPhee is a 50-year-old single man born in Ingersoll, Ontario. He has a lengthy psychiatric history. His first psychiatric admission was at the age of 20, when he was involuntarily admitted to hospital in London. Between 1996 and 2008 he had five admissions to Parkwood Institute in London with psychotic symptoms including delusions and hallucinations, most attributable to paranoid schizophrenia. Historically, Mr. McPhee has often been non-adherent to his medications.
Mr. McPhee has Brugada Type 1 Syndrome, which is a life-threatening heart rhythm disorder exacerbated by psychotropic medication.
Mr. McPhee’s prior criminal history includes a youth charge and conviction, driving while impaired conviction in 1995, and a conviction for assault with a weapon in 2000.
Mr. McPhee does not have a significant employment history and appears to have relied on social assistance and family the majority of his adult life.
Course Since Last Disposition
The Hospital Report provides information regarding Mr. McPhee’s course in hospital since his last Disposition.
Mr. McPhee remained highly impacted by the symptoms of his mental illness, which have fluctuated in intensity and frequency. The frequency and intensity of his symptoms (including inattentiveness, severe diaphoresis, eyes rolling upward, pacing in the halls of the unit, and biting his fingernails) lessened slightly compared to previous years with an increase in his dose of amisulpride. However, he became more symptomatic in the summer of 2025 with no known trigger. He frequently needed PRN medications such as olanzapine and lorazepam to relieve his symptoms.
Mr. McPhee’s hallucinations and delusions have remained fixed for many years, with only minimal improvement from various combinations of psychiatric medications. Mr. McPhee endorses hearing voices constantly through the day, which are often negative, derogatory, harassing, and have themes that are morbid, hostile, and violent. The voices cause Mr. McPhee emotional distress when they are more intense. He has tried to cope with his symptoms by wearing headphones and listening to very loud music.
Mr. McPhee has brought up the topic of Medical Assistance in Dying (MAID) several times, enquiring if the hospital provides this service.
Mr. McPhee’s clozapine serum level dropped significantly over the previous review year due to daily cigarette smoking and led to an increase in his paranoia. He has five passes per week for up to five hours each to enter the community indirectly supervised, contingent on using his nicotine inhaler instead of smoking for at least two of those passes. Mr. McPhee agreed that he would smoke five cigarettes during three of his indirectly supervised passes. The team suspects that smoking is the only motivation for him to use passes as he refused to use passes into the community when he ran out of cigarettes.
In June 2025, Mr. McPhee completed the Cognitive Behavioural Therapy (CBT) for Psychosis group. He was unable to attend three sessions when he was highly impacted by his symptoms. He had an initial meeting with Psychology staff on October 1, 2025, and will have regular contact with them in the future.
Mr. McPhee’s insight into his mental illness is limited. His insight fluctuates with the intensity of his symptoms.
Mr. McPhee’s insight into his need for treatment remains limited. Given the intensity of his symptoms and the high level of preoccupation, impulsivity and distractibility, he would likely not take his medication appropriately if unsupervised.
Mr. McPhee has no insight into his violence risk. He denies he can become violent and minimizes the historical assaults. He is unable to identify any factors that may increase his violence or help minimize it.
Mr. McPhee’s urine drug samples have all returned negative for substances this reporting year. He continues to think that cannabis would make him feel better and would not impact his mental health, but he has not relapsed to substance use this reporting year.
Mr. McPhee is incapable of making treatment decisions. His father is his substitute decision maker. Mr. McPhee has remained adherent to his medication regimen in the highly supportive and supervised hospital environment. Mr. McPhee briefly contemplated Electroconvulsive Therapy (ECT) but ultimately declined.
Mr. McPhee maintained full hospital and grounds privileges for the duration of the reporting period. He lost privileges for short periods on a few occasions for minor reasons. Mr. McPhee was escorted for three family visits with his family this year. These visits went well.
Mr. McPhee’s father is an Approved Person.
Oral Evidence at the Hearing
Dr. Amir Ardani, Mr. McPhee’s attending psychiatrist and signatory of the Hospital Report, provided oral evidence at the hearing as follows.
Dr. Ardani testified that Mr. McPhee’s symptoms of psychosis are the same as at the time of the index offences.
Dr. Ardani stated that Mr. McPhee lacks insight into his illness and is unable to identify signs of decompensation of his mental condition.
Mr. McPhee’s Brugada Type 1 Syndrome results in treatment challenges. At the start of the year, Mr. McPhee was on three antipsychotic medications. He is now on two antipsychotics, including clozapine at a high dose.
Dr. Ardani testified that smoking reduces the efficacy of clozapine. Mr. McPhee is a rapid metabolizer in general, without smoking. Mr. McPhee becomes paranoid and unstable when smoking too many cigarettes daily. Mr. McPhee doesn’t have insight into the effect smoking has on his medication. The treatment team has figured out the acceptable number of cigarettes per week to minimize the impact of smoking on his clozapine levels. When Mr. McPhee goes beyond a certain number of passes, he must use a nicotine inhaler at those times. Mr. McPhee is currently using privileges six times per week for three hours each. For three of those passes he must use a nicotine inhaler rather than smoking cigarettes.
Mr. McPhee is adherent with his medication in hospital.
Mr. McPhee attended a group for cognitive behavioural therapy (CBT) this year. His participation was not consistent. It was suggested by a treatment team member that he have one-to-one CBT. Between October and December 5, 2025, Mr. McPhee attended five of the seven scheduled sessions. His ability to participate started at 15 minutes and gradually increased. The therapist walks with him during sessions to reduce anxiety and distractibility during these sessions.
Mr. McPhee has not used substances since his ROL in June 2024. Cannabis causes decompensation of Mr. McPhee’s mental state. In July 2018 and in 2020 when Mr. McPhee relapsed to cannabis use, he experienced agitation, disorganization, disturbed sleep, and paranoia. The treatment team has provided education regarding the impact of substance use on his mental state; however, his cognitive capacity and concentration have prevented him from fully understanding its impact. Dr. Ardani stated that Mr. McPhee has asked him why he can’t use cannabis.
Dr. Ardani testified that at times Mr. McPhee can tolerate the level of distress he experiences from his daily symptoms. However, once or twice per week he is unable to handle the distress and is unable to ask for help. He requires PRNs two to three times per week to manage his distressing symptoms. He decompensates very quickly. If he were living outside the hospital at this time, Mr. McPhee would decompensate. He would not take medications in a timely manner, would not be able to manage his distress from his symptoms and would experience frustration and anger. This would lead to him acting out in a manner similar to the index offences.
Dr. Ardani stated that there is a plan for community living in the future. Community Homes for Opportunity (CHO) will not be sufficient housing for Mr. McPhee’s needs. The treatment team is hoping to eventually find Mr. McPhee an appropriate placement at a Crest Support Services (Crest) home, which provides a better experience for individuals highly impacted by mental illness. Crest provides 24/7 supervision with trained staff and might be able to replicate some of the types of supervision that Mr. McPhee receives in hospital. Mr. McPhee is not on the waiting list for Crest at this time because he has not reached the level of stability necessary for a referral to Crest.
Dr. Ardani testified that Mr. McPhee requires 24/7 supervised accommodation, which reflects his risk level. The treatment refractory nature of his schizophrenia, along with the symptoms he continues to experience, makes it likely that he will not be able to reside in an unsupervised setting. He noted that the hospital has asked for “accommodation approved” instead of supervised accommodation in the recommendations because the hospital already knows he will need 24/7 accommodation.
In response to questions of Mr. Rows, Dr. Ardani testified that Mr. McPhee’s symptoms must respond to medications for him to have unsupervised accommodations. Mr. McPhee has never reached remission, so it is unlikely that he would be approved for unsupervised accommodations. At this point, based on Dr. Ardani’s evidence, Mr. Rows confirmed that the Crown recommends supervised or 24/7 supervised accommodations, at the Board’s discretion, when Mr. McPhee is discharged to the community.
In response to questions of Ms. Circelli, Dr. Ardani testified that Mr. McPhee’s medications are not optimized. He is still optimizing Mr. McPhee’s medications based on the recommendations of experts that he has sought guidance from. Because Mr. McPhee’s Brugada 1 Syndrome is a life-threatening condition, even small changes in medications need to be made gradually to give his heart time to adjust to the changes. Dr. Ardani recommends ECT, which Mr. McPhee has declined. In most cases, ECT is not contraindicated for heart conditions, though Dr. Ardani would refer Mr. McPhee to a heart specialist for confirmation prior to commencing ECT.
Mr. McPhee has not used illicit substances in 18 months. Dr. Ardani stated that Mr. McPhee has always expressed a desire to return to cannabis use. The abstinence clause in the Disposition is motivating for Mr. McPhee to abstain from cannabis. Mr. McPhee does not have insight into how substances can increase paranoia and lead to instability. The external motivator of the abstinence clause is keeping him from returning to cannabis use.
In response to questions of the Board, Dr. Ardani testified that Mr. McPhee has not exercised overnight passes because there have not been requests from the family. The family does not feel that he has reached a level of stability appropriate for overnight visits with them. In addition, the hospital would not approve such visits because the family would not be able to detect symptoms of decompensation or respond quickly enough. In hospital, Mr. McPhee is able to seclude in his room to deal with the stress of his symptoms. The increase in stimuli in a home environment would not be conducive for home visits. Mr. McPhee would need to be monitored for cigarette smoking, medication adherence, and abstinence. He also has cognitive limitations that require a high level of supervision. The failure to manage any of these issues would cause Mr. McPhee to be a risk to the safety of the public.
Mr. McPhee is currently using Amisulpride, which is sourced from France. Amisulpride is only covered in hospital. It would not be available to Mr. McPhee in the community. The hospital pharmacist is confident that Amisulpride would be available to Mr. McPhee if placed in the community in a supervised setting.
Mr. McPhee was referred to Western University for repetitive transcranial magnetic stimulation (RTMS). Unfortunately, the referral was declined.
Submissions of the Parties
- At the conclusion of the hearing, the hospital, represented by Ms. J. Zamprogna submitted that Mr. McPhee continues to represent a significant threat to the public and the necessary and appropriate Disposition is a Detention Order with the same terms as last year, with changes as follows:
Addition of a clause to permit Mr. McPhee to enter the community of Southwestern Ontario accompanied by staff, or a person or delegate that is approved by the person in charge; and
a removal of clause 2(e) and 2(f) as they are redundant and can be captured by clause 2(d).
clause 2(g) to specify 24/7 supervised accommodation.
Mr. Rows, counsel for the Attorney General, submitted that the Crown supports the hospital’s submissions. He submitted that Mr. McPhee needs supervised or 24/7 supervised accommodation when living in the community.
Ms. Circelli conceded the issue of significant threat. She requested that the abstain clause (4(a)) be removed from the Disposition since Mr. McPhee has been abstinent for 18 months and the urine testing clause remains in the Disposition. In all other respects she agreed with the hospital’s position.
Analysis and Conclusions
Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board independently finds that Mr. McPhee remains a significant threat to the safety of the public.
Mr. McPhee’s risk arises from his treatment refractory schizophrenia and substance use disorder. His hallucinations and delusions have remained chronic and fixed for several years, with only minimal improvement from a combination of psychiatric medications. He has limited insight into his mental illness and need for treatment. His long-standing illness has been marked with a history of assaultive behaviour.
Mr. McPhee’s schizophrenia is only partially responsive to medications, which will likely continue. Mr. McPhee’s symptoms are of the same nature as at the time of the index offences. His insight into his violence risk is limited.
The evidence is clear that were Mr. McPhee not managed on a Disposition he would not take medications in a timely manner, would not be able to manage his distress from his symptoms and would experience frustration and anger. This would lead to him acting out in a manner similar to the index offences.
Mr. McPhee remains vulnerable to substance use relapse. He has indicated to the treatment team that he wishes to use cannabis. The Board accepts Dr. Ardani’s evidence that the abstinence clause in the Disposition is motivating Mr. McPhee to remain abstinent. But for that abstinence clause, he would return to substance use. Substances have a destabilizing effect on his mental illness, which increases his risk to the safety of the public. Additionally, the treatment team has had to limit his use of cigarettes because of the significant effect it has on blood serum levels of clozapine. Mr. McPhee remains vulnerable to substance use and increases in cigarette use with increased community access.
In coming to its conclusion regarding significant threat, the Board relies on the Re-Offence Scenario found at page 213 of the Hospital Report, extracted as follows:
“Absent intense psychiatric support and supervision, Mr. McPhee would experience increased stressors due to ongoing and active psychotic symptoms and would not be able to effectively deal with them. He would not be able to administer his medications as prescribed and he would relapse into substance use, which would result in exacerbation of his already intense psychotic symptoms i.e., an increase in persecutory hallucinations and delusions, and paranoia. If he were to feel unsafe, he would likely act out in an aggressive and assaultive manner, as evident in the index offence as well as violence towards the group home staff in 2022. Any decompensation of his mental state would significantly increase his violence risk.”
In light of the Board’s finding of significant threat, it is charged with shaping a Disposition for the coming year.
The Board finds that a Detention Disposition is necessary. Mr. McPhee’s mental health remains very fragile as is demonstrated by the continuing symptoms and treatment-resistant nature of his illness. Ongoing support and monitoring are essential to maintaining Mr. McPhee’s level of mental stability. Due to Mr. McPhee’s lack of insight in all domains, his risk to the public would increase to dangerous levels without monitoring of medications, abstinence from substances, and timely administration of PRN’s during quick decompensations. Once Mr. McPhee is ready to be discharged to the community, his risk to public safety cannot be safely managed outside of the framework of 24/7 supervised accommodation.
The panel accepts Dr. Ardani’s evidence that Mr. McPhee is externally motivated by the abstinence clause in the Disposition to remain abstinent from substances. He has no insight into the connection between substance use and his risk to the public. He has expressed a wish to return to cannabis use and does not understand why he cannot use it. Therefore, this clause will remain in the Disposition.
The Board wishes Mr. McPhee the best for the coming year.
For the above reasons, the Board finds that the necessary and appropriate, least onerous and least restrictive disposition is a Detention Disposition with terms as set out in our formal Disposition.
DATED this 13^th^ day of January 2026, at the City of Toronto, in the Region of Toronto.
Ms. C. Murray Legal Member Office of the Registrar Ontario Review Board