Re: K. (A.)
ORB File No: 8220
Hearing held on: Friday, April 10, 2026
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. C. Fromstein
Members: Dr. J. Kis Dr. A. Kerry Hon. N. Kozloff Mr. S. Doherty
Parties Appearing:
Accused: K. (A.) Counsel: Ms. M. Addie
The person in charge of hospital: Counsel: Ms. G. Meaney
Attorney General of Ontario: Counsel: Mr. M. Feindel
*Pursuant to section 110(1) of the Youth Criminal Justice Act, no person shall publish the name of the accused, or any other information, if such publication would identify the accused as a person who was dealt with as a young person under the Youth Criminal Justice Act or the former Young Offenders Act.
REASONS FOR DISPOSITION
(Dated May 13, 2026)
Introduction
On January 17, 2023, K. (A.) was found not criminally responsible (“NCR”) on account of mental disorder on the charge of second-degree murder, contrary to the Criminal Code of Canada. He is currently subject to a Disposition dated May 7, 2025, detaining him at the Forensic Service at the Centre for Addiction and Mental Health, Toronto (“CAMH”) with privileges up to and including to live in the community in supervised accommodation approved by the person in charge.
On April 10, 2026, this panel of the Board convened at CAMH to conduct the annual review of K. (A.)’s Disposition. K. (A.) was present and represented by counsel, Ms. Addie.
The purpose of the hearing to is to determine if K. (A.) represents a significant threat to the safety of the public and, if so, to create a Disposition that is necessary and appropriate.
Position of the Parties
At the outset of the hearing the parties were canvassed as to their initial positions. Ms. Meaney, the articling student representing the hospital, indicated the hospital’s position is that there should be no change to K. (A.)’s current disposition.
Mr. Feindel, on behalf of the Crown, indicated his support for the detention order but that he would have questions with respect to the inclusion of the community living privilege.
Ms. Addie, on behalf of K. (A.), noted that significant risk was conceded and that she supported the hospital recommendation for no change to the current disposition.
Index Offences
- The circumstances of the index offences can be summarized as follows:
“On March 9, 2021, K. (A.) shot his mother, causing her death. She had fatal wounds to her back and her head. He telephoned police to indicate “my mother is dying.”
The Hospital Report does not contain surrounding details.
Evidence at the Hearing
- The evidence of the hearing was comprised of the letter from CAMH dated August 7, 2025, regarding K. (A.)’s abscondment, exhibit 1; the responding letter from the Ontario Review Board, exhibit 2, and The Hospital Report dated March 24, 2026, was entered as Exhibit 3. Dr. Swayze provided oral testimony.
Evidence of Dr. Swayze
Dr. Swayze indicated he has been K. (A.)’s inpatient psychiatrist since K. (A.)’s October 2024 admission to CAMH. Dr. Swayze updated the Hospital Report to note that as recently as the day before the hearing. K. (A.) continues to request a reduction in his antipsychotic medication or alternatively, a change to or discontinuation of the medication. K. (A.) is deemed competent to make decisions regarding his psychiatric treatment. K. (A.) approaches Dr. Swayze weekly asking for medications that he finds on internet searches.
According to Dr. Swayze, K. (A.)’s schizophrenia is in partial, and possibly full, remission. His diagnoses also include substance use disorder which Dr. Swayze indicates is severe, in partial remission, in a contained environment. Dr. Swayze noted that conduct disorder is a prerequisite to a diagnosis of antisocial personality disorder and that K. (A.) does show antisocial traits in his defiance, lack of truthfulness on occasion and there is a strong likelihood that he will meet the antisocial personality diagnosis with some narcissistic and borderline personality traits.
His cognitive disorder remains unspecified and there may be some cognitive deficits. Dr. Swayze noted that K. (A.) had very limited academic success and difficulties in high school studies, including when he was at Syl Apps Youth Centre. Dr Swayze referred to K. (A.)’s apparent lack of understanding of certain issues which he finds hard to explain, particularly K. (A.)’s seemingly flagrant disregard of expectations that this team set out for him. Potentially there might be intellectual disabilities that interfere with K. (A.)’s understanding.
K. (A.) has continued to decline psychological testing to clarify his cognitive status. Dr. Swayze indicated that if he were to engage in testing the treatment team would be better able to tease out personality characteristics and look at intellectual functioning. This would provide the treatment team with a more complete clinical picture, clarify his diagnosis, and perhaps help to understand the function of his behaviours. K. (A.) has agreed to see a counsellor and is engaged in 1:1 therapy with the same team who would conduct the cognitive testing.
In the past year, while Dr. Swayze was away, K. (A.) requested that his medication be changed from Paliperidone to Aripiprazole. Dr. Woodside made the change. Following that K. (A.) began exhibiting sexually disinhibited behaviours, walking around naked and reportedly timing his masturbation to when staff were anticipated to attend at his room on rounds as part of their protocol. K. (A.) was aware of the scheduling. This happened several times in an evening and continued over a period of days; as such, the treatment team considered the behaviour to be intentional. K. (A.) would also solicit female staff or ask to bring a prostitute to the unit. He was seen by the Sexual Behavioural Clinic for a consultation, but they were unable to give any diagnosis because K. (A.) both denied that those acts took place and indicated that he had no sexual motive. Dr. Swayze thought initially that this might have been due to a medication change because Paliperidone, his original medication, can reduce libido. After Dr. Swayze returned the behaviours continued. Dr. Swayze testified that he does not find that these were psychotically motivated. K. (A.) has ceased those behaviours, suggesting, in Dr. Swayze’s opinion, an ability to control the behaviours and indicating that they were not psychotically motivated.
Dr. Swayze was of the opinion K. (A.) would not engage in any programming if he was not required to do so. He has been advised that if he engages in four weeks of programming he can move up a privilege level but because he does not engage, he is unable to be moved forward. Recently K. (A.) has shown some motivation and is engaging minimally. In order to be able to move up the privilege ladder, the team would need K. (A.) to engage in sessions weekly, engage in social activities, and show that he is able to use his passes without difficulty.
With respect to programming, Dr. Swayze indicated that K. (A.) completed a module about how the Ontario Review Board operates; however, has not participated in any relapse prevention. Dr. Swayze stressed the necessity of substance use treatment. K. (A.) has a history of alcohol and drug use. He was reportedly smoking up to 14 grams a day daily, half an ounce, which reflects a severe disorder.
K. (A.) has continued to not provide consent to allow the treatment team to speak with his family.
Dr. Swayze was asked about last year’s concerns about K. (A.)’s overuse of his cell phone and his sleep/wake cycles. Dr. Swayze noted that K. (A.) had become engaged with a behavioural therapist who organized a routine. K. (A.) would not comply with voluntarily handing over his phone at night to be returned to him in the morning. CAMH has a policy that if devices interfere with sleep, they can be confiscated. Because K. (A.)’s routine was to be up all night and sleep all day, the policy was enacted. He continues to ask for it back and the team refuses. His sleep unfortunately has not shown improvement. Dr. Swayze said K. (A.) is not usually awake until about 1:30pm. Medications have been tried, without success, to assist him in falling asleep. This current sleep cycle interferes with his future ability to engage in programming.
When asked about the cause of the sleep behaviour, Dr. Swayze opined that K. (A.) may perceive his hospital admission as akin to jail, and that all he needs to do is sleep his way through it and he will move forward. Dr. Swayze recognized that with his minimal passes there is not much for K. (A.) to do during the day.
With respect to attendance at team reviews, he has improved over last year, often not attending or showing late, but he has made some attendances. These team reviews would be important to K. (A.) in that it is there he can ask for privileges.
Dr. Swayze indicated there is no indication that psychosis was a contributing factor to K. (A.)’s absconding in August 2025. Days before this incident, K. (A.) had attended his individual session and asked what would happen if he smoked marijuana and what would happen if he ran away. He was told that was not allowed and the therapist alerted Dr. Swayze. Dr. Swayze then spoke directly to K. (A.) and the treatment team’s response was explained to him, including police notification, return to hospital, loss of privileges, and potential return to the secure unit. K. (A.) absconded from a pass two days after this discussion. He was accompanied on his escorted pass by a peer support worker who is someone who has a history of mental illness and thereby someone to whom the patient might be in a better position to relate. On his return, K. (A.) indicated that he was upset and did not understand why his privileges had been curtailed. He indicated he had behaved perfectly well, did not use drugs and had simply gone to his father’s home. This gives Dr. Swayze concern whether there are cognitive issues and/or personality issues impacting K. (A.)’s behaviour.
K. (A.) went to his father’s house. Dr. Swayze said he does not have any information about what took place because K. (A.) continues to refuse consent to allow the treatment team to speak with his father. His father attends at the hospital to leave food or money for K. (A.) in the lobby but does not have visits with him. He was asked whether it would be possible for K. (A.) to be brought down to see his father or to meet with his father on occasions that he attends but Dr. Swayze indicated that K. (A.) could not be brought down to the lobby to see his father and that visits would have to take place in a meeting room.
Dr. Swayze testified that if K. (A.) was to abscond again in the future, he would be transferred to the secure forensic unit. He noted that that K. (A.) would find it less comfortable than the general forensic unit, due to multiple overhead announcements made, more staffing and more unwell clients.
When asked what he hopes to see in the next year, Dr. Swayze set out a clear list. There has been variable compliance with medication and K. (A.) acknowledged medication noncompliance. His levels of blood testing for medication which are done every two weeks show that his levels of medication were below normal and hovering at the lowest level. This is likely explained by noncompliance. Given his history of noncompliance, K. (A.) needs to go on injectable medications. These would be the same medications that he is currently taking. He noted as well that housing opportunities will not be available if K. (A.) refuses to do so because housing will not take people who have compliance issues. Secondly, K. (A.) must engage in activities and programming. Further, he must be able to use his privileges without any AWOL. Fourth, he must consent to completing psychological testing. Fifth, K. (A.) must grant access to allow the team to speak with his family. He noted that if K. (A.) does those things he will move quickly in the ORB process. Dr. Swayze reported that K. (A.) is putting a roadblock to his progress by declining to engage in those recommended steps.
When asked what K. (A.)’s response to the request for psychological testings, Dr. Swayze indicated that he simply says no without reasons. It is the same in discussions about medication. K. (A.) does not have access to more sophisticated programming for substances at this time. K. (A.) is able to indicate that he has schizophrenia and that he heard voices, but K. (A.) expresses the belief that it will not happen again, so he does not require medication. He may be on a sub-therapeutic level of medication, but he has not been seen showing psychotic symptoms of speaking to himself. K. (A.) indicates the voices are mild and do not bother him.
There has been no discussion about the index offence. Dr. Swayze has indicated that he has told K. (A.) that he must reflect on it so that he stays well and ensures it will not happen again.
It was put to Dr. Swayze that the report indicated that at Sprucedale K. (A.) was well liked, became more social after medication compliance, and more engaged. It appears that it is possible that K. (A.) has the ability to respond well to medication and show improvement.
Dr. Swayze indicated again that a psychological assessment will be critical to continue making an assessment of K. (A.)’s readiness for a community discharge. When asked whether he has explained that his lack of engagement will hinder his progress before the Ontario Review Board, Dr. Swayze said he tells K. (A.) this repeatedly at their monthly meetings.
Mr. Feindel asked Dr. Swayze whether the privilege of community living in the disposition results in an issue wherein K. (A.) feels he is therefore entitled to this privilege, which can be detrimental. Dr. Swayze indicated that is not the case and that it, rather, acts as a reasonable motivator because K. (A.) wants to be discharged. There is a clear pathway to that future trajectory if he were to cooperate and engage in the above noted necessary steps. Dr. Swayze said K. (A.) is currently at privilege level 4. He has stopped making sexual comments and appears to be moving forward. If he continues to move forward there is a prospect of community discharge in the upcoming year, although this remains very low without the other steps taking place. Without those steps K. (A.) would not get high enough on pass levels and he needs to be past level 6 privileges in order for the team to test and assess his response to greater privileges. K. (A.) has been told that variation of his medication to what is recommended would improve his discharge prospects.
Dr. Swayze was asked, given that the Hospital Report notes K. (A.)’s risk as being moderate to high in the community, why should the disposition include community housing. Dr. Swayze replied that if K. (A.) addressed the ongoing issues that risk will be recalibrated. His clinical and future risk could change in the upcoming year.
K. (A.)’s Muslim religion is important to him. Upon admission to CAMH he regularly prayed but he has not wished his Imam to return for months.
Dr. Swayze agreed that K. (A.) has made progress in the past year since January of 2026. He is thrilled that K. (A.) is at the hearing today to hear the evidence and understand the concerns of the team. At the hospital’s request, K. (A.) also took off both of his hoods so that his face could be seen. He is also doing some programming and using passes. Dr. Swayze indicated that he is cautiously optimistic by K. (A.)’s improvements over the past three months. With respect to K. (A.) transitioning to community housing within the upcoming year, Dr. Swayze opined that is a low probability, but not zero.
Dr. Swayze was asked about his evidence regarding K. (A.)’s capacity to consent to psychiatric treatment. Dr. Swayze said that K. (A.) skims the surface of capacity. He is able to recite his symptoms, but he has struggles in applying those to himself. He can articulate that medication was the cause of his delusions stopping but he thinks that there is a very low risk of that occurring again for him. K. (A.)’s capacity is tenuous in that he can describe his symptoms including delusions and thought insertions. Even were Dr. Swayze to find K. (A.) incapable, it would not allow him to impose injectable medication upon him if K. (A.) was willing to continue on oral medication. If K. (A.) was found incapable, then the hospital would be reaching out to his father as a substitute decision maker which, based on the information in the Hospital Report, could prove problematic. Dr. Swayze was also of the view that if he were to find K. (A.) incapable that a Consent and Capacity Board would be unlikely to uphold that finding based on K. (A.)’s understanding of the illness and ability to articulate his symptoms and the fact that medications caused those to disappear.
Dr. Swayze was asked whether there was an affective component to K. (A.)’s presentation. Dr. Swayze responded that K. (A.) has very little insight and his lack of involvement has caused Dr. Swayze to question whether there are any negative symptoms of schizophrenia at play.
Dr. Swayze was asked extensively questions concerning a cognitive assessment. K. (A.) is a 20-year-old young man who is legally an adult; however, from a neurodevelopmental perspective is considered a transitional age youth or emerging adult (approximately ages 18-25). In response to a question from a panel member, Dr. Swayze agreed that K. (A.) presents more like an adolescent. According to the June 2025 Reasons for Disposition and the current Hospital Report, K. (A.) was engaged and “well-liked by staff” when he was a resident at Sprucedale and at Syl Apps Youth Centre (2021 to October 2024). In contrast, K. (A.) has been described as less engaged in programming at CAMH, often spending time alone in his room sleeping. Dr. Swayze noted that K. (A.) is the youngest patient on the unit, with other patients approximately 20-30 years older, and K. (A.) likely functioned better at youth facilities because he had similar aged peers. The composition of older patients on the unit may inadvertently increase risk for social isolation and reduced treatment engagement, while limiting developmental learning opportunities with similar-aged peers. A developmentally responsive approach to understanding and responding to K. (A.)’s behaviours would be beneficial. The psychologist (Dr. Henry-Gordon) who worked with K. (A.) at Syl Apps Youth Centre and developed a strong therapeutic rapport with him is now employed at CAMH, outside of the forensic units. With K. (A.)’s consent, it may be worthwhile to explore whether she could provide a developmental consultation. Additionally, when clinically appropriate and prioritizing public safety, it may be beneficial to provide K. (A.) with opportunities to participate in recreational activities and/or programming with similar aged peers.
When asked further questions about the fact that K. (A.) does not have access to peers his own age, Dr. Swayze agreed and noted that if he is able to move up the privilege level, he could join community centres and engage in activities that may be more meaningful to him with similar aged peers. K. (A.) in the past showed athletic strengths and would have the opportunity for athletic activity if he were receptive to same. He is currently so low on the pass level that he is restricted from doing so.
Dr. Swayze was asked whether it might be possible to assist K. (A.) having access to his peer group, such as engaging with patients on the adolescent unit at CAMH. Dr. Swayze said that this might be worth looking into, but he does not expect that it could take place. K. (A.) would need to achieve a higher privilege level to have any such opportunities.
It was suggested to Dr. Swayze by counsel that K. (A.) does in fact have communication with his father and speaks to him regularly on the phone despite the fact that they do not meet in person. Dr. Swayze was unaware of this or that K. (A.)’s father does not speak English. Dr. Swayze said he would get an interpreter to be able to speak with the father if permitted to.
Submissions
Ms. Meaney, on behalf of the hospital, indicated that K. (A.) has had another challenging year, but his engagement has shown improvement lately and it is hoped that it will continue. He is relatively new to the hospital, and the Board so there remain a lot of unanswered questions with respect to his diagnosis. His team is working hard to understand it. Their efforts are limited by K. (A.)’s refusal to engage in testing. It is hoped that he will continue on a trajectory and agree to the assessment which would help clarify his needs and optimize his care. It is also hoped that K. (A.) will engage in further programming, increase his use passes, and allow communication between the team and his family members so that the team can better understand K. (A.) and what would benefit him. She submitted that the detention order as currently set out is that which is necessary and appropriate.
Mr. Feindel joined the hospital except with respect to the issue of community living. He asked the Board to consider whether that should be included in the upcoming disposition. Mr. Feindel downplayed the fact that K. (A.) attended today’s hearing because he is required to do so by law and could only be excused with agreement of the Board. He noted that there are a lot of unanswered questions, particularly the fact that there is no psychological assessment is very concerning with respect to any opportunity for discharge in the next year. There are both cognitive and personality issues that need to be explored vigorously. Mr. Feindel opined that K. (A.)’s understanding of issues does not suggest cognitive impairment to him. His use to some extent does inform his behaviour. Mr. Feindel articulated in his view K. (A.) needs to understand that he has to take steps because the team is seeking to assist him so that he can move forward with strengths and the team seeks to provide programming that will support K. (A.) in this regard. Mr. Feindel further submitted that it will be important that K. (A.) understand how drug use impacts his mental stability and opined that these are issues that K. (A.) might not understand due to his youth. He recognized that K. (A.) appearing today may result in his hopeful appreciation of the nature of the Ontario Review Board process. K. (A.) engaged in the most serious of index offences. Mr. Feindel submitted that there is no evidence that supports the prospect of community living in the next 12 months. There is, however, a pathway forward if K. (A.) was willing to be more cooperative and had greater understanding and respect for the steps that he must take.
Ms. Addie, on behalf of K. (A.), submitted that the Ontario Review Board disposition is perspective. It looks forward to the upcoming year and what might be accomplished. The issue of community living was discussed in fair detail at the hearing and Dr. Swayze was unmoved in his recommendation that it remain in his disposition and that it was a net positive and did not cause any entitlement behaviours. Dr. Swayze’s evidence was that it was more motivating than problematic. On this basis, she submitted that the Board should prefer to follow that opinion in maintaining community living as a privilege in the upcoming disposition. She noted that objectively there have been signs of progress in the last three months which shows that K. (A.) is able to do things to progress. She submitted that it was helpful that he was present to hear their concerns and see all people who are involved in supporting his progress. The five steps necessary remain clear. Ms. Addie submitted that it is helpful that more attention might be paid to K. (A.)’s needs by reason of his age and peers. On all of these bases, she joined the hospital position for no change to the current disposition.
Analysis and Conclusion
The Board joins all parties in noting how positive it is that K. (A.) made the decision to attend today’s hearing. It was observable that he was listening to the evidence and paying attention. The evidence of Dr. Swayze set out clearly what steps K. (A.) must make in order to move forward towards his goals that clearly include being discharged from the hospital. There is a stepwise process involving his achieving greater privileges that using these successfully to provide a foundation for his team to recommend community living. Having these set out again today for K. (A.) will hopefully have the effect of him taking steps to engage with the team and move forward.
The Board is unanimous in finding K. (A.) remains a significant threat to the safety of the public. We make that finding based on the severe seriousness of the index offence and the evidence before us. On the evidence before us a detention order is clearly that which is necessary and appropriate. K. (A.) does not appear to be sufficiently medicated. Although he is not showing clear psychotic symptoms there are ongoing significant behavioural issues that require the very close supervision and behavioural management. Within that disposition there is a lot of room for K. (A.) to move forward. He has full range of privileges up to community living. If he is able to take the steps to achieve greater privileges that will also importantly allow him access to engage with people, his own age and in activities he enjoys. The Board hopes that he will take all of the steps including allowing the team to speak to his family and perhaps most importantly, to adhere to the medication recommendations of his doctor. If there remain issues of concern about medication compliance, he will not be able to be recommended for community living as no housing would accept him. His options in that regard are to show full compliance with his oral medication which appears not to be the case based on his low-test results. It would be to his benefit to agree to take injectable medications for his personal wellbeing and treatment of his illness and to assist in his readiness for community discharge.
The Board is unanimous in its position that the privilege of discharge into the community should be maintained in the disposition. The evidence of Dr. Swayze supports that. As noted by Ms. Addie the disposition is perspective and despite his challenges there is optimism that K. (A.) will take the steps to move himself forward in the upcoming year.
For all of these reasons we make no change to his current disposition. We do so in consideration of the prime necessity of protection of the public, K. (A.)’s mental disorder, his personal needs and reintegration into the community.
DATED this 13^th^ day of May, 2026, at the City of Toronto, in the Toronto Region.
Ms. C. Fromstein Alternate Chairperson
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Office of the Registrar Ontario Review Board