Re: Joe Puthenkulam, 2026 CanLII 26885

Ontario Review Board

Re: Joe Puthenkulam

ORB File No. 8325

Hearing Date: March 5, 2026

Hearing Location: St. Joseph’s Healthcare Hamilton, West 5th Campus

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

Before:

Alternate Chairperson: Mr. R. Bigelow

Members: Dr. K. Hand Dr. T. Stirpe Ms. M. McKinnon Mr. K. McKenna

Parties Appearing:

Accused: Joe Puthenkulum Amicus: Mr. A. Confente

The Person in charge of Hospital: Counsel: Mr. S. O’Brien

Attorney General of Ontario: Counsel: Mr. B. Adsett

REASONS FOR DISPOSITION

(Dated March 24, 2026)

Introduction

1. Mr. Puthenkulam was found not criminally responsible (NCR) on June 21, 2023, for the criminal code offences of assault with a weapon and forcible confinement.

2. He is currently subject to a discharge with conditions under a Disposition dated April 7, 2025. He is required to reside at 4629 Harbottle Rd. in Burlington, and with his consent, he agreed to take treatment in accordance with s. 672.55(1) of the Criminal Code of Canada.

3. A panel of the Ontario Review Board (the panel) convened this annual hearing on March 5, 2026, at St. Joseph’s Healthcare Hamilton, West 5th Campus, (St. Joseph’s or the Hospital) to review the current Disposition pursuant to s.672.81(1) of the Criminal Code. Mr. Puthenkulam expressed his intention to represent himself, and Mr. Confente appeared as Amicus to assist the panel.

4. At the commencement of the hearing, the Hospital indicated that Mr. Puthenkulam was no longer a significant threat to the safety of the public, and that it was recommending an absolute discharge. Crown Counsel recommended a continuation of the conditional discharge, and Mr. Puthenkulam advised that he was content with either a conditional or absolute discharge.

5. After considering the evidence, the panel concluded that Mr. Puthenkulam was no longer a significant threat to the safety of the public, and accordingly, an absolute discharge was necessary and appropriate.

Index Offences

6. The following is a synopsis of the facts pertaining to the index offences.

“On February 28, 2023, the accused and his mother were inside their family residence. He was extremely agitated and forced his mother into a bedroom, locking the door. He pinned her to the floor, face down, and repeatedly smashed her face off the ground. He then attempted to wrap a guitar chord around her neck. He then proceeded to stab her in the back approximately 50 times with nail cutting scissors. When Mr. Puthenkulam left the room, the victim messaged her husband saying, “call 9-1-1, he’s trying to kill me.” The police were called and while en route to the home, they received a call from a neighbour who described seeing the accused outside of his house, holding a knife, rocking back and forth, and yelling about someone hiding in the attic. The police arrived at the house and arrested Mr. Puthenkulam. The victim was transported to hospital for treatment of her injuries. He provided a statement to the police in which he explained that he was stolen from his biological parents at birth and that the victim was an imposter. He stabbed her to force a confession. After the assault, he ran downstairs and grabbed two butcher knives to protect himself from her. He also advised the police that he had used cannabis that day and had not been taking his medication.”

Evidence

7. The evidence at this hearing consisted of the Hospital Report dated February 4, 2026, the testimony of Dr. Sutton, the testimony of Mr. Puthenkulam’s mother, Ms. Deepthi Alex, and his father, Mr. George Puthenkulam.

8. The Hospital Report was prepared for this hearing and contains a detailed review of Mr. Puthenkulam’s personal and mental health history.

9. The current diagnoses are bipolar I disorder and cannabis use disorder in sustained remission.

10. In addition to his parents, Mr. Puthenkulam has twin sisters who are 22 years of age. The parents are originally from India, but they have also lived in Saudi Arabia and Dubai, and in 2013, the family came to Canada.

11. Mr. Puthenkulam is an intelligent and educated young man. His time at university and being away from home for the first time, appear to have been precipitating factors in the onset of his substance use and the deterioration of his mental health. In 2013 he started the Mechatronics program, which is part of the Engineering program at the University of British Columbia (UBC). It was at this time he started using cannabis and by 2017, he was consuming cannabis daily.

12. In November 2016, he was brought to the emergency unit of St. Paul’s Hospital in Vancouver by his friends. His behaviour was bizarre and disorganized. He was agitated and experiencing hallucinations, and Mr. Puthenkulam advised hospital staff that he had consumed mushrooms earlier in the day.

13. In June 2017, Mr. Puthenkulam was admitted to Vancouver General Hospital for five days. He was disorganized and fixated on having been sexually assaulted by his friends and family. He displayed anxiety and paranoia and admitted to daily use of cannabis and recent experimentation with MDMA. Mr. Puthenkulam was responding to internal stimuli and pre-occupied with recurring thoughts of rape. He returned home to Burlington, Ontario, following his discharge from hospital, and was referred to the Phoenix Outpatient Program for Early Intervention in Psychosis.

14. He returned to UBC in 2018 and was followed by the Kitsilano-Fairview Mental Health Clinic. Shortly after the pandemic emerged in March 2020, he resumed his use of cannabis. After being notified by his friends that Mr. Puthenkulam was unwell, his father travelled to Vancouver to see his son. Mr. Puthenkulam returned to Burlington with his father and reconnected with the Phoenix Outpatient Program. From June 2020 to September 2021, he attended school on-line. He had insight into the harmful effects of cannabis use on his mental health and abstained from cannabis during this time.

15. Mr. Puthenkulam returned to Vancouver in September 2021, and very quickly started using cannabis and stopped taking his prescribed medication. He was again admitted to Vancouver General Hospital in November 2021. He was running through traffic and behaving aggressively toward his female cousin, who sought police assistance. He was taken by the police to the hospital under the Mental Health Act. Mr. Puthenkulam was observed to be animated and responding to strangers on the street. The hospital noted that he presented as grandiose with blunted affect and with odd speech. He admitted to consuming alcohol and cannabis earlier in the day, and not adhering to his medication for several weeks. Mr. Puthenkulam returned to Burlington after his discharge from hospital.

16. He began working for his father’s company as a software programmer and lived with his parents. His cannabis use continued which created significant tension within the family.

17. In June 2022, he booked a last-minute flight to Calgary without notifying any family members or his employer. He stayed with friends as much as possible, until he was asked to leave, and then stayed in hotels in Vancouver. He spent over $10,000.00 in a two-week period. His parents requested the police check on his wellbeing, and the police found him to be very distraught, psychotic and with a substantial amount of cannabis in his hotel room. He was admitted to Vancouver General Hospital for three weeks and then returned to Burlington with his father. The hospital described his presentation as bizarre with symptoms of psychosis and mania. Mr. Puthenkulam acknowledged to the hospital staff that he was using cannabis daily.

18. Mr. Puthenkulam’s parents noted that their son’s demeanor had changed significantly since returning to Burlington. He was verbally abusive and hostile; he was not attending work regularly, and was ultimately terminated from his employment in October 2022. As a result of this behaviour, he was asked to leave his parent’s house and he lived temporarily with his cousin. It was during this time that Mr. Puthenkulam began suggesting that his parents were not his biological parents. The serious and violent index offence against his mother occurred in the family home in February 2023.

19. Mr. Puthenkulam was admitted to St. Joseph’s on May 1, 2023. His thought process was disorganized, and he expressed his belief that his parents were imposters. He had poor insight into his illness and was insistent that he should not be prescribed medication. He became increasingly suspicious and irritated and suspected that some of the staff had a sexual interest in him.

20. His sleep was poor, and he spent most nights awake. He became more disorganized and endorsed bizarre beliefs, such as referring to himself by various names and informing staff he was the king of Britain. Staff observed Mr. Puthenkulam respond to internal stimuli, and he was placed in seclusion after he became verbally aggressive to staff. He continued to refuse medication and became highly disorganized and delusional.

21. Mr. Puthenkulam was deemed incapable to consent to treatment and his father became his substitute decision maker. His father consented to long-acting antipsychotic medication being administered. With treatment, his symptoms improved significantly.

22. As his admission progressed, he became less resistant to his scheduled antipsychotic medication, and he became more engaged in recreational programming. Initially, he was distracted in group settings, responding to internal stimuli and experiencing auditory hallucinations. These symptoms subsided with treatment.

23. In August 2024, Mr. Puthenkulam was discharged from hospital to live in his family home. He continued to be followed by the forensic team.

24. Mr. Puthenkulam is employed with his father’s company. He receives injections of Aripiprazole.

25. Mr. Puthenkulam is both treatment and financially capable. Since the early Review Board hearing in March 2025, his mental status has been stable and remained unchanged from his baseline. Typically, Mr. Puthenkulam presents as cooperative, pleasant, and appropriately engaged in all interactions. His thought processes are logical and goal-oriented, and he denies any perceptual disturbances. Throughout all his interactions with forensic staff he has been cooperative and polite.

26. In June 2025, the reporting to his case manager was reduced from once weekly to once monthly. There have been no fluctuations in his mental status since this change.

27. Mr. Puthenkulam appreciates that bipolar I disorder requires long-term treatment, but he periodically questions whether he requires Aripiprazole long-term. Even so, he consistently expresses his intention to take any medication prescribed by his physicians.

28. Mr. Puthenkulam is candid and forthright when discussing his understanding of the impact cannabis use has had on his mental health, and he is committed to abstain from cannabis use.

29. In May, 2025, he travelled to Pennsylvania for his cousin’s wedding. He declined cannabis that was offered at the event. He later expressed to staff that he felt very good about making this decision. His urine samples have all been negative for any substances.

30. Mr. Puthenkulam feels guilt and shame for the index offences and the harm he caused his mother. He is currently on a waitlist for the Healing and Forgiveness group through the forensic outpatient team to assist him cope with these emotions.

31. He has travelled quite extensively in 2025. In July 2025, he travelled to India for his grandmother’s funeral. In October 2025, he travelled to New Jersey for a work retreat and then to Florida with his family. These trips were all uneventful.

32. Joseph Brant Hospital has agreed to provide aftercare services for Mr. Puthenkulam should he receive an absolute discharge. His first appointment with the Intensive Case Management Services was January 30, 2026. This program offers comprehensive outreach services for adults with psychotic or severe mood disorders and will support his ongoing community reintegration.

33. Mr. Puthenkulam participated in 12 sessions of 1:1 psychotherapy from April 29 to August 19, 2025. These sessions focused on a variety of areas including cognitive restructuring and identifying unhelpful thinking patterns. He also explored the stress vulnerability model, examining his history of mood episodes and identifying triggers, such as stressors, substance use, and maladaptive thinking patterns. The report indicates that Mr. Puthenkulam demonstrated a high level of engagement throughout the therapy and showed a strong understanding of the concepts and a willingness to apply new skills. He also expressed an interest in completing a program addressing self-blame and issues related to the index offences.

34. Mr. Puthenkulam is employed full-time with his father’s audiovisual company.

35. Mr. Puthenkulam was seen by Dr. Sutton on January 14, 2026. His mood was stable, his thought process was coherent, and his insight and judgment were intact. Mr. Puthenkulam was able to speak in depth about his experiences of illness, and his diagnosis, while recognizing the need for treatment and medication.

36. A risk assessment was conducted by Dr. Mamak on December 2, 2025. Dr. Sutton expressed to Dr. Mamak that he was uncertain if the psychosis was linked to cannabis use rather than an underlying major mental disorder. Dr. Sutton also indicated that, if Mr. Puthenkulam receives an absolute discharge and engages with Joseph Brant Hospital, he would not be opposed to Joseph Brant discontinuing Mr. Puthenkulam’s medication.

37. The conclusion of the risk assessment was that Mr. Puthenkulam remained a significant threat to the safety of the public. Dr. Mamak relied primarily on the uncertainty of the diagnosis, and Mr. Puthenkulam’s history of disengaging from treatment and his substance use to conclude that he was a significant threat to public safety.

Testimony of Dr. Sutton

38. Dr. Sutton confirmed in his testimony that Mr. Puthenkulam has done very well during his time under the Review Board, and that he has not had any symptoms for three years. He confirmed that Mr. Puthenkulam has been consistently compliant with his medication and has not used substances.

39. In response to a concern raised by Dr. Mamak in the risk assessment, Dr. Sutton thought it was reasonable for Mr. Puthenkulam to question the diagnosis and the need for medication long-term. He reminded the hearing that Mr. Puthenkulam had been consuming a significant amount of cannabis prior to the index offences.

40. Dr. Sutton accepts that Mr. Puthenkulam will engage with Joseph Brant Hospital if given an absolute discharge, and that Joseph Brant will be able to monitor his condition and mitigate any potential risk to public safety.

41. Dr. Sutton also referred to the strong family support. He indicated that the family, as well as Mr. Puthenkulam, has learned a great deal about their son’s illness. He is confident that the family would report any concerns to their son’s health care providers. Dr. Sutton expressed his belief that it is more likely than not that Mr. Puthenkulam will continue with his treatment. Accordingly, Dr. Sutton does not believe that Mr. Puthenkulam meets the threshold test for significant threat, and is, therefore, entitled to an absolute discharge.

42. The Crown raised certain concerns with Dr. Sutton. Dr. Sutton acknowledged that Mr. Puthenkulam has always had strong family support. Dr. Sutton also confirmed that the diagnosis is unclear. The Crown presented Dr. Sutton with Dr. Mamak’s opinion that it would be safer to manage the risk under a Disposition rather than under a community provider. Dr. Sutton responded by stating that the issue of risk is not simply determining the diagnosis, but also considering the protective factors. Dr. Sutton believes that the community providers of care and the family would be alert to a decline in Mr. Puthenkulam’s condition, and they both would respond appropriately.

43. Mr. Puthenkulam questioned Dr. Sutton. He asked if he would experience cravings for cannabis for the rest of his life. The response from Dr. Sutton was, maybe. Dr. Sutton also stated, that not experiencing a relapse when off medication does not necessarily mean that Bipolar Disorder is not the proper diagnosis.

44. Dr. Sutton confirmed in his answers to questions from the panel that Mr. Puthenkulam had a good working relationship with the treatment team which explained his willingness to accept a conditional discharge. Dr. Sutton reiterated that Mr. Puthenkulam and the family are well aware of the dangers of cannabis use.

Testimony of Deepthi Alex

45. Mr. Puthenkulam’s mother testified. She stressed that whatever she and her family have experienced, her son has experienced more. She emphasized that the family is much more aware of the effects of drugs and alcohol on his mental health. Ms. Alex testified that the family would report any use of drugs, and that they would ensure Mr. Puthenkulam remains on his medication.

Testimony George Puthenkulam

46. Mr. Puthenkulam’s father testified. He said that his son is very intelligent and had been high performing. He believes his son started using cannabis in university as a result of peer pressure and stress. George Puthenkulam stated that he was unaware of the effect of cannabis on his son’s mental health, and didn’t know that sleep and eating issues were symptoms of his son’s declining mental health. He further stated that he is now familiar with resources in the community, such as Joseph Brant Hospital, that he can access if necessary.

Submissions

47. The Hospital submitted that the evidence, including the testimony of Mr. Puthenkulam’s parents, strongly supports an absolute discharge. They have been educated in their son’s mental illness and have become aware of indicia of a mental health decline. Mr. Puthenkulam has not experienced any symptoms of his illness in three years and has been abstinent from substances. In the Hospital’s submission, Mr. Puthenkulam is no longer a significant threat to the safety of the public and he should be granted an absolute discharge.

48. The Crown expressed agreement with the Hospital’s submissions concerning Mr. Puthenkulam’s progress and stability, but suggested that an absolute discharge was premature at this point. He referred to Mr. Puthenkulam expressing a desire to live independently at some time in the future, and the fact that a diagnosis of bipolar disorder has not been established, and further treatment may be required. The Crown also referred to the serious violence committed by Mr. Puthenkulam at the time of the index offences.

49. Mr. Confente supported the recommendation for an absolute discharge. He referred to Mr. Puthenkulam’s effort and commitment to mental health stability, and the strong support he receives from his family,

50. Mr. Puthenkulam made submissions to the panel. He stated that he was 17 years old when he left home for university, and that he is no longer 17. He is now an adult who works full-time in his father’s company. He has not used cannabis since the index offences and he is committed to abstaining from cannabis in the future. He is also committed to taking whatever medication is prescribed by his physicians.

Analysis

51. Mr. Puthenkulam committed a vicious assault on his mother, which could very easily have resulted in her death. He was experiencing a psychotic episode at the time. He believed that his parents were imposters and he needed to get a confession from this woman.

52. He began using cannabis when he started university in Vancouver at the age of 17. The quantity of cannabis consumed increased over the years in Vancouver which resulted in numerous psychotic episodes and admissions to hospital.

53. Mr. Puthenkulam has made steady progress in the forensic system. He was admitted to St. Joseph’s on May 1, 2023. He has not experienced any psychotic symptoms since that time, and has not used cannabis.

54. He was discharged to live in the family home in August 2024, and began working at his father’s company.

55. Mr. Puthenkulam has been reporting regularly to the outpatient team. He has attended to his scheduled appointments, and was described as engaged, polite and cooperative during his meetings with the outpatient team.

56. Dr. Sutton indicated that there has been no evidence of any perceptual disturbances or concerning behaviour.

57. Dr. Sutton believes that Mr. Puthenkulam has good insight into his illness, and he believes that Mr. Puthenkulam is committed to abstain from cannabis in the future. Although Mr. Puthenkulam may question the need for his current medication, which Dr. Sutton finds reasonable in the circumstances, Dr. Sutton believes that Mr. Puthenkulam will continue to take his medication as long as it is prescribed for him.

58. The evidence indicates that Mr. Puthenkulam was highly engaged in psychotherapy which he attended from April to August 2025.

59. The panel heard from Mr. Puthenkulam’s parents. Their evidence was very sincere. The parents are committed to doing whatever is necessary to maintain their son’s mental stability. They are now aware of symptoms that could arise indicating a decline in his mental health. The parents expressed their commitment to ensuring that Mr. Puthenkulam does not use cannabis. They also expressed a commitment to ensuring that Mr. Puthenkulam remains on his prescribed medication. There is no doubt that they will provide strong support for their son.

60. The courts have declared repeatedly over the years that significant threat to the safety of the public means a “foreseeable risk of serious physical or psychological harm that goes beyond trivial or annoying and conduct giving rise to the harm must be criminal in nature”; Winko v British Columbia (Forensic Psychiatric Institute) 1999 CanLII 694 (SCC), [1999] 2 SCR 625. It is further stated that the threshold for significant risk is onerous…and there must be a likelihood of the risk materializing; Re: Carrick 2015 ONCA 866. It was further defined as a “foreseeable and substantial risk of physical or psychological harm.” The determination of significant threat cannot be based on speculation, but rooted in the evidence that the accused is not appropriate for an absolute discharge. R v Ferguson 2010 ONCA 810. The panel is also required to impose the least onerous and least restrictive Disposition that is appropriate in the circumstances taking into consideration the factors enumerated in s. 672.54 of the Criminal Code.

61. The evidence at this hearing does not support a foreseeable and substantial risk of serious physical or psychological harm beyond mere speculation. Mr. Puthenkulam is entitled to an absolute discharge.

62. The panel wishes to commend Mr. Puthenkulam for his efforts and accomplishments working towards good mental health.

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

Kevin McKenna

Legal Member

____________________

Office of the Registrar

Ontario Review Board