Re: Shawn D. Alfredson
ORB File No: 5851
Hearing held on: Thursday, April 30, 2026
Place of hearing: Centre for Addiction and Mental Health Via Zoom Videoconference
Pursuant to: Section 672.81(2.1) of the Criminal Code
Before:
Alternate Chairperson: Mr. J. Weinstein
Members: Dr. R. Wood Hill Dr. G. Nexhipi Ms. M. den Haan Mr. A. Bouvier
Parties Appearing:
Accused: Shawn D. Alfredson Counsel: Mr. A. Rai
The person in charge of hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Mr. D. Brandes
REASONS FOR DECISION
(Dated May 20, 2026)
Introduction
On March 24, 2011, Mr. Shawn Alfredson was found not criminally responsible on account of mental disorder, on charges of aggravated assault, and possession of a weapon for dangerous purposes, both contrary to the Criminal Code of Canada (“Criminal Code”).
Mr. Alfredson is subject to the terms and conditions of a Disposition of the Ontario Review Board (the “Board”), dated September 24, 2025, which ordered that he be detained at the Forensic Service of the Centre for Addiction and Mental Health, Toronto (“CAMH”).
Pursuant to s. 672.56 of the Criminal Code, CAMH notified the Board that Mr. Alfredson’s liberty had been restricted, by letter dated March 2, 2026.
On March 2, 2026, Mr. Alfredson was residing on a General Forensic Unit (“GFU”) at CAMH. He was transferred to the Structured Observation and Treatment Unit (“SOTU”) until March 9, 2026, when he was transferred to the Forensic Assessment Treatment Unit (“FATU”).
On April 30, 2026, a panel of the Board convened a hearing by Zoom to review the restriction of Mr. Alfredson’s liberty, pursuant to s. 672.81(2.1) of the Criminal Code.
Mr. Alfredson was present at the hearing and was represented by his counsel, Mr. A. Rai.
A Restriction of Liberty Hospital Report, dated April 1, 2026 ("the ROL Report"), was entered as Exhibit 1.
A Hospital Report dated August 21, 2025 (“the Hospital Report”) was entered as Exhibit 2.
When a hospital significantly restricts the liberty of an accused for more than seven days, it has an obligation, under s. 672.56(2)(b) of the Criminal Code, to provide notice to the Board as soon as possible. Under s. 672.81(2.1), the Board is then required to convene an ROL hearing to review the hospital’s decision, also as soon as is practical.
For the Restriction of Liberty, the issues at this hearing were:
a) whether the decision made by the person in charge to significantly increase the restriction of liberty on Mr. Alfredson was warranted and necessary, as well as being the least onerous and least restrictive option in the circumstances, at the time of its onset, on March 2, 2026; and
b) whether it continues to be so.
Position of the Parties
- Counsels for the hospital, for the Attorney General, and for Mr. Alfredson advised that this was a joint position. All agreed that the initial restriction of liberty was necessary and appropriate, as is the ongoing restriction of liberty.
Index Offences
- The circumstances giving rise to the Index Offences are extracted from the most recent Reasons for Disposition, dated October 9, 2025 (with identities redacted):
“On Sunday, August 14, 2005, at approximately 12:10 PM, Mr. Alfredson was at his place of employment, Tim Horton’s with the victim, a co-worker. As Mr. Alfredson was leaving work, he attacked the victim, who was helping the manager unload boxes from the vehicle. He kicked the victim and slashed his face deeply with a knife. The knife also cut the victim on the throat. Mr. Alfredson then fled. The victim required 28 stitches to close the face wound, and in addition, he required medical follow-up for dental, and nerve damage. The attack was witnessed by the manager and another employee. It occurred without provocation, or prior warning.”
Course in Hospital Prior to the ROL
- Mr. Alfredson’s course at CAMH prior to the restriction of liberty are set out in detail in the ROL Report. The following extracted paragraphs are relevant to this hearing:
“Mr. Alfredson is a 50-year-old single male who is an inpatient at the Centre of Addiction and Mental Health (CAMH) in Toronto, Ontario. He was readmitted to hospital on November 14, 2024. Since coming into hospital Mr. Alfredson has had four elopements. His most recent elopement was from February 27, 2026, to March 2, 2026. Before coming into hospital, he was living at Dowling Avenue, a highly supportive accommodation with 24-hour supervision. While living there, Mr. Alfredson had multiple readmissions to hospital, eight in 2024 alone. As of the preparation of this report, he was an inpatient at CAMH on the Forensic Assessment and Treatment Unit (FATU), a secure forensic unit after he returned to hospital on March 2, 2026, following his elopement from hospital and substance use, on February 27, 2026.
Since his most recent readmission on November 14, 2024, Mr. Alfredson has been an inpatient on the LGUB up until his most recent elopement. While on the unit, and within just over one year, he has had four elopements coupled with substance use. These included December 26 to 29, 2024; May 15 to 17, 2025; July 21 to 23, 2025; and February 27, 2026, to March 2, 2026. These elopements were planned. He did not describe any exacerbating factor inclusive of any cravings or acute stressors. While he was away from hospital, during every elopement, he used crack cocaine and returned voluntarily after a couple days. His mental state destabilized for several days before returning to baseline.”
Reasons for the Restriction of Liberty, both Initial and On-Going
- The ROL Report provides the reasons for the restriction of liberty as follows:
“In his last team review on February 24, 2026, no concerns were identified. He did not endorse any psychotic symptoms, cravings, or desires to abscond. There were no behavioural concerns noted. He briefly opted to discontinue one of his medications, topiramate, an anticonvulsant medication used to address cravings for stimulants, as he opined that this was due to concerns that the medication was delaying his chronic wound healing. He was asked directly about any new cravings or desires to use stimulants, which he denied. When he was educated on the role of the medication and the importance of taking it, especially as he progressed into the community, he agreed to restart it.
On February 27, 2026, Mr. Alfredson went on an escorted community pass to “Burgers Priest” for lunch. There were no concerns noted before leaving for his pass. He was not agitated or irritable. He did not describe any cravings for substances. After he ordered his food at the restaurant, he asked to go outside for fresh air. When he got outside, there was a car waiting. He got into it, said “Okay, see you later,” and drove away. He was calm and organized. He did not display any psychotic symptoms. This level of organization and planning was consistent with prior elopements.
A forensic division case conference with senior leadership was held on March 5, 2026, to discuss Mr. Alfredson’s overall care plan. It was unanimously that Mr. Alfredson’s characterological challenges coupled with his problematic substance use have prevented him from progressing on the general unit. Extensive efforts have been made, and failed, to maintain and progress Mr. Alfredson on a general unit, despite his repeated ULOAs and substance use.
If Mr. Alfredson remains on the general unit, he would likely continue to abscond and fail to progress, which would likely lead to demotivation, resentment, and a cascade of more problematic behaviours, including substance use, that will compromise his mental health and rehabilitation trajectory. There was agreement that transfer to a secure setting was necessary and appropriate, and the least onerous and restrictive approach, commensurate with both the needs of Mr. Alfredson and public safety. It was agreed that he required placement in a secure unit with closer monitoring and more structured support. There, he will have a higher level of physical security and procedural security. He will have more staff support and greater opportunity for on-unit programming aligned with his risk needs. His repeated and planned ULOAs that have not been foreseeable by the team, necessitate greater structure and security for a period of time, while he works on his dynamic risk factors. This milieu will help ensure that Mr. Alfredson progresses through hospital, in a more rigorous and organized manner.”
Course in Hospital Since the ROL
- Mr. Alfredson’s course in hospital since his ROL is set out in detail in the Hospital Report. The following extracted paragraphs are relevant to this hearing:
“Mr. Alfredson returned voluntarily to CAMH emergency department in the early morning on March 2, 2026. When he was seen, he admitted to using crack cocaine “a lot… but I am out of money, so I decided to come back.” He also admitted to drinking “2 beers”. However, he refused a urine drug screen. He did not appear disorganized or psychotic. He was held in the emergency department overnight and was transferred to the Structured Observation and Treatment Unit (SOTU) the next morning. On assessment, he presented as irritable and disheveled though he did not appear psychotic or disorganized. He was guarded and dismissive when responding to questions. When asked why he eloped, he responded, “I felt like [using substances] that day… you were taking too long [to move him through hospital].” He denied planning the abscondment. He refused to provide further insight.
Mr. Alfredson remained on SOTU until a bed became available on the Forensic Assessment and Treatment Unit (FATU) on March 10, 2026. On the FATU, Mr. Alfredson has been more engaged with staff, but he has continued to rationalize his behaviours, blaming the treatment team for his abscondment.”
Current Diagnoses
- Schizophrenia;
Cocaine Use Disorder;
Antisocial Personality Disorder.
Evidence at the Hearing
- The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Chan. Dr. Chan is a PGY-6, Forensic Fellow, under the supervision of Dr. Chatterjee. Dr. Chan testified as follows:
a) He worked with Mr. Alfredson on the GFU from January 2026 until Mr. Alfredson’s recent transfer.
b) Since the transfer to the FATU, Mr. Alfredson has had no critical incidents, and he has been participating consistently in available forensic programming on the unit.
c) In the weeks leading up to Mr. Alfredson’s fourth ULOA, he had been progressing well under a structured, supportive management plan aimed at preparing him for an inpatient substance rehabilitation program. The program would have been available to him once he was ready for indirectly supervised passes.
d) There were no precursors suggesting a pending elopement, such as a mental health deterioration, increased cravings, behavioural issues, or disengagement from treatment.
e) Despite Mr. Alfredson’s apparent stability, the fourth ULOA occurred in the same calculated and unpredicted manner as the previous three elopements.
f) The treatment team had attempted multiple structured approaches on the GFU to prevent any further ULOA, including behavioural analytic interventions. The repeated pattern of unexpected elopements demonstrated that the GFU environment could not safely contain Mr. Alfredson’s risk.
g) A case conference concluded unanimously that a secure unit placement was the least restrictive, and most appropriate, next step. A secure forensic unit has both physical and procedural security, including double locked doors, controlled elevator access, and the absence of indirectly supervised passes. The secure forensic unit environment allows for a more structured, consistent approach and greater access to programming.
h) Since his transfer to the FATU, Mr. Alfredson has been attending CBT and DBT groups, acceptance in commitment therapy, cooking group, and substance use relapse prevention programming.
i) Mr. Alfredson is currently on level 1 (escorted 1:1) passes, and the team is considering level 2 (accompanied) passes.
j) Mr. Alfredson superficially acknowledges his wrongdoing in elopements; however, he continues to externalize responsibility, blaming the treatment team and the care plan for his decision to elope. Mr. Alfredson’s lack of insight, combined with the patterned nature of his elopements, means that if he were returned to a general forensic unit now, the risk of an ULOA would be extremely high.
k) The drivers of Mr. Alfredson’s behaviour appear rooted in his personality structure, which is compounded by a complex stimulant use history.
l) The clinical team has now formalized a diagnosis of antisocial personality disorder, leading it to conclude that Mr. Alfredson requires a highly structured environment.
m) Mr. Alfredson is taking topiramate again, after having previously stopped it because of concerns about wound healing, He is now educated on its role in reducing cravings.
n) Mr. Alfredson had three ULOAs prior to this most recent one.
Counsel for the Attorney General and for Mr. Alfredson had no questions for Dr. Chan.
In response to questions from the panel, Dr. Chan testified:
a) The diagnosis in the current ROL Report has been updated from “antisocial personality traits” to “antisocial personality disorder.”
b) An updated PCL-R re-assessment referenced in last year’s Reasons is still in progress.
c) Behavioural therapy resources are available on a secure forensic unit. Mr. Alfredson is currently participating in group DBT sessions and is on the waitlist for 1:1 DBT.
d) The treatment team does not feel that Mr. Alfredson is capable of changing his behaviour while living on a general forensic unit, which is why the decision was made to transfer him to the FATU and why the ongoing restriction of liberty is necessary and appropriate.
e) The treatment team is hoping that the new structure and resources available on the FATU will enable Mr. Alfredson to change his behaviour and eventually progress from the FATU to a secure forensic unit and then to a GFU.
f) The treatment team is still prepared to recommend an inpatient residential treatment program once any concerns about future ULOA are resolved.
- No other evidence was given.
Analysis and Conclusions
Pursuant to the Decision of the Court of Appeal in R v MLC, 2010 ONCA R43, as well as Regina v Campbell, 2018 ONCA 141, the Board agrees that a restriction of liberty has taken place. It found that the initial restriction of liberty on March 2, 2026, and the ongoing ROL, represented the least onerous and least restrictive interventions in the circumstances. They were both warranted and necessary for public safety. On February 27, 2026, while using escorted community passes to a local fast-food restaurant, Mr. Alfredson again absconded. He returned on his own volition to the emergency department at CAMH on March 2, 2026.
In particular, the Board relies on the following extracted paragraph from the Hospital Report as to why the initial ROL was warranted and necessary as is the ongoing restriction of liberty.
“If Mr. Alfredson remains on the general unit, he would likely continue to abscond and fail to progress, which would likely lead to demotivation, resentment, and a cascade of more problematic behaviours, including substance use, that will compromise his mental health and rehabilitation trajectory. There was agreement that transfer to a secure setting was necessary and appropriate, and the least onerous and restrictive approach, commensurate with both the needs of Mr. Alfredson and public safety. It was agreed that he required placement in a secure unit with closer monitoring and more structured support. There, he will have a higher level of physical security and procedural security. He will have more staff support and greater opportunity for on-unit programming aligned with his risk needs. His repeated and planned ULOAs that have not been foreseeable by the team, necessitate greater structure and security for a period of time, while he works on his dynamic risk factors. This milieu will help ensure that Mr. Alfredson progresses through hospital, in a more rigorous and organized manner.”
Mr. Alfredson has ongoing poor insight into his substance use, his illness, and his current legal circumstances.
The calculated, unpredictable, and repeated nature of Mr. Alfredson’s abscondments, in spite of a multitude of therapeutic programming, medication treatment, and behavioural plans, makes it imperative that he remain on the Secure Forensic Unit in the interim.
Returning Mr. Alfredson prematurely to a GFU will result in ongoing risk-enhancing behaviours that the hospital has seen over the last 15 months.
DATED this 20th 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