Re Alexis C. Akonobi, 2026 CanLII 26876

Re: Alexis C. Akonobi

ORB File No: 8674

Hearing held on: Monday, March 9, 2026

Place of hearing: St. Joseph's Healthcare Hamilton West 5th Campus, 100 West 5th Street

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

Before: Alternate Chairperson: Ms. C. Fromstein Members: Dr. S. Bouskill (via Zoom) Dr. P. Wright Mr. M. Garfield Mr. S. Doherty

Parties Appearing: Accused: Alexis C. Akonobi Amicus: Mr. R.W. Browne The Person in charge of Hospital: Counsel: Mr. S. O’Brien Attorney General of Ontario: Counsel: Ms. C. Gzik

REASONS FOR DISPOSITION

(Dated: March 26, 2026)

Introduction

1. On November 21, 2024, Alexis Akonobi was found not criminally responsible on account of mental disorder (“NCR”) on charges of Possession of a Weapon for a Dangerous Purpose and Assault with a Weapon, both contrary to the Criminal Code of Canada.

2. She is currently subject to her initial Disposition of January 15, 2025 by the Ontario Review Board (“Board” or “panel”) detaining her at the Forensic Psychiatry Program of St. Joseph’s Healthcare Hamilton (“St. Joseph’s” or “Hospital”), with privileges up to and including “hospital and grounds, indirectly supervised” and “to enter the community of Southern Ontario, accompanied”.

3. Ms. Akonobi’s next review Board hearing was scheduled for January 26, 2026, but was adjourned. Ms. Akonobi had not heard from her counsel, Russell Browne, who had not yet been retained. Ms. Akonobi indicated that she wanted to represent herself. The panel adjourned on that day to March 9, 2026 and appointed Mr. Browne as amicus counsel. Ms. Akonobi was advised that she still could choose to self-represent after meeting with Mr. Browne.

March 9, 2026 Annual Review Hearing

4. The Board convened a hearing on March 9, 2026. Ms. Akonobi was present and indicated that she chose to represent herself and did not object to Mr. Browne acting as amicus counsel.

5. The issue at this hearing is whether Ms. Akonobi continues to represent 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, taking into account the factors listed in s. 672.54 of the Criminal Code. If she is found to not pose a significant threat to public safety, then an Absolute Discharge Disposition must be granted.

6. For the reasons set out below and based on the expert evidence before it, the panel has determined that Ms. Akonobi continues to represent a significant threat to the safety of the public. The Board has further decided that her risk could be best managed with a continued Detention Order at St. Joseph’s on the current, plus additional, terms and conditions as found in the Board’s new Disposition Order dated March 17, 2026. The panel finds that this is the necessary, appropriate, least restrictive and least onerous Disposition in the circumstances.

Index Offences

7. The circumstances of the index offences may be found at page 3 of the Hospital Report as follows:

“On Sunday May 26th, 2024, the accused, Alexis AKOBOBI while in her residence located at B[…] Drive unit […], in the Town of Oakville did possess a weapon in the form of a knife and used it to threatened [sic] her roommate NL with a knife.

The accused got into an argument with her roommate in regards to the air conditioning being turned off. The accused then got upset and went and grabbed a kitchen knife and a balloon. The accused then stated to her roommate "that if she does not turn on the air conditioning then her and her family are in trouble and that they are not in my kingdom". The accused then used the kitchen knife to stab the balloons and her roommate ran up to her son's room where they secured the door and called Police at 6:24 PM and waited for Police to arrive.

At 6:37 PM Police arrived on scene and conducted call outs in attempts to get the accused to come out of the residence peacefully. The accused failed to comply with demands, so Police entered the residence and located the accused in her bedroom on the third floor. The accused then took a fighting stance to which the accused resisted arrest but was subsequently arrested at 6:50 pm.”

Current Psychiatric Diagnosis

8. Schizophrenia

Initial Position of the Parties

9. Counsel for St. Joseph’s stated at the outset of the hearing that the Hospital believes that Ms. Akonobi remains a significant threat to the safety of the public and that the Detention Disposition should continue, with recommended changes. These changes include the deletion of urine/breath testing clauses plus additional terms and conditions geared toward the future goal of transitioning her to living in the community. The other parties agree with those positions. All parties maintained the joint position in final submissions.

Background Information of Ms. Akonobi

10. The background information is derived from the current Hospital Report and the Board’s Reasons for Disposition dated January 27, 2025.

11. Ms. Akonobi is a 41-year-old woman born in Nigeria. She came to Canada in 2003 to attend university where she graduated with a Bachelor of Nursing degree with Honours and worked as a nurse in Alberta. She married her husband in 2010 and moved to Toronto and began working as a nurse at Waypoint Centre for Mental Health Care, Forensic Program in Penetanguishene.

12. Ms. Akonobi experienced her first psychotic episode during a visit to see her family in Nigeria in 2011. She was hospitalized there as a result. “According to health records, Ms. Akonobi was reported to have attempted suicide on three occasions by jumping out of her third story hospital room in Nigeria.”

13. She was hospitalized in Ontario when she returned. She went back to Alberta in 2012 to work with geriatric patients. She had a psychiatric admission to a hospital in Calgary that autumn “after a few months of erratic and impulsive behaviour...”

14. Ms. Akonobi returned to Ontario to be with her husband after her 2012 hospitalization. Several hospitalizations followed. Her husband sought a Form 2 Order when his wife missed her monthly injection of anti-psychotic medication.

15. In June 2022, their marriage ended. Ms. Akonobi had struggled to find stable housing for two years and had utilized shelter beds.

16. Two community treatment orders were issued in 2023 and 2024 to assist Ms. Akonobi in adhering to her medication regimen. “In both cases, Ms. Akonobi did not follow up with her appointments and could not be located by the respective clinical teams.”

17. The index offences took place on May 26, 2024. The following day she was escorted by police to the emergency room at Oakville Trafalgar Memorial Hospital after being charged and “presenting with symptoms of psychosis (auditory hallucinations, grandiose and religious delusions, disorganized behaviour and selective mutism).” On July 2, 2024, she was released into police custody.

18. Ms. Akonobi was admitted to St. Joseph’s on July 31, 2024. She was returned to the Hospital on a Warrant of Committal following her NCR finding by the Court. The Hospital Report notes that she continued to say that she was communicating with Jesus and hearing Jesus’ voice and that she is the wife of Jesus. On August 8, 2024, she made homicidal threats to her treating physician at St. Joseph’s. Also noted: “The hospital report notes that she continues to exhibit symptoms which resemble those present during her index offences and initial admission.”

19. Ms. Akonobi has no prior criminal history. She does not use alcohol, tobacco or illegal substances.

Evidence at the Hearing

20. The Board had available to it the documents forming the Record, the Hospital Report dated December 30, 2025 as a filed exhibit (“Hospital Report”), and the oral testimony of Dr. O. Kolawole, the attending psychiatrist and co-author of the Hospital Report. No other evidence was before the Board.

Hospital Report

21. “Part IV: Current Hearing” of the Hospital Report covers the period between January 28, 2025 to October 30, 2025. Under the “Psychological Risk Assessment Note” it states that the most recent psychological risk assessment was completed in December 2024:

“At this time, her treatment team is recommending a continuation of her Detention Order disposition with the possibility of living in the community. Ms. Akonobi’s mental status is considered to be at baseline and there have been no enduring changes in her clinical presentation or risk factors…The results of the psychological risk assessment completed in 2024 remain valid.”

22. At page 28 the Hospital Report quotes the following from the December 2024 risk assessment:

“After reviewing risk and protective factors relevant to Ms. Akonobi, her risk for reoffending is considered to fall in the low-moderate to moderate range while under the strict supervision of a Detention Disposition…However, if legal and medical oversight was decreased or removed, her risk of reoffending increases to the high range. The primary factors driving this risk categorization are her diagnosis of Schizophrenia, as well as her lack of insight about, and history of problems complying with treatment and supervision efforts to address the same.”

23. The Hospital Report’s “Clinical Risk Summary” at page 29 states in part: “Over the reporting year, Ms. Akonobi’s course has been characterized by both periods of stabilization and a significant setback related to medication nonadherence.” (Dr. Kolawole testified about this, referred to later in these Reasons.)

24. And written further:

As a result of her “rocky” early adjustment period, “her treatment was transitioned to long-acting intramuscular antipsychotic medication…, to which she has been cooperative. Following this change, her mental state progressively improved and she is now considered back to her baseline, though she continues to endorse chronic residual psychotic symptoms, predominantly religious delusions.” The Hospital Report notes that she has maximized her current privileges. It further opines: “The treatment team continues to view her as meeting the threshold for significant threat to public safety, and recommends continuation of the Detention Order with additions that would permit a carefully structured step toward community living with intensive oversight.”

“The treatment team recommends continuation of the current Detention Order dated January 15, 2025, with the following additions to support a gradual and carefully monitored pathway toward community living. These conditions are recommended to ensure that any increased liberty occurs within a framework that maintains robust supervision, supports adherence to treatment, and mitigates relapse-related risk.”

25. The Hospital’s concluding recommendations at page 32 endorsed the treatment team’s opinion stated above for the continuation of the current January 15, 2025 Detention Order with the following five additions:

i) To enter the community of Southern Ontario, indirectly supervised;

ii) Passes to enter the community of Southern Ontario, for up to 7 days, accompanied by staff or a person approved by the person-in-charge;

iii) Passes to enter the community of Southern Ontario, for up to 7 days, indirectly supervised;

iv) To live in the community within the catchment area of St. Joseph’s Healthcare Hamilton, West 5^th Campus, in accordance approved by the person-in-charge;

v) When living in the community, report to the person in charge of St. Joseph’s Healthcare Hamilton, West 5^th Campus, not less than four times per month.

26. At the hearing, Counsel for St. Joseph’s indicated that it omitted to include in the Hospital Report two terms and conditions from the January 15, 2025 Detention Order that it wanted to remove going forward: specifically, paras. 3(b) and 4(a) requiring random urine/breath samples for substances. There is no indication of past or present substance abuse issues for Ms. Akonobi. All of her screening tests have come back negative. (The Hospital acknowledged at the hearing that there was a mistake at page 23 where it stated “most” of her drug and alcohol screenings came back negative.)

Dr. Kolawole’s Testimony

27. Dr. Kolawole adopted the contents of the Hospital Report. He reiterated the statements in the Hospital Report that Ms. Akonobi had a “mixed year in terms of treatment and progress.” The first six months were more challenging when she was transferred to her current unit. She evidenced a deterioration as documented at pages 23-25 of the Hospital Report. But with the change in her psychiatric medication to intramuscular injections, the team saw a significant improvement in her mental health in terms of fewer and less intense symptoms resulting in a significant improvement in a number of risk areas. The last six months of the Report period saw Ms. Akonobi more engaged and cooperative with the team on- and off-unit and on the hospital grounds. He stated that there was “some residue of psychiatric symptoms” like delusional, religious ideas but they did not affect her level of progress or result in her becoming violent. For example, she believes that she is a goddess and married to Jesus Christ and had children with him.

28. Dr. Kolawole averred that his patient needs to work on her insight into the nature of her mental disorder. While Ms. Akonobi does not think she needs to take medications and wouldn’t consent to dosage adjustments, she offered no resistance to the intramuscular injections on a monthly basis. She was cooperative with her team, calm and utilizing her privileges. The doctor testified that the team believes that they and Ms. Akonobi can now consider community living options. She is currently maxed out on her current privileges. She clearly has shown signs of improvement over the last six months. The previous behavioural difficulties in the first half of her reporting year seem to have been attributed to Ms. Akonobi not adhering to oral medications. That problem appears to have been resolved.

29. Dr. Kolawole stated that St. Joseph’s wishes to remove the urine/breath testing clauses for substances as Ms. Akonobi has no history of using substances and indeed the several screening tests all came back “negative”. Hence, that degree of monitoring is no longer required.

30. Regarding whether he and the clinical team still believe that Ms. Akonobi constitutes a significant threat to public safety, Dr. Kolawole replied in the affirmative. He said this is based on the historical number and type of behaviour of Ms. Akonobi. He acknowledged that her detention treatment in hospital has contained her risks at pages 29-30 of the Hospital Report. However, in the absence of external oversight, there is a heightened risk that she will discontinue her pharmacological therapy away from her hospital monitored treatment environment. This would result in a significant decrease in her mental health with her likely to reoffend.

31. Dr. Kolawole testified that he is hopeful that she will continue to show progress in the next twelve months, continuing on the same trajectory with her team with therapeutic interventions and pharmacological treatment. Treatment would also include future consideration of psychotherapeutic intervention (e.g., CBT for psychosis) once she becomes sufficiently stable to benefit from them.

32. The goal with the continued improvement is a transition to community living. One of the advantages of remaining on a Detention Disposition with a “community living” term is that Ms. Akonobi can be placed on a housing waiting list.

33. During cross-examination by the Crown, Dr. Kolawole stated that it would be best if there was some degree of supervision “to start with” in the transitional housing options for Ms. Akonobi. He averred that “structure and supervision is critical for success.”

34. During cross-examination by the amicus lawyer, the witness stated that it was not only the change of medications that helped, while being significant for sure. Rather, it was a combination of that, and the structure and support for Ms. Akonobi at St. Joseph’s, that contributed to the progress over the year, and specifically, during the last six months. He emphasized that it was not the injections alone, but a combination of the medication and team support, and that cognitive therapy would also assist Ms. Akonobi.

35. Dr. Kolawole was clear in his testimony that a disposition short of a detention one would not sufficiently manage risk to the safety of the public. He opined that a conditional discharge would be premature at this stage, given the poor first half year Ms. Akonobi had. The continued Detention Disposition with expanded, additional terms will give St. Joseph’s a greater ability to intervene if necessary, including a more rapid return to the hospital. A Detention Disposition also provides greater access to programs that will benefit Ms. Akonobi. Dr. Kolawole also testified about the negative consequences of her not taking her psychiatric medication.

Final Submissions

36. The parties’ final submissions did not deviate from their initial ones. The Hospital indicated that it “was happy to note the breakthrough” with Ms. Akonobi’s progress with the change to the monthly intermuscular injections during the last six months and was happy to recommend the community living goal with additional expanded conditions. Hospital counsel stated that Ms. Akonobi’s “current risk is well understood and the team has a plan to advance her progress.” The Hospital congratulated Ms. Akonobi “on a very good year.”

37. The other parties joined with the Hospital’s final submissions. Even amicus counsel who had earlier submitted that the Board could consider a conditional discharge disposition acknowledged that, given the doctor’s testimony, it would not be an appropriate disposition now: “the safe decision is to keep the Detention Order.” (And indeed Ms. Akonobi has no place to live now, other than St. Joseph’s.)

Findings of the Board

Significant Threat to the Safety of the Public

38. In making findings regarding continued significant threat to public safety, the panel is mindful of and applies the principles enunciated by the Supreme Court of Canada in Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625, in particular those dealing with provincial/territorial review boards’ obligation and factors to consider when determining if an accused constitutes a significant threat to the safety of the public.

39. The Board unanimously accepts the joint submission of the parties that Ms. Akonobi continues to pose a significant threat to the safety of the public and so finds. In arriving at this determination, the panel considered the joint position of the parties, the contents of the Hospital Report including its risk assessment and the uncontroverted testimony of Dr. Kolawole. The Board finds that he was a credible witness and that his evidence was reliable. The panel accepts the contents of the Hospital Report, to which Dr. Kolawole was cross-examined by the parties and questioned by members of the panel.

40. As noted, Ms. Akonobi is diagnosed with schizophrenia. She has a history of non-compliance with psychiatric medications. She is currently incapable with regard to the treatment of her psychiatric illness. While suffering symptoms of schizophrenia, she exhibited aggressive behaviour in the community leading to her index offences. She continued to exhibit this aggressive behaviour during her early admission to St. Joseph’s, which required seclusion. The effective treatment at St. Joseph’s eliminated said behaviour.

41. The panel also finds that Ms. Akonobi’s significant threat to the public safety is evidenced in her objectively false belief that she does not have a mental disorder. She continues to have religious pre-occupations (i.e., that she is a goddess and the wife of Jesus and the mother of his children). The Board accepts the Hospital’s opinion that such factors heighten her risk level.

42. The Board accepts the Hospital’s opinion that the results of the psychological risk assessment completed in December 2024 remain valid. At page 28, her current treatment team agrees with the risk assessment in that report: “…if legal and medical oversight was decreased or removed, her risk of reoffending increases to the high range. The primary factors driving this risk categorization are her diagnosis of Schizophrenia, as well as her lack of insight about, and history of problems complying with treatment and supervision efforts to address the same.” The panel adopts this risk assessment, and taking into consideration the nature of the index offences involved, finds that Ms. Akonobi continues to be a significant threat to the safety of the public.

Appropriate and Least Restrictive, Least Onerous Disposition

43. The panel unanimously accepts the joint submission of the parties and finds that the appropriate, least restrictive and least onerous disposition to be made is to continue the current Detention Order dated January 15, 2025, with additional, expanded terms and conditions. These will assist the Hospital and Ms. Akonobi in transitioning, with continued improvement, to living in the community. Also, as part of the joint submissions, the panel orders the current urine/breath sample terms be removed as they are not necessary.

44. The Board accepts the testimony of Dr. Kolawole that a Conditional Discharge disposition is premature at this point. Indeed, absent a continued Detention Disposition with expanded terms and conditions, Ms. Akonobi would likely become non-compliant, not take her intramuscular injections and other prescribed medications. The panel notes that Ms. Akonobi had a “poor first half year”. The progress is recent and over a short period – the last half-year. This buttresses the statement about prematurity by Dr. Kolawole and the joint position of the parties that the most appropriate, and least restrictive, least onerous disposition in the circumstances is a continued Detention Order with additional, expanded terms and conditions.

Conclusion

45. In making this Disposition, the Board has considered the Hospital Report, the testimony of Dr. Kolawole, the joint submissions of the parties, and the criteria set out in s. 672.54 of the Criminal Code. We have considered the paramount need to protect the safety of the public, Ms. Akonobi’s current mental health condition, her reintegration into society along with her other needs. The Board wishes Ms. Akonobi continued improvement toward her transitioning to the community.

DATED this 26^th day of March 2026, at the City of Toronto, in the Toronto Region.

Mr. M. Garfield Legal Member

Office of the Registrar Ontario Review Board