Re: Alfred Marfo
ORB File No: 7666
Hearing held on: Thursday, January 9, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
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: Alfred Marfo Counsel: Ms. A. Szigeti
The Person in Charge of Hospital: Representative: Dr. P. Darby
Attorney General of Ontario: Counsel: Ms. V. Culp
REASONS FOR DISPOSITION
(Dated February 20, 2025)
Overview
On December 18, 2019, Alfred Marfo was found not criminally responsible (NCR) on Criminal Code charges of sexual assault, assault bodily harm, and assault with a weapon.
Mr. Marfo is currently subject to a disposition of the Ontario Review Board (the Board) dated January 18, 2024, discharging him subject to conditions including that he reside at a specified address and that he take medication and treatment as prescribed by his psychiatrist. He is also required to report to the person in charge of the Centre for Addiction and Mental Health, Toronto, (CAMH or the hospital) not less than once every two weeks, or as required.
On January 9, 2024, this panel of the Board convened a hearing at CAMH for the annual review of Mr. Marfo's disposition pursuant to s. 672.81(1) of the Criminal Code. Mr. Marfo was present for the hearing and was represented by counsel, Ms. Szigeti.
The issues for the Board to decide were whether Mr. Marfo is a significant threat to the safety of the public and, if so, what is the necessary and appropriate disposition for the coming year based on a consideration of the factors in s. 672.54 of the Criminal Code.
At the outset of the hearing, the parties were asked for their positions. The hospital representative, Dr. Darby, recommended a continuation of the current conditional discharge with two changes. One was a reduction in reporting to not less than once per month. The hospital also supported a change to paragraph 1(j) of the current disposition regarding travel. The term would now read “remain within the Province of Ontario, except for national or international travel for up to three weeks…”. The travel is currently restricted to Ghana, Africa. Crown counsel agreed with the hospital position, as did counsel for Mr. Marfo. In the result, the Board was presented with a joint recommendation by the parties.
For the reasons which follow, the Board finds Mr. Marfo is a significant threat to the safety of the public and the necessary and appropriate disposition is the one jointly recommended by the parties, a conditional discharge with the changes requested regarding reporting and travel.
Index Offences
- The circumstances of the index of offences are excerpted from last year's Board Reasons dated February 8, 2024 at paragraph 5, as follows:
“[4] In April 2001, the appellant assaulted his common law wife and, for several hours, forcibly confined her in their apartment. In October 2001, he was found not criminally responsible due to a mental disorder (“NCR”) on charges of forcible confinement, assault with a weapon, and aggravated assault, and came under the jurisdiction of the Board.
5The appellant continued under the Board’s jurisdiction until 2014. Between 2001 and 2014, he had a number of lengthy admissions to CAMH, Millhaven Institution, and the Mental Health Centre Penetanguishene (now Waypoint Centre for Mental Health Care). There were also periods during which he was permitted to live in the community.
6In November 2003, while living in the community, the appellant assaulted, sexually assaulted, and forcibly confined a second intimate partner. On this occasion, the forcible confinement lasted nine hours. He was ultimately found NCR on charges arising from that conduct.
7In August 2014, the appellant received an absolute discharge from the Board.
8Within a year of his discharge, on March 8, 2015, the appellant committed the index offences against a third intimate partner. He confined her in an apartment for five hours, prevented her from calling the police, hit her, and threatened to kill her.
9After an initial period of detention following his arrest for the index offences, the appellant was granted bail and lived in the community for more than four years. He was supported by payments under the Ontario Disability Support Program, and episodic work. He was treated by family physicians and prescribed anti-psychotic medication; he had a number of psychiatric assessments.
10On December 18, 2019, the appellant was found NCR in relation to the index offences, on charges of assault causing bodily harm, assault with a weapon, and sexual assault.".
These index offences were committed against Mr. Marfo’s ex-wife, Ms. Andrina Biscette.”
Background and Course Since Last Hearing
Mr. Marfo's personal background and history, including his criminal offending and the circumstances of the index offences, are set out in detail in the hospital report dated November 25, 2024 (exhibit one). These details need not be repeated in these Reasons. Some relevant information will be highlighted.
Mr. Marfo is 51 years of age and has current diagnoses of schizophrenia (in remission) and substance use disorder (alcohol and cannabis, in remission). Mr. Marfo is treatment capable for psychiatric decisions and can manage his financial affairs. This is Mr. Marfo’s third NCR finding. He has been under the jurisdiction of the Board for approximately five years on this most recent finding. He previously received an absolute discharge by the Board in 2014 for index offences which were similar to the current index offences - intimate partner violence. Mr. Marfo’s first finding of NCR in 2001 was also serious intimate partner violence. All three are different victims. The details of these prior circumstances of the NCR findings are set out in the hospital report at pages 10 to 11.
Mr. Marfo was born and raised in Ghana. He moved to Canada when he was 19 years of age with his mother and stepfather and attended York University. He left his schooling temporarily due to relationship problems that led to interactions with the mental health system but returned and completed his degree, a Bachelor of Arts (History).
Mr. Marfo started using alcohol and cannabis between the ages of 17 and 18 in Ghana. He has indicated that alcohol consumption played a factor in his offences, i.e., increased impulsivity and anger. He reported he would consume cannabis mainly on the weekends and occasionally after work and used cocaine and ecstasy, each on one occasion.
Mr. Marfo reports that he is single and has not been in a romantic relationship since the index offence in 2015. He is a divorced father of two adult children, one in Ghana and one in Ontario. Mr. Marfo maintains contact with his mother, stepfather and four maternal step siblings who reside in Brampton.
Mr. Marfo has a longstanding history of psychiatric illness. As mentioned, this is Mr. Marfo’s third NCR finding. His first hospitalization occurred in 1999. His symptoms from schizophrenia have included delusional ideation, auditory and visual misperceptions, affective instability, disinhibition and agitation. His delusional system has been pervasive and complex, encompassing family members, past intimate partners, other inmates, correctional officers, his lawyer and the justice system in general.
In the past reporting year, Mr. Marfo has remained in the community, living independently in a one-bedroom community housing apartment. The rent is subsidized. He has continued to work for Skip the Dishes and Uber Eats doing food deliveries. He also does work as a technician. Mr. Marfo did not engage in violence, or aggression. His mental status has remained stable with no evidence of psychosis or disturbance of mood. He regularly attended appointments as required with his team.
Evidence at the Hearing
Dr. Darby gave the evidence for the hospital at the hearing. Dr. Darby is not involved in the care of Mr. Marfo but is assisting a colleague who was unable to attend the hearing. Dr. Darby said he had fully informed himself with the clinical file for Mr. Marfo prior to giving his evidence.
Dr. Darby described an unfortunate situation for Mr. Marfo in the past year with several changes to his primary psychiatrist. Dr. Igoumenou is currently his treating psychiatrist and in the past year Dr. Ali and Dr. Eid were also involved at different times. Mr. Marfo’s most recent caseworker attended the hearing to support him.
Dr. Darby said this has been a good year for Mr. Marfo (like the year before).
Dr. Darby pointed out the checkered history for Mr. Marfo while under the jurisdiction of the Board and that this is his third NCR finding for matters which relate to violence towards different intimate partners.
It was the opinion of Dr. Darby that Mr. Marfo continues to meet the threshold for significant threat to the safety of the public given his long-standing history of criminal offending in the context of his mental illness.
According to the hospital report, Mr. Marfo has partial insight into the need for ongoing support and supervision to attenuate the factors that increase his risk of violence. He has some difficulty appreciating how his mental illness can lead to a worsening of psychotic symptoms and the potential for violence. Mr. Marfo has re-offended while under the jurisdiction of the Board in the past and again following his absolute discharge in 2014.
Dr. Darby was asked why the travel term is being extended. The doctor said Mr. Marfo is stable and that he has a good relationship with the treatment team. Dr. Darby viewed travel, nationally or internationally, as less risky than travel specifically to Ghana. Regardless of these factors, the team will only approve a travel itinerary if appropriate.
Dr. Darby said that there was a female refugee from Ghana who lived with Mr. Marfo for a short time in the fall last year (2024). Mr. Marfo provided accommodation, but the relationship was not intimate. It was clarified in questions from Mr. Marfo’s counsel that the female refugee was in fact a distant relative of Mr. Marfo, and he disclosed this new living arrangement to the Canadian Mental Health Association (CMHA) worker during an intake interview. It was confirmed that this person has now left Mr. Marfo’s residence.
Dr. Darby confirmed that Mr. Marfo is now followed by the CMHA case management group and that this will be helpful in the future to transition Mr. Marfo to the civil mental health system if given an absolute discharge.
Dr. Darby confirmed that during the past year Mr. Marfo has not shown any symptoms of a major mental illness, and he has been fully compliant with his antipsychotic medication. He has held down three jobs. Going forward, Dr. Darby said that better employment would be a motivator for Mr. Marfo, as he would like to find something more permanent and suitable, apart from the food delivery business.
Dr. Darby said there was a strong therapeutic alliance between Dr. Pauls (clinical psychologist) and Mr. Marfo, for approximately one year. Dr. Darby was asked about the alcohol consumption by Mr. Marfo, which the disposition prohibits. It is noted in the hospital report that he occasionally consumes small amounts of alcohol. Dr. Darby was asked if this is a risk factor. Dr. Darby said he had reviewed Dr. Pauls’ notes which reflect that this had been discussed with Mr. Marfo, and although theoretically a concern (given the alcohol use disorder), it has not been an actual issue for Mr. Marfo.
No further evidence was called at the hearing.
In final submissions, the parties maintained their joint recommendation to the Board.
Analysis and Conclusion
The Board finds Mr. Marfo is a significant threat to the safety of the public based on s. 672.5401 of the Criminal Code, and Winko, and its related authorities.
The Board notes that the issue of significant threat to the safety of the public was not contested by the parties. Despite this, the Board makes its own finding of significant threat based on the expert evidence of Dr. Darby, as supplemented by the hospital report.
Mr. Marfo's concerning history of violence towards intimate partners involves sexual and serious physical assaults. Following Mr. Marfo's original finding of NCR in 2001, he violently re-offended while under the jurisdiction of the Board. Within a year of being absolutely discharged by the Board in 2014, he again violently re-offended in 2015. Mr. Marfo’s violent behaviour can be driven by active psychosis and is reactive and impulsive in nature. It is focused on intimate partners who are incorporated into his delusional beliefs. The Board finds that this history of serious violence, specific to intimate partners, is a significant risk factor for Mr. Marfo. When he is unwell and experiencing psychotic symptoms, these partners are at grave risk of serious harm.
The Board notes that according to the hospital report (pg.24), Mr. Marfo has agreed to counselling for intimate partner violence and anger management and a referral has been made. Participation and successful completion in this counselling will mitigate Mr. Marfo’s potential for future violence towards female partners. The Board is hopeful this can occur within the reporting year as Mr. Marfo is on a positive trajectory towards an absolute discharge.
The Board finds Mr. Marfo’s partial insight into his need for ongoing supervision and support increases his risk for violence. In the past when he experienced psychotic symptoms, he did not always seek professional supports and treatment.
Mr. Marfo does not fully understand the need for supervision to prevent re-offending. The Board finds that the historical relevance of this factor (multiple NCR findings for similar serious offending behaviour) has applicability to the current assessment of whether Mr. Marfo is a significant threat to the safety of the public.
Mr. Marfo has a history of alcohol, and cannabis use which alone or in combination, can increase his risk for violence. To Mr. Marfo’s credit, he continues to actively participate in individual substance abuse relapse prevention programming.
The Board adopts with approval the following scenario as set out in the hospital report at page 21, as follows:
“If Mr. Marfo is to re-offend, this will likely transpire in the context of falling away treatment services and/or discontinuing psychotropic medication, leading to worsening psychosis. Additional destabilizing factors would include commencing an intimate partner relationship, negative peer influences, external stressors, and substance abuse. While suffering from active symptoms of psychosis, he would exhibit behavioural and affective instability, paranoid and persecutory delusions, and auditory hallucinations, and he is likely to engage in violent and aggressive behaviour, such as those witnessed during the time of his index offences. While psychotic, he would likely be unable to appreciate that he is suffering from symptoms of a mental disorder and appropriately seek out treatment and professional support.”
Based on the foregoing identifiable risk factors, the Board makes a positive finding that Mr. Marfo remains a significant threat to the safety of the public.
The necessary and appropriate disposition is the one jointly recommended by the parties, a continuation of the conditional discharge disposition with the requested changes to the reporting and travel terms.
In arriving at the disposition, the Board has considered the paramount factor of the safety of the public, Mr. Marfo’s mental condition, his community reintegration, and his other needs, all as required by s. 672.54 of the Criminal Code.
A disposition will issue accordingly.
DATED this 20^th^ day of February, 2025, at the City of Toronto, in the Toronto Region.
Mr. C. Fraser
Alternate Chairperson
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Office of the Registrar
Ontario Review Board