Re: Elias Silver
ORB File No: 8320
Hearing held on: Thursday, October 30, 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: Ms. J. Ferguson Dr. R. Sheppard Dr. L. O. Lightfoot Mr. S. Duffy
Parties Appearing:
Accused: Elias Silver Counsel: Ms. M. Addie
The person in charge of hospital: Counsel: Mr. D. Blumenkrans
Attorney General of Ontario: Counsel: Mr. Mushlian
REASONS FOR DISPOSITION
(Dated March 11, 2026)
Introduction
[1]. On June 8, 2023, Elias Silver was found not criminally responsible by reason of mental disorder on charges of assault, obstruct a peace officer, robbery, and sexual interference. The Court directed that Mr. Silver be detained at the Centre for Addiction and Mental Health (“CAMH”) pending an ORB Disposition hearing.
[2]. On Thursday, October 30, 2025, the Ontario Review Board convened his annual hearing. The hospital was represented by Mr. D. Blumenkrans; the Attorney General by Mr. R. Mushlian. The accused was present, represented by his counsel, Ms. M. Addie.
Position of the Parties
[3]. At the outset of the hearing, the parties were canvassed as to their recommendations to the Board.
[4]. Mr. Blumenkrans submitted that Mr. Silver continues to represent a significant threat to the safety of the public and that the necessary and appropriate Disposition was a continuation of the current Detention Order with the same conditions.
[5]. Mr. Mushlian supported the position of the hospital.
[6]. Ms. Addie conceded the issue of significant threat and agreed with the hospital as to the appropriate disposition. Therefore, the parties made a joint submission to the Board.
Index Offence
[7]. “Re: Assault and Obstruct Peace Officer on December 31, 2021:
“On Friday December 31st, 2021, the victim was out front of the Denny’s restaurant located at 121 Dundas Street West in the City of Toronto. Without provocation, the accused approached the victim and assaulted him by punching him in the right face using his right closed fist.
The victim flagged down police and reported the incident. The accused was located nearby, placed under arrest and read his rights to counsel. However, he wilfully obstructed PC ZAMMIT #11623 by not identifying himself. As a result, the accused was transported to 52 Division. Upon being fingerprinted, the accused was positively identified as Elias SILVER. He is being held for show cause hearing.
“Regarding an offence of Robbery on April 28, 2022:
On Thursday April 28th, 2022, at approximately 2:37 pm, the female victim was working her shift at the Convenience Store located at 6007 Yonge Street in Toronto. At this time, the accused entered the store. The victim recognized him from a prior incident when the same male entered the store and stole a lighter. She told him not to return at that time. On this occasion, the accused ignored the female’s pleas to leave and selected a can of juice from the store and left to drink the juice. He returned almost immediately, and the female stood in his way to prevent him taking further items. The accused pushed the victim out of the way, selected various merchandise and also went behind the counter and stole a quantity of cigarettes. The accused then left the store, and the female locked the door and notified police. Officers attended and spoke to the female who was shaken up but declined medical attention. The incident was captured on store surveillance. The juice box discarded by the accused was seized as evidence. Officers from 32 Division viewed the barefaced images and made attempts to locate the accused.
“On the 30th of April 2022, the accused was observed by uniform officers in 32 Division. The accused was placed under arrest for robbery, given his Rights to Counsel and transported to 32 Division for further investigation. The green bandana worn by the suspect during the time of his arrest matched the one worn by him during the incident on the 28th of April 2022, and was subsequently seized. The accused was charged accordingly and held for a Show Cause Hearing.
PROPERTY STOLEN: 1 Lighter, 1 can of juice, 1 chocolate and 1 pack of Du Maurier cigarettes – Approximate Total - $26.90
“Re: Sexual Assault on June 24, 2022:
On Thursday June 23, 2022, the 14-year-old victim and 13-year-old witness, [AW], were travelling WIB on the Bloor Street Subway. They were in the process of transferring to a northbound train at the Yonge/Bloor station located at 20 Bloor Street East in the City of Toronto when they noticed the accused following them. At this time the accused reached out and grabbed the victim's buttocks squeezing as he did so. The victim immediately screamed "he sexually assaulted me!" alerting other patrons of the subway who intervened. The accused was held pending the arrival of Police.”
Evidence at the Hearing
[8]. The evidence at the hearing consisted of the Revised Notice of Hearing dated September 10, 2025, the most recent disposition dated December 12, 2024, Reasons for the most recent disposition dated January 2, 2025, the Hospital Report dated October 3, 2025, and the viva voce evidence of Dr. Liu, Mr. Silver’s treating psychiatrist. The evidence confirmed that Mr. Silver’s diagnoses are Schizophrenia, Possible Cannabis Use Disorder, and Possible Antisocial Personality Disorder.
[9]. The Hospital Report contained the following evidence with respect to the reporting year, which was confirmed by Dr. Liu:
“Over the year, Mr. Silver remained on FSUA. Although this was a relatively uneventful year for Mr. Silver, he went ULOA again on March 5, 2025 (see below). Clinically, his mental condition was stable, i.e., with residual symptoms of schizophrenia but he did not present with psychomotor activation, agitation, or physical aggression. He was not considered at an acute heightened risk of causing harms to others and there was no use of chemical/mechanical restraints or locked seclusion.
“At the beginning of the year, Mr. Silver exhibited extended clinical stability and compliance behaviours. His mental condition remained stable. Although he occasionally endorsed his previous delusions, he did not show any emotional/behavioural reactions towards them. He asserted that they were no longer relevant to his current legal situation and there was no point dwelling over them. His insight remained partial at best - he occasionally, especially when he was anxious or upset about something, mentioned that he believed his past delusional experiences were side effects caused by excessive use of antipsychotic medications. Such residual symptoms and lack of insight did not affect his day-to-day interactions with people or compliance behaviours to unit rules and medications. He actively participated in programs and activities along the ORB pathway.
“Mr. Silver was able to make progress on the privilege ladder after he restarted his passes and reached Level 6 (independently supervised passes to HGA and accompanied passes to the community) without delay on January 27, 2025. He was able to exercise IS passes without issues and hence was considered suitable for transfer to a general forensic unit. The transfer request was reviewed and approved by the Hospital on February 10, 2025.
“Mr. Silver was thrilled when he knew that he would be transferred soon. Although he continued to complain that he was being overly medicated and asserted that his past psychosis was caused by excess of medications, he remained compliant with medications and unit rules. He continued to exercise level 6 passes without issues for the next 2 weeks. He was cooperative with UDS and the results came back all negative.
“On February 26, 2025, without any change in his medications, routines and programs, Mr. Silver suddenly accused staff of making inappropriate comments about him. There were no discernible events that would substantiate his account of what happened. He continued to assert that the inconsistency of his report of events was caused by over-medication.
“On February 27, 2025, Mr. Silver went on his IS passes and returned without issues. Afterwards, he suddenly stopped talking with staff and communicated only through writing. He passed on slips of paper to staff indicating that he requested absolute discharge, some of them with threatening contents. Despite the changes, he remained complaint with his medications and was described to be generally calm as his usual self.
“As similar unprovoked shutdowns in communication happened before, likely when he felt stressed and unhappy about something, his passes were put on hold; he was advised of the concerns and potential consequences that his privilege might be restricted since the AWOL risk could not be properly assessed. Despite repeated encouragement and explanation about the importance of communication for proper risk assessment, he remained mute; he avoided eye contacts with restricted affect. He spent his days pacing up and down the unit without interactions with staff or co-patients. His passes were put on hold and he was aware that his passes could only be reinstated if he resumed proper communication with staff. He remained mute for the next 4 days and only started talking with staff to demand that his IS passes be reinstated immediately. When explained that he needed to start from supervised passes, he was unhappy and became mute again.
“This episode of communication breakdown continued for 7 days. He did not show overt change in other spheres. He was not overtly hostile or agitated. He continued to pass on letters to indicate what he wanted. He declined all invitations to discuss or review his passes and privileges.
“On March 5, 2025, Mr. Silver attended the team review and started talking. He did not explain why he refused to talk but stated that he had recovered and could live with being overly medicated. He spontaneously mentioned that he needed to demonstrate compliance and denied plans for ULOA. He stated that with his commitment and reassurance, he should have his IS passes back immediately. He pledged that he would not go ULOA and emphasized that he had been patient enough to refrain from ULOA. When told that he needed to start from supervised passes as start, he was frustrated and asked for “the real MRP’ to sign off the pass orders. He was upset but was assessed not to present with acute behavior dysregulation. The team decided that he could be tried on accompanied passes. In the afternoon, he was cooperative with the pre-pass assessment and went out on passes. He then ran away from staff once they got to the community. 911 was called and he was brought back to the hospital in less than an hour.
After returning to the unit, he did not show overt agitation or a threatening attitude. Nevertheless, he became mute again. Despite repeated attempts, he continued to be silent and only communicated through written messages. He did not talk about the reason why he went ULOA.
“Mr. Silver remained mute for the following 2 months and only communicated through writing for requesting his basic needs. He did not express specific thought contents sufficient for the team to understand the reason for his ULOA. However, he did not exhibit significant change in his level of general compliance of unit rules and medications. He was consistently observed to be calm and keeping to himself, with occasional self-laughing. There was no psychomotor activation, agitation or irritability; the DASA scores had been consistently 0. There were no immediate safety or management concerns. Despite the team’s daily attempt to communicate and assessment, he declined the assessments. His passes thus remained on hold.
“At the beginning of May 2025, Mr. Silver called and wrote to patient advocate. When the patient advocate visited him, he refused to talk with her. He pretended not to hear her. His mutism was generalized. He did not talk with anyone and adopted the same strategy of avoiding engagement.
“His mutism continued until May 16 when he started asking to meet with the MRP and team. He was able to be better engaged. He explained that he had been feeling tired and was afraid he might not answer questions properly—that’s the reason why he preferred to remain silent and communicate via writing. He pledged to cooperate with his assessments and follow the ORB condition. As a result, his passes were resumed and increased stepwise without further incidents.
Before the ULOA, Mr. Silver had repeatedly asked his aripiprazole Maintena LAI be switched back to oral due to local pain and had asserted that the nature of his mental illness was medication induced psychosis. His medication was switched back to aripiprazole 30 mg oral on May 23, 2025, to accommodate his needs.
“Subsequently, Mr. Silver resumed his participation in programs and activities and no longer complained of side effects or ask to change the dosage of medications. Still, he was hesitant to talk about why he often changed his attitude suddenly. He did not want to talk more about his previous psychotic experiences or their impacts on his decision making and behaviours. He did not think he should be fully responsible for his previous ULOA but agreed that he should not have violate the ORB conditions.
“Mr. Silver’s general demeanor and compliance to unit rules and medications were well maintained; his participation in programs and activities remained active and appropriate. There were no further concerns for safety or management issues. He progressed gradually through the privilege ladder. At the time of the report, he regained supervised passes to the community without issues.
“Mr. Silver also repeatedly asserted that he understood that he was under the auspices of ORB and he needed to abide by the ORB conditions. He asserted that he wanted to follow the ORB pathway to move on to a general unit and then get discharged. He continued to avoid or minimize the impacts of previous psychotic experiences on his behavioural and judgment. He pledged to be complaint with prescribed medications. He agreed that he should take mediations as long as they were considered clinically necessary.
“Physical Health
“Mr. Silver does not have significant physical health issues during the reporting period.
“Program/Activity Participation
“Overall, over the year, Mr. Silver actively participated in a variety of therapeutic and recreation-based programs, except during the 2 months period when he was mute. The activities included on-unit recreation and various Therapeutic Neighbourhood (TN) programs. He valued being able to get off the unit to attend programs, and reported that it helped him fill his time and he could positively reflect on programs he enjoyed and why. However, he often still reported feeling bored, or that his medication side effects were a barrier to participating in programs.
Mr. Silver regularly participated in a variety of therapeutic and recreation-based programs. He attended on-unit recreation participation activities including yard regularly and he attended many of the TN programs offered. In the review period, he had attended 40+ programs on and off unit. He started with 4 programs and increasing this to attending over 20+ different programs this year at the TN, engaging in a variety of programs from CBT to social programs.
In group settings he could keep to himself, or be engaged in discussions. Mr. Silver’s response to programming remained appropriate and active. He could follow the topics and processes. There was no evidence that his participation was interrupted by thought disorders or delusions. Mr. Silver’s response to programming progressed to being positive for him, and he engaged well in the group setting, and was interactive with staff. Previous issues of difficulty interrupting the group excessively to talk about his thoughts about the forensic system, medication and other delusional content, decreased. He always was polite and aware of others in programs, but was not aware of how others did not want to repeatedly hear about his ruminations.
“Mr. Silver was agreeable to meeting 1:1 to discuss concerns and was working though the Risk and Recovery program material. He did better to talk about these topics in private session, versus a group. When meeting he was very communicative and engaged in these 1:1 discussions.
“While using community passes and recreation activities in the community, he was not a management issue and followed staff’s direction and was respectful of others in the community. He attended outings to the mall, for shopping and lunch. He managed TTC (streetcar) there and back, without issue. He was quiet and calm in the community and polite to others. He was looking forward to starting his passes to the community soon.
“In August and September of 2024, Elias attended Start Now, a Pillar 4 program intended for individuals with problem behaviours. The program addresses impulsive decision making and draws on CBT, DBT, Motivational Interviewing, and the Neurocognitive-Modifications of the Clinical Approach. During these sessions, he was an active participant and shared how the content applied to him. However, he occasionally made delusional statements that demonstrated a lack of insight. For example, on September 19, 2024, he described how he was resurrected from the dead and that this resurrection was proof that he did not have a mental illness.
“On January 30, 2025, Mr. Silver was agreeable to completing the Contemplation Ladder, an outcome measure used in forensic substance use programming. He selected the following statement as best representing his situation: “I have changed my substance use and will never go back to the way I was before.” He also selected “Not important” when asked “How important is it for you to change your substance use?”
“Mr. Silver participated in the unit cooking group on two occasions. This group provides opportunities for patients to improve their cooking skills, explore different foods, and socialize with co-patients. Elias completed both the pre-group and post-group measures. The measures include a scale of 1 to 10, with 1 being indicative of low importance, confidence, satisfaction, and connection, and 10 being indicative of high.
“Mr. Silver agreed to take on the role of canteen operator on the unit. He could do the job and interacted with clients appropriately. He was able to stay focused throughout the entire shift and was meticulous about carrying out the details. Although he was a little ambivalent whether he should do it full time, he agreed to help as substitute when others need help.
“Concerning Behaviour
“Other than the ULOA incidents, there were no major concerning behaviours over the year. Mr. Silver did not show significant psychomotor activation or agitation. He no longer protested about being in hospital or taking the medications against his will. He was not hostile, directly threatening or intimidating. He maintained good behavioural control and was generally rule-abiding, even when mute. There were no behavioural incidents that require physical intervention, chemical/mechanical restraint or locked seclusion.
“As mentioned above, the only behavioural incident was his ULOA in March 2025. He ran off from CAMH during accompanied passes and was brought back within 1 hour. He was cooperative and did not resist. After returning to the unit, he did not show changes in mental and behavioural manifestations. His scores on Dynamic Appraisal of Situational Aggression (DASA) scale were mostly 0.
“Passes
Before the ULOA, Mr. Silver had progressed to Level 6 passes, which allowed him to have indirectly supervised passes to the HGA. Mr. Silver had always been appropriate and cooperative during escorted and accompanied passes off the unit. There had been no major rules violation or concerns until the ULOA. As a result of ULOA, his transfer to general forensic unit was cancelled due to the ULOA and he resumed his passes from Level 1 in May 2025 and had slowly progress to the current Level 3 (Supervised community passes).
“Drugs or Alcohol
Mr. Silver no longer spontaneously mentions that his psychosis is induced by the use of psychotropic medications or he needs medical marihuana. He does understand that the current ORB disposition doesn’t allow the use of cannabis and he pledges to abide by the conditions. When he had higher level of passes, he had been receiving regular random urine drug screening and tests of illicit substances and alcohol all turned out negative.
“Current Medication
Aripiprazole 30 mg per day
Paliperidone 3 mg per day
“Composite Assessment of Risk and Re-offence Scenario
“When psychiatrically unwell, Mr. Silver has been disorganized, paranoid, and delusional. He has behaved aggressively, incurred legal charges, engaged in assaultive behaviour while in hospital, and has been sexually aggressive. His problematic behaviours have tended to occur in the context of his mental illness, though there have been times when his behaviours appeared to stem from pathological personality traits, as opposed to psychosis. He remains with only partial insight into his mental illness but has significant improvements in terms of his understanding and compliance of his obligations under ORB after his psychotic symptoms are further attenuated after optimization of antipsychotic symptoms. This has been very helpful for Mr. Sliver to benefit from formal psychoeducational programming. Still, Mr. Silver’s insight is relatively wanting and compliance in the community has been doubtful. When not supervised under the auspices of the ORB, remains at risk of decompensation, particularly in the context of non-compliance with medication and/or substance use. It is the team’s unanimous opinion that Mr. Silver continues to represent a significant risk to the safety of the public absent close ORB supervision.
In risk assessment, one of the best predictors is a patient’s history of violence. Mr. Silver was found NCR for violent and sexual offences, which occurred in the context of poorly controlled psychotic symptoms.
“Mr. Silver has been on antipsychotic medications since his admission to CAMH in January 2023, with a reduction in psychotic symptoms. However, he remains with limited insight into his illness and does not wish to be on medication. His compliance is passive at best. Absent a Detention Order, given his current lack of insight and long history of medication non-compliance, he would highly likely stop his medication, which would result in a worsening of psychotic symptoms. He would also not engage in psychiatric services and may return to cannabis use, further exacerbating psychosis. This would likely lead to physical or sexual violence, against strangers or individuals involved in his psychiatric care (if hospitalized), as has occurred in the past.”
[10]. In addition to the documentary evidence, the Board heard from Dr. Shi-Kai Liu who authored the Hospital Report. Dr. Liu has been Mr. Silver’s attending psychiatrist for this past clinical year.
[11]. Mr. Silver has been residing at CAMH in a secure unit for the past reporting year.
[12]. Dr. Liu testified that there are no updates in the past month since the Hospital Report was prepared. Dr. Liu reminded the Board that Mr. Silver had a previous NCR finding in 2007 and is back under the auspices of the Board for the second time.
[13]. Dr. Liu testified that over the past reporting year, Mr. Silver has generally been compliant with hospital rules and the conditions set out in the current disposition. In the upcoming year, provided Mr. Silver remains compliant, the hospital will increase his pass level. Dr. Liu testified that he expects Mr. Silver to make progress over the coming year and be transferred to the general unit where the general team would look at next steps including community living. Dr. Liu testified that at present Mr. Silver still needs time to show self control and gain greater understanding of his situation. However, the hospital is seeking to continue to have community living option in Mr. Silver’s disposition.
[14]. Dr. Liu testified that when Mr. Silver becomes nervous, he becomes overwhelmed which led to an ULOA event in early 2025 which led to Mr. Silver’s transfer back to a secure unit.
[15]. Dr. Liu testified that the factors which support a conclusion that Mr. Silver remains a significant threat include a history of noncompliance, that this is his second tenure with the ORB, the first being for the period of 2010 to 2013. Mr. Silver then suffered a major decompensation in 2019 which led to repeated hospitalizations. Dr. Liu testified that when in the community under community treatment program, Mr. Silver did not comply with his treatment which resulted in an unstable living environment, homelessness and then readmission to hospital. Dr. Liu expressed concern about possible noncompliance if Mr. Silver is not in hospital given that when Mr. Silver is not in hospital and not properly treated, he becomes non-compliant which causes him to become paranoid, to exhibit erratic beahviour and suffer thought disorganization resulting in impulsive, erratic and reckless and volatile behaviour which could hurt other people.
[16]. Dr. Liu commended Mr. Silver for his hard work over the reporting year during which he has responded to treatment and generally followed the rules and that as a result, the combination of medication compliance and a stable living environment have led to clinical stability and an improvement in Mr. Silver’s symptoms.
[17]. Dr. Liu testified that Mr. Silver’s medications were changed from injectable to oral to try to alleviate the longstanding problem of the side effects of the injectable medication and that Mr. Silver prefers a higher oral dose to the injectable medication. Dr. Liu confirmed that when Mr. Silver is ready to be moved into the community, whether he is taking oral medication of receiving injections won’t matter.
[18]. No further evidence was presented.
Analysis and Conclusion
[19]. The Board finds that Mr. Silver remains a significant threat to public safety. This issue was not disputed at this hearing.
[20]. The Board is also of the unanimous opinion that Mr. Silver’s Disposition be a continuation of the current Detention Order pursuant to the same conditions as in the current Disposition. This will continue to allow the hospital to have great discretion in managing Mr. Silver’s care and ensure he is receiving the care needed as well as appropriate access into the community and eventually on to community housing. The evidence before us, which was not challenged, leads us to the conclusion that this Disposition is necessary and appropriate and is the least restrictive and onerous Disposition available to manage Mr. Silver’s risk to the safety of the public.
[21]. Mr. Silver continues to be a significant threat to the safety of the public because notwithstanding his antipsychotic treatment with medication, his symptoms are not completely alleviated, and he has shown only limited insight into his condition and does not want to be on medication for his mental illness. Without close supervision by his treatment team, he would likely become non-compliant and use cannabis, which would result in a worsening of his psychotic symptoms which would likely lead to physical or sexual violence against others.
[22]. Mr. Silver has been making progress, and the Board commends his efforts and wishes him a successful reporting year ahead.
[23]. In arriving at our conclusion, the Board has carefully considered the evidence, and, particularly, the paramount factor of the safety of the public. We have also considered Mr. Silver’s mental condition, his community reintegration, and his other needs, all as required by s. 672.54 of the Code.
DATED this 11th day of March, 2026, at the City of Toronto, in the Region of Toronto.
Ms. J. Ferguson Legal Member
Office of the Registrar Ontario Review Board