Re Mark R. Staikopoulos, 2026 CanLII 23905

Re: Mark R. Staikopoulos

ORB File No: 6750

Hearing held on: Monday, January 5, 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: Mark R. Staikopoulos Counsel: Mr. B. Funston

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

Attorney General of Ontario: Counsel: Mr. M. Feindel

REASONS FOR DISPOSITION

(Dated March 19, 2026)

Introduction

1On May 5, 2015, Mark Staikopoulos was found not criminally responsible on account of mental disorder (“NCR”) on a charge of assault causing bodily harm.

2Mr. Staikopoulos is currently subject to a Disposition of the Ontario Review Board dated January 6, 2025, discharging him on conditions, including, inter alia: a requirement that he live at a specific residence (Bailey House); a requirement that he report to the person in charge at the Centre for Addiction and Mental Health (hereinafter “CAMH”), Toronto, or his or her designate not less than once per week; a condition that he abstain absolutely from the non-medical use of alcohol or drugs or any other intoxicant; and, a requirement that, on his consent, he take medication and treatment as prescribed by his psychiatrist or as directed by the person in charge of CAMH.

3On January 5, 2026, this panel of the Ontario Review Board convened in person at CAMH to hold a hearing to review that Disposition. Mr. Staikopoulos was present and was represented by his counsel, Mr. B. Funston.

4The issues to be decided at this hearing were whether Mr. Staikopoulos continues to pose a significant threat to the safety of public and, if so, what is the necessary and appropriate disposition, considering the four factors of s. 672.54 of the Criminal Code.

5None of the parties contested a finding of significant threat, and the parties jointly submitted that the current conditional discharge with all of the conditions (including the consent to treatment condition) should continue for the coming year. Based on the evidence, we agree with the joint position of the parties both on the issues of significant threat and necessary and appropriate disposition. These are our reasons.

6With respect to background and the index offences, the following is extracted from last year’s Reasons for Disposition:

"Background and Index Offences

Mr. Staikopoulos is 42 (now 43) years old. He was born in Winnipeg and was adopted by his mother when he was 12 days old. By all reports, he had a happy childhood.

At 16 years of age, Mr. Staikopoulos exhibited a dramatic change in his behaviour. He presented as angry and abusive towards his mother and stepfather, and physically destructive toward property. Mr. Staikopoulos’ mother later reported that although her son first began exhibiting symptoms of mental illness at about this same time (in grade 10), she had been in denial about the possibility of him experiencing a mental illness for a number of years. When she eventually asked him to see a doctor he refused, saying that there was nothing wrong with him.

Mr. Staikopoulos reported that he first consumed marijuana at 13 or 14 years of age and alcohol at 16 or 17. He viewed substances as not being an issue for him. He reported that in grade 11 he began selling marijuana at school and engaging in theft. At 16 or 17, he had the first of several contacts with the police. When he was about 18, his mother told him he had to leave their home as he could not live by their house rules. He then lived in various shelters in Toronto.

Mr. Staikopoulos was first diagnosed with schizophrenia sometime between the age of 18 and 20 years old, as result of some odd behaviours while he was living at the Seaton House shelter. He was treated with olanzapine and received community support from COTA. In November 2003, when he was 21, Mr. Staikopoulos was taken by police to CAMH. He had reportedly smashed holes in walls, yelled at other residents and broken a window. He endorsed feeling paranoid that people were talking about him and watching him. He was diagnosed with schizophrenia and possible substance use disorder. On discharge he was referred to the CAMH First Episode Psychosis Program, as well as the LEARN program to address his goal of completing high school.

Over the 10-year period that followed, Mr. Staikopoulos was admitted to hospital multiple times after being brought in by police under the Mental Health Act. These admissions were frequently the result of Mr. Staikopoulos engaging in significant aggressive, bizarre, threatening and/or erratic behaviour in the community in the context of medication noncompliance and an exacerbation of his psychotic symptoms. He was also charged with and convicted of various offences, including break, enter and theft (in 2002) and assault (2003).

Mr. Staikopoulos also has some prior history with the ORB. In May 2010, he was charged with assault after he punched the victim (a co-tenant in his building) five or six times in the head (unprovoked), then fled the scene. The victim suffered bruising and swelling to his face. Mr. Staikopoulos reportedly believed the victim was a vampire and was trying to recruit him to his “witch team.” Mr. Staikopoulos denied substance use and medication noncompliance prior to the incident, although a supplementary record of arrest indicated that he had not taken his medication for approximately three months before that time. In May 2011, Mr. Staikopoulos was found unfit to stand trial in relation to the charge of assault and was remanded to CAMH on a treatment order. He was found fit to stand trial in October 2011, and returned to CAMH on a keep fit order. After being released on bail shortly after, he eventually completed mental health diversion and the charge was stayed in June 2013.

In April 2014, Mr. Staikopoulos was a resident of Regeneration House, a home for adults experiencing mental health difficulties. At that point he had been living at Regeneration House for approximately two years. On April 13, 2014, a female co-resident was walking to the common area in the home when she was approached by Mr. Staikopoulos who punched her in the head, threw her to the ground and began repeatedly kicking her head and body. At one point he jumped in the air and landed on top of her. She was rendered unconscious for a brief period of time. When staff arrived Mr. Staikopoulos attempted to evade them, kicking the victim and striking her in the head. Police were called and arrested Mr. Staikopoulos. The victim was transported to hospital and treated for her injuries, including various lacerations and bruising. These are the circumstances underlying the index offences. It should be noted that although the synopsis in the hospital report indicates that the victim was pregnant at the time, at a Review Board hearing in 2019, Crown and defence counsel agreed that was not the case.

Following the finding of NCR in May 2015, Mr. Staikopoulos initially resided in the community. However, he was admitted to CAMH in December 2015 following a decompensation in his mental state when he became increasingly hostile and irritable, and ultimately threatened to stab his treating psychiatrist in the eye. He remained an inpatient at CAMH until July 2021, when he was discharged to live at Bailey House, a residence that provides 24-hour supervised housing for persons experiencing mental health challenges and diabetes, with medication oversight and meals provided on site."

7At the current hearing, we received evidence in the form of the Hospital Report (Exhibit 1) and the oral testimony of Dr. A. Simpson, the attending psychiatrist of Mr. Staikopoulos. The relevant portions of the Hospital Report regarding the current clinical year read as follows:

"Current Clinical Year

FOPS December 2024-2025

Mr. Staikopoulos continues to reside at Bailey House, which is high support for people with diabetes as he has since 2021. There are housing staff during the day but not at night after meds have been given out. On nights there is a security staff present. He is seen weekly by his case manager and sees Dr. Simpson monthly.

Mr. Staikopoulos has metabolic disorder, obesity, and type 2 diabetes. As Bailey House is housing for people living with diabetes, they have a nurse practitioner from Parkdale Queen West who comes on site who manages the medical care of residents and provides health teaching. Mr. Staikopoulos has limited insight regarding his diabetes management and requires ongoing education and prompting. In January, the client was refusing to attend footcare. During the winter months he’s had a pattern where he tended to sleep in until the afternoon and thus miss his morning/lunchtime medications.

Mental Health Progress

He has been stable for this last year, saying that his mood is okay. He often talks about how he feels he’s doing well and will say things such as he’s working towards having good mental health and working to do what he can “to prevent a nervous breakdown” or "I'm trying not to have a nervous breakdown". This occurs particularly if suggestions about doing more activities are made. Mr. Staikopoulos is calm and pleasant most of the time but can be slightly irritable if the team or housing are trying to address something he doesn’t feel like talking about (e.g. hygiene or attending FOPS groups/outings).

Religion/spirituality is both the content of some of his hallucinations and a source of comfort for him as he often talks about church, spirituality and prayer as important to him and being a positive influence on his life. Sometimes Mr. Staikopoulos denies hallucinations and sometimes readily admits to having them. Housing staff report that he talks to himself at times. He says God communicates with him both verbally (voice) and non-verbally in his heart. The voices Mr. Staikopoulos usually reports hearing give him positive feedback and reinforcement and they are a source of comfort. He denies command hallucinations or content of a derogatory in nature.

Along with spiritual thought content, Mr. Staikopoulos will sometimes talk about things from fantasy and sci-fi movies as if they are real and talk about magic, dark forces, his clairvoyancy, being Shaolin, Master Yoda talking to him, Fantasia, Andromeda, and Teenage Mutant Ninja Turtles/Splinter. He has some disorganization of thought, especially when discussing things of a spiritual and/or psychotic nature. His thought process can be a little incoherent at times but usually the overall flavour is typically positive and pro-social. Mr. Staikopoulos often reports having "clear and positive thoughts" or “calm and clear thoughts” despite what he’s voicing being disorganized. He has occasionally told case manager that his thoughts were “a bit scattered.” A couple of times this year he talked about thoughts in his head that are not his. He did report having “bad thoughts” and had more psychotic disorganized thought content immediately after last year’s ORB. Mr. Staikopoulos shows partial insight at times and will agree that he has a diagnosis of mental illness, but has impaired insight in relation to the psychotic nature of his experiences.

Details of Issues from January to April:

Starting in January 2025, Mr. Staikopoulos started to experience issues with sleep. On January 3 he told case manager he hadn't slept in 2 days. On January 9, 2025, Mr. Staikopoulos met with Dr Simpson and said that he hadn’t slept for 2-3 days. He was elevated and talkative (more than usual) in the clinic and during the interview. He talked about not being able to sleep due to more thoughts and bad dreams. He voiced more psychotic content than usual and endorsed hearing voices. He asked for medication for sleep and Dr. Simpson prescribed a week of 50mg quetiapine at bedtime for a week which continued.

On January 24, 2025, Mr. Staikopoulos reported taking the quetiapine daily. He said it helped him sleep most nights but there were a few nights where he didn't get to sleep until later. He wanted to end the meeting as soon as it began and a little guarded with regards to cleaning and his mother. Housing expressed concern regarding his room and hygiene. The cleaner wasn't able to do the floor because of the bags of clothing all over the floor. There was a bucket of urine in client’s room. Mr. Staikopoulos’ housing worker reported that he had been wearing dirty clothing, had been malodourous, and was letting his hair get matted again.

On January 27, 2025, Mr. Staikopoulos told Dr. Simpson he wanted to continue with his 50mg quetiapine. The team tried to address the hygiene issues raised by his housing staff and he was reluctant to discuss this but did begrudgingly agree that he would try and organize his clothing and would not keep urine in his room.

On January 31, 2025, Mr. Staikopoulos’ housing worker reported that he was still distant, dismissive and slightly irritable with her and other staff and this had been going on for a few weeks. His housing worker said he smelled of vomit one day and she asked him about it but he denied vomiting or feeling sick. On January 30, the evening staff on shift made multiple attempts to get him to come downstairs for his clozapine but he was dismissive and didn't come down for meds. The staff later had to go to his room with the security to give it to him. Housing staff also observed Mr. Staikopoulos rubbing the head of another resident. When a staff asked what he was doing Mr. Staikopoulos told her he was healing the other resident. Housing staff said the other resident was just sitting there and seemed to be enjoying it so they didn’t intervene. When his case manager spoke with him about the incident, he became a little irritable and dismissive. He said he felt the case manager was criticizing him and not providing positive feedback. He began to escalate a little and was talking over his case manager. He later calmed down but remained guarded.

In February 2025, housing staff reported that Mr. Staikopoulos was still a little irritable, not doing laundry/wearing dirty clothes, and staying in his room. They had to give multiple reminders and having to go get him so that he would take meds. They said even though he was struggling with hygiene during periods like this, he was not causing trouble in the house. One significant change was that Mr. Staikopoulos said he was open to the idea of moving to a bigger room (he had refused for a few years) and he did move to a bigger room with his own private washroom. After the move, Mr. Staikopoulos reported getting up earlier and feeling better in his new room. His sleep and hygiene seemed to be doing a bit better after moving to the bigger room.

In March, he reported "scattered thoughts". He talked about focusing on one thought for the day that helps connect him to the other thoughts. He reported hearing voices telling him bad things about his case manager and Dr. Simpson. He said they were trying to get him not to like case manager and Dr. Simpson but he knew the things the voices were saying are not true. He reported he heard a voice tell him his mother called the police and doesn't want him calling her. Mr. Staikopoulos said there was something important and disturbing he wanted to tell Dr. Simpson on Tuesday. He did not want to tell case manager alone as he felt Dr. Simpson should be there to provide support to the case manager and himself. He said he might have to notify police and the fire department and other officials. He talked about not being allowed to use marijuana or alcohol but that they would help cleanse his eyes and soul. He talked about his soul being in pain. He said he saw his friend, "Master Splinter", earlier that day. The case manager asked if Splinter was a person or in rat form. Mr. Staikopoulos said Splinter can take on many forms. The case manager asked if she or others would have been able to see Splinter or just him. He said he and God can see Splinter but case manager might be able to if she has a pure heart. Mr. Staikopoulos said, "I'm from different dimensions". He said sometimes he thinks the person in the bedroom next to him is Master Yoda. Overall Mr. Staikopoulos was elevated and unusually forthcoming regarding his psychotic thought content. Housing staff reported that he had been in a good mood and was not causing problems.

On March 11, 2025, Mr. Staikopoulos came in to see Dr. Simpson. Mr. Staikopoulos reported no sleep for last few days. He asked for antipsychotic medication, although he stated that he was "not a psychotic person". He denied feeling paranoid about others and said he felt safe at his housing. He talked about hearing God and said that he got a message from God that his mother might not be good. He referred to his mother as having done many bad things to him in the past, including chaining him down and subjecting him to torture and burns, lying about him to authorities and calling the police about him. He was not wanting contact with her. A clozapine level was taken on March 11 to see if there was room to increase his clozapine. His clozapine level was low but the team later found out that Mr. Staikopoulos may have missed his clozapine on March 10 (there was some confusion about this) which may have been the reason he reported that he hadn’t slept well when he came into the clinic on March 11 and his level was low. As a precaution his level was taken a second time and it also showed room for an increase. It was decided to increase client’s clozapine by 25mg.

In all he missed clozapine doses on February 8, 2025, and March 14, 2025. He required considerable encouragement to take meds on other dates over this period.

On April 14, 2025, Mr. Staikopoulos saw Dr. McMaster (covering for Dr Simpson) and said, "I like to think I am doing quite well". He said his mood was "good, improving every day". He denied that others are bothering him and denied perceptual abnormalities or referential delusions. However, he expressed a fair bit of delusional thought content; he said that there is someone is at his building named "Michel or Lee, two different guys that live at the building, the same person... they are Shang-Tsung from Mortal Kombat". He said he knows this because it is his "instinct" and that they have bothered him in the past. He denied that he would try to hurt him or them. When asked re: magic or sorcery occurring, he said, "behind closed doors". When asked if others are controlling his thoughts, he responded, "I would not let that happen". He said the "same guy" is doing that to him (Michel or Lee).

On April 17, 2025, housing staff reported no concerns and said Mr. Staikopoulos’s mood has improved recently and medication changes implemented. After the medication changes in April happened his sleep patterns improved, his mood seemed improved, overall, there was fewer delusions voiced, and he was more willing to have contact with his mother. Through May and June, he remained stable.

On June 30, 2025, Mr. Staikopoulos said he would like to request some more medication. When asked what is the issue that he wants to address he said, "Something to help with calm and clear thoughts.... maybe Advil or Tylenol". When asked if his thoughts had changed recently, he said no but he would like to see if they could be more positive and "blue skies and fluffy clouds". The case manager clarified if he wanted to see if there could be further improvement in his thoughts and he said yes. On July 8 Mr. Staikopoulos brought this up with Dr. Simpson. He asked Dr. Simpson about medications that would allow him to think more about blue skies and positive thoughts. Dr. Simpson explained that the medication was largely helpful for keeping bad thoughts at bay which frees him to think about the good things. Mr. Staikopoulos remained stable with good sleep patterns and hygiene throughout the summer months and into the fall. In November housing staff reported that sometimes he can be "moody" or "abrupt" but they just give him space. No further issues were reported.

All UDS results were negative this year. On January 9, 2025, Mr. Staikopoulos was overheard talking to another client in the FOPS clinic about marijuana and he was overheard telling her. "I can get you some". He has consistently denied cravings or substance use but a few times he made comments about not being allowed to use marijuana or alcohol but that they would help cleanse his eyes and soul. He also mentioned that he would like to be able to use marijuana some day because sometimes his soul is in pain and he feels it would help.

Mr. Staikopoulos reports showering and doing laundry and he often expresses pride in his self-care and talks about how showering and clean clothes makes him feel good. His self care improved over the year, though he is sometimes malodourous and wears dirty clothing. Over the year his hygiene and laundry improved along with his sleeping patterns and getting up earlier.

There were no reported issues with finances.

Mr. Staikopoulos sometimes voiced resentment towards his mother. Earlier this year when Mr. Staikopoulos was voicing more delusional content, he also voiced negative feelings and delusions regarding his mother and said that God told him she might be a bad person, and that she had tortured him and had told police she didn’t want him calling her. As the year progressed these reports lessened and he has been in semiregular phone and in person contact with her. She remains involved with him and concerned about him. Even when Mr. Staikopoulos has been refusing contact with his mother, he has continued to call his mother’s brother. The uncle visited Mr. Staikopoulos in September and installed coat hooks in client’s bedroom.

Mr. Staikopoulos reports going for walks, out for coffee, and for monthly free dinners at Parkdale United Church or a Seventh Day Adventist church which he reports enjoying. He attends a weekly music group at housing where a volunteer will come and play guitar and sing for them. He also attends BBQs and parties at his housing. He has refused to attend FOPS outpatient programming.

Mental Status Examination

When seen most recently in December, Mr. Staikopoulos presented on time, cooperative and somewhat better groomed than usual. He had new clothes for the winter that he took pride in. His manner was warm and rapport good.

He spoke of his last month, of regular attendance at the music group and monthly church dinner with a friend from his housing. There was no abnormality of speech.

He continues to experience ongoing psychotic symptoms as described above, sometimes experiencing negative feelings of dark forces or bad spirits. He feels he needs to manage his feelings so as to not have a “nervous breakdown.” He talked of reading more, about 30-40 minutes per day. He is currently reading the autobiography of a basketball player that he finds uplifting. He denies feelings of direct threat from others in his housing, or the need to act violently. He thought form is slightly vague, but no major thought disorder.

He denies perceptual abnormality currently, although some of his experiences of “dark spirits” are things he sees.

He is oriented. In terms of insight, he is happy with his medication, sees himself as a “team player” with us in his own well being.

Current Medications:

Clozapine 425mg po at 19:00

Quetiapine 200mg po qHS

Dapagliflozin/Metformin combo 5/1000mg at noon and dinner

Insulin Glargine 100iu/ml, 60units subQ qHS

Rosuvastatin Calcium 5mg po qHS

Semaglutide 1mg subQ once a week on Fridays"

8With respect to the issues of significant threat and the necessary and appropriate disposition, the relevant portions of the Hospital Report are set out below:

"RISK ASSESSMENT

Structured Clinical Judgment

Mr. Staikopoulos was scored on the HCR-20 V3, an instrument that uses structured clinical decision-making to assess an individual’s future risk of violence. The HCR-20 is based on a systematic consideration of both static and dynamic factors that the literature has shown to be empirically related to violent recidivism. It contains 20 risk factors across three subscales: 10 items consider historical or static factors, 5 consider current dynamic factors, and 5 consider future dynamic risk-management factors. The purpose of the HCR-20 V3 is to structure clinical decisions about the likelihood of violent behavior rather than to generate a numerical score or probability, and also to inform risk-reducing treatment and management decisions.

Mr. Staikopoulos was rated on the HCR-20, Version 3 on 1/12/25 by the clinical team. Historical items that are present, and relevant, included a history of problems with violence, major mental disorder, substance use, treatment/supervision response, relationships and employment. The primary clinical items deemed present, and relevant ongoing symptoms, problems with insight (mental disorder), and treatment response. This is unchanged from last year with improvement in stability and insight. In the context of the recommended disposition (conditional discharge), risk management factors deemed present, and relevant, are treatment/supervision response, stress/coping, and personal supports. His HCR score has been stable this last year after last year’s slight decline secondary to his relapse in THC use, brief non-compliance and readmission in 2024. 2025 was notable for some struggles with his mental stability but without non-compliance or need for readmission.

SAPROF

The Structured Assessment of Protective Factors (SAPROF) was developed for the assessment of protective factors for adult offenders. It was intended to be used in addition to risk focused structured professional judgment tools, such as the HCR-20. The SAPROF contains 17 protective factors organized into three scales. 15 of the factors are dynamic, making them valuable treatment targets and treatment evaluation measures.

Mr. Staikopoulos’ key protective factors include professional care, living setting and external controls in a background of secure attachment in childhood and intelligence. Goals areas to increase protective factors include life goals, stress and coping, understanding medication and treatment and greater internalisation of his motivation for treatment (physical and mental) and rejection of substance use. His overall protection is in the moderate range, with both internal and external protection.

Re-Offence Scenario

If Mr. Staikopoulos were to reoffend, this would likely transpire as a result of an exacerbation of his symptoms of schizophrenia, perhaps due to non-compliance with medications or cannabis use. This would likely result in delusional misinterpretations and persecutory delusions, as well as an increase in intensity and frequency of his auditory hallucinations. As a result, he would likely experience fear and agitation resulting in violence as a means of protecting himself, or anger with an inability to rationally appraise the situation and act accordingly.

PSYCHIATRIC IMPRESSIONS AND RECOMMENDATIONS

3. Diagnoses

Schizophrenia

Polysubstance abuse disorder, sporadic use of THC

4. Composite Assessment of Risk

Mr. Staikopoulos ratings on the HCR-20 Version 3 and clinical progress as assessed using the DUNDRUM 3 and 4 are consistent with a profile of a man at moderate medium to long term risk related to persisting positive symptoms of his illness but showing shorter term reduction in risk levels as he has successfully progressed to community living and shown the ability to demonstrate stable behavioural and interactive style. This is showing slow but steady consolidation. He had a few months of less stability but not to the point of requiring readmission this year, and worked effectively with staff. His behaviour can continue to be influenced by psychotic symptoms and he has limited ability to cope with external demands. He has limited understanding of his illness and risk, coupled with ongoing symptoms and limited coping ability supports that in totality, the clinical team opines that Mr. Staikopoulos continues to remain a significant threat to the safety of the public as defined in Section 672.5401.

5. Risk Management

a. Major Mental Illness (Schizophrenia)

Mr. Staikopoulos has suffered from symptoms of schizophrenia since early adulthood, resulting in significant functional impairment and multiple hospitalizations. When unwell, he experiences religious and grandiose delusions, auditory hallucinations, and disorganized behaviour, with ongoing persisting symptoms even when on his current best treatment regime. His illness is difficult to treat, and did not respond to multiple medication trials. Fortunately, he has responded well to clozapine, with significant improvement in his symptoms and some functional recovery albeit he continues to experience symptoms of psychosis.

He would benefit from remaining on clozapine indefinitely, with close monitoring and psychiatric follow-up, and help him cope with persisting positive psychotic symptoms.

b. Substance Use Problems

Mr. Staikopoulos has not had a clear history of consistent substance use in the past to warrant a frank diagnosis of an abuse disorder but has used cannabis twice in the last three reporting years. Periods of acute psychosis and behavioural dyscontrol have been attributed to comorbid substance use this year, particularly cannabis. He should remain abstinent from the use of alcohol, illicit drugs, or non-prescribed medication. He will continue to receive random urine drug testing.

c. Personality traits/Impulsivity/Destabilizers/Stressors

Mr. Staikopoulos has a history of problematic cognitions and behaviours which are relevant to risk. These traits tend to manifest when Mr. Staikopoulos is subject to destabilizers and stressors, and have been less evident of late. Mr. Staikopoulos will receive support in improving his ability to manage stressors. Future planning should be geared toward realistic and attainable goals.

d. History of Non-Compliance with Psychiatric Treatment/Limited Insight

Our principal risk management strategy in this area has been ongoing monitoring, supervision and psycho-education. Clozapine is provided in suspension and dispensed under staff supervision. Mr. Staikopoulos is seen on a frequent basis with regular reviews and mental status examinations, and ongoing building of trust to enhance understanding of his illness and assist his coping styles. Urinalysis and blood work for metabolites and levels of his clozapine continue and are viewed as essential."

9The recommendation of the treatment team is set out at pp. 45-46 of the Hospital Report:

"Team Review of Recommendation

The clinical team is pleased to have supported Mr. Staikopoulos in another year of community living. He had one readmission under the Mental Health Act after use of cannabis, missed medication and a worsening of psychotic symptoms in 2024. He has major issues with both his diabetes and mental health needs and feel his current housing is very well suited to his needs.

The team recommended and he was granted a conditional discharge last year. He had had one readmission and we found that the Mental Health Act was effective for ensuring rapid return to hospital and an effective return of his usual level of function, as we opined last year. He remains sensitive to stress and behaviour remains influenced by psychosis but not in an aberrant manner in terms of behavioural dyscontrol. We feel that on balance a conditional discharge continues to be necessary and most appropriate disposition to manage his risk and recovery needs.

His conditional discharge should continue to have the following stipulations: namely accommodation at Bailey House, a consent to treatment clause, a condition that he abstain absolutely from the non-medical use of alcohol or drugs or any intoxicant, ongoing urine monitoring and continuance of weekly reporting. He does best with higher frequency but low intensity clinical oversight.

We also recommend a condition that if he is arrested pursuant to section 672.91 of the Criminal Code for a breach or anticipated breach of the terms of this disposition, he may be under s.672.91(1)(b) of the Criminal Code be delivered to CAMH. Victims related clauses (4 (c) and (d) in his disposition) should continue."

The Oral Testimony of Dr. Simpson

10In response to questions from counsel for the Hospital, Dr. Simpson stated that Mr. Staikopoulos had a more stable and successful year with no readmissions and no substance use. He had some issues with sleep which resolved. He moved to a larger bedroom and his ADLs improved. He presented with some paranoid experiences (religious and spiritual) as well as various auditory and visual hallucinations. All of his drug screens (UDS) were negative. Mr. Staikopoulos displayed a positive outlook and has a positive relationship with his treatment team. Dr. Simpson opined that despite his fragility his positive attitude is impressive.

11In response to questions from Mr. Feindel regarding abstinence from substance use, Dr. Simpson explained that while he knows it is required of him Mr. Staikopoulos occasionally raises the possibility of using substances even though he appreciates that it (abstinence) is for his wellness.

12With regard to his refusal to attend for programming, Dr. Simpson (who had earlier observed that given his need to stay calm and in control, there were limits to how much activity and programming Mr. Staikopoulos can cope with) opined that he should not be required but rather encouraged to attend (for programming).

13In response to questions from the panel, Dr. Simpson confirmed that while there were no issues (during the current year) regarding either his adherence with antipsychotic medication or his abstinence from substance use, both the treatment clause and abstinence clause should be kept as is, given the history, stated desires, sensitivity to change and level of psychosis of Mr. Staikopoulos.

Analysis and Conclusions

14As stated at the outset of the hearing, none of the parties contested a finding that the test for significant threat is met, and they provided a joint submission that the current disposition should continue. We agree.

15In Winko, the Supreme Court of Canada outlined 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 accused’s own plans for the future, the support existing for the NCR accused in the community, and most importantly, the recommendation provided by experts who examined the NCR accused. In coming to our conclusion in this matter, the Board relies on the uncontradicted expert evidence of Dr. Simpson as well as the documentary evidence before us.

16Mr. Staikopoulos’ current diagnoses include schizophrenia and polysubstance abuse disorder (sporadic THC use). The symptoms of schizophrenia he has experienced since early adulthood have resulted in significant functional impairment and multiple hospitalizations. Historically, he has engaged in significant aggression and violence in the context of medication noncompliance and exacerbation of his psychotic symptoms, including at the time of the very serious index offence.

17Mr. Staikopoulos has responded well to clozapine. There has been a significant improvement in his symptoms and functioning; however, he continues to experience symptoms of psychosis, and his understanding of his illness remains limited. Mr. Staikopoulos continues to engage well with the treatment team. There have been no instances of non-adherence with anti-psychotic medication and no further indications of drug use. All of this is positive.

18However, given his history of non-adherence with medication and substance use, and his limited understanding of his illness and risk coupled with ongoing symptoms and limited coping ability, there remains a real risk that were Mr. Staikopoulos to be no longer subject to the oversight and supervision provided by the team pursuant to a Review Board disposition, he would (as in the past when on his own in the community) become non-adherent with medication and/or resume his cannabis use. We are satisfied that this would likely result in an increase in his delusional misinterpretations and persecutory delusions, as well as an increase in the intensity and frequency of his auditory hallucinations. As a result, Mr. Staikopoulos would likely experience fear and agitation resulting in violence as a means of protecting himself, or anger with an inability to rationally appraise the situation and act accordingly. (Hospital Report, p. 38).

19We have found that Mr. Staikopoulos poses a significant threat to the safety of the public. We are also satisfied on the evidence before us that the current disposition is the necessary and appropriate, least onerous and least restrictive disposition to manage the risk that Mr. Staikopoulos poses to public safety. This is so for the following reasons.

a. when the treatment team viewed readmission as necessary in May 2024, the Mental Health Act was effectively utilized to return Mr. Staikopoulos to hospital, maintain him in hospital until he was stable and back to his usual level of function, and allow him to return back to his community placement.

b. Bailey House provides the necessary structure and supervision to manage Mr. Staikopoulos’ risk while living in the community.

c. Mr. Staikopoulos, although incapable of consenting to treatment, remains willing to consent to the continued inclusion of a treatment condition, which is necessary to ensure his continued adherence with medication. As required, Mr. Staikopoulos understands the proposed treatment condition and the consequences of noncompliance with that condition: See Ohenhen, 2018 ONCA 65, at paras 57-58; Re Lawrence, [2020] ORBD 994.

20To summarize, the Board agrees with the joint submission that Mr. Staikopoulos remains a significant threat to the safety of the public. Moreover, upon considering all of the relevant factors including public safety, which is paramount, as well as Mr. Staikopoulos’ mental condition, his reintegration into the community and his other needs, we agree that the current conditional discharge is the necessary and appropriate, least onerous and last restrictive disposition for the coming year, and we so order.