Re Jerome Martin, 2026 CanLII 23894

Re: Jerome Martin

ORB File No: 8332

Hearing held on: Tuesday, January 6, 2026

Place of hearing: Centre for Addiction and Mental Health

Pursuant to: Section 672.81(1) of the Criminal Code

Before: Alternate Chairperson: Dr. K. Connidis Members: Hon. N. Kozloff Dr. K. Hand Dr. G. Kerry Mr. S. Duffy

Parties Appearing: Accused: Jerome Martin Counsel: Ms. M. Murphy

The person in charge of hospital: Counsel: Ms. S. Rosales-Zelaya

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

REASONS FOR DISPOSITION

(Dated March 19, 2026)

Introduction

1. On June 19, 2023, Jerome Martin was found not criminally responsible on account of mental disorder (“NCR”) on a charge of aggravated assault. That charge arose out of an incident at his family home in November 2021, when Mr. Martin hit his brother in the head with a hammer during an argument. The injuries to his brother were significant. He was transported to Sunnybrook Hospital with a fractured skull and a small brain bleed. He stabilized with treatment and largely recovered.

2. After Mr. Martin’s initial Review Board hearing in December 2023, he was ordered to be detained at the Forensic Service of the Centre for Addiction and Mental Health (“CAMH” or “the Hospital”), with privileges extending to the ability to live in the community of the GTA in accommodation approved by the person in charge.

3. On January 6, 2026, a panel of the Review Board convened in person at CAMH to hold a hearing and review that Disposition. Mr. Martin was present and was represented by counsel, Ms. M. Murphy.

4. The issues to be decided at this hearing were whether Mr. Martin poses a significant threat to the safety of the public and, if so, what is the necessary and appropriate disposition.

5. The Hospital, the Crown (subject to the inclusion of a clause requiring that the police also be notified in advance of any change of address) and the Accused jointly submitted that the test for significant threat is met and that a conditional discharge is the necessary and appropriate disposition to meet any risk to the public.

6. Having heard and considered all of the evidence and the submissions of the parties, we find that Mr. Martin meets the threshold test for significant threat, and that the necessary and appropriate disposition, which is also the least onerous and least restrictive in the circumstances, is a conditional discharge. These are our reasons.

7. At the time of this hearing, Mr. Martin was a 45-year-old single man who was living at York House in Acton, Ontario, where he has resided for the duration of his tenure under the ORB. He is unemployed and supported by Ontario Disability Support Program (“ODSP”). He is not in a relationship and had never been married. He has no children. He had a valid driver’s license; however, he is not driving. He is followed by the Expanded Forensic Outpatient Service (“EFOPS”) through CAMH. He is also supported by a case worker through his group home.

8. The following is reproduced from last year’s Reasons for Disposition:

“History and Index Offences

Mr. Martin is 44 years old. He is the third of four siblings. Both he and his elder brother (the victim of the index offence) were living at home with their parents at the time of the index offence.

Mr. Martin’s current diagnoses include schizophrenia, as well as cannabis and alcohol use disorder (both in sustained remission). He began using cannabis at the age of 16, and his use escalated to daily heavy use. Given the negative effects that he experienced with cannabis use, he stopped using cannabis at the age of 25. At about the same time, his alcohol use increased. He drank alcohol daily to intoxication and occasionally binged alcohol to the point of unconsciousness. He stopped drinking alcohol in 2018, following a conviction for impaired driving and attendance at an addiction program at CAMH. Since coming under the jurisdiction of the Review Board, regular random urine drug screens have confirmed his ongoing abstinence from recreational substances.

Mr. Martin has a longstanding history of schizophrenia. He experienced prodromal symptoms of his illness as early as 2000, and was hospitalized in 2011 (and possibly 2008) for schizophrenia and alcohol abuse. He was also followed by a psychiatrist in the community until sometime in 2014.

In May 2015, after a period of significant deterioration, Mr. Martin was brought to the emergency department of the Credit Valley Hospital by his mother. He had stopped his prescribed antipsychotic medication, resulting in a one year decline in his mental state, including social isolation, paranoia and anger. He had started installing a surveillance system in the family home because he believed that someone was maliciously putting rats in the house, and he threatened his brother with a machete due to his delusional belief that his brother was planning to place rats in the ducts of their home. In hospital, he was restarted on antipsychotic medication (risperidone) under the substitute consent of his mother. He remained in hospital for approximately two weeks and was discharged home on risperidone with a referral for follow-up. His mother noted that on discharge he was less angry but he did not wish to see one of his brothers and wanted only a limited relationship with his other siblings.

Following his arrest for the index offence on November 13, 2021, Mr. Martin was held in custody. Four days later he was released on bail to reside with his sister (his surety). The following day, he was admitted to the Oakville Trafalgar Hospital after being brought in by his sister as he was behaving bizarrely at her home. When his sister could not answer one of his repeated questions, Mr. Martin lunged at her. He was certified on a Form 1 and restarted on medication, as he had been non-adherent in the community for several years. In hospital, he reported that he had been sleeping in his car because there were pests/rodents in the ceiling of the family home that had kept him awake. His mental status improved with treatment and after a two-week admission, he was discharged back to his sister’s home in early December 2021.

Thereafter, Mr. Martin was followed by the North Halton Mental Health Clinic (NHMC). He was seen monthly by a psychiatrist and also saw a nurse for his monthly antipsychotic injection. The opinion of both psychiatrists who treated him at the clinic was that Mr. Martin was only superficially engaged in care. He responded minimally to questions and appeared suspicious and guarded. He did not endorse any psychotic symptoms, though both doctors suspected ongoing symptoms. At times he denied having schizophrenia or ever having had symptoms of psychosis, and said that the medication was doing nothing for him. He repeatedly said that “if it were not for the charges and court order, he would not attend appointments or receive his medication.”

By April 2022, Mr. Martin’s sister was increasingly concerned by his lack of motivation, angry appearance, and failure to engage with her family or appreciate how much work her family was doing for him. In October 2022, with the assistance of his sister, Mr. Martin moved into a 24-hour staffed group home in a room shared with a roommate. He has continued to live at the same home since that time. His meals are prepared for him at the group home, where staff also dispense oral medications. He has not seen or spoken to his brother or parents since the index offence, but continues to have contact with his sister, who is also his SDM for psychiatric treatment."

Course Since the Last Hearing

9. At the current hearing, we received evidence in the form of the Hospital Report dated December 8, 2025 (Exhibit 1 in these proceedings) as well as the oral testimony of Dr. Valoo, Mr. Martin’s attending psychiatrist. The relevant portions of the Hospital Report are set out below:

"CAMH Expanded Forensic Outpatient Service: January to December 2025

Following his previous Annual Review Board hearing, Mr. Martin remained under a detention order with privileges up to living in the community, and a requirement to report to his team not less than every two weeks. The prohibition on recreational substance use and routine screening to monitor for substance use was removed from his disposition. Substance use was not a concern for Mr. Martin throughout this reporting period.

Mr. Martin continued to receive outpatient psychiatric follow-up from the Expanded Forensic Outpatient Service. Dr. Valoo remained his psychiatrist. His case manager was switched from Ms. Amanda Dam to Ms. Anne Marie Roberts. Mr. Martin’s mental status remained stable over the past year with no hospitalizations, emergency room visits, or episodes of acute psychiatric deterioration.

Mental Health, Medications, and Insight

Mr. Martin saw his psychiatrist approximately every four weeks, and saw his case manager every one to two weeks for both scheduled check-ins and group programs. He attended all scheduled appointments as required.

Mr. Martin did not demonstrate observable positive psychotic symptoms (such as delusions or hallucinations), and denied having any of these symptoms. His thought process was concrete but organized. He continued to present with longstanding negative symptoms of schizophrenia, including flat affect, restricted speech, and guarded engagement during formal psychiatric appointments. However, staff consistently observed that he was significantly more open, friendly, and engaged during non-clinical interactions (such as groups, outings, and volunteering), suggesting that his guarded affect was situation-dependent and related at least in part to discomfort in formal clinical settings. He consistently demonstrated good judgment in routine functioning, maintained a structured weekly schedule, and coped well with everyday stressors.

Mr. Martin remained incapable for antipsychotic treatment, and his sister remained his substitute decision-maker (SDM). He continued to receive antipsychotic treatment with paliperidone injections at a dose of 100 mg every four weeks. He reported intermittent tremulousness and temperature dysregulation (“hot/cold sensations”) for several days post-injection. These symptoms were self-limited and did not affect adherence. He declined to add additional medications to his regime to manage these side effects. Due to his dislike of needles, his psychiatric team proposed a transition to Invega Trinza (paliperidone injections dosed every 12 weeks) to his SDM; however, she declined this proposal due to concerns about worsening metabolic side effects. Mr. Martin also took oral quetiapine for sleep and mood stabilization, at a dose of 150 mg at bedtime.

Mr. Martin expressed minimal insight into his mental illness and treatment needs. He opined that he would be perfectly fine without involvement with CAMH or antipsychotic treatment. He frequently stated that he would prefer to stop all psychiatric medications. Despite this, he believed that he benefitted from CAMH groups and programs. He acknowledged that his injection helped with sleep, and he continued to comply with antipsychotic treatment under consent of his SDM. This suggested that Mr. Martin’s insight improved modestly over the past year, and this seemed to be largely due to his ongoing engagement in structured psychoeducational programming.

In December 2025, Mr. Martin’s insight into the nature of the index offence was canvassed. He said that this event was out of his hands and beyond his control. He also said that he was “pushed” to act in this manner. He viewed this as a historical event and opined that there was no chance something similar could happen because his life circumstances were now different. He also believed that his involvement with CAMH groups and programs protected against future violent incidents. He did not think that antipsychotic treatment contributed to this, saying, “I don’t think it’s the injection, I think it’s me.” When asked about his anticipated trajectory under a Conditional Discharge, Mr. Martin stated that if granted a Conditional Discharge, he would maintain his current schedule, would continue to stay at his current home (due to a lack of alternative accommodation), would continue to attend required appointments with his psychiatric team, and would continue to take injectable antipsychotic medication, “because I have to.”

Programming and Routine

Mr. Martin was a regular and active participant in the FOPS Illness Management and Recovery Group, which he completed in January 2025. He participated in a culturally adapted CBT group between December 2024 and January 2025. He also participated in one-to-one Wellness Recovery Action Plan (WRAP) sessions with a Peer Support Worker. These individualized sessions helped him begin to identify early warning signs, reflect on emotional experiences, and consider coping strategies. While his overall insight remained limited, these incremental gains suggested a capacity for self-reflection and improving insight when supported through structured and relationship-based interventions. This led his inpatient team to refer him for individual therapy through the Forensic Consultation and Assessment Team (FORCAT) to further enhance improvements in insight, self-awareness, and adaptive coping. He remained on a waitlist for individual therapy at the time of this report.

Mr. Martin additionally participated in various recreational programs through FOPS, including the weekly cooking group, a gardening program (during the summer months), and the weekly horse stables group.

Mr. Martin continued to volunteer at a food bank in Acton once per week. He also spent free time going to a nearby public library.

One of Mr. Martin’s main goals for the reporting period was to find paid employment. He worked with his case managers to create a resume, which he independently delivered to several potential employers in Acton. At the time of this report he had not succeeded in finding employment, and this was thought to be due to the limited number of job opportunities in Acton. Despite this, Mr. Martin remained cooperative with employment planning and was open to a referral to a supported employment agency, which was currently in progress.

Physical Health

Mr. Martin’s physical health remained stable over the past year. He continued to follow up regularly with his family physician for metabolic and general medical monitoring. In April 2025, bloodwork demonstrated prediabetes and elevated triglycerides, for which he was prescribed rosuvastatin. Mr. Martin’s weight remained stable, and he continued to work toward weight reduction through increased physical activity and healthy eating (with support and encouragement from his professional supports). He declined to consider pharmacological weight loss interventions, expressing a preference to focus on lifestyle modifications.

Social Supports

Mr. Martin maintained limited but stable family connections. He had intermittent contact with his sister, Nadine, who was his Substitute Decision Maker (SDM) for treatment. He also had occasional contact with his mother, which he described as positive. He visited her once over the reporting period and spoke to her periodically by phone. He did not have contact with his brothers, in keeping with the ORB disposition, which included a no-contact direction regarding one sibling.

Mr. Martin was well-regarded within his housing environment. Staff reported that he got along with peers and contributed positively to household responsibilities. He developed additional supportive connections through community engagement, including volunteer work at a local food bank and regular visits to the Acton Public Library, where he interacted with staff and peers.

Within CAMH programming, Mr. Martin engaged appropriately with group facilitators, peer support workers, and staff. His ongoing participation in therapeutic and recreational activities had strengthened his social skills and broadened his support network. He demonstrated improved comfort interacting with others in these less-formal, activity-based settings.

Overall, Mr. Martin seemed to be benefitting from positive peer interactions in structured and community settings, and ongoing opportunities to strengthen pro-social connections through programming.

Housing

Mr. Martin continued to live at York House in Acton, a 24-hour staff-supported group home operated by Summit Housing. Supports included medication monitoring by staff, assistance with ADLs as needed, and structure for meals, chores, and independent living skill development. Housing staff reported that Mr. Martin demonstrated good engagement, cooperative interactions, stable behavior, and positive contributions to household tasks. However, they expressed ongoing concern that he often spent extended time in bed and required prompting for morning engagement. Mr. Martin underwent a change in roommates during the year, and adapted to this change without conflict.

Mr. Martin remained on a waitlist for independent housing through HATCH. His CAMH team additionally continued to monitor for other housing vacancies that would meet his needs more adequately, given the opinion that his current housing provided more support to him than required, and also limited his ability to engage in rehabilitative activities due to its remote location.

Self-Care and Activities of Daily Living

Mr. Martin’s self-care remained stable and adequate over the past year. He consistently presented with good hygiene when attending FOPS and community programming. Housing staff reported that he manages basic personal care independently without prompting.

Mr. Martin was independent in managing his transportation needs. He travelled from Acton to CAMH using ODSP-funded taxis, and was fully capable of calling, arranging, and coordinating his own taxi rides without assistance from staff. He also managed his personal finances, including daily spending and budgeting, with minimal support.

MEDICATIONS

Paliperidone 100 mg intramuscularly every four weeks

Quetiapine 100 mg by mouth nightly

Rosuvastatin 10 mg by mouth daily

Mr. Martin received his antipsychotic injection at CAMH. His oral medications were dispensed by staff at his supportive housing.

MENTAL STATUS EXAM (December 2025)

Mr. Martin presented as well-groomed and appeared his stated age. His eye contact was limited, though he remained attentive throughout the assessment. He presented as guarded with limited spontaneous speech and he provided brief answers to questions. He became mildly irritable with certain lines of questioning. Overall, his affect was flat and restricted. His mood was usually described as “good.” His thought process was coherent, though he often provided vague answers to questions and did not elaborate. He frequently responded, “I don’t know.” He denied experiencing auditory or visual hallucinations and did not appear to be responding to internal stimuli. He denied experiencing any suicidal ideation, intent, or plan. He denied violent ideation. His insight into his mental illness and need for treatment was limited, but demonstrated modest improvements over the reporting period. His judgement was fair. His attention appeared grossly intact, but he appeared to have difficulty recalling events and timelines.

PSYCHOLOGICAL TESTING

Mr. Martin underwent a psychological assessment on February 6, 2024, with Bronwyn MacKenzie, M.C., RP, through the Forensic Consultation and Assessment Team (FORCAT) at CAMH. The following information is taken from Ms. MacKenzie’s psychological report following this assessment.

The WRAT-5 is a measure of foundational academic skills.

Mr. Martin completed the word reading, spelling, and math computation subtests from the Wide Range Achievement Test (WRAT-5).

The word reading subtest of the WRAT-5 (Wide Range Achievement Test) is a measure of basic reading achievement that is robust against the disrupting effects of the symptoms of major mental illness. Mr. Martin’s score on the Word Reading subtest placed him at the 21st percentile.

The spelling subtest placed him at the 1st percentile, and the math computation subtest at the 18th percentile. These scores indicate that Mr. Martin is reading at a grade 9 level, spelling at a grade 4 level, and solving math problems at the grade 5 level.

These scores indicate that Mr. Martin’s foundational academic skills are in the Low Average range (for basic reading and mathematics), and Mildly Impaired range (for spelling), for someone with a grade 12 education.

Mr. Martin’s scores are somewhat consistent with his educational background. He claimed that he was more interested in playing basketball in high school. However, according to the ORB Hospital Report, "despite a deterioration in his grades in high school, he never failed any classes or grades" and graduated.

The BCSE (Brief Cognitive Status Exam) is a subtest of the Wechsler Memory Scale-4 that is designed as a screening measure for basic cognitive functions including orientation to time, incidental recall, mental control, planning, visual perception processing, inhibitory control, and verbal productivity.

Mr. Martin’s performance on the BCSE indicated global cognitive functioning in the Very Low range as compared to other individuals of comparable age and educational background. Mr. Martin struggled with the Orientation, Mental Control, and Inhibition tasks despite his effort across all tasks.

According to the manual, "If an examinee falls in the Very Low classification, the individual has less than a 2% chance that his or her score is consistent with healthy controls. Scores in the Very Low range are often obtained by examinees diagnosed with dementia or mild to moderate mental retardation".

However, the authors also caution that, A practitioner should note that scores in the Very Low range have a high probability of being considered abnormal, although not specifically diagnostic, because a number of cognitive and non-cognitive factors might contribute to such low scores. Approximately 9% of healthy controls will obtain a score in the Borderline to Very Low ranges."

10. Regarding the issue of significant threat to the safety of the public, the relevant portions of the Hospital Report are set out below:

"RISK ASSESSMENT

Research has shown that actuarial methods of risk assessment are strong predictors of long-term violence risk across a range of populations and contexts. Actuarial methods provide probabilistic estimates of risk, based solely on empirically established relationships between a number of clinically relevant predictors and violent recidivism. Dynamic variables, as discussed below, are more associated with short- to medium-term risk and provide targets for appropriate and timely intervention strategies.

Psychopathy Checklist-Revised (2023)

For many years the term psychopathy was largely a lay term, poorly operationalized and understood. Over the past two decades, due largely to the work of Dr. Robert Hare and his colleagues in the construction and repeated validation of the Psychopathy Checklist-Revised (PCL-R), our understanding of psychopathy has been greatly enhanced. Psychopathy is the personality dimension felt to be most related to offending behaviour.

The “gold standard” for the measurement of psychopathy is the PCL-R. This is a semi-structured instrument that appraises individuals in 20 domains. Each domain may be scored 0, 1, or 2, thus rendering a total score on a continuum from 0 to 40, with 40 out of 40 points representing Dr. Hare’s conceptualization of the prototypical psychopath. All scores on this continuum are felt to be significant. Of note, the PCL-R is not a risk assessment tool per se, albeit it may be informative vis-à-vis an individual’s risk of re-offence.

The PCL-R was scored for Mr. Martin in 2023. Mr. Martin received a score of 13 out of 40 on the PCL-R. This score places him in the 14th percentile of male North American forensic psychiatric patients in the PCL-R standardization sample; that is, 14% of individuals in the standardization sample received a lower score (or, conversely, 86% of individuals received a higher score). Mr. Martin’s score on Factor 1 (i.e. the personality component) fell at the 17th percentile and his Factor 2 score (i.e. the lifestyle component) fell at the 25th percentile compared to male forensic patients.

Violent Offender Risk Appraisal Guide (VRAG) (2023)

The VRAG and SORAG generate statistical estimates of risk over 10 years of opportunity. Within this context, opportunity is defined as having community access outside a locked unit. High scorers on the VRAG or SORAG presented well enough to obtain such access, but long-term risk factors resulted in an increased likelihood of culminating in violent or sexual re-offending. Lower scorers have a low long-term risk of such re-offending, assuming that their dynamic risk factors are well and appropriately managed. Dynamic variables, as discussed below, are more associated with short term risk and provide targets for appropriate and timely risk intervention strategies.

The VRAG was scored for Mr. Martin in 2023. Mr. Martin’s score on the VRAG placed him in the 3rd of 9 ascending risk categories, or “bins” of risk for recidivism. Taking into account the estimated measure of error associated with the VRAG, Mr. Martin’s true score would be expected to fall within one risk category above or below this result (between Bin 2 and 4). Of those in the same risk category, 24% re-offended violently with 10 years of opportunity.

HCR-20 Version 3 (December 2025)

Structured clinical judgment is an approach to risk assessment that includes actuarial or historical risk factors as well as dynamic risk factors, and integrates both types of risk factors into a risk formulation or final risk judgement. This approach is employed in CAMH ORB reports. To guide this process, the HCR-20 V3 Structured Guide for the Assessment of Violence Risk was scored. The HCR-20 is intended for use with civil psychiatric, forensic, and criminal justice populations. There are 10 historical (H) variables, 5 clinical (C) variables, and 5 risk management (R) factors.

The HCR-20 V3 was scored for Mr. Martin in December 2025.

Historical (H) items that were rated as Present and of High Relevance were a history of problems with violence, employment, major mental disorder, and treatment or supervision response.

The Clinical (C) items that was rated as Present and of High Relevance was recent problems with insight. Recent problems with symptoms of major mental disorder was rated as Possibly/Partially Present and of High Relevance.

Under a continuation of the current Detention Order, Risk (R) items that were rated as Possibly/Partially Present were future problems with personal support (medium relevance) and stress or coping (high relevance). The other R items (future problems with professional services sand plans, living situation, and treatment or supervision response) were rated as Not Present and of Low Relevance. Of note, R items were unchanged when rated under the context of a Conditional Discharge.

SAPROF

The Structured Assessment of Protective Factors (SAPROF) is a violence risk assessment tool specifically developed for the assessment of protective factors for adult offenders. The tool was intended to be used in addition to risk focused structured professional judgment assessment tools, such as the HCR-20 V3. The SAPROF aims to contribute to an increasingly well-rounded assessment of risk for future violent behavior. The dynamic positive approach of protective factors aims to create new opportunities for effective and achievable treatment interventions. The SAPROF is suitable for assessment of both violent and sexual offenders. The SAPROF contains 17 protective factors organized into three scales. 15 of the factors are dynamic, making the factors valuable treatment targets and treatment evaluation measures. After recording the 17 items on a three-point scale (0-2), the assessor is asked to point out those items which are the most important protective factors for the assessed individual and his or her specific situation: Key-items (those items deemed the strongest protectors against violence risk) anGoal-items (those items deemed the most important targets for current treatment).

Mr. Martin's key protective factors include leisure activities, medication, attitudes towards authority, professional care, living circumstances, and external control. Possible areas/goals for improvement/treatment targets include coping, work, and motivation for treatment. Mr. Martin’s overall level of protection was judged to fall within the moderate range.

Re-offence Scenario

In risk assessment, one of the best predictors is a patient’s history. Mr. Martin’s index offence was violent and occurred in the context of psychotic symptoms. Prior to his jurisdiction under the ORB, even while well, Mr. Martin continued to resist psychiatric assessment and hospitalization, and presented with very poor insight into his illness and his likelihood of violence. Though gains have been made over the past reporting period with regards to Mr. Martin’s insight into his mental health needs and willingness to engage with mental health care, he continues to exhibit an overall limited level of insight, particularly into the role of antipsychotic medications in his stability and the risk of future violent incidents.

If Mr. Martin were to re-offend, it would likely be in the context of suboptimal supervision and medication non-compliance. If Mr. Martin were to discontinue his medications or resume the use of cannabis or alcohol, he would become increasingly unwell, with delusions, agitation, and impulsivity, and would be at heightened risk of acting out violently towards others, as was the case during the index offence.

Diagnoses

Schizophrenia

Schizophrenia is a major mental illness that tends to have its onset, in males, in the second or third decade of life. Once extant, schizophrenia is a lifelong illness. An individual with schizophrenia suffers from symptoms of psychosis. Psychosis is generally defined as the presence of delusions, hallucinations, grossly disorganized thought and behaviour, or some combination of these. Social and occupational decline are often prominent, as are a diminution of their motivation and self-care. The mainstay of treatment for schizophrenia is antipsychotic medication. This tends to ameliorate or ablate the more florid symptoms of psychosis in over 80% of individuals. Once this medication has had the opportunity to achieve this effect, multidisciplinary psychosocial rehabilitation is generally instituted to treat the other, aforenoted, residual symptoms of schizophrenia. The course of a schizophrenic illness may be adversely affected by psychosocial stress, an unstructured living situation, alcohol or street drug use, and non-compliance with psychiatric treatment, in particular pharmacotherapeutic treatment.

Mr. Martin has a longstanding history of schizophrenia. He initially presented with prodromal symptoms in his early twenties and subsequently developed psychotic symptoms that worsened with time. When ill, he experienced delusions of rat infestations, persecutory delusional beliefs, and irritability. His symptoms worsened in the context of cannabis use. While abstinent from recreational substances and on antipsychotic medications, though there have been significant improvements in his mental state, he is suspected to continue to experience residual symptoms of psychosis, including mild positive symptoms of psychosis, and prominent negative symptoms of psychosis such as flat affect, amotivation, and poverty of speech.

Cannabis Use Disorder, Moderate, in Sustained Remission

Alcohol Use Disorder, Severe, in Sustained Remission

According to the Diagnostic and Statistical Manual of the American Psychiatric Association – Fifth Edition (DSM-V) the essential feature of a substance use disorder is a cluster of cognitive, behavioural, and physiological symptoms indicating that the individual continues using the substance 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 include: impaired control, social impairment, risky use and pharmacological criteria such as tolerance and withdrawal. Early remission is defined as three months without any symptoms of the use disorder (except cravings), while sustained remission is defined as twelve months without any symptoms.

Mr. Martin has historically misused cannabis and alcohol. He began using cannabis at the age of 16 and his use escalated to daily heavy use, which exacerbated negative and likely positive symptoms of psychosis. Given negative effects of cannabis use, he stopped using cannabis at the age of 25, and his alcohol use escalated. He drank alcohol daily to intoxication and occasionally binged alcohol to the point of loss of consciousness. He stopped drinking alcohol at the age of 38 after being charged for driving under the influence. In the past, he continued to use alcohol and cannabis despite it causing him physical, mental health, and legal problems. He reported abstinence from alcohol and cannabis since 2018, and since coming under the auspices of the ORB regular urine drug screens (up until 2025) confirmed ongoing abstinence from recreational substances.

Composite Assessment of Risk

Mr. Martin was found NCR for a violent offence. He demonstrates limited insight into the need for ongoing medication and psychiatric care. He is generally guarded and not forthcoming with treatment providers, particularly in clinical environments. Given his previous illness state including paranoia, serious violence, and non-compliance with treatment, along with ongoing negative symptoms of psychosis, limited insight, and the need for antipsychotic treatment under substitute consent, it is our opinion that he represents a significant risk to the safety of the public absent ORB supervision.

Criminogenic Risk Factors and Risk Management

We propose the following plan to promote Mr. Martin’s well-being and manage his risk to public safety:

Mental Illness and Insight: Mr. Martin’s insight into his mental illness and the need for treatment remains limited, though it has been improving throughout his time under the ORB. He has been taking medications as prescribed, but maintains that he would stop medications if he was able to. He has a longstanding history of treatment non-compliance prior to the index offence. He has benefitted from psychoeducational programming to address his understanding of his mental illness and addiction, and risk of re-offence, and his treating team intends to continue this intervention over the upcoming reporting period.

Stress and Coping: Mr. Martin has previously evidenced difficulties with managing stress. Sources of ongoing stress may include efforts to optimize his educational and vocational pursuits, his ongoing involvement with the ORB system, and a possible transition to more independent housing in the future. Mr. Martin should continue to engage in psychoeducation and psychotherapy in order to increase his awareness of his emotional states, and to learn how to effectively cope with stress. His team has referred him for individual therapy for this purpose. His team will continue to encourage him to engage in vocational pursuits, further education, and structured recreational activities that promote well-being and personal achievement."

11. The recommendation of the treatment team is set out at the conclusion of the Hospital Report which is reproduced below:

"Recommended Disposition

Mr. Martin has had two consecutive successful years in the community, free of psychotic relapses, incidents of concern, or re-admissions. This stability has been mediated by administration of injectable antipsychotic medication under substitute consent, residing in 24-hour supervised housing with medication monitoring, receiving regular support from his outpatient forensic psychiatric team, and developing a weekly structured routine which includes therapeutic and recreational programming and volunteering.

When well, Mr. Martin is cooperative with services and has successfully sustained extended periods of stability without any positive psychotic symptoms. However, in the past, absent forensic psychiatric oversight and monitoring of medication compliance, his mental state has fluctuated and has culminated in numerous episodes of violence towards others.

Over the course of this reporting period, Mr. Martin’s insight into his mental health history and future treatment needs appears to have improved. Although he maintains a belief that he does not benefit from antipsychotic treatment and does not need to receive outpatient care from CAMH, he is reliable in attending all scheduled appointments, accepts antipsychotic injections, and has collaborated positively with his professional supports to increase his structure and routine. He demonstrates motivation to actively participate in therapeutic programs, and this type of programming seems to have resulted in progressive improvements in his insight. He has not used recreational substances, even after a prohibition on recreational substance use was lifted from his disposition. He has expressed an intention to maintain his current routine, living situation, and engagement with psychiatric treatment even if granted a Conditional Discharge.

For these reasons, the team is of the opinion that a Conditional Discharge is the necessary and appropriate, least onerous and least restrictive, disposition to ensure the safety of the public. Under such a disposition, Mr. Martin would continue to receive injectable antipsychotic treatment under the substitute consent of his sister. He would also continue to receive regular follow-up appointments with his outpatient psychiatric team, who could initiate increased monitoring in response to warning signs of a psychotic decompensation and could facilitate an inpatient admission under the Mental Health Act of Ontario if necessary.

Furthermore, Mr. Martin’s stated intent to maintain his residence in supportive housing with supervised medication administration would ensure that he had additional oversight from housing staff, who could notify his CAMH team if there were concerns about emerging psychotic symptoms, and would ensure ongoing compliance with oral antipsychotic treatment. If Mr. Martin is granted a Conditional Discharge, his team will begin the process of submitting referrals to civil psychiatric services in anticipation of an eventual Absolute Discharge, with consideration of initiating a Community Treatment Order (CTO) to ensure future medication compliance.

If a Conditional Discharge is granted to Mr. Martin, the team recommends that the disposition includes the following:

• Notify, in writing, the ORB and CAMH at least 24 hours in advance of any change of address or telephone number;

• Report to the person in charge of CAMH, Toronto, or his or her designate, not less than every two weeks;

• On his consent, shall take treatment as prescribed by the person in charge or his or her designate, pursuant to s.672.55(1) of the Criminal Code;

• If the accused is arrested pursuant to section 672.91 of the Criminal Code for a breach or anticipated breach of the terms of this disposition, he/she may under s.672.91(1)(b) of the Criminal Code be delivered to CAMH;

• Maintenance of the current clauses regarding a prohibition of weapons and a prohibition on contact with Ian Martin without prior written revocable consent."

12. In her oral testimony, Dr. Valoo was asked by hospital counsel why a conditional discharge was the necessary and appropriate disposition She reiterated that Mr. Martin has had a very successful year. His mental status had stabilized due in large part to his adherence with medication, as well as optimization of his routine and participation in programming both at CAMH and off site. He had attended for all his appointments, on time. There was no evidence of substance use.

13. Dr. Valoo opined that Mr. Martin “needs slightly less support” than what is offered by his current accommodation, York House in Acton, Ontario, which provides 24/7 supervision and support which is now “perhaps more than necessary”. For that reason, Mr. Martin is on the “wait list” for alternative accommodation with HATCH (Halton Access to Community Housing) where Mr. Martin would benefit from a location situated closer to programming.

14. In response to questions from Ms. Culp, Dr. Valoo explained that there are challenges to obtaining appropriate housing for Mr. Martin, who “ideally requires less supportive but still supportive housing, and that the CAMH team is considering a variety of options.

15. Asked if there was no residence clause being recommended, she opined that Mr. Martin had “no intention of going anywhere else” given the lack of alternatives and the fact that he values stable housing. She does not think he will move without warning and that he will cooperate with CAMH in the search for new accommodation.

16. Asked about the adequacy of the Mental Health Act in the event of decompensation, Dr. Valoo replied that Mr. Martin is on long-acting antipsychotic medication that controls his psychotic symptoms, that in the event of a relapse those symptoms would be detectable to residence and CAMH staff, and that Mr. Martin would likely cooperate with a return to hospital. Otherwise, the MHA is “sufficient”

17. In Final Submissions, counsel on behalf of the Hospital supported a Conditional Discharge with the addition of the police to the condition requiring written notification to the ORB and CAMH of any change of address or telephone number, as recommended by counsel for the Attorney General. In effect, both counsel for the accused and counsel for the Attorney General joined in that submission. As Ms. Culp put it, there has been no reoffence, no decompensation, and no non-adherence with medication for over 4 years; therefore, a conditional discharge is appropriate.

Analysis and Conclusions

18. The evidence establishes that Mr. Martin has a longstanding history of schizophrenia, as well as a lengthy history of inadequate or non-engagement with mental health supports and non-adherence to treatment. According to his sister, Mr. Martin’s psychiatric history prior to the index offence was problematic – over a period of approximately 20 years, she, her mother and her aunts attempted to get him treated. She described a pattern in which Mr. Martin was hospitalized, resumed treatment while in hospital and stopped taking medication once discharged. When ill, he experienced psychotic symptoms, including bizarre perceptual experiences involving rat infestations, persecutory and paranoid delusional beliefs and irritability. He would also act aggressively when unwell.

19. It was in this context that Mr. Martin committed the very serious index offence. His behaviour at that time was consistent with prior psychotic episodes, including one in 2015 when, while non-compliant with antipsychotic medication, he exhibited increasing paranoia and anger, and ultimately threatened his brother with a machete knife due to his delusional beliefs involving his brother. He was similarly unwell when he lunged at sister within days of the index offence and required rehospitalization for stabilization on medication.

20. Since that time, Mr. Martin has been adherent with treatment. He has not experienced any known periods of decompensation, and he has not required hospitalization.

21. It is true that all of this progress has occurred while Mr. Martin has been subject to the terms of his bail or the Review Board disposition. While it appears that neither order specifically mandated that Mr. Martin adhere to his medication regimen, it is apparent that Mr. Martin understands that non-adherence and/or non-engagement with psychiatric support services would likely result in foreseeable adverse consequences to him, including increasing oversight by the treatment team and/or rehospitalization.

22. It is also true that Mr. Martin continues to exhibit a limited level of insight into his illness and need for treatment. As recently as November 2024, when asked about his clinical course over the past year, Mr. Martin said that he “thought meetings with his forensic team helped, but that antipsychotic medications had not helped him at all. He said that he ‘possibly’ had schizophrenia, but he had not had any symptoms of psychosis in the past and would choose to stop antipsychotic treatment if he could.”

23. The oversight provided by a Review Board disposition is a key factor in ensuring Mr. Martin’s ongoing wellness and continued stability. Given his limited insight regarding his illness, the benefits of treatment and the link between his psychotic symptoms and his offending behaviour, absent a Review Board disposition it is possible that Mr. Martin would stop his medication and fall away from mental health care and that without treatment and appropriate connections to psychiatric services, Mr. Martin would, as in the past, become increasingly unwell with perceptual disturbances, paranoid delusions, misperception of threats and impulsivity. In this state Mr. Martin would be at heightened risk of acting out violently toward others, including as a means of perceived self-protection, as occurred at the time of the index offence and previously. As such, the threshold test for significant threat is met.

24. That said, for the reasons articulated in the Hospital Report and by Dr. Valoo in her testimony at the hearing, we are of the view that a detention disposition is no longer necessary and appropriate in the circumstances.

25. As set out in detail both in the hospital report and in Dr. Valoo’s oral testimony, the Hospital’s ability to approve Mr. Martin’s accommodation no longer remains a critical cornerstone of his risk management plan. At his current housing, Mr. Martin receives a high level of oversight and support from staff, including dispensing and monitoring of medication and encouragement of more independent functioning. At present, Mr. Martin remains on a waitlist for more independent housing in Halton. We agree that under a conditional discharge the CAMH team is able to provide a sufficient level of support in the search for a new residence. Given Mr. Martin’s continued and unbroken level of cooperation with his team it is no longer necessary that the Hospital maintains the ability to approve his housing or to rapidly readmit him to hospital (which can only occur under a detention disposition). The conditions being imposed together with the provisions of the Mental Health Act are sufficient for that purpose.

26. Accordingly, taking into consideration public safety (which is paramount), as well as Mr. Martin’s mental condition, his community reintegration and his other needs, we find that the necessary and appropriate disposition, which is also the least onerous and least restrictive in the circumstances, is a Conditional Discharge with the conditions set out in the Hospital Report subject to the addition of the police to those who are to be notified by Mr. Martin in writing, in advance, of any change of address or telephone number.

27. The panel wishes to express our view that, should Mr. Martin and his brother (the victim of the Index Offence) desire to resume contact with one another, it should be thoughtfully approached and informed by guidance from the treatment team as the team deems appropriate.

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

Hon. N. Kozloff Legal Member

__________________ Office of the Registrar Ontario Review Board