Re: Ange Nawej
ORB File No: 7261 Hearing Held On: Thursday, January 9, 2025 Place of Hearing: Centre for Addiction and Mental Health Pursuant To: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Mr. C. Fraser Members: Dr. W. Johnston Dr. T. Stirpe Ms. A. La Viola Ms. R. Chopra
Parties Appearing: Accused: Ange Nawej Counsel: Mr. A. Rai Person in charge of Hospital: Representative: Ms. L. Senko Attorney-General of Ontario: Counsel: Ms. V. Culp
REASONS FOR DISPOSITION
(Dated February 20, 2025)
OVERVIEW
- On November 22, 2017, Ange Nawej was found not criminally responsible on account of mental disorder of assault with a weapon, contrary to the Criminal Code. Mr. Nawej’s last annual review was conducted on November 6, 2023, as a result of an early hearing requested by the hospital. Mr. Nawej had been conditionally discharged, however, he is now currently subject to a disposition of the Ontario Review Board also dated November 6, 2023, detaining him at the Centre for Addiction and Mental Health – Forensic Service (CAMH), permitting him to live in the community of the Greater Toronto Area, in supervised and approved accommodations. On January 9, 2025, the Board convened at CAMH for a mandatory review hearing of the disposition further to s. 672.81(1) of the Criminal Code. At the time of the hearing Mr. Nawej was in a forensic general unit, where he has been since May 2024.
ISSUES
The issue before the Board was to determine whether Mr. Nawej continues to pose a significant threat to the safety of the public and, if so, to determine the necessary and appropriate disposition for him consistent with the factors set out in s. 672.54 of the Criminal Code. Mr. Nawej attended the hearing in person, along with his Counsel, Mr. Rai.
The Hospital asked the Board to conclude that Mr. Nawej continues to pose a significant threat to the safety of the public, and so he is not entitled to be discharged absolutely. The Hospital recommended that the current disposition remain in place with no change at this time. Counsel for the Attorney General agreed with the Hospital’s recommendation. Counsel, Mr. Rai, submitted that Mr. Nawej would like an Absolute Discharge.
FINDINGS
- After reviewing the evidence, the Board concluded that Mr. Nawej continues to represent a significant threat to the safety of the public and he is not entitled to be discharged absolutely. The recent reemergence of intermittent positive psychotic symptoms, the persistent negative symptoms of Schizophrenia, and the lack of insight into the effects of cannabis on his mental state has raised serious concerns about his recovery process and his level of understanding of his treatment needs. His treatment plan includes the appropriate level of monitoring and supervision, which is still necessary at this time. For the reasons that follow in more detail below, the Board concluded that there be no change to his Detention Order at this time.
PERSONAL BACKGROUND
The Hospital Report dated December 13, 2024, was entered as an exhibit at the hearing. The following background information, including the events surrounding the 2017 index offence, has been taken from the Report, summarized here as follows.
Both Mr. Nawej and the victim were patients at the North Bay Regional Health Centre. Mr. Nawej had been admitted a few days earlier. On July 17, 2017, Mr. Nawej approached a patient in the Psychiatric Intensive Care Unit and assaulted her by punching her multiple times and he attempted to stab her with a pencil. Hospital staff intervened, and he was controlled through chemical restraint, resulting in a minor injury to the victim.
Mr. Nawej is 25 years old, born in Toronto. He is unmarried and has no dependents. His family relocated to North Bay when he was 4 years old. At the age of 10, due to concerns about his friendship with a negative peer group, he moved with his mother and sister to Toronto. Within a year, after showing improved behaviour, they returned to North Bay. Following this, he started facing difficulties in school, including alcohol use and suspected marijuana use. At this time, he was noted to be argumentative, defiant, and disrespectful. When he was 14 years old, Mr. Nawej was stabbed in a fight, prompting his mother to take him to Zambia for a few months to shield him from harmful influences. Upon returning, they settled in Guelph. He then switched to four different high schools in a single semester. Later, he lived with a cousin in Brampton but was eventually asked to move out. He then relocated to Toronto, where he experienced periods of homelessness. In December 2015, he returned to North Bay.
Mr. Nawej previously volunteered at a soup kitchen and worked at a fur auction for one summer. He was employed at Zedd Communications from December 7 to 31, 2020 but chose not to renew his contract. He then worked part-time at Staples Business Depot for a few months in 2021, which he believes ended due to not meeting sales expectations for extended warranties. He has not been employed since then.
A records check of the Canadian Police Information Centre database showed that Mr. Nawej has no criminal convictions. However, he was previously charged with assault with a weapon, but the charge was withdrawn as part of a mental health diversion program.
PSYCHIATRIC BACKGROUND
The psychiatric background information is contained in the Hospital Report. Mr. Nawej's mental health issues began to surface in 2016.
Around April 2016, Mr. Nawej was placed under a Community Treatment Order and received ongoing support from an outpatient psychiatric team. His condition improved over time, and he consented to take his medication. However, the order expired in June 2017, after which he stopped his medication and quickly experienced a decline in his mental health. He was readmitted to North Bay Regional Health Centre, during which time he exhibited behaviours similar to his index offence (including an assault on his father).
Following a finding of ‘not criminally responsible’, Mr. Nawej was admitted to the Forensic Assessment Unit at Waypoint Centre for Mental Health Care on November 29, 2017. After his initial hearing under the Board, he was moved to the Waypoint Beckwith program on February 13, 2018, which offers a highly structured environment for individuals facing mental instability and behavioural issues. On October 1, 2018, he was transferred to the Beausoleil program (a less structured high-security facility with enhanced privileges). Subsequently, on February 21, 2019, he moved to North Bay Regional Health Centre. On October 5, 2020, Mr. Nawej was discharged to a transitional housing program in North Bay (Maplewood House), where he stayed until his transfer to the forensic outpatient program at CAMH on July 19, 2022.
After his annual review hearing on February 17, 2023, he received a Conditional Discharge. Shortly afterwards, while living in the community, he ceased taking his antipsychotic medication and experienced a mental health decline, leading to his hospital readmission on April 25, 2023. His initial stay was marked by significant behavioural issues and violence, requiring extended periods in locked isolation. His mental health improved a few months later, and he was ultimately moved to a less secure setting, notwithstanding, he remained within the parameters of his current Detention Order, as a result of the early hearing, and as ordered by the Board on December 6, 2023.
Mr. Nawej’s current psychiatric diagnoses are Schizophrenia and Cannabis Use Disorder (in sustained remission, in a controlled setting). Mr. Nawej has been found incapable of making decisions about his medical treatment, but he is capable of managing his finances independently. His substitute decision maker is his father. He receives financial assistance from the Ontario Disability Support Program.
EVIDENCE AT THE HEARING
Mr. Nawej’s clinical course for this reviewing year is documented in the Hospital Report. His attending psychiatrist is Dr. K. Valoo, and she gave evidence at the hearing, along with updated information.
She testified that in her opinion, Mr. Nawej requires ongoing patient management due to his fluctuating mental status. During a recent interaction, he exhibited symptoms of psychosis, including disorganized thinking and expressed beliefs related to prior delusional concepts. He believes he no longer needs to be hospitalized, stating his time has been served, and indicated plans to live with a cousin, although he has not communicated with them recently.
Mr. Nawej was approved for Level 5 passes (he previously held Level 7 passes), which include indirectly supervised access to hospital grounds, so that he can participate in programming. He began utilizing these passes as of last week. There have been no incidents of physical aggression during this reporting period. Of note, Mr. Nawej has recently resumed participation in group programming within the therapeutic neighbourhood, with encouragement from the treatment team. Additionally, he has engaged in recreational activities such as unit outings and parties, and has attended several groups, including introductory sessions on Dialectical Behaviour Therapy and cooking.
Dr. Valoo stated that she continues to recommend the administration of injectable antipsychotic medications rather than oral ones for Mr. Nawej due to concerns about potential noncompliance with oral medications, as he has a history of difficulties in this area. However, the treatment team has not been able to obtain substitute consent for that to occur. In the meantime, Mr. Nawej continues to cooperate with a ‘medication watch’ to ensure the administration of oral medications. Also, Mr. Nawej's understanding of the effects of cannabis on his mental state remains limited, even though he does express an intention to refrain from cannabis use for the time being, he has also expressed that he may reconsider cannabis use in the future. In December, two urine samples submitted for toxicology screens were reported as very dilute, but he provided subsequent samples that were within normal concentration levels. Overall, the treatment plan includes ongoing discussions around the importance of medication compliance and the impact of cannabis use on Mr. Nawej's mental health. The treatment team has maintained regular contact with Mr. Nawej's family, who are supportive of his recovery (the Board received a letter of support in evidence). Due to the distance between their residence and CAMH, they have not yet pursued an application for family members to become an ‘approved support person’. The team is open to facilitating this process in the future, should a family member express interest in becoming involved in his care. The treatment team is committed to ensuring that Mr. Nawej has the support he needs while navigating his recovery process.
In Dr. Valoo’s opinion, a return to a Conditional Discharge would not be sufficient to manage the risk to public safety, given Mr. Nawej’s major mental illness and history of medication non-compliance. Without the current level of supervision, Mr. Nawej is likely to discontinue his antipsychotic treatment, leading to further deterioration of his mental state and an increased risk of violence, based on his history of aggressive behaviour towards family and others. He has consistently expressed a desire to leave the hospital setting, stating he does not believe he needs to remain there.
SUBMISSIONS
Counsel for the Hospital submitted that the Detention Order is both necessary and appropriate in this case, emphasizing that Mr. Nawej requires hospitalization due to fluctuations in his mental status. The treatment team is actively working to stabilize him to facilitate a safe discharge. Continued hospitalization is necessary and a Conditional Discharge would not provide sufficient management to ensure public safety. Counsel for the Attorney General agreed that the trajectory of Mr. Nawej's mental health, as outlined, supports this conclusion.
In contrast, Counsel Mr. Rai contended that Mr. Nawej is seeking an Absolute Discharge from the Board. He highlighted that there have been no incidents of physical aggression or violence during the past reporting year. Mr. Nawej has actively participated in group programming and has maintained a strong connection with his family. The recent changes in his medication from injections to oral forms have not led to any concerns regarding compliance. Mr. Rai noted that his client has engaged positively in recreational activities and cooking classes, supporting the argument for a discharge. Given these considerations, Counsel submitted that Mr. Nawej be discharged absolutely, arguing that he has demonstrated sufficient stability and engagement in his treatment.
ANALYSIS AND CONCLUSION
(a) Significant Threat
Where there is a risk of serious physical or psychological harm to members of the public resulting from conduct that is criminal in nature but not necessarily violent, the Board must find that the threshold for ‘significant threat’ has been met. The issue of whether Mr. Nawej continues to pose a significant threat to the safety of the public was contested at the hearing. We have considered all of the evidence presented, and we have made an independent finding on the issue.
Based on the testimony of Dr. Valoo and the relevant contents of the Hospital Report, we find that Mr. Nawej remains a significant threat to the safety of the public, and accordingly, he is not entitled to be discharged absolutely. Several factors convince us that the threshold for ‘significant threat’ has been met. Mr. Nawej has a complex psychiatric profile where his primary diagnosis of Schizophrenia appears to be treatment resistant, which is further exacerbated by his continued cannabis use. Recent risk assessments also point out that Mr. Nawej’s risk for violent recidivism remains in the relatively high range, and this must be balanced with the paramount consideration – public safety. The evidence was clear, and we agree that although he appears to comply with his medication administration, there are serious and ongoing concerns regarding his mental status and his limited insight. Mr. Nawej suffers from a severe mental illness and has demonstrated difficulty adhering to treatment and supervision. He has displayed substance-induced psychotic symptoms, particularly when using cannabis, and his insight remains poor. These concerns were evident during the current reporting period, as he demonstrated potential non-compliance with medication and a severe lack of awareness regarding his psychotic deterioration that led to a marked decline in his mental state. We find that although Mr. Nawej appears to be compliant with the oral antipsychotic, this must be taken together with the fact that he is not capable of making treatment decisions. But for the consent of his substitute decision maker, his past psychiatric history indicates that he was consistently nonadherent to his prescribed psychiatric medications, and there is a likelihood that he will discontinue his medication if not monitored with the necessary level of oversight moving forward – the intensive monitoring provided in a hospital setting, without which Mr. Nawej’s condition would likely have worsened further.
In addition, we note that Mr. Nawej’s ability to manage his Schizophrenia on his own remains brittle at this point, and his current antipsychotic medication may not be sufficient to prevent further symptom escalation. It has been recommended that his treatment involve the administration of a long-term injectable antipsychotic, however this has not been consented to. This risk is compounded by the fact that he may begin using cannabis again once he is discharged. Together these factors underscore the necessity of continued close monitoring, to mitigate his risk to public safety.
(b) Necessary and Appropriate
The plan of care in place for Mr. Nawej appears to be adequate, however we see that it is still in progress. His current disposition appropriately addresses his current level of threat to the safety of others given that he is subject to the level of supervision provided by the forensic psychiatry services at CAMH. His psychiatric treatment and care involves the necessary level of supervision, evaluation, and adjustment to manage his risk level. Without the forensic treatment team, and their interventions and support, his recovery path would most certainly decline. A Conditional Discharge has no air of reality at this time because of the lengthy history of mental illness and the severity of his substance use, the serious nature of the index offence, and the limited recovery progress he has made over the years. Mr. Nawej remains at a high risk of violence under a Conditional Discharge, particularly during periods of mental deterioration or substance use. While the Mental Health Act may allow for his re-hospitalization, it may not be sufficient to ensure his continued level of treatment adherence. The treatment team plays a crucial role in daily medication administration to assist in managing these requirements. Also, the importance of appropriate supportive housing speaks to his specific needs. His ongoing recovery, rehabilitation, and reintegration processes require a certain amount of future planning before he is again suitable for supervised community living. This critical risk management factor – approved housing – can only be assured with a Detention Order disposition. This is an obvious shortcoming of a Conditional Discharge disposition. Although it may be appropriate to begin initial steps for Mr. Nawej’s supervised community living in the future, he has been assessed as a high-risk of committing serious harm to the public, and he continues to require the necessary level of supervision and ongoing treatment needs, which is currently provided by the hospital setting. Community living without supervision is not appropriate for Mr. Nawej at this time because his treatment relies on the clinical expertise and supervision that he is currently being provided with. This plan is in place because of the numerous readmissions to hospital, discontinued medication and continued use of cannabis, resulting in ongoing psychotic symptoms. This presents a significant treatment challenge at this point in time, and there remains a serious risk to public safety should Mr. Nawej be discharged back into the community should his specific needs remain unaddressed or overlooked. These challenges emphasize the need for structured oversight to ensure his sustained stability and prevent any future harm to others.
The forensic treatment team at CAMH is key in helping Mr. Nawej achieve mental stability, and we find given all the circumstances, that he could not be managed without the current level of assistance and supervision. His awareness of the need for ongoing treatment and the importance of abstaining from cannabis use remains superficial and generally limited. As a result, when he eventually becomes eligible for discharge, careful oversight of his living arrangements is crucial. The hospital must retain the authority to approve his housing to ensure he transitions into an environment with adequate supervision. This oversight is also essential for maintaining his stability, particularly through consistent medication monitoring.
It remains to be seen if he is able to make more progress moving forward and achieve more stability with the medication and treatment plan in the upcoming year, however, we also note that Mr. Nawej has resumed participation in group programming within the therapeutic neighbourhood, and this is a good step forward. We conclude on the evidence before us that the most necessary and appropriate outcome for Mr. Nawej is to continue his recovery process under the supervision and authority of the Ontario Review Board, in accordance with a Detention Order, with no change to the disposition at this time.
DATED this 20th day of February, 2025 at the City of Toronto, in the Toronto Region.
Ms. A. La Viola Legal Member
Office of the Registrar Ontario Review Board