Re: Andrew Azevedo
ORB File No: 8437 Hearing held on: Monday, February 23, 2026 Place of hearing: Waypoint Centre for Mental Health Care Pursuant to: Sections 672.48(1) and 672.81(1) of the Criminal Code
Before: Alt. Chairperson: Ms. L. Maunder Members: Dr. P. Darby Dr. L. Lightfoot Ms. M. Chamberlain Mr. J. Cyr
Parties Appearing: Accused: Andrew Azevedo Counsel: Ms. A. Szigeti Person in charge of Hospital: Counsel: Ms. J. L. Lefebvre Attorney General of Ontario: Counsel: Ms. S. Curry
REASONS FOR DISPOSITION
(Dated March 31, 2026)
[1]. In November 2023, Andrew Azevedo was found unfit to stand trial on a Criminal Code of Canada (“the Code”) charge of assault. Mr. Azevedo has been detained in the high-secure forensic program at Waypoint Centre for Mental Health Care (“Waypoint”) since then. At this annual review of his disposition, three issues had to be resolved by the panel: Did Mr. Azevedo remain unfit, what was the necessary and appropriate disposition, and should we order the proposed independent assessment.
[2]. The panel found that Mr. Azevedo remained unfit to stand trial and that the necessary and appropriate disposition was his continued detention at Waypoint – these issues were not contested by Ms. Szigeti, on behalf of Mr. Azevedo. The panel also agreed with the joint position taken by the parties that we should order an independent assessment, to be conducted by Andrea Monteiro, with the report made available to all the parties in advance of an early review of Mr. Azevedo’s disposition in approximately six months.
Brief History / Context
[3]. Mr. Azevedo is 39 years old. He began to show signs of a psychotic illness when he was 17 years old. He engaged with mental health services and accepted treatment but over time his symptoms did not resolve with antipsychotic medication, and he became profoundly unwell. He currently carries diagnoses of schizophrenia, social anxiety disorder, and obsessive-compulsive disorder.
[4]. For more than 15 years, Mr. Azevedo lived with his parents (who were, and remain, very supportive and involved in his life), while he struggled with the symptoms of his illness. He has been trialed on almost every available antipsychotic medication including various combinations. He has undergone courses of electroconvulsive therapy (“ECT”). He experiences distressing paranoia, anxiety, and command hallucinations. These symptoms have caused him to be aggressive towards family, members of the community, as well as co-patients and staff in hospital. They have also caused him to attempt suicide on three occasions.
[5]. Prior to becoming a forensic patient, Mr. Azevedo was hospitalized many times. He was on a Community Treatment Order and supervised by an Assertive Community Treatment (“ACT”) team. He was not involved in the criminal justice system (he has no record) but was frequently described as assaultive in the context of his command hallucinations. He was also occasionally sexually inappropriate.
[6]. Despite being found unfit in November 2023, Mr. Azevedo’s current hospitalization dates back to two years before that. Mr. Azevedo was hospitalized for a year at Ontario Shores Centre for Mental Sciences (“Ontario Shores”), from November 2020 to September 2021, after he assaulted a United Parcel Service worker. Two months after his discharge, he made threats towards his mother causing his ACT team psychiatrist to issue a Form 1. Mr. Azevedo was then admitted to Waypoint as an involuntary patient. He required seclusion to manage his aggression towards patients and staff. Efforts to alleviate Mr. Azevedo’s symptoms with clozapine and ECT were only marginally successful.
[7]. Waypoint was working towards discharging Mr. Azevedo home when, in April 2022, Mr. Azevedo attacked a psychiatrist (the index offence). The psychiatrist was not injured.
Mr. Azevedo Remains Unfit
[8]. In deciding whether Mr. Azevedo remained unfit to stand trial, the panel had regard to the definition of fitness as set out in s.2 of the Code and elaborated upon, by the Supreme Court of Canada, in R v Bharwani (2025 SCC 26).
[9]. Mr. Azevedo’s fitness was assessed several times since his last annual review, including the day before this hearing. Dr. Mishra, Mr. Azevedo’s treating psychiatrist, testified that in his opinion, he remained unfit to stand trial. Despite the combination of antipsychotic medications Mr. Azevedo was taking, his symptoms remained prominent and distressing. He was unable to tolerate social interactions of any length or a lot of stimuli. When Mr. Azevedo was able to engage in a conversation about court processes (pleas, participants, potential outcomes), he was either unable to answer the questions or only partly able to do so. When educated about the processes, he did not retain the information.
[10]. We accepted Dr. Mishra’s evidence that due to his high burden of symptoms and the degree to which they keep him internally preoccupied, Mr. Azevedo could not meaningfully participate in or tolerate court proceedings without significant distress. Mr. Azevedo is unfit to stand trial.
The Necessary and Appropriate Disposition
[11]. The panel was thus obliged to render the “necessary and appropriate” disposition – a conditional discharge or detention order – keeping in mind the safety of the public as the paramount consideration, as well as the mental condition of the accused, the reintegration of the accused into society, and the accused’s other needs. See s.672.54 of the Code.
[12]. Mr. Azevedo has not only been at Waypoint since his admission (prior to the index offence) in November 2021, but he has been in seclusion. As set out in the Hospital Report and reinforced in Dr. Mishra’s testimony, his seclusion is necessary because Mr. Azevedo continues to experience command hallucinations that tell him to hurt others. He is unable to resist acting on these commands. This results in him unpredictably but somewhat regularly (at least ten times during the review period) becoming physically aggressive towards staff. This occurs despite him being in seclusion – usually when interacting with staff as part of seclusion relief. The use of restraints during seclusion relief mitigates the potential harm of these episodes.
[13]. Mr. Azevedo is sometimes remorseful about these incidents and there was no evidence to suggest that he is prone to violence other than in response to command hallucinations. At the same time, Mr. Azevedo lacks insight into the risk he poses.
[14]. The panel was convinced that, given Mr. Azevedo’s ongoing command hallucinations, the least restrictive and least onerous disposition remained a detention order at Waypoint. He needs a high-secure environment so that the risk of him being unpredictably physically aggressive can be managed and mitigated. Anything less would put staff and patients at risk of serious bodily harm.
[15]. The panel noted as well that Waypoint has resources other hospitals do not have such that those in seclusion have better access to seclusion relief and other features designed to alleviate some of the burden of seclusion.
The Independent Assessment
[16]. The Board has the jurisdiction to order an assessment when it has reasonable grounds to believe that the evidence is necessary to fashion a disposition. Depending on the circumstances it may, in fact, be obliged to do so. See s.672.121 of the Code, Mazzei v British Columbia (Director of Adult Forensic Psychiatric Services), 2006 SCC 7 and Hamblett (Re), 2026 ONCA 9.
[17]. The parties in this matter jointly recommended that the panel order an assessment to be conducted by Andrea Monteiro. She is a criminologist with experience working in corrections as well as a consultant with a focus on reducing segregation in corrections. It is hoped that expertise from a different perspective may offer some assistance to the clinical team. The parties also asked that the panel order an early hearing (ideally six months after this hearing) once the assessment report has been prepared and the parties have had a chance to consider it.
[18]. The panel ordered the proposed assessment and an early hearing. We concluded that the assessment was necessary, for several reasons.
[19]. First, no meaningful and lasting progress has been made with Mr. Azevedo for several years. He has been secluded since the index offence in April 2022 (and was largely secluded in the months leading up to the index offence as well). He continues to be unpredictably physically aggressive towards those around him even though he is secluded and restrained when he is offered seclusion relief.
[20]. The hospital has a Policy for Use of Emergency Restraints – Physical, Chemical, Mechanical and Seclusion for Prevention of Serious Bodily Harm. Pursuant to that policy, Mr. Azevedo’s seclusion was reviewed daily, and assessed by an independent psychiatrist every 28 days – 13 times during the review period by five different psychiatrists.
[21]. Waypoint seeks to offer seclusion relief every day. There are occasional days when operational issues interfere with being able to offer relief. On some other days, Mr. Azevedo is deemed not appropriate for seclusion relief based on his state of mind. On all other days, Mr. Azevedo is offered seclusion relief, and he accepts that offer more often than not. Seclusion relief runs from 45 minutes to two hours. Mr. Azevedo sometimes goes outside to the yard, sometimes watches TV, and sometimes visits with or calls family.
[22]. Mr. Azevedo has not progressed out of seclusion or out of restraints.
[23]. This is so despite the hospital’s consistent efforts since 2022 to optimize Mr. Azevedo’s medications and reduce his symptoms that create the need for seclusion. In addition to trials of most available antipsychotic medications (including clozapine), the hospital has sought and gained approval to try medications not available in Canada. They have not been better able to control Mr. Azevedo’s command hallucinations.
[24]. This is so despite two or three trials of ECT (for various lengths of time). Although Dr. Mishra testified that the team noted Mr. Azevedo to be less aggressive with staff, brighter in mood and more engaged. Mr. Azevedo’s family did not share that experience – they reported he was “vacant,” less able to converse with them, and confused. Mr. Azevedo did not like ECT and asked to stop it. His family reports that he was traumatized by it. In any event, Mr. Azevedo’s mother, his substitute decision-maker, withdrew consent for the treatment.
[25]. The hospital has sought input from external psychiatrists, most recently from Dr. Y. Naidoo in October 2025. As summarized in the Hospital Report:
Dr. Naidoo’s recommendations included reinitiation of ECT with the potential for maintenance ECT, as well as some possible medication adjustments, such as increasing Haldol. He suggested that staff continue to employ de-escalation techniques utilizing positive therapeutic relationships, and to continue efforts to build on positive rapport. Given Mr. Azevedo’s instability, Dr. Naidoo identified that psychotherapeutic interventions were unlikely to be helpful at this time.
The hospital implemented his recommendations to the degree possible.
[26]. Second, while we did not find a treatment impasse (and the parties didn’t suggest there was one), it was clear that Mr. Azevedo, his family, and the treatment team, are all frustrated with the lack of progress. All are doing what they can and share the goal of seeing Mr. Azevedo out of seclusion and well. There is some respectful disagreement among them. Mr. Azevedo’s family (in two letters filed with the panel, on consent) see his condition deteriorating and are inclined to attribute that to seclusion, while Dr. Mishra attributes it to a combination of factors including prolonged psychosis. The family have made a conscientious decision regarding ECT and want the team to accept that decision, while Dr. Mishra saw more improvement with ECT than many interventions and (we inferred) feels obligated to continue to offer it and discuss it among the treatment options. The family understands that there are no easy or quick solutions and understand the need to keep staff safe, but question whether limited resources aren’t playing a role in Mr. Azevedo’s lack of progress. For his part, Dr. Mishra does not control the hospital’s (or for that matter, the Ministry of Health’s) resources.
[27]. As Dr. Mishra testified, it is hard to know what helpful and appropriate recommendations might come from Ms. Monteiro, given his different educational and experiential background. Nonetheless, we must look for ways to improve Mr. Azevedo’s circumstances and seeking input from someone who has relevant experience, albeit in a different context, offers an opportunity for new approaches and, along with them, hope.
DATED this 31st day of March 2026, at the City of Toronto, in the Region of Toronto.
Ms. L. Maunder Alternate Chairperson
Office of the Registrar Ontario Review Board