Ontario Review Board
Re: Mahad A. Ibrahim
ORB File No: 8783
Hearing held on: Monday, September 8, 2025
Place of Hearing: Royal Ottawa Mental Health Centre
Pursuant to: Section 672.47(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. M. Labrosse
Members: Mr. P. Hageraats
Dr. S. Lessard
Dr. R. Cormier
Mr. R. Rainboth
Parties Appearing:
Accused: Mahad A. Ibrahim Counsel: Mr. M. Shukairy
Person in charge of hospital: Representative Dr. A. Alabi
Attorney-General of Ontario: Counsel: Mr. J. Ramsay
REASONS FOR DISPOSITION
(Dated October 29, 2025)
Introduction
On May 9, 2025, Mr. Mahad Ibrahim appeared in Court on charges of assault causing bodily harm and assault, offences contrary to the Criminal Code of Canada.
The Court received expert psychiatric evidence establishing that on the first charge, assault causing bodily harm, Mr. Ibrahim was suffering from a serious mental disorder removed his ability to appreciate the nature and quality of his acts or to know that his acts were wrong. Based on the evidence provided, the Court ruled that Mr. Ibrahim was not criminally responsible on account of mental disorder (“NCR”).
Rather than render a Disposition, the Court required Mr. Ibrahim to appear before the Ontario Review Board (“ORB” or “the Board”) for the Board to render a Disposition. On Monday, September 8, 2025, Mr. Ibrahim appeared before a Board panel at the Royal Ottawa Mental Health Centre (“ROMHC” or “the hospital”). He was represented by counsel, Ms. Maya Shukairy. His father was also present. The hearing proceeded in the French language, with interpretation provided to assist the hospital representative, Dr. Alabi.
At the hearing, the Board received direct testimony from Forensic Psychiatrist, Dr. Adedayo Alabi, who had conducted the initial assessment on which the Court relied. In addition, the following documents were filed in evidence:
Criminal Record
Charge Sheet
Release Order dated May 9, 2025
Transcript May 9, 2025
Information
NCR Report dated April 7, 2025
Hospital Report dated August 6, 2025
The issues to be considered by the Board are whether Mr. Ibrahim presents a significant risk to the safety of the public, and, if so, to determine the necessary and appropriate disposition.
Positions of the Parties
Counsel appearing for the Attorney-General, Mr. Ramsay, agreed with the hospital’s recommendation that the accused patient does present a significant risk to the safety of the public, to the extent that a detention order is required. Crown counsel added that it would be appropriate to include a term permitting Mr. Ibrahim to reside in the community in accommodation approved by the hospital.
On behalf of her client, Ms. Shukairy advised they did not dispute the issue of significant threat. However, it was their position that Mr. Ibrahim’s supervision in the community could best be managed under terms of a conditional discharge.
For the reasons set out below, the Board concluded that the issue of significant threat was made out and that a detention order, on terms recommended by the hospital, should issue.
Current Psychiatric Diagnoses
Paranoid Schizophrenia, with multiple episodes, currently in partial remission
History of Alcohol and Khat Dependence leading to the index offence
Underlying Generalized Anxiety Disorder
- Mr. Ibrahim is currently being treated with psychiatric medication: He reports taking Risperidone and Effexor daily, as prescribed by his family doctor, Dr. Huong. He also uses Lorazepam for sleep.
Index Offence
- The circumstances are described in the police and court documents and in the hospital report. In summary:
Mr. Ibrahim had been living in his apartment at 215 Wurtemburg Street in Ottawa for the previous 14 years.
The female victim of the index offence was also a tenant in the same high-rise building. The parties did not know each other.
In the mid-afternoon on October 11, 2024, Ms. B. came out of the elevator and entered the lobby. She crossed paths with Mr. Ibrahim in the vestibule area. For some reason, Mr. Ibrahim began insulting Ms. B. He was speaking in Somali. Ms. B., who also is Somali, could not understand what he was saying.
With no provocation, Mr. Ibrahim struck Ms. B. in the face on her right eye. He grabbed her by the hair and, pulling on it, struck her head against the wall. She fell to the ground. Mr. Ibrahim continued to punch her in the face. Ms. B. believes that she was kicked as well.
Ms. B. suffered injuries: two golf ball sized bruises to the left forehead and temple, a swollen right eye, a cut above the eyelid and below the eye, scratches on her chin, and swelling to the left wrist.
While the incident was unfolding in the lobby, Ms. K. noticed what was happening. She tried to intervene. Mr. Ibrahim backed himself into the elevator and tried to leave. Ms. K called her sister, Ms. P., on the phone, who came quickly. Mr. Ibrahim then struck Ms. K in the face. In the ensuing struggle, the two sisters and Mr. Ibrahim ended up in the elevator which took the three of them to the 8^th^ floor. Once there, the two sisters managed to detain Mr. Ibrahim until the police arrived to arrest him.
The arresting officer provided Mr. Ibrahim with his rights to counsel and a formal caution against making utterances to police. Mr. Ibrahim repeatedly interrupted the officer to say that he had not taken his Schizophrenic medications and “that’s why I attacked the girl”.
Later that day, an assisting police officer spoke with the victim, Ms. B., at the Montfort Hospital. The officer described her as of Somali descent, around five foot, four inches tall, medium build, and 26 years of age. Ms. B. provided details of the assault, adding that her neck was sore as well as her face on the lower side of her cheek.
While she did not know Mr. Ibrahim, she had seen him in the past around the building. There had been an earlier incident, months before, when the same individual insulted her in Somali. On that previous occasion, there was no physical contact, and she did not report it to the police.
In his report, Dr. Alabi noted several details from the police report, summarizing significant portions of the prolonged incident, most of which were captured by surveillance video.
Personal Background
Mr. Ibrahim is now 51. He was born in a general hospital in Djibouti. Mr. Ibrahim advised he was not aware as to whether he achieved his childhood developmental milestones within normal limits or if they were delayed. Up until his twenties, he suffered with respiratory difficulties with asthma and used an inhaler. Mr. Ibrahim reported that, while growing up, he was calm and, at times, excited.
Mr. Ibrahim’s parents are both alive and well. The father first came to Ottawa in 1997, returned to Djibouti and has now been living in Ottawa since 2003. Mr. Ibrahim’s mother reportedly worked at the Bank of Indo China in Djibouti for 34 years before relocating to Ottawa in 2003. Mr. Ibrahim’s family includes an older brother and three sisters. He reports no known history of mental disorder, violence, addiction, or suicidal behaviours in the family although he has said that a maternal Uncle suffered from psychosis.
After attending College for four years, Mr. Ibrahim obtained a university degree in Economics at Nice University in Southern France. After three years at Lemans University, he obtained a Master’s in Economics and Diploma Economics, Science, before returning to Djibouti. There, Mr. Ibrahim worked for the BCI Bank as a credit auditor for three years before relocating to Ottawa in 2003 to join his family. Mr. Ibrahim is currently unemployed. He is supported by social assistance (ODSP). Mr. Ibrahim has reported previous romantic relationships, but he has not been in any long-term relationship for many years. He has no children.
Concerning substances, Mr. Ibrahim has reported drinking four to six beers daily or every two days. He would usually drink towards bedtime and claimed to have no previous dependence on alcohol. He also reported chewing Khat, typically twice weekly. His first use of Khat was in 1991, in Djibouti. He continues to use it in Ottawa. According to Mr. Ibrahim, Khat gives him confidence to speak at community events; it helps him to initiate sleep and boosts his energy levels, which helps him complete domestic chores.
Legal History
- There is no recorded history of Court involvement.
Psychiatric History
According to Mr. Ibrahim, Dr. D. Alberto saw Mr. Ibrahim at the Schizophrenia Department of the Ottawa General Hospital in 2004 and diagnosed him with Schizophrenia. Mr. Ibrahim reported being on medication for several years between 2004 and 2008. He reported being admitted to hospital during that period on about three or four occasions. The admissions involved his coming to hospital either with the police or his parents. There were some times when he came in voluntarily.
Mr. Ibrahim reports he was stable in 2008 and did not need to attend the hospital. He began teaching French at Algonquin College and did so for about a year. Mr. Ibrahim has advised that he then became paranoid about students, about Revenue Canada and about his job as a teacher. He started to hear voices. He reports that he was stable later, in 2010 and 2011.
In 2021, Mr. Ibrahim travelled to Djibouti. For three months, he had no access to psychiatric medications and suffered a relapse of symptoms. On returning to Ottawa, his family doctor restarted him on medication. Mr. Ibrahim reported ongoing stability through the years of 2022-2023 and until October 2024 when he again relapsed, due once more to having no medication for about two weeks. He reported to Dr. Alabi that the family doctor then decided to increase the prescribed dosage of Risperidone and Effexor.
Documentation from March 3, 2004, notes that the police had brought Mr. Ibrahim to the Montfort Hospital, and then to the Ottawa Hospital. The family had called the police, reporting psychomotor agitation, irritability, threatening behaviour and an incident in which he had pushed his mother. Mr. Ibrahim was reported to have been not sleeping and was paranoid about food. Responding to medication prescribed, his condition settled within a week. The discharge diagnosis, dated March 31, 2004, was ‘psychosis, NOS’.
On September 24, 2004, the police brought Mr. Ibrahim to hospital under a Form 2. He had been living with his mother. He was presenting to her as paranoid, hostile and verbally aggressive, while talking about people poisoning his food. Mr. Ibrahim was also responding to auditory hallucinations. He had stopped eating and was not sleeping well. The report notes that he had stopped his medication in the Spring of 2004. Once psychiatric medication was restarted, his condition responded well. The rest of his admission was unremarkable, with no evidence of mood and psychotic disturbances. On about October 1, 2004, Mr. Ibrahim was discharged with the same diagnosis as before: psychotic disorder, NOS.
On December 9, 2004, a community worker and security officer brought Mr. Ibrahim to hospital. His mother had called in, reporting increased verbal aggression to the family. He was talking to himself as if hearing voices, was watching television with the sound volume turned off, and was not sleeping at night.
In the months preceding, Mr. Ibrahim’s mother had been challenging him to restart his psychiatric medication. Not satisfied with his mother’s concerns, he left, to live with his aunt. However, once there, he had to leave due to behavioural problems. He then moved to the home of his uncle, where, again, he was asked to leave after punching the uncle in the eye and causing the uncle to suffer a bruised eye. Following this, Mr. Ibrahim then began living with another uncle where, due to bizarre behaviours, including slapping a ten-year-old nephew in the face, he was asked to leave.
The report notes that Mr. Ibrahim had not renewed his prescription and had discontinued taking medication after the hospital discharge date of October 1, 2004. He was described as lacking insight into the circumstances leading to the December admission. He was adamant he had done nothing wrong.
Mr. Ibrahim was found incapable of making treatment decisions. His mother took on the role of substitute decision-maker. Once medication was restarted (Olanzapine), he responded well, became more cooperative and showed no further aggressive behaviour or irritability. On December 12, 2004, Mr. Ibrahim was discharged, again with the same diagnosis, psychotic disorder, NOS.
On March 3, 2005, having stopped his medication two to three weeks earlier, Mr. Ibrahim was once more brought to hospital under a Form 2. Having missed his appointments, there was a re-emergence of paranoid psychosis and aggression. Feeling too much stress, Mr. Ibrahim had stopped working at Algonquin College as a part-time French teacher.
The report notes that Mr. Ibrahim had been repeatedly phoning his mother, threatening her that if she did not come, he would jump from the 17^th^ floor. He complained of people in his apartment. The mother could hear him yelling. On examination, Mr. Ibrahim did not endorse paranoid aggression and denied using drugs and alcohol but did admit to feeling depressed for the previous two weeks, due to stress at work. In that same report, he noted that he had been taking his medications.
On admission, Mr. Ibrahim was thought disordered and suspicious, with poor insight and judgment. Once more, he was found incapable to treatment and started on psychiatric medication. His mental state improved, although insight and judgment were described as remaining poor throughout the course of admission. On April 21, 2005, Mr. Ibrahim was discharged with a diagnosis of Undifferentiated Schizophrenia.
Following his return from the trip to Djibouti in May 2006, Mr. Ibrahim was the subject of a readmission on June 30, 2006. He had been on a Community Treatment Order following the earlier admission. He had stopped taking medication. The report notes that once back home, Mr. Ibrahim was behaving violently towards his mother and sister and reportedly had beaten the sister with a belt. A week before the admission, his mother had called to report that he was deteriorating. By the second week of hospitalization, Mr. Ibrahim’s condition responded well to medication. He spent the rest of that hospital admission there on a voluntary basis. When discharged on July 21, 2006, with a diagnosis of Psychotic Disorder, NOS, he was recommended for a second Community Treatment Order.
On August 2, 2007, Mr. Ibrahim was admitted to hospital voluntarily after he had reported feeling unwell and troubled by stress. He requested a leave of absence from his job as a French teacher and was worried about the stigma of having a mental illness. On August 10, 2007, he was discharged, again with the same diagnosis: psychiatric disorder, NOS.
The documentation includes a summary of Mr. Ibrahim’s involvement with Dr. Alex Duong who has been his family doctor for many years.
Dr. Duong’s last consultation with Mr. Ibrahim, prior to the October 11, 2024, offence date, appears to have been a year earlier, on October 3, 2023. At that time, Mr. Ibrahim was being prescribed Effexor 150 mg daily and Risperidone 4 mg daily. In late 2023, his Schizophrenia was reported to be well controlled. Dr. Duong wrote the following at the time:
Voices better and well controlled and rarely hears them, no hallucinations, no paranoia, no issues with ideas of reference, no depression and anxiety. Dr. Duong also documented that the patient was linear logical, speech normal, insight and judgment reported to be excellent.
Six days after the index offence dated October 11, 2024, Dr. Duong met with Mr. Ibrahim. Mr. Ibrahim reported he had been hearing more voices since the offence date. He advised he had been out of his medication for two days. Dr. Duong increased Mr. Ibrahim’s Risperidone dosage and restarted Effexor at an increased level.
On December 5, 2024, Dr. Duong noted that the patient’s mental health was well controlled, with no reports of significant psychosis, anxiety, paranoia or fighting with others and no anger outbursts. Dr. Duong noted that Mr. Ibrahim had acted violently at the time of the index offence after he had run out of medications.
Dr. Duong’s referral to psychiatric services at the Montfort Hospital for a psychiatric evaluation saw him indicate paranoid Schizophrenia with generalized anxiety disorder. This mirrored an earlier diagnosis recommended after Dr. Tempier’s consultation from 2017.
Dr. Duong’s further information is that Mr. Ibrahim had apparently gotten into a separate incident, involving a fight that resulted in some engagement with the legal system in Gatineau. Dr. Duong noted that following the referral to the Montfort Hospital in 2017, Mr. Ibrahim had not returned there for follow-up.
On March 18, 2025, when Dr. Alabi conducted the court-ordered NCR assessment, Mr. Ibrahim was still experiencing auditory hallucinations of varying intensity. The voices, he reported, make him fear the police. They can also be commanding in nature. Mr. Ibrahim demonstrated some insight into his mental disorder, advising that he was receiving medication for psychosis and that he continued to have residual psychosis despite being on medication. Mr. Ibrahim also advised that drinking alcohol can exacerbate the intensity of the voices. He claimed that chewing Khat tends to reduce the voices.
After careful review of the underlying facts surrounding the index offence, Dr. Alabi concluded that Mr. Ibrahim was suffering from decompensated Paranoid Schizophrenia. Dr. Alabi wrote that while Mr. Ibrahim was able to appreciate the nature of the index charges, the florid psychotic state and disorganized delusional thinking impaired his judgment and did not allow him to weigh the pros and cons of his actions, nor did he know that they were wrong. This made him act irrationally. Dr. Alabi concluded that Mr. Ibrahim’s mental disorder rendered him unable to know that his actions, in committing an assault causing bodily harm, were wrong.
Regarding the second charge of assault, which involved the ensuing struggle with two sisters who were trying to detain Mr. Ibrahim, Dr. Alabi concluded that a Not Criminally Responsible finding was not available.
On July 28, 2025, Dr. Alabi saw Mr. Ibrahim to conduct a formal risk assessment. Mr. Ibrahim had been living in the community on terms of a bail court release order dated October 12, 2024, and was residing with his parents.
It was learned that Mr. Ibrahim would often go to his empty Wurtemburg Street apartment to spend the night, two to three times each week. Mr. Ibrahim claimed this was to check on the condition of the apartment and to see if he had any mail. Such attendance at Wurtemburg was strictly prohibited by terms of Mr. Ibrahim’s Court Bail Order. He explained that his lawyer had been made aware of the situation and was supposedly working with the Crown to see if a bail variation might be possible to allow access to the apartment.
In assessing Mr. Ibrahim on July 28, 2025, Dr. Alabi recorded that there was no evidence of formal thought disorder. Mr. Ibrahim advised that his auditory hallucinations had reduced in intensity and that a recent increase in the dose of his Risperidone medication was proving beneficial. Auditory hallucinations were still present, which he described as commanding in nature, with varied commands. In the past, these had caused him to be fearful of the police, but no longer. On occasions, the voices would prompt him to chokehold someone. Mr. Ibrahim reported he can now resist and challenge such commands, which is different from his earlier experience. He reported no visual hallucinations and was no longer feeling paranoid that CCTV cameras were monitoring or controlling his thoughts.
Mr. Ibrahim reported ongoing compliance with medication. He explained that were he to stop his antipsychotic medication, Risperidone, the voices would come back. He was open to discussing optimization of medication to control residual psychosis.
Mr. Ibrahim continues to chew Khat every two days, spending 20 dollars on a pack. He also reported drinking six to twelve cans of beer a week. He claims he does not drink to excess, nor does he believe that alcohol will worsen the auditory hallucinations.
Current Violence Risk Assessment
- Based on his detailed review of the various factors enumerated in the HCR-20 v.3 risk assessment tool - including historical, current/recent and risk management items - Dr. Alabi is of the opinion that Mr. Ibrahim’s risk of future violence is moderate to high. Dr. Alabi recommends that the patient’s least onerous and least restrictive disposition is a detention order under the auspices of the ORB, to include the ability to live in the community in approved accommodation.
Evidence at the Hearing
The Board also received direct testimony from Dr. Adedayo Alabi, Forensic Psychiatrist at the ROMHC. Dr. Alabi reviewed and confirmed the contents of the two reports filed in evidence while responding to questions. He explained that the index offence arose when Mr. Ibrahim was non-compliant with medication. It also appeared to Dr. Alabi that Mr. Ibrahim may have been under the influence of alcohol and quite unwell while consuming Khat. Dr. Alabi explained the concern, namely, that Khat is a psycho stimulant.
Dr. Alabi testified that while Mr. Ibrahim has no recorded history of violence, “… we’re dealing with situations in the past with intimate relations where he was violent to his uncle and sister. There were also incidents of threats to the mother”.
With an added diagnosis of generalized anxiety disorder and continued psychotic symptoms, Dr. Alabi explained that Mr. Ibrahim has limited insight into his mental disorder. The history of non-compliance with medication has led him, over time, to other difficulties before the index offence arose in October 2024.
Dr. Alabi noted previous supervision failures, in the sense that situations of aggression and potential violence have arisen in the past when Mr. Ibrahim was the subject of earlier Community Treatment Orders under The Mental Health Act. Having regard to the detailed risk assessment, Dr. Alabi confirmed that Mr. Ibrahim presents a significant threat to public safety and that his condition, at this time, requires a detention disposition.
Responding to questions from both counsel, Dr. Alabi explained that tools available under a conditional discharge are not sufficient to manage the situation. Dr. Alabi noted that because Mr. Ibrahim continues to have psychotic symptoms, with a background where previous hospitalizations were mostly involuntary, a conditional discharge would be premature. According to Dr. Alabi, the hospital requires the ability to have Mr. Ibrahim return to inpatient care, in the event he should again decompensate following any future medication non-compliance.
On behalf of her client, Ms. Shukairy pointed out that the history of non-compliance with medication goes back to earlier, from 2004 to 2007. Dr. Alabi responded that while there is no recorded history of non-compliance for the period of years from 2007 to 2024, this does not necessarily mean that there was no actual non-compliance for seventeen years.
Dr. Alabi agreed with counsel that Mr. Ibrahim does not appear to have been hospitalized between 2007 and 2024, and that he can, at this time, be managed as an outpatient. Dr. Alabi did however note that, following his release on bail in October 2024, Mr. Ibrahim has shown inconsistent compliance with the court ordered release conditions, that is, by going to the apartment frequently and repeatedly, contrary to the court-order.
Counsel and Dr. Alabi engaged in some discussion about whether Mr. Ibrahim’s inconsistent approach to taking medication amounts to an outright refusal to comply with recommended treatment. Dr. Alabi was prepared to agree that, to his knowledge at least, the patient had not refused medication. That said, Dr. Alabi added, much if not most of the patient’s history with regards to medication compliance is based on “self-report”.
In the same discussion, Dr. Alabi reminded us that even when Mr. Ibrahim does comply with medication, his symptoms are not entirely controlled, although they are now controlled better than before. For some patients, the psychiatrist explained, symptoms can be completely controlled. However, in Mr. Ibrahim’s case, his condition is treatment resistant. In that light, the treatment team needs to consider possible changes of medication, which might include the use of Clozapine.
On the topic of command hallucinations, whereby Mr. Ibrahim reports being urged to chokehold people, the treatment team needs to reduce the intensity of the urges and symptoms. Dr. Alabi explained there is no guarantee that such treatment will succeed. In fairness, Dr. Alabi acknowledged, Mr. Ibrahim is currently able to resist these concerning symptoms. Dr. Alabi then added, it is hard to say whether Mr. Ibrahim may or may not have tendencies to violent behaviours which are not related to his mental illness profile.
Dr. Alabi emphasized that alcohol and addiction programs would offer Mr. Ibrahim further assistance.
A Board member asked about some earlier documentation from 2017. Dr. Alabi was not aware of what precise hospital intervention may have been attempted at the time, nor was he able to say whether Mr. Ibrahim had followed up with treatment.
Dr. Alabi was asked how long it would take, following medication non-compliance, for Mr. Ibrahim to decompensate. He responded, ‘within a couple of days to a couple of weeks.’ Long-acting injectable psychiatric medications could become an option. This has yet to be discussed with the patient. Apart from the recent court-ordered assessments, Mr. Ibrahim’s psychiatric involvement appears to be limited: it has mostly been with the family physician, Dr. Duong. Dr. Alabi stated that Mr. Ibrahim also requires a forensic psychiatrist to assume care of his mental health care.
Questions were asked about the hospital’s plan for living in the community. Dr. Alabi explained that, for Mr. Ibrahim, “this is a touchy subject.” While Mr. Ibrahim is doing everything he can to comply with court-ordered conditions, he nevertheless has continued attending his apartment. We learned that, on July 28, the hospital social worker called the police about this. It was confirmed that the three involved parties, including the victim and both sisters, continue to reside at the same address. They have expressed their concerns about Mr. Ibrahim’s possible return to the apartment building. Dr. Alabi and the team have not yet been able to approve the Wurtemburg address as an appropriate location for him to reside.
Dr. Alabi did not want to express any view about prohibiting Mr. Ibrahim from attending Wurtemburg. He prefers to leave this question to the Board’s discretion. Dr. Alabi explained that the patient benefits from a rent subsidy at the apartment and that he has been a tenant there, now for the past fifteen years. It would take many years for the housing authorities to arrange an alternative apartment.
Asked about alcohol and substance consumption, Dr. Alabi explained that the use of Khat, as a stimulant, can undermine the patient’s condition. Mr. Ibrahim has already started to attend two programs at the hospital, namely Risk and Recovery and Healthy Lifestyles. He has also been in contact with their addictions counselling service. It was recent enough that he last attended the hospital, on September 2, 2025, days before the present hearing of September 8. Mr. Ibrahim currently comes to the hospital about twice weekly.
The parties presented no further evidence.
Submissions of the Parties
The hospital representative confirmed their position on the issue of significant threat. Dr. Alabi expressed concern having regard to the patient’s treatment-resistant condition, coupled with the report of impulses which are commanding and violent in nature. Dr. Alabi submitted that a detention order, including complete abstention from substances, would represent the least onerous and least restrictive available disposition.
On behalf of the Attorney-General, Mr. Ramsay endorsed the hospital’s recommendation. He did not seek a strict prohibition which would otherwise prevent Mr. Ibrahim from attending the Wurtemburg apartment. Crown counsel did stress that it remains necessary and appropriate to ensure that Mr. Ibrahim have no contact or communication of any kind with the three women who were involved in the index offence, including the victim.
Speaking for the patient, Ms. Shukairy agreed it is important that Mr. Ibrahim continue to take psychiatric medications. She submitted there is no evidence of his ever having refused to do so. Counsel advised that Mr. Ibrahim understands the importance of taking medication and that the incident in question arose only because he was not doing so at the time. Counsel submitted this was not in any way a situation where the patient was refusing to take medication but, rather, medication, for some reason, was simply not available to him.
Regarding alcohol, while this could be problematic, Ms. Shukairy felt it did not give rise to problems in the past, having regard to the seventeen years, from 2007 to 2024, when Mr. Ibrahim was able to otherwise function with no reported incidents.
Ms. Shukairy advised that her client will cooperate with recommended hospital programs. She submitted he did not “target” the victims on the day in question. Mr. Ibrahim did not know them at all. In counsel’s view, the incident was simply a case of their being at the wrong place at the wrong time due to a strict mental health problem.
Ms. Shukairy concluded her submission by submitting that the Board should discharge the patient, subject to conditions.
Conclusions and Disposition
With clear uncontradicted evidence in support, the Board finds that Mr. Mahad A. Ibrahim does represent a significant threat to the safety of the public. Mr. Ibrahim suffers from a quite serious mental disorder, Paranoid Schizophrenia – Multiple Episodes. When in a state of mental decompensation, he has acted with serious violence to others, including to the victim of the index offence.
Mr. Ibrahim’s condition has required ongoing psychiatric treatment with medications for more than the past twenty years. For several years after 2007, he was able to manage without giving rise to serious concerns. However, there were several occasions when his compliance with recommended treatment fell off, notably so between 2004 and 2007. When it did, he needed repeated admissions to hospital to regain his mental health and to keep family members and others safe.
The Board also finds that a detention order is required. This contrasts with a discharge under conditions. We accept Dr. Alabi’s evidence that the patient’s condition is treatment resistant. Even with focused treatment, Mr. Ibrahim’s symptoms are not fully resolved. We recognize that Mr. Ibrahim does have the ability, when he remains compliant with treatment, to recognize and to resist those command hallucinations urging him to harm others. At the same time, it is necessary that the hospital be able to carefully and consistently monitor the patient’s mental state over time, and that they retain the ability to intervene quickly by readmitting him to hospital should any signs of potential decompensation start to appear.
The evidence satisfies the Board that the risk presented to public safety is increased by Mr. Ibrahim’s use of both alcohol and khat. This was not really disputed at the hearing. We share the concerns described by Dr. Alabi in evidence, where he has strongly recommended that Mr. Ibrahim needs to abstain from such substances and that he will benefit from attending programs dealing with substance abuse.
Following his release on bail in October 2024, Mr. Ibrahim’s condition has been successfully managed in the community. We attribute this largely to his decision to promptly renew contact with the family physician that same month, and to resume his regime of treatment with psychiatric medication. That said, Mr. Ibrahim now needs to embark fully on a course of more specialized forensic psychiatric care under the auspices of the ROMHC.
In his present condition, Mr. Ibrahim qualifies for the privilege of community living – in hospital approved accommodation. It is critical that he shall have no contact or communication with the three parties who were subjected to his violent index offence.
The Board considered prohibiting Mr. Ibrahim from attending at the Wurtemburg apartment building. To date, it appears that he has kept himself away from the affected parties while residing elsewhere with family. We expect and trust that the hospital will take some time to carefully assess the most appropriate residence option for the patient during the coming months, having regard to the fact that his involvement with forensic psychiatric care has only just begun. The hospital treatment team has many options to consider in this respect, including living with family members, or at a hospital allied group home, if not at 215 Wurtemburg Street itself.
For these reasons, considering the primary need to protect the public, along with Mr. Ibrahim’s mental condition, his reintegration and other needs, a detention order will be issued. Terms and conditions are set out in the formal Disposition Order.
We thank Dr. Alabi and both counsel for their careful assistance.
We commend and encourage Mr. Ibrahim to continue his initial collaboration with all members of the hospital treatment team.
DATED this 29th day of October 2025, at the City of Toronto, in the Toronto Region.
Mr. P. Hageraats Legal Member
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Office of the Registrar
Ontario Review Board