Re A. (S.), 2026 CanLII 23880

Re: A. (S.)

ORB File No: 8877

Hearing held on: Thursday, January 8, 2026

Place of hearing: Centre for Addiction and Mental Health

Pursuant to: Section 672.47(1) of the Criminal Code

Before:

Alternate Chairperson: Mr. J. Weinstein

Members: Hon. N. Kozloff Dr. K. Hand Dr. G. Kerry Mr. S. Duffy

Parties Appearing:

Accused: A. (S.) Counsel: Ms. S. Feldman

The person in charge of hospital: Counsel: Mr. D. Blumenkrans

Attorney General of Ontario: Counsel: Ms. V. Culp

REASONS FOR DISPOSITION

(Dated March 19, 2026)

Introduction

1. On May 29, 2025, Mr. A. (S.) was found not criminally responsible on account of mental disorder on charges including sexual interference with person under 16, expose genitals to person under 16 (x2), sexual assault, and indecent act, all contrary to the Criminal Code of Canada (“Criminal Code”).

2. A. (S.) was arraigned at the OCJ Toronto Courthouse before the Honourable Justice D. Maylor, and he had entered pleas of not guilty with the understanding that he would be admitting the facts underlying the offences and that both Crown counsel and counsel for A. (S.) would be jointly asking the Court to find him not criminally responsible on account of mental disorder pursuant to section 16 of the Criminal Code.

3. The Court made an NCR finding and ancillary orders (DNA, SOIRA) but did not make a Disposition; rather, pursuant to s. 672.47(1) of the Criminal Code, the Court ordered A. (S.) to appear before the Ontario Review Board (the “Board”) for an initial Disposition. A. (S.) was and still is subject to a Release Order and is living in the community.

4. On January 8, 2026, the Board convened a hearing at the Centre for Addiction and Mental Health to make an initial Disposition.

5. A risk assessment, dated December 17, 2025, (“Hospital Report”), was marked as Exhibit 1. In addition, Dr. A. Arnold testified at the hearing. A. (S.) was present at the hearing and was represented by his counsel, Ms. S. Feldman.

6. The issues at this hearing were whether A. (S.) is a significant threat to public safety, as defined in s. 672.5401 of the Criminal Code, and, if so, what is the necessary and appropriate Disposition in the circumstances, bearing in mind the factors enunciated in s. 672.54 of the Criminal Code.

7. For the reasons set out below and based on the expert evidence and opinions before us, the Board concluded that A. (S.) represents a significant threat to the safety of the public. The Board also found that the necessary and appropriate Disposition in the circumstances is that A. (S.) be detained at the Forensic Service, Centre for Addiction and Mental Health, subject to certain terms and conditions set out in our formal Disposition. These terms and conditions include living in the community where approved by the person in charge, reporting to the person in charge not less than weekly, abstaining from drugs and submitting to random urine drug screens, no contact with the victims of the index offences, and a weapons prohibition.

Positions of the Parties

8. Counsel for the hospital recommended a detention order with privileges including community living where approved by the person in charge and the conditions set out in the Hospital Report which include reporting no less than weekly, abstaining from drugs and submitting random drug screen, and a weapons prohibition.

9. Counsel for the Attorney General indicated that she was likely to support that position with the addition of a condition providing that A. (S.) have no contact with the victims of the index offences.

10. Counsel for A. (S.) recommended a conditional discharge with conditions to include residing at Dara House, 11 Homewood Avenue, Toronto, and reporting twice per month; she took no issue with the drug and weapons prohibitions.

The Evidence

Current Psychiatric Diagnoses

11. A. (S.)’s diagnoses are set out in the Hospital Report at pp. 19 – 20:

"Diagnoses

Schizophrenia

Based on collateral (sic) from A. (S.)’s sister and health records available for our review, A. (S.) demonstrated functional decline, consistent with schizophrenia prodrome, around the age of 18. He was reported to have his first psychiatric admission for psychosis in Atlanta shortly after and by 2011 (age 22), he was consistently documented as having a diagnosis of schizophrenia. When unwell, his symptoms have included auditory hallucinations, paranoia, thought disorganization, and sexual preoccupation.

Schizophrenia is a life-long major mental illness with an onset in the second or third decade of life. It is often preceded by a prodromal period with depression and/or anxiety and a decline in function. An individual with schizophrenia experiences symptoms of psychosis. This may involve the presence of delusions, hallucinations, disorganized speech, grossly disorganized behaviours, and/or negative symptoms (limited speech and amotivation amongst others). There is a further associated social and occupational decline, as well as diminution of motivation and self-care. Antipsychotic medication is the main form of treatment, which (when optimized) ameliorates or abates the florid symptoms of psychosis in most individuals. Multidisciplinary psychosocial rehabilitation assists in treating the remaining residual symptoms. The course of the illness may be adversely affected by non-compliance with pharmacological treatment, psychosocial stress, unstructured living, and substances of abuse.

Cannabis Use Disorder

In the past, A. (S.) used cannabis daily, despite negative effects on his mental health including exacerbation of paranoia. Consistent, daily use is associated with tolerance and withdrawal. Based on his self-report, he likely meets criteria for cannabis use disorder, currently in sustained remission.

The essential feature of a substance use disorder is a cluster of cognitive, behavioural, and physiological symptoms and continued use despite significant substance-related problems. An important characteristic of substance use disorders is an underlying change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorders. Behaviours related to the use of substances can include impaired control, social impairment, risky use and pharmacological criteria such as tolerance and withdrawal. The main treatments for substance-related disorders often involve both medication treatment and psychological interventions.

Paraphilic disorders were considered, including exhibitionistic disorder and pedophilic disorder, however, A. (S.) denied persistent, deviant sexual interests. Based on his self-report and the collateral available, he has not demonstrated inappropriate sexual behaviours in the absence of psychosis, and these behaviours have been likely a result of his major mental illness."

Index Offence

12. An agreed statement of fact was filed as Exhibit 1 and read into the record. The essential facts are set out at page 11 – 13 of the Hospital Report under Index Offence:

"Extracted from the Synopsis:

On Thursday, June 15th, 2023, between 12:30 PM and 12:50 PM, Victim #1 and Victim #2 were standing on the TTC Ossington bus platform, in the City of Toronto. Victim #1 felt a hand touch her left buttocks and saw the accused walk the corner of the bus platform.

(CHARGE 1 & 2) Victim #1 told Victim #2 that the accused touched her buttocks. Both Victim #1 and Victim #2 looked at the accused who was staring back at them and smiling. Victim #2 then saw the male pull his penis out. Victim #2 told Victim #1 and they both looked over and witnessed the accused stroking his penis. The accused began to pull out his penis further and continue to stroke his penis in front of Victim #1 and Victim #2. (CHARGE 3 & 4) The witness was standing nearby and saw the accused exposing himself. (CHARGE 5) Victim #1 and Victim #2 left the platform and spoke to a TTC collector who called police.

Officers located the accused and placed him under arrest, read his rights to counsel, caution and transported him to 14 Division, where he was held for a Show Cause."

Personal Background

13. A. (S.)’s personal, legal, and psychiatric history is set out in at considerable length in the Hospital Report at pp. 2 -11. Salient details have been excerpted and are reproduced below:

"At the time of our assessment, A. (S.) was a 36-year-old male who resided in a boarding home in Toronto. He was single and did not have any children. He was financially supported by the Ontario Disability Support Program (ODSP) for a diagnosis of schizophrenia. He was followed by Dr. Ray and the Forensic Early Intervention Services outpatient team at CAMH.

Family History and Childhood

A. (S.) was born in Toronto and was primarily raised by his mother. He had a maternal half-sister four years his junior. He saw pictures of his father but did not recall ever meeting him. As far as he was aware, there were no complications in his mother’s pregnancy or delivery and he reached his developmental milestones on time. He had no significant illnesses in childhood.

A. (S.)’s mother, R. (P.), died of kidney failure at age 42. A. (S.) was 23 or 24 years old at the time. He described his mother as very supportive and recalled that she attended all of his sports games when he was growing up. There was nothing he would have wanted to change about her.

A. (S.)’s sister, Q. (N.), was 32 years old at the time of this assessment. She was single, worked a couple of jobs from home, and resided in Atlanta, Georgia. Growing up, they were close. He recalled that they played a lot together and watched TV. They continued to speak on the phone almost daily.

When A. (S.) was approximately ten years old, he met his stepfather, Mr. M.E. (C.), shortly before his mother was incarcerated for two years for substance use. His mother and stepfather were together for approximately six or seven years. A. (S.) was not aware of how they met. A. (S.)’s stepfather was in his fifties or sixties at the time of this assessment. He was a truck driver, and A. (S.) described him as caring and loving. They were no longer in contact.

After his mother’s arrest when he was ten years old, A. (S.) lived with his stepfather for about a year. He also lived with some of his mother’s friends, each for a few months. His sister resided with her paternal grandmother during this time. When his mother was released, his stepfather remained in Toronto while his mother, sister, and he relocated to Atlanta to be near his maternal aunts. A. (S.) lived in Atlanta between the ages of 11 and 17 before they returned to the Greater Toronto Area. He denied any physical, emotional, or sexual abuse in childhood and Children’s Aid Services were never involved with his family.

Psychosexual and Relationship History

A. (S.) identified as straight and reported two previous female sexual partners. His first experience of consensual sex was at the age of 18 with a same age female. He described their relationship as “casual,” and it lasted for one year until he moved to Atlanta. His other casual relationship was at the age of 28, with another same age female, and lasted for approximately six months. At the time of this assessment, he was not active sexually as he did “not go to parties or clubs.” He did not desire a romantic or sexual relationship. He explained that while he used to want a girlfriend and to have children, he felt he was too old now. He denied feeling lonely or that he was missing out. He denied ever paying for sex.

A. (S.) masturbated approximately three times weekly in his teenage years and twenties. In the months leading up to the index offences, he reported his sex drive was increased. He thought about sex more and masturbated three to seven times per week. He watched pornography almost daily on Pornhub. He was interested in Black porn, interracial adult couples, and some group content. He denied consuming frotteurism porn or of thinking of touching non-consenting individuals when masturbating. He denied any current or past sexual arousal from exposing his genitals to unsuspecting persons, from non-genital body parts or inanimate objects, or from coercive sex.

For approximately six months leading up to the index offences, A. (S.) reported fantasies and urges to touch people without consent. He did not have such thoughts previously or since. He explained, “I think I underestimated medication. When I was on parole, I was doing very well.” He described racing thoughts and preoccupation with sex. He did not think about the age of females he wanted to touch and denied a sexual interest in pubescent or prepubescent females.

Legal History

File History

According to his CPIC, A. (S.) was convicted of Aggravated Assault in 2013 and was sentenced to four years (plus two years pre-sentence custody) with a mandatory weapons prohibition.

A summary of this offence was included in an NCR report by Drs. Morgan and Rootenberg dated April 22, 2013, which was reviewed in A. (S.)’s CAMH record. In brief, A. (S.) and the victim were strangers to each other, and A. (S.) had a history of schizophrenia. He was using a computer at the library on November 4, 2011. At some point in the early afternoon, the victim asked him how long he would be. After A. (S.)’s time was up, he walked away and the victim started using the computer. A short time later, A. (S.) returned to the area, positioned himself behind the victim, and without warning began to strike him repeatedly about the head and neck. His expression was described by witnesses as “blank” while this occurred. He was holding the knife in such a way that he was slicing into his own fingers as he was striking the victim. After stabbing the victim, A. (S.) was overheard by several witnesses saying something to the effect of “Now you’re in China.”

A. (S.) was arrested with a knife covered in blood in his sock. When interviewed by police, he admitted to stabbing the victim, stating that the victim was a nuisance and that the other patrons of the library were likely happy with what he had done.

The victim, initially unaware of the extent of his injuries, claimed he was fine and began to walk away. Eventually paramedics took him to hospital for emergency surgery. He required a blood transfusion of 11 units and surgery revealed that his right internal jugular vein was cut. He required over 5 days of intense surgery and was in hospital for 11 days. As a result of the stabbing, the victim also suffered injuries to his vocal cords (resulting in a raspy voice that persisted for over a year) and nerve damage to his right arm, which was still in a sling at the time of the preliminary inquiry over a year later.

Substance Use History

A. (S.) first smoked cannabis at the age of 18 and last used two years prior to this assessment. He used a few joints per day and stopped because it made him paranoid. He denied any urges or cravings to use at present.

A. (S.) tried alcohol at the age of 20. He did not like the taste and did not drink again. He continued to have no interest in alcohol. He did not report any other substance use history, including psilocybin, stimulant, or opioid use.

Psychiatric History

Self-Report

A. (S.) reported that he was diagnosed with schizophrenia at the age of 21 and had two admissions to hospital. He described his illness as “like an angel and the devil on my shoulder.” When unwell, he heard “wrong voices” that commanded him to do things, such as touch women. He reported last hearing voices one year before this assessment. He was on bail and not taking medication at that time.

In his self-report to Dr. Naidoo, A. (S.) reported that the voices first told him to touch random people in his twenties. He generally resisted the voices but was sometimes unable to. Ignoring the voices led to an increase in intensity. The voices also told him to “give up on myself, why should I continue, life has nothing for me.” At times, he became angry and suicidal. In his early thirties, he recalled seeing his name written on the pavement and believed he was being monitored.

During the present assessment, A. (S.) reported one suicide attempt last year when he tried to step in front of a subway. He stopped himself as he feared being in pain. He reported that homelessness was a significant stressor that contributed. To Dr. Naidoo, he also reported one previous suicide attempt in his thirties, but that voices told him to jump in front of a bus. He moved out of the way in as “it looked dangerous.”

A. (S.) denied any periods of sustained low mood or anhedonia. He reported some periods of elevated mood lasting for a few months at a time but denied associated symptoms of mania or hypomania including increased goal-directed activity."

14. The Hospital Report includes the details of A. (S.)’s numerous admissions to psychiatric facilities commencing in 2010 and prior to the index offences. Some of the significant details are set out below:

"CAMH: March 19, and April 12, 2013

A. (S.) was assessed in the Brief Assessment Unit (BAU) pursuant to a Form 48 Assessment Order for criminal responsibility. As part of this assessment, records were reviewed. His earliest admission was to Trillium Health Partners in 2010 after police found him confused and wandering the street without a shirt. He said he was looking for his mother, who lived in Atlanta. He was held involuntarily and treated as incapable with olanzapine. The initial impression was schizophreniform disorder, and the discharge diagnosis was drug-induced psychosis. Records as early as 2011 included a diagnosis of schizophrenia.

CAMH: November 23, 2022, to December 22, 2022

A. (S.) was admitted to CAMH under the auspices of a Treatment Order after he was found unfit to stand trial. He was initially minimally engaged and sexually preoccupied. He remained in his room and was frequently observed masturbating. Although he denied auditory hallucinations, he stuffed paper in his ears. His response to most questions, even ones that did not require recall, was “I don’t remember.” He sometimes urinated on the floor in his room. Paliperidone was initiated. On December 3, 2022, he attempted to jump into the nursing station to obtain a food tray and presented as more agitated. He was placed in locked seclusion and released the following day.

Paliperidone was titrated up to 12 mg daily and olanzapine 5 mg was started. By the time of discharge, he continued to excessively masturbate but did not exhibit other symptoms of psychosis and presented as fit to stand trial. He was referred to the OCTO team for follow up care.

Dr. P. Darby through the Out of Custody Treatment Order Program

A. (S.) had been seen briefly. He was quite bizarre, had heavy glasses. He indicated he had no family and raised by friends, he denied having any illness. He was seen end of April 2023, he was vague and minimally cooperative. He missed a number of meetings. In June 2023, he had 2 knives in his sock which he stated were for construction work, and was vague about the details."

Course Following the Index Offence

15. The Hospital Report sets out in detail a review of A. (S.)’s psychiatric file commencing with clinical notes and records from Toronto South Detention Centre from June 2024. For the purposes of these reasons, it will suffice to excerpt some of the salient details:

"Admission Record, Dr. Kiran Patel, July 2, 2024. A. (S.) was on remand and had been in jail for two days. Noted ongoing psychosis. Treatment plan included FEIS follow up, liaise with TSDC healthcare and social work as needed, psychiatric consult from TSDC psychiatrist.

Assessment – Plans Note, Amanda Ye, July 8, 2024.

A. (S.) reported having a history of schizophrenia. He reported hearing voices telling him to kill himself by jumping in front of a bus. He reported he did not have a plan to harm himself in jail but continued to hear these voices. He was currently on high-risk suicide watch and constant watch. Plan was to refer to the TSDC psychiatrist for assessment and review of treatment. Due to his mental health history and current presentation, would also refer to the CAMH FEIS psychiatrist for assessment and recommendations.

CAMH/FEIS Internal Referral Request to TSDC, July 25, 2024, Amanda Ye. This is a request that A. (S.) be seen by psychiatry. Noted that he continued to hear voices and reported command hallucinations discussing suicide. He had expressed interest in taking long-acting injection, and there was a request to assess this.

Progress Note, Dr. Patel, August 15, 2024.

A. (S.) was seen at TDSC. Medication was olanzapine 5mg PO QHS and paliperidone 12mg PO QAM. Noted A. (S.) was hearing voices. A Progress Note on August 8, 2024, noted the TDSC psychiatrist had offered A. (S.) long-acting injectable medication, Invega, to which A. (S.) agreed and believed he would receive soon. He continued to hear voices, which were bothersome and continued to tell him to hurt himself, but he had not acted on them.

Report by Dr. Maryana Kravtsenyuk, Forensic Psychiatrist, October 30, 2024 (draft version).

Dr. Kravtsenyuk felt that A. (S.) suffered from a primary psychotic illness, namely Schizophrenia. She noted that he had a tendency to become non-compliant and deteriorate to the state where he was no longer able to meaningfully participate in his legal proceedings. She noted that he appeared to have responded better to recent treatment with injectable medications. She indicated that he needed continuous treatment with antipsychotic medication, which should be administered by long-acting intramuscular injection given his history of very marginal medication adherence. She also indicated that he should receive careful monitoring of his response to medication treatment upon any prospective release into the community, and his response to treatment, in addition to rehabilitation, should be overseen by enhanced community mental health and addiction supports.

Case Management FEIS Community: Summary of Documentation:

A. (S.) was initially seen by Dr. Ray biweekly and over time less frequently. He remained stable with respect to his mental status and was focused on exploring employment. He liked the residence he moved into in January 2025 and also attended a housing appointment for a Habitat single room opportunity. On May 30, 2025, he reported he was found NCR the day prior and was stressed about the lifelong reporting order for the Sex Offender Registry. He attended the library, played basketball, and went to the gym regularly. In the summer of 2025, he interviewed for two jobs and started a volunteer position at the Yonge Street Mission packing food twice every two weeks. He was also to start an apprenticeship for construction in November 2025. By October, he was documented as having good insight into his symptoms of psychosis and need for treatment. On November 28, 2025, he described the index offence as hearing the voices of the “devil and an angel who were telling me to touch people.” He reported that at the time he was prescribed medications but was not taking them.

Notes from May 30, 2025, indicated that A. (S.) was a successful candidate for a single room housing vacancy through Habitat housing. On June 2, 2025, A. (S.) attended the initial reporting appointment with SOIRA without issues. In September, A. (S.) started attending the WRAP group run by a CAMH peer support worker. He pled guilty to the remaining outstanding charges he had and obtained a one-year probation. His mental status remained stable throughout, and there were no concerns about his medication compliance.

Collateral information from Mr. Seby Joseph, CAMH FEIS social worker and case manager.

Since A. (S.)’s release in December 2024, he resided in a group home and was followed by the FEIS team, including Dr. Ray. He was maintained on olanzapine and a long-acting injection. On this combination, he was cooperative with treatment and was polite and respectful. He demonstrated insight into his illness and need for treatment. He also reconnected with his sister, who was a support to him. He did not have any relapse of psychotic symptoms. Mr. Joseph reflected that with the right supports (including case work and psychiatry follow up), A. (S.) demonstrated his ability to maintain wellness. He believed A. (S.) would continue to benefit from similar supports to maintain his achieved level of stability and to continue working toward his goal of employment."

16. Information about A. (S.)’s current treatment, insight, plans and mental status is set out in the Hospital Report at pp. 18 – 19:

"Current Treatment

A. (S.) is followed by the FEIS outpatient team. He attended appointments approximately once a month. He receives a paliperidone long-acting injection and takes oral olanzapine. He reported compliance with his medication.

Attitude towards treatment and supervision

A. (S.) had some understanding of the ORB. He spoke positively of his current treatment team. He was hopeful that his current housing would be approved by OPIC in the context of the recommended disposition and did not voice any concerns about potential reporting requirements. If asked to avoid substances, in particular cannabis, he said he would not have a problem with that. If he were advised to go to the hospital, he said he would as “I think the team is here to help me to look out for my better well-being.” He previously completed a WRAP program through CAMH and voiced a willingness to attend additional groups.

Understanding of mental illness

A. (S.) was aware of his diagnosis of schizophrenia and identified symptoms as hearing voices and paranoia. He said that medication was important and if he were to stop, “I would go back to hearing voices and making bad choice.

Attitudes towards the charges

A. (S.) recalled that it was hard for him to tell the ages of the victims, but that “either way it was wrong.” He felt bad for his behaviours at the time. He said that he thought he “got a kick out of it.” He said he was masturbating and the police came. He said he was not thinking clearly at the time. In He felt that the lifetime SOIRA order was harsh and was in the process of appealing it. He recalled that the judge said he had schizophrenia for life and this was the justification.

When asked about the subsequent charges, he said that he was out on bail and touched two or three women inappropriately in a library but was charge for one. The victims were adult females, possibly age 30s. He said that he touched each woman approximately 30 minutes apart. He said he touched them on the buttock then would walk away to a different part of the library. He said he “got a kick out of it at the time.” He said he was not on medication at the time and was using cannabis a few joint daily. He said that he now thinks it was “stupid,” and that there was no need to do it. He said it was not worth it as he went back to jail.

Insight into symptoms and coping

A. (S.) had some insight into previous symptoms of his mental illness. At the time of this assessment, he denied auditory hallucinations, visual hallucinations, thought insertion/withdrawal, paranoia, delusions of reference, delusions of passivity, suicidal ideation, and violent ideation. He was stressed about having to report to the National Sex Offender Registry for life and generally coped with stress by walking or exercising.

Goals and Future plans

A. (S.) voiced several goals. He hoped to get baptized, but was worried about his ankle monitor, and wanted to volunteer at his church and attend more frequently. He wanted to be closer to God. He also hoped to become a peer support worker. He recently applied to a position at Dixon Hall and regularly read the CAMH newsletter for job postings. He was motivated to share his experience with schizophrenia and to learn about other people’s experiences with the illness.

MENTAL STATUS EXAMINATION

A. (S.) was reasonably groomed and attended the appointment on time. He was calm and cooperative. He had reduced spontaneous speech and tended to provide brief responses to questions. He sometimes had difficulty elaborating when asked. His mood was described as “good” and his affect was restricted in range. He denied perceptual disturbances and did not appear to be attending to internal stimuli. His thought process was organized and there was no apparent delusional thought content. He denied suicidal and violent ideation. He had some insight into his history of mental illness and need for treatment. He had fair judgement."

17. The issue of significant threat is addressed at pp. 20 – 23 of the Hospital Report. The salient details are set out below:

"ASSESSMENT OF RISK

STATIC 99-R

Static-99R is intended to position adult men charged or convicted of a sexual offence in terms of their relative degree of risk for sexual recidivism based on commonly available demographic and criminal history information that has been found to correlate with sexual recidivism. Static-99R has moderate accuracy in ranking individuals according to their relative risk for sexual recidivism and is widely accepted by the scientific community and by applied evaluators. For further information, see www.static99.org.

A. (S.)’s Static-99R score was calculated based on the 2016 edition of the coding rules and interpreted using estimates published by Lee and Hanson (2021). A. (S.) received a total score of 7 which places him in Risk Level IVb 'Well Above Average Risk' for being charged or convicted of another sexual offence. A. (S.)’s score represents the 97.2nd percentile, defined as a mid-point average, of adult males in the instrument’s standardization sample (96.0% have a lower score, 2.5% have the same score, and 1.5% have a higher score). In other words, out of 100 individuals convicted of a sexual offence, 96 would have a lower score, 2 would have the same score, and 2 would have a higher score. With a 95% confidence interval, the score could range from the 95.6th to the 98.6th (sic) percentile.

Of note, the Static-99R does not measure all relevant risk factors and A. (S.)’s recidivism risk is likely to be lower that indicated by Static-99R if he is receiving treatment for schizophrenia. In addition, the scored was based on the most recent charge of sexual assault that he reported and was confirmed by his health record and sister, but not by formal police documentation.

HCR-20 V3

Historical (H) items rated present and highly relevant are: a History of Problems with Violence, Major Mental Disorder, Substance Use, and Treatment or Supervision Response. Historical items rated present and of medium relevance are: a History of Problems with Relationships and Employment. The following items were not deemed to be present: a History of Problems with Other Antisocial Behaviour, Personality Disorder, Traumatic Experiences, and Violent Attitudes.

The following Clinical (C) Item was partially present over the past 12 months and of medium relevance: Problems with Insight (in that he initially was resistant to continuing his long-acting injection after release from a custodial setting).

The following Risk Management Items, scored for the recommended disposition, are partially present and highly relevant: Future Problems with Stress or Coping. There may be Future Problems with Treatment or Supervision Response in the event of a relapse of psychosis.

Strengths

SAPROF

A. (S.)’s protective factors include empathy, attitudes towards authority, professional care, and living circumstances. Goal factors include work and coping.

Re-offence Scenario and Assessment of Significant Threat

According to R. v. Winko, a ‘significant threat to the safety of the public’ means 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. Further, it is noted that evidence to determine whether an individual is a significant threat to the safety of the public can include the past and expected course of the NCR accused’s treatment, if any, 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, as well as other items.

It is our opinion that A. (S.) represents a significant threat to public safety from a psychiatric perspective, based on the factors noted above.

In risk assessment, one of the best predictors is a patient’s history of violence. If A. (S.) were to reoffend, it would likely transpire in the context of relapse of psychotic symptoms in the context of medication non-compliance and increased stressors. He may fall away from care as he has in the past and resume cannabis use, further exacerbating symptoms of psychosis. A. (S.) would likely lose insight into his mental illness and he would be unable to appreciate his symptoms, which would include though disorganization, perceptual disturbances, paranoia, and sexual preoccupation. He would be at risk of sexual violence towards people in his vicinity, as was seen in the index offences, or physical violence, as he has exhibited in the past."

18. The issue of necessary and appropriate disposition is addressed at p. 23 of the Hospital Report as follows:

"Risk Management

Medication

A. (S.) should continue to take medications for his mental health, including his long-acting injection.

Case Management with Close Follow up

A. (S.) would benefit from follow-up with a forensic psychiatry team, checking in every week, which would provide collaboration, insight, and management tools to address any potential for violent recidivism.

Substance Use

A. (S.) should abstain from substance use and submit random urine drug screens for monitoring of same.

Stress and Coping

A. (S.) would likely benefit from psychotherapy, individually or in groups, to work on stress and coping. He would benefit from ongoing case management to support his work goals."

19. The recommendation of the authors of the Hospital Report follows:

"Recommendation

A. (S.) is currently residing in the community in 24/7 supervised accommodation. He is content in his current accommodation and does not have any plans to move. However, he has only recently achieved a level of stability. There is concern that should his mental state begin to deteriorate, he will become paranoid, lose insight, potentially relapse to cannabis use, and be rejecting of supports available to him, which has been his pattern in the past. A conditional discharge would not be sufficient to manage his risk.

A Detention Order is necessary in order to manage his risk, however, given his current stability in the community under treatment and supervision, it is likely that he could remain in the community under the supervision of the CAMH Forensic outpatient service.

A. (S.) represents a significant threat to the safety of the public as defined in Winko, and the necessary and appropriate, least onerous and least restrictive disposition to manage A. (S.) risk is:

1. A Detention Order with community living

2. Reporting no less than weekly

3. To abstain from drugs and to submit random urine drug screens

4. Weapons prohibition"

Testimony at the Hearing

20. Dr. A. Arnold, Resident in Forensic Psychiatry, University of Toronto and one of the authors of the Hospital Report, testified at the hearing.

21. In response to a request from counsel for the hospital for an update, she advised that the diagnoses should include Cannabis Use Disorder. (Note: in the Hospital Report it states, “On his self-report, he likely meets criteria for cannabis use disorder, currently in sustained remission.”

22. She advised that the CAMH Outpatient Team would remain involved with A. (S.).

23. Dr. Arnold suggested that the person in charge would have to approve his accommodation, and that while A. (S.) has had a period of stability, regular reporting is necessary at the outset to permit the team to intervene proactively and/or rapidly.

24. She explained that A. (S.) has a previous history of non–compliance with ensuing decompensation which heightens his risk to the public. She added that A. (S.) might not meet the criteria of the Mental health Act to hospitalize him in the event he is non-compliant, and that if a conditional discharge was ordered they might not be able to bring him in rapidly to address decompensation.

25. Dr. Arnold observed that the letter from Dara House where A. (S.) currently resides was very positive, adding that Dara House offers 24/7 support with medication oversight. She opined that (subject to the views of the person in charge and the outpatient team) “it seems like a good fit”, explaining the importance of input from the treatment team regarding accommodation to ensure (a) proper supervision of medication and (b) good feedback about A. (S.)’s mental state, use of substances, and stress levels.

26. In response to questions from counsel for the Attorney General about the pattern of conduct of sexual assaults on strangers she agreed A. (S.) was a high risk.

27. Regarding the Mental Health Act, she explained that (if it became necessary to hospitalize A. (S.) should he become nonadherent and/or relapse to substance use and/or decompensate) even if A. (S.) meets the criteria for certification the Act is not as effective (as a Detention Order) in terms of the timing of bringing him into hospital quickly and, even if he is hospitalized rapidly, keeping him in for an adequate period.

28. In response to questions from counsel for A. (S.), Dr. Arnold agreed with the Hospital Report that “A. (S.)’s recidivism risk is likely to be lower than indicated by Static-99R if he is receiving treatment for schizophrenia”, but added that if he is using substances or is non-compliant with medication he is at very high risk for the commission of sexual offences.

29. The doctor also noted that from 2022 to 2024 A. (S.) was connected with CAMH through the Early Intervention program and that in 2024 he was receiving medication.

30. She agreed that A. (S.) saw Dr. Ray regularly albeit they were meeting less frequently in the summer of 2025 (at the time of the index offence), and that Dr. Ray had reported that they had a good rapport, that A. (S.)’s insight was improving, and that his comments were all positive.

31. Dr. Arnold also agreed that A. (S.) has been very amenable to their referrals, participated in recommended programming, and actively engaged in seeking employment. She reiterated that A. (S.) had done very well over the past year.

32. She acknowledged that his time at Dara has demonstrated his ability to maintain housing and reflects his level of stability.

33. The doctor agreed that the onset of A. (S.)’s illness coincided with the 2011 offence for which he was incarcerated in penitentiary and that following his release he had no supports in the community and no housing until November of 2022.

34. Dr. Arnold agreed that A. (S.) has responded well to medication, and that his current housing seems to support his improved mental state, but added the caveat that decompensation can occur even if he is adherent to medication i.e. due to stress.

35. In response to questions from the panel, Dr. Arnold confirmed that it is possible to have a dual diagnosis of schizophrenia and paraphilia but added that based upon his history A. (S.)’s (criminal) sexual behaviour only occurred in the context of his psychosis. She agreed that his embarrassment from being associated with sexual deviance may impact his self-regard.

36. The doctor was asked whether, in light of the references in the Hospital Report (at p. 6) to A. (S.)’s increased sex drive in the months leading up to the index offences and (at. P.23) to A. (S.)’s sexual preoccupation, paraphilia should be reassessed. She responded with “perhaps,” adding that the current view is that it (i.e. his criminal sexual behaviour) is schizophrenia related. She agreed that A. (S.) would have to be diagnosed with paraphilia in order to be eligible for programming targeting his sexual behavior.

37. Regarding Dara she advised that it was male only and that A. (S.)’s curfew was part of the OCJ recognizance. She reiterated that the team will decide if Dara House is suitable going forward.

38. Dr. Arnold advised that A. (S.)’s medication is a long-acting injectable every 4 weeks in combination with a daily oral dose (Olanzapine). Asked how long it would take for him to decompensate if he stopped taking the Olanzapine, she said “days to weeks.”

39. Asked what would happen if a Condition Discharge was ordered and A. (S.) thereafter stopped medication and decompensated, she replied that he could be brought to hospital but if he was unwilling to stay (and not certifiable) the hospital couldn’t keep him. In addition, his primary psychiatrist would be Dr. Ray rather than a member of the current inpatient team.

40. Asked why the team was not recommending a 24/7 accommodation clause given A. (S.)’s previous history of non-compliance and substance abuse, Dr. Arnold deferred to the outpatient team regarding his current accommodation (Dara) and the required level of support, adding that CAMH does not require a 24/7 clause to determine accommodation.

Final Submissions

41. Counsel for the hospital submitted that notwithstanding A. (S.) had a very good year, a detention order remains the necessary and appropriate disposition. The hospital needs to be able to approve housing, and to manage the risk effectively should A. (S.) decompensate, i.e. by rapidly returning him to hospital and keeping him there as long as required. The MHA is inadequate for those purposes. Decompensation is a real possibility given A. (S.)’s history of noncompliance, substance use, and stress. Counsel concluded by stating that A. (S.) is moving in a positive direction.

42. Counsel on behalf of the Attorney General acknowledged the letters of support from A. (S.)’s sister and aunt and the manager of the Dara Residence which she agreed evidence his progress over the past year. That said, counsel submitted that it was “early days” and that a detention order was the necessary and appropriate disposition.

43. On behalf of A. (S.), his counsel expressed her thanks to the treatment team, to Dara, and to A. (S.)’ family for their support. In her submission, a conditional discharge is the necessary and appropriate disposition. Dara is providing good accommodation for A. (S.), and there is no need for the hospital to be able to stipulate housing. If decompensation should occur, whether because of substance use or nonadherence to his medication A. (S.) would be hospitalized and he is aware of that. The concerns expressed about the inadequacy of the MHA are speculative.

44. Should the Board find that a conditional discharge is inappropriate, her submission is that A. (S.) be ordered to reside at an address approved by the person in charge without stipulating that it be 24/7.

Analysis and Conclusions

Significant Risk

45. Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board finds that A. (S.) is a significant threat to the safety of the public.

46. In Winko, the Supreme Court indicated that, in coming to the 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 treatment; the present state of the NCR accused’s medical condition; the NCR accused’s own plans for the future; the support existing for the NCR accused in the community; and most importantly, the recommendations provided by experts who examined the NCR accused. In coming to our conclusion in this matter, the Board relies on the expert evidence of Dr. Arnold, in addition to the documentary evidence before us.

47. The evidence is quite clear that A. (S.) meets all the criteria of a significant threat to the public safety. The Hospital Report demonstrates that there is a real and foreseeable risk of serious harm to the public, should A. (S.) stop his medication and/or resume substance use and/or become stressed. This apprehended risk is neither trivial nor speculative; it is based on A. (S.)’s past behaviour and the nature of his illness. A. (S.)’s current mental stability is attributable to the intensive oversight that he is getting. He still requires the necessary oversight and support to address that risk.

48. The Board has no difficulty in coming to the decision that Mr. Misk satisfies the test set out in Marmolejo (Re), 2021 ONCA 130, in which Justice Tulloch reviewed the relevant test at paragraph 37:

"The threshold for significant risk is "onerous": Carrick (Re) (2015), 128 O.R. (3d) 209, [2015] O.J. No. 6524, 2015 ONCA 866, at para. 17. A significant threat to the safety of the public means a foreseeable and substantial risk of physical or psychological [page195] harm to members of the public: R. v. Ferguson, [2010] O.J. No. 5138, 2010 ONCA 810, at para. 8. The conduct must be of a serious criminal nature: Ferguson, at para. 8. A very small risk of grave harm will not suffice, nor will a high risk of trivial harm: Ferguson, at para. 8. The threat must be more than speculative in nature; it must be supported by evidence: Winko, at p. 665 S.C.R.; Pellett (Re) (2017), 139 O.R. (3d) 651, [2017] O.J. No. 5025, 2017 ONCA 753, at para. 21.”

49. We note that since his release from custody A. (S.) has been under the very strict conditions of a recognizance imposed by the courts.

50. In Mott (Re), 2019 ONCA 568, at para. 10, the Court of Appeal indicated that the absence of offending behaviour alone is not determinative of whether there is a significant threat to the safety of the public. Significant threat must be considered in the context of other factors.

51. As noted at p. 23 of the Hospital Report, in risk assessment, one of the best predictors is a patient’s history of violence. If A. (S.) were to reoffend, it would likely transpire in the context of relapse of psychotic symptoms in the context of medication non-compliance and increased stressors. He may fall away from care as he has in the past and resume cannabis use, further exacerbating symptoms of psychosis. A. (S.) would likely lose insight into his mental illness, and he would be unable to appreciate his symptoms, which would include though disorganization, perceptual disturbances, paranoia, and sexual preoccupation. He would be at risk of sexual violence towards people in his vicinity, as was seen in the index offences, or physical violence, as he has exhibited in the past.

52. In the result, we find that A. (S.) is a significant threat to the safety of the public.

Necessary and Appropriate Disposition

53. The evidence before us is that A. (S.) is at risk of becoming non-adherent to his medication and/or relapsing to substance use and/or of becoming stressed and thereafter decompensating.

54. A. (S.)’s history demonstrates a pattern of violence including sexual offences during periods of psychosis and/or decompensation, typically in the context of medication non‑compliance and cannabis use.

55. Since 2013, in addition to the index offences his criminal behaviour has included a very serious offence of violence (aggravated assault). His mental illness has required repeated hospitalizations with intensive psychiatric care. While his recent stability is notable, the documented pattern establishes that untreated or destabilized illness has previously resulted in significant risk of serious physical or psychological harm.

56. A. (S.)’s mental stability is dependent on strict treatment adherence, abstinence from substances, and effective supervision. His history demonstrates a pattern of violence when unwell. Given his repeated non-adherences, his past substance relapses, and the ensuing decompensations, as well as the inadequacies of the Mental Health Act to effectively respond should he decompensate for whatever reason, the Board agrees that a Detention Order with the conditions as proposed is both necessary and appropriate in the circumstances.

57. Accordingly, after due consideration of all the evidence, the submissions of the parties and the criteria set forth in s. 672.54, the paramount consideration being the safety of the public, in addition to the mental condition of A. (S.), his reintegration into society and his other needs, the necessary and appropriate Disposition is a Detention Order.

58. As a final note, the A. (S.)’s offences are of a sexual nature that his clinical team attributes to schizophrenia rather than to a paraphilia. Consequently, he has received treatment for schizophrenia but has not received treatment targeting his sexual attitudes and behaviour, such as for example sexual behaviour therapy. Given the sexual nature of his offences, references to his self-reported sexual behaviour during the months preceding his offending (see pages 5-6 of the Hospital Report 2025), his risk to reoffend sexually (pg. 21 of the Hospital Report), and the fact that he is required to comply with conditions of the SOIRA, the Board is of the opinion that he would benefit from offence specific intervention. Ideally, this might involve individual counselling to assist him with (a) developing and maintaining a healthy intimate relationship; (b) the responsible use of pornography; and (c) managing inappropriate/risky sexual thoughts/urges.

DATED this 19^th^ day of March, 2026, at the City of Toronto, in the Region of Toronto.

Hon. N. Kozloff

Legal Member

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Office of the Registrar

Ontario Review Board