Ontario Review Board
Re: Scott Graham
ORB File No: 8414
Hearing held on: Monday, April 13, 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: Scott Graham Counsel: Mr. S. Gehl
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 September 29, 2023, Scott Graham was found not criminally responsible on account of mental disorder (NCR) on Criminal Code charges of dangerous operation of a vehicle, break and enter into a dwelling, and assault. Mr. Graham is currently subject to a disposition of the Ontario Review Board discharging him on conditions, including a consent to treatment condition and a requirement that he report to the person in charge of the Southwest Centre not less than once per month.
On April 13, 2026, this panel of the Review Board convened at the Southwest Centre to hold a hearing to review that disposition. Mr. Graham was present and represented by his counsel, Mr. Gehl. Members of Mr. Graham’s family were also in attendance to show their support for him.
The issues to be decided at this hearing are whether Mr. Graham 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.
At the conclusion of the hearing, the parties jointly submitted that as the legal test for significant threat is no longer met, Mr. Graham should receive an absolute discharge. We agree. These are our reasons.
Background and Index Offences
Mr. Graham is 44 years old. His current diagnoses are: bipolar I disorder (most recent episode manic); narcissistic personality traits (by history); PTSD (by history); and ADHD (by history).
Mr. Graham graduated from high school and attended college intermittently between 2006 and 2018. He also worked for a large telecom company from 2009 to 2013. He is currently supported on long-term disability (since 2013) and there is no anticipated change to his financial situation. He lives in his own home with his long-term partner. He has two siblings with whom he enjoys good relationships and his parents live nearby. All are good supports for him and maintain regular contact.
Though on initial assessment Mr. Graham did not report problematic use of alcohol or cannabis, his partner and his family reported that he used cannabis when in a manic state. Mr. Graham denied and/or did not recall using cannabis prior to the index offences, but he tested positive on the day of his arrest.
Mr. Graham had no criminal history or record prior to the index offences. He did, however, have a significant history of psychiatric contacts and admissions. In 1992, at about the age of 11, he was diagnosed and treated for ADHD. In 2001 and 2002, he had several attendances/admissions at hospital for psychiatric reasons, and was described as manic and aggressive with pressured speech and grandiosity. He was variably diagnosed with methamphetamine induced psychosis, manic depressive illness (in the manic phase) and amphetamine induced mania. Medical records also suggest a history of stimulant use and misuse. After his first psychiatric admission in 2001, he attended Homewood Health Centre for two weeks for substance use residential treatment. Mr. Graham reported that he has not used methamphetamine since then.
From January to March 2013, Mr. Graham was hospitalized at CAMH. His mental health had been stable for the preceding nine years but had begun to deteriorate in June 2012. He was diagnosed with bipolar disorder and recurrent manic episodes. After receiving treatment, his mental state improved and he was made voluntary, but was aggressive while on a pass on CAMH grounds. He was recertified and transferred to an acute care unit, where he had an extremely violent episode during which he used a door as a battering ram at the nursing station. He was found incapable of consenting to treatment and was treated on his parents’ consent. His discharge diagnosis was bipolar disorder, recent manic episode and he was to be followed by his family physician upon discharge.
In 2015, Mr. Graham had three further psychiatric admissions as a result of non-adherence with medication and manic symptoms, including elevated energy, decreased need for sleep, grandiosity and intrusive and demanding behaviours. He was consistently diagnosed with bipolar disorder.
In 2020, Mr. Graham was hospitalized twice. In March 2020, his family took him to the hospital with concerns about mood episodes. He was agitated and got into a physical altercation with hospital security. In April 2020, a police SWAT team was sent to apprehend Mr. Graham after a video was posted online showing him driving erratically. On assessment he was grandiose, threatening and argumentative. On both occasions Mr. Graham was restarted on his medication and left hospital against medical advice. He was then followed in the community by a Family Health Team.
In the days and hours leading up to the index offences, the police received four calls about Mr. Graham: from his father, a person who had received concerning messages from him (with suicidal ideation), and in response to alarms at his home. Ultimately, it was determined that although it appeared that Mr. Graham was suffering from mental health issues, there were no grounds for apprehension.
The circumstances of the index offences are taken from an Agreed Statement of Facts filed with the court and set out in the hospital report. They can be summarized as follows: On February 26, 2022, Mr. Graham was at his residence in Cambridge. He was in a state of escalation and began causing damage to his residence. At approximately 4:00 pm, he got into his rental car and left the area. Within minutes he approached a van driving on the road, rammed the van from behind and forced it off the road, causing the van to strike a parked vehicle. Reconstruction showed that Mr. Graham was travelling 104 km/hr in a 50km/hr zone at the time of the collision and was not wearing his seatbelt. The driver of the van was able to walk away from the incident, although he attended rehabilitative treatments for two to three months and his vehicle was a write-off.
Immediately after the collision with the van, Mr. Graham exited his vehicle and began wandering around the neighbourhood. He was completely nude at the time. A number of people nearby heard the collision and attended the area, where they tried to assist Mr. Graham. Mr. Graham was not cooperative with any of their efforts.
Mr. Graham ran to a nearby plaza where he entered a bar. He ran naked through the kitchen, broke a plate, and then fled outside where a concerned citizen offered him a ride. This person drove Mr. Graham back to the scene of the collision, where he got back in his rental car. He began to drive away until his path was blocked by several tow truck operators.
Mr. Graham exited his vehicle, sprinted through the neighbourhood and ran toward a nearby home. The owner of the home was standing outside and stopped Mr. Graham from entering the garage. However, Mr. Graham ran to the front door, opened it, and tackled the homeowner’s 67-year-old wife, knocking her to the floor. Two other individuals were in the residence and rushed to stop Mr. Graham, who began hitting his head on a window. He was pulled outside by the homeowner where firefighters restrained him. The homeowner’s wife was taken to the hospital and eventually released.
Police arrived on scene and placed Mr. Graham under arrest at 4:23 p.m. Mr. Graham was nude, acting aggressively, speaking rapidly and screaming.
The morning after the index offences, Mr. Graham was brought to hospital. He could not recall why he was there or the events of the previous day. He denied drug use but tested positive for cannabis. However, he was not admitted and returned home under a judicial release order.
Mr. Graham was seen by his family physician and was admitted to hospital several times starting in late March 2022, after presenting as impulsive, disinhibited, elevated, irritable, and displaying reckless behaviours. He was also suspected of not being compliant with his lamotrigine medication. His discharge diagnoses in May 2022 were bipolar disorder (last episode manic), stimulant use disorder, narcissistic personality disorder traits, and rule out cannabis use disorder. He was described as being “displeased” with medication but accepting of treatment and discharged himself against medical advice. He was then seen in out-patient psychiatry at Cambridge Memorial Hospital by Dr. Awoniyi. He was also followed by his family doctor. In late 2023 and early 2024, Mr. Graham appeared to be stable and was functioning appropriately.
After the Finding of NCR
Though found NCR in September 2023, Mr. Graham’s initial Review Board hearing did not take place until May 22, 2024. In the interim, he continued to live at his home in the community. At the request of the ORB, Dr. Ajay Prakash conducted a risk assessment of Mr. Graham, to assist with recommendations for disposition. In his report dated May 1, 2024, Dr. Prakash noted that, “Urgent reassessment of medication and treatment is essential, particularly given the severity of his index offences and historical issues with insight and structure,” among other concerns.
Following his first Review Board hearing, Mr. Graham was discharged on conditions, including a requirement that he report to the forensic team at the Southwest Centre. In the months that followed, the forensic team had significant concerns about Mr. Graham’s presentation in the community, including: increasing manic symptoms; booking and going on trips without telling the treatment team; revoking consent to speak with his parents; and being controlling and attempting to manipulate the treatment team. Ultimately, the treatment team was of the view that Mr. Graham’s risk could no longer be managed under a conditional discharge and that a detention disposition was required. The hospital requested an early Board hearing in the late summer or fall of 2024.
That early hearing never occurred. Sometime after Mr. Graham learned of the hospital’s request, the treatment team saw a “significant shift” in his relationship with the team. Mr. Graham’s compliance with the recommendations of his treatment team improved, as did his general presentation. Members of the treatment team were able to meet with, interview and further educate some of Mr. Graham’s personal supports, including his partner who was viewed as a “well informed, valuable support.” Dr. Prakash also spoke to Dr. Awoniyi, Mr. Graham’s community psychiatrist, about the need for more robust treatment of Mr. Graham’s mood disorder, following which the decision was made to optimize his medication, as suggested by Dr. Prakash.
Course Since the Last Hearing
At his last hearing in April 2025, Mr. Graham’s treatment team described the recent and developing improvements in his symptoms and insight, including his insight into the need for medication. He had recently agreed to a long-acting injectable antipsychotic medication, was taking his oral medications independently and had “reached and sustained a continued level of stability.” However, the team continued to have concerns that Mr. Graham’s compliance may be externally motivated and related to impression management.
At last year’s hearing, Dr. Prakash also expressed the opinion that substance use disorder was not an accurate diagnosis as Mr. Graham did not have sustained use of substances prior to the index offences, but appeared to engage in compulsive consumption when he was experiencing symptoms of mania. Additionally, Mr. Graham had not used substances during the year that he had been under the jurisdiction of the Board. The treatment team therefore recommended the removal of the abstain clause (but not the testing requirement), and the Board agreed.
At the current hearing we received evidence in the form of an updated hospital report, as well as the oral testimony of Dr. Prakash. That evidence indicates that Mr. Graham had a successful reporting year. He continued live with his partner in their home in the community. He was compliant with his treatment plan, remained psychiatrically stable, and was well-engaged with his community and treatment supports. There was no evidence of substance use.
Over the reporting period, Mr. Graham worked with his family doctor, Dr. Mehan, and his community psychiatrist, Dr. Awoniyi, to reduce and eventually discontinue both his lamotrigine and olanzapine medications to address his low energy levels, fatigue, and hair loss. Both of these medications were stopped by July 2025 and, starting in February 2025, were replaced by long-acting injectable Abilify Maintena. In July 2025, Mr. Graham reported increased fatigue and mildly reduced motivation and requested a reduction in his Abilify dosage from 300 mg to 200 mg. Following this adjustment (by Dr. Mehan and Dr. Awoniyi), and despite some stressors, there was no evidence of mania, paranoia, grandiosity, or lability. The long-acting Abilify continues to be prescribed and administered by his family doctor.
Mr. Graham has been stable on his current medication since August 2025. He says that he is satisfied with his medication regimen and plans to continue with medication in the future. He has been seeing his community psychiatrist every 2-3 months, this is anticipated to continue going forward, and Dr. Awoniyi has advised that he has no concerns assuming the role of primary treating psychiatrist if Mr. Graham receives an absolute discharge. Dr. Mehan sees Mr. Graham regularly for his Abilify injections. While it is possible that Mr. Graham’s medication will need to be changed or modified in the future, Dr. Prakash’s opinion is that his current prescribers (Dr. Mehan with the assistance of Dr. Awoniyi) can manage the issue. Mr. Graham reports that he has developed a positive working relationship with both community physicians and feels able to speak openly with either should any concerns arise
Mr. Graham’s personal supports (his parents, sister and partner) were also more actively involved in his care this year. They met with the outreach team on multiple occasions to discuss issues such as treatment adherence, relapse prevention and crisis response. The view of the treatment team is that Mr. Graham’s personal supports,
“…demonstrate a good understanding of Mr. Graham's mental illness, including early warning signs of clinical deterioration, identified risk factors, and appropriate crisis and safety interventions. They are knowledgeable about available community and hospital based supports and have demonstrated the capacity to seek timely professional assistance should concerns arise regarding Mr. Graham's mental state or level of risk.” (p.66 of the hospital report)
Analysis and Conclusions
Having heard and considered the evidence and the submissions of the parties (including the joint submission), we are unable to positively conclude that the evidence establishes that Mr. Graham poses a significant threat to the safety of the public. On that basis, we order an absolute discharge.
In coming to a decision on this issue, we have carefully considered the statements of the Supreme Court of Canada in Winko v. British Columbia, 1999 CanLII 694 (SCC), [1999] 2 SCR 625. In Winko, the Supreme Court held that restrictions can only be imposed on an NCR accused's liberty if the evidence before the Board demonstrates that the accused actually constitutes a significant threat to public safety: Winko, at paras. 47-49 and 54. Absent a positive finding on the evidence that the NCR accused poses a significant threat to the safety of the public, the Review Board must order an absolute discharge.
It goes without saying that the index offences here were very serious in nature, and that Mr. Graham's actions at the time caused the victims serious psychological and/or physical harm. It is also concerning that despite a diagnosis of bipolar affective disorder since 2001, Mr. Graham had a history of non-adherence to his psychiatric medications, which would often result in mental decompensation and a re-occurrence of manic episodes. Although Mr. Graham was receiving professional support/care around the time of the index offences, those supports were not sufficient to prevent the offences from occurring. His behaviour was driven almost exclusively by symptoms of his mental illness.
We also recognize that by the time of Mr. Graham’s last annual hearing, his treatment team had seen a significant change in his willingness to work cooperatively with his treatment team, including accepting their recommendation of a long-term injectable antipsychotic.
Since that time, Mr. Graham has continued to build on those gains. He has been psychiatrically stable and has expressed a strong commitment to maintaining his mental wellness and leading an active, healthy lifestyle. He has been consistently adherent with treatment and engaged with his professional community caregivers, and expresses an intention to continue to do so.
Regardless of whether he is subject to a Board disposition, his monthly injectable medication will continue to be administered by his family physician, with prescribed medications monitored by his psychiatrist, Dr. Awoniyi. He will also continue ongoing psychotherapy with his therapist, Jacob Letkemann, who remains available to adjust the frequency of sessions as clinically indicated. Importantly, as described in the hospital report, Mr. Graham’s treating physicians are “now acutely aware of the need for timely intervention should his symptoms reemerge or if Mr. Graham or his family raised concerns.” Mr. Graham has advised that his care providers have emphasized the importance of prompt access to assessment and follow-up in such circumstances and have communicated a willingness to accommodate expedited appointments when clinically indicated. (hospital report, p. 62)
There is evidence that Mr. Grahams’s insight has also improved. He is now able to express how his mental illness affected his thinking and behaviour at the time of the index offences, and he acknowledges the role of untreated symptoms in contributing to his actions. He has articulated an understanding of early warning signs, the importance of routine, medication adherence, and stress management. His personal supports have also received education in these areas. The view of the treatment team is that in the circumstances, Mr. Graham does not pose a significant risk to public safety.
The threshold for significant threat is onerous. As stated by the Supreme Court of Canada in Winko, to support restrictions on the liberty of an NCR accused, there must be a positive finding on the issue of significant threat. Put another way, the Board has a non-discretionary responsibility to grant an absolute discharge if "it harbours any doubt about whether the NCR accused represents a significant threat": Marmolejo, 2021 ONCA 130, 155 O.R. (3d) 185, at para. 35. We do not believe that the requisite positive finding can be made in this case. Specifically, based on the evidence before us (as outlined above) we are not convinced that Mr. Graham, in his current mental state and with the proposed supports in place, poses a real risk of serious physical or psychological harm resulting from a criminal offence if he is not subject to a Review Board disposition. As we do not find that the threshold test is met, Mr. Graham must receive an absolute discharge.
DATED this 5^th^ day of May, 2026, at the City of Toronto, in the Region of Toronto.
Ms. S. Kert Alternate Chairperson
Office of the Registrar Ontario Review Board