Ontario Review Board
Re: Sean Carter
ORB File No: 6815
Hearing held on: Tuesday, January 6, 2026
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. K.A. Connidis
Members: Dr. K. Hand Dr. G. Kerry Mr. N. Kozloff Mr. S. Duffy
Parties Appearing:
Accused: Sean Carter Counsel: Mr. A. Pollard
The person in charge of hospital: Representative: Dr. P.L. Darby
Attorney General of Ontario: Counsel: Ms. V. Culp
REASONS FOR DISPOSITION
(Dated April 13, 2026)
Introduction
On August 27, 2015, Mr. Carter was found not criminally responsible on account of mental disorder ('NCR') on charges of attempted murder and aggravated assault, contrary to the Criminal Code of Canada ('Code'). Mr. Carter has remained since then under the jurisdiction of the Ontario Review Board ('Board'), pursuant to successive annual Board dispositions.
Under his current Disposition dated January 29, 2025, Mr. Carter is detained at the Forensic Service of the hospital, Centre for Addiction and Mental Health ('CAMH') in Toronto, with conditions including a weapons prohibition and a substance use prohibition with monitoring requirement, and with privileges extending to living in the Greater Toronto Area ('GTA') in approved supervised accommodation, reporting not less than once per week. At the time of the hearing, Mr. Carter was living in the community in such accommodation, as described below.
On January 6, 2026, this panel of the Board convened at CAMH to conduct the annual review hearing for Mr. Carter. The issues to be decided were whether Mr. Carter poses a significant threat to the safety of the public at this time, and, if so, what disposition is necessary and appropriate for him for the year ahead.
The evidence at the hearing included a Hospital Report dated December 23, 2025 (the 'Hospital Report'), entered as Exhibit 1, and the viva voce evidence of Dr. P. Darby.
The Parties' Submissions and the Board's Disposition
At the outset of the hearing, Dr. Darby, as the hospital's representative, advised that the hospital was recommending no change in the new disposition, with the Detention Order and all the terms of the current Disposition continuing for the coming year. Ms. Culp, for the Attorney General, supported that recommendation. Mr. Pollard, for Mr. Carter, advised that his client was asking for an Absolute Discharge; thus, the threshold issue of significant threat was contested. The parties maintained these positions in their closing submissions.
For the reasons given below, we found that Mr. Carter poses a significant threat to the safety of the public at this time, and we accepted the hospital's recommendation for the new disposition, as necessary and appropriate for Mr. Carter for the year ahead. We have accordingly made an order pursuant to s. 672.54(c), directing that Mr. Carter be detained at CAMH, on all the same terms as in the current Disposition, including the community living and other privileges.
Circumstances of the Index Offences on December 26, 2013
The circumstances of the index offences, set out briefly in the Hospital Report (as taken from the Synopsis for a Guilty Plea), are that: On December 26, 2013, shortly after midnight, Mr. Carter stabbed a 19-year-old student in the head with a knife. The young man was standing at the bus stop waiting for a bus, and there had been no prior interaction between them. He suffered serious injuries. Mr. Carter fled, and was arrested at gunpoint.
Prior to and at that time, as further noted in the Hospital Report, Mr. Carter had been experiencing instability in his mental state, with a recurrence of symptoms of psychosis including auditory hallucinations, and had been acting aggressively. Other circumstances of the index offences are noted below in these Reasons (para's 13-14).
Personal and Mental Health Care History Prior to the Index Offences
Reference should be made to the Hospital Report for an account of Mr. Carter's relevant personal background prior to the NCR finding. Information about his early personal life is noted to be somewhat limited and at times contradictory.
The Hospital Report account is briefly summarized here, as follows. Mr. Carter, born in September 1983, is now 42 years old. The only child of his parents' relationship, he has four half-brothers. His parents separated when he was six years old. He was then raised by his mother, and has had no contact with his father since then. Mr. Carter dropped out of high school in grade 11. He has apparently reported that, at 14 or 15 years old, he began using cannabis, and then selling (but not using) crack-cocaine. He has explained that he lacked male role models and financial support growing up, and that hanging around on the street with older boys engaged in such activities, gave him money and a sense of belonging.
By his early twenties, Mr. Carter had fathered two children with two different women: a son born in 2002 and a daughter in 2004. He and his second girlfriend (mother of his daughter) were together for some years, in a sometimes volatile relationship. They became estranged, with reportedly no contact since the index offences. He has had little or no contact with his children. He recently made a poorly-arranged and unsuccessful attempt to visit his daughter.
Mr. Carter's first psychiatric admission to hospital was in 2011, at the age of 28, for a fitness assessment (relating to the 2011 criminal charges noted below); he was described then as "floridly psychotic", aggressive, and threatening. Once treated with medication, he continued to suffer residual symptoms, but was less aggressive. He was again admitted for a fitness assessment in December 2012 (on different charges), and he was described then as extremely disorganized, experiencing auditory hallucinations, and approaching catatonia.
Subsequently, in August 2013 (four months before the index offence), Mr. Carter punched two elderly people in the head, believing they were stealing his blood. Police took him to hospital, where he was agitated and required chemical restraint. Over the course of ten weeks of treatment, his mental state improved. He was discharged in November 2013.
Mr. Carter continued residing with his mother and a brother in Toronto, and again began to relapse. The index offences occurred six weeks later, on December 26, 2013. At the time of his arrest that night, he was experiencing auditory hallucinations and was aggressive.
Prior Criminal Record, from the Hospital Report
Mr. Carter has a significant past criminal record, which began when he left high school. It includes numerous convictions over the years from 1998 to March 2013, many involving seriously harmful criminal conduct – including six assault convictions (two causing bodily harm, three with a weapon), and several weapons charges (two involving firearms) – as well as many failures to comply with probation terms and other legally-binding conditions.
Respecting an assault conviction in 2003, according to collateral information, Mr. Carter admitted to punching his girlfriend's stepfather, who had intervened in an argument between his girlfriend and himself. He reportedly wrestled his girlfriend to the floor in an argument in 2005, denying "really" hitting her, but noting his actions left her with a bruise.
On the sentences for his convictions, he was once given the equivalent of a three-year sentence of incarceration. He has also been required to carry out community service. On his conviction for serious offences in 2011 (assault with a weapon x3, while failing to comply with probation), in addition to the equivalent of just over a six-month sentence, it was recommended that he have a psychiatric assessment, and he was given a three-year term of probation which included a condition that he take medications as directed by a physician.
Psychiatric Diagnoses, from the Hospital Report
- Mr. Carter's current diagnoses, which were made following the index offences and have remained the same since then, are:
(1) schizophrenia,
(2) cannabis use disorder (qualified as 'in remission in a controlled setting' on the front page of the Hospital Report, but not so in the 'Diagnoses' section at pg. 53), and
(3) antisocial personality traits.
Course from the Index Offences (December 2013) to the NCR finding (August 2015)
On December 30, 2013, Mr. Carter was transferred to CAMH, for a fitness assessment. That was followed by an unfit finding, and extended treatment under court orders. It took many months for Mr. Carter to be stabilized in hospital. Several trials of antipsychotic medication failed to resolve his symptoms of psychosis. He then acquiesced in a trial of clozapine. There appeared to be some modest benefit after three months of gradually increasing the dosage. However, Mr. Carter refused to continue to take clozapine.
Since then, Mr. Carter's medication has been optimized on a long-acting injectable ('LAI') antipsychotic (zuclopenthixol) every two weeks. Over the years, he has continued to experience both positive and negative symptoms of psychosis, but has consistently refused to try clozapine again or to try another oral medication to augment his treatment regimen.
In March 2014, Mr. Carter was placed under a Warrant of Committal, and continued in treatment at CAMH. In July 2014, he was transferred to the Forensic Secure Unit A ('FSU-A'). He was found NCR on the index charges at a trial of the issue on August 27, 2015.
Course under the Board's Jurisdiction (August 2015 to December 2024)
The Hospital Report should, again, be referred to for its annual accounts of Mr. Carter's course under his successive Board dispositions, which is briefly noted here.
Mr. Carter remained detained as an in-patient at CAMH for the next three and a half years. He was cooperative and largely pleasant in hospital. He remained abstinent from substance use. His insight into his illness and need for medication remained limited. He adhered to his LAI medication administration every two weeks, with hospital staff supervision and support. He showed significant amotivation and avolition, which slowed his progress towards a discharge from hospital. He struggled with his hygiene. Over time, he worked with his treatment team on programming designed to assist him with the transition to community living.
In March 2019, he was discharged to the CMHA-operated Transitional Rehabilitation Housing Program ('TRHP'), to reside in the high-support TRHP-2 residence located on CAMH grounds. This transitional residence provides 24-hour-staff supervision and on-site medication support, and an intensive multidisciplinary team to help prepare forensic patients to move on to community living. Mr. Carter followed the rules and participated in programs as required (but no more than that). He abstained from cannabis use, but for one occasion (in June 2020) when he tested positive for it. He denied residual symptoms of psychosis, but he was often observed responding to internal stimuli, and he expressed persistent delusions about a man following him and using voodoo against him.
In February 2022, Mr. Carter moved from the TRHP-2 high-support residence into his own independent apartment, operated by the CMHA Forensic Supportive Housing ('FSH') program. He was supported in the community by his CAMH Forensic Outpatient Services ('FOPS') Transitional Case Management team.
The initial transition went well. But in August and September, Mr. Carter returned to cannabis use. He did not tell the team about it until confronted with his positive urine drug screens ('UDS'). His paranoid concerns intensified, but he refused to accept that the cause was his cannabis; rather, he insisted that smoking cannabis made the voodoo go away. Notably, however, when given the option to either re-establish abstinence from cannabis within two weeks or else return to hospital, he stopped using cannabis and did not require readmission.
The year 2023 was a difficult one for Mr. Carter. In April 2023, he was readmitted to hospital, after his cannabis use escalated, with associated clinical deterioration that included notable agitation, auditory hallucinations, thought manipulation, grandiose delusions, and preoccupation with his belief that voodoo was being used against him. The dosage of his LAI antipsychotic medication (zuclopenthixol) was increased to 500 mg. every two weeks.
In June 2023, after two months' treatment in hospital, Mr. Carter had returned to his baseline, and was discharged back to his apartment. Initially, his mental state remained close to baseline, but with some fluctuations. Notably, he faced significant psychological stressors, stemming from his mother's poor health and his intense concern about her welfare. He began using cannabis, regularly and unabated, in September and October 2023, and showed worsening symptoms of psychosis. In October, he tested positive for ethanol (indicating alcohol use) in addition to cannabis. He abruptly terminated his sessions with his FORCAT-referred Substance Relapse Prevention ('SRP') therapist at that time, and declined to transfer to another therapist. He also refused to have the CMHA nurse come to meet him at his apartment.
Given his deteriorating clinical engagement, escalating substance use, and lack of transparency in his reporting, his team began to plan his readmission to hospital. However, at that point, he became very ill with a respiratory illness, which interrupted his substance use and forestalled readmission. He remained in his apartment and recovered by November 2023.
His clinical team had continuing concerns about Mr. Carter's long-term stability in the community. His mental state was noted to remain susceptible to the destabilizing effects of both cannabis and psychosocial stressors, with exposure to either of these increasing his susceptibility to the other. There were limited options for further medication optimization in the community, in part due to the treatment-resistant nature of his illness, and in part due to his reluctance to consider oral augmentation strategies. Mr. Carter was advised that, should he deteriorate again, he would likely require a longer hospital readmission to optimize his treatment and ensure he remained suitable to reside independently in the community. He was also advised that his community living was contingent on his engaging in substance use treatment and at least one structured group per week. He agreed to a FORCAT referral to a new SRP therapist in December 2023, and to continue attending the FOPS music group
At the time of the December 2023 annual Board review hearing, Mr. Carter was residing in his apartment. At that point, it was thought that he was not using cannabis. He was noted to have continuing increased instability, to be very susceptible to substances, and to be highly likely to act out aggressively when unwell.
On January 4, 2024, Mr. Carter was readmitted to CAMH, due to unmitigated substance use and progressive deterioration in his mental state. This significant increase in the restrictions on his liberty ('ROL') was upheld on a Board review as necessary and appropriate at that time.
During the next four months in hospital, Mr. Carter was more cooperative with treatment recommendations: He agreed to participate in structured programming, cognitive interventions training, and individual psychotherapy. He enrolled in both a FOPS Enhanced Illness Management and Recovery Program ('E-IMR') group and an SRP Maintenance group. He did show some early signs of increased psychotic symptoms, including intermittent distress about voodoo, but there was no evidence of agitation or paranoid hostility; he was overall more settled and cooperative, and his mental state showed appreciable improvement and more stability than in the year before.
On May 13, 2024, Mr. Carter was discharged back to his apartment, reporting minimal distress from his voodoo beliefs. The rest of the year was described as largely uneventful.
Notably, however, Mr. Carter was more closely supervised than before, and the clinical team had ongoing concerns about his long-term stability in his community housing. He continued to have poor insight into his illness, his substance use, and his other reoffence risks
He was also noted to be generally only a passive attendee in his programs, and somewhat superficial in his individual SRP psychotherapy with his new FORCAT therapist, Dr. Cripps. He was guarded and reluctant to share information with the team about his friends (thought to regularly use cannabis), and about his new girlfriend, his mother and family, and his activities.
In October 2024, Mr. Carter engaged in intermittent cannabis use for a two-week period. He was not forthcoming about it initially, then gave a dubious explanation for it, then minimized it, and blamed it on his illness and voodoo. However, he agreed to increase his reporting, program attendance, and urine drug testing, and he successfully abstained from cannabis use for the rest of the year. This improvement led to his reporting frequency being reduced in late November, from up to three times a week, depending on his stability, back to weekly.
The Past Reporting Year (December 2024 to December 2025)
The Hospital Report should be referred to for an account of Mr. Carter's course over the past reporting year, which is briefly noted here as follows.
Mr. Carter's limited and poor insight into his mental health has continued. However, he is now able to identify that cannabis use can increase his risk of psychosis.
Mr. Carter's LAI antipsychotic medication remains the same (zuclopenthixol, at 500 mg. since the spring of 2023). He receives his injection every two weeks, but still requires reminders to attend the appointments. He continues to have tremors, a suspected side effect of his LAI medication; in 2024, he discontinued a trial of benztropine (a daily oral medication to manage tremors), after reluctantly agreeing to it and reporting meaningful benefit from it.
He has not exhibited any physical or verbal aggression over this reporting year, and he has denied having thoughts of harming himself and harming others. He has not had any critical incidents. There have been no concerns reported to the treatment or housing teams by his apartment building management this reporting year.
Mr. Carter continues to present with residual symptoms of psychosis, including that voodoo is being performed on him. In October 2025, he reported feeling depressed, that his "soul was being sucked out", that God speaks through him and has big plans for him, which he did not want to discuss with the team, and that he did not understand why people were jealous and acted differently around him. In November 2025, in the context of sleep problems, he reported that a "wickedness" being done to him was making him physically unable to rest his neck and head and fall asleep. He denied having any delusions, hallucinations, or other signs and symptoms of changes to his mental status.
He also continues to present with duplicitous behaviour and to be very vague and not forthcoming with the team about how he spends his time in the community. He reports staying at home, listening to music, and going on walks as his daily activities. He says he does not know where his funds are being spent. When his positive UDS for cannabis was brought to his attention in October 2025 (the only positive UDS this year), he initially reported he did not use it; after much probing, he gave an explanation that could not have led to a positive result, and then, he explained that it resulted from second-hand smoke in his friend's car, saying he was not aware was possible, although this potential had been discussed with him previously.
Mr. Carter reluctantly agreed to resume individual SRP therapy with a FORCAT clinician in October 2025. However, his referral was denied due to staffing shortages and his lack of engagement over the years with FORCAT clinicians, most recently with Dr. Cripps in 2024 after being discharged from hospital. He continues to resist other SRP groups or individual counselling, has declined attending virtual groups, and stated that he has done all the SRP group programming previously. He attends the mobile arts program (MAPS); however, he often arrives late and attends only the last 2-10 minutes of the session.
This year, Mr. Carter was found incapable of managing his finances, and they are managed for him by his Public Guardian and Trustee ('PGT'), who pays his rent and internet bill directly from his funds, and gives him a weekly $100 allowance and an additional $100 monthly for cigarettes. He is also issued an allowance for transportation, groceries, and other expenses on a monthly basis. His case manager has reviewed his budget with him, and discussed how to plan his spending. Despite this, Mr. Carter continues to run out of funds for necessities before the end of each week, and has not been willing to show his case manager what food he does have, when he reports having run out of food. He is described as not being forthcoming with the team about where his funds are spent.
Mr. Carter declined this year to remain with his primary care physician in the community. His case manager encouraged him to have a primary physician, and accompanied him to meet a new physician in December 2025, as well as to a bloodwork appointment in November 2025.
Mr. Carter continues to require prompting to maintain a moderate level of cleanliness in his apartment, with a behavioural cleaning plan, reminders, rewards of Presto transit cards as incentives, and biweekly home visits by his case manager do support him in doing this.
With respect to family, friends, and social support, Mr. Carter remains guarded. He will occasionally mention his friends, but provide very limited information. His mother now lives in a long-term care residence, he has not visited or spoken with her in several months, and he has reported not wanting to speak about her or visit her, as seeing her in her current physical and mental state is difficult for him. He is guarded with information about his brother Patrick. He does not have contact with either of his two children. In October, he informed his case manager that he had attempted to visit his daughter in Whitby, but was informed by her grandparents that they had moved and not give an address. He has told his case manager that he would like to connect with his daughter, but has been reluctant to make attempts to contact her other than by the unannounced visit, which his case manager has cautioned him against.
The Hospital Report should also be referred to for the summaries of the risk assessment results and risk management needs for Mr. Carter; the psychiatric opinion on the threshold issue of significant threat, and recommendations for his new disposition for the year ahead. These are noted in the concluding section of these Reasons.
The Viva Voce Evidence given at the Hearing by Dr. P. Darby
Dr. Darby, the signatory of the Hospital Report, on behalf of the hospital, has been Mr. Carter's attending psychiatrist for the past six months, during the absence on leave of Dr. Meng, Mr. Carter's outpatient psychiatrist. Having just returned from her leave, Dr. Meng will be resuming as his attending psychiatrist following this hearing.
In his viva voce evidence at the hearing, Dr. Darby elaborated and highlighted relevant contents of the Hospital Report, relating particularly to Mr. Carter's past reporting year. In chief, Dr. Darby testified as follows.
This has been a good year for Mr. Carter. He remained in the community, with no readmissions to hospital. He had only one positive UDS this year.
Mr. Carter had a number of challenges. The ongoing negative symptoms of his illness are really quite profound and quite evident, and have persisted throughout his time under the Board. He is very reluctant to initiate activity, even when he is interested in it. He even missed the weekly FOPS music group he had agreed to participate in, partly due to his amotivation.
Confirming his opinion that a significant threat to the safety of the public still exists in Mr. Carter's circumstances, Dr. Darby highlighted the significance of a number of the factors referred to in the evidence set out in the Hospital Report:
(i) Mr. Carter's schizophrenia is chronic and he has profound ongoing symptoms, including many negative symptoms, as well as positive symptoms of psychosis, such as his delusion that voodoo is being used against him. These have been under better control this past year; however, they remain.
(ii) He has a significant criminal record, with some significant offences.
(iii) He has deficits in insight, notably in tying his diagnosed illness and its symptoms to his aggressive conduct.
(iv) He has no realistic plan, should he receive an Absolute Discharge, on where he would get medications. And it is clear that he does not want to see a psychiatrist (noting Mr. Carter's responses in his November 2025 Mental Status Examination: Hospital Report, pg. 48). It is almost sure that he would fall away from treatment quite quickly, decompensate, and experience paranoid ideation.
(v) A Conditional Discharge would not be adequate to manage his risk. Although the Box B criteria would be available, given that Mr. Carter is incapable, he would not necessarily meet the Mental Health Act criteria, in the case of his substance use or self-care problems. This could also put his housing at risk. Thus, Dr. Darby and the rest of the team believe that Mr. Carter still poses a significant threat to the safety of the public.
In answer to questions from Ms. Culp, for the Attorney General, Dr. Darby confirmed that Mr. Carter's current housing is a unit in a CMHA-operted independent building, not a group home with staff on site. An ODSP subsidy provides his rent, which his substitute decision-maker, the Public Guardian and Trustee ('PGT') pays directly to CMHA.
Dr. Darby did not know whether cannabis use would lead to his eviction. In the 2024 occupational therapist's housing assessment, it was noted that his housing was tenuous, and it was questioned whether it was appropriate and if he could retain it. If Mr. Carter lost this housing, CAMH would want to be in a position to approve any other housing. CAMH is not looking now for alternative housing. Mr. Carter moved in 2022 from the high-support TRHP housing on the hospital campus, to this CMHA housing. His tenure there has always been tenuous. It requires a lot of encouragement, with his case manager visiting him frequently there.
Nothing acute was found in the November 2025 blood work (Hospital Report, pg. 45).
While Mr. Carter would benefit from benztropine medication to treat his side effects, it is not such a huge concern that he does not adhere to it, since there is no concern that he will fall away from his antipsychotic, which is a long-acting injectable medication, due to side effects.
Mr. Carter is incapable of both making his own treatment decisions and managing his finances. He finds the logistics and dealing with the PGT difficult.
There is no community service in place for Mr. Carter at this point. He has no follow-up in the community, he just has his family, and his family doctor is new to him.
In answer to questions from Mr. Pollard, Dr. Darby confirmed that Mr. Carter has had a good year overall. He has made significant progress with respect to understanding that cannabis use increases his risk; being able to identify his diagnosis; having no aggression this entire year, and no criminal charges that Dr. Darby knows of.
Mr. Carter could stay on in his current housing if given an Absolute Discharge, but Dr. Darby added that that would not be appropriate for him. The significant negative symptoms of his illness are one concern, in that he could quickly drift away and not make appointments. With respect to his cannabis use, Dr. Darby did not agree that Mr. Carter simply admitted it, but noted that he initially made up reasons for it, and only admitted it when the results were put to him.
When it was put to Dr. Darby that Mr. Carter has said he composed a number of pieces of music over the holiday, Dr. Darby noted that it was hopeful that he would do that, as he has not engaged in music for some time.
In answer to questions from members of the Board panel, Dr. Darby confirmed that if Mr. Carter presents a high risk of future violence on a Conditional Discharge, then he would be at even more risk if he was given an Absolute Discharge. Mr. Carter's case manager has offered to support him to renew visits to his mother.
Closing Submissions of the Parties
As the representative of CAMH, Dr. Darby noted, in explaining why Mr. Carter continues to present as a significant threat to the safety of the public, that his evidence blended elements of his submissions. Dr. Darby also stressed that – to Mr. Carter's credit – he had a good year, and his team along with Dr. Darby hope he will have a good year going forward. Ms. Culp, for the Attorney General, highlighted that the significant threat standard is met by the evidence of Mr. Carter's index offence and the continuum of his history. Mr. Carter has done well this year, but there are more things to do, given the significant risk factors that remain to be addressed, notably including Mr. Carter's ongoing profound symptoms.
Mr. Pollard, for Mr. Carter, stressed the evidence that there were no incidents of aggression and threatening behaviour in the past year, and that Mr. Carter had a good year: he acknowledged his diagnosis, and his insight into his cannabis use has improved. Even if he was given an Absolute Discharge, his housing would continue, and the treatment team would offer him continued support. Mr. Pollard urged the panel to see that the time is now, after ten years, for Mr. Carter to receive an Absolute Discharge.
Our Findings and Conclusions
(1) The Threshold Issue of 'Significant Threat to the Safety of the Public'
On the first issue, we find that Mr. Carter continues to present a significant threat to the safety of the public at this time. This finding is amply supported by the whole of the evidence and by the rational analysis of the evidence based on the applicable law.
The term "significant threat" is defined in s. 672.5401 of the Criminal Code as "a risk of serious physical or psychological harm to a member of the public … resulting from conduct that is criminal in nature but not necessarily violent." In making our finding, we are guided by the principles of law established in Winko v. British Columbia, 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625, as applied and elaborated in numerous judicial decisions since then. To state the Winko jurisprudence in only a nutshell: A finding of significant threat cannot be speculative; it must be based on positive findings, supported by the evidence, that the risk of a particular person engaging in criminal conduct is a "real" risk, and that the harm caused by this conduct would be "serious" harm. Both findings are required: Neither a miniscule risk of grave harm, nor a high risk of trivial harm, is sufficient to find a real risk of serious harm.
The evidence set out in the Hospital Report and elaborated in Dr. Darby's evidence at the hearing (summarized above in these Reasons), which we accept, positively supports the significant threat finding in Mr. Carter's circumstances. The key points of this evidence and the rational legal analysis are well summarized in the risk assessments and formal conclusions set out in the Hospital Report.
On the actuarially-based probability measurements for assessing Mr. Carter's risk of violent reoffence, the scores for him indicate that he has "a moderate level of psychopathic traits overall" (PCL-R); that he falls in the sixth highest of nine ascending categories of increasing risk of violent reoffence among NCR accuseds, in which "approximately 58% … re-offended violently within an average of 10 years of opportunity" (VRAG), and that, in his strengths or protections against violence risks, he has overall "a Low-Moderate level of protective factors".
On the HCR-20-v.3 guide for structuring clinical judgment, the results for Mr. Carter indicate a high number (seven out of ten) of historical or static risk items that are present and highly relevant, and four out of ten current or dynamic items (in this past year) that are present or partially present and highly relevant. Respecting future risk management items, five items would be present or partially present and are highly relevant, if under a Conditional Discharge, and would not be present or would be mitigated to various extents, if under a Detention Order with Community Living.
Clinical or "criminogenic risk factors" that are important in understanding Mr. Carter's current and future risk, are identified (pgs. 51-52), and can be noted as follows:
(1) chronic schizophrenia, with active symptoms of psychosis when he is unwell (which Dr. Darby elaborated as including ongoing profound symptoms that still remain), and which have historically led to his seriously harmful criminal conduct against others:
(2) substance use, notably of cannabis, which has aggravated his symptoms and his underlying antisocial behavioural tendencies, and was apparently in sustained remission when he was detained at CAMH for over five years following his index offences, but has not been so since his return to community living in 2019;
(3) non-adherence to medication and other treatments, in the contexts of the absence of external controls and structure, and his lack of internal motivation, and
(4) antisocial traits, which have been aggravated by his substance use and by active symptoms of psychosis.
- Additional factors can be seen on the evidence (noted above in these Reasons) to be important contributors to Mr. Carter's risk of relapse and the resulting seriously harmful behaviour that flows from the four important criminogenic risk factors identified. These are:
(5) his unreliable reporting, with a pattern of being unforthcoming, guarded, and very vague with the team, and giving clearly dubious explanations about important matters, such as how he spends his time and with whom, how he spends his money, and whether he has been or is using cannabis;
(6) his ongoing lack of insight into his diagnosis, symptoms of psychosis, and reoffence risk, with, as Dr. Darby elaborated, notable deficits in making the connection of his diagnosed illness and symptoms to his aggressive conduct;
(7) respecting cannabis use, notwithstanding his ability this year to identify that cannabis can increase his risk of psychosis, it is noted in the risk assessment (pg. 52) that "unfortunately, despite ongoing substance treatment and psychoeducation, Mr. Carter has demonstrated [our emphasis] limited insight into the effect of substance use on his mental illness and the probability of the symptoms returning should he use substances" and
(8) his vulnerability to psycho-social stressors, such as understandable concern and distress over his mother's declining health and circumstances, and worries about his finances, heightening his risks of relapsing into cannabis use and resulting increasingly acute symptoms of psychosis.
- Integrating the actuarial and clinical risk factors, the following 'Final Risk Judgment' is made (pg. 51):
Taken together, when weighing Mr. Carter's pertinent risk and protective factors, his risk of any future violence would be High in the context of a Conditional Discharge. In contrast, should he be subject to a detention order with community living, his risk of future violence would be Low-Moderate.
- The risk of violent reoffence is illustrated by this likely reoffence scenario (pgs. 52-53):
Taken together, when weighing Mr. Carter's pertinent risk and protective factors, his risk of any future violence would be High in the context of a Conditional Discharge. In contrast, should he be subject to a detention order with community living, his risk of future violence would be Low-Moderate.
If Mr. Carter was to re-offend, this will likely transpire … in the context of exposures to destabilizers and disengagement from the care team, leading to non-compliance with psychotropic medications, and return to his historical pattern of substance use, leading to psychosis. As he experiences further symptoms of psychosis, he will become further disorganized, paranoid, agitated and non-compliant with psychiatric supervision and treatment. The effects psychosis and substance use will render him more disinhibited and impulsive, and aggravate his underlying antisocial traits. In such a scenario, Mr. Carter would be more likely to engage in physically violent behaviours, such as those at the time of the index offence. Those most at risk would be anyone in his general vicinity.
- The Composite Assessment of Risk is given, as follows (pg. 53):
Mr. Carter, from a psychiatric perspective, continues to meet the threshold for significant risk to the safety of the public as defined in Section 672.5401 of the Criminal Code. This is based on the severity of his index offence, history of violence, antisocial traits, risk of relapse if non-compliant with treatment, level of active support he requires for engagement in programming, and limited insight into the effects of substance use on his mental illness.
Based on the whole of the factual and opinion evidence, which we accept, we find there is a real risk that the following would occur, were Mr. Carter not under the Board's jurisdiction at this time: He would leave hospital, and be unable to find a safe and secure place to live in the community; he would be unable to cope on his own with the psycho-social stressors he would inevitably face in the community; he would not adhere to his medication and other recommended treatment, and would fall away from forensic care and oversight, resulting in his relapse into serious symptoms of psychosis. In a state of emerging psychosis and increased stress, he would turn to regular and unabated cannabis use, which would exacerbate the risk arising from his serious psychosis and his potential antisocial behaviour, and he would engage in seriously harmful criminal conduct against a member of the public, similar to that in his past history, including in his index offence in December 2013.
At this time, Mr. Carter is not able to manage his risk and treatment needs on his own. To protect the safety of the public requires that the hospital's care, support, and oversight under the Board's jurisdiction.
(2) The Disposition Terms for the Year Ahead
In deciding what disposition is necessary and appropriate for Mr. Carter for the year ahead, the Board is required by s. 672.54 of the Criminal Code to take four factors into account: the safety of the public, as the paramount consideration, and Mr. Hambly's mental condition, his reintegration into society, and his other needs.
We agree entirely with the recommendations in the Hospital Report and in Dr. Darby's testimony at the hearing. At this point in Mr. Carter's treatment and process of transitioning to community living, a Conditional Discharge would be premature and would not adequately protect the safety of the public. Mr. Carter still clearly requires the close support and supervision from his outpatient psychiatrist and case manager and all his FOPS team members, while living in his CMHA-operated, ODSP-supported, independent apartment. The hospital needs to be able to ensure he remains in safe and secure housing, and to approve any other community housing if for any reason he no longer can reside at his current apartment. This is a crucial part of the external structure and control that is required to ensure his treatment and manage his risk to the safety of members of the public.
The treatment and risk management plans recommended for the coming year, are set out in detail in the Hospital Report and need not be repeated here. Notably, the terms and conditions of Mr. Carter's current Disposition will clearly support and further the process of his treatment and rehabilitation, including his ability to continue living in the community, and improve his insight, engagement in individual and group treatments and activities, and his more structured life in the community.
It remains to be said, as did Dr. Darby and both counsel in their submissions at the hearing, the Mr. Carter has had a good year this year, and has progressed further than he had in 2023 and 2024. Mr. Carter is to be commended for this. We wish him all the best, in his work with the team in the coming year, and his engagement in treatment and in structured and prosocial activities.
DATED this 13^th^ day of April 2026 at the City of Toronto, in the Toronto Region.
Ms. K.A. Connidis Alternate Chairperson Office of the Registrar Ontario Review Board