Re: Martin Hall
ORB File No: 4381
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: Dr. B. Sheppard
Dr. L.O. Lightfoot
Ms. J. Ferguson
Mr. S. Duffy
Parties Appearing:
Accused: Martin Hall
Counsel: Ms. L. Leinveer
The Person in charge of Hospital: Counsel: Mr. D. Blumenkrans
Attorney General of Ontario: Counsel: Mr. R. Mushlian
REASONS FOR DISPOSITION
(Dated February 4, 2026)
Reasons of the Majority
(Ms. J. Ferguson, Dr. R. Sheppard, Dr. L.O. Lightfoot, Mr. S. Duffy)
Introduction:
On January 20, 2006, Martin Hall was found not criminally responsible on account of mental disorder (“NCR”) on charges of assault, and carrying a concealed weapon, all contrary to the Criminal Code of Canada (“Criminal Code”). Mr. Hall is currently subject to a Disposition of the Ontario Review Board (“ORB” or the "Board") dated October 7, 2024, which detains Mr. Hall on a General Forensic unit of the Centre for Addiction and Mental Health (“CAMH” or the “hospital”). This Disposition provides Mr. Hall with a variety of discretionary privileges up to and including the privilege of living in the community of the Greater Toronto Area in supervised accommodation approved by the person in charge of the hospital.
On October 30, 2025, a panel of the ORB convened to hold a hearing to conduct an annual review of Mr. Hall’s existing Disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. Hall was present at the hearing and was represented by his counsel, Ms. Leinveer.
The issues to be considered at this hearing are whether Mr. Hall is a significant threat to public safety as now defined in s. 672.5401 of the Criminal Code and, if he is found to be a significant risk to the community, the determination of the necessary and appropriate disposition in the circumstances bearing in mind the factors enunciated in s. 672.54 of the Criminal Code.
For the reasons set out below, the decision of the majority of this Board is that Mr. Hall continues to pose a significant threat to public safety. It is our view that the necessary and appropriate Disposition and the least restrictive option in the circumstances is that Mr. Hall be detained at CAMH on the same terms and conditions as are set forth in the current Disposition, amended to restore the prohibition against the use of cannabis, and remove the no contact provision.
Index Offences:
- The circumstances giving rise to the index offences are extracted from the Hospital Report to the ORB dated August 9, 2024 (the “Hospital Report”), as follows:
"Police reports indicated that on October 6, 2005, Mr. Hall attended a show at The Government nightclub with the victim of the offence. Following the show, Mr. Hall asked the victim to accompany him, as he wanted to speak with him. The victim accompanied Mr. Hall to a place underneath the Gardiner Expressway, where there was a wall with a hole in it. Mr. Hall requested that the victim look in the hole and told him that, “his fraternity brothers had killed a girl and hid her body in there”. The victim reportedly refused to look in the hole and attempted to leave. As he started to leave, Mr. Hall punched him in the face repeatedly, which caused the victim’s nose to bleed and jaw pain. Mr. Hall subsequently fled the scene and the victim later met with friends. Later in the evening, the victim reportedly located Mr. Hall on the street and called the police. When the officers arrived, they searched Mr. Hall and found a pellet handgun in his jacket pocket. When his knapsack was subsequently searched, a large, fifteen-inch knife, two smaller knives, a hammer, a steel bar, and a small propane torch were also discovered. Mr. Hall and the victim were known to one another as friends. Once charged, Mr. Hall was released on bail conditions."
Background and Personal History:
Mr. Hall’s personal background, mental health history, criminal history, and course in the hospital subsequent to their arrest and NCR finding are set out in considerable detail in the Hospital Report which was entered as an Exhibit at the hearing and need not be repeated here. Briefly stated, Mr. Hall was 41 years old at the hearing date, having been born in August 1983, the youngest of three children.
He did not complete high school, having failed three of five years spent in three different schools.
Mr. Hall has reported that he began drinking alcohol when he was 16. After leaving high school, he started using drugs regularly, including cannabis, which became a daily habit for some years. While under the jurisdiction of the Board, Mr. Hall has used alcohol and substances of abuse, primarily cannabis and cocaine. At times, his drug use has compromised his mental state and resulted in his re-hospitalization.
After leaving school, Mr. Hall was employed in various sales positions but had difficulties (including poor attendance) and was fired on a number of occasions.
In 2003-2004, when he was 21 years old, he attended Ryerson University. He subsequently transferred to the University of Toronto and completed his first year of undergraduate studies at U of T, but due to a period of deterioration in his mental health in the fall of 2011, his second year was interrupted. He moved to part-time studies and then withdrew from the program.
Criminal History:
- Prior to the commission of the index offences, Mr. Hall did not have any criminal history.
Psychiatric History:
Mr. Hall had a history of psychiatric contacts prior to the commission of the index offences. At 16, he was diagnosed with bipolar disorder and ADHD. The doctor also suspected that he suffered from a learning disability. He was prescribed medications: the stimulant, Ritalin, the mood stabilizer, Lithium, and an antidepressant. He stopped taking Ritalin after a brief time and stopped taking Lithium a few years later. By the time of the index offences, he had not been taking any psychotropic medications for some time.
In 2004, while attending Ryerson University, Mr. Hall received a psycho-educational assessment by Dr. Margles, and she concluded that he likely suffered from generalized anxiety disorder and that he had indicators of a learning disability.
In the summer of 2005, a few months prior to the index offences, Mr. Hall started experiencing symptoms of psychosis, including paranoid and grandiose delusions. His father informed that his son had been threatening and aggressive towards a young woman, and Mr. Hall had been asked to leave the home where he was staying as he was frightening others there. At the time, Mr. Hall was abusing alcohol and occasionally using cannabis, and his behaviour was described as bizarre.
In the early fall of 2005, Mr. Hall was very depressed and remained in bed for three weeks. In early October 2005 (at the time of the index offences), he was experiencing paranoid delusions. He reported feeling very anxious and terrified for his life in the weeks leading up to the index offences and felt that he needed to carry weapons because a secret society was trying to kill him. He believed that fraternity boys and police were members of this secret society, and eventually that his family were also involved.
Current Diagnoses:
- Mr. Hall’s current diagnoses are:
Schizoaffective Disorder;
Alcohol Use Disorder;
Cocaine Use Disorder
Cannabis Use Disorder; and
Rule out Unspecified Trauma Disorder.
Positions of the Parties:
At the commencement of the hearing, the parties were canvassed as to their recommendations to the Board. Counsel for the hospital submitted that Mr. Hall continued to represent a significant threat to public safety and that the existing Disposition remained necessary and appropriate but sought an amendment restoring the term prohibiting the use of cannabis, which condition had been removed in last year’s disposition but took no position with respect to the “no contact” with the victim clause. Mr. Mushlian for the Attorney General supported the hospital’s recommendation with the exception that he agreed that the no contact clause should be removed. Ms. Leinveer, counsel for Mr. Hall indicated she was seeking an absolute discharge of Mr. Hall, or, in the alternative, a continuation of his current Disposition with the exception that the Board remove the prohibition against contact with the victim of the Index Offence given that the victim has passed away.
All three parties maintained their respective initial recommendations to the Board in closing submissions.
Course Subsequent to NCR Finding:
Following his initial ORB hearing in March 2006, Mr. Hall received a Conditional Discharge Disposition, including conditions requiring him to reside with his father and to abstain from substance use. Within a month, he was admitted to CAMH in a floridly psychotic state. He had been non-adherent with his prescribed medication (as he did not believe he needed the medication) and was using marijuana and cocaine.
He had sent sexually threatening messages to his sister by e-mail and voiced violent intentions toward women, which caused his sister and stepmother to fear for their safety. Initial diagnoses of acute intoxication and substance-induced psychosis were made. Mr. Hall was discharged back to community living in mid-May 2006. Shortly after, he tested positive for cannabis. He also continued to express ambivalence towards medications on several occasions to a variety of clinicians. In view of concerns regarding Mr. Hall's insight, in early 2007, his Disposition was changed to a Detention Disposition.
The year that followed was a challenging one for Mr. Hall, including positive tests for cannabis, non-compliance with his prescribed medications, active attempts to avoid detection and two re-hospitalizations. His Detention Order was continued.
From March 2008 to March 2009, Mr. Hall did not require any hospitalizations. In November 2008, he moved into an independent, supportive and subsidized bachelor apartment operated by HouseLink. He was followed in the community by a CAMH Forensic Outpatient Services (“FOS”) team, with support and supervision varying in intensity depending on treatment and risk management concerns.
In 2009, Mr. Hall’s Disposition was changed to a Conditional Discharge, and he remained in the community until 2014 when he had two hospital readmissions due to increasing use of alcohol and cannabis as well as noncompliance with medication. His Disposition was changed back to a Detention Order in April 2015.
In January and February 2019, Mr. Hall missed a number of appointments with his attending psychiatrist and his case manager, and he became consistently difficult to locate in the community. He also missed his ORB hearing in mid-February. He was re-hospitalized to assess his mental state and functioning, reassess his medications and provide for a period of abstinence from intoxicants. He was discharged back into the community in March 2019 and remained in the community until December 2022. When living in the community during that time frame, he was mostly compliant with his medications and reporting requirements, but he returned to the use of alcohol, cocaine and cannabis.
In the Fall of 2022, housing staff contacted the FOS team due to Mr. Hall’s concerning behaviour. He was often out late and repeatedly disruptive to other co-tenants living at the building by banging on their doors or buzzing their units to be let in. As he had spent much of his monthly ODSP allowance on substances of abuse, he would also request food from his neighbours and was late on his rent payments. Due to these concerns, tenants petitioned to have him evicted, and Mr. Hall was subsequently served a notice of eviction. Due to lack of housing, Mr. Hall was re-admitted to hospital under a Form 49. This readmission was the subject of a Restriction of Liberty hearing in December 2022, where the Board found the readmission to be necessary and appropriate. Mr. Hall has remained an in-patient at the hospital on the Forensic General Unit B (“FGUB”) since his readmission.
Evidence at the Hearing:
Dr. A. Igoumenou, who took over as Mr. Hall’s treating psychiatrist from Dr. Van approximately two weeks before the hearing, testified at the hearing to supplement the information contained in Hospital Report, which was tendered as Exhibit 1 and was written by Dr. Van. Dr. Igoumenou indicated that she had met with Mr. Hall three times in the previous two weeks and that in her clinical opinion he continues to pose a significant threat to the public.
Mr. Hall also gave evidence at the hearing.
With respect to the current reporting year, the Hospital Report set out the following:
“Mental health, insight and concerning behaviours
“As in previous years, Mr. Hall’s mental state continues to fluctuate with periods of instability characterized by increased irritability, pressured speech, suspicion and somatic preoccupation, lasting days to weeks. At other times, Mr. Hall can present as generally calm and more cooperative, without any overt mood abnormalities. He typically denied auditory hallucinations, though at times, had been observed talking to himself. He denied visual hallucinations, or other psychotic symptoms. Mr. Hall frequently asked for medication changes and there were a number of changes made this year. In September 2024, he requested to discontinue aripiprazole injections and was switched to oral aripiprazole. He went back to aripiprazole injections in March 2025. Lurasidone, quetiapine sertraline were all started during the year and then discontinued at his request. Fluoxetine had been discontinued and then restarted in August 2025 at his request. At the time of this report, Mr. Hall remains on aripiprazole monthly injections and fluoxetine.
“Mr. Hall’s insight remains superficial this year. Mr. Hall was aware that he had a diagnosis of schizoaffective disorder with symptoms that could include “mood swings, mania, psychosis, racing thoughts, delusions, paranoia.” However, he reported that the index offence was due to a “bad acid trip and on LSD.” He reported having “minor relapses” during his course under the ORB. He reported his treatment as “Epival, Abilify, Prozac, heart pills” (he was advised that he was no longer on epival). When asked about the consequences of stopping aripiprazole, Mr. Hall said it “depends if [he is] doing drugs, staying up.” He reported that he has not any psychotic episodes in a “long time” and needed a “perfect storm” in order to become psychotic as he felt he was healthy. Regarding the index offence, Mr. Hall explained that he assaulted his friend and said he “tried to coax him” and had weapons on him “intending to torture him.” He said he was paranoid at the time and was “trying to escape the frat house, gather evidence.” When asked about his thoughts about substance use in the future, he said he was “ambivalent” regarding this.
“Mr. Hall has requested to use cannabis throughout the year as cannabis was exempt from his substance abstinence clause in last year’s disposition. However, the CAMH Forensic Service has determined that cannabis use cannot be permitted for inpatients given the risk-enhancing effect on the patient milieu as cannabis use remains a risk factor for the majority of patients with concurrent disorders. Mr. Hall reported that this year he obtained a prescription for cannabis at an external cannabis medical clinic for chronic pain and seizures. However, there was no indication that he had ever had seizures and chronic pain could be managed by other interventions such as physiotherapy. As per CAMH policy, use of cannabis products would need to be prescribed and deemed necessary by physicians at the hospital. There was no medical indication for cannabis at this time.
“In December 2024, Mr. Hall was transferred to a different general forensic unit (FGUA), citing a therapeutic rupture with the clinical team on FGUB. He reported that he felt “marginalized” and spoke about his progress being impeded on FGUB in various ways including blocking his access to housing, not allowing him to have the right medications, staff encouraging him to breech his disposition and concluding that it was a “toxic” environment for him.
“Critical incident: Unauthorized leave of absence May 5 to May 6, 2025. As was the case in the previous reporting period, Mr. Hall had a ULOA during the month of May in 2025. Mr. Hall was signed out on a Level 6, 30-minute recreation/socialization hospital grounds pass on May 5, 2025, at 1 PM. Staff noted that his mental status was at baseline prior to utilization of the pass. When he did not return from pass after 15 minutes, ULOA protocol was initiated. He was not seen on a search of hospital grounds and review of camera footage confirmed that he had gone to the cash office prior to leaving hospital grounds.
“To his credit, Mr. Hall returned to the unit the next day at 2:20 PM. He appeared slightly anxious and was profusely sweating but was cooperative. He denied symptoms of psychosis. He reported being exposed to cockroaches and bed bugs, as such his clothing and shoes were bagged.
“When Mr. Hall was assessed by the psychiatrist, he reported that he had known he was going to abscond two days prior and explained various reasons for this including “frustrations,” having a “bad attitude,” wanting a “reset,” and said that “the pass ladder is so cumbersome.” He reported that he absconded to meet a friend but they did not show up so he went to another friend’s house near Bloor St and Dufferin St. He socialized with this friend and others the whole night. He used crack cocaine, about 2 grams by smoking, and had last used the morning of his return to hospital. He also used cannabis during his ULOA. He denied using alcohol or other drugs. He slept for about 3 hours total. Mr. Hall reported that he planned to abscond and then return when his money ran out. He spent $400 during this time. He reported feeling intoxicated from crack cocaine on his return (and demonstrated some signs of stimulant intoxication including elevated mood, slurred and mildly disorganized speech) but denied hallucinations or paranoia. He was aware of the consequences of his ULOA being placed back to Level 0 on the pass ladder. When asked about triggers (especially given that he absconded in the month of May last year), he could not identify any. Mr. Hall’s subsequent UDS were positive for cannabis and cocaine.”
- The Hospital Report contains the following summary with respect to Mr. Hall’s risk to the public:
“Criminogenic Risk Factors
“The following criminogenic risk factors are important in the understanding of Mr. Hall’s current and future risk:
“A. Major Mental Illness
“Mr. Hall has a major mental illness, schizoaffective disorder. During a psychotic episode, he presents with agitation, increased aggression, racing thoughts, increased psychomotor activity, impulsivity and paranoid delusions. This has resulted in acts of aggression in the past, in particular, the index offence. With his current psychotropic regimen, he has achieved relative control over his symptoms, however there remains cyclic withdrawal and irritability, and the team cannot rule out possible break-through psychosis. Should his psychotic symptoms worsen, they would place him at a significantly higher risk of violence.
“B. Substance Use
“Mr. Hall has a history of polysubstance use, including alcohol, cannabis and crack cocaine. His insight into his use and its impact on his illness is limited and he is pre-contemplative to change. During this reporting period as in his previous reporting period, he went on a ULOA to use substances. Substance use has contributed both directly and indirectly to Mr. Hall’s history of offending behaviour. At times, he has engaged in aggressive or disinhibited behaviours while under the influence of substances, and his use of such agents has precipitated episodes of psychosis and/or mood disturbance. In addition, his substance use has contributed to non-adherence with psychiatric treatment.
“C. Problems with Insight
“Mr. Hall has limited insight into his mental illness and its direct connection to violence. As discussed, he has also exhibited limited insight into the consequences of substance use on his mental health. Mr. Hall has challenges reflecting on his own contributions to setbacks, and has been instead focused on perceived mistreatment by the forensic system.
“A. History of Non-adherence with Treatment and Supervision:
“Mr. Hall has a recent history of non-adherence with psychiatric treatment, as evident when he would miss his outpatient appointments in 2022, and his ULOAs in June 2023, May 2024 and May 2025. Since his admission, he has been agreeable and adherent to psychotropic medications with standard inpatient monitoring in place. He has a history of avoiding mental health professionals including active attempts to avoid detection by adulterating his urine.
“Re-Offence Scenario
“If Mr. Hall were to re-offend, it will likely occur in the context of a relapse into substances, failure to follow up with appropriate psychiatric services, and non-adherence with psychiatric treatment. This would precipitate a psychotic episode, resulting in hallucinations, persecutory delusions, and disorganization, which would lead to aggression towards other individuals in close proximity to him, as evidenced by similar occurrences in his past. At baseline, Mr. Hall has superficial insight into his mental illness, and in a disturbed mental state, his insight would likely be absent into his need for treatment. He would likely evade psychiatric supports during those times, when efforts are made to intervene and offer appropriate care.”
Dr. Igoumenou referred to the Hospital Report at pages 52-54 which sets out that Mr. Hall poses a 48% chance of reoffending within 10 years of opportunity. She testified that the assessment tool used to arrive at this conclusion takes into account both historic and dynamic risk factors and leads her to conclude that with detention, Mr. Hall’s risk of re-offending is low, but under a conditional discharge he would have problems with many issues, including his living situation, adequate support and treatment.
Dr. Igoumenou testified that Mr. Hall has some strong protective factors including empathy but that he needed to work with his coping skills and self-control and that he continues to lack insight into his mental status.
Dr. Igoumenou testified that Mr. Hall had achieved level 6 passes when in May of 2025 he went AWOL for 24 hours before returning on his own and reported he had used crack cocaine and cannabis and felt intoxicated. The treatment team confirmed that Mr. Hall appeared intoxicated and also that he had suffered some decompensation. As a result of having absconded, Mr. Hall’s pass level was reduced to zero. He has not increased his pass level to 3 which allows him to go onto the hospital grounds and into the community with staff members.
Dr. Igoumenou testified that the treatment team was considering community housing for Mr. Hall before he absconded in May 2025, and that they are no longer looking for accommodation for him. In addition, she testified that Mr. Hall has ceased participating in all of his usual activities while awaiting this hearing.
With respect to Mr. Hall’s insight, Dr. Igoumenou testified that he doesn’t agree with his diagnosis but does admit he has a mental disorder. Mr. Hall also doesn’t agree that he has a substance abuse problem although he does admit that while cannabis is not his drug of choice, crack cocaine is. Dr. Igoumenou testified that Mr. Hall believes that cocaine has no relationship to decompensation of his mental health status. Dr. Igoumenou testified that it is difficult to say if there is a link between his use of cannabis and decompensation. While there was decompensation in his mental status after he reportedly used both cannabis and cocaine while ULOA, it is difficult to say which substance caused the decompensation as he had used both.
Dr. Igoumenou pointed out the historical evidence of decompensation of Mr. Hall’s mental state after substance use as set out in the Hospital Report. Dr. Igoumenou also testified that substance use also leads Mr. Hall to fall away from his support systems to non-compliance with taking his medication and to decompensation. In order to minimize his risk to the public, Mr. Hall needs to continue taking his medication and preferably to remain abstinent.
Dr. Igoumenou testified that in her clinical opinion an absolute discharge was not the appropriate disposition and that if granted an absolute discharge, housing would be an issue. She testified that Mr. Hall wants to live with his father who has cancer, and she fears that it would be too much for both Mr. Hall and his father to handle if Mr. Hall resided with his father. Dr. Igoumenou also testified that if Mr. Hall obtained an absolute discharge, he will use substances, lose contact with his mental health services and supports and that, he would not have access to forensic services or the hospital’s programming but will be offered help until he obtains community psychiatric services.
When asked if during the upcoming reporting year Mr. Hall did not abscond and there was no evidence of unpermitted substances, whether that would impact her opinion with respect to the issue of significant threat, Dr. Igoumenou replied that significant threat has to be tested for a longer period of time but, if for next year he doesn’t use unpermitted drugs and takes his medication and moves through pass levels, then that is an important and necessary first step. Dr. Igoumenou testified that Mr. Hall needs the protection of a detention order because if Mr. Hall were to use substances or decompensate, the hospital could bring him in under detention order and would also be able to approve where he lives.
Dr. Igoumenou testified that Mr. Hall’s best and only safe option is a detention order with the ability for the hospital to move him into community living.
Dr. Igoumenou testified that Mr. Hall was last in the community in 2022 before being returned to hospital and that the hospital was working on securing him housing in the community when he went AWOL which stopped that process. Because his pass level went to zero, the hospital is not currently looking for community housing for Mr. Hall.
When asked by Mr. Hall’s counsel if Mr. Hall was under the influence of drugs during the Index Offence, Dr. Igoumenou replied that Mr. Hall self-reported being under the influence of drugs during the Index Offence and that Mr. Hall had been very unwell at that time because of his mental illness.
Dr. Igoumenou confirmed that Mr. Hall takes his medication without incident and that although he has not missed an appointment in some time, this is something that has happened throughout his involvement with psychiatric services including 2000 and 2003 at which times he stopped taking lithium. Dr. Igoumenou testified that, on one occasion when he stopped taking lithium, he indicated he wanted to stop, that he was working and had a relationship and didn’t think he had a problem, and he was helped to be weaned off meds against medical advice.
Dr. Igoumenou testified that when Mr. Hall was in the community between May 2021, and April 2022 he missed three of his appointments and that, on each occasion, he eventually came voluntarily a day or two late to receive his injection.
Dr. Igoumenou testified that at present, Mr. Hall hasn’t expressed a desire to stop taking medication if he is granted an absolute discharge. Dr. Igoumenou gave evidence that she remains concerned about Mr. Hall returning to the community given that the last time he was living in the community, he used his apartment as a crack house. Dr. Igoumenou confirmed that there were many periods over the last 20 years in which Mr. Hall has consumed drugs while living in the community and that there was no violence exhibited by Mr. Hall during those periods but that every time, he decompensated he was returned to hospital. Dr. Igoumenou testified that, as recently as September 2022 he was evicted from his housing in the community and was then returned to hospital. She elaborated by saying that Mr. Hall was evicted because he bothered other tenants who complained about Mr. Hall, he spent money on drugs and didn’t have any food in his apartment.
Dr. Igoumenou confirmed that in the current disposition, the cannabis prohibition had been removed and that, to the best of her knowledge, Mr. Hall used cannabis only once in the reporting year and that was when he absconded in May of 2025 and returned to the hospital the following day with no reports of aggression.
When asked about Mr. Hall’s decompensation in May 2025 when he returned to hospital, Dr. Igoumenou testified that he showed signs of intoxication including slurred speech and was in an elevated mood, which is a symptom of bipolar disorder. In addition, Dr. Igoumenou testified that during the reporting year, as set out on page 50 of the Hospital Report, Mr. Hall was observed by hospital staff talking to himself, which points to signs of mental illness despite Mr. Hall denying any such symptoms.
Dr. Igoumenou agreed with the evidence of Dr. Chatterjee set out in last year’s Reasons that Mr. Hall’s use of cannabis in conjunction with alcohol and cocaine has led to decompensation in his mental state while in the community. Dr. Igoumenou also confirmed that Mr. Hall can be very guarded with the treatment team which makes his mental state difficult to assess. Dr. Igoumenou confirmed that the treatment team had seen Mr. Hall responding to internal stimuli as likely evidence that he was experiencing symptoms of his mental illness as previously reported by Dr. Chatterjee. Dr. Igoumenou testified that it is difficult to determine if Mr. Hall continues to experience symptoms of his mental illness because the team relies on his self-reports. Dr. Igoumenou also confirmed that it is difficult to assess which drug causes decompensation as Mr. Hall’s pattern of drug use is to use more than one drug at the same time.
Dr. Igoumenou testified that in her clinical opinion abstinence from cannabis should be included in this year’s disposition given the difficulty in determining whether it contributes to Mr. Hall’s decompensation because of Mr. Hall’s affinity for using multiple drugs at the same time but that such use does alter Mr. Hall’s mental state.
Dr. Igoumenou testified that Mr. Hall had been doing well prior to May 2025 when he absconded despite knowing what the consequences would be. When asked what Mr. Hall’s motivation for leaving the grounds without permission, she indicated she was not certain but knows that Mr. Hall is frustrated with the hospital’s pass system and how long it takes to move through the pass system. Dr. Igoumenou added that she has not asked him whether he absconds to sabotage his chances of being granted an absolute discharge because he wants to remain in hospital but that this is something for the treatment team to explore with him. She further testified that Mr. Hall has said that he collected money to purchase drugs and that once the drugs are finished, he comes back to hospital, but why he does so is not known to the treatment team. Dr. Igoumenou added that she thinks Mr. Hall doesn’t want to be homeless or he may have some insight that he needs the hospital or that he wants to be in hospital but that every time he makes progress, he sabotages himself.
Dr. Igoumenou testified that Mr. Hall has the capacity to do well but that he has a pattern of using drugs and decompensating while in the community and that he has experienced significant stressor including his mother’s illness, his father’s illness and a medical issue he himself faced.
Dr. Igoumenou testified that the main issue preventing the hospital from placing Mr. Hall in housing in the community are his tendency to abscond, the use of substances while in the community and that although he was doing well before absconding in May, 2025, that event set back his progress and that, in addition, his prior eviction from housing in the community makes it more difficult to find appropriate housing.
When asked whether Mr. Hall could live with his father, Dr. Igoumenou replied that this is one option being considered but she is concerned about both Mr. Hall’s mental health fragility and his father’s physical fragility and that the team is looking at how he can spend time with family given these concerns.
With respect to Mr. Hall’s history of violence, given that it is quite limited and that he has no criminal record prior to the Index Offence, Dr. Igoumenou testified that she remains of the opinion that Mr. Hall could commit violence if given an absolute discharge as he has only partial insight into his major mental illness and as a result of his decompensation when he uses substances while in the community.
When asked what level of supervision Mr. Hall would require if living in the community, Dr. Igoumenou testified that he has been evicted from the previous two living situations and that he would initially require 24-hour supervised housing, which, if successful, would allow him to move on to other housing. Dr. Igoumenou added that there are steps Mr. Hall needs to take before getting back on housing lists including that he must re-engage with the treatment team and use his passes appropriately. Dr. Igoumenou reiterated that Mr. Hall has put everything on hold until after the ORB annual review hearing.
With respect to Mr. Hall’s medications, Dr. Igoumenou testified that he receives an injection once per month and she was unaware where he was in terms of his injection when he went on the ULOA in May 2025.
Regarding the impact of cannabis use on the absorption of Mr. Hall’s medication, Dr. Igoumenou testified that cannabis should not affect the absorption of his medication or its effectiveness but that doesn’t mean he could not experience psychotic symptoms because of the cannabis. Dr. Igoumenou noted that when Mr. Hall absconds, it is only for a day or two and his medication is long lasting but that if he were to abscond for a month or more the therapeutic level of the medication would be lost.
When asked if a substance rehabilitation program had been considered for Mr. Hall, Dr. Igoumenou replied that she had no idea if that would be helpful, and that Mr. Hall would need to be interested and motivated to take such a course.
Mr. Hall gave evidence on his own behalf. He testified that if given an absolute discharge he would be willing to be followed by the ACT team and that he recognized the benefits of anti-psychotic medication and added that he was a bit more complex than most because he experiences mood swings which would become worse without medication and if he took drugs.
With respect to any concerns, he may have about living with his father, he testified that his father is 74 years of age, has been through chemotherapy, still works as a security guard, has a few good years left and that he doesn’t want to ruin them.
With respect to the impact of drug use on his condition, Mr. Hall testified that there is a difference between hard drugs, which he doesn’t want to use, and soft drugs, legalized drugs about which his is unsure as to whether or not he wants to use them.
When asked about why there are long periods of time between his going on an ULOA, Mr. Hall responded that that is how long it takes him to get to a level 6 pass level.
No other evidence was presented.
Analysis and Conclusions:
After considering all the evidence presented and the joint recommendation of the parties, the majority of the Board finds that Mr. Hall continues to pose a significant threat to the safety of the public. The panel accepts the evidence of Dr. Igoumenou, and the evidence set out in the Hospital Report in this regard. We note that Mr. Hall suffers from a major mental illness, Schizoaffective Disorder, which is further complicated by a diagnosis of Alcohol, Cannabis and Cocaine Abuse Disorders. Mr. Hall has exhibited symptoms of his mental disorder during the reporting year despite medication compliance. During a psychotic episode, he presents with agitation, increased aggression, racing thoughts, increased psychomotor activity, impulsivity and paranoid delusions which symptoms were present during the commission of the Index Offences.
Historically, Mr. Hall’s polysubstance use contributed to his offending behaviour at the time of the Index Offences and as recently as May, 2025, while on a level 6 pass went on an ULOA and when he returned voluntarily to hospital the following day, he was still exhibiting signs of intoxication and self-reported to be intoxicated, and there was evidence that, despite having absconded only a day earlier, he was experiencing psychotic symptoms and/or mood disturbances.
Mr. Hall also has a recent history of non-attendance for psychiatric treatments, a pattern of going on ULOAs whenever the opportunity presents itself and of using substances including cannabis and cocaine while on ULOAs resulting in decompensation of his mental state in a very short period of time.
Mr. Hall also has limited insight into his mental illness and the impact of using substances on his mental state.
Mr. Hall’s own evidence did not include a stated determination not to go on ULOAs in the future and he indicated that he had gone on an ULOA in May 2025 because he had reached a level 6 pass level. At no time during his evidence did he assure the Board that he had no plans to do so in the future when he again achieves a Level 6 pass level. During his evidence, Mr. Hall drew a distinction between hard drugs and soft, legal drugs and testified that he was not sure if he would use soft drugs in the future.
According to the Hospital Report, with respect to the current reporting year, Mr. Hall experience periods of instability with respect to his mental state characterized by increased irritability, pressured speech, suspicion and somatic preoccupation, lasting days to weeks.
The Index Offences involved Mr. Hall becoming physically violent and attacking his friend and was carrying concealed weapons at that time. As well, he has been housed in the community on two previous occasions, and, although he did not exhibit violence, he did cause concern among other residents but was evicted and returned to hospital without incident. According to Dr. Igoumenou’s evidence, when Mr. Hall was on an ULOA in May 2025, he self-reported using both cannabis and cocaine and Mr. Hall has admitted that he prefers cocaine to cannabis. Dr. Igoumenou also testified that, although Mr. Hall had been on an ULOA only one day, when he returned to hospital, psychotic symptoms were observed by hospital staff. Dr. Igoumenou also testified that Mr. Hall does well with the supervision of his treatment team and the oversight of the ORB, but that, if granted an absolute discharge, Mr. Hall would be likely to fall away from treatment and decompensate and develop symptoms similar to that at the time of the Index Offences when his paranoia resulted in serious violence.
In coming to our decision that Mr. Hall continues to pose a significant threat to public safety, the panel carefully considered the decision of the Supreme Court in Winko v. British Columbia. In that case, the Court identified a significant risk as a "real risk of physical or psychological harm to members of the public that is serious in the sense of going beyond the merely trivial or annoying. The conduct giving rise to the harm must be criminal in nature". In Winko, the Supreme Court also outlined that in coming to a conclusion on the issue of significant risk, a Review Board should closely examine a range of evidence including: the circumstances of the original offence, the past and expected course of the accused's circumstances and treatment, the present state of the NCR accused's medical condition, the NCR accused's own plans for the future, the support services existing for the NCR accused in the community and, perhaps most importantly, the recommendations provided by experts who have examined the NCR accused. According to Dr. Igoumenou’s testimony, the clinical team unanimously agrees that Mr. Hall continues to represent a significant threat to public safety.
The hospital and the Attorney General both recommended that the current Detention Order remains the necessary and appropriate Disposition with the exception that the hospital recommended re-instating the prohibition against cannabis use. Counsel for Mr. Hall submitted that Mr. Hall no longer poses a significant risk to the safety of the public and that an absolute discharge was the necessary and appropriate disposition. This Board agrees with the position of the hospital that Mr. Hall cannot be safely managed under a less restrictive detention order, much less an absolute discharge at the present time.
The year in review has posed many challenges for Mr. Hall. He went on an ULOA in May 2025, which is a longstanding pattern of behaviour repeated when Mr. Hall has a level 6 pass and is able to abscond, and, while in the community, he breached his Disposition and engaged in cannabis and cocaine use which resulted in a decompensation in his mental state to the point of psychosis. Mr. Hall has exhibited this pattern for the last three years and indicates that Mr. Hall continues to engage in impulsive behaviour that has negative consequences for him and that he fails to learn from these incidents insofar as he fails to change his behaviour to avoid the same consequences including the loss of pass privileges.
Since returning to hospital Mr. Hall has not engaged in any programming. He is again required to work his way back up the pass ladder and at the time of the hearing had attained level 3. This has resulted in a significant delay in terms of his readiness for a return to community living. At the present time, Mr. Hall requires a period of detention in hospital to demonstrate to the treatment team his ability to progress through the privilege ladder and manage greater liberties with less supervision and without incident such as going on an ULOA and using drugs such as cannabis and cocaine.
The evidence before us indicates that it is necessary that the hospital have the authority to approve Mr. Hall’s community housing to ensure that it provides him with the requisite degree of structure, support, supervision and monitoring to effectively manage his risk when he is ready to return to community living. It is also important that the current provision in the Disposition that if and when Mr. Hall is allowed to move into the community, that he have some level of on-site staff supervision. Given Mr. Hall’s tendency to use unauthorized substances such as cannabis and cocaine which have been shown to cause almost immediate decompensation, the supervisory housing staff must be in a position to advise the hospital of any such potential decompensation. For this reason, this panel finds that his community housing privilege will continue to specify that it must be in supervised accommodation.
The panel also finds that although Mr. Hall has not exhibited threatening or violent behaviour when going on an ULOA, that is likely the result of the excellent care and oversight he has received from his treatment team and the fact that he has returned to hospital within a very short period of time after absconding.
The panel also takes into consideration the evidence in the Hospital Report that Mr. Hall’s protective factors are low to moderate and that he has a 50/50 chance of reoffending within 10 years of opportunity.
Additionally, we note that the hospital requires the ability to readmit Mr. Hall expeditiously and at an early juncture to manage his risk to members of the public, should he suffer a decompensation in mental state while living in the community, whether as a result of substance use, stressors, medication non-compliance, or otherwise.
In terms of the current exemption in Mr. Hall’s current Disposition allowing Mr. Hall to use cannabis, the Board finds that, given the decompensation experienced by Mr. Hall after using cannabis and given that it is as yet undetermined if this compensation is the result of cannabis use or polysubstance use, and given how quickly such decompensation occurred after Mr. Hall used both cannabis and cocaine as recently as May, 2025, a majority of the Board finds that it is necessary and appropriate to once again include such a prohibition in the current Disposition.
In coming to this conclusion, the Board has taken into consideration the assertion that cannabis use, in and of itself, specifically increases Mr. Hall’s risk to public safety. In coming to our decision, we have been mindful of the decision of the Court of Appeal in Davies (Re), 2022, ONCA 716 (“Davies”).
In Davies, the Court noted that “…there was insufficient evidence that cannabis use in a controlled hospital environment, with a medicated and compliant patient, such as Ms. Davies, would rise to the level of significant risk to public safety.”
In addition, Davies referenced Amero (Re) [2020] O.R.B.D. No. 2618, that “the Board amended Mr. Amero’s disposition to allow him to consume cannabis due to the tenuous linkage between his cannabis use and an [sic] increased risk of public safety. It noted that there was ‘no evidence that consumption of cannabis precipitated the index offence.’ This was despite its finding that he had a long history of opiate, cannabis, and alcohol abuse.”
In Mr. Hall’s case, despite his detention order, when he has achieved a level 6 pass giving him access to the community, he has used this opportunity to use cannabis in conjunction with cocaine in the community and not in a controlled hospital setting, which polysubstance use led to rapid decompensation and psychotic symptoms such as those present when the Index Offences occurred. For these reasons, a majority of the Board finds that the reasoning in Davies does not apply to Mr. Hall’s situation. In light of the foregoing, it is the view of the majority of the Board that the necessary and appropriate Disposition and the least restrictive in the circumstances is that Mr. Hall be detained at CAMH on the same terms and conditions as are set forth in the current Disposition subject to amendment to his existing Disposition to read “abstain absolutely from the non-medical use of alcohol or drugs or any other intoxicant” and to remove the exception allowing the use of cannabis.
In reaching our decision, the Board considered public safety, Mr. Hall’s mental condition, his reintegration into society and his other needs.
Reasons of the Minority
(Mr. B. Garrow)
The primary question in every annual review is whether the accused presents a significant threat to the safety of the public. Significant threat is defined in section 672.5401 of the Code: For the purposes of section 672.54, a significant threat to the safety of the public means a risk of serious physical or psychological harm to members of the public………[resulting] from conduct that is criminal in nature but not necessarily violent.
In R. v. Winko, the Supreme Court of Canada considered the meaning of “significant threat” and wrote: “There is no presumption that [an NCRMD] accused poses a significant threat to the safety of the public. Restrictions on his or her liberty can only be justified if, at the time of the hearing, the evidence before the court or ORB shows the [NCRMD] accused actually constitutes such a threat…… if [the court or Board] cannot come to a decision with any certainty, then it has not found that the [NCRMD] accused poses a significant threat to the safety of the public”.
In Gibson (Re), 2022 ONCA 527 the Court of Appeal for Ontario reviewed the meaning of significant threat in the context of the Board’s application of the test in recent cases emphasizing the following points:
The Board is required to consider both the likelihood of the risk materializing and the seriousness of the harm that might occur.
The correct test is of real, foreseeable risk.
The risk must not be speculative.
The standard for significant risk has been described as an onerous one.
The ongoing presence of mental health issues and a lack of insight into the need for medication, does not by itself establish a significant threat to the safety of the public.
In making our decision we must consider the accused’s overall mental state at the time of the hearing, including the presence or absence of symptoms, the accused’s insight into the relationship between their mental disorder and the index offence and their insight into the need for medication, as well as their willingness to seek assistance if they become unwell. Other factors include the accused’s plans for the future, and available support in the community. And the accused’s criminal history and the gravity of the index offence.
Mr. Hall is 42 years of age. He committed the index offences in 2005 at the age of 22, at a time in his life when he was unwell and untreated. He had no prior criminal history. According to the Hospital Report, Mr. Hall punched his friend in the face repeatedly, which caused the victim’s nose to bleed and jaw pain to the nose and jaw. Years later he reconciled with his friend, who has since passed away.
The weapons offence stems from a search conducted at the time of his arrest. A pellet gun was found in his jacket pocket and a large, fifteen-inch knife, two smaller knives, a hammer, a steel bar and a small propane torch were discovered in his backpack. Mr. Hall explained that he had the “weapons” because he believed it was necessary to carry them around the city, as he felt “terrified for his life” and thought he required protection because others “were plotting against him”. There is no evidence that Mr. Hall has had weapons in his possession since the index offences.
Mr. Hall was found NCR in 2006 and has been under the Board’s jurisdiction since that time. Although he was granted a conditional discharge at his initial hearing, over the ensuing years he has been detained in hospital, discharged on conditions, and readmitted to hospital for non-adherence to medication and relapse into the use of substances, primarily cannabis. When discharged to the community Mr. Hall has lived independently in an apartment.
At Mr. Hall’s last annual hearing, the prohibition against using cannabis was removed from his Disposition. In the Reasons for Disposition, Dr. Lightfoot dissenting, the Board noted that other than the index offences Mr. Hall had not engaged in any acts of violence since that time, despite ongoing use of cannabis. The majority also found that there was no compelling evidence to substantiate the assertion that cannabis use, in and of itself, specifically increases Mr. Hall’s risk to public safety.
On May 5, last, Mr. Hall left the hospital on an unauthorized leave of absence. He returned to hospital the following day and disclosed that he had used crack cocaine and cannabis. According to the Hospital Report, Mr. Hall demonstrated some signs of stimulant intoxication but denied symptoms of psychosis, namely hallucinations and paranoia. Mr. Hall testified at the hearing and confirmed, as reported, that he had absconded because he was frustrated with his progress on the pass ladder, his privileges being limited to indirectly supervised passes on hospital grounds at the time.
Mr. Hall is treated with aripiprazole, receiving an injection once a month. He has been medication compliant for many years whether in hospital or residing in the community.
The Hospital Report summary of Mr. Hall’s mental condition for the period April 2016 – March 2017 notes that Mr. Hall continued to struggle with substance use. The team decided that admission to hospital had not been beneficial in the previous reporting period and that they would continue to work with him in the community as long as his mental state was such that it did not pose an imminent risk to himself or the public. Overall, the treatment team found that despite substance use, Mr. Hall exhibited no psychotic symptoms and that his level of substance use did not pose a risk of violence. The team expressed that there were no concerning incidents during the year and in particular, there was never any concern about violence. There has been no substantial change in Mr. Hall’s mental status or behaviour in subsequent years. Despite his substance use he has remained medication compliant and has not engaged in any violent or aggressive behaviour, of a criminal nature or otherwise. While he has breached the conditions of his Dispositions with respect to substance use there is no evidence that he has ever decompensated to the extent hypothesized in the reoffence scenario detailed in the Hospital Report.
Dr. Igoumenou, Mr. Hall’s treating psychiatrist since September, expressed that her main concern with discharging Mr. Hall was his housing situation; he could end up homeless. Mr. Hall testified that if discharged he will live with his father, who has agreed to him moving home. Dr. Igoumenou was also concerned with Mr. Hall’s continuing use of substances and the possibility that he will lose contact with treatment. She also said that in the event he is discharged the team would offer transitional treatment including his prescribed medication. Mr. Hall testified that he will continue to take his medication if discharged and engage with an ACCT team once arrangements are in place.
Having considered all of the evidence, I am unable to determine with any certainty that Mr. Hall presents a significant threat to the safety of the public that meets the definition of the Code as interpreted by the jurisprudence, at this point in time. In the circumstances Mr. Hall should be discharged absolutely.
DATED this 4th day of February, 2026, at the City of Toronto, in the Toronto Region.
Ms. J. Ferguson
Legal Member
Office of the Registrar
Ontario Review Board