On a cold January morning in downtown Toronto, a frantic man ran shouting down Church St., gripping a kitchen knife.

Within minutes, he had attacked four people on a busy sidewalk outside the old Maple Leaf Gardens.

He knifed a young man in the abdomen. He stabbed a jogger above the kidney and pierced a 19-year-old student in the rib cage. In his final move, investigators say the assailant tried to drive his knife into a woman’s chest, but an auspiciously pocketed cellphone blocked the weapon’s plunge.

Police arrested Shawn O’Neill, 61, near the College subway station. He is charged with four counts of attempted murder in what investigators described as a random act of violence. The allegations against him are unproven.

His sister, Maureen O’Neill, was in her car that evening when she heard his name on the radio. Filled with rage, she swore silently. “I knew it,” she thought.

Maureen was angry — not at her eldest sibling, who had struggled with mental illness and addiction his whole adult life, but at the tribunal that had recently discharged him from mandatory psychiatric care, deciding he was no longer a threat to public safety.

Nineteen years earlier and six blocks south, there had been another knife incident.

On June 13, 1996, O’Neill was walking on Queen St. W. near the Eaton Centre when a pedestrian passing in the opposite direction accidentally bumped into him. O’Neill stopped, turned and pulled out a knife with a four-inch blade.

“What the f--- are you doing?” he shouted. “Try that again, I got something for you.”

The man ran away. O’Neill, then 42, was arrested on charges of assault with a weapon and possession of a weapon. After he underwent psychiatric tests, a judge found him not criminally responsible, or NCR, a verdict that rendered him legally blameless. Instead of receiving jail time, O’Neill was detained in a psychiatric hospital. He would remain in the system for 17 years — far longer than he would have been incarcerated for a guilty verdict on the same charges.

Raised in Brampton with five younger siblings, O’Neill was the son of an executive in the frozen foods industry and a pediatric nurse. He had been an intelligent young man with a promising future, but health problems gradually surfaced after he left home to study at the University of Western Ontario,where he began abusing drugs and experienced his first episode of psychosis.

The two decades leading up to the 1996 incident outside the Eaton Centre were marked by a series of psychiatric hospital admissions and 11 violent offence convictions, including a 1987 break-in at the residence of former Ontario premier Bill Davis, who chased a knife-wielding O’Neill out of his home with a fireplace poker.

The 1996 verdict placed O’Neill under the authority of the Ontario Review Board, an independent tribunal that has jurisdiction over people deemed NCR. The board — an experienced pool of retired judges, lawyers, psychiatrists and members of the public — is tasked with overseeing the rehabilitation process, deciding when to grant certain privileges and when a person has met the legal threshold for an absolute discharge.

Research has shown that people discharged from the review board system reoffend far less frequently than those released from jail or prison. Roughly 1 per cent of NCR offenders who were granted an absolute discharge committed a serious violent offence in the three years after release, according to a national study led by McGill University researchers. The fresh allegations against O’Neill make him an outlier in a system that appears to work well, but his case underscores the difficulty of risk assessment, where the stakes are high and the consequences, for the public and the accused, can be severe.

In November 2013, five board members convened in Toronto for an annual review of O’Neill’s case. At the time, he was allowed to live in the community so long as he met certain conditions — reporting regularly to the Centre for Addiction and Mental Health, submitting to weekly drug tests, taking prescribed medication and abstaining from drugs and alcohol.

His psychiatrist recommended they continue the plan. The Crown concurred.

In an unusual move, the review board disagreed and granted O’Neill an absolute discharge. Though he would still have access to mental health supports, he was no longer obligated to continue treatment.

“We were devastated,” says his sister Maureen, who has been involved in her brother’s care for 40 years. “It was like waiting for the shoe to drop.”

O’Neill stopped taking medication and relapsed within months, Maureen says. He returned to hospital voluntarily for a while, then spiralled again after Christmas last year and cut off communication with his siblings, except for a few strange phone calls.

Maureen and her family have questions about what happened in her brother’s case, chief among them: What was the board thinking?

The arguments made at the hearing that led to O’Neill’s discharge are summarized in review board records. No one directly involved would speak to the Star about the case due to patient and client confidentiality concerns.

According to his medical history, O’Neill’s schizophrenia had been in remission for a decade, but a serious substance abuse disorder remained the primary concern for his treatment team.Dr. Mark Pearce, who had been his psychiatrist for six years, told the review board panel that O’Neill was “simply unable to conquer his addiction.”

O’Neill had tested positive in four weekly drug screens during the previous year, but he wasn’t readmitted to hospital because had been honest with his medical team about the drug use and, despite it, had not become violent or psychotic.

Pearce said O’Neill had shown “some insight” into the need to quit non-prescription drugs, but the medical team believed that without a board order he might stop treatment and return to substance abuse, which could lead to psychosis.

O’Neill is not a violent person, Pearce told the panel, but extended drug use and an interruption in medication would raise “a significant likelihood of violence.”

Acting for O’Neill, Toronto lawyer Anita Szigeti argued he was entitled to an absolute discharge.

She pointed out that he had not been charged with a crime in 17 years. He had not experienced an episode of psychosis in 10 years. He had lived in community housing for a decade under CAMH supervision. He had been taking his medication. Even when he had slipped and reverted to substance abuse, he had not been violent. She said O’Neill was willing to continue treatment even after discharge.

The law says board decisions must balance concern for public safety with the rights of the NCR individual. Decisions hinge on a fundamental question: Does the accused pose a “significant risk” to public safety?

In order to justify keeping O’Neill in the system, Szigeti argued, the board’s answer had to be yes. If the panel members were merely uncertain about whether he posed a significant risk, or if the answer was no, the board had to give him an absolute discharge.

Michael Feindel, counsel for the Attorney General, sided with the hospital and urged the board not to focus solely on the length of time O’Neill had been under its watch.

Though it wasn’t said at the hearing, everyone present would have been aware that 17 years is a lot of time to be detained for a knife-waving incident in which no one was injured. But a minor “index offence” — the charge that leads to the NCR verdict — does not necessarily make a person less likely to reoffend.

“Just as an individual charged with a very serious index offence might obtain an absolute discharge very early on in the review board process, an individual with a less serious offence could remain in the board system for a much longer period of time,” Feindel said, according to the board summary.

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A person who committed murder during a psychotic episode can, when the health factors that led to that episode are addressed, be a lot less dangerous than a person with a history of substance abuse and minor but escalating violent episodes.

The panel delivered its verdict on Nov. 21, 2013: “While the evidence called by the hospital and the submissions made on behalf of the Attorney General are reasonable, a majority of the board are unable to conclude that the accused represents a significant threat to public safety.”

The board accepted the arguments made by O’Neill’s lawyer. The panel further noted that O’Neill had kept his alcohol addiction under control with the prescription drug Antabuse, which he had taken willingly for three years. The board acknowledged that his drug addiction persisted, but came back to the time argument: O’Neill had not been charged with a crime in 17 years.

One of the five members disagreed. Dr. Robert Sheppard, a Thunder Bay psychiatrist, gave a dissenting opinion that argued the fact that O’Neill had done well under hospital supervision “simply confirms the effectiveness of the risk management techniques employed by the forensic treatment team.”

Without supervision, Sheppard believed the accused posed “a real and substantial risk” to public safety.

On Christmas Eve, one month before he was charged in the January stabbing, O’Neill was at his sister’s house, chatting with her at the kitchen counter while she baked. The following day, his siblings observed that he seemed agitated. After the holidays, he disappeared.

No one saw him again until the family heard his name in the news. Now he’s awaiting trial at the Toronto South Detention Centre — where, according to his defence lawyer, he is being held in solitary confinement. The lawyer, Christopher Murphy, said it was too early to comment on the case.

Maureen O’Neill feels terribly for the victims, who police said are expected to make full recoveries. She also laments the loss of the quality of life her brother had achieved in the years before the absolute discharge. “It wasn’t perfect, that’s for sure,” she says. “But there wasn’t any major psychotic episodes.

“We had a safety net in place. And losing that, it burns.”

Maureen believes the balance between public safety and individual rights was tipped too far in her brother’s favour.

Others argue the balance is tipped in the opposite direction, and counter that there are more cases where people detained on minor offences live have their liberties restricted for too long.

“To the extent that (board members) lean in the balancing act one way or the other, I would say on the whole they tend to be somewhat conservative,” said Michael Davies, an Ottawa defence lawyer with expertise in mental health law.

“The only way to guarantee that nobody ever does anything ever again in the future is to lock everybody up in maximum security,” Davies said, “and that’s not the mandate that the board has been given by Parliament.”

Justice Richard Schneider, chair of the Ontario Review Board, said it would be inappropriate to comment on an individual case, but agreed to speak about the system in general terms. He stressed that in any prediction-based system, no matter how good it is, nothing can be 100 per cent. Predicting risk is a science, but it is an inexact science.

“And with any inexact science there will always be outlier cases, which maybe to a member of the public might not on the face of things make a lot of sense, but that is an inevitability,” he said.

“I would hate to see the system get lambasted over one of these inevitable outliers.”

When individuals do reoffend, Schneider said, the board takes it seriously. “We’re always trying to improve, that’s for sure.”

But perfection, he said, is an elusive target.

After release

92% of Ontario Review Board decisions side with hospital recommendations

1% of people found not criminally responsible (NCR) who are given an absolute discharge reoffended in a seriously violent manner in the three years after release

22% of NCRs given an absolute discharge committed some type of offence in the three years after release

(Source: National Trajectory Project (McGill University, Royal Ottawa Mental Health Centre, University of British Columbia)