Re Paul Ikeda-Douglas, 2026 CanLII 48362

Re: Paul Ikeda-Douglas

ORB File No: 7994

Hearing held on: Monday, February 2, 2026

Place of hearing: Centre for Addiction and Mental Health

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

Before:

Alternate Chairperson: Mr. M. Segal

Members: Dr. G. Chaimowitz

Dr. S. Wiseman

Hon. N. Kozloff

Mr. S. Duffy

Parties Appearing:

Accused: Paul Ikeda-Douglas

Counsel: Mr. J. Ioannidis

The person in charge of hospital: Counsel: Ms. M. Warner

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

(Dated May 15, 2026)

Introduction

On December 15, 2021, Mr. Paul Ikeda-Douglas was found not criminally responsible on account of mental disorder, on charges of criminal harassment, and uttering threats to cause death or bodily harm, both contrary to the Criminal Code of Canada (“Criminal Code”).
Mr. Ikeda-Douglas is currently subject to an Ontario Review Board (hereinafter also “ORB” and “Board”) Disposition dated February 12, 2025, which detains him at the Forensic Service of the Centre for Addiction and Mental Health (hereinafter also “CAMH”) with privileges up to and including living in the community of the Greater Toronto Area, specifically excluding Hamilton.
On February 2, 2026, the Board convened a hearing at CAMH to review that Disposition pursuant to s. 672.81(1) of the Criminal Code.
Mr. Ikeda-Douglas was present at the hearing and was represented by his counsel, Mr. J. Ioannidis. The hospital was represented by Ms. M. Warner, and the Attorney General by Mr. M. Feindel.
The issues at the hearing are whether Mr. Ikeda-Douglas continues to pose a significant threat to the safety of the public and, if so, what is the necessary and appropriate, least onerous and least restrictive disposition in all the circumstances, bearing in mind the factors enunciated in s. 672.54 of the Criminal Code.
The most recent Hospital Report dated January 15, 2026, was entered as Exhibit 1 in the hearing.
For the reasons set out below and based on the expert evidence and opinions before us, the Board concluded that Mr. Ikeda-Douglas represents a significant threat to the safety of the public and, that the necessary and appropriate Disposition in the circumstances is that Mr. Ikeda-Douglas be detained, subject to the same terms and conditions as in the current Disposition with the exception that the reporting requirement in paragraph 4 (e) be reduced from “not less than once per week” to “not less than once every two weeks”.

Position of the Parties

Counsel for the hospital recommended a Detention Order, upon the same terms as set out in the current Disposition, with the exception that the reporting requirement in paragraph 4 (e) be reduced from “not less than once per week” to “not less than once every two weeks”.
Counsel for the Attorney General agreed with the hospital’s recommendation.
Counsel for Mr. Ikeda-Douglas advised that his client was seeking an Absolute Discharge, as the test for significant threat had not been met.

Index Offence

The following is taken from the Hamilton Police Service Crown Brief Synopsis, as set out in the Hospital Report:

"The offences occurred between December 1, 2020, and May 25, 2021, i.e., over a six-month period. The victim and Mr. Ikeda-Douglas were in a relationship for 3 months in 1998. They did not share any children, did not reside together, and had not had any contact since 1998. At the time of this offence, Mr. Ikeda-Douglas was bound by a Release Order with the Toronto Police Service. No conditions were breached during this incident.

On May 25, 2021, the victim called police regarding unwanted contact from Mr. Ikeda-Douglas since December 2020. She stated that between December 2020 and January 2021, Mr. Ikeda-Douglas was calling the victim at her office at her medical practice (she worked as a physician). Mr. Ikeda-Douglas would identify himself as Dr. Teruma Ikeda and expressed an immediate urgency to speak with the doctor. The receptionist estimated that over 50 voicemails were left on the office phone during that time, not including the times contact was made over the phone. Between January 2021 and May 25, 2021, Mr. Ikeda-Douglas also began posting YouTube videos and Facebook rants about his relationship with the victim, while also slandering her name. Between May 19, 2021, and May 25, 2021, the victim received over 16 voicemails and a text on her personal cell phone from Mr. Ikeda-Douglas. On the voicemails, he made mention about dragging her from her office, showing her how he is a monster, and impregnating her. He also mentioned that if she called the police, she would require a gun or a safe house. The victim was fearful of Mr. Ikeda-Douglas.

Self-Report

In his video-recorded statement to police, Mr. Ikeda-Douglas stated that he began calling the victim because he believed she was depressed, suicidal, and in need of help. He reported that he and the victim had dated for approximately 8 years. He referred to himself as a "remote healer" noting that he was able to know when an individual was in trouble without having seen them. He stated that he knew the victim was suicidal and that he was contacting her in an attempt to provide her with support. He also stated that he was contacting the victim in order to enter into a romantic and/ or co-parenting relationship with her, noting that he was willing to have a child with her (they did not share any children). He stated that he knew the victim wanted to have a baby with him. He shifted between these different rationales throughout the statement. He stated that he was persistent in contacting the victim as this was necessary to engage her in responding. He made a number of disparaging and degrading comments about the victim. His speech was pressured and he tended to ramble. His thoughts appeared to be disorganized and marked by a high degree of tangentiality and loose associations as he had difficulty staying on topic to answer the officer's questions and often interrupted her. He made inappropriate comments to the female officer at the start of the interview, asking her personal questions about her relationship starts and inviting her to give him a call, noting “you're my kind of gal." He later asked the female officer if she wanted him to ''make a private line" for her, referring to a private phone number on which she could contact him, after the officer asked him for his phone number in the course of questioning.

He indicated that he had not slept in the three days prior to the interview and he appeared to be quite thin at that time, in comparison to his current presentation. He made a number of unsolicited, grandiose statements throughout the interview; for example, he stated that he “wrote the platform for the next prime minister" and referred to himself as a “high level politician." He made reference to dining with Bill Gates, stating that Bill Gates was jealous of him. He referred to the victim as "the highest profile doctor in North America." He also noted that he was in danger and made a few statements suggesting persecutory beliefs; for example, he stated multiple times that he was involved with bikers, and that somebody from ''bikers, bricks, and 55 division (Toronto Police)" wanted him dead."

Background History

Mr. Ikeda-Douglas’s personal, legal and psychiatric history are set out in detail in last year’s Reasons for Disposition dated March 18, 2025:

"Briefly summarized, Mr. Ikeda-Douglas is presently 64 years of age, he was born in Toronto and has three younger sisters. He has never been married and has no children.

Mr. Ikeda-Douglas attended elementary and secondary school in Markham. He completed some post-secondary studies and completed a two-year training program to become a paramedic. Prior to the index offences, he was living alone in the family home in Toronto. He was on an administrative leave from a position as a paramedic.

He had some involvement in the criminal justice system as well as the mental health system prior to the index offences. He has no criminal convictions prior to the index offences.

Mr. Ikeda-Douglas was involved in harassing and threatening behaviour towards family, neighbours and strangers. He made a number of harassing and threatening phone calls to his sisters between September 2020 and January 2021. These were described as aggressive and escalating in nature. One sister was reportedly granted a restraining order against Mr. Ikeda-Douglas. Mr. Ikeda-Douglas was also cautioned by police, escorted off of public property, and apprehended under the Mental Health Act (“MHA”) for numerous incidents of harassing various individuals in the one to two years leading up to the index offences. In addition, Mr. Ikeda-Douglas had outstanding charges in Toronto related to a number of occurrences in the year preceding the index offences, characterized by alleged similar behaviours demonstrated during the index offences and described above.

In August of 2022, Mr. Ikeda-Douglas entered into a s. 810 Peace Bond for a period of one year, and a charge of criminal harassment was withdrawn. A second charge of criminal harassment was resolved by a plea, the granting of an absolute discharge, and the imposition of a three-year common-law Peace Bond.

Mr. Ikeda-Douglas was involved with the mental health system. Starting in 2007, Mr. Ikeda-Douglas has had numerous emergency department visits, often in the company of the police due to bizarre behaviour and aggression, though he was usually discharged on the same day or the next day.

Mr. Ikeda-Douglas also has a significant history of polysubstance abuses. The hospital report details use of different types of recreational drugs, including stimulants (cocaine, crack cocaine), hallucinogens (LSD, MDMA, psilocybin, peyote, DMT), cannabis, and ketamine. He used cocaine regularly in the months preceding his arrest. Mr. Ikeda-Douglas also described a history of problematic alcohol use, referring to himself as a “functioning alcoholic.”

Following the NCR finding, Mr. Ikeda-Douglas was initially at St. Joseph's Healthcare Hamilton and was transferred to CAMH in February of 2022, at which time he was symptomatic and expressing delusional beliefs. Mr. Ikeda-Douglas was admitted to the General Forensic Unit of the hospital but around February 2, 2023, he started experiencing a mental health decompensation during which he sustained a self-inflicted laceration which caused him to be admitted to hospital at St. Michael’s where he was treated for the injury and returned to CAMH on February 11, 2023. For safety reasons he was transferred to the Forensic Assessment Unit and upon improvement of his symptoms he was transferred back to the General Unit on February 27, 2023. Mr. Ikeda-Douglas remained in hospital during that year and in September of 2023 he received a diagnosis of likely ALS resulting in referrals to Sunnybrook Hospital and to palliative care services at Mount Sinai Hospital for consultation."

Current Psychiatric Diagnoses

Mr. Ikeda-Douglas’s current psychiatric diagnoses are set out in the Hospital Report:

Psychiatric Diagnoses

Schizoaffective Disorder, bipolar type

Schizoaffective disorder is a major mental illness which results in symptoms of psychosis, both in the context of, and independent of, abnormal mood episodes. Psychosis is generally defined as the presence of delusions, hallucinations, grossly disorganized thought and behaviour, or some combination of these symptoms. Negative symptoms such as flat affect, avolition, and anhedonia may also be present. Mood episodes in schizoaffective disorder include manic or hypomanic episodes and/or depressive episodes. Psychosis may also be present. During manic or hypomanic episodes, there may be the presence of elevated or irritable mood, decreased need for sleep, and impulsive risk-taking behaviours. During depressive episodes, an individual may experience low mood, a lack of interest or pleasure, and suicidal thoughts. In males, symptoms generally begin to emerge in late adolescence or early adulthood. This often results in marked functional impairment, such as an inability to maintain employment, achieve educational goals, or form lasting relationships with others. Once extant, schizoaffective disorder is a lifelong illness. The mainstay of treatment is antipsychotic and mood stabilizing medication.

Mr. Ikeda-Douglas has a history of episodes of significantly elevated, energetic mood, irritability, pressured speech, diminished need for sleep, racing thoughts, significant increase in goal-directed activities, and engaging in reckless behaviours. During these episodes, he also experienced paranoia, grandiosity, and erotomanic delusions. He described periods of higher intensity usually lasting around 2 weeks. Such an episode occurred between February and March 2023, on the inpatient unit, and during the November 9, 2024, weekend. This combination of symptoms is consistent with a major mood disturbance, namely, mania/hypomania. Although he has a significant substance use history, his symptoms have persisted despite periods of sobriety, during time spent in hospital, in keeping with a major mental illness.

Substance Use Disorder (Alcohol and Stimulants)

The essential feature of a substance use disorder is a cluster of cognitive, behavioural, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. Behaviours related to the use of substances include: impaired control, social impairment, risky use and pharmacological criteria such as tolerance and withdrawal. The mainstay treatments for substance-related disorders often involve both medication treatment and psychological interventions (e.g., psychoeducation, relapse-prevention groups, motivational interviewing, 12-step groups).

Mr. Ikeda-Douglas described a pattern of excessive alcohol use, resulting in difficulty controlling his consumption, use despite harm and in hazardous situations, failures to fulfill major role obligations, cravings, and withdrawal symptoms. Based on the pattern and nature of these symptoms, criteria are met for a severe alcohol use disorder. He returned to alcohol use in November 2024.

In addition, Mr. Ikeda-Douglas also described using cocaine and crack cocaine, in larger amounts longer periods of time, despite recurrent social, vocational, interpersonal, and legal problems, as well as failure to fulfill major role obligations, including at work and at home. Based on the pattern and nature of these symptoms, criteria are met for stimulant use disorder. He is currently in remission from alcohol and stimulant use.

Of note, Mr. Ikeda-Douglas also reported a history heavy use of cannabis, though he did not endorse other symptoms consistent with a cannabis use disorder.

Narcissistic Personality Disorder

Personality traits are characteristic ways of interacting with one's environment. When these are maladaptive and inflexible, and cause social or occupational dysfunction, then personality disorders are said to exist. Personality disorders tend to become evident by adolescence or by early adulthood, and tend to be sustained thereafter, with some attenuation of the more dramatic personality traits towards middle and late age. The course of the symptoms of a personality disorder may be adversely affected by psychosocial stress, an unstructured living situation, alcohol or substance abuse, and non-compliance with psychological treatment. Psychiatric treatment for individuals who suffer from personality disorders tends to fall within the psychological, rather than the pharmacological realm. At times, pharmacological approaches may be used in an adjuvant fashion, targeting specific emotional or behavioural difficulties. Individuals with narcissistic personality disorder present with a pervasive pattern of grandiosity, need for admiration, and lack of empathy that is present in a variety of contexts. Other features may include fantasies of unlimited success and power, a belief that he or she is “special,” a sense of entitlement, a willingness to exploit others in order to meet his or her own needs, pervasive envy, and arrogance.

Mr. Ikeda-Douglas has a long-standing history of presenting with a high degree of focus and a need to emphasize his achievements and talents. He requires a certain degree of recognition praise, and admiration. He has had many goals, most of which are directed towards achieving great success. He also has been noted to present with a sense of entitlement and arrogance at times, although this has been less evident over the review period. He has also been noted to lack empathy, specifically with respect to the victim. Of note, these personality traits seem to become amplified when Mr. Ikeda-Douglas is experiencing manic symptoms, but may remain, to a lesser degree, when he is euthymic."

Course of Treatment Since the Current Disposition

Mr. Ikeda-Douglas’s course of treatment since the current Disposition is set out in the Hospital Report:

Centre for Addiction and Mental Health: January 2025 – January 2026

"Following his most recent ORB hearing on January 21, 2025, his detention order was continued on the same conditions. For the initial months of 2025, he remained on FGUB (also known as unit 1.3) at CAMH under the care of Dr. Deep Jaiswal. On May 22, 2025, he was discharged to Pine Villa on Eglinton Avenue (a supportive transitional care accommodation placement for older adults provided in partnership between LOFT and Sunnybrook Health Sciences Centre). He remained on the wait list for long-term care (Kensington Gardens).

Under the EFOPS (i.e., forensic outpatient service), his MRP was initially Dr. Juliette Dupré and he transitioned to the care of Dr. Owen O’Sullivan in July 2025. He has attended without issue for his outpatient reviews. These have typically been held with his MRP every 3-4 weeks and with his case manager on a weekly basis, often by phone check-in. He missed one appointment in October 2025 due to confusion with dates. He has attended appointments on his own using WheelTrans.

Overall, his mental state has remained stable with no significant decompensations or relapses. He has maintained a positive therapeutic relationship with his treatment team. He generally has appeared well groomed and neatly presented. Owing to his neurological condition, he has minimal spontaneous movement and strength in his upper limbs bilaterally. He can, however, mobilize, independently. He has required assistance with seating-to-standing transfers. There has generally been warm rapport. He has maintained a calm, easygoing and softly spoken demeanor in interactions with his care team. His mood has frequently been notable for a low-grade sadness however he has not presented as persistently or pervasively depressed. There have been no identified periods of elation. His affect has remained stable albeit restricted. His speech has been normal in rate tone and volume. He does not have significant slurring of speech or swallow issues. There has not been any formal thought disorder identified. He has reported some word finding difficulties and cognitive slowing. He has consistently described low energy and a low threshold for becoming fatigued. He has described chronically poor appetite and some associated weight loss. There have been no psychotic symptoms.

He has regularly spoken openly and candidly about ending his life in the context of availing of MAID in due course for which he has already consulted. He has stated he may pursue this next year although 'the horizon always changes when you get to the new point'.

Whilst he has expressed an intention to pursue a romantic relationship by reconnecting with ex partners, the team have not identified any intense preoccupations or concerning risk behaviors in this domain. He has not expressed any thoughts of harming others. He has denied having any cravings for substances. He has expressed an intention to continue to abstain from substances.

In terms of his insight, overall, this has been limited, particularly so in respect of his acceptance and understanding of his violence history and the risk of relapse and re-offending.

He had stated he did not agree with his diagnosis of schizoaffective disorder. He has acknowledged he has suffered from mood instability and depressive periods. He has agreed that mood stabilizing medication has reduced mood instability. He has, however, minimized his overall mental health history stating that he only had one episode of “being crazy.” He has expressed concern as to whether he has been correctly diagnosed. He has identified the following symptoms as ones he has experienced during acute phases of his illness: acting out in public, being too noisy with the police, phoning City Hall and making racial statements.

Regarding his understanding of the need for treatment, he has stated he was unsure what consequences may follow were he to discontinue medication. He has stated to the effect he was doubtful he would experience a relapse were he to do so.

In terms of his understanding of his history of violence and future risk, he has stated he did not feel he represented a threat to the public and disagreed with various aspects of his forensic risk assessment. At several times during his inpatient stay, he was noted as preoccupied with the contents of hospital report and perceived inaccuracies. During discussions with his inpatient MRP, for example, he contested details regarding his interactions with family and members of the public when unwell. He has frequently asked regarding how he met the criteria for significant threat.

He has stated he self-appraised his risk to others as ‘zero’ and that it has been ‘zero’ in the past. He has expressed feeling offended and misunderstood by the suggestion he continued to represent a threat of violence to others. He has stated that the potential for him to cause psychological harm to others was "a big stretch” in his view. He has stated he did not believe the communication around the index offence was threatening but rather represented a "nuisance". He described feeling ill-treated by the police insofar as he believed they should have merely warned him and not charged him. He stated he believed the victim had her complaint taken more seriously by the police owing to her social status as a physician.

He minimised the nature of the threats he made to her also. Regarding the threat to impregnate her, he stated he meant "I'm willing to have a child with you now". He maintained he was misinterpreted by the police and these statements were exaggerated by the Crown. Regarding the threats of her needing a weapon or safe house if she were to involve the police, he stated “that's not true, it's not a threat that I would make.” He contextualized these statements by referring to their previous relationship (twenty years prior to the offence) whereby he noted she "really liked sex play games, including one of those, as being overpowered by a beast.”

During his inpatient period, he was offered FORCAT sessions, however he declined. He has stated he had no current interest in re-engaging in psychotherapy or psychological interventions.

In terms of treatment, his psychotropic medication regime has been: sodium valproate 1250mg orally at night, lamotrigine 50mg orally at night, and, olanzapine 10mg orally at night. There have not been any significant compliance concerns. His residence has provided medication supervision, and according to both housing staff and himself, he has neither missed nor refused his medication since discharge. He has reported a side effect of dry mouth.

Since discharge, there have not been any significant risk concerns. UDS results have been negative and there have not been issues in collecting. He has denied craving substances. In addition, he has stated he would need assistance if he wished to use substances or alcohol due to his physical health issues and associated limitations. Housing staff has not reported any concerns in this domain.

Following his discharge from hospital he has stated that his other main goal was in reconnecting with an ex-partner. He was seeking a romantic relationship. He described considering contacting 2 ex girlfriends with whom he had not been in touch for many years. He expressed a hope that one of them called Kim would travel from Vancouver to see him. He has stated he has reached out to ex-partners through the means of phone calls and messages. Appropriate boundaries have been stressed and reiterated. He has advised that in the event his ex-partners did not respond to initial correspondence, he would send a second to express his disappointment and thereafter would desist. He stated he was willing to work with the team around maintaining appropriate boundaries and modes of communication with ex-partners. The team have not been made aware of any concerning reports regarding his use of electronic telecommunications.

In terms of privileges, prior to discharge, Mr. Ikeda-Douglas utilized indirect supervised passes to visit his sister, Bonnie, and friends in the community. This included intermittently attending their residence overnight. He has reported accessing sex workers in the community. The team have not been made aware with any issues or offending in relation to this.

In terms of therapeutic interventions and programming, prior to his discharge, he attended several activities including the following groups, rising with resilience, mindfulness, movie groups. In addition, he also attended several unit outings. In his housing, Mr. Ikeda-Douglas has attended drag bingo, pet therapy, and a musical concert in his housing. Following his discharge to housing initially in the early months he reported enjoying taking walks on the grounds however these have become less frequent owing to chronic fatigue and low threshold for becoming fatigued. Owing to the decline in his physical health, he has been less able to participate in group programs in housing. He has reported attending death cafe in the community, where he speaks to others about death.

In terms of his physical health, his ALS has seen some progression: mainly in terms of fatigue and bilateral upper limb weakness. His care has remained at Sunnybrook Health Sciences Centre where he has been reviewed every three months. He has mild dysphagia secondary to ALS. He underwent a surveillance colonoscopy at Toronto Western Hospital in October 2025 which showed internal haemorrhoids. He has had weekly physiotherapy sessions at his housing focused on his upper limb range of motion. His occupational therapist has been exploring the option of a powered wheelchair.

He requested to speak to Dr. Zrenner (CAMH neurologist) about a ketamine prescription for relief of symptoms of ALS, citing an American study that showed improvements in ALS patients. He stated his goals for this treatment were pleasure and experiencing relief in his body. He wanted to access these mind and body states as he approaches death from ALS. In February, the Sunnybrook ALS clinic recommended holding his cycle of radicava (he had completed three cycles of this medication for ALS). On unit 1.3, he had several minor falls. At his ALS review in Sunnybrook in September 2025, they noted mild interval progression over the course of the year. They planned to refer to a respiratory therapist in view of a mild decline in his FVC (a pulmonary function test). He had previously been assessed by palliative care but expressed that he was not particularly interested in getting them re-involved.

In terms of supports, he reported having an active social life where he sees his sister for dinner and speaks to his friends over the phone. He reported having spent New Year’s overnight with his sister. Mr. Ikeda-Douglas has required assistance with activities of daily living and self-care due to his physical impairments. He can no longer lift objects with his hands or arms, for example. He has required assistance with feeding, dressing, showering, toileting and using a telephone/computer at times. He has been able to walk without mobility aids, however. He has reported experiencing fatigue readily with exertion and has reported spending extended periods resting in bed during the day. He has denied major issues with swallowing. He reported slowed speech and some word-finding difficulties. Mr. Ikeda-Douglas maintained the ability to utilize the phone and write emails by the hands-free function. He has relied on WheelTrans to attend his clinic appointments. He has consistently stated he feels adequately supported by his housing provider. He has been in receipt of CPP disability and OAS.

In the lead-up to his discharge, his inpatient team applied to several supportive accommodation placements before ultimately securing a placement at Pine Villa. Overall, he made a relatively smooth transition to housing. He initially reported feeling alienated by the age and appearance of other residents, though recognized that Pine Villa is very well suited for his current physical needs. In terms of pathway progression, he remained on the waitlist for Kensington Gardens, a long-term care facility.

Regarding international travel, a goal of his has remained to take a trip to Thailand and he has drafted a travel itinerary. He has struggled to identify a friend willing to accompany him, which has delayed his plans. At time of writing, a friend Suzanne Kwon, has been undergoing the approved person process to that end. Mr. Ikeda-Douglas was previously accompanied by Suzanne on a two-night travel pass to Quebec between October 12 and 14, 2024. The pass was successful and without incident. He has stated a preference to travel in the early months of 2026. This will be subject to approval by OPIC and preceded by meetings with any approved person, his housing provider and his neurology team to carefully plan the trip. He has suggested he could hire some person informally ‘from the street’ in Thailand to help given his physical care needs. The team have suggested it would be preferable if this was somebody from a healthcare agency. Discussions around this potential trip have been ongoing.

In the longer-term, he has consistently expressed a preference to be granted an absolute discharge and no longer sees himself as a posing a significant threat to others."

Risk Assessment and Risk Management

The following relevant portions are excerpted from the Hospital Report:

RISK ASSESSMENT

HCR-20, Version 3

"Historical items deemed present and relevant included a history of problems with: violence, relationships, employment, substance use, major mental disorder, personality disorder, treatment/supervision response.

Clinical items deemed partially present and relevant included problems with insight.

Risk management items, in the context of the current inpatient setting or a high support community setting (such as a long-term care facility or a supportive transitional care facility), deemed to be partially present and relevant include future problems with treatment/supervision response.

Risk management items, in the context of a non-supported setting, deemed to be present and highly relevant include future problems with professional services and plans, living situation, personal support, treatment/supervision response and stress and coping.

SAPROF

Key protective factors that Mr. Ikeda-Douglas possessed include self-control, attitudes towards authority, medication, professional care, living circumstances, and external controls.

Items that Mr. Ikeda-Douglas can develop to increase his level of protection (i.e., goals) include leisure activities, and life goals.

Composite Assessment of Risk

Accounting for the above risk and protective factors, in the context of an Absolute or Conditional Discharge, Mr. Ikeda-Douglas's risk of violent re-offending is high. However, in the context of the current disposition, Mr. Ikeda-Douglas's risk of violent re-offending is in the low-moderate range.

Re-Offence Scenario

Absent ORB involvement, Mr. Ikeda-Douglas is likely to return to substances, get exposed to stressors, and/or disengage from treatment.

His insight into the nature of his condition, the need for treatment, the risk of relapse and how these interplay with his violence history and risk is limited. Indeed, he has minimized his offending history and there is a limited acceptance in terms of wrong-doing associated with a sense of perceived injustice.

These factors independently or in combination are likely to lead to an episode of major mood disturbance (e.g., mania) and/or a decompensation into florid psychosis. In this context, he is likely to engage in aggressive or threatening behaviours towards members of the public that he incorporates in his psychotic experiences. Consequently, he continues to meet the threshold for significant threat to the public.

Given his physical state, and mindful of the nature of his past offending, this risk of harm is likely to be psychological as opposed to physical in nature. Based on the above risk assessment, the necessary and appropriate disposition at this juncture is a Detention Order with community living.

Risk Management

The treatment team’s plan to promote Mr. Ikeda-Douglas’s well-being and manage his risk to public safety is as follows:

Mr. Ikeda-Douglas will continue to benefit from a high level of community monitoring, supervision and supports for any signs of relapse, or the re-emergence of any potential harmful or offending behaviours.
His current transitional supportive housing placement at Pine Villa remains appropriate to his level of needs, however, this may require review depending on how these needs evolve.
With regards to his major mental illness, schizoaffective disorder, Mr. Ikeda-Douglas has benefited from treatment with mood stabilizing and antipsychotic medications, and he should continue to take these medications in perpetuity.
He has a history of substance use. Ongoing substance use is likely to lead to mental state decompensations and consequently is risk-enhancing. Prohibition from the use of substances, including cannabis and alcohol, is necessary and appropriate. We also recommend that he continue to be subjected to random drug screens to monitor his ongoing abstinence.
Mr. Ikeda-Douglas's clinical team will continue to engage in the coordination of supports to help him manage his progressive neurological illness (ALS). This is likely to reduce potential stressors emanating from his medical condition and their impact on his mental state.
The team are currently supportive of his plans to organize international travel accompanied by an approved person, however, the precise details have yet to be finalized. Any trips will need to be carefully planned with approved itineraries and clear communication.”

The recommendation of the treatment team as set out in the Hospital Report is reproduced below in full:

Team Review of Recommendations

"It is the team’s opinion that the necessary and appropriate disposition is the continuation of his current ORB detention order with the following amendment to his disposition being proposed: a reduction in reporting frequency from weekly to biweekly.

A conditional discharge was considered. The team continues to require the need to approve his housing to safely monitor and manage his mental state and re-offending risk. His recent motivation and efforts to develop romantic relationships with previous female contacts is of concern. Such overtures may precede a recurrence of previous offending behaviours, which have the potential to escalate and cause serious psychological harm to victims. This warrants close monitoring. This behaviour would require risk management but would likely not meet criteria for certification under the Mental Health Act. As he is capable of consenting to treatment, Box B of the MHA Form 1 would also not apply. In the team’s view, the civil commitment provisions would be inadequate to affect a swift re-admission in the event of an escalation of risk associated with such behaviour and communication patterns. He would likely similarly fail to satisfy the ongoing detention criteria if reliant on these provisions alone in the context of such a presentation and increase in risk. On these bases, a conditional discharge is not currently appropriate."

Evidence at the Hearing

The Board had available to it the evidence and documents forming the Record, the exhibits, and oral evidence from Dr. Owen O’Sullivan, one of the authors of the Hospital Report (Exhibit 1).
Dr. O’Sullivan has been the outpatient forensic psychiatrist for Mr. Ikeda-Douglas since July of 2025, when he replaced Dr. Dupree.
In response to questions from hospital counsel, Dr. O’Sullivan testified:

a. that Mr. Ikeda-Douglas had made good transitions from the FGUB to Pine Villa following his discharge in May 2025, and from Dr. Dupree to himself in July 2025.

b. that Pine Villa is a 24-hour highly supportive transitional accommodation furnished in partnership with LOFT and Sunnybrook (which provides neurological follow up of Mr. Ikeda-Douglas’s ALS).

c. that the plan was for Mr. Ikeda-Douglas to move to Kensington Gardens – where he is currently on a waiting list - when and if accommodation there becomes available.

d. that Kensington Gardens will be able to meet his needs regarding the ALS.

e. that Mr. Ikeda-Douglas wishes to travel internationally to Thailand - which para. 2 (f) of his current disposition permits subject to approval by the person in charge of CAMH or his/her designate of the itinerary and of the person accompanying him - and that the approval process of his friend Suzanne Kwon is currently underway.

f. that in terms of this travel proposal there is a need to consult with Sunnybrook to ensure that his physical care needs can be met, and a need to share his mental health information with Sunnybrook.

g. that if Ms. Kwon is approved the next step would be to get more details of and finalize his itinerary in collaboration with Sunnybrook.

h. that Mr. Ikeda-Douglas’s insight into his need for psychiatric treatment is limited: he does not accept his diagnosis, downplays its nature, and does not appreciate the risk of relapse should he discontinue his medication, albeit he has been medication adherent.

i. that he minimizes the index offences (particularly the threats) and contextualizes them (for example his stated belief that the victim was given “preferential treatment” because she is a physician), and, that he dismisses the risk he posed and still poses to the public (“0 risk now and 0 risk in the past”).

j. that Mr. Ikeda-Douglas has been both compliant with his medication and diligent about his appointments.

Regarding what would likely happen if there was no ORB oversight, Dr. O’Sullivan responded that Mr. Ikeda-Douglas benefits from a high degree of monitoring, and opined that if discharged absolutely he would uses substances as in the past including (but not limited to) cocaine, crack cocaine and cannabis, that he would discontinue taking his antipsychotic medication, that he would be subject to stress without ORB support, and that he would likely relapse.
While Dr. O’Sullivan was mindful of the physical limitations imposed on Mr. Ikeda-Douglas by his ALS diagnosis – specifically to his upper limbs – he noted that Mr. Ikeda-Douglas can still use the telephone and that the risk of psychological harm remains given that the Index Offences involved harassment as swell as slanderous YouTube and Facebook posts.
Dr. O’Sullivan also expressed concern about Mr. Ikeda-Douglas’s stated wish to contact ex-partners for the purpose of romantic relationships (referred to above under Course of Treatment Since the Current Disposition). He spoke to the risk of what might occur if supervision by the Board is no longer in place while noting that the hospital does not monitor his devices and would therefore be dependent for information on self-report from Mr. Ikeda-Douglas and/or notification by the police.
Asked why a Detention Order was the necessary and appropriate disposition, he replied that this disposition was necessary to manage the risk Mr. Ikeda-Douglas poses by:
monitoring him closely,
requiring him to submit samples of his urine and/or breath for the purpose of analyzing whether he has ingested alcohol and/or drugs, and
approving his accommodation to ensure the necessary supports are in place for both his mental illness (especially as he is now on oral antipsychotic medication) and his physical care.
Dr. O’Sullivan added that a Conditional Discharge is not yet appropriate, for the reasons set out in the Team Review of Recommendations. The Board requires the authority to approve suitable accommodations. The Mental Health Act is “insufficiently sensitive” for a number of reasons, most especially the need for rapid rehospitalization in the event of a relapse and decompensation (whether due to discontinuation of antipsychotic medication or a return to substance use or stress or otherwise).
Lastly, in reply to the question regarding why he was recommending a reduction in reporting requirements, Dr. O’Sullivan replied that Mr. Ikeda-Douglas is very diligent in attending, maintains a positive relationship with his treatment team, and has not had any positive urine screens for drugs.
In response to questions from counsel for the Attorney General, Dr. O’Sullivan opined that Kensington Gardens would provide Mr. Ikeda-Douglas with a level of support comparable to that provided by Pine Villa.
Regarding international travel, only Thailand has been proposed. Ms. Kwon had previously been approved as the accompanying person on a trip to Quebec City last year.
Asked about his concern regarding the stated desire of Mr. Ikeda-Douglas to renew several romantic relationships, Dr. O’Sullivan replied that this could be a prelude to “unwanted contact” as occurred in the Index Offences and that the risk of psychological harm to those women would rise in the event he relapses, particularly if their responses are a rejection of his advances and/or if he misreads their responses. The doctor noted that Mr. Ikeda-Douglas had reported that his relationship with the victim had been 8-10 years in duration as opposed to the 3-month relationship she had described. He also acknowledged that he did not know whether or not the reports by Mr. Ikeda-Douglas regarding those romantic relationships were accurate, and that therefore his approaches to (either or both of) those women might come as a “surprise.”
Regarding the timing of his unwanted contact with neighbours and family members, he replied that it occurred around the same time as the index offences.
Asked if Mr. Ikeda-Douglas had regular contact with his sister, he replied in the affirmative but was not sure if that was the same sister who had sought a restraining order.
Regarding substance use, Dr. O’Sullivan agreed that the Hospital Report indicates a high probability of a Substance Abuse Disorder, both alcohol and stimulants (in remission). The November 2024 incident of alcohol use was a concern to Dr. O’Sullivan both because it was a breach of his Disposition and because of his lack of transparency with the treatment team.
In response to a question from counsel for Mr. Ikeda-Douglas whether there has been any decompensation during the past year, Dr. O’Sullivan responded that Mr. Ikeda-Douglas has a schizoaffective disorder, bipolar type and that there were no manic or depressive episodes and no substance use.
Regarding reporting, he said that Mr. Ikeda-Douglas had been reporting weekly to the team and meeting every 3 to 4 weeks with him.
Regarding medication, Mr. Ikeda-Douglas takes 2 mood stabilizers and Olanzapine by himself, supported by staff, and he has been compliant.
Dr. O’Sullivan confirmed that Mr. Ikeda-Douglas gets along well with the treatment team. He sees his case manager every few weeks.
Regarding his desire to reconnect with ex-partners, Mr. Ikeda-Douglas had informed the team of contacts he has made with a view to developing romantic relationships.
Regarding his use of substances, Dr. O’Sullivan listed alcohol, cocaine, crack, and cannabis. Asked if Mr. Ikeda-Douglas had received any counselling for this disorder, he replied that it had been offered to Mr. Ikeda-Douglas while he was an inpatient, and that he had declined, adding that he seems to be internally motivated in his present physical state.
Regarding the ALS diagnosis, Dr. O’Sullivan was asked if Mr. Ikeda-Douglas was deteriorating. He replied that Mr. Ikeda-Douglas has a sub type of ALS that has largely affected his upper limbs but is a less aggressive type of the disease, and added that there has been a mild, integral progression over the past few months affecting his arms and lungs. He confirmed that Mr. Ikeda-Douglas has difficulty getting from a seated to a standing position, and that the Occupational Therapist is exploring the acquisition of a power wheelchair.
Asked if Mr. Ikeda-Douglas requires assistance with devices, Dr. O’Sullivan replied, “Not with a telephone or computer.” He confirmed that the OT is planning for an evolution in his needs.
In response to questions from the panel, Dr. O’Sullivan confirmed that Mr. Ikeda-Douglas has been “accepted” on the Kensington Gardens waitlist.
Asked what had changed (from the previous year) regarding concerns about medication adherence and substance abstinence while travelling internationally, Dr. O’Sullivan replied that Mr. Ikeda-Douglas values the proposed trip which he regards as a quality of life issue, that his physical state has not yet deteriorated, that his mental state is stable, and that therefore the team was trying to determine if it can be safely achieved.
Para. 27(d) of last year’s Reasons for Disposition was put to Dr. O’Sullivan. It states that the team had recommended the removal of international travel passes because of the uncertainty of his (major mental illness) diagnosis at the 2023 hearing, and that again in November 2024 the treatment team had cited concerns with the feasibility of international travel due to incidents of substance use and indicated that international travel was not supported, specifically if he was to travel internationally for a lengthy period or were he to do so without accompaniment by an approved person. Dr. Jaiswal had opined at last year’s hearing that Mr. Ikeda-Douglas should not be approved for travel for more than seven days and only with a person approved through the CAMH approval process. Dr. O’Sullivan replied that they were at an early stage of planning and that there was a need to consult with the various stakeholders including Sunnybrook.
Asked if there was any possibility of a change from threat to action in respect of the victim (of the index offences) he replied, “A possibility.”
Asked about the limits of his insight, Dr. O’Sullivan explained that it had been a challenge to bolster his insight given his minimal engagement (e.g. declining FORCAT and stating that he had no current interest in re-engaging in psychotherapy or psychological interventions).
Asked what more could be done, he replied, “Reinforcing the need to comply and abstain and encouraging structure in his days.
Dr. O’Sullivan was unsure if Pine Villa is a locked door setting but posited that Mr. Ikeda-Douglas can go as he pleases albeit he mostly rests in bed.
Asked if he thought Mr. Ikeda-Douglas would stay at Pine Villa were the choice up to him he responded, “Probably. He is very positive about Pine Villa.”
Asked by counsel for the Crown if he was concerned about Mr. Ikeda-Douglas having access to substances and resisting them while traveling, he said he was.
Asked about his contacts with ex-partners, Dr. O’Sullivan said he was open about those.
Asked if Mr. Ikeda-Douglas would require assistance to acquire substances, Dr. O’Sullivan responded that he has “very little function in his upper limbs.”
Asked by his counsel whether Mr. Ikeda-Douglas required assistance walking around Pine Villa, Dr. O’Sullivan replied that his energy and confidence are affected. Asked if he can’t just get up and go out, he responded, “He can. He comes to his appointments.”

Note: Following the completion of Dr. O’Sullivan’s oral testimony and prior to Final Submissions, counsel for the Attorney General informed the hearing that the victim of the index offences remains concerned about any contact with Mr. Ikeda-Douglas.

Final Submissions

Counsel for the hospital began by stating the positives:

a. Mr. Ikeda-Douglas has made a good transition to Pine Villa

b. He has been compliant with his medication

c. He has a good rapport with his treatment team

d. He has cooperated with all aspects of the Disposition

That said, she submitted that Mr. Ikeda-Douglas remains a significant threat, and (citing the Hospital Report at p. 29) a “high risk” in the context of a Conditional (or Absolute) Discharge due to the limitations of his insight.
She posited that there is a real concern about him “falling away” in the absence of ORB oversight, and that the risk of psychological harm is not mitigated by his physical limitations.
She submitted that the Mental Health Act was inadequate because the hospital required the ability to rapidly readmit Mr. Ikeda-Douglas in the event of a relapse.
Counsel for the Attorney General adopted the submissions of counsel for the hospital, adding that the evidence supports close supervision under a detention order and citing the stated desire to renew romantic relationships as being reminiscent of the onset of the index offences.
Counsel for Mr. Ikeda-Douglas began by citing Marmolejo, submitting that if there is any doubt about significant threat there must be an Absolute Discharge.
He argued that while Mr. Ikeda-Douglas was in good physical condition at the time of the index offences, he now suffers from ALS and requires assistance to do simple physical tasks. He no longer has the physical means to carry out those offences even if he was to decompensate.

Analysis and Conclusion

Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board finds that Mr. Ikeda-Douglas is a significant threat to the safety of the public, and that the appropriate and necessary Disposition is the proposed Detention Order.
We adopt the following statement from last year’s Reasons for Disposition at para 33 under Analysis and Conclusion:

"33. Mr. Ikeda-Douglas suffers from a major mental illness, schizoaffective disorder. When unwell, he exhibits an expansion of his mood, delusions, impaired judgement, and poor behavioural controls. Historically, in the context of acute manic and/or psychotic episodes, he has engaged in aggressive and threatening behaviours towards members of the public."

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. O’Sullivan, in addition to the documentary evidence before us.
Multiple experts, including Dr. O’Sullivan, have opined that Mr. Ikeda-Douglas lacks, and continues to lack, insight into his mental disorder. He has made statements doubting the accuracy of his diagnosis. He does not appreciate the risk of relapse should he discontinue his medication, albeit he has been medication adherent, and he is ambivalent about the need for ongoing medication. This lack of insight is seen as a significant risk factor because it increases the likelihood of non-adherence to treatment, which has previously led to relapse and violence.
We also rely upon and emphasize the relevant contents from his Background History:

“Mr. Ikeda-Douglas was involved in harassing and threatening behaviour towards family, neighbours and strangers. He made a number of harassing and threatening phone calls to his sisters between September 2020 and January 2021. These were described as aggressive and escalating in nature. One sister was reportedly granted a restraining order against Mr. Ikeda-Douglas. Mr. Ikeda-Douglas was also cautioned by police, escorted off public property, and apprehended under the Mental Health Act (“MHA”) for numerous incidents of harassing various individuals in the one to two years leading up to the index offences. In addition, Mr. Ikeda-Douglas had outstanding charges in Toronto related to a number of occurrences in the year preceding the index offences, characterized by alleged similar behaviours demonstrated during the index offences and described above.

We note with concern the following response by Dr. Jaiswal at para. 27(a) in last year’s Reasons for Disposition set out below:

"27. In response to questions posed by members of the Panel, Dr. Jaiswal responded as follows:

a. The non-contact provision with the victim of the index offence is still necessary and appropriate to be included in Mr. Ikeda-Douglas’ current Disposition. Mr. Ikeda-Douglas continues to entertain some preoccupations that the victim might wish to reconcile with him. Dr. Jaiswal believes that he tends to minimize the severity of the index offence. In any event, the non-contact provision continues to present external control against contact with the victim of the index offence."

Additionally, we rely upon the following relevant information extracted from last year’s Reasons for Disposition:

“With respect to Mr. Ikeda-Douglas’ mental condition over the course of the last reporting period, Dr. Jaiswal confirmed that in February of 2024, Mr. Ikeda-Douglas reported symptoms consistent with major depression which were addressed with medication which brought his mood back to baseline. In November of 2024, Mr. Ikeda-Douglas is also noted presenting as elevated and expressing some delusional content. It is now believed that this was triggered by increased caffeine use. In the opinion of Dr. Jaiswal, these episodes show that Mr. Ikeda-Douglas’ mental state still warrants supervision and can require further medication adjustments to address fluctuations.”

Finally, we rely upon the following excerpts from the Hospital Report and from last year’s Reasons for Disposition regarding an incident involving alcohol use by Mr. Ikeda-Douglas in November of 2024:

From the Hospital Report:

“Mr. Ikeda-Douglas remained admitted on the Forensic General Unit B (FGUB – unit 1-3). For most of the reporting year, he evidenced mental health stability. However, he briefly experienced an episode of hypomanic symptoms around November 9, 2024. Similarly, most urine drug screens did not evidence the presence of substances including alcohol. However, urine drug testing conducted on November 19, 2024, tested positive for alcohol.”

From the Reasons for Disposition:

“Dr. Jaiswal sought to bring a clarification to the Hospital Report regarding an incident where Mr. Ikeda-Douglas tested positive for alcohol. On November 19, 2024, when Mr. Ikeda-Douglas was presented with the fact that he had tested positive for alcohol, he initially reported that he had consumed a cup of sake. He later acknowledged that he had consumed three cups of sake. As a result, Mr. Ikeda-Douglas’ privileges were withheld as this is a breach of the terms of his Disposition.

With respect to the episode of alcohol use in November 2024, Mr. Ikeda-Douglas acknowledged that this was contrary to his Disposition and that it impacted the level of trust between him and the treatment team, however, his insight as to the impact of alcohol use is limited in the opinion of Dr. Jaiswal.”

Although Mr. Ikeda-Douglas has been abstinent from other substances, this has occurred under the close supervision and with the ongoing support of the hospital. There are realistic concerns that he may relapse without these controls.
The Board has no difficulty in coming to the decision that Mr. Ikeda-Douglas satisfies the test set out in Marmolejo (Re), 2021 ONCA 130, in which Justice Tulloch reviewed the relevant test at paragraph 37:

The threshold for significant risk is "onerous": Carrick (Re) (2015), 128 O.R. (3d) 209, [2015] O.J. No. 6524, 2015 ONCA 866, at para. 17. A significant threat to the safety of the public means a foreseeable and substantial risk of physical or psychological [page195] harm to members of the public: R. v. Ferguson, [2010] O.J. No. 5138, 2010 ONCA 810, at para. 8. The conduct must be of a serious criminal nature: Ferguson, at para. 8. A very small risk of grave harm will not suffice, nor will a high risk of trivial harm: Ferguson, at para. 8. The threat must be more than speculative in nature; it must be supported by evidence: Winko, at p. 665 S.C.R.; Pellett (Re) (2017), 139 O.R. (3d) 651, [2017] O.J. No. 5025, 2017 ONCA 753, at para. 21.

In summary the evidence persuades us that Mr. Ikeda-Douglas meets all the criteria of a significant threat to the public safety. The doctor’s evidence is that there is a real and foreseeable risk of serious harm to the public should Mr. Ikeda-Douglas stop his medication or resume substance use. This risk is not considered trivial or speculative; it is based on his past behaviour and the nature of his illness. His current stability is attributed to the intensive oversight that he is getting. He still needs the support of a treatment team.
Moreover, the evidence persuades us that the proposed Detention Order is the necessary and appropriate, least restrictive, and least onerous disposition in all the circumstances of this case.

DATED this 15^th^ day of May, 2026, at the City of Toronto, in the Region of Toronto.

Hon. N. Kozloff

Legal Member

__________________

Office of the Registrar

Ontario Review Board