Ontario Review Board
Re: Noran Clein
ORB File No: 4409
Hearing held on: Thursday, April 16, 2026
Place of hearing: Southwest Centre for Forensic Mental Health Care St. Thomas, ON
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Kert
Members: Dr. S. Simpson
Dr. S. Wiseman
Ms. K. Tomaszewski
Ms. C. Plyley
Parties Appearing:
Accused: Noran Clein
Counsel: Ms. C. Whillier
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. J. Huber
REASONS FOR DISPOSITION
(Dated May 5, 2026)
Overview
On February 22, 2006, Noran Clein was found not criminally responsible on account of mental disorder (NCR) on a number of Criminal Code charges including: theft over $5000, break, enter and theft, robbery, damage to property, mischief, dangerous operation of a motor vehicle, and resisting a police officer.
Mr. Clein was charged with those offences in early September 2005 after he stole his father's car, broke into and stole items from his parents’ home and went on what police described as a “rampage”. He committed several crimes involving a semi-automatic air pistol, including robbery (he threatened to shoot a bystander and stole his money) and mischief (he shot at and shattered the windows of vehicles in a parking lot and in a car that was driving next to him). Ultimately, Mr. Clein was arrested after a high-risk takedown by police to stop his vehicle. Once stopped, he refused to obey the officers’ demands and was arrested after he was tasered and pepper sprayed by the police.
Mr. Clein is currently subject to an Ontario Review Board disposition detaining him at the Southwest Centre for Forensic Mental Health Care (Southwest Centre or the Hospital), with privileges extending to community passes accompanied by staff, and indirectly supervised hospital and grounds privileges.
On April 16, 2026, this panel of the Review Board convened at the Southwest Centre to hold a hearing and review that disposition. As has been the case for a number of years, Mr. Clein chose not to attend. Ms. Whillier (his lawyer) advised that she had met with Mr. Clein, that he finds Review Board hearings difficult and that he had asked to be excused. He had also provided her with instructions to proceed in his absence. In the circumstances, and as neither of the other parties opposed the request, we allowed Mr. Clein to absent himself and proceeded with the hearing.
The issues to be decided at this hearing are whether Mr. Clein continues to pose a significant threat to the safety of the public and, if so, what is the necessary and appropriate disposition, considering the four factors in s. 672.54 of the Criminal Code.
The hearing proceeded based on a joint submission in respect of both issues. None of the parties contested a finding of significant threat, and the parties submitted that the current detention disposition should continue, the only change being to add “approved delegate agency/organization” to the list of persons or entities that can accompany Mr. Clein into the community. We agree. These are our reasons.
Background
Mr. Clein is 45 years old. His current diagnoses are listed in the hospital report as chronic, treatment-resistant schizophrenia (paranoid type); substance use disorder (in remission in a controlled environment); and rule-out maladaptive daydreaming. The latter potential diagnosis is relatively new, as outlined below. A diagnosis of OCD was also added at the hearing.
Following the finding of NCR in February 2006, Mr. Clein was detained on the medium secure unit at the Royal Ottawa Mental Health Centre (Royal Ottawa). Treatment with risperidone was initiated and Mr. Clein showed gradual improvement in his mental state. In November 2005, he attended a four week residential substance abuse program run by the Royal Ottawa, and his insight improved regarding the impact of substance use on his mental health.
Given Mr. Clein's progress, in December 2006, following an early hearing, a community living privilege was included in Mr. Clein's disposition. He returned to community living at his parents' home but this did not last long. He was returned to in-patient status at the Royal Ottawa in early 2008, and remained an in-patient due to his ongoing use of drugs, breaches of his disposition and his lack of insight.
In early July 2009, Mr. Clein was transferred to the Brockville Mental Health Centre (Brockville). At Brockville, Mr. Clein did not make significant progress. He eloped from the hospital five times between 2010 and 2014, during which he used substances. Overall, his response to treatment was poor. When Dr. Ahmed (his then treating psychiatrist) recommended a trial of clozapine, Mr. Clein declined, citing concerns about side-effects. Although Mr. Clein's substitute decision maker, the Public Guardian and Trustee, consented to a trial of clozapine, the oral medication could not be started without his cooperation.
At a hearing in April 2015, Mr. Clein requested a transfer to the Southwest Centre. At the time, Mr. Clein had been confined to the Brockville hospital with no privileges after his most recent elopement in October 2014. The treatment team in Brockville supported his request for transfer, believing that he would be better off at a facility where he could have a fresh start with a new treatment team. The Southwest Centre agreed to the transfer.
In mid-May 2015, Mr. Clein was transferred to the Southwest Centre. He has remained an in-patient since that time. The years that followed were difficult for Mr. Clein. He could become easily agitated when his needs were not met immediately. On numerous occasions he was verbally threatening and aggressive to staff and co-patients, and he was involved in several incidents of destructive acts. When he was less distressed by his symptoms, he could be pleasant, polite and appreciative of the assistance of staff.
In May 2020, due to ongoing difficulties managing Mr. Clein appropriately on the unit, concerns around a treatment impasse, and to try to assist the clinical team on the issue of treatment of Mr. Clein's refractory schizophrenia, the Review Board ordered the Hospital to arrange for an independent assessment addressing recommendations for psychopharmacological and/or other treatment for Mr. Clein. The Board noted at that time that:
Mr. Clein has been in the forensic system for over 14 years. In that time, there has been little progress. Indeed, as described by Dr. Mokhber [his then psychiatrist], it appears that since 2013, Mr. Clein's mental status has declined. His illness is treatment refractory and his symptoms continue to impact almost all aspects of his life. Despite this, Mr. Clein does not recognize his symptoms as being part of a mental illness. This has been a barrier to treatment of Mr. Clein, as has his refusal to consider a trial of clozapine, although multiple psychiatrists (including Dr. Ahmed, Dr. Gray and Dr. Mokhber) have recommended this as the best way forward.
The Hospital arranged a consultation with Dr. Richard O’Reilly, a psychiatrist with the Parkwood Institute in London. Following his investigation in the fall of 2020, Dr. O'Reilly made recommendations, noting that, “research and clinical experience strongly suggest that only two treatment options offer a reasonable clinical improvement chance in patients like Mr. Clein, who have not responded to standard antipsychotic medication, electroconvulsive therapy (ECT) and the atypical antipsychotic clozapine.” When the treatment team met with Mr. Clein to discuss Dr. O’Reilly’s findings and possible treatment options, he said that he’d had ECT in the past and refused further ECT treatment. He also indicated an unwillingness to take clozapine or to comply with the appropriate monitoring (bloodwork and EKGs). It was also suggested that a psychologist's assistance and a behavioural management plan could be of assistance to him, but Mr. Clein had little interest in participating.
Thereafter, while there were few significant changes in Mr. Clein’s presentation, there were some improvements — Mr. Clein was somewhat more settled and there were fewer incidents of aggression. However, he continued to be highly impacted by the symptoms of his mental illness, including auditory and visual hallucinations and paranoid, delusional thinking. As he refused to accept recommended alternative treatments, he remained sub-optimally treated.
Course Since the Last Hearing
At Mr. Clein’s last annual hearing (in April 2025), Dr. Ashley Malka advised that she had recently taken over care of Mr. Clein. She explained that given his history, she was not looking at medication changes, but was targeting some of Mr. Clein’s behaviours through the use of a behavioural support plan (with the assistance of a behaviour analyst), using things that Mr. Clein cared about (e.g. access to the tuck shop or to funds in his account) to influence his behaviour. As part of the plan, Mr. Clein’s privileges had been reduced to zero and he was provided with clear expectations regarding the behaviour required for him to regain privileges.
The evidence at the current hearing consisted of an updated hospital report and the oral testimony of Dr. Malka. As described at p.181 of the hospital report,
The focus of the current reporting year was to reassess and revise Mr. Clein’s behavioural support plan to better determine the extent to which his instability was behaviorally maintained versus symptom driven. On July 7, 2025, a revised structured behavioural plan was implemented and resulted in notable and sustained improvements in functioning and stability, including a reduction in long-standing patterns of disruptive behaviour. He demonstrated increased openness to work with his attending psychiatrist, Dr. Malka, and tried different medications.
… Furthermore, he had been compliant with all of his medications, and, at times, independently requested PRN medications when needed. He also demonstrated improved sleep hygiene, cessation of property destruction (e.g., kicking objects or walls, voiding on the floor or in cups), reduced aggression, consistent engagement in daily personal hygiene (including daily showering, cleaning his bed sheets weekly and washing his own clothes), and increased participation in programming, recreation (e.g., crafting, volleyball, basketball, and billiard’s) and overall routine. He also attended to meals in the dining room appropriately and notably maintained a level 3 privilege (full [indirectly supervised] hospital access) for an extended period of time. (emphasis added)
Dr. Malka elaborated on this in her testimony. She said that when the behavioural support plan was first implemented, Mr. Clein required constant supervision. When this level of supervision was discontinued, Mr. Clein tried to test limits, but staff were able to address these issues. Overall, the behavioural support plan has been successful — the more problematic behaviours have largely resolved, Mr. Clein is more socially interactive and his mood is better. Psychotherapeutic intervention with the psychology program was also recommended to Mr. Clein (to address, for example, his feelings of loneliness and failure which have been identified as contributing factors to his behavioural dysregulation and withdrawal), but Mr. Clein declined to participate. The team has tried to engage him through less formal, activity-based sessions, and recently Mr. Clein has agreed to play pool with the psychologist.
Dr. Malka also testified that diagnostic clarification remains ongoing. This is outlined in the hospital report (at p. 183) as follows:
In addition to psychotic spectrum considerations, the treatment team is exploring alternative and overlapping formulations to better account for Mr. Clein’s presentation. One emerging area of consideration is maladaptive daydreaming, conceptualized as a compulsive cycle of dissociative absorption and vivid mental fantasy that functions as a coping mechanism and results in clinical distress and functional impairment
- Dr. Malka testified that maladaptive daydreaming is not officially a diagnosis in the DSM-5, but is being actively researched and may be proposed for the next DSM. She said that it describes symptoms that align fairly well with Mr. Clein’s presentation, but that he has rejected this as a diagnosis. She explained that current treatment efforts for Mr. Clein are focused on interventions more closely aligned with the maladaptive daydreaming formulation, and that ongoing assessment and diagnoses refinement will continue over the next year.
Analysis and Conclusion
Having heard and considered all of the evidence, we find that the threshold test for significant threat is met, and that the current detention disposition, with the minor change/addition suggested by the parties, is necessary and appropriate in the circumstances.
Mr. Clein’s recent improvements in his clinical progress this past year are commendable. However, his mental status remains fragile (he remains somewhat impacted by the symptoms of his mental illness), he continues to require pharmacological and psychotherapeutic intervention and support within a highly controlled environment and his motivation to progress further is questionable. Mr. Clein has been clear that he does not want to leave the hospital, and there are reports in the past of him threatening violence and/or substance use (a significant risk factor for him) to avoid progressing through the forensic system. As described in the re-offence scenario portion of the hospital report,
Absent forensic supervision, Mr. Clein may become increasingly dysregulated due to various factors including lack of appropriate accommodation and professional and personal support. These factors along with other realities of the external world would exacerbate his mental health symptoms. He would also likely discontinue his medication regimen and behavioural plan and engage in cannabis use or other substances as a coping strategy. This would quickly exacerbate his symptoms of his mental illness, and his risk of violence and reoffence would be significant.
In terms of disposition, we agree that Mr. Clein's risk to public safety continues to be best managed under the current detention disposition. In hospital, his symptoms and behaviour can be managed by staff who are familiar with him. The privileges potentially available under the disposition allow him the opportunity for further rehabilitation and community reintegration once he is better able and/or willing to utilize the extent of those privileges. To that end we have expanded his community access to allow him to be accompanied by an individual associated with a hospital-approved delegate agency or organization, in the hope that there might be additional structured activities outside the hospital that Mr. Clein may consider participating in in the future.
Accordingly, taking into consideration public safety (which is paramount), as well as Mr. Clein’s mental condition, reintegration into society and other needs, we find that the necessary and appropriate disposition is one continuing to detain Mr. Clein at the Southwest Center with privileges and prohibitions as set out in the current disposition, with the single change recommended by the parties and above.
DATED this 5^th^ day of May, 2026, at the City of Toronto, in the Toronto. Region
Ms. S. Kert
Alternate Chairperson
Office of the Registrar
Ontario Review Board