Re Jhaydn Fowler, 2026 CanLII 21122

Ontario Review Board

Re: Jhaydn Fowler

ORB File No: 7488

Hearing held on: Wednesday, February 4, 2026

Place of hearing: Centre for Addiction and Mental Health

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

Before:

Alternate Chairperson: Mr. M. Segal

Members: Hon. N. Kozloff Dr. G. Chaimowitz Dr. H. Moulden Mr. S. Duffy

Parties Appearing:

Accused: Jhaydn Fowler Counsel: Mr. A. Rai

The person in charge of hospital: Representative: Dr. P. Darby

Attorney General of Ontario: Counsel: Mr. C. Coughlan

REASONS FOR DISPOSITION

(Dated March 10, 2026)

Overview

1. On January 16, 2019, Jhaydn Fowler was found not criminally responsible on account of mental disorder (“NCR”) on charges of assault police, and assault police with a weapon or causing bodily harm, all contrary to the Criminal Code.

2. Mr. Fowler is currently subject to a Disposition of the Ontario Review Board (“ORB” and “the Board”) dated February 25, 2025, ordering that he be discharged subject to conditions.

3. On Wednesday, February 4, 2026, the Board convened a hearing at the Centre for Addiction and Mental Health (“CAMH” and “the hospital”) to review Mr. Fowler’s Disposition pursuant to section 672.81(1) of the Criminal Code. Mr. Fowler was present at the hearing and represented by counsel, Mr. A. Rai.

4. The issues to be determined at the hearing are whether Mr. Fowler continues to represent a significant threat to the safety of the public as defined in section 672.5401 of the Criminal Code and, if so, what is the necessary and appropriate disposition which is also the least onerous and least restrictive, taking into account the factors set out in section 672.54 of the Criminal Code.

Positions of the Parties

5. At the commencement of the hearing the parties were requested to provide their initial without prejudice positions with respect to the issues before the Board.

6. On behalf of the hospital, the position taken by Dr. Darby was no change to the current disposition except for the addition of a term allowing travel only with an approved itinerary.

7. Counsel on behalf of the Attorney General agreed with the position of the hospital.

8. Counsel on behalf of Mr. Fowler took the position that Mr. Fowler is no longer a significant threat to the safety of the public and should receive an Absolute Discharge.

Findings

9. For the reasons that follow, the Board finds that Mr. Fowler continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition is a discharge with the conditions recommended by the hospital.

The Evidence

10. The evidence at the hearing consisted of the Hospital Report dated January 14, 2026, (Ex. 1), and the viva voce evidence of Mr. Fowler’s treating psychiatrist, Dr. Darby.

The Index Offences

11. The circumstances surrounding the index offences (as adapted from the Peel Regional Police synopsis) are set out in the Hospital Report:

"On June 16, 2018, at 2:19PM Mr. Fowler attended the McDonalds located inside the Walmart at 100 City Centre Drive, in the City of Mississauga, carrying a baseball bat in his right hand. He jumped over the restaurant’s front counter entering the employee area. He picked a drink cup, filled it, and poured its contents over the face of one of the employees. He fled the scene on foot and was located by police at approximately 2:50pm at a nearby bus stop. Police attempted to arrest Mr. Fowler for the offences Weapons Dangerous and Assault with Weapon. At that point Mr. Fowler started to swing the bat at the police officers causing “minor injuries” to one of the officers and a concussion and wound to the back of the skull of a second officer."

Background

12. The Hospital Report contains detailed information under PERSONAL AND DEVELOPMENT HISTORY including Childhood and Family History, Education History, Employment History, Relationship History, and Self-Perception. For the purposes of these Reasons the following information is material:

"Mr. Fowler is a 28-year-old man, never married, with no children, living in a high support residence in the community. He has been diagnosed with schizophrenia and cannabis use disorder. To treat his schizophrenia, he receives the oral antipsychotic clozapine at 425 mg daily in suspension to ensure compliance. Mr. Fowler is capable to consent to his antipsychotic treatment.

Mr. Fowler is the second child of four siblings born to Ms. Cheryl Morgan-Fowler and Mr. Boswell Fowler in Brampton, Ontario. Mr. Fowler has an older sister and two younger sisters sixteen months and three years his junior. In addition, Mr. Fowler has two younger half siblings from his father’s second marriage.

Mr. Fowler’s parents were both born in Jamaica. His mother immigrated to Canada in 1974 and met Mr. Fowler’s father during a visit to Jamaica. They were married when she was 25 years of age and she sponsored him to immigrate to Canada. The couple separated in February of 2000, when Mr. Fowler’s mother was pregnant with the couple’s fourth child. After the couple’s divorce the children remained with Ms. Morgan-Fowler, who did not remarry.

As a child, Mr. Fowler was described as gentle, “easy going, friendly” caring towards his younger siblings, well behaved and dependable, often being in charge of taking his youngest siblings to and from school until his mother came home from work. Mr. Fowler did not have issues socializing or making friends during his formative years.

Mr. Fowler’s family noticed a shift in his behaviour between the ages of 15 to 17, when he started to stay out with friends for long periods of time, coming home intoxicated from parties, and using marijuana. Mr. Fowler’s behaviour continued to escalate, and he started to miss school. His academic performance declined and his teachers expressed concern. At this point he changed his dressing style and his hygiene declined. Mr. Fowler was noted to have become disrespectful of rules and when arguments would ensue with his mother, he became verbally threatening and abusive. This was noted as a significant shift. Given his escalating behaviour in the home his mother asked him to leave the house, and he moved in with his father before completing high school. He returned to live with her in 2017 after leaving his father’s home and residing in shelters for some months.

Although Mr. Fowler informed that he has never been employed during the risk assessment interview of March 18, 2019, collateral sources indicated that he was briefly employed at Canada’s Wonderland but fired after bringing drugs onto the site. It is not known how long he worked there. His medical file also indicated that he obtained a job as a Forklift operator but there was no further information. Prior to being adjudicated ODSP in 2017, Mr. Fowler was financially supported by his mother.

Mr. Fowler reported not currently being in a romantic relationship. He identified as heterosexual. He denied any romantic relationships of significance so far. Mr. Fowler denied being sexually active to date.

Mr. Fowler’s relationship with his mother suffered significant strain over the last couple of years. She used to be his main caretaker and support until he assaulted her in May of 2017 following a psychiatric admission. Since then, she has taken a step back and her ex-husband has become the main source of support for their son. Both Mr. Fowler and his father reported their relationship was good, although collateral sources reported that their relationship struggled when Mr. Fowler was a teenager, and his father was not as present in his life.

Mr. Fowler’s father informed that his son has become “very impulsive” in the last couple of years and that he is “a lot more impulsive” when not taking medication. He informed that his son is not able to care of himself or tend to his activities of daily living appropriately. He informed that his son hears voices, and he has seen him talking to himself. He indicated that over the past years he hears "voices telling him to do things"."

13. Mr. Corey Wilson, who was Mr. Fowler’s former case worker at Peel Youth Village provided the following observation for the purposes of the NCR assessment in November of 2018:

"Mr. Wilson identified Mr. Fowler as not having the ability to assess when he is in distress and express it effectively. He advised that Mr. Fowler tends to become more guarded when experiencing more acute symptoms of schizophrenia and would benefit from working with a team on a long-term basis."

Psychiatric History

14. The following contains excerpts from last year’s Reasons for Disposition and additional summaries, all of which information is set out in the Hospital Report:

"Mr. Fowler was residing with his mother when he first started to experience symptoms of schizophrenia’

Mr. Fowler’s first encounter with mental health services took place in May of 2017, when Mr. Fowler’s mother became concerned that her son was suffering from alcohol poisoning and called an ambulance. He was taken to Brampton Civic Hospital where he was admitted for a brief stay and diagnosed with schizophrenia. Mr. Fowler was prescribed an antipsychotic during his stay in hospital and discharged with a prescription. He refused to fill the prescription on the day of his discharge and assaulted his mother in the parking lot of the pharmacy.

Since then, Mr. Fowler has not been able to return to live with his mother and has mostly relied on safe beds and shelters for residence. His father reported being unable to have his son reside with him due to safety concerns, given he has two young children. Mr. Fowler struggled with compliance with psychiatric medication and follow up. He had three subsequent encounters with Emergency Services, necessitating police intervention. Mr. Fowler was kicked out of a variety of shelters for acting bizarrely or engaging in aggressive behaviour towards staff or co-residents.

Mr. Fowler was taken to hospital for psychiatric intervention on three occasions in 2017. The first was on May 24^th when he was taken to Brampton Civic Hospital by his mother (strange behaviour, alcohol poisoning, talking to himself). Mr. Fowler endorsed auditory hallucinations for a couple of years. He was initiated on a trial of aripiprazole and discharged on May 26^th with the following differential diagnoses: substance use disorder, substance-induced psychotic or mood disorder, a primary psychotic disorder, or a mood disorder with psychotic features. He was to follow up with the early psychosis clinic and prescribed aripiprazole 5mg. It was following this discharge that he assaulted his mother in the parking lot of the pharmacy after he refused to fill the prescription, and she threatened to call the police.

Following his admission to hospital in May 2017, Mr. Fowler repeatedly ceased taking his antipsychotic medication and refused to believe that he suffered from schizophrenia. Despite that, he endorsed a number of psychotic symptoms, including command hallucinations to harm others. He believed that if he did not follow the commands, they could become angrier.

He was then taken to Etobicoke General Hospital on October 25^th under a Form 2 completed by his mother (psychiatric assessment). He was admitted for observation, treated with Olanzapine, and discharged on October 27^th as he had not displayed symptoms indicative of psychosis or mood disorder. He was to follow up with a substance abuse program.

Mr. Fowler was next taken to Mississauga Hospital November 15^th by his case worker Mr. Corey Wilson (bizarre behaviour). He was placed on a Form 1 and seen in psychiatric assessment. He denied auditory and visual hallucinations albeit endorsing ideas of reference in the form of voices from the TV and denied all other psychotic or mood symptoms He was still being treated with aripiprazole 5 mg. He was diagnosed with a psychotic disorder, not otherwise specified and discharged on November 16^th with a referral for follow up with the Mental Health Urgent Response Service (MHURS) at Mississauga Hospital.

Mr. Fowler attended MHURS on November 20th and 27^th, and December 11^th of 2017 and January 3^rd and 31^st, March 14^th, April 2^nd and 26^th, 2018. He was apparently compliant with his aripiprazole medication which was increased to 10 mg. on November 27^th when he admitted hearing voices, delusions of reference, thought insertion and thought withdrawal. On January 3^rd, after he had exhibited more bizarre behaviour, his aripiprazole was increased to 12 mg and then to 15 mg. On January 31^st he continued to exhibit psychotic symptoms, and his medication was further increased to aripiprazole 20 mg and quetiapine 50 mg at bedtime was added to help with sleep. On March 14^th the medication was again increased to aripiprazole 25 mg and quetiapine 75 mg as he was still experiencing intermittent auditory hallucinations and acting bizarrely during assessments. He was ultimately discharged from the clinic on April 26^th continuing to take aripiprazole 25 mg and quetiapine 75 mg, less than two months later the index offences took place.

In August 2018, Mr. Fowler was deemed incapable of consenting to treatment, and his father became his substitute decision maker. Pursuant to his father’s consent, Mr. Fowler was administered his antipsychotic medication by long-acting injection."

Course Since the NCR Finding

15. The following summary is taken from last year’s Reasons for Disposition:

"Following the NCR finding, Mr. Fowler was admitted to CAMH in May 2019. Over the next year he exhibited behavioural dysregulation. He assaulted co-patients, sexually touched female staff repeatedly, and became increasingly argumentative and uncooperative, leading to code white situations. His treatment team believed that these incidents were precipitated by psychosis due to lack of medication efficacy, in combination with his frustration owing to lack of progress under the ORB.

A MAPS consultation in May 2020 concluded that given the refractory nature of Mr. Fowler’s psychotic illness and his history of violence, he met the criteria for clozapine. However, Mr. Fowler refused to trial clozapine and refused any increase in his medication except for an increase in Haldol.

On August 28, 2020, Mr. Fowler engaged in a serious assault towards a co-patient. Four staff members were required to physically intervene. It appeared that Mr. Fowler initiated this unprovoked assault from behind the co-patient. He was seen forcefully punching and kicking the co-patient in the back of his head.

On September 24, 2020, Mr. Fowler was started on clozapine and switched to clozapine liquid suspension in January 2021 to ensure compliance. Since that time, Mr. Fowler has presented as calm and cooperative. He passively accepted his medications under direct staff observation, although he continued to believe that his treatments were neither necessary nor beneficial. He remained incapable to consent to his antipsychotic treatment and his father continued to be his Substitute Decision Maker.

In November 2021, Mr. Fowler was transferred from a secure forensic unit to a general forensic unit. He tolerated the transition well and continued to be cooperative with the rules and expectations.

In July 2023, he was discharged to a high support Supportive Housing in Peel (SHIP) residence in Brampton. He related well to both the staff at SHIP and the Forensic Outpatient Service (FOPS) team at CAMH."

Course Since the Last Hearing

16. The following is set out in the Hospital Report and refers to the period between November 2024 and January 2026:

"Housing

Mr. Fowler continues to live in high supportive housing (S.H.I.P - Service and Housing in the Province) located at Henderson Avenue, Brampton, Ontario. He has a bachelor apartment. Clinical staff are on site from 0830 to 2030hrs.

Physical Health

Mr. Fowler has no known health problems and no known allergies. He is followed by his GP in Brampton. This past review year there have been no major medical concerns.

Mental Health

Mr. Fowler’s mental state has remained stable and at his baseline over this treatment year. He is capable with respect to treatment. He identified his diagnosis as Schizophrenia and understood that he took Clozapine for this reason. He reports his mood as "fine", his affect is appropriate, and he denies any depressive symptoms or suicidal ideation.

Medication

Mr. Fowler’s clozapine was decreased to 350mg tablets in July 2025. Mr. Fowler’s medication is observed and supervised by staff. He is compliant with medication and has voiced no adverse reactions. He remains at baseline with the lower dose.

During this reporting year Mr. Fowler has had the opportunity to carry his medications when visiting family. He is compliant with taking his medications as reported by his father.

Substance Use

This past review year the FOPS clinical team obtained weekly samples of urine to screen for drugs and alcohol. They were negative for non-medical drugs, alcohol or another intoxicant. During each visit enquiries were made regarding substance use and Mr. Fowler always denied any cravings or substance use.

All the urine results showed positive for clozapine; his prescribed psychiatric medication.

Concerning Behaviour

No behavioral issues were noted or reported by staff or his family.

While living in the community and during this reporting year, Mr. Fowler has had no conflicts or arguments and has engaged well with co-residents and staff. Housing staff reported that he did not pose a management problem.

Self Care

Mr. Fowler is independent in managing his ADL’s. SHIP housing staff report his unit most of the time was clean, but he did need frequent reminders. He is able to do his own laundry, cook, and do his grocery. He needed frequent reminder and encouragement regarding his body odor and need to take a shower. He is independent in taking public transportations and attended his doctor’s appointment independently.

Mr. Fowler is financial capable and is supported by ODSP.

Mr. Fowler was supported by the SHIP trustee with managing his money upon admission to SHIP program. In June 2025 Mr. Fowler requested and began managing his own finance; he has reported no issues in managing on his own. Staff also have been following up with him and have reported no issues.

Structured Activity

During the year, Mr. Fowler attended the maintenance Culturally based CBT. He also attended a number of recreational activities both at CAMH and at his housing.

Mr. Fowler is presently working at a factory warehouse.

Family/Social Support

While living in the community, Mr. Fowler’s social support consists of FOPS staff, SHIP clinical team and his family, especially his father. He is seen by housing staff daily and FOPS weekly with regards to managing his risk. He is supervised and monitored regarding any changes in his mental status, and with supervising his oral medications.

He has a very good therapeutic rapport with the SHIP and FOPS team.

Mr. Fowlers main support is his father. He had regular contact and visited with him often. Mr. Fowler reported he received frequent phone calls and received home cook meals regularly. Mr. Fowler was able to spend Thanksgiving with his father and had dinner. He also spent Christmas day with his father He reported the visits went well and was enjoyable.

Strengths

• Has diligently pursued employment and obtained part time employment for several months

• Has attended FOPS for cooking and soccer.

• Engaged with CA-CBT

Collaborative in talking with the team about his medication. Approached team about side effects (drowsy) he was experiencing at work

• Improved insight around illness and medication

• Very collaborative with the team

• Has been out of hospital for 1.5 years and has done very well

Challenges

• Still some superficiality with the team

• Insight into symptoms of illness and risk remains somewhat limited

The team noted the following as treatment foci for the coming year:

• Increase engagement in employment

• Increase understanding of treatment and risk."

17. The following appears in the Hospital Report under MENTAL STATUS EXAMINATION:

"Mr. Fowler is always calm and cooperative during interviews. He demonstrates stable, albeit somewhat blunted affect. His thought form is generally intact and undisturbed but at times he exhibits mild tangentiality and circumstantiality. There are no loosened associations. He evidences no overt delusions and denies paranoid or grandiose themes or ideations. He denies ideas of reference, thought withdrawal, insertion or broadcasting. He denies self-harm or aggressive ideation, plans or intent. He denies hallucinations and does not appear to be acutely responding to internally generated stimuli. He reports stable and normal neurovegetative signs. He denies racing or intrusive thoughts or subjective impulsivity. He denies the use of, or cravings for, substances of abuse. He is orientated to time, place and person.

When interviewed on January 14, 2026, Mr. Fowler was asked about his understanding of his illness and its relationship to the index offence. Mr. Fowler acknowledged his diagnosis of schizophrenia. When asked what specific symptoms he had experienced, he was somewhat hesitant. He indicated that he had been "unpredictable". He did not volunteer the experience of auditory hallucinations. When prompted, he acknowledged that he had experienced auditory hallucinations, but when asked whether they represented symptoms of schizophrenia he responded, “They say it is”. When asked about further incidents where he had experienced command hallucinations from the television, he was again quite uncertain as to whether these were clearly symptoms of schizophrenia.

Mr. Fowler indicated he would be willing to continue on medication and to see a psychiatrist were he did receive an Absolute Discharge. When asked whether he thought anything untoward could happen were he to stop his medication, he responded, "I hope not". He indicated that he acknowledged that he might not "keep on the straight track" were he to discontinue his medication but was quite uncertain as to whether this could result in the return of psychotic symptoms or any aggressive behaviour."

Diagnoses

18. As noted in the Hospital Report, Mr. Fowler has the following diagnoses:

a) Schizophrenia, residual type

b) Cannabis Use Disorder, in remission, in a controlled setting

Risk

19. The following relevant excerpts appear under Risk Assessment in the Hospital Report:

"Mr. Fowler’s score on the VRAG places him in bin 5, where bin 1 represents the lowest risk group, and bin 9 the highest. Among individuals of the standardization sample who were in the same bin/risk category, 35% violently reoffended over 7 years, and 48% violently reoffended over 10 years. Mr. Fowler’s score on the VRAG places him in a moderate risk category.

Mr. Fowler was scored on the HCR-20, Version 3 (scored on proposed continuation of present Detention Order). Historical items that were deemed present were violence as well as problems with relationships, employment, substance use, major mental disorder, and treatment/supervision response. Historical items that were deemed possible/partial were other antisocial behaviour, traumatic experiences, and violent attitudes. Current dynamic factors that were deemed present were symptoms of major mental disorder and those deemed possible/partial were problems with insight, instability, and treatment/supervision response. Future dynamic risk-management factors deemed present were personal support and those deemed possible/partial were professional services/plans, living situation, treatment/supervision response, and stress/coping.

Overall, his risk of future violence/case prioritization and serious physical harm were rated as medium whereas his risk of imminent violence was rated as low in the context of the recommended disposition.

Clinical Risk Factors/Re-offence Scenario

Criminogenic risk factors include:

ii) Psychotic disorder (schizophrenia) with residual symptoms.

iii) Cannabis use disorder, moderate, in full remission in a controlled environment;

iv) Poor insight/ medication noncompliance.

v) Limited social/community supports.

Clinical or dynamic risk factors which may serve as proximal indicators for violent reoffence include active symptoms of his schizophrenia, non-compliance with medications, use of alcohol, cannabis or illicit/prescription drugs, interpersonal conflict with others, stressors, unstructured daytime routine and exacerbation of underlying personality traits.

If Mr. Fowler is to reoffend, this will likely occur in the context of exposure to destabilizers and stressors, with a return to his historical pattern of medication noncompliance and the use of psychoactive agents leading to psychosis."

20. The following appears in the Hospital Report under Composite Assessment of Risk:

"Mr. Fowler’s actuarial assessment of static long-term risk for violent recidivism is best described as moderate. Mr. Fowler’s HCR-20 V3 profile is consistent with moderate risk. In addition, he presents with several significant criminogenic risk factors. Taken in totality, the clinical team opines that Mr. Fowler continues to represent a significant risk to the community as defined in Section 672.5401."

21. The following appears in the Hospital Report under Risk Management:

"a. Schizophrenia

Our principal risk management intervention for this criminogenic variable has been continued administration of ongoing administration of antipsychotic medication. Mr. Fowler is treated with the oral antipsychotic clozapine at 425 mg once daily. Mr. Fowler has been declared incapable to consent to treatment and his substitute-decision maker (his father) has consented to clozapine dosage up to 700 mg once daily if needed.

To date, there has been a robust response with attenuation of his delusions and hallucinations with resultant behavioural control; when noncompliant his psychosis rapidly intensifies. Although Mr. Fowler exhibits mild residual symptoms, there are presently no plans to modify his medication regimen as his clozapine levels are therapeutic and he demonstrates behavioural control.

Psychotherapy, such as cognitive behavioural therapy, may also have a role in mitigating the distress related to residual psychotic symptoms.

b. Cannabis Use Disorder

Mr. Fowler is subject to urinalyses to monitor for alcohol and drug use. His abstinence is secondary to his present inpatient hospitalization with substantive external monitoring. Mr. Fowler would benefit from involvement in maintenance substance use programming, delivered in a group setting or individual to promote abstinence, or a harm reduction model, from psychoactive substances.

c. Non-compliance with psychiatric treatment/limited insight

Our principal risk management strategies have been ongoing monitoring, supervision and psychoeducation. Mr. Fowler has staff encouragement and supervision to adhere to his medication regimen. Testing for levels of clozapine are ongoing to confirm therapeutic levels of medications. Administering his medication in suspension and under supervision enhances compliance."

22. The recommendation of Mr. Fowler’s treatment team appears at the conclusion of the Hospital Report:

"Team Review of Recommendation

This report has been reviewed with Mr. Fowler’s treating clinical team and there is unanimous consensus as to the contents of this report and its implications.

Current Exercise of Privileges

Mr. Fowler is residing in a high support residence in the community

Proposed Order

The clinical team is of the opinion Mr. Fowler remains a significant risk and as such does not warrant consideration of an absolute discharge.

Mr. Fowler’s insight into his mental illnesses and the relationship between active psychosis, and historical aggression has improved, but is still somewhat limited. Mr. Fowler’s psychiatric history is replete with episodes of acute psychosis, violence and hospitalization flowing from these risk factors. Ensuring medication compliance, abstinence from substance use and monitoring of Mr. Fowler’s mental status will continue. He has historically attempted to avoid medication compliance and/or detection of substance use.

To his credit, Mr. Fowler has done well for a further year in the community. He has been compliant with medication, has been abstinent from substances, has participated in programming and work, and has a good relationship with the clinical team. However, as is evident from Mr. Fowler's most recent mental status examination, his insight into the symptoms of his illness and the risk of decompensation and recurrence of aggression remains underdeveloped.

The clinical team believes that, in Mr. Fowler's case, a longer period of stability and a period of overlapping transition to a non-forensic team is critical to mitigate the risk of Mr. Fowler's falling away from treatment, becoming noncompliant, and suffering a relapse of his psychotic illness.

The clinical team believes that the risk posed by Mr. Fowler can be managed under the terms of a conditional discharge with residence specified.

Mr. Fowler has expressed some interest in possible international travel over the coming year. Should he be maintained under the jurisdiction of the Board, the team recommends a term allowing travel only with an approved itinerary."

Evidence at the Hearing

23. Dr. Darby was the only witness who testified at the hearing.

24. He began by acknowledging that since being discharged into the community in July 2023 Mr. Fowler has done very well. There have been no readmissions. He likes his residence. He has good engagement with his team. He hasn’t used substances. He had obtained part time employment and continues to pursue employment opportunities. He has good family support. There has been some improvement in his insight. He is now capable of consenting to treatment.

25. Dr. Darby then summarized his concerns about an Absolute Discharge disposition for Mr. Fowler at this time, opining that there is still some superficial element to Mr. Fowler’s engagement and his insight. Referring to the most recent Mental Status Examination (at p. 35 of the Hospital Report), he posited that Mr. Fowler does not appreciate the risk of discontinuing his medication.

26. The doctor also expressed his concern that access to non-forensic (psychiatric) care in Brampton is difficult, adding that a period of overlap with a non-forensic team is critical in Mr. Fowler’s case before he is discharged absolutely.

27. In response to questions from counsel for the Attorney General, Dr. Darby noted that while Mr. Fowler is not employed currently, he has demonstrated a commitment to seeking and maintaining full employment.

28. Regarding the reduction in Mr. Fowler’s antipsychotic medication, the doctor observed it had resolved Mr. Fowler’s issues with drowsiness, and that no further reduction had as yet been requested but would be considered if the same issues persist.

29. Regarding the issue of international travel, Dr. Darby said his understanding is that it would be with family.

30. Regarding medication, Dr. Darby stated that Mr. Fowler’s history of violence had ended with the administration of clozapine and his concern that if Mr. Fowler stops his clozapine he would decompensate and become violent again.

31. In response to questions from counsel for Mr. Fowler, Dr. Darby agreed that Mr. Fowler has been residing in SHIP housing since 2023, that it is permanent housing, that he has a very good rapport with the SHIP team, and that he can continue to reside there.

32. He also agreed that since Mr. Fowler was discharged into the community, there have been no rehospitalizations and no acts of violence, threats or aggression, that the last act of violence occurred in August of 2020, and that clozapine was started in September of 2020.

33. The doctor acknowledged that Mr. Fowler’s father was a positive support, and that Mr. Fowler was now capable of consent, had been medication compliant, and had indicated his willingness to continue medication and psychiatric treatment.

34. Regarding substances, Dr. Darby agreed that all of Mr. Fowler’s UDSs have been negative since 2019, that he had not voiced any cravings, and that he could access them if he chose to.

35. Regarding programming, the doctor agreed that - based on what is noted at p. 27 of the Hospital Report about his engagement in directed risk management programming, including IMR (illness, management, and recovery) as well as CBT - Mr. Fowler has made recent progress.

36. He also agreed that (as noted at p. 19 of the Hospital Report) Mr. Fowler had “made some gains in respect to accepting his diagnosis and how drugs, alcohol, and prescribed medication can impact him.

37. Dr. Darby said that in the event of an Absolute Discharge he would offer follow-up and connect Mr. Fowler to a non-forensic team.

38. In response to questions from the panel, Dr. Darby agreed that in addition to the index offences there were other incidents of physical and sexual violence in Mr. Fowler’s past that were of concern, that clozapine was a required means of addressing that concern, and that Mr. Fowler is liable to stop if he is discharged absolutely.

39. Asked what could support an Absolute Discharge, the doctor’s response was “a greater depth of insight and recognition” of his symptoms, their relationship to risk, and the importance of maintaining clozapine use.

40. He added that the involvement of a non-forensic team would be “absolutely critical”, that his clozapine regime requires “sophisticated oversight”, and that if Mr. Fowler stopped the clozapine, he would become psychotic.

41. Regarding medication, Dr. Darby opined that no further reduction of clozapine was required, that a long-acting medication was not appropriate in Mr. Fowler’s case because only clozapine is able to manage his mental illness.

42. Asked if it might now be appropriate to remove the (alcohol/drug/other intoxicants) abstention condition, Dr. Darby thought it might be an appropriate step towards an Absolute Discharge, albeit reiterating that the link between medication adherence and abstention from substances is crucial in Mr. Fowler’s case.

43. In response to a follow-up question from Mr. Fowler’s counsel regarding how his medication is supervised, Dr. Darby stated that it was one of SHIP’s rules that Mr. Fowler must take his medication under their supervision and agreed that Mr. Fowler needs to comply with that rule in order to stay there.

Final Submissions of the Parties

44. On behalf of the hospital, Dr. Darby stressed that Mr. Fowler still meets the threshold for significant threat as defined in Winko. The main concern of his team is Mr. Fowler’s limited insight into his symptoms and their connection to his psychosis and acts of violence. Clozapine is critical to his mental stability. The treatment team is concerned that Mr. Fowler will likely disengage from treatment and medication over time.

45. In response to a question from the panel about counselling (to address his limited insight), Dr. Darby said that Mr. Fowler is doing CBT for his psychosis and continues to work with the doctor and his case worker on a one-to-one basis.

46. Counsel for the Attorney General also submitted that Mr. Fowler continues to be a significant threat and that a Conditional Discharge is the necessary and appropriate disposition. Acknowledging that Mr. Fowler had another good year, he submitted that clozapine is still a major support factor for Mr. Fowler’s mental stability and argued that Mr. Fowler has a superficial and limited insight into his need for medication.

47. Counsel for the Accused submitted that Mr. Fowler no longer meets the significant threat threshold. He has been living in the community since (July of) 2023. All of his urine drug screens (UDS) have been negative since 2019 even though he has been living in the community for over 3 ½ years. There have been no concerns about him at SHIP. He has a good relationship with the staff and his co-residents, and he seems to want to stay there. He has been medication compliant as observed and supported by SHIP staff. He has stated that he is willing to continue with a therapeutic relationship and to take his medication. He has completed a number of programs. Regarding insight, he may eventually develop fuller insight but a lack of or limited insight is not the equal to significant threat. Accordingly, he should receive an Absolute Discharge. It is apparent to the panel that Mr. Fowler has made considerable progress under the jurisdiction of the ORB since the finding of NCR some 7 years ago. Since his discharge into the community, he has remained stable. He has been medication adherent. He is now considered capable with respect to treatment. There have been no positive UDLs and no reported concerns about his behaviour. He is independent in managing his ADLs. He has a good therapeutic rapport with both the SHIP staff and his CAMH treatment team. He continues to attend programming at CAMH, and his insight has improved.

Analysis and Conclusions

48. We have carefully considered the evidence in its totality, including the information contained in the Hospital Report and the testimony of Dr. Darby, as well as the submissions of counsel.

49. We are unanimous in finding that Mr. Fowler continues to represent a significant threat to the safety of the public. Although his insight into the symptoms of his mental illness and the benefits of being medication adherent has improved, it is still limited. The responses he provided in his most recent Mental Status Examination are demonstrative of that.

50. The clear and uncontradicted evidence is that clozapine is what keeps Mr. Fowler at his baseline. Without supervision, he will likely fall away from treatment, become non-compliant with his medication and/or return to substance use, suffer a relapse of his psychotic illness, and act out violently as he did with his mother in the pharmacy parking lot, with the police officers during the index offences, and with a co-patient in 2020 over a year after being admitted to CAMH.

51. We find the reasoning of the clinical team at the conclusion of the Hospital Report both compelling and convincing:

"The clinical team believes that, in Mr. Fowler's case, a longer period of stability and a period of overlapping transition to a non-forensic team is critical to mitigate the risk of Mr. Fowler's falling away from treatment, becoming noncompliant, and suffering a relapse of his psychotic illness."

52. Accordingly, we are unanimous in finding that the necessary and appropriate, least restrictive, and least onerous disposition is the continuation of a discharge with the conditions recommended by the hospital.

53. In coming to this conclusion, the panel has considered the paramount factor of the safety of the public, Mr. Fowler’s mental condition, his reintegration into society and his other needs pursuant to s. 672.54 of the Criminal Code.

DATED this 10^th day of March, 2026, at the City of Toronto, in the Toronto Region.

Hon. N. Kozloff Legal Member

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Office of the Registrar Ontario Review Board