Re: Benjamin Karem, 2026 CanLII 26880

Re: Benjamin Karem

ORB File No: 8868

Hearing held on: Tuesday, March 10, 2026

Place of hearing: Centre for Addiction and Mental Health

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

Before:

Alternate Chairperson: Mr. J. Weinstein

Members: Dr. R. Wood Hill Dr. G. Nexhipi Dr. K. Connidis Mr. A. Mete

Parties Appearing:

Accused: Benjamin Karem (via Zoom) Counsel: Mr. N. Gehl (via Zoom)

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

Attorney General of Ontario: Counsel: Mr. D. Brandes

REASONS FOR DISPOSITION

(Dated March 24, 2026)

Introduction

1. On September 24, 2025, Mr. Benjamin Karem was found not criminally responsible on account of mental disorder, on charges of one count each of being unlawfully in a dwelling house, and arson, and two counts of assault causing bodily harm, all contrary to the Criminal Code of Canada (“Criminal Code”). That finding was based on an assessment and related report of Dr. Van dated June 30, 2025 (“NCR Reports”).

2. Mr. Karem was permitted to live in the community under the terms of a Judicial Release Order.

3. The Court did not make a Disposition, and ordered, pursuant to s. 672.47(1) of the Criminal Code, that Mr. Karem appear before the Ontario Review Board (the “Board”) for an initial Disposition.

4. On March 10, 2026, the Board convened a hearing at the hospital, Centre for Addiction and Mental Health, Toronto (“CAMH”), to make an initial Disposition.

5. Mr. Karem was represented by his counsel Mr. N. Gehl, and they both appeared by video conference.

6. A Hospital Report, dated February 10, 2026 (the "Hospital Report"), was entered as Exhibit 1.

7. A letter from Mr. Gehl’s office dated March 9, 2026, was entered as Exhibit 2.

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

9. For the reasons set out below, and based on the expert evidence and opinions before us, the Board concluded that Mr. Karem represents a significant threat to the safety of the public. The Board found that the necessary and appropriate Disposition in the circumstances is a Detention Order with the terms and conditions set out in our formal Disposition. The highest level of privileges is to permit Mr. Karem to live in the community in accommodation approved by the person in charge. While living in the community, Mr. Karem should report no less than once per month.

Current Psychiatric Diagnoses

10. Schizophrenia

Substance Use Disorder (cannabis, stimulants)

Position of the Parties

11. Counsel for the hospital recommended a Detention Order with the terms set out on pages 22 and 23 of the Hospital Report. This included the privilege to enter, indirectly supervised, the Greater Toronto Area community.

12. Counsel for the Attorney General joined the hospital in its recommendation of a Detention Order.

13. Counsel for Mr. Karem advised that for the purposes of this hearing, significant threat was not in dispute.

14. Mr. Karem’s counsel was requesting a Conditional Discharge Disposition; however, should this Board find that a Conditional Discharge was not appropriate, he agreed with the hospital’s recommendation of a Detention Order.

Index Offences

15. The Index Offences are set out in detail in the Hospital Report. The following is a summary of the Index Offences:

Mr. Karem attacked the male victim with a pickaxe in their residence. The attack included multiple strikes to the head and face, attempts to set the couch and carpet on fire, and further aggression towards the male victim’s wife, who was also struck with the pickaxe. Both victims sustained visible injuries and required medical attention. The incident escalated with Mr. Karem pulling the fire alarm and fleeing the scene. This led to a police search and Mr. Karem’s eventual arrest. The weapon used, a Welders Chipping Hammer, was seized as evidence.

Personal Background

16. Mr. Karem’s personal background is set out in detail in the Hospital Report. The following extracted paragraphs are relevant to this hearing:

“At the time of this report, Mr. Karem was a 33-year-old single male with no dependents. He was residing in a rented room in a house in Cambridge, Ontario. He said he shared the space with ten other roommates with whom he had no prior relationship. He had been living at this address for the last two years. Mr. Karem was financially supported by Ontario Disability Support Program (ODSP) and had been supported by the program since October 2025. Prior to that, he was supported by Ontario Works (OW). He denied having a driver’s license or access to a car. He is a Canadian citizen. Mr. Karem was called “Kevin Allishaw” prior to his [formal] name change in 2021.

At the time of his assessment on January 12, 2026, Mr. Karem confirmed that he has remained unemployed since the Index Offence.

Mr. Karem said that he was “terrified” of his current financial situation. He owed $9500 in credit card debt and owed the Canadian Revenue Agency another $450. He had three credit cards that had no more credit. At the time of his assessment on January 12, 2026, Mr. Karem confirmed that he had ongoing credit card debts that he has continued to pay off. He added that he has also borrowed money from friends.

Mr. Karem reported that he was homeless for one year after he was released from custody for the Index Offence, and he stayed at shelter during that time. He has lived at his current place of residence in Cambridge since February 2024.

Mr. Karem identified as “pansexual,” and reported that he was sexually attracted to men, women and transgender individuals.

Mr. Karem stated that his father has a history of bipolar disorder and dementia and was currently in a long-term care facility.”

Substance Use History

17. Mr. Karem’s substance use history is set out in detail in the Hospital Report, and is summarized as follows:

a) Alcohol:

Started drinking at the age of 20. He was not a daily user but occasionally engaged in heavy drinking (up to 14 drinks at a bar).

b) Cannabis:

Started cannabis use at the age of 18 or 19. He did not use daily but would, on occasion, use it over two or three consecutive days. At peak, he would use up to 7 grams daily. According to his self-report, financial constraints limited his cannabis use. He reported no negative mental health consequences.

c) Crystal Methamphetamine:

Mr. Karem started using methamphetamine at the age of 20, and would use it twice a month; sometimes for several days in a row.

Psychiatric History

18. The Hospital Report sets out Mr. Karem’s psychiatric history in detail. The following are the relevant extracted paragraphs:

“Mr. Karem denied any psychiatric history prior to the Index Offence. He denied any psychiatric admissions to hospital and he denied ever taking any psychiatric medications. This was supported with collateral.

Mr. Karem’s mother stated that she first noticed Mr. Karem describe paranoid delusions in 2011, when he was 19 years old. It began with periodic statements, occurring every several months. In 2019, when Mr. Karem was 28 years old, his mother said that he started to “spiral out of control”. He began speaking “nonsense” and laughing to himself. He spoke about needing to kill Asians, Africans, and East Indians. He started to refer to himself as the “leader of Hell’s Angels” and a member of the “Ku Klux Klan.” Around that time, Mr. Karem took off to California without clarifying why, but she suspected it was to deliver money to a gang. In 2022, when Mr. Karem was 30 years old, his mother asked her family doctor for support but was told that she would need to bring Mr. Karem to them, and he refused to go. Near the end of that year in October 2022, three months prior to the Index Offence, Mr. Karem went back to California. Again, he did not clarify why, but asked his mother prior to going to pay for an expedited passport. Then, during the trip, he called his mother distressed and suicidal, asking for money to pay for food and a flight home. When he returned, things began to escalate. He again spoke about needing to kill Asians, Africans and East Indians without any clear plan. His mother recalled seeing Mr. Karem using cannabis, but did not observe him using any other recreational drugs.”

Legal History

19. Mr. Karem has no history of criminal charges or convictions prior to the Index Offences.

Course Since the Index Offences

20. Mr. Karem’s course since the Index Offences is outlined in detail in the Hospital Report, and the following extracted paragraphs are relevant:

“Canadian Mental Health Agency, Outpatient Appointments, December 18, 2024

Mr. Karem denied any mental health issues and did not want to discuss the circumstances around the index offence. During the meeting, Mr. Karem expressed paranoid thoughts and referred to “random” topics such as “lizard people.” He denied any visual or auditory hallucinations.

Grand River Hospital, Inpatient Admission, December 20, 2024 - January 17, 2025

Mr. Karem was admitted to Grand River Hospital pursuant to a Form 6 assessment and was placed on a Form 1. On admission, Mr. Karem was very disorganized, rambling about receipts and his court appearance.

Flexible Assertive Community Treatment Team (FACTT), Outpatient Appointments, January 30, 2025 – May 7, 2025

Mr. Karem met regularly with his support worker thought the FACTT team, Ms. Nichole Raposo.

In his appointments, Mr. Karem acknowledged ongoing crystal methamphetamine and cannabis use, and he denied any negative impacts from his use. When asked directly, Mr. Karem denied any paranoid or persecutory ideas or thoughts of harm to others or himself. His mood was stable. He continued to have residual disorganized speech and thoughts, which made him difficult to follow at times. Again, this disorganization was more prominent when Mr. Karem was distressed or spoke of the index offence.

Flexible Assertive Community Treatment Team (FACTT), Outpatient Appointment, December 4, 2025

Mr. Karem was seen in follow up by his outpatient psychiatrist, Dr. Matti. In that appointment, Mr. Karem was noted to be stable, settled, and organized. He continued to visit community centers throughout the city for food, including “Trinity Community Table.” He also sought out dental care independently. He did not describe any psychotic symptoms, inclusive of any auditory hallucinations or delusional content. He was noted to be compliant with his medications, and reportedly recognized that his stability was due to the medications. It was noted that Mr. Karem had ongoing infrequent cannabis use, roughly half a gram over two weeks. He denied any alcohol use.

Mr. Karem has seen his psychiatrist, Dr. Simon Matti, every one to two months, and has continued to receive his long-acting injection monthly. Dr. Matti is part of the CMHA Flexible Assertive Community Treatment Team (FACTT). Mr. Karem has attended his appointments consistently. At times, he has been driven to his appointments, but he has also taken the bus independently. Ms. Jennings has consistently sent him reminders via text.”

Evidence at the Hearing

21. The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Chan who isa PGY-6 Forensic Resident under the supervision of Dr. Wilkie. Dr. Chan co-authored the Hospital Report, and testified, in chief, as follows:

a) He participated in the January 12, 2026, assessment of Mr. Karem.

b) There are no updates to the Hospital Report.

c) Mr. Karem continues to meet the Criminal Code threshold of significant threat due to his:

i. ongoing psychotic delusions and disorganization;

ii. limited insight into his illness and the role that substance use plays in his risk;

iii. unreliable reporting of his substance use, and

iv. lack of housing clarity.

d) The treatment team has little information about Mr. Karem’s current housing. Mr. Karem indicated that he wishes to move to the city of Cambridge but provided no timeline or specifics as to the type of housing he would obtain.

e) Housing is a very important risk factor. The treatment team needs to retain the ability to approve Mr. Karem’s housing in order to monitor his mental stability, and to ensure he remains abstinent from substances and adheres to his medication regimen.

f) The Mental Health Act (“MHA”) would be insufficient to manage the risk to the safety of the public if Mr. Karem were conditionally discharged. The MHA requires that a person be assessed within seven days before admission pursuant to the MHA. The FACT team currently sees him only once per month.

g) It is his opinion that should Mr. Karem be returned to a hospital under a Conditional Discharge Order, the treating physicians there may not be able to certify him if he presented differently than he did during his forensic assessment.

h) Mr. Karem did not show the same level of psychosis to the FACT team as he did to the assessing treatment team.

i) Mr. Karem’s insight into his mental health is limited. He attributes his issues to “memory problems,” and acknowledges the “label” of schizophrenia, but he cannot describe its symptoms.

j) Symptoms of deterioration or decompensation in his own mental stability is unlikely to be recognized by Mr. Karem. He would not return voluntarily to the hospital and in fact told the assessment team that he did not wish to return to hospital.

k) Substance use remains a concern. The FACT team reports no current substance use; however, Mr. Karem indicated that he continues to use cannabis, alcohol, and crystal methamphetamine despite previous denial, including when urine drug screens tested positive for these substances. Mr. Karem also tested positive for substances around the time of the Index Offences.

l) Stimulants and cannabis are a major destabilizer for patients with schizophrenia, including Mr. Karem.

m) The treatment team will need to monitor Mr. Karem’s urine drug screens to ensure that he remains abstinent from substances.

n) The FACT team has been helpful in stabilizing and allowing Mr. Karem to remain in the community; however, they do not have forensic-specific programming essential for Mr. Karem to engage in.

o) Forensic Outpatient Services provide specialized risk-focused programming into insight, substance use, and distress tolerance.

p) The treatment team plan is to collaborate with the FACT team to ensure appropriate monitoring of Mr. Karem’s mental stability and medication regimen optimization.

q) Appropriate and approved housing remains a major unresolved risk factor.

22. In response to questions from the Attorney General, Dr. Chan testified:

a) Mr. Karem continues to meet the threshold for significant threat. As set out on page 22 of the Hospital Report, he represents a moderate risk of re-offending violently in the coming year under a Detention Order. His risk of reoffending would be the same under a Conditional Discharge as it would under an Absolute Discharge, which would be much greater than under a Detention Order.

b) Without a Detention Order the treatment team would not be able to address or monitor Mr. Karem’s dynamic risk factors.

c) The treatment team has ongoing concern about Mr. Karem’s cannabis and stimulant use, especially should he use crystal methamphetamine.

d) Mr. Karem gave the FACT team accounts that were contradictory to those he gave to the assessing psychiatrist.

e) Substance misuse is a major contributor to Mr. Karem representing a significant threat to public safety.

23. In response to questions from counsel for Mr. Karem, Dr. Chan testified:

a) There is little known about Mr. Karem’s current housing, as this is an initial hearing, and an outpatient forensic team would only be assigned after a Disposition is made. Going forward, a Forensic Outpatient Team would visit a proposed residence for Mr. Karem, assess his housing supports and risks, and confirm how long he can remain in that housing.

b) Mr. Karem has said he intends to move somewhere more central in the city of Cambridge. The assessing team has no details about where or when he would move, or the type of housing into which he would move.

c) Mr. Karem has remained on bail for over three years and there have been no reports of any further aggression or criminal acts.

d) Since 2022, Mr. Karem has remained adherent to his medication regimen. The treatment team has recently increased his antipsychotic dose due to his experiences with residual symptoms of schizophrenia.

e) He could not opine whether the FACT team can provide the equivalent support to that of a Forensic Outpatient Team, as each FACT team varies by jurisdiction. It is unknown whether the FACT team can provide insight-oriented programming, specific substance use interventions or a forensic level of risk monitoring. Collaboration between the FACT team and the Forensic Outpatient Services will be essential.

f) There has been some improvement in Mr. Karem’s insight, due to his new medication regimen; however, his insight into his major mental illness is limited. Mr. Karem’s substance use reporting remains inconsistent and unreliable.

24. In response to questions from the panel, Dr. Chan testified:

a) The treatment team does not have a plan to bring Mr. Karem back into hospital until such time as they can ascertain the appropriateness of his housing. His recent community stability does, however, support the initial plan of allowing him to remain in the community in approved accommodation.

b) Mr. Karem has not had contact with his parents since the Index Offences. He has had some contact with his brother, but what support he is receiving from him is still unclear.

c) Mr. Karem’s medication regimen still needs to be optimized.

d) The key reasons the hospital needs to retain the authority to approve Mr. Karem’s housing are to ensure that he remains engaged with the treatment team, and that he adheres to his medication regimen. In addition, his housing must provide enough support to monitor his substance abstinence and mental stability.

25. No other evidence was called.

Analysis and Conclusions

26. Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board finds that Mr. Karem poses a significant threat to the safety of the public at this time, and that the appropriate and necessary Disposition for the year ahead is a Detention Order.

27. In Winko, the Supreme Court 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 NCR accused’s own plans for the future; the support existing for the NCR accused in the community; and most importantly, the recommendations provided by experts who examined the NCR accused. In coming to our conclusion in this matter, the Board relies on the uncontroverted expert evidence of Dr. Chan, in addition to the documentary evidence before us.

28. Mr. Karem suffers from a major mental illness, schizophrenia. He has clearly exhibited symptoms of psychosis in the form of hallucinations and paranoid delusions, accompanied by disorganized thinking and behaviours. Although he has partially responded to treatment, he has continued to display residual symptoms including delusions and thought disorder.

29. He also has poor insight into his illness, though the has followed up with his treatment team’s medication recommendations, which is a positive factor.

30. Mr. Karem currently has psychiatric follow-up in the community, which has involved regular appointments with a psychiatrist and support worker. He does not appear to have much support outside of these professional services. The FACT team only meets with him monthly, and it does not have the ability to provide Mr. Karem the kind of specialized programming necessary to maintain public safety that a Forensic Outpatient Team would.

31. Housing for Mr. Karem is currently uncertain and highly relevant to his risk profile. He would be very vulnerable to changes to his current living circumstances, as they could destabilize his mental health.

32. Conflicting reports were given by Mr. Karem on his abstinence from substances, indicating to the treatment team that he is continuing to use cannabis, alcohol, and crystal methamphetamine.

33. Mr. Karem also meets the criteria for a diagnosis of substance use disorders, inclusive of cannabis and stimulants. This use has put him into debt and has led to job loss. He has also continued to use substances despite the negative impacts they were having on his mental health. The extent of his active abuse of these substances is still unclear.

34. In particular, the Board relies on the following extracted paragraphs from the Hospital Report:

“Criminogenic Risk Factors

Major Mental Illness: Mr. Karem has a diagnosis of a primary psychotic illness, schizophrenia, and the index offences occurred in the context of significant psychosis. He would be at risk of re-offence if he were to become paranoid and disorganized in a similar manner. He has poor insight into his illness and has continued to have residual psychotic symptoms despite compliance with his treatment and ongoing follow up with his outpatient psychiatric team.

Substance Use: Mr. Karem has a history of polysubstance use disorder, inclusive of cannabis, stimulants, and potentially alcohol. He has provided inconsistent accounts regarding his substance use on the day of the index offence, but he has consistently acknowledged using those substances around the time of the index offence. Mr. Karem is at risk of decompensation with ongoing substance use.

Re-Offence Scenario

Mr. Karem would be at risk to re-offend if he suffered a relapse in his psychotic symptoms. This would likely occur in the context of medication non-compliance and substance use. Stress may also contribute to a deterioration in his mental state. Mr. Karem is known to become paranoid, delusional and disorganized when unwell. He is also known to harbor violent attitudes towards various racialized groups. If he became paranoid again, any individuals incorporated into his paranoid delusions could be at risk of harm. Although his parents are no longer in contact with him, other family members may be at risk as well as the racialized groups that he has previously targeted.

Based on the risk assessment, in the context of a detention order with community living, Mr. Karem likely represents a moderate risk to re-offend violently in the coming year. Mr. Karem’s index offence was violent, and marks the potential seriousness of a subsequent offence. Although he had no prior incidents of violence, he had consistent violent attitudes towards various racialized groups. Mr. Karem has remained compliant with his antipsychotic medications and has continued to follow up with his outpatient team, but he has continued to display residual psychotic symptoms. Mr. Karem has also continued to use substances, inclusive of cannabis, alcohol and crystal methamphetamine use, though the frequency of his current use is unclear. Mr. Karem remains at risk of decompensation in the context of ongoing substance use. Although Mr. Karem has remained stable under the care of his outpatient psychiatric team and in his current housing, the outpatient follow up is ending next year, and the stability of his housing is unknown. As such, it is our opinion that Mr. Karem continues to present a significant threat to public safety.”

35. Given the Board’s finding of significant threat, it is charged with shaping a Disposition for the coming year.

36. Mr. Karem has continued to use substances, including cannabis and alcohol, though the frequency of his current use is unclear.

37. The stability and the appropriateness of Mr. Karem's housing are unknown and as such the hospital needs to retain the ability to approve it in order to monitor his mental stability, his use of substances and his reaction to stressors. The treatment team is also uncertain if his current housing situation provides the necessary support and supervision for Mr. Karem’s needs and the safety of the public.

38. The Board accepts the doctor’s uncontroverted evidence that the MHA would not be sufficient to protect public safety. Given the weight of his significant static violent risk variables and ongoing dynamic risk variables, Mr. Karem is best managed under a Detention Order.

39. The evidence before us is that he would not recognize the symptoms of any decompensation in his mental state nor would he return to a hospital voluntarily. It is also clear from his past presentations to the FACT team versus the treatment team that he may not be certifiable under the MHA in a timely enough fashion to prevent any further violence. Accordingly, a Conditional Discharge is not appropriate.

40. In consideration of all the evidence, submissions of the parties and criteria set forth in s. 672.54, the paramount consideration being the safety of the public, in addition to the mental condition of Mr. Karem, his reintegration into society and his other needs, the necessary and appropriate Disposition is a Detention Order Disposition, with the terms set out in our formal Disposition.

DATED this 24^th^ day of March, 2026, at the City of Toronto, in the Region of Toronto.

Mr. J. Weinstein

Alternate Chairperson

__________________

Office of the Registrar

Ontario Review Board