Toomas Palo (Re), 2026 CanLII 45657

Re: Toomas Palo

ORB File No: 3993

Hearing held on: Wednesday, April 1, 2026

Place of hearing: Centre for Addiction and Mental Health

Pursuant to: Section 672.81(1) of the Criminal Code

Before:

Alternate Chairperson: Mr. J. Weinstein

Members: Dr. S. Lessard

Dr. M. Green

Hon. C. Nelson

Mr. J. Cyr

Parties Appearing:

Accused: Toomas Palo

Counsel: Ms. F. Glaizghi

The person in charge of hospital: Counsel: Mr. L. Crowell

Attorney General of Ontario: Counsel: Mr. M. Feindel

REASONS FOR DISPOSITION

(Dated May 11, 2026)

Introduction

1. On May 25, 2004, Mr. Toomas Palo was found not criminally responsible on account of mental disorder, on a charge of utter death threat, contrary to the Criminal Code of Canada (“Criminal Code”).

2. Mr. Palo is subject to a Disposition of the Ontario Review Board (the “Board”), dated May 7, 2025, which ordered that he be detained at the General Forensic Unit of the Centre for Addiction and Mental Health, Toronto (“CAMH”).

3. On April 1, 2026, the Board convened a hearing at CAMH to conduct the annual review of the current Disposition.

4. Mr. Palo was represented by his counsel, Ms. F. Glaizghi, who advised that her client did not wish to attend this hearing and that she had instructions to proceed in his absence. An order pursuant to s. 672.5(10)(a) was made, allowing Mr. Palo to be absent from this hearing.

5. A Hospital Report, dated March 11, 2026 (the "Hospital Report"), was entered as Exhibit 1.

6. The issues at this hearing were whether Mr. Palo is a significant threat to public safety, as defined in s. 672.5401 of the Criminal Code, and, if so, the necessary and appropriate Disposition in the circumstances must be determined, bearing in mind the factors enunciated in s. 672.54 of the Criminal Code.

7. For the reasons set out below and based on the expert evidence and opinions before us, the Board concluded that Mr. Palo continues to pose a significant threat to the safety of the public. The Board found that the necessary and appropriate Disposition in the circumstances is a continuation of the existing Detention Order.

Current Psychiatric Diagnoses

8. Schizophrenia, partial remission;

Polysubstance Use Disorder (cannabis, alcohol, other, e.g., Gravol, Benadryl and cough medication), in partial remission in a controlled environment.

Index Offence

9. The circumstances giving rise to the Index Offence are extracted from last year’s Board Reasons, as follows:

“On December 21, 2003, police were called to a hotel by the manager, who was concerned that a guest, Mr. Palo, was refusing to answer his door at one and a half hours past checkout time. The police officers spoke to Mr. Palo, who after some conversation decided to leave. He was in an agitated and drunken state. While riding in the elevator, he turned to one of the police officers and said, “You’re dead, you’re dead” and “I’m going to kill you.” He was arrested and charged with threatening death. He was described as verbally and physically aggressive at the police station.

At the time, Mr. Palo was 37 years old, unemployed, and had no fixed address. He was on probation relating to a conditional discharge for a charge of Mischief to Property.”

Background Information

10. Mr. Palo’s background is outlined in the Hospital Report, and is accurately summarized in last year’s Reasons:

“In 2022, Mr. Palo was readmitted to hospital in an extreme state of intoxication. It was decided that, because of Mr. Palo’s escalating use of substances and significant medical problems, it was unsafe for Mr. Palo to remain in the Services and Housing in the Province (SHIP) residence (his community placement) as there was minimal staffing and oversight at night.

When first readmitted to CAMH in October 2022, Mr. Palo was placed in a non-forensic unit and was transferred to a forensic unit in December 2022 under the care of Dr. Woodside. Mr. Palo reported that he was brought to hospital as a result of overdosing on hand sanitizer and he reported smoking marijuana intermittently and abusing Gravol daily. Although observed by others to exhibit concerning behaviour, Mr. Palo did not perceive any significant issue with his behaviour, despite the substance abuse.

Mr. Palo has a long psychiatric history that dates to his early 20s. He has been hospitalized in several Ontario hospitals over the years, including Toronto General, Toronto Western, the Centre for Addiction and Mental Health, Etobicoke General, Queensway, Northwestern General and Humber River Regional Hospital. In the ten years prior to his finding of NCR and being under the jurisdiction of the Board, Mr. Palo was followed at the Lakeshore Outpatient Service of CAMH.

In general, during Mr. Palo’s many hospitalizations, he was variously noted to be psychotic, with symptoms including auditory hallucinations, paranoid delusions, grandiose delusions, religious delusions and delusions of reference. At times, he exhibited depressive symptoms and suicidal ideation. It is reported Mr. Palo jumped from a bridge on one occasion and overdosed on pills on another occasion. These events are denied by Mr. Palo. Mr. Palo has no criminal convictions and has had minimal police contact.”

Course Since Last Disposition

11. Mr. Palo’s course since his last Disposition is set out in detail in the Hospital Report. The following extracted paragraphs are relevant to this hearing:

“Mr. Palo has had a good clinical year. He remains in the community, residing at the “Pipe and Slipper” group home in Keswick (Belhaven). The placement is a 24-hours, 7 days a week supervised facility residence. He has not required presentation for acute reassessment or hospitalization. He has not been a behavioural or management problem in the community. He has not engaged in violence, aggression or any concerning behaviours. He has complied with all reporting requirements. He has been medication compliant and substance free. His psychosis remains in partial remission. His daytime activities and routine remain limited and unstructured.

He is regularly provided with psycho education regarding his illnesses and treatment but without any change in his understanding. He continues to maintain his actions at the time of the commission of the index offence were warranted and had no relationship to his schizophrenia or substance misuse illness.”

Position of the Parties

12. Counsel for the hospital, for the Attorney General, and for Mr. Palo advised that this was a joint recommendation. All were recommending the continuation of the existing Detention Order.

13. For the purposes of this hearing, counsel for Mr. Palo advised that significant threat was not in dispute.

Evidence at the Hearing

14. The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Swayze. Dr. Swayze co-authored the Hospital Report and testified as follows:

a) He is Mr. Palo’s treating outpatient psychiatrist in the Forensic Service and has been since Mr. Palo’s discharge to the community, approximately one-and-a-half years ago.

b) Mr. Palo has a long-standing substance abuse history, which is a core risk factor. He used substances both as an inpatient and as an outpatient while residing in the community of the Greater Toronto Area. Mr. Palo’s last substance use occurred when he was an inpatient, just prior to his discharge to his current residence.

c) In Mr. Palo’s case, substance use has been closely linked to episodes of psychotic relapse and reduced medication adherence. Mr. Palo’s current residence is a cornerstone in his risk management. It has staff available 24/7. They supervise Mr. Palo’s medication and monitor his abstinence from substances. The residence’s isolated geographic location is particularly important to Mr. Palo’s stability, as it makes it much more difficult for him to obtain substances.

d) There are very few residences in Toronto that are currently available with the same level of supervision. If Mr. Palo lived in Toronto, he would likely use substances regularly because of easier access.

e) Mr. Palo had a smooth transition to his current residence, and there have been no instances of aggression reported during this time period. He has expressed that he is content at the current residence and has no complaints or requests.

f) Should Mr. Palo continue with his stability, including remaining abstinent from substances, adherent to his treatment program and compliant with his current Disposition, the treatment team would most likely recommend a Conditional Discharge in the following reporting year. Terms of such a Conditional Discharge would be a specified residence and a consent to treatment clause. It would not change Mr. Palo’s day-to-day experience, but it would be viewed as a less onerous and less restrictive Disposition.

g) Mr. Palo is currently considered capable of consenting to treatment, although his capacity is reassessed every six months. He could not explain why Mr. Palo was considered incapable for finances, as he did not make this finding.

h) While the residence has staff on site 24/7, Mr. Palo is not under constant observation. Residents can generally come and go as they please, although the logistics of the location make independent travel quite difficult.

15. No other evidence was called.

Analysis and Conclusions

16. Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board agrees with the joint submission: Mr. Palo remains a significant threat to the safety of the public.

17. In Winko, the Supreme Court outlined that, in coming to the conclusion on the issue of significant risk, a Review Board should closely examine a range of evidence, including: the circumstances of the original offence; the past and expected course of the accused’s treatment; the present state of the NCR accused’s medical condition; the NCR accused’s own plans for the future; the support existing for the NCR accused in the community; and most importantly, the recommendations provided by experts who examined the NCR accused. In coming to our conclusion in this matter, the Board relies on the uncontroverted expert evidence of Dr. Swayze, in addition to the documentary evidence before us.

18. Mr. Palo continues to maintain his actions at the time of the commission of the Index Offence were warranted and had no relation to his schizophrenia or his substance use. He regards his history of substance use as of no relevance to periods of aggression, or to the exacerbation of his psychosis or level of risk.

19. In particular, the Board relies on the following extracted paragraphs from the Hospital Report:

“Mr. Palo has a history of rapid relapse in the community. If Mr. Palo is to re-offend, it will likely occur in the context of lack of support, supervision and structure. He remains at high risk of return to alcohol and drug use. In the past, substance use has led to violent behavior. Substance use has also compromised his compliance with medication. The latter has been associated with a relapse of his psychotic symptoms, increased risk of aggression and readmissions to hospital.

Mr. Palo has a long history of psychotic symptomatology that began in his early twenties and has included religious and persecutory delusions and perceptual abnormalities. He had numerous hospitalizations due to psychotic symptoms, exacerbated by noncompliance with antipsychotic medication and polysubstance dependence. He has a superficial understanding of his mental illness but lacks depth of understanding into his mental disorder and the impact of substance abuse.

Mr. Palo’s actuarial assessment of long-term static risk for violent recidivism is best described as moderate. Mr. Palo’s HCR-20 V3 profile is also consistent with moderate risk. In addition, Mr. Palo has numerous, and significant, outstanding dynamic/clinical risk factors. Taken in totality, both actuarial and clinical assessments of risk support the opinion that Mr. Palo continues to remains a significant threat to the safety of the public as defined in Section 672.5401.

Mr. Palo presents with an actuarial assessment of static long-term risk indicating a moderate risk of violent recidivism. He has, in addition, numerous, and significant, dynamic or clinical criminogenic risk factors. When previously in the community followed by the Forensic Outpatient Service and an ACT team, he was chronically noncompliant with antipsychotic medication and using substances (while refusing testing). As such, the clinical team does not support consideration of an absolute discharge, or at this juncture a conditional discharge.

Mr. Palo has remained in the community since discharge from hospital in November of 2024 and should be commended as such. His successful placement in the community has occurred, however, in the context of significant supervision and support, specifically psychiatric follow up with the Forensic Outpatient Service at CAMH and placement in supervised residence, which have formed the cornerstone of Mr. Palo’s risk management and success to date, ensuring vigilant medication compliance and minimizing substance use. The hospital requires the ongoing ability to approved supervised housing and for rapid intervention in the event of substance use.

As such, the clinical team is of the unanimous opinion that the continuation of the present disposition without amendment would both protect the public and represent the necessary and appropriate disposition.”

20. In light of the Board's finding of significant threat, it is charged with shaping a Disposition for the coming year. It is clear from the Hospital Report that the hospital needs to retain the ability to approve Mr. Palo’s housing, and to intervene rapidly in the event of substance use. A key factor that protects Mr. Palo from engaging in future violence is his legal obligation to remain in his current residence, together with the high degree of professional support that he is receiving there. Accordingly, a Conditional Discharge is not appropriate.

21. In consideration of all the evidence, submissions of the parties and criteria set forth in s. 672.54, the paramount consideration being the safety of the public, in addition to the mental condition of Mr. Palo, his reintegration into society and his other needs, the necessary and appropriate Disposition is a continuation of the existing Detention Order.

DATED this 11th day of May, 2026, at the City of Toronto, in the Region of Toronto.

Mr. J. Weinstein

Alternate Chairperson

__________________

Office of the Registrar

Ontario Review Board