Re: Michael B. Alexander
ORB File No: 7691
Hearing held on: Thursday, February 19, 2026
Place of hearing: Waypoint Centre for Mental Health Care
Pursuant to: Section 672.81(2.1) of the Criminal Code
Before:
Alternate Chairperson: Mr. M.D. Segal Members: Dr. W. Johnston Dr. R. Kunjukrishnan (via Zoom) Ms. C. Murray Mr. K. Brisson
Parties Appearing:
Accused: Michael B. Alexander Counsel: Mr. M.G. Eaton-Kent
The person in charge of hospital: Counsel: Ms. J. Lefebvre
Attorney General of Ontario: Counsel: Ms. S. Curry
REASONS FOR DECISION
(Dated March 12, 2026)
Introduction
[1]. Michael B. Alexander, age 45, was on January 31, 2020, found not criminally responsible on account of mental disorder on charges of robbery, uttering threats to cause death or bodily harm, contrary to the Criminal Code.
[2]. On February 19, 2026, Mr. Alexander, who is the subject of a Detention Order, appeared before the Ontario Review Board (the “Board”) at the Waypoint Centre for Mental Health Care – Provincial Forensic Programs Division, Penetanguishene, (the “hospital”) in relation to four Restriction of Liberty notices.
[3]. Exhibit 1 was a Restriction of Liberty Report dated February 12, 2026. Exhibit 2 was a Hospital Report dated January 24, 2026. The Board had before it as background a Hospital Report dated August 5, 2025, which included a 2020 neuropsychological report, the most recent Decisions, and the most recent Reasons for Decisions. We also had the Restriction of Liberty correspondence.
[4]. The four Restrictions of Liberty are as follows:
| Date of Notification | Date of Entry into Seclusion | Termination of Seclusion | |
|---|---|---|---|
| 1. | July 2, 2025 | June 23, 2025 | July 1, 2025 |
| 2. | July 25, 2025 | July 17, 2025 | July 25, 2025 |
| 3. | December 29, 2025 | December 20, 2025 | January 4, 2026 |
| 4. | February 11, 2026 | February 3, 2026 | Ongoing |
[5]. Mr. Alexander was brought before the Board from seclusion. He was in Pinel hand restraints. He was represented by counsel, Mr. Eaton-Kent.
[6]. In preliminary positions, Ms. J. Lefebvre for the hospital, indicated that the four restrictions were necessary and warranted and the least restrictive and least onerous actions that could have been taken to manage the risk. That also applied to the ongoing restriction. Crown counsel, Ms. S. Curry, took the same position. Mr. Eaton-Kent advanced that the restrictions were not necessary and not the least restrictive measures that could be taken.
[7]. Following Mr. Alexander’s testimony before the Board, Mr. Eaton-Kent conceded he could no longer take the position that triggering the restrictions was not justified. He did, however, maintain his position regarding the length and level of restrictions and continued to question the ongoing restriction that commenced on February 3, 2026. After hearing the evidence and submissions, the Board concluded that all four restrictions were necessary and appropriate and the least restrictive and least onerous measures that could be taken. That applied as well to the length of all the restrictions and the ongoing restriction.
[8]. The facts surrounding the restrictions are set out in the two Restriction of Liberty Reports. They all involved to some degree an accumulation of acts and words with threats of violence, inappropriate conduct, or actual violence.
Diagnoses
[9]. Mr. Alexander’s diagnoses are:
- Schizoaffective Disorder, Bipolar Type
- Alcohol Use Disorder, in sustained remission in a controlled environment
- Cocaine Use Disorder, in sustained remission in a controlled environment
- Antisocial Personality Disorder
- Intellectual Disability, mild
[10]. Mr. Alexander is incapable to consent to treatment. His Substitute Decision Maker is a friend of his. Mr. Alexander, through his SDM, had indicated that Mr. Alexander should no longer be on antipsychotic medications. As a result, Aripiprazole is being tapered down and is currently at 2 mg per day. Mr. Alexander takes Diazepam for sleep.
Evidence at Hearing
[11]. Dr. S. Bouskill, the patient’s psychiatrist, testified. Dr. Bouskill indicated that, in essence, the rationale for all four restrictions was the risk of harm to others. Dr. Bouskill reviewed the most recent restriction noting it involved yelling at a female nurse on the care desk: “K, duck!” and then throwing a bag of chopped apple at male staff. When de-escalation was commenced Mr. Alexander yelled loudly and directed profane and racially derogatory language toward staff. He slammed his door and said he wanted to kill the male staff so he could return to the penitentiary. Soon after he threw an electric charging block (3” x 1.5” x 1”) at a staff member’s head but missed. Mr. Alexander then moved on to trying to destroy his room. He ripped some drywall off the wall and repeatedly struck the sink with his chair.
[12]. Dr. Bouskill described that staff members always attempt de-escalation with Mr. Alexander. A variety of tools are employed including trying to remove the patient from the scenario, affording quiet time, removing a patient from the unit, and offering PRNs. When a patient begins to dysregulate, guidance is sought from a behavioural therapist. Before seclusion is ordered a doctor must approve.
[13]. Once seclusion occurs it is carefully reviewed after 24 hours, three days, one week and one month. In addition, the necessity of seclusion is reviewed daily.
[14]. Dr. Bouskill described how last October the SDM had requested that all antipsychotic medication be stopped. Mr. Alexander requested that the medication be tapered down which request is being accommodated. The last therapeutic level of aripiprazole was in October. In 2026, Mr. Alexander began to refuse his antipsychotic medication on some days. Since January 1, there have been 12 outright refusals. The PRN Diazepam has no lasting impact on Mr. Alexander’s mental health. It has a short-term benefit regarding temporarily reducing aggression and is also used as a sleep aid.
[15]. Mr. Alexander’s history reveals that cessation of antipsychotic medication leads to significant mental health issues, disorganization, and a real risk of violence. On one occasion, following a declaration that he was incapable of consenting to treatment he stopped his medications and within six months made death threats to staff resulting in incarceration in a provincial correctional facility.
[16]. The Hospital Report at page 211 describes a history of engaging in repeated acts of violence resulting in police intervention
[17]. Mr. Alexander targets particular staff. He sometimes attempts physically assaultive behaviour. He has thrown bodily fluids and feces at staff.
[18]. Dr. Bouskill described the robust components of seclusion relief. Mr. Alexander does not always wish to engage in seclusion relief.
[19]. On February 17, 2026, he made death threats to staff. On February 18 he twice attempted to spit at staff.
[20]. Mr. Alexander’s violent demeanour increases when off medications but is probably primarily rooted in his antisocial personality disorder.
[21]. Dr. Bouskill described many contacts and discussions with the SDM about the importance of taking antipsychotic medications.
[22]. Dr. Bouskill was clear that the risk is escalating and is likely to increase further.
[23]. The goal is to get Mr. Alexander out of seclusion. This is done by adhering to a crisis prevention plan that is developed for each patient. It is assisted by the fact that the hospital has a dedicated seclusion relief unit. Every day the team looks at whether Mr. Alexander can manage some form of activities.
[24]. Typically, once placed in seclusion, Mr. Alexander refuses seclusion relief for the first few days, then engages, then discontinues relief.
[25]. Mr. Alexander has been provided a list of desired actions and behaviours that will lead to removal from seclusion.
[26]. Dr. Bouskill continues to meet with Mr. Alexander.
[27]. There is an ongoing concern regarding suicidal ideation. Mr. Alexander has voiced an interest by harming himself by accumulating PRNs to provoke an overdose.
[28]. Mr. Eaton-Kent explored the following:
- Mr. Alexander has been hopeful of a transfer to a less secure hospital but has been frustrated by his lack of progress. Mr. Alexander is also interested in a transfer into a less secure part of his current hospital.
- Even when on his antipsychotic medication there was no discernable difference. Dr. Bouskill disagreed. When on higher doses of Abilify, Mr. Alexander did better.
- Dr. Bouskill disavowed that there was a therapeutic impasse. Mr. Alexander still engages with Dr. Bouskill. Mr. Alexander works well with therapists when he is well.
- Situational frustration may have been at the root of the first three restrictions. For example, a delay on the part of the pharmacy in being able to immediately offer PRNs apparently caused frustration.
- Whether there was an option of removing Mr. Alexander from seclusion following the administration of PRNs. Dr. Bouskill indicated that seclusion relief was dependent on safety concerns.
- Following the hearing, counsel should be provided with the list of expectations placed on Mr. Alexander to exit seclusion. Mr. Alexander had been previously supplied with a copy of that list.
[29]. When Mr. Alexander was at 400 mg of his antipsychotic medication his mental state improved, there was less seclusion, he was able to work with the psychiatrist, he was using privileges, attending groups, and working. His behaviour was such that the hospital was contemplating the possibility of transfer to a medium secure forensic hospital.
[30]. Dr. Bouskill was concerned that the current SDM was not acting in the best interests of the patient. This was a live concern that is being actively examined.
[31]. Mr. Alexander, when more stable, has recognized that he suffers from depression and on occasion has acknowledged his bipolar diagnosis.
[32]. The SDM is of the view that the antipsychotic medication causes more harm than good, that they cause brain damage despite evidence to the contrary, that tardive dyskinesia is a result of the medication although that condition has not been observed by the hospital, and finally that it causes weight gain.
[33]. Mr. Alexander is of the view that he is not a violent person although his understanding of violence is quite literal.
[34]. Dr. Bouskill is of the view that the SDM’s friendship with Mr. Alexander clouds treatment decisions.
[35]. Mr. Alexander appears to be biding his time as he awaits an appeal against his not criminally responsible status.
[36]. Mr. Alexander addressed the Board. He was thoughtful and articulate.
[37]. He explained that during his seclusions staff had not meaningfully checked in on him every 15 minutes as required, and that seclusion relief was offered in an uneven manner.
[38]. Mr. Alexander indicated to the Board a number of times that he did not dispute the need to seclude him, and he understood the reasons why such action had been taken.
[39]. Mr. Alexander said he had a temper but that his behaviour was, in his view, the same on or off antipsychotic medication.
[40]. Mr. Alexander affirmed his goal of moving forward and expressed frustration with lack of progress. Mr. Alexander explained that spitting and throwing things arose out of frustration.
[41]. In final positions, Mr. Eaton-Kent fairly acknowledged that the initial decisions to seclude were no longer being contested, however, the length of the detentions and the current restriction were not justified. More attentiveness to Mr. Alexander’s needs once secluded ought to be exercised. The patient should not be left to stew on his own in seclusion.
Analysis
[42]. In view of the concession that the seclusions were justified, the focus of the Board was directed at the length of the seclusions, and particularly the current seclusion.
[43]. Mr. Alexander showed some insight into how his conduct precipitated the seclusions. It is clear to the Board that generally, seclusion was employed only after several incidents.
[44]. Mr. Alexander’s insight into his mental state, the benefits of antipsychotic medication, and his response to the cessation of medication is lacking.
[45]. The Board is of the view that the hospital has a robust review process that involves daily assessments of the continuing need to remain in seclusion. The record, including the evidence of Dr. Bouskill, supports that each of the seclusions was appropriately managed with a view to ending seclusion as soon as practicable and in a manner that offered appropriate relief.
[46]. The Board observes that the hospital has tried very hard with the SDM to emphasize the benefits of Mr. Alexander being on antipsychotic medications. The Board has concerns about whether the SDM truly understands Mr. Alexander’s needs and is acting in his best interests. When not on antipsychotics, or on a sub-therapeutic dose, threatening and unwanted behaviour, and violence have increased resulting in more frequent seclusions than was the case when Mr. Alexander was on that higher dose. At an earlier point in time the Public Guardian and Trustee acted as Mr. Alexander’s SDM.
[47]. The diagnosis of antisocial personality disorder will always contribute, to some degree, to Mr. Alexander’s behaviours, however, the administration of therapeutic levels of antipsychotic medication significantly attenuates unwanted behaviours including violence.
[48]. The Board appreciates Mr. Alexander’s candour. Clearly, Mr. Alexander has positive attributes to offer. He understands why he was secluded and the process for leaving seclusion.
[49]. The Board finds that all four seclusions were justified and necessary and the least restrictive and least onerous actions that could have been taken in the circumstances. The current seclusion continues to be justified. We wish Mr. Alexander well.
DATED this 12th day of March 2026, at the City of Toronto, in the Region of Toronto.
Mr. M.D. Segal Alternate Chairperson
Office of the Registrar Ontario Review Board