Ontario Review Board
Re: Gilles Mushitsi
ORB File No: 8197
Hearing held on: Wednesday, January 8, 2025
Place of Hearing: Royal Ottawa Mental Health Centre
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. P. Hageraats
Members: Dr. S. Lessard
Dr. G. Glancy
Mr. P. Capelle
Mr. M. Hajek
Parties Appearing:
Accused: Gilles Mushitsi
Counsel: Ms. L. Konarowksi
Person in charge of hospital: Representative: Dr. M. Strike
Attorney-General of Ontario: Counsel: Ms. M. Dufort
REASONS FOR DISPOSITION
(Dated March 17, 2025)
Introduction
On December 12, 2022, Gilles Mushitsi appeared in court on charges of indecent act (x2) sexual assault, invitation to sexual touching and mischief to property, offences contrary to the Criminal Code of Canada.
The court received additional evidence of a psychiatric nature establishing that Mr. Mushitsi was suffering from a mental disorder when he committed the offences. Based on that evidence, the court found that Mr. Mushitsi was not criminally responsible on account of mental disorder (NCR).
Mr. Mushitsi is currently bound by a disposition of the Ontario Review Board (ORB or “the Board”) dated January 30, 2024.
The current disposition ordered that Mr. Mushitsi be detained at the Secure Forensic Rehabilitation Unit of the Royal Ottawa Mental Health Centre (ROMHC or “the hospital”). Privileges were awarded, including the possibility for Mr. Mushitsi to reside in hospital approved accommodation in the community of Eastern Ontario.
On January 8, 2025, the Board convened at the ROMHC to conduct an annual review and to render a disposition. Mr. Mushitsi attended in person. He was represented by counsel, Ms. Lauren Konarowski. A hospital report, dated December 24, 2024, was filed in evidence.
The issues to be considered by the Board are whether Mr. Mushitsi presents a significant threat to the safety of the public, and if so, to determine the necessary and appropriate disposition.
Initial Positions of the Parties
- When the hearing began the parties presented what essentially was a joint submission. On behalf of the hospital, Dr. Strike recommended a few changes to the existing detention order, namely that Mr. Mushitsi be granted increased access to the community, including permission to travel in Eastern Ontario and Western Quebec to visit family. Counsel for the Attorney-General agreed, as did the patient’s counsel. Ms. Konarowski advised she would have some questions.
Index offences
- The circumstances are set out in the hospital report. In summary:
May 10, 2022:
Mr. Mushitsi was at the food court at the St. Laurent Shopping Centre in Ottawa. A security guard found him yelling and causing a scene. When Mr. Mushitsi was told to stop yelling, he did not acknowledge this but charged at the security guard. Mr. Mushitsi punched the victim multiple times in the arm and once in the right side of his face. Ottawa Police attended and arrested Mr. Mushitsi. He was later released on an undertaking.
June 17, 2022:
Ottawa Police officers responded to a call about a sexual assault at 1240 Donald Street. The first victim stated she had left her apartment and was headed to the elevator. Two males were in the hall at the elevator. One was her neighbour, the other was Mr. Mushitsi. As she walked past him, Mr. Mushitsi slapped her right buttock.
The second victim stated she was working as the assistant manager and cleaning the building’s lobby. On that same day, she was approached and sexually assaulted by Mr. Mushitsi. This was captured on CCTV footage. The victim had been standing on a chair when Mr. Mushitsi came up from behind and grabbed her buttocks.
The property manager at Mr. Mushitsi’s apartment building told police she had been getting similar complaints about Mr. Mushitsi from other female tenants in the past week.
About an hour later, Ottawa Police officers were sent to the OC Transpo bus station at Albert and Booth Street responding to a complaint of an indecent act in progress. They found Mr. Mushitsi sitting inside the glassed in bus stop. Three witnesses described seeing Mr. Mushitsi exposing himself, removing his penis from his shorts and masturbating while focusing his attention on a female within the bus shelter.
The female victim stated Mr. Mushitsi had followed her and was staring at her. He pulled down his shorts and exposed his penis. He masturbated to the point where she saw him ejaculate.
A second victim reported she was sitting in the bus shelter when Mr. Mushitsi came in and sat next to her. He began to stroke her leg. When she looked over to tell him to stop, she saw him rubbing his crotch with his other hand as he stroked her leg. The incident was captured on OC Transpo video. Further video, from June 17, 2022, showed Mr. Mushitsi masturbating while riding on the O-Train.
A male witness to the bus stop incident described Mr. Mushitsi as “either on drugs or feeble minded” due to his countenance and behaviour.
On June 24, 2022, Mr. Mushitsi was released on conditions, this time requiring that he reside at the Ottawa Mission.
June 27, 2022:
In the early evening hours, Ottawa Police officers were called about a male who was walking around with his pants down, approaching children aged 10 to 15. A witness at the Overbrook Community Centre identified Mr. Mushitsi standing outside. She reported a lifeguard had run in from the pool area looking for a place of safety as there was a male outside with his pants down. This same male had followed the lifeguard into the community centre and refused to leave when directed. He walked in with his pants down around his ankles and was holding his genitals through his long shirt.
He had also approached a group of children who fled in fear. One child, age 13, reported that the man had approached the group of children. He asked them if they wanted to see him naked. He also said, “Who wants to help me pull up my pants?”
Officers found Mr. Mushitsi walking away nearby. His black pants were down around his ankles with a long shirt covering his genital area.
In Mr. Mushitsi’s later version of the facts, he reported he had stopped taking his medication. He recalled that in June 2022, he was drinking lots of coffee, smoking a lot of cigarettes and cannabis. He was sleeping poorly and would often be up and about at night. He was masturbating excessively and watching porn. He reported hearing voices telling him not to sleep and that the devil will kill him.
Family members described Mr. Mushitsi’s mental health deterioration for the eight to twelve months leading up to the index offences. He was not taking his medication. Symptoms included talking to himself, insomnia, tangential thoughts and speech, aggression, irritability and other concerning symptoms including lack of personal hygiene, delusions and bizarre behaviour. He would become particularly agitated and aggressive when he was out of cannabis or cigarettes.
Family members also reported that in the same period, Mr. Mushitsi was having numerous conflicts with his mother, resulting in four or five calls to the police. On more than one occasion he shoved her and stole her money. Mr. Mushitsi was having frequent conflicts with people and would talk about harming others. He did not grasp the gravity of his actions.
Current Psychiatric Diagnoses
Schizophrenia, Treatment Resistant, in partial remission.
Cannabis Use Disorder in early remission, in a controlled environment.
Current Medication
Aripiprazole 400mg intramuscular every 21 days
Clozapine 500mg at bedtime
Lactulose 15ml daily & 30ml at bedtime
Metformin 250 mg twice daily
Mirabegron 50 mg daily
Oxybutynin chloride 5 mg at bedtime
Perindopril 4 mg daily
Sennosides 17.2mg at bedtime
Personal Background
Mr. Mushitsi is 42. He is single, with no dependants. During recent years when not hospitalized, he lived with his three brothers, Stephane, Gilles, and Michael. Their mother spends time living in both the Ottawa-Gatineau region and in Ivory Coast, Africa. While the brothers are close, they have found it difficult to deal with Mr. Mushitsi’s mental health difficulties. In recent years, Stephane and Michael moved out due to his mental health deterioration.
Mr. Mushitsi’s younger sister, Murielle Mutoni, distanced herself from him a few years ago due to his use of cannabis and his mental health condition. Mr. Mushitsi did not complete attempted education levels. He has been unable to hold down a job for any significant period. He enrolled at La Cité Collégiale several times but never stayed in any program for very long. He has a pattern of “hanging out with whoever is using”. He has often been taken advantage of for drugs and money before finding himself alone once he runs out of resources.
When unwell, Mr. Mushitsi exhibits poor hygiene. He talks to himself, hears voices, stops sleeping, withdraws and detaches from people. He will wear atypical clothing pairings, such as putting shorts over his pants. He also tends to wander about outside, asking people on the street for cigarettes.
Previous Psychiatric History
Mr. Mushitsi first saw a psychiatrist in early 2002 when he was living in Tunisia with his father. Symptoms included bizarre behaviour, thought disorder, delusions and hallucinations. He was admitted to a Tunisian psychiatric hospital twice in the first part of 2003. After immigrating to Canada, he was treated at the Pierre Janet hospital in Gatineau and referred to Dr. Alain Labelle, a Schizophrenia specialist.
Mr. Mushitsi has previously been under the jurisdiction of the ORB. The first set of index offences arose in August 2003, within three days of his arrival in Canada with his family. At the time, he was on medication and was scheduled to see a psychiatrist a few days later. He was then seen regularly seen at the Schizophrenia outpatient clinic of the ROMHC.
In 2004, soon after the NCR verdict, the family thought it best for him to rejoin his father. He went to Kenya. Once there, he required hospitalization and was treated by a psychiatrist in Nairobi. In 2005, Mr. Mushitsi returned to Canada and enrolled in school, while living with his mother and siblings in Orleans, near Ottawa.
From 2005 to 2008 Mr. Mushitsi was on a conditional discharge under the ORB. In 2008, concerns arose about his lack of compliance with medication. He was ordered detained in hospital. Intramuscular injectable medication was started. From 2008 to 2010, Mr. Mushitsi was stable on injectable medication. However, by the end of 2010, he was more reluctant to comply with injections.
In December 2010, after experiencing a significant decompensation, he was hospitalized.
From 2011 to 2013, Mr. Mushitsi was relatively stable. In the summer 2013, he was hospitalized for six weeks after having again stopped medication. Once back on injectable medication, he travelled to Tunisia. Once more, there was some decompensation, arising in July 2014.
In early 2015, Mr. Mushitsi travelled to the Ivory Coast for two months. He did well and found employment with an insurance company, while maintaining mental health stability.
From 2015 until the time of the most recent index offences, Mr. Mushitsi was using cannabis on a regular basis. He tried to pursue post-secondary education but did not manage to complete any programs.
From 2016 to 2019, Mr. Mushitsi was sharing an apartment with roommates in the Vanier neighbourhood of Ottawa. He was followed by a Canadian Mental Health Association (CMHA) case manager. Dr. Martin Dufour provided him with psychiatric care at the ROMHC.
In 2018, the Board granted Mr. Mushitsi a conditional discharge. He had a good year in the reporting period of 2018-2019 after being switched to oral antipsychotic medication, Olanzapine. In 2018, he coped adequately with the death of his father and worked full-time for several months as a taxi driver.
In February 2019, Mr. Mushitsi’s mother confirmed to Dr. Dufour that he was doing well and that she supported an absolute discharge. In March 2019, the Board granted Mr. Mushitsi an absolute discharge. His plan at the time was to return to the Ivory Coast and to receive mental health care from his regular psychiatrist in that country.
In January 2020, Mr. Mushitsi was admitted to the Ottawa Hospital Civic Campus for a week. He was brought in on a Form 1 due to bizarre behaviour. Once the dose of Olanzapine was increased, his psychosis settled entirely.
On March 4, 2020, Mr. Mushitsi was again admitted to the Civic for severe agitation and disorganized behaviour. He had broken a television and other items in the mother’s home. Admitted involuntarily, Mr. Mushitsi was declared incapable of making treatment decisions. The mother took on the role of substitute decision-maker. He was started on injectable medication, Abilify Maintena.
On March 20, 2020, Mr. Mushitsi was transferred to the ROMHC Schizophrenia inpatient program. He remained there as an inpatient until August 29, 2020. The injectable medication was changed to Invega Sustenna. Connection was re-established with the CMHA. Subsidized housing was provided. Dr. Bourget then took over Mr. Mushitsi’s outpatient care under a community treatment order (CTO).
In November 2020, the CTO was renewed. In January 2021, Dr. Bourget noted that Mr. Mushitsi wanted to stop his medication and return to Africa. His plan was not realistic. In February 2021, he missed an appointment but soon after resumed treatment.
In June 2021, Mr. Mushitsi told Dr. Bourget he had stopped taking his oral medications a week before. He readily agreed to resume. He showed insight into needing his injectable medication to remain stable. At the time, Dr. Bourget felt they did not need to renew the CTO. Mr. Mushitsi then continued receiving his injectable medication through to November 2021. However, on three occasions, he was late by at least a week.
In December 2021, Mr. Mushitsi stopped attending for his injections. He also missed a scheduled appointment with Dr. Bourget.
On February 20, 2022, Dr. Bourget recorded receiving numerous emails from the mother who was expressing her concerns about the patient’s well-being. Mr. Mushitsi was described as disorganized, spending his days smoking cannabis and tobacco and was refusing to come to hospital.
On February 26, 2022, the Mobile Crisis Team brought Mr. Mushitsi to the Ottawa Hospital Civic Campus, intending to restart his CTO and long-acting injection. There were concerns about the patient’s self-care, increasingly disorganized behaviour and aggression. He endorsed frequent cannabis use and reported ongoing hallucinations. Following his acceptance of Invega Sustenna 150 IM at the hospital, he was discharged with a plan to follow up with the outpatient program three weeks later for the next injection.
Mr. Mushitsi did follow-up on March 21, 2022, but he missed the subsequent appointment for April 2022. When contacted by the nurse, he indicated he would not come in and that he was no longer obligated to attend.
This was the hospital’s last contact with the patient before the first index offence arose on May 10, 2022.
Course following the NCR Verdict of December 12, 2022
Mr. Mushitsi was admitted to the Brockville Mental Health Centre (BMHC) on February 28, 2023. At Brockville, Mr. Mushitsi did reasonably well in that forensic setting and did not present problematic behaviours. His inappropriate sexual behaviours at the time of the index offences were believed likely related to an active phase of mania with psychosis so that a problematic sexual interest was unlikely to have played a role.
Mr. Mushitsi reported that he was confused at the times when he was charged and was not in full understanding of what was happening. He told Dr. Gray he never intended to cause distress to anyone. Mr. Mushitsi appeared to have some insight into the fact that not taking medications will cause him to decompensate which, in turn, can actually lead to him having inappropriate behaviours that will have a harmful psychological impact on members of the public and that can also make him more prone to physical violence.
During Mr. Mushitsi’s 2023 reporting year, he did reasonably well at the BMHC. He complied with medications and tested negative for substance use. Regular phone contact was maintained with family members, including with his mother who would call in from Africa on Mondays. Other family members would visit him at the hospital.
Mr. Mushitsi participated in programs and was described to be rather pleasant. He participated in community reintegration outings offered weekly, including at local stores, shops, restaurants, and at seasonal events. He followed direction from the recreational therapist without any issues and actively engaged in hospital recreational programs. Mr. Mushitsi was also cooperative in accepting different medication regimens which were proposed to him including Risperidone and Clozapine.
Recent Course in Treatment, December 2023 to January 2025
On February 8, 2024, Mr. Mushitsi was transferred from the BMHC to the ROMHC Assessment Unit. He cooperated with the admission, followed unit rules and presented at his baseline mental state. Soon after, on February 12, 2024, he transferred to the lower security Rehabilitation Unit.
Dr. Strike of the ROMHC has assumed the patient’s care. She determined that Mr. Mushitsi is capable to consent to treatment of his treatment-resistant Schizophrenia. She recommended increasing the Clozapine dose gradually to bring it into the therapeutic range - with the hope of achieving full remission of positive symptoms and optimal functional recovery. Mr. Mushitsi had concerns about side effects which are noted in the hospital report at p. 18.
In addition to having to deal with Mr. Mushitsi’s reports of difficult side effects, Mr. Mushitsi was still smoking cigarettes. This can present a problem, in medical terms, since Nicotine products will reduce the active level of Clozapine in the blood stream. Mr. Mushitsi agreed to participate in the smoking cessation group, starting in the Spring of 2024, with a goal to reduce his smoking to around five cigarettes daily, or less. Throughout the summer and fall, he managed to achieve this several times.
At various times over the months following the admission to the ROMHC, Mr. Mushitsi was very eager to advance his off-unit passes. He was also very keen to be able to reside outside the hospital. However, the treatment team assessed this as unrealistic. In March 2024, Mr. Mushitsi’s off-unit privileges were suspended due to use of cannabis.
Between August 22 to September 16, 2024, Mr. Mushitsi was temporarily transferred to the more secure Assessment Unit. On August 21, he had absconded from the hospital overnight. This was when he was about to learn he had been accepted to the Grove Transitional Housing Residence. Upon returning to the hospital on August 22, he tested positive for cannabis.
When Dr. Strike explored Mr. Mushitsi’s activities during his time away, he said he was “visiting his grandmother on August 21 because he missed her”. He then claimed he had forgotten he had been admitted to hospital. He claimed he could not remember where he had spent the night nor how he had returned to hospital. Dr. Strike explained her serious concerns about his memory and other cognitive functioning. In later discussions, Mr. Mushitsi eventually admitted to having spent the night at the apartment of an ex-girlfriend.
In October 2024, Dr. Strike and the hospital social worker had discussions with Mr. Mushitsi’s mother. She was visiting Ottawa, having come in from the Ivory Coast where she lives. The mother advocated for her son to travel to Burundi in November 2024 to attend the wedding of his brother. She asked that the doctor be changed to Dr. Bourget, the previous psychiatrist. The mother asserted that since Dr. Bourget had earlier opined that Mr. Mushitsi was no longer a risk, he was now “finished with the ORB”.
Eventually however, after education was provided about the life-long nature of Mr. Mushitsi’s psychiatric, legal, and social history, the mother seemed to appreciate that the current ORB disposition was helpful. The mother expressed frustration with the pervasiveness of cannabis and alcohol everywhere. She stated that these substances are readily available in the community, making it hard to expect Mr. Mushitsi to avoid them.
On November 9, 2024, Mr. Mushitsi’s privileges were reduced for 30 days. He had used substances. His hallucinations got worse through to late November.
On December 6, 2024, immediately after privileges were reinstated, he drank alcohol. In days soon after, nursing staff on the rehabilitation unit saw him posturing in fixed positions. The on-call psychiatrist assessed him as demonstrating catatonia related to his treatment-resistant Schizophrenia. With medication quickly provided, the symptoms resolved.
The hospital is making efforts to gradually reintegrate Mr. Mushitsi into the community, notably to a 24-hour supervised group home, Wymering Manor. Mr. Mushitsi has required extensive assistance from both Ms. Agathe Gramet-Kedzior, the social worker, and from Ms. April Stapleton, the occupational therapist.
Current Risk Assessment
- Dr. Strike made recent use of the HCR-20-v3 structured clinical judgment instrument. Based on consideration of the three factors, including historical, clinical and risk management, Dr. Strike is of the opinion that Mr. Mushitsi continues to present a significant threat to the safety of the public. She recommends continuation of the current detention order, with permission to live in the community in approved accommodation. In the report, Dr. Strike wrote the following, at pp. 27-28:
Mr. Mushitsi should continue to be required to abstain from all substances, including cannabis and alcohol. Substances have rapidly and repeatedly destabilized his schizophrenia, acutely increasing his risk of harm to others.
I recommend removing the word “non-medical” from this condition, so as to clearly require him to refrain from the use of substances. With his mental disorder, there would not be any safe medical indication for the use of cannabis or other substances, and the inclusion of the term “non-medical” has prompted many NCR accused to seek medically prescribed cannabis from physicians who are naïve to their psychiatric condition and their ORB disposition.
Evidence at the Hearing
The Board also received direct expert testimony from Dr. Melanie Strike, Forensic Psychiatrist at the ROMHC. Dr. Strike is the Clinical Lead of the Forensic Rehabilitation Program at the hospital. She is the author of the report filed in evidence and provided the Board with further explanations before responding to questions.
Dr. Strike explained that Mr. Mushitsi has been doing well in more recent days. He is resuming access to hospital grounds and will start attending in the wider community - indirectly supervised - for an hour and a half at a time. There have been no further substance use incidents since December 2024.
According to Dr. Strike, Mr. Mushitsi engaged well when undergoing neuropsychological testing with the neuropsychologist, Ms. Marcil. The hospital needs to better understand his level of thinking cognition and deficits before being able to completely assess future community access and living.
Mr. Mushitsi’s Schizophrenia remains treatment resistant. He continues to hear voices which have never abated. Before Mr. Mushitsi came to the hospital from Brockville, he had only just started on Clozapine medication. His Clozapine blood levels have remained low, which is a concern. There have been two incidents of catatonia because of lower Clozapine levels, both in December 2024. Dr. Strike believes that, intermittently, Mr. Mushitsi was not taking his Clozapine as directed. This lowered the medication levels in his system, as did his continued smoking of cigarettes.
Counsel for the Attorney-General, Ms. Dufort, had some questions for the doctor. Regarding community access, Dr. Strike explained that Mr. Mushitsi has two brothers in Gatineau, along with other friends. The hospital will need to carefully manage community access by use of an approved itinerary. Numerous concerns about future cannabis use arise in the context of one brother and possibly others who use this substance. The one brother knows he is not to supply Mr. Mushitsi with cannabis. However, the hospital is concerned, particularly when overnight visits are contemplated, that Mr. Mushitsi will be exposed to the drug.
Asked about Clozapine adherence and blood testing, Dr. Strike confirmed that Mr. Mushitsi has been very compliant with testing. When he does hopefully get to be transitioned to the Wymering Residence, it will be easy for Mr. Mushitsi to continue with tests, since the residence is near the hospital. This will also make it easier to manage Mr. Mushitsi’s attendance at therapeutic and group counselling sessions in hospital. So far, Mr. Mushitsi has been very good at keeping up with those appointments.
Dr. Strike confirmed that the proposed outpatient case manager, Mr. Su, will be involved. She expects that the patient and Mr. Su will be able to establish a good therapeutic rapport. Once discharged from hospital, Mr. Mushitsi will be motivated to remain in the community. He knows he will struggle to stay away from substances, realizing that he is subject to return to hospital if he should start to consume.
Dr. Strike spoke of the ongoing need for education to be provided to Mr. Mushitsi’s brothers about Mr. Mushitsi’s illness and his need to remain substance-free.
Counsel for the patient, Ms. Konarowski, also had questions for Dr. Strike. Dr. Strike confirmed that Mr. Mushitsi has a level of insight into his current symptoms (voices). Dr. Strike confirmed that following her discussion with the mother, there was a short-lived strain in the doctor-patient relationship when Dr. Bourget was requested.
Since then, however, things have improved. Mr. Mushitsi has been open with her, telling Dr. Strike how he likes working with her. He was understandably frustrated about certain things, including medication side effects. Mr. Mushitsi does experience frustration, not just with his doctor, but also with his lack of coping skills, and his difficulty at fully understanding his overall situation.
Asked about future goals, Dr. Strike noted that Mr. Mushitsi’s family do want him to succeed in maintaining sobriety from cannabis. All involved would like to see Mr. Mushitsi achieve his potential goal of having overnight visits with family. In the longer term, at least for the year to come, Dr. Strike believes it is not realistic to expect that Mr. Mushitsi would be able to travel to Africa.
Dr. Strike responded to questions from Board members. A suggestion was made about a further term designed to enforce abstinence from cannabis, that being a requirement that Mr. Mushitsi not be in any place where cannabis is kept or used. Dr. Strike replied, stating that she was interested in exploring this further. She added that random urine drug screens (UDS) will be done by the hospital when Mr. Mushitsi starts to have increased access to the community.
Dr. Strike was asked about the time it could take for Mr. Mushitsi to decompensate if he uses substances. Looking at the patient’s history, Dr. Strike explained that he becomes intoxicated right away. However, for the most recent reporting period, Mr. Mushitsi has not shown any aggressive incidents or violence. With long-acting injection in place, it does take him quite a while to decompensate after using substances.
A Board member pointed out that Wymering Manor has both male and female patients. Dr. Strike explained that when Mr. Mushitsi was assessed last year, it was determined that he does not appear to have any problem or interest regarding children or adolescents. As an inpatient, Mr. Mushitsi has not displayed any inappropriate behaviour with females. There have not been any boundary violations during his time at Brockville or at the ROMHC. The only history of sexual offending with Mr. Mushitsi arose in the context of actual ongoing psychosis.
Responding to a final set of questions from Ms. Konarowski, Dr. Strike confirmed that Wymering Manor is holding a bed available for Mr. Mushitsi. The hospital is expecting he will maintain his abstinence from cannabis and will be making appropriate use of his privileges while he moves forward to transitioning from the hospital. Dr. Strike expressed optimism that things could move quickly within the coming few weeks.
The parties presented no further evidence.
Submissions of the Parties
Dr. Strike congratulated Mr. Mushitsi on his progress at navigating through various difficulties, including with both mediation compliance and abstaining from cannabis. Recent community access passes did see concerns arise in terms of substance use. Mr. Mushitsi is now well aware that any future cannabis use will not be tolerated.
To assist Mr. Mushitsi with access to the community, including family reintegration, Dr. Strike was prepared to recommend he be permitted to go to certain places in Eastern Ontario and Gatineau, subject to hospital pre-approval, for overnight visits.
On behalf of her client, Ms. Konarowski recommended that passes to visit family, for up to seven days in the communities of Eastern Ontario or Gatineau, be awarded. Ms. Konarowski agreed that Mr. Mushitsi should be prohibited from any non-medical use of cannabis. Counsel voiced no objection to having her client prohibited from attending in places where cannabis was being kept, sold or consumed.
Counsel for the Attorney-General took a similar view. Draft wording was proposed to deal with the issue of restricted access to cannabis.
Conclusions and Disposition
Based on the evidence, and the appropriate joint submission, the Board had no difficulty coming to the unanimous conclusion that Mr. Gilles Mushitsi does present a significant threat to the safety of the public. When he is unwell and off medication, he tends to gravitate to concerning use of substances, including cannabis and alcohol.
The history is clear that when he does so, his mental condition deteriorates dramatically. He is unable to take care of himself or manage activities of daily living. He becomes unaware of his mental state and develops impulsive behaviours leading to public disturbance, assaults, and disturbing sexual behaviours in any number of public places. He is also aggressive and dangerous in his behaviours to family members and to others, including in public places when in the grip of his treatment-resistant Schizophrenia.
Mr. Mushitsi requires ongoing intensive medical treatment for his psychiatric condition. He has a severe life-long illness. Mr. Mushitsi also requires ongoing and extensive assistance in terms of non-pharmacological interventions. These have to do with treatment for his still unresolved substance abuse disorder. Concerns remain about Mr. Mushitsi’s level of cognitive functioning, so that ongoing involvement with occupational therapy and psychological counselling is highly recommended.
These treatment objectives can only be advanced in the context of a detention order. The Board recognizes that Mr. Mushitsi has made progress during his inpatient stay, first at the BMHC, and more recently in 2024, at the ROMHC. The hospital will need to gradually supervise the patient’s increased access to the community while carefully monitoring his mental state and potential return to substance use.
Regarding cannabis, it is obvious that Mr. Mushitsi and cannabis, although otherwise legal in wider society, must now go their separate ways. For good. It is unfortunate that Mr. Mushitsi was able to access cannabis, even when he was on inpatient status. The Board is most concerned that as he progresses to enjoy greater access to the community, including family visits, he will be exposed to any number of substances.
Just as his mother has explained to Dr. Strike, cannabis and other products are readily available in many places. Now that Mr. Mushitsi understands he must abstain, failing which he will be returned to hospital, the Board orders that Mr. Mushitsi not attend anywhere where cannabis or alcohol is dispensed or sold for a fee. He must also not attend at any private residence where alcohol, cannabis, or other drugs are readily available or while they are being consumed.
In this last context, we encourage the hospital to reach out to the patient’s various family members, with a view to providing them with further education about the detrimental effects of cannabis to his mental state and future progress.
This is not Mr. Mushitsi’s first experience as a patient under the controls of the Ontario Review Board. It is essential that Mr. Mushitsi continue to follow the hospital’s directions about remaining on medication. We encourage both Mr. Mushitsi and the hospital to continue in their collaboration at finding the right formula and balance regarding his treatment with medications. We encourage Mr. Mushitsi to participate fully with the hospital treatment team and his psychiatrist and to maximize his involvement in the various programs and resources which are available. To the extent that Mr. Mushitsi is able and willing to follow through, he likely will come to enjoy a safe and healthy lifestyle.
For these reasons, having regard to the primary need to keep the public safe, the patient’s mental condition, his reintegration and other needs, a detention order is provided. Terms and conditions, as discussed, are set out in the new disposition.
We thank Dr. Strike and the treatment team members, along with both counsel, for their assistance.
DATED this 17th day of March 2024, at the City of Toronto, in the Toronto Region.
Mr. P. Hageraats Alternate Chairperson
Office of the Registrar
Ontario Review Board