Re: Preston Petitti
ORB File No: 8130
Hearing held on: Tuesday, November 25, 2025
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. C. Finley
Members: Dr. Y. Alatishe Dr. L.O. Lightfoot Hon. B. Allen Mr. J. Cyr
Parties Appearing:
Accused: Preston Petitti Counsel: Mr. J. Marshman
The person in charge of hospital: Counsel: Ms. S. Rosales-Zelaya
Attorney General of Ontario: Counsel: Ms. V. Culp
REASONS FOR DISPOSITION
(Dated January 22, 2026)
Introduction:
1On July 21, 2022, Preston Petitti was found not criminally responsible on account of a mental disorder on a charge of aggravated assault, contrary to the Criminal Code of Canada. He is currently subject to a disposition of the Ontario Review Board (“ORB” or “the Board”) dated November 20, 2024, detaining him at the Forensic Service of the Centre for Addiction and Mental Health, Toronto (“CAMH” or “the hospital”), with discretionary privileges up to and including the ability to reside in the community in approved accommodations.
2On November 25, 2025, the Board convened a hearing pursuant to s. 672.81(1) of the Criminal Code. The issues to be determined were whether Mr. Petitti continues to represent a significant threat to the safety of the pubic, and if so, the necessary and appropriate disposition to manage that threat having regard to the criteria set out in s. 672.54 of the Criminal Code. Mr. Petitti was present and represented by Mr. Marshman. Mr. Petitti’s mother also was present.
3Ms. Rosales-Zelaya, on behalf of the hospital, submitted that Mr. Pettit remains a significant threat to the safety of the public and the necessary and appropriate disposition is a continuation of the current disposition with a broadening of the conditions pertaining to passes in the community to include the Greater Toronto Area (“GTA”). Ms. Culp concurred in the hospital’s positions. After hearing the evidence, Mr. Marshman agreed with the hospital. He specifically conceded the issue of significant threat. Thus, a joint submission was made before the panel.
Findings
4For the reasons that follow, the panel finds that Mr. Petitti remains a significant threat to the safety of the public and the necessary and appropriate disposition is a detention order with the same terms and conditions but for a broadening of the community to include the GTA.
The Evidence
5The evidence at the hearing consisted of the Hospital Report, dated November 13, 2025 (ex. 1), and the viva voce evidence of Dr. O’Sullivan, Mr. Petitti’s treating psychiatrist, and Mr. Petitti.
The Index Offence
6The index offence occurred on March 5, 2021. It involved an unprovoked knife attack on Mr. Petitti’s stepfather. In the days leading up to the incident, Mr. Petitti’s family noted a significant decline in his mental health. At the encouragement of his stepfather, Mr. Petitti had a COVID test. He developed a range of psychotic beliefs about a microchip being inserted in his brain during the test. He experienced voices, which he attributed to the microchip, that had a command element, telling him to kill his stepfather. His family staged an intervention and pleaded with Mr. Petitti to seek medical help the following day. Mr. Petitti took three knives from the kitchen and concealed them on his person. He then approached his stepfather and stabbed him twice. His stepfather sustained a stab wound to the upper chest and a punctured lung.
Background Information
7The Hospital Report contains considerable information about Mr. Petitti’s personal background and psychiatric history. As it was an exhibit in the proceedings, it need not be reviewed in detail beyond the following material points. Mr. Petitti is a 27-year-old man who was born and raised in Scarborough. He graduated from high school and completed one year of university. He did not continue due to the onset of mental health issues.
8Mr. Petitti has a history of problematic use of both alcohol and cannabis commencing in his teens. By 2020, he was consuming cannabis several times a day. He continued his use even though he reported that it made him “very panicked and paranoid”.1
9Mr. Pettit was diagnosed with Obsessive Compulsive Disorder (“OCD”) at the age of thirteen or fourteen. However, he was never under the care of a mental health professional or prescribed medication. His first contact with a psychiatrist did not occur until shortly before the index offence. He reported experiencing auditory hallucinations, anxiety and paranoia. He was convinced that he had an infection in the form of an amoeba resulting from the COVID test. In late February 2021, his mother, stepfather and sister took him to the hospital. Notwithstanding assurances from the doctor, he remained convinced.
10The day before the index offence, he again attended the CAMH emergency department. Mr. Petitti was prescribed quetiapine and told to attend therapeutic programming offered as an outpatient.
11Following the index offence, Mr. Petitti was incarcerated until March 9, 2021. The day after his release, he was brought to hospital on a Form 2 under the Mental Health Act, which had been filled out by his aunt. He was admitted pursuant to a Form 1. He continued to be preoccupied with the thought of having an amoeba in his brain. He was prescribed Olanzapine, Prozac, and Clonazepam. He soon stabilized and his anxiety decreased. His diagnoses were rule out delusional disorder paranoid type, unspecified anxiety disorder, rule out unspecified psychotic disorder, and rule out cannabis-induced psychosis.
12While his case was before the court, Mr. Pettit was receiving psychiatric follow up with CMHA2. He regularly met with a psychiatrist and a community case worker. He was prescribed Fluoxetine 40mg and Olanzapine 5mg daily. He was also connected to the Rapid Access Addiction Medicine Clinic (“RAAM”) Clinic for additional support with respect to his alcohol consumption.
13Following his initial hearing before the Board, Mr. Petitti was subject to a conditional discharge. He was receiving psychiatric support and supervision from the CAMH forensic outpatient team and residing with his father. Unfortunately, Mr. Petitti soon became noncompliant with medication, used cannabis and altered his urine samples to conceal his substance use. He initially denied using cannabis and altering his urine samples but later acknowledged both. The treatment team determined that his risk to the public could not be managed with a conditional discharge and his disposition was replaced with a detention order in October 2023. In August 2024, he was admitted to hospital for similar behaviour where he remains.
14Since shortly after coming under the jurisdiction of the Board, Mr. Petitti has consistently declined low-dose antipsychotic medication. This has been recommended by each of his treating psychiatrists for the purpose of prophylaxis against a potentially undiagnosed primary psychotic disorder and/or to manage symptoms that may occur with the use of cannabis or other substances. In Mr. Petitti’s view, the index offence was solely a result of his cannabis use, not an underlying psychotic illness. He regarded his tenure under the ORB as punitive and unnecessary.
15Mr. Petitti had an adversarial relationship with his treatment team and engaged only minimally with staff. He stopped taking all of his medications, including those used to manage his cannabis cravings.
16His treatment team made a referral to FORCAT3 in order to better understand Mr. Petitti’s personality, risk for violence, and to assess him for undisclosed psychotic symptoms. He repeatedly declined testing. He expressed concern that he would say something bad or that testing would make him seem worse than he was.
Course Since the Last Disposition
17Mr. Petitti’s current diagnoses are Cannabis-induced Psychotic Disorder, Substance Use Disorders (Cannabis, Alcohol), in partial remission in a controlled setting, and Adult Antisocial Behavior. He currently resides on a general forensic unit at CAMH and since December 2024, has been under the care of Dr. O’Sullivan.
18Mr. Petitti has continued to decline recommended medication. He has been determined to be capable of making that decision. While in hospital, his mental health has remained stable. He has not demonstrated any features of psychosis, or acute risk indicators in terms of harm to self or others.
19Mr. Petitti’s engagement with programming has been selective. He continues to decline a referral to FORCAT for an assessment. As noted above, that assessment would allow the treatment team to have a better understanding of his personality, his personality vulnerabilities and coping strategies. It would assist the team in tailoring risk mitigation strategies. Mr. Petitti also has repeatedly declined Cognitive Adaptation Training and several therapeutic programming as recommended by his treatment team.
20However, Mr. Petitti has shown good engagement in other programs including substance relapse prevention, CBT4 stress & coping, leisure education, forensic systems and other social programs. He also completed an online course towards his degree at Toronto Metropolitan University.
21Mr. Petitti’s insight remains partial. He agrees that his mental health was poor at the time of the offence and agrees that cannabis and alcohol were contributing factors. He indicated that “large amounts” of cannabis could impact his mental status and could result in him experiencing paranoia.
22Although there have not been any episodes requiring seclusion, there have been observations of more subtle aspects of his personality and relational style, which have proved challenging. In March 2025, Mr. Petitti became fixated on a particular female nurse that was assigned to him. Initially, they had a good working relationship. However, when some of her time and attention was focused on training a new staff member, Mr. Petitti began to use denigrating language towards her. It became quite distressing for her, and she was reassigned.
23A fellow patient took exception to his behaviour toward the nurse, resulting in verbal exchanges between the two men that escalated to the point where Mr. Pettit challenged the other patient to a fight in the washroom. Fortunately, that did not occur and there were no further issues between the two men. However, Mr. Petitti later declined a referral to a housing provider on the basis that the co-patient, who he described as “his mortal enemy,” was residing there.
24On the positive side, Mr. Petitti has successfully progressed through the pass ladder and is currently exercising level eight passes, which allow for indirectly supervised passes in the community. He underwent an Occupational Therapy assessment and, with prompting, is able to complete his activities of daily living independently. The assessment determined that supported accommodation was required as opposed to independent living.
25The treatment team is currently engaged in discharge planning. Because Mr. Petitti has continued to decline various therapeutic programs as well as a risk assessment, and also owing to his previous behaviour in the community while under the Board, a residence that provides some support and supervision is required. The team is looking for low to medium supported accommodation. As noted above, Mr. Petitti declined a referral to a TRHP-2 residence, a transitional supportive residence located close to the hospital.
26Further complicating his discharge are resources. Mr. Petitti is not interested in making an application for funding through the Ontario Disability Support Program (“ODSP”) due to concerns about the long-term implications and stigma attached to ODSP. The team is assisting him with obtaining funds through Ontario Works. This has been slow as Mr. Petitti is required to submit his tax returns, birth certificate and an OHIP card. Even with those funds, Mr. Pettit will still need to supplement rent, thereby limiting the available supportive housing options. Initially, Mr. Petitti suggested that he could reside with a friend’s father for free. However, upon reflection and discussions with the treatment team, he came to recognize that he requires support and supervision at this time.
27Dr. O’Sullivan testified before the Board. He indicated that it has been a positive year for Mr. Petitti. His mental status has remained largely stable. However, in the doctor’s opinion, Mr. Petitti remains a significant threat to the safety of the public. He remains unmedicated in terms of antipsychotic prophylaxis. Further, although his insight has improved with respect to his mental health condition and his risk, it remains partial.
28In Dr. O’Sullivan’s opinion, there are significant risks were Mr. Petitti to resume cannabis misuse or use cannabis to cope with stressors. He could experience psychotic symptoms and, as at the time of the index offence, become violent. In addition, because Mr. Petitti prefers not to engage in several proposed psychological and risk assessments, the team’s understanding of his personality structure and how that interplays with his risk profile is therefore limited.
29The treatment team is recommending an expansion of the area where Mr. Petitti can exercise passes. This would allow for increased access to volunteering, education and work opportunities. It also would allow him to participate in group outings to Milton, and Caledon. Importantly, it would broaden his search area for supportive accommodation.
30Dr. O’Sullivan indicated that any proposed accommodation would provide regular monitoring of Mr. Petitti’s mental state and supervision in terms of identifying drug use. It would also provide practical supports, such as cooking and organizing his schedule, and support him to identify, engage and maintain that engagement with whatever vocational avenues he wishes to pursue. The hope is that a placement will be secured this coming year and Mr. Petitti will successfully transition to a forensic outpatient team.
31In Dr. O’Sullivan’s opinion, the provisions in the Mental Health Act would not be adequate to affect a speedy readmission in the event of a deterioration in Mr. Petitti’s mental status. If brought to hospital, he would likely be discharged prematurely and, as a result, may not receive the care that would be needed. He likely would not stay in hospital voluntarily.
32Dr. O’Sullivan testified that cannabis use is one risk factor. Mr. Petitti has used cannabis to cope with stress and difficult emotions. In the doctor’s opinion, even in the absence of using cannabis, were Mr. Petitti to become acutely stressed, he may be more likely to experience a relapse of psychotic symptoms. Further, there is also the possibility that Mr. Petitti could experience a relapse in the absence of cannabis use or significant stress. It could represent a progression of his illness perhaps to a more chronic form of psychosis. The doctor agreed that the current diagnostic impression is that at the time of the index offence, Mr. Petitti experienced a cannabis-induced psychotic episode.
33Dr. O’Sullivan testified that Mr. Petitti is ambivalent about his diagnosis. Critically, he does not have a full appreciation of the risks were he to resume cannabis in the future. Mr. Petitti has a sense that he is in control of when he may become unwell, in that he may be able to use smaller amounts of cannabis and not become unwell. That is of concern. He does not fully appreciate that, in the absence of antipsychotic medication, he is at an increased risk of experiencing psychosis in the future. His preference is to remain unmedicated and shoulder the risk without any recognition of the danger he would pose to other people.
34Dr. O’Sullivan agreed that Mr. Petitti demonstrated good participation in substance relapse prevention programming which he completed twice. He also engaged well with CBT stress and coping programs among other.
35Mr. Petitti testified before the Board. He referred to the incident involving the co-patient and indicated that the co-patient had been cursing at him and cursing about his family. Mr. Petitti acknowledged that at the time of the index offence, he was experiencing a cannabis-induced psychosis. He has learned from substance relapse prevention programming and is currently attending Marijuana Anonymous meetings. He stated he has been sober for 17 months.
36All parties maintained the joint submission.
Analysis and Conclusion
37The panel has carefully considered the Hospital Report and the evidence of both Dr. O’Sullivan and Mr. Petitti and finds that Mr. Petitti remains a significant threat to the safety of the public. The threshold of significant threat to the safety of the public is a significant one. The risk must not be speculative. It must be significant both as to the nature of criminal offending and the likelihood of occurrence. It must be more likely than not that, if the person is discharged, they will engage in criminal offending that is serious.
38The panel notes the issue of significant threat to the safety of the public was conceded by the parties. Despite this, the panel makes its own finding based on the expert evidence of Dr. O’Sullivan, as supplemented by the Hospital Report. At the time of the index offence, Mr. Petitti was experiencing psychotic symptoms, apparently induced by cannabis and alcohol use. He developed delusions that caused him to believe that a microchip had been implanted in his brain following a COVID test. The delusions also included auditory hallucinations that were command in nature. He maintained this belief over a significant period of time. His family had noticed a deterioration in his mental status well before the index offence.
39The panel accepts Dr. O’Sullivan’s opinion that without support and supervision, Mr. Petitti remains a significant threat to the safety of the public. He has partial insight into the impact of cannabis use on his mental status. Were Mr. Petitti to resume cannabis use or use cannabis to cope with stressors, there is a real possibility that he could experience psychosis as at the time of the index offence and become violent. Further, there remains the possibility that the psychotic symptoms that Mr. Petitti experienced were a progression of his illness perhaps to a more chronic form of psychosis.
40Having found that the threshold for significant threat has been met, the panel also had to determine the necessary and appropriate disposition taking into consideration the criteria set out in s. 672.54 of the Criminal Code. It is clear from the evidence that Mr. Petitti will require some supervision and support when he is discharged from hospital.
41The panel accepts Dr. O’Sullivan’s opinion that the Mental Health Act would not suffice should Mr. Petitti experience a deterioration in his mental status. Nor would it be able to keep Mr. Petitti in hospital until he is adequately treated. Although a conditional discharge was not recommended by the parties, the panel independently finds that a discharge would not adequately address the risk posed by Mr. Petitti.
42Mr. Petitti’s personality traits posed a significant supervision challenge when he was last residing in the community. Noncompliance with medication, tampering with urine tests, dishonesty with the treatment team and cannabis and alcohol use were present. There were also a number of interpersonal challenges. Although he has developed further insight, successfully exercised indirectly supervised passes in the community, and been able to remain abstinent while in hospital, he has yet to be tested when residing in the community. In order to achieve a successful transition to the community, Mr. Petitti needs to be both supervised and supported. Approved accommodation is critical to managing Mr. Petitti’s risk while residing in the community at this time.
43Mr. Petitti is aware that his decisions to not take medication, not engage in some programming aimed at addressing his risk factors, not participate in a FORCAT risk assessment and not apply for ODSP funding will make finding appropriate accommodation in the community more challenging. He also acknowledges that he will need support.
44Accordingly, the panel orders that Mr. Petitti continue to be subject to a detention order with the same terms and conditions as his current disposition with the expansion of community privileges to include the GTA.
DATED this 22nd day of January, 2026, at the City of Toronto, in the Toronto Region.
Ms. C. Finley Alternate Chairperson
__________________ Office of the Registrar Ontario Review Board