Re Andy A. Ramlall, 2026 CanLII 51033

Ontario Review Board

Re: Andy A. Ramlall

ORB File No: 6290

Hearing held on: Monday, May 4, 2026

Place of hearing: Ontario Shores Centre for Mental Health Sciences 700 Gordon Street, Whitby

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

Before:

Alternate Chairperson: Mr. J. Weinstein

Members: Dr. S. Chatterjee Dr. M. Green Hon. A. Sosna Mr. A. Mete

Parties Appearing:

Accused: Andy A. Ramlall Counsel: Mr. T. Whillier

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

Attorney General of Ontario: Counsel: Ms. N. MacDonald

REASONS FOR DISPOSITION

(Dated May 27, 2026)

Introduction:

1. On February 22, 2013, Mr. Andy Ramlall was found not criminally responsible on account of mental disorder, on one charge each of utter a threat to cause death or bodily harm and assaulting a police officer and two charges of assault, all contrary to the Criminal Code of Canada (“Criminal Code”).

2. Mr. Ramlall is subject to a Disposition of the Ontario Review Board (the “Board”), dated May 5, 2025, which ordered that he be detained at the General Forensic Unit (“GFU”) of Ontario Shores Centre for Mental Health Sciences (“Ontario Shores”).

3. On May 4, 2026, the Board convened a hearing at Ontario Shores to conduct an annual review of the current Disposition.

4. Mr. Ramlall asked to represent himself and Mr. Whillier was appointed as amicus.

5. A Hospital Report, dated March 30, 2026 (the "Hospital Report"), was entered as Exhibit 1.

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

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

Current Psychiatric Diagnoses:

8. Schizophrenia

Cannabis Use Disorder, “in remission in a controlled setting”

Alcohol Use Disorder, “in remission in a controlled setting”

Cocaine Use Disorder, “in remission in a controlled setting”

Social Anxiety Disorder

Antisocial traits

Index Offences:

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

“On October 8, 2010, Toronto police received a call to attend an Esso Station. Upon their arrival, Mr. Ramlall ran from the scene and, as the officers gave chase, he shouted a threat to kill the police. He was charged with uttering a threat to cause death and assault police.

On April 11, 2012, without warning or provocation, Mr. Ramlall punched the victim who had exited a building in Toronto, striking the victim twice on the right side of the face and causing the victim to fall to the ground. An unidentified person drew the attention of Mr. Ramlall away from the victim. Mr. Ramlall moved toward the unidentified person saying, “I’m going to fuck you. I’m going to take my pain out on you,” causing this person to flee. Police arrived and Mr. Ramlall approached the officer stating, “I will fuck you up. I will make you feel my pain.” He moved toward the officer with clenched fists and arms waving. The officer placed Mr. Ramlall under arrest."

Background and History:

10. Mr. Ramlall’s background and history are outlined in the Hospital Report, and they are accurately summarized in last year's Reasons:

“Mr. Ramlall has prior criminal charges for assault and utter threats in 2005, and theft under in 2008 and 2009. The Hospital Report outlines further convictions for use of imitation firearms, threaten death, theft, mischief, possession of marijuana, assault, assault police officer, and failure to comply with probation.

Mr. Ramlall reported that he had approximately five prior psychiatric admissions for psychosis exacerbated by drug use. He admitted to having been non-compliant with psychotropic medication and psychiatric care.

Mr. Ramlall historically used cannabis daily and abused crack cocaine. He also admitted to having consumed alcohol and had been arrested after being involved in incidents while intoxicated.

Mr. Ramlall worked in restaurants primarily as a line cook. However, he has not worked in a number of years.

Historically, Mr. Ramlall regularly stayed at shelters. He acknowledged that he struggled to maintain housing given his mental illness and non-compliance with medication.

Mr. Ramlall is supported by the Ontario Disability Support Program (“ODSP”).”

Course Since Last Disposition:

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

“Since Mr. Ramlall’s last Ontario Review Board hearing, he has remained an inpatient on the general Forensic Transitional Unit (FTU), where he currently resides. During the period under review, Mr. Ramlall has posed no management difficulties. There have been no reported incidents of violence, relapse to substance use, or inappropriate behaviours. He has remained adherent with his prescribed medication regimen.

Mr. Ramlall did not demonstrate any frank psychotic symptoms during the reporting period. However, there was an isolated incident in which he appeared to experience delusional ideation. On December 5, 2025, Mr. Ramlall stated, “Someone is documenting about me back there,” while pointing toward one of the interview rooms.

Mr. Ramlall’s engagement in structured programming has been variable.

Throughout the period under review, Mr. Ramlall has successfully utilized graduated privileges without incident. This includes Level 2 hospital grounds access (accompanied), Level 3 hospital grounds access (indirectly supervised) for up to four hours with a two-hour check-in, and the use of a unit-issued cell phone as required. He has also utilized Level 5 community access (accompanied) and Level 6 community access (indirectly supervised) for up to six hours with a three-hour check-in within Whitby and Oshawa. Additionally, he has accessed Level 6 community privileges for up to four hours accompanied by his Forensic Transitional Case Manager, his mother, and/or his brothers within the Durham Region. All privileges were used appropriately and without incident during the reporting period.”

Position of the Parties:

12. Counsels for the hospital and the Attorney General, as well as Mr. Ramlall on his own behalf, advised that this was a joint submission. All were adopting the hospital’s recommendation of a continuation of the existing Detention Order Disposition.

Evidence at the Hearing:

13. The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Alioglou. Dr. Alioglou testified as follows:

a) She is Mr. Ramlall’s treating physician, responsible for his ongoing care.

b) In the last reporting period, there have been no incidents of violence, substance use relapse or inappropriate behaviour. Mr. Ramlall has remained stable. Some psychiatric symptoms re-emerged on occasion, but these episodes were of a short duration and were resolved without significant incident.

c) Overall, Mr. Ramlall had a good year, clinically. Therefore, the hospital is recommending no change to the current Disposition, noting that the existing structure has been effective in supporting Mr. Ramlall’s stability and minimizing his risk to public safety.

d) Mr. Ramlall is currently on the DMHS Complex Care housing (“DMHS or McKay House”) waiting list. Based on information from the treatment team’s social worker, the wait time is expected to be approximately six months to one year.

e) DMHS is a 24-hour supervised and staffed setting, where medication administration is overseen by staff on an ongoing basis. This type of housing also offers greater flexibility in programming, allowing residents more individualized participation.

f) The level of supervision provided by DMHS is necessary for Mr. Ramlall’s successful functioning and transitioning into the community. Mr. Ramlall continues to experience residual psychiatric symptoms and has undeveloped insight into his illness, making a fully supervised environment appropriate at this time.

g) It remains very important for the hospital to approve, and secure, appropriate housing for Mr. Ramlall.

h) Mr. Ramlall has limited insight into his need for medication. While he understands that he is required to take medication and generally complies with medication directives, this adherence is not driven by internalized insight into his illness. Rather, he takes medication because he is subject to a Disposition that he understands must be followed. Mr. Ramlall has expressed that he does not think medication is necessary.

14. Mr. Ramlall had no questions for the doctor. However, in response to questions from amicus, Dr. Alioglou testified as follows:

a) Although Mr. Ramlall has been on a waitlist for 24-hour supervised accommodation in the prior year, delays of this length are common because of systemic shortages. From a clinical perspective, Mr. Ramlall would be ready for discharge if a bed were available at DMHS.

b) The team is recommending the DMHS facility to prevent relapse or readmission to hospital. Mr. Ramlall did not have the necessary level of supervision and support in the past during earlier community discharges, which resulted in decompensation, requiring readmission to the hospital.

c) DMHS will provide a consistent medication administration and monitoring of Mr. Ramlall mental health.

d) Mr. Ramlall’s symptoms can re-emerge quickly if early warning signs are not addressed. The structure and support at DMHS are key to maintaining his stability in the community.

e) Mr. Ramlall last used substances in March 2023.

15. In response to questions from the panel, Dr. Alioglou testified:

a) Mr. Ramlall wants to leave the hospital, but he is not highly motivated, nor is he actively pursuing discharge. If housing were offered, he would quickly accept it, but he does not consistently demonstrate initiative regarding community placement.

b) In the past, Mr. Ramlall had returned to hospital shortly after discharge because of fears and difficulties in the community. The treatment team has been working with him to address these issues. His recent period of stability represents an improvement compared to earlier years, when readmissions were often associated with substance use and insufficient support.

c) In December 2025, Mr. Ramlall experienced a brief reoccurrence of his psychotic symptoms, lasting approximately two days. Such episodes are brief, rare, isolated, and typically stress related. These symptoms resolve quickly with staff support, and with as-needed medication. Placement in McKay House would allow similar staff support and as-needed medication to manage such incidents safely in the community.

d) The diagnoses regarding cannabis use disorder, alcohol use disorder and cocaine use disorder listed on page 1 of the Hospital Report should now read: in remission in a controlled setting.

e) The following paragraphs from last year's Reasons are still true today:

“Dr. Alioglu testified that she would like the alcohol and cannabis prohibition to remain in the Disposition because these substances are one of the biggest risk factors for Mr. Ramlall. The Hospital must be able to intervene quickly when needed when there are psychotic symptoms related to substance use. Around the time of the offence Mr. Ramlall was using cannabis and alcohol on a daily basis. He currently has residual symptoms of his mental illness. If he used cannabis or alcohol his mental state would deteriorate even further including hallucinations and delusions, which would result in violent behavior and significant risk to the safety of the public.

Dr. Alioglu testified that if Mr. Ramlall used substances, it would impact his ability to be discharged to housing in the community. His daily functions are already impaired. The use of substances would cause an increase in disorganization. He would disengage from professional services and personal support systems. Mr. Ramlall is considered marginally capable to consent to treatment at this time. However, the use of alcohol and cannabis would likely affect his capacity.

Mr. Ramlall does not have specific life goals and has difficulty setting clear objectives. Dr. Alioglu testified that the treatment team is trying to deal with this issue but Mr. Ramlall is declining group treatment. The occupational therapist, recreational therapist, and psychotherapist are all working on helping him to engage in treatment.

Dr. Hartfeil provided oral evidence. She stated that Mr. Ramlall engaged in significant alcohol and cannabis use during the period of time that covered both index offences. He has a history of non-responsible use of substances around the time of the index offences and she expects this would be true if he were allowed to use alcohol and cannabis at this time.”

16. No other evidence was called.

Analysis and Conclusions:

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

18. 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. Alioglou, in addition to the documentary evidence before us.

19. Mr. Ramlall’s insight into his illness, risk, and need for treatment remain underdeveloped. He acknowledges his diagnoses and is able to identify symptoms of his illnesses. His insight into his need for medication is externally motivated.

20. Paragraphs 31, 32, 33 and 37 from last year's Reasons for Disposition are also still true today and are reproduced in paragraph 15(e) of these Reasons.

21. In particular, the Board relies on the Clinical Assessment of Risk set out in the Hospital Report:

“Mr. Ramlall’s historical risk factors for violent recidivism, as outlined by the HCR-20V3, include at least partial evidence for a history of problems with violence, other antisocial behaviour, relationships, substance use, major mental disorder, personality disorder, traumatic experiences, violent attitudes, and treatment or supervision response, all of which are considered relevant to his risk.

Over the past reporting year, there has been partial evidence for problems with insight, symptoms of major mental disorder, instability, and treatment or supervision response. While Mr. Ramlall has remained generally stable, symptom fluctuations continue to be evident. Engagement can be challenging at times, requiring prompting. He continues to require a structured environment with clear guidance and direction. Mr. Ramlall has at times appeared mildly downcast, labile, anxious, irritable, or angry, with symptoms tending to increase in response to stress, particularly surrounding ORB hearings, reflecting an overall vulnerability to stress. Notably, there was a period during which Mr. Ramlall endorsed delusional thoughts; however, these resolved relatively quickly without sustained deterioration.

There is partial evidence for recent problems with insight, as Mr. Ramlall continues to minimize the extent of his past psychotic symptoms. He did not appear to fully recognize or appreciate the therapeutic effects of his medications or the risks associated with substance use although he reports that he would continue to follow rules while under the ORB. His motivation to remain adherent to treatment and abstinent from substances appears to be driven more by external factors than internalized understanding. However, to his credit, Mr. Ramlall has not had any recent incidents of substance use or medication non-adherence.

Absent an ORB Disposition, Mr. Ramlall would likely relapse with respect to substance use, withdraw further from personal and professional supports, and reduce or discontinue his medications. He would then likely experience a re-emergence of psychotic symptoms, including severe disorganization, paranoia, agitation, and perceptual disturbances. He would be at risk of rapid decompensation to a psychotic state similar to that present at the time of his index offences, at which point he would pose a significant risk to others.”

22. In light of the Board's finding of significant threat, it is charged with shaping a Disposition for the coming year. The necessary and appropriate Disposition continues to be a Detention Order. It is necessary to ensure that Mr. Ramlall remains in hospital until suitable housing becomes available for him.

23. The hospital needs to retain the authority to approve Mr. Ramlall’s housing, to ensure that it meets his need for supervision and support. Mr. Ramlall needs to be in 24/7 supervised housing to monitor his medication adherence as well as his mental state. He has had previous discharges into the community in less supervised settings, and these placements were unsuccessful. Moreover, if Mr. Ramlall is successfully discharged over the next reporting year, the hospital will also require the authority to readmit him immediately if he should decompensate because of stress, non-adherence to medication, substance use or other factors. Accordingly, a Conditional Discharge is not appropriate.

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

DATED this 27^th 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