Re G. (K.), 2026 CanLII 34198

Ontario Review Board

Re: G. (K.)

ORB File No: 5051

Hearing held on: Friday, February 13, 2026

Place of Hearing: Royal Ottawa Mental Health Centre

Pursuant to: Section 672.81(2.1) of the Criminal Code

Before: Alternate Chairperson: Ms. M. Labrosse Members: Dr. S. Lessard Dr. R. Cormier Ms. T. Mann Ms. B. Naegele

Parties Appearing: Accused: G. (K.) Counsel: Ms. M. McMahon Person in charge of hospital: Representative: Dr. M. Strike Attorney-General of Ontario: Counsel: Ms. M. Dufort

*Pursuant to s. 672.501(1) of the Criminal Code, the Ontario Review Board prohibits the publication, broadcasting, or other transmission of any information that could identify a victim in this matter or a witness who is under 18 years of age.

REASONS FOR DECISION

(Dated April 2, 2026)

Introduction

1On March 7, 2008, the accused, G. (K.), was found not criminally responsible on account of mental disorder on charges of indecent acts and breaking and entering, all contrary to the Criminal Code of Canada. G. (K.) is currently subject to a Disposition of the Ontario Review Board dated September 15, 2025 which detains him at the secure forensic unit of the Royal Ottawa Mental Health Centre (“the Royal Ottawa” or “the Hospital”) with an envelope of privileges the most liberal of which permits him to live in the community in 24-hour a day supervised accommodation, approved by the person in charge.

2On July 31, 2025, G. (K.) absconded from the Hospital, while on an indirectly supervised grounds pass and took a bus to Kingston. He was returned to hospital on August 1, 2025. Thereafter, he was restricted to the Forensic Rehabilitation Unit (“FRU”) and his privileges “removed”.

3G. (K.)’s annual review of his disposition Order took place on September 10, 2025.

4At the time of G. (K.)’s annual review hearing in September, he was residing in the Forensic Rehabilitation Unit, where he had been for the past year in review. His privileges continued to be circumscribed but the issue of whether this state of affairs constituted a significant increase in the restrictions on his liberty was not formally addressed.

5On September 22, 2025, G. (K.) was transferred to the Hospital’s Forensic Assessment Unit (“FAU”) from the Forensic Rehabilitation Unit, due to continued deterioration in his mental state and behaviour.

6On October 15, 2025, the Hospital provided notice to the Ontario Review Board of the above-noted transfer pursuant to s. 672.56(2)(b) of the “potential restriction of the liberty as the accused’s privileges will be decreased for a period exceeding seven days”.

7On February 13, 2026, the Board convened a hearing to review the increased restrictions on G. (K.)’s liberties pursuant to s. 672.81(2.1) of the Criminal Code.

8G. (K.) was in attendance at the hearing and represented by counsel, Ms. M. McMahon. The Board made an Order appointing Ms. McMahon as counsel for G. (K.).

Position of the Parties

9At the outset of the hearing, the parties were canvassed as to their initial without prejudice recommendations to the Board. Dr. Strike, for the Hospital, represented that G. (K.)’s transfer from the FRU to the FAU on September 22, 2025, was necessary and appropriate to manage his risk to public safety as well as least onerous and least restrictive, from the time it began on September 22, 2025, to February 10, 2026. Ms. Dufort, for the Attorney-General, supported the Hospital’s position. Ms. McMahon for G. (K.) submitted that the increased restrictions on his liberty actually commenced on August 1, 2025 and that she wished to question Dr. Strike on this issue before committing to a position. All parties concurred that there was no need to review the terms of G. (K.)’s existing Disposition.

10In closing submissions, the Hospital and the Attorney General maintained their respective initial positions. Dr. Strike allowed that there may have been an increase in the restrictions on G. (K.)’s liberty commencing August 1, 2025 and not September 22, 2025 as initially posited but left this determination to the panel. Ms. McMahon did not take issue with the Hospital’s decision to increase the restrictions on G. (K.)’s liberties on August 1, 2025, nor with transferring him to the FAU on September 22, 2025, but felt it was unfortunate he could not be transferred back to the FRU more quickly.

Index Offences

11G. (K.)’s index offences are more fully set out in the Reasons for Disposition dated October 14, 2025, arising from the last annual review of his disposition Order. Briefly, G. (K.) was found not criminally responsible of indecent acts involving female staff members of a shelter where he was residing, as well as break and enter. His behaviour was serious and criminal, involving sexually disinhibited behaviour (masturbation) and forcing his way into an office where one of the victims had retreated in an effort to avoid his intrusive and inappropriate behaviour. At the time of his arrest a short time later, he was masturbating in full view of a police officer.

Background

12The Hospital Report provides a great deal of information concerning G. (K.)’s personal, criminal, substance use, mental health history, and course in hospital under the jurisdiction of the Board subsequent to the date he was found NCR. As the Hospital Report was made an Exhibit at the hearing, it is not necessary to reproduce the information contained within it in these Reasons.

13Briefly, by way of background and for context in the making of the panel’s decision, G. (K.) has a lengthy history of major mental illness, problems with substance abuse, and a significant criminal record, beginning at an early age. His criminal record includes convictions in 2001 and 2005 for assault, criminal harassment and failing to comply with court orders. As an adult, G. (K.) has convictions for indecent act, criminal harassment, failure to comply with court orders (multiple) and breaking and entering.

14G. (K.) has remained under the jurisdiction of the Board since 2008. Despite treatment with psychiatric medication, which has attenuated his positive symptoms to a significant degree, and the benefit of residing in a highly structured and supervised forensic setting, he has continued to demonstrate behaviours such as intrusiveness with staff members, particularly females, difficulty maintaining appropriate boundaries with peers and others, incomplete insight into his co-morbid psychiatric disorders, selective compliance with medication and sexual preoccupation. His mental state is fragile and subject to rapid decompensation with substance use and/or medication non-adherence.

15Re-offence scenarios iterated in the Hospital Report over the years consistently emphasize the necessity for significant supervision from a forensic clinical team and the extrinsic support provided by the oversight of the Board to mitigate risk. Absent these, G. (K.) would likely stop his medications, relapse to substance use, rapidly decompensate and return to the state of mind which engendered the index offences. In September 2025, at his annual review, G. (K.) was again found to present a high risk of future violence. His mental stability continued to be closely tethered to medication adherence and abstinence from substances. Based on the history, it is clear that a single missed dose of clozapine or relapse to use of cannabis or illicit substances could cause rapid decompensation in G. (K.)’s mental state and a recurrence of aggression and inappropriate sexual behaviour. As such, swift, robust, and proactive intervention by the clinical team is necessary to prevent and reduce the likelihood of harm to others.

16Longer term behavioural shaping as part of G. (K.)’s treatment plan and overall rehabilitation has relied to a significant degree on his motivation to smoke cigarettes. This feature of his presentation has allowed the clinical team to develop and implement a token economy of sorts (behavioural plan) which serves to increase his adherence to medication, abstinence from substances, as well as compliance with behavioural expectations around interpersonal boundaries and institutional rules.

17It is in this context that the Hospital’s actions from August 1, 2025, to the date of the within ROL hearing must be assessed.

18G. (K.)’s current psychiatric DSM-5 diagnoses are as follows:

• Schizophrenia, multiple episodes, in partial vs. full remission
• Antisocial personality disorder
• Other unspecified paraphilia disorder
• Stimulant use disorder, in early remission (in a controlled environment)
• Cannabis use disorder, in early remission (in a controlled environment)
• Opioid use disorder, in early remission (in a controlled environment), and
• Periodic limb movement disorder

Circumstances Giving Rise to Increased Restrictions on G. (K.)’s Liberty

19G. (K.) eloped from hospital on July 31, 2025, while on an indirectly supervised grounds pass. He took a bus to Kingston by himself. His family was promptly notified and managed to connect with him on July 31st. His aunt returned him to hospital on August 1st. Upon admission, G. (K.) was found to have multiple joints of cannabis on his person. He admitted to using cannabis while AWOL. He made bizarre statements about seeing fuzzy caterpillars turning into butterflies on the faces of staff members, which he later denied. Notably, he missed taking his clozapine and other medications during his elopement.

20G. (K.) was then restricted to the ward on the forensic rehabilitation unit. His privileges were removed in line with a newly instated ward protocol for relapse or elopement as well as his behaviour plan. Over the next six weeks, he became increasingly demanding of staff, was more defiant and oppositional and significantly less engaged with his treatment plan. He required substantial redirection and guidance to refrain from intrusive or entitled behavior. He was frustrated he did not have off-unit passes as this prevented him from smoking cigarettes. He misused and stole nicotine replacement spray from co-patients, causing management challenges on the FRU. Ultimately, he was completely restricted from prescribed nicotine replacement therapy.

21By mid-September, G. (K.) was more disorganized in his behaviour and speech and had become increasingly intrusive with staff and co-patients. He engaged in sexually inappropriate behaviours (such as putting his hand over the groin area of a co-patient). Despite demonstrating an increase in positive symptoms of Schizophrenia, including grandiose delusions and hallucinations, he declined to accept a recommended increase in his oral clozapine dose and was not agreeable to adding fluvoxamine to his medication regimen.¹ His engagement in programming, including his behavioural plan, declined. He was transferred to the more restrictive FAU on September 22, 2025. The Board was notified of this on October 15, 2025. Following a brief escalation in problematic behaviours in January 2026, which was handled by removing him from the waitlist for transfer to the FRU for a week, he was transferred to the FRU on February 10, 2026.

Evidence at the Hearing

22The Board had available to it the information in the form of the documents comprising the Record as well as the updated Hospital Report dated February 2, 2026 (Exhibit 1), which was cumulative in nature and contained a summary of the facts and circumstances leading to the hospital’s decision to increase the restrictions on G. (K.)’s liberty.

23In addition to the documentary evidence, the Board also received oral evidence from G. (K.)’s attending forensic psychiatrist, Dr. M. Strike. Dr. Strike endorsed the contents of the updated Hospital Report and provided a brief update, indicating that G. (K.) was currently doing well overall. Plans were being formulated to liberalize his privileges in consultation with the multidisciplinary clinical team.

24Dr. Strike explained that G. (K.) was granted passes (accompanied) in or outside the Hospital in January but often declined, indicating he only wanted to go if he were allowed to smoke (which he was not). The inclement weather was also a factor limiting his interest in accepting passes. Currently, he is working towards level 3 passes (the earliest level at which smoking is permitted) and remains very motivated to achieve this goal. G. (K.) now has 1:1 staff escorted access to grounds and as early as next week, provided all continues to go well, he can go to the Wintergarden to meet up with his family. Dr. Strike said that smoking privileges will come “down the line”, provided he is not aggressive, does not touch other people, refrains from making sexual comments and takes his medication (all in accordance with his behaviour plan).

25In late October 2025, G. (K.) agreed to increase his dose of clozapine and to start fluvoxamine. It remained challenging to get G. (K.)’s serum clozapine to a level where it would be stable. In consultation with the hospital pharmacy, a decision was made to focus on increasing the dose of clozapine as opposed to augmenting with increased titration of fluvoxamine; G. (K.) agreed. By December 2025, the treatment team noted a gradual improvement in his presentation and adherence to his care plan, which continued into January. By January 15, 2026, G. (K.) had improved to the point that he was placed on the FRU waitlist for transfer.

26G. (K.) is very happy to be back on the FRU. His clozapine level is higher than it was in the fall and is now within therapeutic range. This has resulted in an improvement of psychotic symptoms, functioning, hygiene and a diminution in sexually inappropriate behaviours.

27In questioning by Ms. McMahon, Dr. Strike agreed that:

a) G. (K.) lived on the FRU from April 4, 2024, until September 22, 2025;

b) Up until July 31, 2025, G. (K.) was allowed to exercise indirectly supervised passes to hospital grounds for 1 hour, up to 7 times a day;

c) Following his return to Hospital on August 1, 2025, to September 22, 2025, he was completely restricted to the FRU;

d) He was not allowed to be on hospital grounds or in the community with or without staff and was not permitted to have any smoke breaks;

e) After September 22, 2025, he could only see approved visitors;

f) He was not given the opportunity to have staff-escorted walks in until January 2026.

Analysis and Conclusions

28Having heard and considered all of the evidence and the submissions of the parties, the Board finds that there was a significant increase in the restrictions on G. (K.)’s liberty from August 1, 2025, continuing to the date of the hearing. Further, the Board finds that this significant increase was warranted when it began, continuing to the date of the hearing. The uncontradicted evidence contained in the ROL Report, along with the oral evidence of Dr. Strike, provides ample grounds in support of the Hospital’s actions on August 1, 2025, and September 22, 2025. The Board accepts and relies upon this evidence in its entirety.

29In coming to its decision, the Board is cognizant of G. (K.)’s lengthy history of non-adherence to psychotropic medication, increased irritability/anger/violent ideation, intrusive and/or sexually inappropriate behaviour when symptomatic and clear pattern of worsening sexual and physical aggression when non-adherent to medication and/or using substances.

30Given this, the totality of the evidence supports a finding that it was entirely appropriate for the Hospital to prevent his behaviour from deteriorating. G. (K.) has a pattern of worsening sexual and physical aggression when using substances, including cannabis. When symptomatic, G. (K.) pushes limits, demonstrates defiance of unit rules, and engages in intrusive behaviour and non-consensual touching. He has an ongoing high risk of sexually inappropriate behaviour, substance use, non-adherence to psychiatric medication and elopement. He decompensates extremely quickly, in a matter of hours to days. During his elopement, he used cannabis and did not take his antipsychotic medication. His mental status rapidly deteriorated.

31The Board is also of the view that the restrictions on G. (K.)’s liberty commenced August 1, 2025, following his return to hospital following his elopement to Kingston, and were ongoing, albeit somewhat liberalized, as of the date of the hearing. Although G. (K.)’s physical environment (the FRU unit) was the same on August 1st as it was on July 31st, his liberty norm was very different on August 1st than it was prior to his elopement. There was a further significant increase in the restrictions on G. (K.)’s liberty on September 22, 2025, when he was transferred from the FRU to the FAU.

32Currently, G. (K.) is doing well and continues to make progress. He has only been on the FRU for three days and cannot go off the unit unless with staff, nor can he have family visits in the Wintergarden (although one has been planned, provided he continues to do well). Because he is not permitted to access hospital and grounds indirectly supervised, he cannot smoke and remains highly motivated to participate in treatment so that he can do so.

33In this regard, the panel notes the dramatic improvement in G. (K.)’s mental and behavioural stability following his acceptance of a higher dose of clozapine and the clinical team’s stepwise approach to liberalizing his privileges apace with the diminution of his risk to the safety of the public. Despite the Hospital not yet having implemented privileges consistent G. (K.)’s pre-elopement liberty norm, the evidence taken as a whole gives every indication that this will soon be the case.

34For the foregoing reasons, the Board finds that the Hospital’s decision to significantly increase the restrictions on G. (K.)’s liberty was eminently reasonable and appropriate in the circumstances and represented the least onerous and least restrictive option to manage both his risk to public safety and his care.

Footnotes

1. 1Mr. Gravelle’s serum clozapine levels were low, which correlated to an increase in symptoms of psychosis. The low levels could have been caused by non-adherence (e.g. “cheeking”, which was suspected but not proven) or excessive intake of nicotine causing rapid metabolization. Fluvoxamine acts to raise serum clozapine by slowing the speed with which it is metabolized, thus prolonging the length of time clozapine remains active in the body.