Re: Malcolm Burke
ORB File No: 7310
Hearing held on: Wednesday, October 29, 2025
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. B. Garrow
Members: Dr. B. Sheppard Dr. L.O. Lightfoot Ms. J. Ferguson Mr. S. Duffy
Parties Appearing:
Accused: Malcolm Burke Counsel: Mr. D. Medd
The Person in charge of Hospital: Counsel: Mr. D. Blumenkrans
Attorney General of Ontario: Counsel: Mr. R. Mushlian
REASONS FOR DISPOSITION
(Dated February 3, 2026)
Introduction
On February 22, 2018, Malcom Burke was found not criminally responsible (“NCR”) on account of mental disorder on charges of uttering threats to cause death or bodily harm (x3), assault with a weapon (x2), and failure to comply with probation order (x2), all contrary to the Criminal Code, (the “Code”).
Mr. Burke is currently subject to a Disposition of the Ontario Review Board (the “Board”), dated November 6, 2024, detaining him at the Forensic Service of the Centre for Addiction and Mental Health (“CAMH”/the “hospital”), with discretionary privileges up to and including the ability to reside in the community in approved accommodations.
On October 29, 2025, the Board convened a hearing, pursuant to s. 672.81(1) of the Code to conduct the annual review of the current Disposition. Mr. Burke was present at the hearing and represented by counsel.
The issues before the Board are whether Mr. Burke continues to pose a significant risk to the safety of the public, and if so, what is the necessary and appropriate disposition to manage that risk having regard to the criteria set out in s. 672. 54 of the Code.
On behalf of the hospital, counsel submitted that there be no change to Mr. Burke’s current Disposition. Counsel for the Attorney General of Ontario supported the hospital’s position. Counsel for Mr. Burke requested that his client be conditionally discharged. The issue of Mr. Burke’s significant threat was conceded.
For the reasons that follow, the Board finds that Mr. Burke continues to pose a significant threat to the safety of the public and that his care should continue on the same terms as his current Disposition.
Evidentiary Record
- Dr. Igoumenou co-authored the Hospital Report dated October 9, 2025, Exhibit 1, and testified on behalf of the hospital. No further evidence was adduced at the hearing.
Background
Mr. Burke’s personal and psychiatric history, including the details of his mental disorder and treatment since being found NCR, are described in detail in the Hospital Report. Briefly, Mr. Burke is 32 years of age, single with one son who resides with his mother. He has no unsupervised contact with him. Mr. Burke lives in the community independently in a housing unit provided by the Canadian Mental Health Association (“CMHA”). The housing is unstaffed. He is supported by the Forensic Supportive Housing Program (“FSHP”) and Dr. Igoumenou, who became his community psychiatrist in December 2024. Mr. Burke is unemployed and financially supported by Ontario Disability Support Program (“ODSP”). He is deemed incapable of consenting to psychiatric treatment.1 However, he is capable of managing his personal property.
Mr. Burke was discharged to the community and his current residence in February 2021. Since that time there have been multiple positive urine drug screens for cannabis and cocaine, including the reporting period. He has been readmitted to hospital from August 4 to November 2, 2023, and from June 1 to June 7, 2024, due to reemergence of psychotic symptoms, substance use and with his forensic psychiatric team.
Mr. Burke’s current diagnoses are schizophrenia, cannabis use disorder, moderate severity, possible stimulant use disorder and antisocial personality disorder.
The circumstances surrounding the index offences are reproduced from last year’s Reasons for Disposition:
In February of 2017, Victim#1 and Mr. Burke were in the victim’s apartment consuming alcohol. They got into an argument. Mr. Burke grabbed a cooler jug and hit the victim on the head. Victim#1 started bleeding profusely. She managed to escape the apartment and proceeded toward the building lobby.
Mr. Burke, while following Victim#1, bumped into Victim#2, and threatened to hit her with the same water jug. Victim#2 started to run away from Mr. Burke while he was swinging the water jug, in an effort to hit her.
Police were called and attended. It came to light that Mr. Burke had previously been convicted of Assault x2 and Fail to Comply Recognizance x3 and was on probation with conditions to keep the peace and be of good behaviour.
The next month Mr. Burke entered a retail establishment and began following employees around the store. At one point, Victim#3 asked him if he needed any help. He stood and stared, then got angry and told her, “If I catch you outside, I will knock you out.” The victim called mall security who escorted Mr. Burke off mall property and banned him from the mall for three years.
A few days later, despite being banned from the mall, Mr. Burke again entered the same establishment and started stomping around in a rage. Two employees remembered Mr.
Burke and when approached, he became angry and said, “You don’t think I know you called security on me. If I see you outside here, I will drag you by the hair.” Again, mall security was called, and arrested Mr. Burke. Security staff believed that Mr. Burke was suffering from a mental illness.
Police attended the scene and took over the arrest. Officers determined that Mr. Burke was on probation. Once at the station, Mr. Burke was evasive and was not answering questions, stating that he “treats people how they treat him and worse.” He started talking about unrelated topics and displayed “disorganized thinking.”
Course Since Last Annual Review
Mr. Burke remained on a detention order while living in the community. Dr. Igoumenou became Mr. Burke’s psychiatrist in December 2024. It has taken some time to develop a therapeutic relationship with him. He is guarded and not forthcoming. Initially he presented as irritable, but his demeanor has improved over time. Over the course of the reporting period Mr. Burke met with his FSPH case manager once per week until August, when his reporting was reduced to once every two weeks. He met with Dr. Igoumenou once every four weeks. She confirmed that Mr. Burke was often late and missed some appointments. He frequently changed the time or meeting location with short or no notice.
In the spring Mr. Burke’s medication was changed from a monthly injection of paliperidone to aripiprazole to alleviate some negative side effects. There have been no issues with Mr. Burke’s compliance with medication.
The primary issue in treating Mr. Burke and preparing him for reintegration in the community absent the oversight of the Board remains his lack of insight into his need for medication and his substance use disorder. According to the Hospital Report he became irritable and elevated particularly when discussing the topics of medication and substance use. Mr. Burke’s insight into his mental illness and the necessity of medication varied. At times he acknowledged experiencing symptoms and believed that the medication alleviated his psychotic symptoms. Alternatively, he said his symptoms were intermittent and that medication was unnecessary when he was asymptomatic. He also expressed that he does not suffer from a psychiatric illness, does not require medication, and only takes it because he ordered to do so.
As noted in the Hospital Report, Mr. Burke tested positive for cannabis and cocaine consistently over the reporting period. Through September 19, 37 screens were positive for cannabis and were either positive or had traces of cocaine. Mr. Burke confirmed his use of cannabis but denied using cocaine. He reported using cannabis because of the stress of being under the Board’s supervision and not being able to see his son. Dr. Igoumenou confirmed that Mr. Burke’s use of cannabis and cocaine is likely having a major influence with respect to his ongoing psychotic symptomatology.
Unfortunately, Mr. Burke is dismissive of the teams concerns about his substance use. He has refused to engage in therapeutic programming for substance use and harm reduction approaches. Moreover, he is not interested in abstaining from the use of recreational substances at this time.
The treatment team’s concerns with Mr. Burke’s insight and noncompliance are summarized in the Hospital Report:
“Mr. Burke’s remains with limited insight into his psychotic disorder and the risks of substance use. He also has a tendency to minimize his potential for violence when unwell. In addition, Mr. Burke has a history of treatment and supervision noncompliance. Though he has been compliant with pharmacological treatment over the course of the past year, he has repeatedly requested medication dose reductions and changes. He has also refused to modify his substance use. His compliance with supervision requirements has fluctuated, and he has presented late, asked to reschedule, and missed appointments with his forensic team. He has also repeatedly requested to reduce his reporting. When unwell in the past, Mr. Burke has fallen away from psychiatric services and has been unwilling to seek assessment and treatment.”
While there have been no observed or reported critical incidents or occurrences of either physical or verbal aggression and no hospital readmissions over the past year the treatment team is unanimous in its opinion that Mr. Burke remains a significant threat to the safety of the public and a detention order is both necessary and appropriate to manage his risks.
According to the Hospital Report, Mr. Burke’s static violence risk profile, and ongoing dynamic risk variables it is necessary for the hospital to be able to approve his accommodations to appropriately address his supervision and support needs and minimize his exposure to destabilizers. Furthermore, Dr. Igoumenou confirmed that the if Mr. Burke’s mental state deteriorates while he is in the community, or he becomes non-adherent to treatment, the team requires the ability to intervene quickly and return him to hospital.
Dr Igoumenou cited the situation that arose in June 2024 when Mr. Burke was readmitted to hospital due to his ongoing substance use, emergence of psychotic symptoms and reduced engagement with the treatment team. On that occasion, while under a detention disposition, Mr. Burke did not show up for a scheduled appointment. Furthermore, he did not fill a prescription for his antipsychotic medication. Upon being informed by his treating psychiatrist that she was initiating a readmission to hospital to assess his mental; status he protested. He was advised to present to CAMH’s emergency department otherwise the police would be notified to pick him up. Mr. Burke did not attend the emergency department until four days later.
In response to Mr. Burke’s request for a conditional discharge Dr. Igoumenou explained that he is not ready, and the hospital would be unable to manage the risks associated with his mental illness in the community absent a detention order.
In Dr. Igoumenou’s opinion if Mr. Burke was discharged on conditions and he became unwell he would not return to hospital voluntarily. The treatment team needs to act quickly and readmit him to hospital when his psychotic symptoms. His symptoms fluctuate considerably, and the provisions of the Mental Health Act would be insufficient to assess and address his needs in the event of a deterioration in his mental status. Nor is Mr. Burke agreeable to a treatment order, which would require not only medication compliance but scheduled reporting and psychotherapeutic programming as a condition of his discharge.
Furthermore, the team needs to approve Mr. Burke’s housing. He is already under stress due to the conditions at his current residence; contamination with cockroaches, occasional flooding, open substance use and his vulnerability to the same. Moreover, he cannot be relied upon to make wise decisions with respect to appropriate housing. Dr. Igoumenou expressed that it is only as a result of the terms of the current detention disposition, and the treatment team’s quick response to changes in Mr. Burke’s mental state that has allowed him to remain in the community thus far.
Mr. Burke has requested that he be permitted to travel to Jamaica with his father for a period of two weeks. Mr. Burke’s current Disposition provides for such travel. if approved by the person in charge. Dr. Igoumenou expressed that the treatment team is open to considering Mr. Burke’s request provided that he presents a detailed travel plan, arrangements can be made to assess his mental status while he is in Jamaica and provide treatment if necessary, and that he demonstrates through a sustained period of abstinence that he is capable of managing his risk of relapse into substance use while he is away. Dr. Igoumenou also expressed in that in the interim there is standing offer to provide Mr. Burke with either one to one or group therapy to address his substance use issues. What is required is that Mr. Burke motivate himself to embrace change in his behavior and avail himself of the support on offer.
Analysis and Conclusions
Having considered all of the evidence and the submissions presented by the parties the Board finds that Mr. Burke continues to pose a significant threat to the safety of the public. We decline to order that Mr. Burke be granted a conditional discharge. Rather, his care should continue on the same terms as his current Disposition.
We accept Dr. Igoumenou’s uncontroverted evidence that the Mental Health Act is insufficient to manage Mr. Burke’s risks given his current mental status.
Mr. Burke’s continuing use of substances is troubling and clearly presents an obstacle to his ability to progress with steps to fully reintegrate him in the community absent the Board’s supervision. Finding the motivation and the courage to address his substance use disorder is critical. The treatment team is ready and willing to support him when he is ready to engage. However, Mr. Burke needs to take the first step in recognizing that he has a problem and committing himself to address it. As Dr. Igoumenou stated, at present Mr. Burke is stuck and unable to move forward with the task of managing the risks associated with his mental disorders. The team is hopeful however that he will come around and accept their advice and recommendations even if that requires his consent to attend a residential detoxification and rehabilitation treatment program. We urge Mr. Burke to embrace his treatment team’s recommendations and open offer of support.
In coming to these conclusions, the Board has considered its responsibility pursuant to s. 672.54 of the Code to make a disposition that is necessary and appropriate in the circumstances, taking in to account the safety of the public, which is the paramount consideration, the mental condition of the accused, his reintegration into society, and his other needs.
DATED this 3rd day of February, 2026, at the City of Toronto, in the Toronto Region.
Mr. B. Garrow
Alternate Chairperson
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Office of the Registrar
Ontario Review Board