Re: Esfand Afra
ORB File No: 5445
Hearing held on: Wednesday, October 8, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Sections 672.81(1) and 672.81(2.1) of the Criminal Code
Before:
Alternate Chairperson: Ms. L. Banks Members: Dr. L. Cappe Dr. C. Rose Hon. C. Nelson Mr. J. Cyr
Parties Appearing:
Accused: Esfand Afra Counsel: Mr. T. Whillier
Person in charge of the Hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Ms. S. Cressman
REASONS FOR DECISION AND DISPOSITION
(Dated October 30, 2025)
Introduction:
On September 9, 2009, Esfand Afra was found not criminally responsible on account of mental disorder (“NCR”) on charges of mischief not exceeding $5000, assault peace officer, utter threat to cause bodily harm, assault and fail to comply with a recognizance, all contrary to the Criminal Code of Canada (“Criminal Code”). He is currently subject to the terms of a Disposition of the Ontario Review Board (“ORB” or the “Board”), dated October 3, 2024. That Disposition requires him to be detained on a General Forensic unit at the Centre for Addiction and Mental Health (“CAMH” or the “hospital”), with privileges up to and including living in the community in supervised accommodation approved by the person in charge.
By letter dated July 22, 2025, the hospital notified the ORB that Mr. Afra was readmitted to the hospital on July 14, 2025. The letter is considered notice pursuant to s. 672.56(2) of the Criminal Code of a significant increase in the restrictions on the liberty (“ROL”) of Mr. Afra.
On October 8, 2025, a panel of the Board convened to review Mr. Afra’s existing Disposition and to review the ROL imposed on Mr. Afra. Mr. Afra was in attendance at the hearing and was represented by his counsel, Mr. T. Whillier.
The issues for the hearing are whether Mr. Afra continues to pose a significant threat to the safety of the public and, if so, to determine the necessary and appropriate Disposition having regard to the factors set out at s. 672.54. The Board was also tasked with reviewing the ROL in order to determine whether it was reasonable and warranted and represented the least onerous and least restrictive course of action available to the hospital, both initially on July 14, 2025 and throughout its duration to the hearing date.
For the reasons set out below, this Board concluded that Mr. Afra continues to represent a significant threat to the safety of the public. This Board is satisfied that the necessary and appropriate Disposition is that Mr. Afra continue to be subject to the terms of his existing Detention Order. The Board also concluded that ROL imposed on Mr. Afra was necessary and appropriate, and least onerous and least restrictive intervention in the circumstances, both initially when it was imposed and throughout its duration to the hearing date.
Position of the Parties:
At the outset of the hearing, the parties were canvassed as to their recommendations to the panel. Counsel for the hospital submitted that Mr. Afra continues to pose a significant threat to the safety of the public and that the maintenance of the current Detention Order, on the same terms and conditions, remains necessary and appropriate at this time. With respect to the ROL, the hospital submitted that it was necessary and appropriate in the circumstances and was the least onerous and least restrictive course of action available to the hospital to manage the heightened risk presented by Mr. Afra at that time.
Counsel for the Attorney General of Ontario supported the recommendations of the hospital.
Counsel for Mr. Afra submitted that his client was supportive of the hospital’s ROL decision, both initially and on an ongoing basis to the hearing date. With regard to Disposition recommendations, counsel advised that Mr. Afra was seeking an Absolute Discharge as he no longer represented a significant threat to public safety.
All parties maintained their respective recommendations to the Board in closing submissions.
Index Offence:
- The circumstances giving rise to the index offence are extracted from the Board’s Reasons for Disposition dated October 21, 2024, and can be summarized as follows:
"On September 3/4, 2008 Mr. Afra was arrested by the police under the Mental Health Act, after his mother called the police and expressed concern that he was not taking his medications. At hospital, he was held on a Form 1 for an assessment. Hours later, Mr. Afra left the hospital, went to his mother’s home and starting banging on her bedroom door. While his mother called the police, Mr. Afra entered her room and removed some cash from her closet. The police arrived and Mr. Afra was again arrested under the Mental Health Act. On route to hospital, Mr. Afra kicked and broke a window in the cruiser, then when the officers stopped the car in order to control Mr. Afra, he spat on one officer more than once, and bit the finger of another. He also threatened one of the officers.
Ten days later, the police encountered Mr. Afra at 4:30 in the morning, when they answered a call about a “prowler”. Mr. Afra was in breach of curfew term pursuant to a recognizance.
On June 10, 2009, Mr. Afra was admitted to hospital. He was suffering auditory hallucinations, had stopped his medications and had been using marijuana and Ecstasy for a few days. When a nurse came to his room to give him his medication, Mr. Afra seemed angry and grabbed her wrist and then forced the victim’s hand into her own face with some force. He also swung at the victim while holding a glass of water. After the first two incidents, Mr. Afra was charged and released on a recognizance.
After the incident of June 10, 2009, Mr. Afra’s bail was revoked. He was sent for a psychiatric assessment for fitness. Ultimately, these charges were resolved with an NCR finding.”
- Charges of unlawfully in a dwelling house and assault peace officer were withdrawn.
Personal Background/Psychiatric History:
The Hospital Report and Restriction of Liberty Report dated September 25, 2025 (the “Hospital Report”) details Mr. Afra’s personal, psychiatric and criminal background and course in hospital and need not be repeated in detail. Briefly stated, Mr. Afra is a 38-year-old man born in New Delhi, India and is a Canadian citizen. He is not in a relationship, does not have any children, and is financially supported by ODSP. He went to school until grade 10 and obtained 13 OAC credits.
Mr. Afra reported working on two occasions for about a month each in July 2005 and October 2005, both times as a busboy in a restaurant. He stated that he had to stop these jobs because of sedation and an associated inability to "keep up".
Mr. Afra has a history of using illicit substances since age fourteen. He continued to use cannabis on a regular basis and quite heavily at times. He has also used ecstasy, opioids, ketamine, benzodiazepines, cocaine and crack cocaine. He has used alcohol on an intermittent basis.
The Hospital Report sets out Mr. Afra's involvement with the criminal justice system. A charge of assault was stayed on March 6, 2003. He entered Mental Health Diversion on October 21, 2003, and charges of threatening death x 2 were stayed. On June 8, 2008, Mr. Afra was convicted of threatening death and received a conditional discharge with a weapons prohibition, and probation for twelve months. On February 17 and 18, 2012, charges of mischief under $5000, assault, and theft under $500 were withdrawn following Mental Health Diversion.
Mr. Afra had ongoing admissions to the hospital before the commission of the index offence and the finding of NCR in 2009. Since that time, he has been in a hospital setting virtually continuously but for two discharges in the community, both of which were unsuccessful and led to readmission in hospital. The first discharge to supervised housing was from April 2016 to May 2017. He was readmitted at that time, and transferred as an inpatient to CAMH in December 2018.
From 2020 to present time, Mr. Afra spent a significant amount of time on secure forensic units at CAMH. From December 2023 to October 16, 2024, he resided on a general forensic unit, LGUB, before being discharged to Manse Road, a 24-hour high support supervised housing.
Current Diagnoses:
- Mr. Afra’s current diagnoses are:
Schizophrenia (Treatment Refractory);
Cannabis Use Disorder; and
Antisocial Personality Traits.
Evidence at the Hearing:
Dr. A. Igoumenou, who had been Mr. Afra’s out-patient community psychiatrist from May 20 to August 18, 2025, testified at the hearing to supplement the evidence contained in the Hospital Report. Dr. Igoumenou advised that Mr. Afra’s in-patient psychiatrist is Dr. Benassi, with whom she spoke in order to prepare for today’s hearing. Dr. Igoumenou adopted the contents of the Hospital Report and advised that there were no material updates thereto.
The Hospital Report indicates that Mr. Afra was discharged from Forensic General Unit 1 on October 16, 2024 to the Forensic Out-patient Service (“FOPS”) team under the care of Dr. Meng. He resided at a 24/7 supervised housing through Good Shepherd.
In the community, Mr. Afra reported to his case manager 2-3 times a week, depending on concerns around safety, mental status, and substance use. He was seen by his psychiatrist approximately monthly.
Dr. Igoumenou commented that overall, Mr. Afra had a challenging reporting period in review, with multiple instances of destabilization and two readmissions to hospital.
Mr. Afra is assessed as capable to consent to psychiatric treatment. At the start of the reporting year, Mr. Afra was prescribed olanzapine 20mg and sertraline 100mg daily. His medications were supervised by housing staff while he resided at Good Shepherd housing. In hospital, he remains medication compliant.
Dr. Igoumenou testified that she recently met with Mr. Afra on October 7, 2025 and at that time, he presented with residual symptoms of his illness, including paranoid ideation, irritability and rigid thinking.
When living in the community, Mr. Afra was encouraged to participate in daily structured activities; however, although initially agreeable, he would change his mind and decline same. He spent the majority of his time on his phone listening to music or watching television/movies. He also spent time going for walks in the neighbourhood and going to the local plazas/malls.
At the start of the reporting period, Mr. Afra expressed an interest in volunteering or finding employment; however, despite frequent offers of support by FOPS, he declined.
Mr. Afra was adherent to his medications but at his baseline, his mental state was fragile. His thought process was rigid and he had a low tolerance for change. In the community, he presented with underlying negative attitudes about authority figures, particularly to his housing staff. On several occasions, he exhibited increased anxiety and paranoia about his housemates and staff targeting him.
There were a number of concerning incidents in the community which included verbal aggression directed towards housing staff, making racist comments to co-residents, and trying to pick fights with co-residents, some of whom reported being fearful of him.
There was an incident of physical aggression against a co-resident on November 24, 2024 which prompted his voluntary return to the hospital from November 27-29, 2024. During this brief admission, Mr. Afra experienced paranoia around staff injecting him with unknown medication while he was sleeping. He called his FOPS case manager to report same but later did not recall making the allegation.
By July 2025, housing staff reported to the FOPS team that they needed to de-escalate situations in the home involving Mr. Afra approximately every 30 minutes and reiterated that certain residents were fearful of him. As a result of his challenging behaviours, Mr. Afra was admitted on a Form 49 on July 14, 2025, and was subsequently evicted from his community housing.
Regarding the ROL, Dr. Igoumenou testified that there was no other less restrictive option available to the treatment team to manage Mr. Afra’s risk of harm in lieu of his hospital readmission. A number of his co-residents as well as certain housing staff members were fearful of him, and housing staff could not effectively manage his risk. As set forth below, Mr. Afra was also consuming cannabis in the community in violation of his Disposition.
A behavioural management plan had been implemented at Mr. Afra’s community residence outlining that he did not need to interact with staff or housemates if he did not want to, and that the only requirement was that he followed staff direction when there was an emergency (e.g., fire alarm). Mr. Afra was unable to adhere to the behavioural plan. In addition, staff increased their contact with him to provide further support and actively tried to coach and de-brief Mr. Afra to assist him in managing interpersonal relationships. Despite all of these attempts to manage Mr. Afra in the community, Dr. Igoumenou advised that it was necessary to readmit Mr. Afra to interrupt his cannabis use and allow for a period of stabilization, and possible medication optimization, within the hospital. At the time of his re-admission, Mr. Afra was presenting with decompensated mental state with increased risk of violence. The ROL remains ongoing as Mr. Afra was evicted from his community residence.
While living in the community, urine drugs screens (“UDS”) were conducted on Mr. Afra at least twice a week. Unfortunately, he tested positive for cannabis on November 18, 2024; November 19, 2024; June 17, 2025; and June 24, 2025. To his credit, he was forthcoming about his cannabis use to his clinical team in November 2024. He disclosed that he experienced cravings about using and purchased cannabis for himself at the local dispensary. Mr. Afra expressed disappointment that he had relapsed after five years of abstinence and was able to take some responsibility; however, he focused mainly on his housemates using in a common area of the residence.
In June 2025, Mr. Afra again had a positive UDS for cannabis but he was not transparent with the team regarding same and initially explained that his housemates were smoking cannabis around him. Later, he admitted to use and stated that he had smoked a joint the weekend of June 14, 2025 after seeing his housemates doing the same.
Dr. Igoumenou testified that cannabis has been noted to exacerbate Mr. Afra’s psychotic symptoms in the past and Mr. Afra was referred for individual counselling through FORCAT to provide support and coping mechanisms around his relapse to cannabis.
During his current admission at CAMH, Mr. Afra voiced paranoia that others were cutting his hair and forcing him to undergo a sex change. With ongoing health teaching in the hospital, Mr. Afra agreed to increase his olanzapine dosage to 30mg daily and he has remained compliant with his medication within the structured environment of the hospital.
On August 16, 2025, while an in-patient at the hospital, Mr. Afra engaged in a verbal altercation with a co-patient requiring staff intervention.
In response to questions posed, Dr. Igoumenou testified that Mr. Afra has underdeveloped insight across all relevant domains, particularly, his need for medication, and how his non-compliance with medications had led to decompensation, aggression, and violence in the past.
In terms of privileges, Dr. Igoumenou stated that Mr. Afra has been enjoying level 3 passes, which includes staff escorted passes into the community for group programs and other rehabilitative purposes. As well, he recently was granted level 4 passes which extends his privileges to passes into the community with an Approved Person and the doctor reported that he has exercised this pass with his mother.
Mr. Afra’s mother and maternal uncle remain his primary supports. His family visited with him in the community and often accompanied him to local malls and restaurants and he reported enjoying this time with them. His mother is designated as an Approved Person.
Dr. Igoumenou was asked by Ms. Cressman what Mr. Afra’s housing plans would be if he received an Absolute Discharge. The doctor responded that he had expressed his intention to live independently and he expected to be financially supported, in part, by his mother. When asked if it would be appropriate for Mr. Afra to reside in his mother’s home, the doctor responded in the negative indicating that Mr. Afra has been violent towards his mother in the past and given her frail health status, residing with her would not be recommended by the treatment team. Dr. Igoumenou was not aware whether or not Mr. Afra was currently on any community housing waitlists.
Dr. Igoumenou stated that at the present time, Mr. Afra requires an extended in-patient admission in order for him to demonstrate:
ongoing compliance with his prescribed medications;
progression through the hospital’s privilege ladder, without incident;
sustained abstinence from cannabis and other intoxicants;
ongoing behavioural stability; and
participation in relapse prevention programming.
Counsel for Mr. Afra asked Dr. Igoumenou to identify what the treatment team would consider necessary in order to progress his client to an Absolute Discharge. Dr. Igoumenou identified the items listed in paragraph 32 above and added that Mr. Afra would also need to demonstrate a period of stability living in the community.
Dr. Igoumenou opined that if the Board granted Mr. Afra an Absolute Discharge following the hearing, it was highly likely that he would become non-adherent with his medications, relapse to substance use, and over time, experience a decompensation in his mental state. The doctor expressed her opinion that any decompensation in Mr. Afra’s mental state would increase his risk to public safety. Dr. Igoumenou noted that even at his baseline presentation in the hospital, Mr. Afra still engages in intimidation towards others.
Dr. Igoumenou endorsed the finding that Mr. Afra presently represents a significant threat to public safety and referenced the conclusion included in the Hospital Report indicating that “… Mr. Afra’s risk of violent reoffending is high if he were to be released into the community unsupervised. In contrast, if Mr. Afra remained subject to his current disposition of detention on a forensic unit with community living in supervised accommodations, his risk of future violent offending overall is considered moderate, with his risk of serious physical harm and imminent violence considered to be medium.”
When asked why the hospital was recommending a Detention Order, Dr. Igoumenou testified that the clinical team requires the ability to approve Mr. Afra’s housing in the community at such time as he is ready for discharge to ensure that it will provide him with sufficient support, structure and monitoring to manage his risk. Further, the treatment team requires the ability to rapidly readmit him to the hospital should he suffer a deterioration in his mental state as a result of relapse to substance use, medication non-adherence, or otherwise. It is the opinion of the treatment team that civil commitment measures under the Mental Health Act (“MHA”) would not adequately address these risks. Given that the team recommends that Mr. Afra requires an extended period of hospital admission and that he does not have approved community residence available to him at this time, Dr. Igoumenou stated that a Conditional Discharge is premature at this juncture.
Mr. Afra testified at the hearing. In response to a series of questions posed by his counsel, he advised that:
if he were to receive an Absolute Discharge, he would continue to take his medications as prescribed as they assist him in managing his mood and thought processes;
he understands that he will need to take his medications forever and he agreed to accept an increase in his dose of olanzapine upon his readmission to the hospital;
his residential placement at the Manse Road home was very challenging because co-residents were using alcohol and cannabis regularly in common areas and this was very triggering for him;
prior to his discharge to the community, he had been abstinent of alcohol and substances for approximately five years but it was too difficult for him to remain abstinent when others in the home were using substances in his proximity;
with respect to the incident that triggered his readmission to hospital, there had simply been friendly “horseplay” between himself and the victim and it escalated and then he simply defended himself;
if he receives an Absolute Discharge from the Board, his plan is to reside in a shelter for a few days until he secures an independent market rent apartment. He then hopes to secure employment and would be amenable to receiving vocational supports from the hospital; and
he would be amenable to receiving some mental health supports, possibly a caseworker and a doctor to oversee his medications.
- No further evidence was called at the hearing.
Analysis and Conclusion:
The panel sees much merit in the position of the hospital and the Crown that Mr. Afra continues to represent a significant threat to the safety of the public. In coming to this conclusion, the panel relies on the evidence of Dr. Igoumenou and the documentary evidence before us. Mr. Afra suffers from Schizophrenia and he continues to experience symptoms of his illness, including paranoid ideation, irritability, and rigidity of thought. When unwell, he has presented with more intense delusions, hallucinations, agitation, mood disturbances and behavioural dyscontrol that has resulted in physical violence and multiple episodes of verbally threatening and intimidating behaviours.
Mr. Afra continues to have underdeveloped insight across all domains, and specifically with regard to the impact of substance use on his mental state. He engaged in numerous episodes in breach of his ORB Disposition over the past year.
The Hospital Report indicates that “The most likely re-offence scenario of future violence in the current setting is for Mr. Afra to become aggressive towards staff or a co-patient. Mr. Afra has a history of non-compliance or partial compliance with medication, and this substantially increases his risk of decompensation of mental state and of violence. In the context of living unsupervised in the community, he would become overwhelmed by the demands of independent living, and his compliance with medication would be rapidly compromised. In the context of stressors, impaired insight, and deteriorating judgment, he is susceptible to engage in extensive and sustained substance use to the further detriment of his mental state. These factors would precipitate a significant decompensation in his mental state. His susceptibility to paranoid and hostile misinterpretation of benign social interactions would acutely intensify, with corresponding impairment in rational thinking, judgment, and behavioural control. This would likely result in aggression and violent reoffending akin to the index offence.”
Over the past reporting year, he engaged in physical violence against a co-resident in his community home. He also engaged in numerous threats and intimidation against other co-residents to the point of some of his housemates being fearful for their safety. Mr. Afra presents with antisocial personality traits that typically become exacerbated with stress. He struggled in his residence with relationship dynamics with staff and housemates alike and evidenced numerous concerning behaviours.
In this panel’s assessment, Mr. Afra continues to meet the threshold of significant threat. Having come to that conclusion, we are tasked with arriving at the least onerous and least restrictive Disposition to manage Mr. Afra’s risk of harm to others.
Mr. Afra requires in-patient admission at this time. He requires this admission to achieve a prolonged period of stability, sustained abstinence from substance use and possible optimization of his medication. He has yet to demonstrate his ability to progress through the privilege ladder and utilize indirectly supervised passes, both on hospital grounds and in the community, appropriately. For all of these reasons, a Detention Order is the necessary and appropriate Disposition at the present time.
This Board is certain that a less restrictive Conditional Discharge and reliance on the MHA would be insufficient to manage Mr. Afra’s risk to the community at this juncture. The hospital requires the risk management tools available under a Detention Order. On his return to the community, Mr. Afra will require high-support housing in order to ensure that he is adequately supported, supervised and monitored. The hospital must retain oversight with regard to his placement in the community.
Additionally, in the event of a decompensation in his mental status while living in the community, the treatment team will require the ability to quickly return Mr. Afra to hospital for readmission rather than to wait until such time as he meets criteria for certification under the MHA. When unwell, Mr. Afra can present in a threatening, aggressive, and agitated manner and he has exhibited violent behaviour. Further, evidence suggests that given Mr. Afra’s chronic and ongoing experience of symptoms of his psychotic illness, it is likely that any decompensation in his mental state would occur rapidly, underscoring the need for rapid intervention. For all of these reasons, the panel is unanimous in agreeing that the necessary and appropriate Disposition is a continuation of his current Detention Order.
With respect to the ROL, the hospital’s decision to readmit Mr. Afra to the hospital was the least restrictive and least onerous intervention available in the circumstances. Mr. Afra was engaging in cannabis use in the community in contravention of his ORB Disposition. As well, he was threatening and aggressive with co-patients and housing staff alike. His behaviour culminated in a physically assaultive altercation with a co-resident.
The treatment team and housing staff attempted to provide Mr. Afra with additional supports. The FOPS team increased its contact with him to more closely monitor and assist him. In addition, a behavioural management plan was introduced in his residence to assist Mr. Afra in dealing with challenging interpersonal interactions and other stressors. He was also offered a brief readmission to hospital in November 2024 to provide him with some respite from his community residence and allow him to settle. All of these interventions were not successful in attenuating Mr. Afra’s challenging presentation and his heightened risk of harm to his co-residents. He required a period of hospital readmission to manage his risk.
Mr. Afra’s detention in hospital has continued to the hearing date as a result of the fact that he was evicted from his community residence and he has no other approved community housing.
In view of the foregoing, we find that the initial decision to return Mr. Afra to the hospital on July 14, 2025 was reasonable and warranted, and in the circumstances, it represented the least onerous and least restrictive decision available at that time. It continues to be necessary to date in order to safely manage his risk given that Mr. Afra does not have any other approved residence in the community at this time.
In making this Disposition, the Board has reviewed the provisions of s. 672.54 of the Criminal Code and has carefully considered the need to protect the public from dangerous persons, Mr. Afra’s mental condition, his reintegration into society and his other needs.
DATED this 30th day of October, 2025, at the City of Toronto, in the Toronto Region.
Ms. L. Banks Alternate Chairperson
Office of the Registrar Ontario Review Board