Re: Joseph Pepin
ORB File No: 5681/6941
Hearing held on: February 17, 2026
Place of hearing: St. Joseph's Healthcare Hamilton West 5th Campus, 100 West 5th Street
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. K.A. Connidis
Members: Dr. J. Cheston Dr. S. Bouskill Mr. D. D’Intino Ms. B. Little
Parties Appearing:
Accused: Joseph Pepin Counsel: Mr. M. Schloss
The Person in Charge of Hospital: Counsel: Ms. L. Barney
Attorney General of Ontario: Counsel: Mr. I. Shaikh
REASONS FOR DISPOSITION
(Dated June 2, 2026)
Introduction
On August 17, 2010, Joseph Pepin was found not criminally responsible on account of mental disorder (NCRMD), on a charge of uttering a threat to burn, destroy or damage property, contrary to the Criminal Code of Canada (“Criminal Code”).
On March 17, 2015, Mr. Pepin was found NCRMD on charges of dangerous operation of a motor vehicle and assault simpliciter, both contrary to the Criminal Code.
Mr. Pepin is subject to a Disposition of the Ontario Review Board (the “Board”), dated March 3, 2025, which orders that he be detained at St. Joseph’s Healthcare Hamilton (SJHH) with privileges up to and including residing in the community of Hamilton in accommodation approved of by the Person in Charge.
On February 17, 2026, a panel of the ORB convened in person and a hearing was held at SJHH. The purpose of the hearing was to determine if Mr. Pepin continues to represent a significant threat to the safety of the public as defined in the Criminal Code, and if so, what is the necessary and appropriate Disposition for him for the year ahead.
For the reasons set out below, the Board unanimously finds that the threshold for significant threat to the safety of the public is met in Mr. Pepin’s circumstances, and that the necessary and appropriate Disposition is a continuation of his current Detention Order Disposition with no changes to its terms and conditions.
Current Psychiatric Diagnoses:
Schizophrenia;
Cocaine Use Disorder, in early remission, in a controlled environment;
Alcohol Use Disorder, in sustained remission, in a controlled environment;
Cannabis Use Disorder, in sustained remission
Index Offences:
- The facts arising from the index offences are reproduced from last year’s Reasons:
“February 5, 2010—First Set of Index Offences:
Mr. Pepin visited his parents’ residence in an agitated state and was off his medication. He threatened to burn his parents’ house down as well as his own. He was hearing voices which told him to burn his 4-year-old daughter. He later advised that instead of burning his daughter, he had burned his cat. Subsequent investigation found that he had killed his cat by placing it in a wood-burning stove.
January 22, 2015—Second Set of Index Offences:
Mr. Pepin was an outpatient of the North Bay Regional Health Centre. He absconded and was arrested for dangerous operation of a motor vehicle and assault in the Province of Quebec.”
Without Prejudice Positions of the Parties:
At the commencement of the hearing, the parties were canvassed for their initial positions.
The Hospital took the position that Mr. Pepin continues to meet the threshold for significant threat to the safety of the public, and that the necessary and appropriate Disposition for the coming year is a continuation of the existing Detention Order with no changes to its terms and conditions.
Counsel for the Attorney General supported the Hospital’s position.
Counsel for the accused advocated for a Conditional Discharge with a residence clause, a consent to treatment clause and a Young clause and advised that significant threat would not be contested at the hearing.
Evidence at the Hearing:
The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Yuri Alatishe, who is Mr. Pepin’s attending psychiatrist.
Dr. Alatishe testified by way of update to the Hospital Report that:
a. He has been Mr. Pepin’s attending psychiatrist since February of 2016;
b. Mr. Pepin has had a good reporting year and demonstrated psychiatric stability;
c. Mr. Pepin is using cannabis more frequently than what was agreed upon with the treatment team. He has developed a daily habit and is now wanting to use higher potency strains of cannabis because he says they are more affordable. Thus far he has remained psychiatrically stable despite his increased consumption of cannabis;
d. The treatment team does not support Mr. Pepin’s increased use of cannabis or the use of higher potency strains of cannabis. The higher the potency, the greater risk that Mr. Pepin’s mental status will destabilize and the greater the risk he poses to members of the public;
e. The team is unsure what Mr. Pepin’s increased cannabis use frequency will do to his mental status going forward, and that is one of the reasons that a conditional discharge is not the least onerous or least restrictive Disposition at this time;
f. When the team agreed to recommend removing the prohibition on cannabis use in his prior Disposition, Mr. Pepin told the team that he would use perhaps three to five times weekly and would engage in periods of abstinence and neither has held true;
g. A Conditional Discharge is at best, a “reactive risk management tool” and Mr. Pepin’s risk to the safety of the public would rise to an unacceptably high level under that Disposition;
h. Mr. Pepin’s index offences were very serious and in the past when restrictions on him were lessened, it led to Mr. Pepin reoffending;
i. Increased cannabis use impacts not only judgment but memory as well;
j. Mr. Pepin is seeing the Forensic Outpatient Psychiatric Team once per week and seeing the other teams twice weekly. He is prescribed both a monthly injectable medication and oral clozapine which he takes himself;
k. In 2018, Mr. Pepin was granted a Conditional Discharge and by December that year he was apprehend by police in Sault St. Marie for stealing a vehicle. After he was returned to SJHH, an early hearing was called, and he was returned to a Detention Order Disposition;
l. Mr. Pepin lacks insight into the connection between cannabis consumption and his major mental illness. While it has not yet led to noticeable changes in his mental status, Mr. Pepin does not appreciate the risk if he continues to push his luck by increasing the frequency of his use and by increasing the potency of the strains of cannabis he consumes. The fact that he is mentally stable now, does not mean that he will stable in the future if his cannabis consumption patterns continue;
- In response to questions from the Crown Attorney, Dr. Alatishe testified to the following:
a. According to Canada’s “low-risk guidelines”, Mr. Pepin should not be using cannabis at all. While he has been compliant with his Disposition by purchasing low-potency cannabis, he has not been compliant with the agreed upon frequency or quantity of cannabis consumption;
b. Mr. Pepin lacks insight into his cannabis use disorder and disagrees with medical recommendations on cannabis abstinence;
c. With a cannabis use disorder, if Mr. Pepin were to continue to consume cannabis in excess of what is recommended, it is likely that changes in his mental status and his thinking will be more incremental. While Dr. Alatishe hopes that there will be clear warning signs that Mr. Pepin’s mental status is starting to decompensate, he could not say that there will be;
d. Prior to recommending a Conditional Discharge, Dr. Alatishe wants to see a longer period of mental status stability from Mr. Pepin
- In response to questions from Mr. Schloss, Dr. Alatishe’s evidence was the following:
a. Mr. Pepin has been residing in the community since 2020 and has been readmitted to Hospital since then, but has not required any readmissions during this reporting period;
b. Mr. Pepin’s outpatient case manager would occasionally attend Mr. Pepin’s apartment to monitor and observe his mental status after cannabis consumption;
c. Dr. Alatishe agreed that to his knowledge, Mr. Pepin’s cannabis consumption has only been purchased from licensed dispensaries, but the source of the cannabis cannot be determined by his Urine Drug Screens (UDS);
d. While Mr. Pepin is willing to listen to what the team says about his increasing cannabis consumption, he feels that he doesn’t need any formal substance abuse counselling;
e. Mr. Pepin earns income by driving around tenants in his business. The team has seen no evidence that Mr. Pepin has been using cannabis before driving. Dr. Alatishe thinks that Mr. Pepin understands the legal consequences for him if he were to engage in cannabis-impaired driving;
f. Apart from cannabis, no other substances were detected in Mr. Pepin’s UDS this year.
- In response to questions from the Panel, Dr. Alatishe testified as follows:
a. Given that Mr. Pepin has three concurrent substance abuse disorders and considering his cannabis consumption pattern and intentions, Dr. Alatishe is very concerned that his increasing use beyond what was agreed to is a slippery slope. A Detention Order is needed to closely monitor Mr. Pepin and manage the risk that he poses to the safety of the public given his cannabis use pattern;
b. SJHH does not have a robust outpatient drug counselling service. If the Hospital did, Mr. Pepin would likely meet with that person.
c. Mr. Pepin’s insight into his mental disorder is “partial”. He knows what he is diagnosed with, but he doubts that it is the cause of his symptoms – he attributes these to his prior head injury. Also, his insight fluctuates;
d. Mr. Pepin has “good” insight into his need for medication. He has a history of medication noncompliance, but for a long period Mr. Pepin has been able to acknowledge the benefits of his medication. At times, Mr. Pepin has told his case manager that if he received another Absolute Discharge, he would discontinue his medication;
e. Medication compliance is another concern on a Conditional Discharge;
f. Mr. Pepin has “poor” insight into the connection between cannabis use and the risk of psychosis. He also does not understand that the protective effect of antipsychotic medication against breakthrough symptoms is limited when psychoactive substances are being consumed;
g. Mr. Pepin has previously received an Absolute Discharge for other offences. Over the past 15 years, Mr. Pepin has received numerous Conditional Discharges and always seems to be brought back to a Detention Order. It is difficult to say what role cannabis has played in those failed Discharges, but cannabis was consumed proximate to his Sault St. Marie charges while on a prior Discharge;
h. At the present time, the treatment team has no concerns for Mr. Pepin’s cats, notwithstanding his past history with cats when he was unwell;
i. The treatment team is not yet recommending a reimposition of a prohibition on cannabis use, but they will continue to work with Mr. Pepin to reduce his consumption. He would benefit from either or both of individual and group therapy for substance abuse;
j. Mr. Pepin’s desire to graduate to more potent strains of cannabis is a regular point of discussion;
- At the conclusion of the evidence, all parties maintained their initial positions.
Analysis and Conclusions
Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board agrees with the parties that the threshold for significant threat to the safety of the public is met on the evidence of Mr. Pepin’s circumstances at this time, and concludes that a continuation of the existing Detention Order Disposition with no changes is the least onerous and least restrictive, necessary and appropriate Disposition for the year ahead.
The Panel has come to this decision after a careful review of the Ontario Court of Appeal decision in Ramos (Re), 2025 ONCA 820. While the facts in Ramos differ from those of the present case, the ratio decidendi is relevant to all cases that the Board hears.
In summary, the case of Ramos (at paragraph 18) requires the Board to:
Remain attentive to constitutional protections and avoid the influence of stereotypes or prejudice;
Give thoughtful weight to the reasonable wishes and preferences of NCR individuals, while still prioritizing community safety;
Undertake a careful, individualized assessment that avoids assuming permanent or inherent dangerousness and instead evaluates the person’s present clinical and social circumstances;
Keep the legal thresholds distinct from hospital preferences or institutional rule compliance, recognizing that clinical convenience cannot substitute for the legal test and conducting a holistic assessment which acknowledges strengths and improvements;
Exercise its own independent judgment when reviewing professional opinions; and
Approach hearsay evidence with care, ensuring that any reliance on such information is fair, balanced, and consistent with the Board’s dual role of protecting both individual rights and public safety.
In determining whether Mr. Pepin represents a significant threat to the safety of the public, the Board has carefully analyzed the evidence as it relates to the Supreme Court of Canada decision in Winko, 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625 and the definition of the term in s. 672.5401 of the Criminal Code. It is well-established in the seminal Supreme Court decision in Winko and the many cases which have applied and elaborated it, that significant threat to the safety of the public cannot be speculative. It must entail a real risk of serious physical or psychological harm arising from conduct that is both serious and criminal in nature.
While the presence of significant threat was not contested by Mr. Schloss at this hearing, the Panel must nonetheless come to its own conclusion in this respect based on the evidence before it.
Mr. Pepin suffers from a psychotic disorder which is largely treated by his current medication regimen and the structure and supports of the forensic mental health system. Two of his three substance use disorders remain in remission, however, as set out in the testimony of Dr. Alatishe, since Mr. Pepin has been permitted to indulge in cannabis consumption, he has been unable to moderate the amount or frequency of his consumption in line with what was agreed upon with the Hospital.
While Dr. Alatishe maintains that there have been no changes to Mr. Pepin’s mental status, the connection between cannabis use and psychosis, especially for patients with a psychotic disorder is beyond debate and at this hearing was unchallenged and uncontradicted.
Mr. Pepin’s historical trajectory in the forensic mental health system is set out neatly at pages 2-4 of the Hospital Report. He was previously granted an Absolute Discharge in 2005 – less than three years from the date of his NCR finding – and within 2.5 years from the date of his Absolute Discharge, he committed a second set of index offences.
In 2014, while on a Conditional Discharge, Mr. Pepin breached his Disposition, was arrested in Sault St. Marie and was readmitted to the Hospital. In 2015, he committed the second set of index offences in Quebec and was found NCRMD by the Quebec Review Board.
Then again in 2018, he was arrested in Sault St. Marie on new charges and readmitted to SJHH.
Twice in 2020 he was readmitted to Hospital for breaching his Disposition, as was the case in 2022 when he thrice breached his Disposition, once again.
Mr. Pepin has had at least six failed discharges during his tenure under the Ontario Review Board.
All of Mr. Pepin’s index offences were serious. Under his initial tenure with the ORB in 2005, the index offence involved striking his grandfather in the head with a blunt instrument and disconnecting the natural gas line at his grandparents’ home while they slept.
In 2010, when floridly psychotic he murdered the family cat and uttered threats to burn his then 4-year-old daughter, as well his house and that of his parents.
In the past, when unwell, Mr. Pepin has experienced command auditory hallucinations, visual hallucinations, persecutory delusions, thought insertion, thought withdrawal, thought broadcasting, ideas of reference and Capgras delusions. He has acted on command hallucinations to harm others.
Mr. Pepin has reported using cannabis since his mid-teens. While under the jurisdiction of the ORB, his UDS screens have consistently shown cannabis consumption as well as past use of amphetamines or MDMA. Mr. Pepin has long articulated a goal of resuming cannabis use, which demonstrates his total lack of appreciation for the risks that such use poses not only to himself, but to others.
Moreover, his inability to honour his commitments regarding the frequency and quantity of his cannabis consumption clearly demonstrates an inability to control his cannabis use, which lends considerable support to Dr. Alatishe’s fears.
It is for those reasons that the Panel concurs with the Parties that Mr. Pepin represents a significant threat to the safety of the public.
Turning now to the issue of the least onerous and least restrictive, necessary and appropriate Disposition, the Panel first considered whether a Conditional Discharge should be granted.
Mr. Schloss argued that a Conditional Discharge with an accompanying residence clause, treatment clause and a Young clause would address the Hospital and Crown’s concerns about potential medication and treatment compliance, and that those clauses if breached would lead to Mr. Pepin’s detention in Hospital.
It would be helpful perhaps at this juncture to set out the distinctions between a Detention Order and a Conditional Discharge, in order to more clearly explain why the Panel believes that the former – and not the latter – is the least onerous and least restrictive Disposition.
The first major distinction between these Dispositions is that once an accused is granted a Conditional Discharge, they can no longer be detained in the Hospital. If an accused breaches a term in a Conditional Discharge, prior to recent amendments to the Code, they could be detained in jail, whereas if they breach a term in a Detention Order, the result is usually a return to the Hospital.1
A further important distinction between the two Dispositions is the types of terms that may be included in either. Under a Detention Order, community living is a privilege that is usually worded in a manner that requires the Hospital to “approve” the accommodation. Under a Conditional Discharge this term is not available. Similarly, under a Conditional Discharge a clause requiring the accused to consent to treatment can only be imposed with their consent, whereas such a term is not required under a Detention Order.
As Michael Davies, Anita Szigeti, Meaghan McMahon and Jill Presser note in their authoritative text A Guide to Mental Disorder Law in Canadian Criminal Justice2:
It may appear at first that a conditional discharge is, by definition, less onerous or less restrictive than a detention order would be. This is not necessarily the case…
Ultimately, whether a Conditional Discharge is “less onerous” than a Detention Order depends on the conditions attached to either.3
In the recently released Ontario Court of Appeal of Singh (Re)4, the Court concluded its decision at paragraph 10 with the following direction to the ORB:
…What was needed is a determination of whether a Young clause – together with the other proposed conditions – could practically and effectively address the risk to the public posed by a comparatively stable NCR accused who meets regularly with the treatment team, is compliant with anti-psychotic medication, whose symptoms are managed well with the current medication regime, and who has a commitment of continuing support from the treatment team. The Board would need to make this determination given the evidence of the nature of the appellant’s particular treatment history and likely clinical path to decompensation…
Returning the case of Mr. Pepin, Defence counsel proposed that a residence clause, a Young Clause and a treatment compliance condition be added to the Conditional Discharge.
In Ramos (Re)5, the ONCA directed the ORB to consider a number of factors, including whether the accused would attend the Hospital voluntarily while under a Conditional Discharge.
A second important consideration is that even if a Young clause was to be included in a Conditional Discharge, as the ONCA in Ramos pointed out, such a clause simply gives a Justice discretion to make an order pursuant to 672.93(2) of the Code:
Order of justice pending decision of Review Board
(2) If the justice is satisfied that there are reasonable grounds to believe that the accused has contravened or failed to comply with a disposition or an assessment order, the justice, pending a hearing of a Review Board with respect to the disposition or a hearing of a court or Review Board with respect to the assessment order, may make an order that is appropriate in the circumstances in relation to the accused, including an order that the accused be returned to a place that is specified in the disposition or assessment order. If the justice makes an order under this subsection, notice shall be given to the court or Review Board, as the case may be, that made the disposition or assessment order [emphasis added].
Even if a Justice were to issue an Order under this section that directed the accused be returned to the Hospital for a breach of a Conditional Discharge, the process under s. 672.93(2) is not instantaneous. As set out in Ramos, such an Order requires Judicial Authorization. The Hospital (or police) would have to become aware of a breach of the Conditional Discharge Disposition and then seek judicial authorization to have Mr. Pepin apprehended and returned to the Hospital.
This process would take time and when unwell, Mr. Pepin has become extremely violent. The time required in pursuing this procedure would cause an unacceptable delay in apprehending Mr. Pepin, during which he likely would cause harm or endanger the lives and safety of numerous members of the public, his own family or his animals. That is assuming firstly, that a Justice would even order Mr. Pepin back to the Hospital for breaching say, the cannabis consumption clause in a Conditional Discharge and secondly, that Mr. Pepin does not go AWOL such that he cannot be located by police in a timely manner.
When the Panel reviewed Mr. Pepin’s history in the forensic system, three things became crystal clear:
a. When unwell, Mr. Pepin is unable to resist his command hallucinations, leading to tragic consequences;
b. The prospect of being returned to Hospital for breaching his Conditional Discharge Dispositions has had zero deterrent or rehabilitative effect on Mr. Pepin;
c. Even when the breach provisions of the Criminal Code relating to Conditional Discharges have been used to achieve the desired result, it has not prevented the commission of new criminal offences that have endangered the safety of the public.
Moreover, if the Panel imposed a Conditional Discharge with the terms requested by Defence Counsel, the resulting Disposition would at the very least mirror a Detention Order, or else become more restrictive and more onerous than a Detention Order.
It begs the question then, why advocate for a Conditional Discharge if the patient is agreeing to terms and conditions that are at least as restrictive, if not more so, than those on a Detention Order?
Ultimately, on the issue of the necessary and appropriate Disposition, the Panel draws the following conclusions:
a. A Conditional Discharge with the terms suggested by Mr. Schloss is not the least onerous, least restrictive Disposition that is in keeping with the factors set out in s. 672.54 of the Code;
b. Neither the provisions of the Mental Health Act, nor the breach provisions of the Code would be sufficient to return Mr. Pepin to the Hospital with the requisite haste, in the event his risk to the public becomes unmanageable in the community;
c. This is in large part because while the frequency of quantity of Mr. Pepin’s cannabis consumption steadily increases, changes in his mental health may not be readily apparent to the treatment team. The evidence from Dr. Alatishe was uncontradicted in this regard and in all others;
d. Mr. Pepin lacks insight into the connection between his cannabis consumption, his cannabis use disorder and the risk he poses to the safety of the public. This insight has been absent for his entire history under the ORB;
e. Mr. Pepin seems to lack an appreciation of the contribution his cannabis consumption has played in the index offences and the aforementioned criminal charges accrued while on past discharges;
f. Mr. Pepin lacks the ability to control the frequency and quantity of his cannabis consumption and should he begin to consume higher potency strains, as he is requesting to do, his risk to the public may become unmanageable in the community;
g. Mr. Pepin has been subject to numerous failed discharges, including a prior Absolute Discharge, and has been unable to maintain long-term stability in the community while abstaining from substance use and being medication compliant;
h. The risk Mr. Pepin poses not only to the safety of the public at large, but also to his cats cannot be understated. At this juncture Mr. Pepin has not made sufficient progress with respect to his main risk factor – his escalating cannabis use – such that his risk to the public can be managed under a Conditional Discharge.
- In consideration of all the evidence, the submissions of the parties, the wishes of Mr. Pepin and the criteria set forth in s. 672.54 - the paramount consideration being the safety of the public, in addition to the mental condition of Pepin, his reintegration into society and his other needs - the Panel finds that a continuation of the existing Detention Order Disposition with no changes to its terms and conditions is the necessary and appropriate Disposition.
DATED this 2nd day of June 2026, at the City of Toronto, in the Toronto Region.
Mr. D. D’Intino Legal Member
Office of the Registrar Ontario Review Board
Footnotes
- Ibid at p. 193
- 2020; LexisNexis Canada Inc at p. 191
- Ibid at p. 194
- Singh (Re), 2026 ONCA 331
- 2025 ONCA 820