Ontario Review Board
Re: Edward St. Louis
ORB File No: 6447
Hearing held on: Tuesday February 24, 2026
Place of Hearing: Royal Ottawa Mental Health Centre
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. J. Weinstein
Members: Dr. R. Kunjukrishnan Dr. G. Boulais Mr. P. Hageraats Mr. R. Rainboth
Parties Appearing:
Accused: Edward St. Louis Counsel: Ms. M. Munsterman
Person in charge of hospital: Representative: Dr. M. Strike
Attorney-General of Ontario: Counsel: Ms. M. Dufort
REASONS FOR DISPOSITION
(Dated March 16, 2026)
Introduction
[1]. On December 3, 2013, Mr. Edward St. Louis was found not criminally responsible on account of mental disorder, on a charge of attempt to commit murder, contrary to the Criminal Code of Canada (“Criminal Code”).
[2]. Mr. St. Louis is subject to a Disposition of the Ontario Review Board (the “Board”), dated March 4, 2025, which discharges him from the Royal Ottawa Mental Health Centre (“Royal Ottawa”), on conditions set out therein. This Disposition required him to submit samples of his urine and/or breath. (See Clause 1(d)). Pursuant to s. 1(e) of the Disposition, this Disposition further required that he refrain from contact or communication with the named victim.
[3]. On February 24, 2026, the Board convened a hearing at Royal Ottawa to conduct the annual review of the current Disposition.
[4]. Mr. St. Louis was present at the hearing, and was represented by his counsel, Ms. Marni Munsterman.
[5]. A Hospital Report, dated January 22, 2026 (the "Hospital Report"), was entered as Exhibit 1.
[6]. The issues at this hearing were whether Mr. St. Louis is 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.
[7]. For the reasons set out below and based on the expert evidence and opinions before us, the Board concluded that Mr. St. Louis continues to represent a significant threat to public safety. The Board found that the necessary and appropriate Disposition in the circumstances is a continuation of the existing Conditional Discharge order with deletion of paragraph 1(d) and 1(e).
Current Psychiatric Diagnoses
- Schizophrenia, multiple episodes, currently in full remission
- Cannabis and alcohol use disorder, in sustained remission
- Borderline intellectual functioning
Positions of the Parties
[8]. Dr. Strike, as hospital representative and most responsible physician, counsel for the Attorney-General, and counsel for Mr. St. Louis, advised that this was a joint recommendation. All agreed to the continuation of the existing Conditional Discharge with the deletion of paragraph 1(d), which requires him to submit samples of his urine and/or breath and 1(e), which was included in error.
[9]. Counsel for Mr. St. Louis advised that the issue of significant threat was not in dispute for the purposes of this hearing.
Index Offence
[10]. The circumstances giving rise to the index offence are extracted from last year’s Board Reasons, as follows:
“On September 13, 2013, Mr. St. Louis’ mother, Dorothy Maw, provided an audiotaped statement to police investigators at approximately 12:00. She mentioned that she lived with her son, Edward St. Louis.
She got up that morning at around 7:00 a.m. and he was standing in the kitchen. She asked him if he wanted coffee. For some reason, she felt nervous. She offered him a cup of coffee, and he accepted. There was not much conversation between them, according to her.
She was still in the kitchen and was putting dishes in the dishwasher when he suddenly came at her with a knife that he’d got from the kitchen drawer. He pushed her to the other side of table then to the floor. He then stabbed her in the neck. He said, “I’m going to kill you right now,” a few times.
She pleaded with him not to kill her. He was holding her down with one hand around the neck area and was stabbing her with the knife in his other hand. He was kneeling down and straddling over the top of her while doing this. He was motioning around with the knife around her neck. She was holding onto the knife as she was trying to keep it away from her neck to protect herself from him and pleading with him. Ms. Mau reported that Mr. St. Louis had so much anger, and he was so violent that he was capable of killing her.”
Personal, Criminal, and Psychiatric Histories
[11]. Mr. St. Louis’ personal, criminal, and psychiatric histories are outlined in the Hospital Report, and they are accurately summarized in last year’s Reasons:
“Mr. St. Louis was born and raised in Pembroke, Ontario. In 1991, when he was 5, his father died in a drowning accident. Mr. St. Louis did not complete Grade 8. The school had placed him in a special education stream. In 1992, at age 16, he was moved to an Ottawa Group Home after an earlier assault against his mother.
Mr. St. Louis and his mother are close. They speak daily by phone. Mr. St. Louis visits Ms. Maw in Pembroke at least twice a year. She is in her sixties, or even older. A few years ago, she moved from her home to a retirement residence. The hospital social worker, Mr. Robins, plays a key role in organizing and facilitating visits. Mr. Robins drives Mr. St. Louis from Casselman to Pembroke. Mr. St. Louis is dropped off at his mother’s to spend a large portion of the day with her. This leaves Mr. Robins free to see other Pembroke clients elsewhere in town. Later, in the same day, Mr. Robins collects Mr. St. Louis for the drive back to Casselman. This arrangement has worked well for all concerned over the last years.
Criminal History
Mr. St. Louis has no previous criminal record.
Psychiatric History
In 1982, when he was 6, Mr. St. Louis was admitted to child psychiatry at the ROMHC. He had acted out at school and in the home. A neuropsychological assessment revealed he had cognitive issues, either because of mild retardation or borderline intellectual functioning. Previous medical records indicate that his mother was also affected by an intellectual developmental delay.
For the last two years, Mr. St. Louis has not needed to be involuntarily admitted to hospital. On March 21, 2024, he reached out on his own, seeking psychiatric help. Mr. St. Louis had been non-adherent to some of his medications. It was on his insistence that he was admitted to the Queensway-Carleton Hospital. Once there, he made a rapid recovery after Clozapine oral medication was carefully restarted. When he returned to the group home on April 2, 2024, the staff were given clearer instructions about the need to properly supervise medication adherence.
Mr. St. Louis has long wanted to relocate to Pembroke, to a different group home. This would permit him to be closer to his mother and to visit more frequently. The ROMHC treatment team has applied on his behalf to the Pembroke Assertive Community Treatment Team (ACT Team) and to their 24-hour supportive residence in Pembroke.
Mr. St. Louis has regular case management visits from Mr. Robins at the Casselman group home. Mr. Robins provides active help for Mr. St. Louis’ attendance at his required hospital appointments. Mr. Robins is Mr. St. Louis’ primary support in the community, offering him supportive counselling and ongoing psychoeducation. Mr. Robins continues to describe their interactions as very polite and friendly.
The attending psychiatrist, Dr. Strike, confirms that Mr. St. Louis remains free of alcohol and other substances, including cannabis. Mr. St. Louis has maintained complete abstinence since he first came under the ORB in 2013. Mr. St. Louis is highly motivated to avoid peers who use substances.
Dr. Strike reports that Mr. St. Louis continues to struggle with anxiety and fatigue. He attributes this to his oral medication, Clozapine. For the last few years, they have worked on reducing the dosage. A year ago, it was down to 105mg daily. A more recent adjustment saw the medication administered twice daily, once in the morning, at a lower level, and later, at bedtime, with a higher dose.”
Course Since Last Disposition
[12]. Mr. St. Louis’ course since his last Disposition is set out in the hospital report. The following extracted paragraphs are relevant to this hearing:
“Mr. St. Louis had a very good year overall. He continued to demonstrate fairly good stability in his mental health, bevaviour, mood and thinking patterns. There were no hospital admissions or police encounters. The team is not aware of any aggressive behaviours or violent thinking/attitudes during the reporting period.
He continued to abstain fully from alcohol, cannabis and all illicit substances, putting him at over 12 years of sobriety at this point. His urine toxicology results were consistently negative for all substances.
We brought him to the hospital for an urgent appointment on February 25th, voluntarily (transported by Richard Robins). He had reached out to Mr. Robins to express concern about his mother’s hospital admission for medical issues. He also revealed to Richard that he has not been taking his bedtime clozapine for about two months; he had been taking only 50 mg of clozapine daily, in the morning. The group home staff had been dispensing all medication and were observing to take his clozapine, however he would spit it out.
With prompting from Mr. Robins, he admitted to recently hearing voices and having nightmares. He experienced physical side effects after taking the full prescribed dose of clozapine the previous week, after taking only 50 mg for the past two months. He said he would agree to take 50 mg of clozapine twice daily, but not anymore. He agreed to increase his paliperidone Trinza to 525 mg intramuscular every nine weeks.
Mr. St. Louis’ mental state remained stable following these medication changes. He did not complain of his medication or side effects after February 2025.
He remained living at his group home in Casselman following his last annual hearing. He is dissatisfied with his current situation, and he is very anxiety to change something in his life. He believes this stems from his living environment, which he believes is a poor fit. He has resided there for many years, since his initial discharge from the hospital following his NCR finding. He gets along very well with the staff and co-residents. However, he misses his hometown of Pembroke, Ontario, and has longed to return to that community for many years.
As discussed with the ORB at recent hearings, we had referred him to the Carefor supported residence in Pembroke and to the Pembroke Assertive Community Treatment Team (ACTT). His referral was finally assessed in the fall of 2025. Unfortunately, the Carefor residence declined his application.”
Evidence at the Hearing
[13]. The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Strike, who co-authored the Hospital Report. Dr. Strike testified as follows:
a. Mr. St. Louis came in for a scheduled appointment two weeks ago. At that time, he was concerned that his tremors were getting worse, as he had an unfortunate incident in which he spilled his coffee. He is currently on Paliperidone, a long-acting injectable anti-psychotic which tends to cause tremors and other side effects. In the past reporting year, they had increased his IM medication dose to 525mg in order to allow for a reduction in his Clozapine dose, as the Clozapine was causing him a lot of side effects and distress.
b. At their February 9, 2026, meeting, Dr. Strike prescribed an as-needed medication, Benztropine, to address his tremor issues as well as to reduce the frequency of Paliperidone from every nine weeks to every ten weeks. This approach to the medication change was very safe and measured.
c. Mr. St. Louis advised today that his tremors are better, and he has not needed his as-needed medication. The treatment team has no plans to change his medication regimen.
d. Mr. St. Louis now wishes to stay at his specified group home. The reason she is requesting the deletion of Paragraph 1(d), which requires Mr. St. Louis to “submit samples of his urine and/or breath”, is no longer necessary or appropriate. It has been 12 years since Mr. St. Louis has used any substances, and he takes his sobriety very seriously. For several years, he has consistently indicated to the treatment team that he wishes to avoid all substances, as he understands the effect they have on his mental health. Therefore, the hospital has recommended deleting the paragraph.
e. The requirement that Mr. St. Louis abstain from substance use was removed from his last Disposition, and he has not used any substances in the current reporting period. There is confidence that if Mr. St. Louis were to use substances, whether alcohol or cannabis, he would report doing so to the treatment team, the staff at his group home, and the hospital.
[14]. In response to questions from counsel for the Attorney General, Dr. Strike testified:
a. Ongoing medication adherence is an issue with Mr. St. Louis and will have to be continued to be monitored. While Mr. St. Louis did not take his bed-time Clozapine for about two months and did not report this promptly to the treatment team, this does not change her opinion that he no longer needs to submit samples of his urine.
b. Mr. St. Louis did, with very little prompting from Mr. Robins or herself, admit to experiencing auditory hallucinations and having nightmares.
c. She is very confident that the group home staff would detect if Mr. St. Louis were to attend a liquor store, use substances himself, or associate with persons who use substances. Mr. St. Louis would, on his own, report any use of substances.
d. There is a high risk that Mr. St. Louis may stop his oral medication; however, his current mental stability is approximately 80 percent controlled by his IM medication. Given that he is now on a much lower dose of Clozapine than in the past, there is less concern about the effects of him not taking it.
e. Mr. St. Louis now wishes to continue to reside at his current group home, as his mother, who lived in Pembroke, and was his primary motivation for wanting to move there, recently passed away.
f. He reaches out to the team quite frequently, and often more than his Disposition requires. He has a very good relationship, with herself, the staff at the group home, and his social worker Mr. Robins.
[15]. In response to questions from counsel for Mr. St. Louis, Dr. Strike testified:
a. While the death of Mr. St. Louis’ mother was a significant stressor for him, he managed the loss appropriately, signifying a very positive step forward.
b. He has been in the same group home for 12 years and no longer wishes to move to Pembroke. This housing stability is also a protective factor.
c. He is happy with his group home and the staff there.
d. The long-acting injectable medication provides the bulk of Mr. St. Louis’ protection against a deterioration in his mental stability, which is also a very positive factor.
e. Mr. St Louis is no longer complaining of any side effects from either his Clozapine or his current, and accepted, IM medication.
f. For the treatment team to recommend an absolute discharge, they would like to see Mr. St. Louis:
i. continue to want to remain at his group home ii. remain adherent to his medication regimen iii. remain mentally stable iv. continue being associated with CMHA and the ACT team v. develop a therapeutic rapport with his ACT team
[16]. In response to questions from the panel, Dr. Strike testified:
a. Mr. St. Louis no longer has a desire to move to Pembroke.
b. He appreciates the positive aspects of staying where he is as well as the support he currently receives from her, the treatment team, and the staff at his group home. The treatment team was worried about the risk of destabilization when Mr. St. Louis’ mother passed away; however, he managed this significant life stressor very well and appropriately.
[17]. No other evidence was called.
Analysis and Conclusions:
[18]. Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board agrees with the joint submission: Mr. St. Louis remains a significant threat to the safety of the public.
[19]. 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. Strike, in addition to the documentary evidence before us.
[20]. Dr. Strike’s testimony is that Mr. St. Louis’ adherence to medication is an ongoing issue as evidenced by his failure to take his Clozapine for a period of two months and concealing this behaviour from the treatment team.
[21]. The treatment team has recently changed Mr. St. Louis’ medication regimen, and they need to see him adhere to it and remain stable for a period of time. Also, he needs to develop a rapport with an ACT team before they can consider whether he no longer represents a significant threat to public safety.
[22]. In particular, the Board relies on the following paragraphs set out in the hospital report:
“Mr. St. Louis continues to present a real risk – not just speculative – of harm to the public that would be criminal in nature. His treatment-resistant schizophrenia persists. He achieved superior control of his positive symptoms with the addition of clozapine several years ago. Since then, he had multiple episodes of partial or full clozapine non-adherence, due to his strong dislike of this medication which he attributes to various somatic experiences. One of his primary and most pervasive complaints, fatigue, is suspected to stem from obstructive sleep apnea which has never been evaluated, diagnosed or treated due to his firm reluctance for same. He developed acute episodes of his schizophrenia with distressing hallucinations and delusions with violent themes, similar to those that drove the index NCR offences.
In recent years, his risk of aggression has been sufficiently managed these via prompt voluntary admission to local schedule 1 hospitals where his medication was adjusted and adherence was addressed. This has worked well due to the trusting therapeutic relationship Mr. St. Louis has with Mr. Robins and myself, where he reaches out to report psychotic symptoms promptly and is agreeable to voluntary admission when unwell. He has not yet transitioned to community-based mental health services. We could not transfer his psychiatric care to his family physician, they would be unable to prescribe his clozapine, and his psychopharmacology is rather complex. He will require psychiatric follow-up long term, with rapid access to be able to change medication in the event of abrupt cessation or refusal of antipsychotic agents. This remains a long-term area of concern that is directly related to his risk of reoffending. Although he has reported satisfaction with his current medication regimen, it is too early to know if this combination will continue to be acceptable to him in the long term, as well as too early to know if his schizophrenia will remain adequately controlled.
His violence risk has not changed in the past couple of years. His likely violence scenarios are unchanged overall, although his late mother is obviously no longer a potential target. Potential targets of aggression would be those in his environment, including co-residents and staff at his group home (similar to violent ideation and minor aggressive behaviour toward peers that he experienced in past years, managed with prompt intervention), health care providers (particularly those unknown to him, such as during an admission – similar to previous aggression toward hospital security staff), or general members of the public that he may encounter in his environment. He continues to present a chronic risk of verbal aggression, property destruction, and assaultive behaviour in the context of acute psychosis that can occur quickly following missed medication doses. Medication non-adherence is his primary risk factor that is likely to occur intermittently while he is under the ORB, including over the upcoming year. I expect that his medication non-adherence would worsen without an ORB disposition.”
[23]. The Board agrees with the removal of the condition requiring him to submit urine samples as it represents the least onerous and least restrictive Disposition.
[24]. Mr. St. Louis has 12 years of sobriety and is internally motivated to remain abstinent from substances. The staff at his group home would also be aware should he use substances or associate with persons who do use substances. The treatment team is also very confident he would self-report any substance use.
[25]. 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. St. Louis, his reintegration into society, and his other needs, the necessary and appropriate Disposition is to continue with his Conditional Discharge Order with the deletion of paragraphs 1(d) (submit samples) and 1(e) which was contained in error in his current Disposition.
DATED this 16th 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