Re Michael McGrath, 2026 CanLII 2098

Re: Michael McGrath (a.k.a. Michael Alexander)

ORB File No: 8723

Hearing held on: Wednesday, January 7, 2026

Place of hearing: Waypoint Centre for Mental Health Care

Pursuant to: Sections 672.47(1) and 672.48(1) of the Criminal Code

Before:

Alternate Chairperson: Ms. C. Finley

Members: Dr. R. W. Hill

Dr. G. Stones

Ms. C. Murray

Mr. J. Cyr

Parties Appearing:

Accused: Michael McGrath (a.k.a. Michael Alexander)

Counsel: Mr. S. Gehl

The person in charge of hospital: Representative: Ms. M. Kraftscik

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

REASONS FOR DISPOSITION

(Dated January 16, 2026)

Introduction

1. On July 9, 2025, Michael McGrath was found unfit to stand trial on a charge of aggravated assault, contrary to the Criminal Code of Canada. Mr. McGrath has been the subject of a Warrant of Committal, dated July 9, 2025, detaining him at Waypoint Centre for Mental Health Care (“Waypoint” or “the hospital”).

2. Mr. McGrath advised that he has changed his last name to Alexander; therefore, he is referred to as “Mr. Alexander” throughout these Reasons.

3. On January 7, 2026, a panel of the Ontario Review Board (“ORB” or “panel”) convened to determine whether Mr. Alexander remains unfit to stand trial and to conduct an initial hearing pursuant to s. 672.47(1) of the Criminal Code.

4. Mr. Alexander was present and represented by his counsel, Mr. Stephen Gehl.

5. At the outset of the proceedings, all parties were canvassed as to their positions on the issues to be determined by the Board. Ms. Kraftscik, on behalf of the hospital, submitted that Mr. Alexander is unfit to stand trial and recommended that the necessary and appropriate disposition is a Detention Order on the terms set out on pages 40 to 42 of the Hospital Report. Of note, there is a Rule 13 transfer request wherein the hospital recommends that Mr. Alexander be transferred to the Centre for Addiction and Mental Health (“CAMH”).

6. Ms. Curry, on behalf of the Ministry of the Attorney General, concurred with the hospital’s position.

7. Mr. Gehl reserved his comments on the issue of fitness until the completion of evidence. He indicated that Mr. Alexander did not want to have his care transferred to CAMH; however, he otherwise took no position with regard to the remaining terms as recommended by the hospital.

Findings

8. For the reasons that follow, the panel found that Mr. Alexander remains unfit to stand trial and the necessary and appropriate disposition is a Detention Order at Waypoint with the privileges and conditions as recommended by the hospital.

The Evidence

9. The documentary evidence at the hearing consisted of the following:

a. Hospital Report dated August 1, 2025, and Update dated December 11, 2025 (Exhibit 1)

b. Waypoint Inpatient Progress Reports (Exhibit 2)

i. Dated July 9, 2025;

ii. Dated August 18, 2025;

iii. Dated December 30, 2025

c. Waypoint Rule 13 Notice to CAMH (Exhibit 3)

d. CAMH Response to Rule 13 Notice (Exhibit 4)

e. Transcripts – October 11, 2024, January 13, 2025, June 27, 2025

10. Dr. Van Imp gave viva voce evidence.

11. Mr. Alexander gave viva voce evidence.

Psychiatric Diagnosis

12. Schizoaffective Disorder, Bipolar Type

The Index Offence

13. The Hospital Report contains details of the alleged incident. Briefly, it is alleged that on March 18, 2022, police officers attended at a rooming house in Toronto in response to an assault in progress. A witness to the assault provided information that Mr. McGrath / Mr. Alexander was assaulting another male by kicking him in the head and hitting him with a frying pan. When the officers arrived, they located the victim, R.O., lying on the floor seemingly unconscious. The area around the victim had a pool of blood and blood splatter along the hallway walls. The victim had multiple facial lacerations and contusions, an active brain bleed, and open cavitation on the right side of his head. The police located and arrested Mr. Alexander.

Background Information and Course in Hospital

14. The Hospital Report contains detailed information about Mr. Alexander’s personal background and history and therefore need not be repeated in these Reasons beyond the following material points. Mr. Alexander is a single 61-year-old man who was born in St. Catharines, Ontario. Mr. Alexander reports that he graduated from grade 13. He was adopted at a young age. Both of his biological and adoptive parents are now deceased.

15. In 2004, Mr. Alexander changed his surname from McGrath to Alexander.

16. Mr. Alexander reported that he started to use alcohol at the age of 12 and drank alcohol regularly by the age of 19. He reports numerous blackouts. He has used marijuana, ecstasy, and cocaine.

17. Mr. Alexander has a lengthy criminal history commencing in 1985, including multiple convictions for violent offences such as sexual assault, assault, uttering threats, assault with a weapon, and assault causing bodily harm.

18. Mr. Alexander has been supported by the Ontario Disability Support Program since 2005.

19. Mr. Alexander is considered capable of consenting to his psychiatric treatment.

20. Mr. Alexander has an extensive history of psychiatric admissions to hospital commencing in 2002. His history of psychiatric admissions to hospital includes Form 1 Mental Health Act admissions, admissions for fitness assessments, and admissions pursuant to treatment orders. During an admission in 2013, Mr. Alexander successfully appealed a finding that he was incapable of making psychiatric treatment decisions.

21. As Mr. Alexander’s fitness has been raised a number of times, it is helpful to have a brief overview of these proceedings. Mr. Alexander represented himself during his trial in Superior Court which commenced on April 8, 2024. He was convicted of aggravated assault and acquitted on charges of assault with a weapon, attempt murder and being in possession of a weapon dangerous to the public peace. In her Reasons for Decision, Madame Justice Boucher made the following observation:

At all times, Mr. Alexander understood the trial process, that I was the trial judge and decision-maker, the roles of the Crown and police, and his role as the accused person, not obligated to give evidence. He fulfilled his role of challenging and testing the evidence that was in issue for him, and he had the opportunity to present evidence as he chose according to the governing legal framework. He conducted all the cross-examinations himself and touched on relevant issues and other issues important to him. He made strategic decisions throughout the trial.

22. On May 9, 2024, Mr. Alexander was admitted to Waypoint for an NCR assessment. In his report to the Court on the NCR issue, dated July 5, 2024, Dr. Mishra recommended that Mr. Alexander’s fitness should be reassessed in Court at the time of proceedings.

23. On October 11, 2024, both the Crown and amicus alerted the Court to concerns about Mr. Alexander’s fitness. Mr. Alexander would not accept that he had been found guilty of aggravated assault. Further, he voiced some of the delusions about Her Honour that he continues to endorse. An order was made for a fitness assessment. Dr. Jaiswal, from CAMH, ultimately gave an opinion that Mr. Alexander was unfit to stand trial and recommended that the Court issue a Treatment Order. That order was made and Mr. Alexander was readmitted to CAMH on December 9, 2024. On February 10, 2025, the Court found that Mr. Alexander remained unfit to stand trial. He was remanded to the jurisdiction of the ORB and transferred to Waypoint pursuant to a Warrant of Committal.

24. On June 11, 2025, Mr. Alexander had his initial hearing. Based on the opinion of Mr. Alexander’s treating psychiatrist, Dr. Van Imp, the Board found that Mr. Alexander was fit to stand trial. An order was made for him to return to court for the court to determine Mr. Alexander’s fitness to stand trial. Before Mr. Alexander’s court appearance on July 9, 2025, Dr. Van Imp assessed Mr. Alexander’s fitness. Dr. Van Imp changed his opinion with respect to Mr. Alexander’s fitness to stand trial. The doctor found that Mr. Alexander was much more overtly delusional than in past assessments. In the Waypoint inpatient progress report, Dr. Van Imp wrote the following:

“Mr. Alexander does not currently have a reality based understanding of the nature and object and possible consequences of the proceedings. He does not appear to understand that he has already been found guilty and that an NCR hearing needs to take place…He does not appear to understand available options and does not appear to have any appreciation for the possibility of him being found NCR and not simply not guilty. He has not consistently demonstrated an ability to intelligibly communicate to counsel or the court. A review of recent court transcripts suggested that he struggled mightily participating in court proceedings in what I would consider to be a meaningful manner.”

25. On July 9, 2025, the Court found that Mr. Alexander remains unfit to stand trial.

26. Mr. Alexander was assessed for fitness again on August 13, 2025. Dr. Van Imp’s Progress Note of August 20, 2025, is extracted as follows:

“ Ultimately at the conclusion of this assessment, I was of the opinion that MM remained unfit to stand trial and am in agreement with the Judge who determined that MM was unfit to stand trial following a fitness hearing that occurred on July 9, 2025. I remain concerned that he will struggle to meaningfully participate in proceedings. I do not believe that MM has a reality-based understanding of the nature and object and possible consequences of the proceedings. He remains insistent that the Judge and others are involved in a conspiracy against him with the goal being the protection of the police officer who he insists actually killed the victim. In my opinion, it would be difficult to argue that an individual has a reality- based understanding of the nature and object of the court proceedings when he believes the Judge who found him guilty actually had involvement in the offense for which he was found guilty. Furthermore, MM continues to harbor the belief that two separate transcripts exist for his court proceedings and one of these versions is hidden to help prevent people from knowing the truth of what actually occurred. This is clearly not a reality-based interpretation by MM. I am of the opinion that MM’s ongoing delusions are directly responsible for preventing him from achieving this reality-based understanding.”

27. On December 30, 2025, Dr. Van Imp again assessed Mr. Alexander’s fitness to stand trial. During the interview, Mr. Alexander told Dr. Van Imp that he and the doctor were both in the navy and “I’m above you in the Navy”. He told Dr. Van Imp that he needed more time to work with the FBI and participate in physiotherapy and, because of this, he would be unfit to stand trial and would remain at Waypoint. Mr. Alexander informed Dr. Van Imp that he had to contact the FBI because the judge during his previous court appearance is an international criminal connected to Ryan Wedding and was the “nucleus of crime in the Toronto area”. Mr. Alexander stated that there were two distinct transcripts from each court appearance, one of which was fabricated. He described that the judge had a swastika on her gavel during his court appearance in March 2025. Dr. Van Imp opined that Mr. Alexander clearly remains delusional and many of the delusions have a direct impact on Mr. Alexander’s fitness to stand trial. Dr. Van Imp remains concerned that Mr. Alexander will struggle to meaningfully participate in proceedings and does not believe that he has a reality-based understanding of the nature and possible consequences of the proceedings. Dr. Van Imp stated in his December 30, 2025, report that Mr. Alexander’s “ongoing delusions are directly responsible for preventing him from achieving this reality-based understanding.”

28. Dr. Padraig Darby, on behalf of CAMH, responded to Waypoint’s Rule 13 notice concerning Mr. Alexander. Dr. Darby agreed that Mr. Alexander’s risk does not appear to necessitate the level of security of the Provincial Forensic Program at Waypoint and could be managed at CAMH. He did not object to an order detaining Mr. Alexander at CAMH.

29. Mr. Alexander remains on the Forensic Assessment Program, unit B, at Waypoint under the care of Dr. Van Imp.

30. Since Mr. Alexander’s initial ORB hearing on June 11, 2025, his mental state and presentation have remained relatively unchanged. He has been frequently observed responding to unseen persons in his room, at times loud and animated. He is preoccupied and has delusional thought content. In a meeting with Dr. Van Imp on July 9, 2025, Mr. Alexander referred to having sexual relations with over ten staff members at Waypoint. He is boisterous and, at times,

interrupts conversations and requires redirection. However, he has maintained a security level that permits independent off-unit access for up to an hour at a time.

31. Mr. Alexander declines to participate in any form of leisure or recreation program.

Oral Evidence at the Hearing

32. Dr. Van Imp testified before the panel as follows:

a. Mr. Alexander is clearly unfit. Dr. Van Imp anticipates that it will be a lengthy process to get Mr. Alexander to the point of receiving antipsychotic medication. Mr. Alexander has declined treatment with antipsychotic medications and, in August 2025, he challenged Dr. Van Imp to find him incapable. Mr. Alexander suggested that he had never lost a Consent and Capacity Board (CCB) hearing, and even if he were unsuccessful, he would appeal the finding. These challenges and anticipated appeals will make it a long time before Mr. Alexander ultimately receives treatment with antipsychotic medications.

b. Historically, Mr. Alexander is very aware of the Taylor Test questions. However, considering the requirements set out in Bharwani and the fact that Mr. Alexander’s fixed delusions are embedded in his understanding of the legal process, it would not be possible to conclude that he is fit to stand trial. At this time, Mr. Alexander has no reality-based understanding of what is happening in court nor an understanding based in reality of what is happening at this ORB hearing. Mr. Alexander believes that it is pre-determined that he will be transferred to CAMH. He requires constant redirection and the delusions are overwhelming. Dr. Van Imp stated, “I feel very strongly that Mr. Alexander is unfit.”

c. Dr. Van Imp does not object to Mr. Alexander remaining at Waypoint rather than being transferred to CAMH. Initially, the clinical team recommended that Mr. Alexander be transferred to CAMH purely from a management perspective. However, Mr. Alexander was previously hospitalized at CAMH, does not like it there, and would prefer to remain at Waypoint. Dr. Van Imp believes that Mr. Alexander could be aggressive if he is ordered to take medication, which ultimately is likely to be pursued. If he was transferred to CAMH, such aggression would restrict his privileges there and make it more likely that he ends up in seclusion than if he were to remain at Waypoint. Therefore, it is possible that although Waypoint is high security, CAMH could be more restrictive for Mr. Alexander if he becomes aggressive when ordered to take medication.

d. Mr. Alexander has a bit more freedom with privileges within the secure perimeter of Waypoint as opposed to the restrictions that would have to be imposed to manage his behaviour at CAMH.

e. Mr. Alexander poses a significant threat to the safety of the public. When treatment starts, it will be very difficult to treat him even though he is in a forensic hospital. Dr. Van Imp said that he could not imagine trying to restore fitness if Mr. Alexander resided in the community. As the likelihood of being treated becomes more apparent to Mr. Alexander, to which he would resist, a Detention Order will be the only way to treat him with a view to restoring fitness.

f. Mr. Alexander has been untreated for 20 years. Dr. Van Imp stated that he does not have tremendous faith that medications will make him fit: however, this ultimately remains the appropriate path to follow. Dr. Van Imp stated further that the longer one goes without treatment for schizoaffective disorder, the more treatment refractory the illness generally becomes.

33. In response to the questions of Mr. Gehl, Dr. Van Imp testified as follows:

a. Mr. Alexander is being treated for his physical illnesses at Waypoint. He is getting along with the treatment providers at Waypoint. There is no guarantee that Mr. Alexander would find the same kind of rapport with a treatment team at CAMH because he harbours negative views about CAMH. His health could deteriorate if he does not get along with the CAMH treatment team and does not follow their recommendations.

b. Mr. Alexander can understand the purpose of a court proceeding in a broad sense, but he cannot understand the purpose as it relates to himself. He understands the pleas available in general, but he does not understand how they apply to him. He does not understand the potential outcomes at trial or an NCR hearing because he thinks it is predetermined in a “kangaroo court”. He is unfit due to the degree of fixed delusional beliefs relating to his own court proceedings. For instance, he believes that there are two separate transcripts from the proceedings to date, one which is accurate and one that is not. He also believes that the judge was in a romantic relationship with the person creating the transcripts.

c. Dr. Van Imp reiterated that Mr. Alexander’s delusions are embedded in his understanding of his own court proceedings in which he was found unfit in court before the NCR proceeding. He believes that Mr. Alexander is now even more unfit than at that time.

34. In response to questions from the Board, Dr. Van Imp clarified that he believes that a Disposition ordering Mr. Alexander detained at Waypoint would be less restrictive than an order for detention at CAMH, because once the likelihood of treatment with antipsychotic medications becomes more apparent to Mr. Alexander, it is likely he will be resistive. There is a greater possibility that privileges would be restricted and he would be secluded at CAMH for such behaviours than if he remained at Waypoint.

35. Mr. Alexander testified at the hearing. He explained that he wants to stay at Waypoint because CAMH would steal his ODSP cheques and he would not be able to access diabetes supplies without his ODSP. He stated that he does not know if CAMH has a Honeywell tub to manage his diabetes. Presumably in reference to diabetes treatment, Mr. Alexander stated that the treatment provider at Waypoint only fills the Honeywell tub half full and states they are in a hurry. He feels he can manage his diabetes better at Waypoint than at CAMH.

36. Mr. Alexander stated that he did not get along well with staff at CAMH during a previous admission. He stated he gets along with the staff at Waypoint quite well and, in fact, 22 of the staff at Waypoint are old girlfriends of his. He is afraid that if he goes to CAMH, he will lose those relationships. He then interjected that he is “with the British Navy.”

37. Mr. Alexander stated, “they tried to put syringes in me at CAMH. I am St. Michael. I am going to solve four murders while I am here.”

38. Mr. Alexander was concerned about the mail service at Waypoint but was unable to express his concerns coherently.

39. Mr. Alexander testified that he knows the Taylor Test. He knows Michael Taylor. The judge in Toronto is a mental case, a criminal with a swastika on her gavel. He stated that the judge knows he is St. Michael. He went on to provide frantic and unfocused oral evidence about the court, Ryan Wedding, and the judge being in cahoots with Mr. Wedding. He requested that the Board take documents to feel the weight of them.

40. Mr. Alexander stated his concern that there were violations of his rights at trial. Because his rights were violated, he expressed his request that the process be stopped. He stated that having two crown attorneys at his trial is an inefficiency of service, and the fact that there are two transcripts is improper. He added that there were two chest cams worn by the police officers at the scene that showed that the victim was sitting in a door frame with not a drop of blood on him.

41. There were no questions for Mr. Alexander by any of the parties, and he was thanked for providing his comprehensive evidence.

Submissions

42. Ms. Kraftscik submitted that the evidence is clear that Mr. Alexander is unfit to stand trial. She submitted that it would be nearly impossible to deem Mr. Alexander fit to stand trial when his delusions cause him to believe that the whole court system is colluding against him. Regarding Mr. Alexander’s placement, he has spent most of his life in Toronto, and from a current perspective, the least restrictive placement is at CAMH. Ms. Kraftscik acknowledged that there are stressors that he may experience at CAMH and it may be best for Mr. Alexander to remain at Waypoint.

43. Ms. Curry submitted that the evidence is clear that Mr. Alexander is unfit to stand trial. She was content that Mr. Alexander remain at Waypoint considering that there is a likelihood that he may be medicated in the future should he be found treatment incapable, resulting in increased aggressivity, thereby increasing his risk of safety to the public.

44. Mr. Gehl submitted that Mr. Alexander believes he is fit to stand trial. With respect to the issue of a transfer to CAMH, he directed the Board to section 672.54 of the Criminal Code, which provides guidance regarding the factors to be considered when making a disposition, including “the other needs of the accused”. Mr. Gehl submitted that in Mr. Alexander’s case, his “other needs” includes the physical treatment he is receiving for diabetes at Waypoint. He submitted that were Mr. Alexander transferred to CAMH, it would take time to set up treatment for his physical needs, which would potentially compromise his physical health. Additionally, Mr. Gehl supported the submissions of the Crown and hospital that the least restrictive placement is Waypoint for the reasons explained by Dr. Van Imp.

Analysis and Conclusion

FITNESS TO STAND TRIAL

45. The Board has carefully considered the documentary and oral evidence of Dr. Van Imp and unanimously concludes that Mr. Alexander remains unfit to stand trial. The Board has the benefit of the recent Supreme Court of Canada decision in R v Bharwani, 2025 SCC 26, at para 6:

“[A]n accused is fit to stand trial when they are able to make and communicate reality-based decisions in the conduct of their defence or instruct counsel to do so. Conducting a defence includes making decisions that an accused must always make personally and those which relate to the exercise of their right to full answer and defence, such as decisions about pleas, the mode of trial, selection of counsel, whether to testify, whether to call or cross-examine witnesses, and closing submissions, among others. The capacity required to make those decisions is a reality-based understanding of the nature or object of the proceedings and their possible consequences, an ability to understand the available options and their consequences, and an ability to select between those options when making decisions. Fitness to stand trial does not require an accused to make decisions in their best interests. Rather, it requires making decisions based on an understanding of reality that is not overwhelmed by delusions, hallucinations, or other symptoms of their mental disorder. Transient mental health symptoms do not necessarily compromise an accused’s ability to conduct a defence. The focus is always on assessing the extent to which an accused’s mental disorder impairs their understanding of reality when making and communicating decisions in their defence.”

46. The panel is cognizant of the serious consequences of a finding of unfitness to stand trial, including the loss of the accused’s liberty, and appreciates that such a finding must not be made lightly (Bharwani, 2025 SCC 26 at para. 73). The panel accepted Dr. Van Imp’s opinion that Mr. Alexander lacks the ability to meaningfully participate in a court process and that the ongoing delusions are directly responsible for preventing Mr. Alexander from achieving a reality-based understanding of the court process as it relates to him personally. Dr. Van Imp was clear that Mr. Alexander has no problem reciting answers to the Taylor Test questions. However, applying the Bharwani principles, it is clear that Mr. Alexander is unfit to stand trial.

47. In Clayton (Re), 2025 ONCA 308, the Court of Appeal for Ontario held that “the nature of the charges and allegations” facing an accused is important context when applying the fitness test. In particular, at paragraph 11: “the simpler the case is, the easier it is to understand, appreciate and talk about.” Extending this concept, it is noteworthy that Mr. Alexander’s case is procedurally complex and unusual. He was fit for a portion of the trial. However, his fitness failed at the time that the NCR hearing process was to begin. The fitness findings have not been consistent throughout his court process. The Board finds that this is not a straightforward case procedurally.

48. Mr. Alexander’s delusions remain embedded in his understanding of the court process, in particular his own court proceedings. Mr. Alexander believes that the Judge is involved in a conspiracy against him with the goal being the protection of the police officer who he insists actually killed the victim. The Board agrees with and relies on Dr. Van Imp’s opinion that it would be difficult to argue that an individual has a reality-based understanding of the nature and object of the court proceedings when he believes the Judge who found him guilty was involved in the offense for which he was found guilty.

49. Therefore, the Board finds that Mr. Alexander is unfit to stand trial.

NECESSARY AND APPROPRIATE DISPOSITION

50. Mr. Alexander will require treatment, including medication, to return him to fitness. Dr. Van Imp opined that when treatment starts, it will be very difficult to medicate Mr. Alexander, even in a forensic hospital. Dr. Van Imp said that he could not imagine trying to restore fitness if Mr. Alexander resided in the community. It is likely he will be resistive, in fact, to the extent that a transfer to CAMH would place the public at increased risk. The Board finds that as the likelihood of being treated becomes more apparent to Mr. Alexander (in the hospital’s efforts to restore his fitness), a Detention Order will be required to manage him given the anticipated increased aggressivity due to his resistance to taking medication.

51. Mr. Alexander was found by the court to be guilty of the very serious index offence that left the victim with multiple facial lacerations and contusions, an active brain bleed, and open cavitation on the right side of his head. He has an extensive history of psychiatric admissions to hospital commencing in 2002. His history of psychiatric admissions to hospital includes Form 1 Mental Health Act admissions, admissions for fitness assessments, and admissions pursuant to treatment orders.

52. Mr. Alexander is frequently observed responding to persons unseen in his room. He is preoccupied and has delusional thought content, which he exhibited at this hearing.

53. A Detention Disposition is the necessary and appropriate disposition. There is no air of reality to any other disposition.

54. The Board agrees with Mr. Alexander’s position that he should not be transferred to CAMH. Ironically, detention within the secure Waypoint hospital will likely be less restrictive than detention at CAMH, a less secure facility for the reasons expounded by Dr. Van Imp in his evidence and agreed with by all parties in their submissions.

55. The Board has carefully considered s.672.54 of the Criminal Code, which provides guidance regarding the factors to be considered when making a disposition, including “the other needs of the accused”. The Board finds that, as per Mr. Gehl’s submissions, the ongoing and consistent treatment of Mr. Alexander’s diabetes is an “other factor”. Given his history, it is likely that Mr. Alexander will be generally wary of and resist any treatment at CAMH as he does not have positive relationships at that facility.

56. In their submissions, all parties conceded that Mr. Alexander should not be transferred to CAMH and should remain at Waypoint and that this would be the least onerous and least restrictive Disposition for Mr. Alexander.

57. Therefore, the panel finds that the necessary and appropriate disposition is a Detention Order at Waypoint Centre for Mental Health Care – High Secure Provincial Forensic Programs Division with the privileges and terms as recommended by the hospital.

DATED this 16th 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